Thursday, October 14, 2010

The Informatics Outlook for Physicians

In looking over the topics I have addressed in the year and a half of this blog, I have tried to convey biomedical and health informatics as a broad field with many roles and opportunities for people from a wide variety of professional backgrounds. One group that I have not addressed explicitly is physicians.

I admittedly have a kinship for physicians in the informatics field. After all, I am a physician by training, and even though I know longer actively care for patients, my training and early career experience provide a perspective that informs my understanding of the role of physicians in informatics.

Overall, the opportunities for physicians in informatics are substantial and growing. While many early informatics roles for physicians focused on research and development, the real growth opportunities are now for those seeking to be informatics practitioners. These practitioners play a variety of roles not only in planning and implementing systems, but deriving value from the information within them.

An ever increasing number of healthcare organizations have recognized the importance of physician informatics leadership, manifested most frequently in positions that go by the name of Chief Medical Information Officer or Chief Medical Informatics Officer (both of which conveniently are represented by the acronym CMIO). While the CMIO position is probably now the most visible physician role in informatics, it is hardly the only one. Physicians also play other roles in healthcare organizations as well as other entities, such as vendor, consulting, government, and research organizations.

The OHSU biomedical informatics graduate program has always had a strong representation from physicians, who comprise about 50% of our enrollment. They are therefore not the only demographic of student in the program, as we also have students from other healthcare professionals (e.g., nurses, pharmacists, lab/radiology technicians, health information managers) as well as from outside the health professions (e.g., information technology, computer science, and even further afield from law, biology, business, and others). Furthermore, the professional diversity of our program has always, in my mind, been one of the program's assets, even though trying to teach informatics simultaneously to a physician, nurse, computer scientist, and businessperson can be a challenge!

But it nonetheless has been gratifying to see many physicians go on to assume roles and leadership in the field. The diverse roles that physicians who enter the field take exemplifies the expansion of these roles.

There are a number of issues ahead for physicians contemplating careers in informatics to ponder. One concerns training. How much should they seek? Should they get it at all? If they do, in what kinds of programs should they train? I honestly cannot give an unequivocal answer. There are many physicians who move into informatics roles without any formal training. However, I do believe over time that formal training will be a requisite for informatics jobs. If nothing else, one's competitors for those jobs will have such training.

As for how much training, that is also an uncertainty. There is a growing recognized knowledge base for the informatics field. There is also recognition of an increasing number of best practices. Physician-informaticians might not need to understand all the technical details of the systems with which they work, but they must have the big picture both of the technology and how it fits into their environment.

Another issue on the horizon for physicians is certification, in particular the proposed clinical informatics subspecialty. This subspecialty will be available to physicians in many, perhaps all, specialties (e.g., internal medicine, pediatrics, family medicine, surgery, etc.). There are still many unknowns about this process, such as how will other informatics experience and training besides formal on-site fellowship training be viewed and how physicians without board certification might be able to take part. Nonetheless, certification is important in healthcare professions, and certification in informatics will lead to more professional recognition of the field.

I believe it is safe to conclude here are tremendous opportunities for physicians to be innovators and leaders in the proper and most effective use of information technology IT) not only in healthcare, but also personal health, public health, and research.

Despite the uncertainty about some of the details, the outlook for physicians in informatics is bright, even after the initial wave of EHR adoption is complete (as addressed in a previous blog entry). The need for expertise in health IT implementation will only increase, especially as we see more coordination and quality measurement of care delivery.


  1. Professor Hersh,
    This is a fantastic article that addressed many key issues for me, as a physician contemplating a career in health informatics. Do you have a strong opinion about what type of education or qualifications for physicians to pursue who would like to move their career into the health informatics realm--either in CMIO type positions or as future entrepreneurs in the field. From what I can discern there is a multitude of options including an MS in Health Informatics, a certificate program in Health Informatics, doing a fellowship in the clinical specialty of Health informatics or getting a accreditation from CPHIMS after working in the field for a while. I am sure there is no clear cut answer to this question, but perhaps you can comment of these options more specifically. Can you recommend a specific path or direction that you see as being superior? Thanks for your help. Take care.-Amer Moiduddin

  2. Thanks for your comments on my posting. I appreciate that you find them of value. Because of the 4096-character limitation of replies to postings, I will break this reply into two.

    There are indeed many training options available for physicians that you list, including:
    - None at all - i.e., training on the job with or without prior knowledge
    - Single courses, such as the AMIA 10x10 program or AMIA CMIO Boot Camp
    - Certificate programs, which are typically more than a single course but not a full master's degree, such as the Graduate Certificate Program at OHSU and others being developed through funding from the ONC University-Based Training (UBT) programs
    - Master's degree programs, such as those at OHSU and elsewhere
    - Research training, such as postdoctoral fellowships and PhD programs, typically available through funding from National Library of Medicine, Veteran's Administration, and other training grants
    - And of course in the future, presuming the clinical informatics subspecialty comes to be, there will be practitioner-oriented (clinical) fellowships

    Informatics training varies not only in size and scope as shown above, but also in orientation. Programs can be classified in many ways, but probably the most pertinent is whether they are oriented to researchers or practitioners. As described in my original posting, physicians in informatics historically operated in a researcher role (though many often had varying amounts of operational duties) but the real growth in the field now is for informatics practitioners, who go on the kinds of roles such as CMIO, vendor consultant, or other positions that draw on both their clinical as well as informatics knowledge. This does not mean there is not a continued need for researchers (who often serve as faculty in programs, including those oriented to practitioners), as we know there is still plenty of research to be done, but just that the largest numbers of need are in the practitioner category.

    Therefore, what training is best for an aspiring physician informatician? Since there is no formal certification yet, no one can say with absolute certainty. It probably depends on your current position and progress in your career. Certainly someone who is already a seasoned veteran CMIO does not need to return for a master's degree, although their knowledge and skill set would probably not be worse for it. Likewise, someone older and more established in their local setting probably has a lesser need for more training.

    Conversely, those who are younger and/or not necessarily well-established in their careers might consider more intensive training. Like many fields, we are likely to see more people formally trained in informatics entering the career pipeline. Therefore if nothing else, those who have formal training might have more appealing resumes than those who do not, which could matter, especially among those who are younger and/or less established in their careers.

    One important thing to note about training at this point in time is that there is currently a great deal of funding available to pursue clinical informatics practitioner training that will not last once the ARRA stimulus funding for HITECH ends. Many of the UBT programs, including ours at OHSU, have tracks for physicians. This is typically not the only track in the program (i.e., there are opportunities for other healthcare professionals, public health practitioners, and those with computer science or IT backgrounds), but it is among those available. Other opportunities for funded training include the NLM and VA fellowships, although as noted above, they are oriented to researchers.

  3. Continuing from my previous reply...

    This leads to your final question, which is certification. The value of the CPHIMS certification for physicians is not clear. While the exam does indicate knowledge of health IT, it is not clear that it tests for knowledge of the physician role. I am not aware of any organizations wanting to see it in candidates for their physician informatics positions.

    The clinical informatics subspecialty will likely be a different matter. Over time, I can see that certification becoming very important for informatics practitioners. One of the challenges will be how to receive training in accredited programs, since the current paradigm of clinical fellowship training is the on-site full-time model, while many physicians now seek training in distance learning programs in a part-time manner while they maintain their existing careers. Only time will tell on how the training and employer desirability will evolve for this role.

    So what do I recommend for the aspiring physician informatician? Most important is to scope out the various career pathways and the education and training pathways to achieve them. Then you can plan your course to achieving them. (This sounds like the kind of advice one might give for any type of professional career, which is good, since I hope to see informatics become a "normal" career option for individuals of many backgrounds and interests.)

  4. Wow! Thanks for taking the time to flesh-out these options. At this point I am interested in following a informatics practitioner pathway and I am in a relatively early stage in my career; therefore I am leaning toward seeking formal training in a distance learning or fully online masters or post-masters program. Your point about funding available at this time is well taken and points to the fact that there is no better time to pull the trigger toward this pursuit than now. Again, I appreciate your comments here very much. Take care-Amer Moiduddin

  5. I agree that the medical establishment has yet to fully understand or embrace the physician informaticist. Out of sheer demand for physician involvement in EMR design and implementation, I am fortunate to have grown a number of physician informaticists who have benefitted tremendously from your class. Thank you for your dedication and committment to educating people about this important field which is still so puzzling to many people in healthcare.

  6. Professor Hersh (and Amer Moiduddin),
    I want to thank you for this excellent piece on the physician's outlook in informatics. I almost get giddy (not in the medical-sense of the word, but in the excited-sense) thinking about a possible career in clinical informatics. I am a very grateful 2007 graduate of your AMIA 10x10 course at OHSU, having taken it after a brief retirement from family medicine after 23 years.I kept hearing the word 'informatics', so googled it and arrived at the 10x10 course. I have since gone back to clinical medicine part-time but am actively pursuing more education, training in this exciting career. OHSU's excellent UBT is in my sights, and I have learned is one of many opportunities, to prepare to ride, what I call the"HIT Tsunami". After using the EpicCare EHR from about 1993 until 2005, I do cannot envision a world without (interoperable) EHRs. There is not better time for engaging in this pursuit! (go for it Amer!) Manuel

  7. I know this is coming two years after the initial post, i'm sorry if it seems awkward. I am Nigerian medical doctor with interest in practice oriented informatics(EMR). Working with a Nigerian computer programmer, we have developed an e-clinic software that helps doctors convert from paper records to electronic records in all departments. I believe i would need further education in the field of clinical informatics and i would appreciate advice and suggestions from you. Thank you
    Dr Fajuyitan F.B

    1. No problem for the late reply. I agree that further education in clinical informatics is your best course of action. There are many programs across the world that may meet your needs. One is our program at OHSU:

      You can also find programs in many different countries at the Health Informatics Worldwide site:

      Finally, there is also a listing of program in the United States at the site of AMIA:

      You might also want to consider getting involved in the IMIA Informatics Education Working Group:

      Good luck!