Next Steps for the Clinical Informatics Subspecialty: Initial Certification Exam and Board Review Course

Progress on the clinical informatics subspecialty for physicians continues to be steady but slow. Some additional information recently became available at a late-breaking panel at the American Medical Informatics Association (AMIA) 2012 Annual Symposium this past week, although there are still many unanswered questions, especially the acute question of exactly who will be eligible to take the certification exam during the grandfathering era. In addition to myself, the panelists consisted of two AMIA members who were question-writers, Charles Safran and Justin Starren, and two representatives from the American Board of Preventive Medicine (ABPM), Joshua Lipsman and William Greaves. The latter two described the process of applying for and taking the certification exam, along with maintenance of certification once the exam was passed. The details of these will be posted to the ABPM Web site by the end of 2012. (Disclaimer: What follows in the rest of this posting is my recollection of what I heard during the panel; the "truth" will be what is posted on the ABPM Web site before the end of this year.)

The first certification exam will be offered during a two-week period in October, 2013. It will be a computerized exam offered at Pearson VUE Test Centers. Registration for the exam will open in the spring of 2013, with ABPM reviewing each application to determine if the applicant is eligible to sit for the exam. The discussion that follows assume some knowledge about the subspecialty from pervious postings in this blog, including:

• First description of subspecialty certification
• Approval by the American Board of Medical Specialties (ABMS)
• Update from late 2011
• Challenges in building capacity of the subspecialty
• Mapping core content into the OHSU informatics curriculum

One thing that was clear from the ABPM representatives was that the starting point for their criteria for the certification exam and eligibility will be based literally on the original proposal submitted by AMIA to ABMS in 2009. This document has not been shared publicly yet, though it (or a summary of it) presumably will be made available when the ABPM releases details of the exam at the end of this year. This means that the "grandfathering" era of training requirements will be determined by exactly what was put forth in the proposal. My understanding of what was said on the panel is that there will be two paths to eligibility to take the exam:

1. Practice pathway - To meet this criteria, someone has to have "practiced" clinical informatics for a minimum of 25% time (i.e., 10 hours per week). The work can be any type of informatics work, including research.
2. Non-traditional fellowship pathway - To meet this criteria, someone must have completed a formal training program that involves a commitment of time that is double that of the practice pathway, i.e., a minimum of 50% time over three years or full-time over 1.5 years. This amount of commitment must have been made over a 36-month period during the previous five years. The baseline list of programs will consist of 33 programs listed in the ABMS proposal, which was comprised of the 18 programs that were funded under the National Library of Medicine (NLM) training grant program at the time of the ABMS submission, along with 15 others who were members of the AMIA Academic Forum. This list was never intended for this purpose; some of the programs funded by NLM do not have a focus in clinical informatics and furthermore, a new cycle of NLM training grant funding has been awarded, with six programs no longer funded by NLM and two new programs added to the 12 whose funding was continued. Likewise, there are now many more members of the AMIA Academic Forum. The original purpose of the list was to demonstrate that training programs in the field currently exist. The ABMS representatives did state that graduates from other informatics programs would be considered for the non-traditional fellowship pathway in the application process. (Note to Oregon Health & Science University [OHSU] students and alumni: My interpretation of the time commitment required for the non-traditional fellowship is that graduates of our master's degree programs would be eligible if they had completed the program over a three-year span, since these programs take in total the equivalent of 1.5 years of full-time study. Of course, I will also argue to ABPM that at least from a content standpoint, our Graduate Certificate program graduates should also be eligible. But these are ultimately for ABPM to decide.)

The cost of the exam will consist of an exam fee and an additional registration fee that will be lower for those in the non-traditional fellowship pathway than the practice pathway. The registration fee covers the cost of an assessment of whether the applicant meets the qualifications to sit for the exam. The purpose of the fee is to stand up the resources that will be required to  determine whether the applicant is qualified. (If not, he or she will get his or her exam fee returned.)

My role on the panel was to describe a new activity I will be leading for AMIA, which is serving as Course Director of the AMIA Clinical Informatics Board Review course. The course will initially be offered as an in-person course, probably three days in length, but will later be moved to an on-line format. Those taking the exam will also have access to a test bank of practice questions. One question I am sure many potential certification candidates will ask is, should I take the course? One group for whom this will be a complicated question is those in the Practice Pathway track with little or no formal training in informatics. As noted in some of blog posts, the volume of material that will be assessed on the exam is substantial. It is unlikely that someone with no previous exposure to this material will be able to master it with three days of review. A portion of the material is covered in the 10x10 ("ten by ten") course that I teach, but in reality, a full Graduate Certificate or possibly even a master's degree will likely be required. Even more problematic is that most graduate programs have not yet aligned with the core content specified in the ABMS proposal. Based on an analysis of our program, we are exploring how to put a substantial amount of the content in as few courses as possible, which may require some substantial revision of our curriculum. (We do not plan to make our curriculum identical to the core content, since we have students with other aspirations besides clinical informatics certification. We will, however, try to create a pathway through the program as efficiently as possible.)

A final question that always comes up in these discussions is, what about certification for others in the field, including physicians who do not have a board certification and are thus ineligible for the subspecialty. As noted in my previous posts, AMIA has established an advanced interprofessional task force to make recommendations for certification of other doctoral-level (healthcare doctorates such as PharmD, DPM, DPT, and DNP, as well as PhDs) informaticians. This certification will likely have core content that is very similar to the physician subspecialty, which is really not very physician-specific.

It is clear that there will be a number of bumps in the road along the way to development of the clinical informatics subspecialty and other certifications in clinical informatics. I still believe, however, that certification will be important for the recognition of those who work as clinical informatics professionals. I am looking forward to seeing many who are reading this post in the Board Review course or in other informatics training courses in which I am involved. I am actually hoping to be eligible to take the exam myself (I was one of the last cohorts of those trained in internal medicine who received lifetime certification, so I am still board-certified!), so I may be studying with some of you for the test next summer.

Postscript (November 15, 2012): A couple minor errors about required qualifications have been corrected, which are that the practice pathway and non-traditional fellowship must be completed over a three-year period during a five-year span and that for those who are not deemed eligible to take the certification exam, only the exam fee and not the registration fee will be refunded. In addition, two new links of note should be mentioned:

• Coverage of the panel by Joseph Conn of Modern Healthcare Magazine
• Interview of myself on Healthcare Now Radio from October 12, 2012