Sunday, September 12, 2010

Will There Be a Need for Informaticians After EHR Implementation? Yes!

A question I am asked from time to time is whether there will be a need for informaticians once we are "done" implementing electronic health records (EHRs). My reply is that implementing EHRs is only a beginning, and actually not the most interesting part. Much more important is what we do with those EHRs and other information systems after they are implemented.

Once EHRs are implemented, there will still be all sorts of "meaningful" things that need to be done with them, and I am not just talking about the meaningful use guidelines, though those will keep us busy well past the middle of this decade. (Even the Office of the National Coordinator for Health IT [ONC] believes it unlikely that most eligible professionals and hospitals will achieve Stage 3 meaningful use before 2018-2019.)

But I only see healthcare becoming more data-driven in the future, with increasing emphasis on managing information to provide safe and less costly care. Activities such as quality measurement and improvement, improving efficiency, dealing with new types of information, and continued advances in information technology (IT) are likely to keep us busy for a long time to come.

One insight to these future needs comes from a new article by Bill Stead and colleagues (Academic Medicine, 2010, Epub ahead of print). It is unfortunate that this article is published in a journal that requires an individual or institutional subscription to access it, because it presents a clear picture that the complexity of information required to practice medicine is increasing and that clinicians - and the educators who train them - must learn how to function in the increasingly "information-rich" healthcare environment.

This article also lists a number of key competencies in informatics for physicians, organizing them within the framework Accreditation Council for Graduate Medical Education (ACGME) core competencies for physicians. The article also recommends that informatics become a foundational science for healthcare, advocating development of academic units involved in academic and operational activities, using the IT infrastructure of academic health centers as testing laboratories, and retraining faculty to lead the transformation of healthcare through the use of informatics.

There are many other reasons why informatics will not cease to be important once there are EHRs on every desk in healthcare. As us baby boomers age and develop more health problems, we will likely want to manage our healthcare the way we manage many other things in life (e.g., banking, air travel, buying certain things such as books, etc.), which is on-line. We also know that there is still plenty of room for improvement with existing EHRs. Data entry is too time-consuming, poor interfaces can hide critical data, and we still need much smoother interoperability, especially of data. The ONC SHARP program acknowledges the need for continued research in the four areas it is funding: architecture, privacy and security, secondary use of data, and cognitive-centered computing.

In essence, the implementation of EHRs enables a whole host of other activities that will allow improvement of health, healthcare, public health, and biomedical research. As such, there will only be increased demand for informaticians to perform and lead these activities.


  1. I am looking forward to the program and your class beginning in a couple weeks.
    Pat Martin

  2. I often tell the providers that I work with that an EHR is really nothing more then an electric pencil when implemented poorly and a magical communication and analytical tool when implemented in concert with a systems approach to healthcare.

    It is a long way from data capture, through information retrieval, to knowledge sharing and finally behavioral change.

    I believe that information systems will be a key tool that allows providers and consumers to develop and implement patient centered models of care but that the real change will only happen when we include patient centered design principals in informatics. What for example might a workflow for a diabetic look like if you included the patients needs?

    Sherry Reynolds

  3. Pat - We look forward to you and 60+ others joining the program next week!

    Sherry - Thanks for your comments, which drive my point home. I particularly agree that we don't want electric pencils, and that is where skilled informaticians will come in.

  4. Another good indication of the continuous need post-implementation can be obtained by looking at numbers and experiences from other countries where EHR already is widely implemented.

    Scandinavia is an interesting example where the EHR adoption is getting close to 100% (for Hospitals, and slightly lower for family medicine et al). I would still challenge anybody to find a single MD in Scandinavia who would claim that EHR implementation is complete (even though it has been close to 100% for a number of years).

    If anything, EHR implementation opens up more new opportunities than the analogue problems it solves.

  5. Thanks for sharing the international perspective!