The Emergence of the Informatics Practitioner

There have been many changes in the biomedical and health informatics field since its inception in the 1960s and even since my entry into it in the late 1980s. Some of these changes have been due to changes in technology, e.g., from the teletype and punch card computers of the 1960s to the advent of personal computers in the 1980s to the current era of high-powered computers and smaller devices connected to the ubiquitous global Internet. Other changes have come from scientific maturation of the field, such as a better understanding of the proper role for computerized clinical decision support and the emergence of enabling technologies from genomics and related areas.

Another area where profound change has occurred is in the professional work of informatics. When the field started to develop in the 1960s, and even when I assumed my first faculty position in the early 1990s, most who worked in informatics thought of themselves as researchers. The primary work of academic informatics departments was research and development. Most who were trained in the field obtained fellowships and/or advanced degrees. While many academic informaticians took on some operational roles in their institutions, the focus of that work was mainly implementing novel cutting-edge technology. Research, meanwhile, focused on developing new systems, models, and algorithms to meet what we thought were the needs of clinicians, scientists, consumers, and others.

Over the last decade, many changes have occurred. One of the biggest of these changes is the emergence of the informatics practitioner (or professional). Now that the use of information technology (IT) has become a routine (if mission-critical) activity of healthcare and other health-related organizations, there is growing recognition of the need for skilled individuals who understand both the technology and its use in a given underlying health domain. These professionals need not be highly technical, though they must be facile with IT and, perhaps more importantly, savvy with the management and analysis of information.

The jobs of informatics practitioners are diverse. These individuals may undertake tasks such as extracting data from "dirty" data sources (such as clinical records) for quality measurement and improvement. They may serve as champions or implementers for information systems to meet the needs of these organizations. They might maintain large bioinformatics databases or use them to analyze the data of researchers with whom they collaborate. At the top end of organizations, the chief information officer (CIO) or chief medical information officer (CMIO) increasingly provide key strategic leadership around information systems and use of the data within them.

A number of academic informatics faculty who grew up in the earlier era have not recognized the change. I have to admit that I realized it earlier than most mainly because of the demands from students in our nascent educational programs asking to learn more about how to implement systems than do research. Many academic leaders still have difficulty discerning between the differences in training researchers and practitioners.

I do not, however, see the emergence of informatics practitioners or educational programs designed for them as being at odds with the research mission of academic informatics departments. In fact, I view it as complementary. All mature fields, certainly those in the health professions such as a Department of Medicine, have both practitioners as well as researchers and educators. The researchers discover new knowledge and techniques while the educators disseminate it to the practitioners. All professions have academic departments whose missions entail both research and education. I see this starting to occur in informatics programs around the world and is certainly the modus operandi of our department at Oregon Health & Science University (OHSU).

With the large IT investments being made in healthcare, public health, and research organizations, along with the need and desire for baby boomers to manage their increasing use of healthcare, I see a bright future for informatics practitioners. The informatician will rightfully take his or her place on the larger healthcare team, delivering needed expertise on the integration and coordination of information for optimizing people's health.

Update on the ONC Workforce Development Program

It's hard to believe that it has only been a little more than seven months since the Office of the National Coordinator for Health IT (ONC) announced the awardees for its Workforce Development Program. A tremendous amount has been accomplished since the grants were awarded on April 2, 2010. Our department at Oregon Health & Science University (OHSU) has played a substantial role in several aspects of the program.

The ONC Workforce Development Program is devoted to building the professional workforce that will help eligible hospitals and professionals achieve meaningful use of the electronic health records (EHR). The program is based on the need for an estimated 51,000 such professionals who will work in twelve workforce roles. Half of these workforce roles are deemed to be trained in six-month certificate programs in community colleges, while the other half are to be trained in 1-2 years in university-based programs.

The overall program consists of four specific initiatives:
1. Community College Consortia - 84 community colleges, grouped into five regional consortia, have been funded to offer six-month certificate programs in the six community workforce roles.
2. Curriculum Development Centers - Because the community colleges do not have curricula for these programs, five universities have received awards to develop curricular components that are to be developed into courses by the community colleges. One of the five universities (OHSU) was additionally designated the National Training and Dissemination Center (NTDC), tasked with developing the Web site for dissemination of the materials and carrying out training activities for community colleges, including a training event that took place in August, 2010.
3. Competency Examination - An examination to test the competencies gained by graduates of the community college programs for the six workforce roles trained in their programs is being developed.
4. University-based Training (UBT) programs - Additional training funds were awarded to nine universities (including OHSU) for longer-term university-based training.

As noted above, OHSU has been playing a major role in the ONC Workforce Development Program. We are one of the five Curriculum Development Centers and also serve as the NTDC. In addition, we are also one of the nine universities funded under the UBT program.

The work in all of these programs has been substantial over the past seven-plus months. Led by the NTDC, the Curriculum Development Centers have delivered the first version of the 20 curricular components, which are available to the community college programs on the NTDC Web site. The NTDC also put on the training event over August 9-11, 2010 in Portland, OR that brought together over 200 community college faculty, the five Curriculum Development Centers, and some of the ONC leadership.

The Curriculum Development Centers project has spawned another exciting project that will, in the long run, benefit the entire informatics field. This is the development of an educational version of the VA VistA EHR system along with teaching exercises in using and configuring EHRs. The lack of EHR access has always been a problem in informatics education, as vendors have been reluctant to make their systems more readily available. (This is in contrast to companies like IBM and Apple that make development tools available to computer science students for free or at substantial discounts, which makes sense, as it trains a new generation of students in their wares.) This project will rectify this problem and hopefully get vendors to consider ways to be more open with their systems for educational purposes.

OHSU is likewise very busy with its UBT training grant, which will fund 135 Graduate Certificate and 13 Master of Biomedical Informatics over three years. The certificate students are admitted on a rolling basis each quarter (OHSU is on an academic quarter system) and must make the commitment to complete the program in one year. While not requiring full-time study, this pace does require more concentrated commitment than typical part-time students. The program is on-line with no on-campus requirement. We have enrolled 47 certificate students to date and plan to continue admitting 20-30 students per quarter until the funding is completely committed (probably in early 2012). Unfortunately, the number of qualified applicants has vastly exceeded the resources of the grant (about 100 applicants per quarter), although most are offered admission on a self-funded (i.e., paying tuition) basis.

The master's students are admitted in two cohorts, one that started in the fall of 2010 and another that will begin in the fall of 2011. This program is full-time and on-campus.

One novel feature of both programs is the requirement of a practicum (certificate) or internship (master's). We believe that hands-on, real-world experience is essential for learning informatics, even those in on-line programs. We had experience in remote students doing practicums and internships prior to the grant and feel ready to scale up to all of the students funded by the UBT grant. To this end, we have hired a Practicum/Internship Coordinator who will handle the organization and logistics of the program.

We also plan to use the resources of the grant to hire a Career Counselor. This addresses another challenge that informatics programs have faced, which is having the resources to provide career guidance. We have found that generic career advising centers can be helpful to a point, but there is much advice specific to informatics, especially for the students of diverse backgrounds and interests who enroll in our program.

We also hope that in the long run, these enhancements will carry over into our regular program, especially once the ONC UBT grant ends in 2013. I am optimistic that informatics education will continue to be pursued by a variety of students to carry on the work that will not end once the HITECH program finishes. Informatics is and will continue to be a great career option for those wanting to work at the intersection of health disciplines and information technology. As I always say, informatics is more than EHRs, and there will also be continued opportunities in other areas in bioinformatics, other aspects of clinical informatics, public health informatics, and more.

Selected to the Informatics All-Star Team!

This past week I was awarded with a gratifying honor. I was named by Modern Healthcare magazine as one of the Top 25 Clinical Informaticists in the US. I am truly honored to be among this group, which I view as a kind of all-star team for clinical informatics. I am also grateful to OHSU student Paul DeMuro who nominated me for the honor.

Unfortunately, the article describing the awardees in detail is password-protected. However, the list of the 25 awardees and a brief statement about them, including me, is freely accessible.

A big part of this honor has to do with the fact that I am, as the magazine notes, the only full-time educator among the 25. (There are a few other academics, such as Blackford Middleton and Chris Longhurst.) I am delighted that the award committee chose to recognize the value of informatics education as an important part of clinical informatics.

This is actually not my only recent appearance on a "top" list. A blog called HealthTechTopia named me among the Top 10 Most Influential Informatics Professors.