Saturday, November 20, 2010

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.


  1. Bill--

    Your observations are particularly important as sub-certification through specialty boards becomes available. The present research focused graduate programs (alone) eventually won't suffice for the curriculum required for accessing sub-certification examination. /Steve

  2. Yes, the plan to establish a clinical subspecialty for physicians exemplifies my point about the emergence of the informatics practitioner. I wrote about the plans for the subspecialty that were published in a posting in this blog last year:

    The current status of the proposal is that it is being reviewed by the American Board of Medical Specialties (ABMS) and will be voted on next year (2011). There is no vocal opposition at this time. If it passes, physicians will be able for five years to garner informatics work experience to then be eligible to sit for the certification exam, which will likely first be offered some time in 2012.

  3. Do you foresee OHSU setting up a program, review courses, or a pathway to facilitate obtaining certification for the physicians that have obtained a Master's in Informatics?

  4. Tripp,

    Naturally I plan for OHSU to be involved in the activities you list. Of course, without the subspecialty or the rules for getting certified in it approved yet, it is hard to predict what our activities will look like. But you can be sure we will be involved.

  5. Bill,

    With my brief 6 years into the field, I'm already very excited about how fast it is growing and how much increasing recognition it has gained. I agree with you that this is happening all over the world, even in places where high-quality informatics programs are still non-existent like Thailand. We have begun to realize the role of informatics (not just IT) in health care, but the biggest challenge for us in the next 10 year is the shortage of informatics workforce. I'm glad that we are slowly following the U.S. and elsewhere in terms of informatics education and research, and I'm proud to be in one of the few institutions in the country that are committed to this endeavor (as well as working alongside a student of your program!).

    Informatics programs in the U.S. and Europe in general, and OHSU in particular, will continue to be our role models. While we probably won't measure up to your footsteps, we will certainly walk in them and try our best.

    We at the Faculty of Medicine Ramathibodi Hospital, Mahidol University thank OHSU and other programs for showing us the way! We hope one day that we will stand united with pride alongside your program and others.

  6. Thanks Nawanan, I enjoyed visiting your hospital and university when I was in Bangkok earlier this year.