Proposing the Addition of a Standard Occupational Classification (SOC) Code for Informatics

About a decade ago, as my interests and work activity began to focus more on informatics education and workforce development, I started to ask questions about the size, scope, and required education of that workforce. Despite seeing great interest in the informatics education programs at Oregon Health & Science University (OHSU), I could find very little data about how many people were working in the field, how many more were needed, what their job activities were, or what knowledge and skills they required. I noted these problems in the first paper on this topic I published [1], and then tried to answer some of the questions on the size of the workforce with the best data I could find, which was the HIMSS Analytics Database. This led to my widely publicized finding of a need for at least 40,000 more health information technology professionals [2], which was part of the motivation for including workforce development in the Health Information Technology for Economic and Clinical Health (HITECH) Act. At the same time, I was learning that many human resources (HR) professionals were unaware of the background and skills of those working in the growing number of clinical informatics roles in healthcare organizations.

One reason for all these problems was the lack of informatics being visible in federal labor statistics. In particular, there was no Standard Occupation Classification (SOC) code for informatics. I came to learn that the importance of such codes cannot be underestimated, as they define the labor statistics maintained by the US government. They also are used by others, such as Human Resources (HR) departments in organizations to classify job offerings.

There is one code that is somewhat related to informatics, and sometimes used to point to workforce needs: 29-2071 Medical Records and Health Information Technicians. The occupations described by this code are those that "compile, process, and maintain medical records of hospital and clinic patients in a manner consistent with medical, administrative, ethical, legal, and regulatory requirements of the health care system. Process, maintain, compile, and report patient information for health requirements and standards in a manner consistent with the healthcare industry's numerical coding system." However, this code refers to the relatively low-level work of coding and maintaining medical records, and not the myriad of activities carried out by informatics professionals.

The SOC system is maintained by the US Bureau of Labor Statistics (BLS) and is revised periodically with a multi-year process. The last update was in 2010, and the informatics field was not organized enough to pursue a revision. The next update will be in 2018, and a few months ago, the government made its first call for public input for modifications to the SOC 2010 system, with recommendations by this past Monday, July 21st. For over the last year, I have been part of a team of individuals and groups (ONC, AHIMA, AMIA, and HIMSS) working to propose the inclusion of the health informatics occupation into the SOC. Our letter was submitted this week, with an AMIA press release noting the large and diverse groups supporting the inclusion.

In the process of preparing the letter, I learned a great deal about the SOC system and the process for revising it. SOC codes are supposed to describe occupations more than specific jobs. There need to be substantial numbers of people in the occupation, which must be unique from others in the SOC. The classification unfortunately has a single hierarchy, which makes it difficult to represent occupations that cross boundaries, such as health informatics. But in the end, the overwhelming sentiment of the group, one I strongly advocated as well, was that health/biomedical/clinical informatics is primarily a health professional occupation and not a computing occupation. Therefore, our overall recommendation was to add a new Health Informatics occupation residing under the major group, 29-0000 Healthcare Practitioners and Technical Occupations.

I was also pleased with several other aspects of the letter:

• It notes that while we are asking to call the new occupation "health informatics," there are other terms, such as "biomedical informatics" and "clinical informatics," which are used to describe this occupation, and all of these all refer to the same general occupation of "health informatics."
• There is inclusion of discussion about the new clinical informatics physician subspecialty, which not only demonstrates that informatics is important to medicine (and all health professions) but that it was not unique to any primary medical specialty.
• It calls out the large and growing number of informatics educational programs, most of which are at the graduate level.

As noted on the BLS site, there are many more steps for revision the 2018 SOC. But it has been made clear from leaders in the field that there is an important occupation of health informatics, which is a health profession that should be included in the SOC.

References

1. Hersh, WR (2006). Who are the informaticians? What we know and should know. Journal of the American Medical Informatics Association. 13: 166-170.
2. Hersh, WR and Wright, A (2008). What workforce is needed to implement the health information technology agenda? An analysis from the HIMSS Analytics™ Database. AMIA Annual Symposium Proceedings, Washington, DC. American Medical Informatics Association. 303-307.

Competencies in Clinical Informatics for Medical Education

I wrote last year about efforts at Oregon Health & Science University (OHSU) to introduce content on clinical informatics as part of its revision of its medical school curriculum. Physician competence in clinical informatics is important for a number of reasons, such as the continuously expanding knowledge base of medicine, the need for care provided to be more accountable, and the desire of patients to interact electronically with the healthcare system the way they interact with other industries (such as retailers and banks). An additional reason for such competence for some physicians is the career opportunity provided by the designation of clinical informatics as a new medical subspecialty.

In order to integrate more clinical informatics into OHSU's curriculum, we established a working group of informatics faculty leaders to develop a set of competencies in clinical informatics. We aimed to go beyond the usual searching and basic EHR skills that increasing numbers of medical schools provide. We also wanted to focus less on mastery of the technology and more on the tasks for which it is used.

From the broad competencies, we also developed specific learning objectives and milestones, an implementation schedule, and mapping to general competency domains. After producing this material, we believed there would be value in publishing our work in a peer-reviewed journal. By doing so, we hoped that this work, and the resulting curricula, will be evaluated by ourselves and our colleagues. To this end, our published paper has just appeared (1). We chose to publish in an open-access journal so everyone can access the paper, and the publisher even provides a video abstract describing the work.

Our next steps involve implementing this new portion of our medical school curriculum. We also hope to evaluate our effort as well as learn from others who are adopt, modify, and/or evaluate our approach.

I might add that there is nothing about this work is highly specific to medical students. In other words, the competencies we have developed likely apply to all health professions students, i.e., nurses, physician assistants, pharmacists, etc.. For that matter, they also should apply to non-clinical students, e.g., health administration, public health, and so forth.

References

1. Hersh WR, Gorman PN, Biagioli FE, Mohan V, Gold JA, Mejicano GC. Beyond information retrieval and electronic health record use: competencies in clinical informatics for medical education. Advances in Medical Education and Practice. 2014, 5: 205-212.

Advice to a Young Person Considering a Career in Informatics

One of the biggest challenges I face in introducing potential students to the myriad of career opportunities in biomedical and health informatics that potentially await them comes with young people. I believe that the main reason for this is this group's little exposure to our healthcare system and its myriad of problems and challenges. Like most young people, they tend to be healthy and have had very little experience with healthcare and other health-related areas. While there is little difficulty in explaining the problems that informatics tries to solve to older individuals, perhaps whose parents or children have been impacted by healthcare, or who are among the myriad of mid-career students who already work in healthcare, it is considerably more challenging to introduce someone to the importance of informatics who has had little interaction with healthcare. I was recently invited to write a chapter on the topic of introducing young people to the study of informatics, and a co-editor of the book has allowed me to reproduce it in my blog. The book will be published as: Vaidya, K., Soar, J. [eds.] 2015. Health Informatics for the Curious: Why Study Health Informatics. Canberra, Australia. Forthcoming [ISBN 978-1-925128-71-0]. What follows is an edited version of my draft chapter.

While society will always need professionals who provide hands-on care of patients, there are growing opportunities for others in health professions to contribute to not only contribute to people’s health, but also improve the delivery of healthcare and advanced research. One such profession is biomedical and health informatics, which aims to apply information and associated technologies for the benefit of health and biomedicine.

There are many trends in healthcare that demonstrate increased need for professionals trained in informatics. It begins with the person in good health who aims to maintain their health and prevent disease. If that person becomes a patient, he or she wants to interact with the healthcare system in the same way they interact with other industries such as retail or banking, i.e., through electronically connected means. For those who work in healthcare, informatics competence is needed to function in their profession, such as accessing clinical knowledge and being guided by clinical decision support. As patients, especially those with one or more chronic illnesses, are cared for by teams of individuals from home caregivers to medical subspecialists, there will be a growing need for care teams to communicate effectively and coordinate care. Likewise, as the population disperses, systems employing telemedicine and other forms of remote communication will be required.

Moving to the population level, public health authorities need to be vigilant about health-related threats, whether natural (emerging infectious diseases) or manmade (bioterrorism). And of course we will continue to require a robust medical research infrastructure, with particular promise for data-intensive research methods, such as identifying genomic causes of health and disease or leveraging the data in the growing number of electronic health record systems. As new models of healthcare financing demand more accountability for care, information systems will be required so patients can be tracked and complications can be identified and addressed early. Some combine all of the needs described in this paragraph together into the concept of the learning health system, which continuously learns based on accumulated data and its analysis [1].

A common thread across all of these trends is the growing use of data and information systems. Unlike the common uses of information technology (IT), these applications are more complex, from their need to be standardized, interoperable, and reliable as well as their requirement to protect safety and individual privacy. The field that most directly addresses these issues is what I prefer to call biomedical and health informatics [2].

A variety of data points show that professionals from this discipline are in high demand. An analysis of online job postings found 226,356 positions advertised between 2007-2011 [3]. In the meantime, a survey of healthcare CIOs shows a concern for shortages of workers in this area who have the proper skills [4]. For physicians working in this area, there is now a new medical subspecialty has been designated [5]. The nursing profession has had a specialization in nursing informatics for over a decade, and we are likely to see more certifications, as the American Medical Informatics Association (AMIA) has created a task force to develop an Advanced Interprofessional Informatics Certification that will apply to all informatics professionals, not just those who are physicians and nurses.

The occupation providing the expertise and leadership in health IT is also called, for short, informatics [2]. Other adjectives sometimes appear before “informatics” in other contexts, such as clinical informatics, biomedical informatics, bioinformatics, etc., but all generally refer to the discipline working to apply information to improve health and healthcare delivery [2]. While the occupation of informatics is fundamentally a health profession, it is not just an extension of a specific healthcare field, i.e., a physician, nurse, or allied health professional who is savvy with IT. By the same token, those who work in the occupation of health informatics are not IT professionals or managers who happen to be applying general IT skills to health or healthcare settings.

This unique occupation is increasingly valued in healthcare organizations. In the United States, for example, an analysis by the Office of the National Coordinator for Health IT of a comprehensive database of 84 million online job postings to find a total of health IT-related 434,282 job postings between 2007-2011, with 226,356 health IT core jobs and 207,926 health IT-related clinical user jobs [3]. The former would contain many who work in the occupation of informatics.

Informatics is more about information than technology, with the latter being a tool, albeit an important one, to enable better use of information. The former School of Informatics at the State University of New York Buffalo defined informatics as the Venn diagram showing the intersection of people, information, and technology. Friedman has defined a “fundamental theorem” of informatics, which states that informatics is more about using technology to help people do cognitive tasks better than about building systems to mimic or replace human expertise [6]. He has also defined informatics as “cross-training,” bridging an application domain (such as public health or medicine) with basic information sciences [7].

Within informatics are a myriad of sub-disciplines, all of which apply the same fundamental science and methods, but focused on particular subject domains. As shown in the first figure below, informatics proceeds along a continuum from the cellular and molecular (bioinformatics) to the person (medical or clinical informatics) to the population (public health informatics). Within clinical informatics may be a focus on specific healthcare disciplines, such as nursing (nursing informatics), dentistry (dental informatics), pathology (pathology informatics), etc. as well as among consumers and patients (consumer health informatics). There are also disciplines in informatics that apply across the cell-person-population spectrum:

• Imaging informatics – informatics with a focus on imaging, including the use of PACS systems to store and retrieve images in health care settings
• Research informatics – the use of informatics to facilitate biomedical and health research, including a focus on clinical and translational research that aims to accelerate research findings into healthcare

What are the competencies required for a career in informatics? They can be grouped into three categories, as shown in the next figure below, which broadly include health/biomedical domain knowledge, information and computing science, and people/communication skills. (This is an update of a figure I have published elsewhere, e.g., [2].)

Does one need to be a clinician to be trained and effective in a job in informatics? Must one know computer programming? The answers are no and no. Informatics is a very heterogeneous field, and there are opportunities for individuals from all types of backgrounds. One thing that is clear, however, is that the type of informatics job you assume will be somewhat dependent on your background. Those with healthcare backgrounds, particularly medicine or nursing, are likely to draw on that expertise for their informatics work in roles such as a Chief Medical or Nursing Informatics Officer. Those who do not have healthcare backgrounds still have plenty of opportunities in the field, but are more likely to end up in the wide variety of other jobs that are available.

Informatics is a career for the 21st century. There are a wide variety of jobs for people with diverse backgrounds, interests, and talents, all of whom can serve the health of society through effective use of information and associated technologies. The pathway to get to that career usually involves graduate (i.e., beyond a bachelor's degree) education, and a database of such programs is available from AMIA and includes our program at Oregon Health & Science University (OHSU).

References

1.     Smith M, Saunders R, Stuckhardt L, and McGinnis JM, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. 2012, Washington, DC: National Academies Press.
2.     Hersh W, A stimulus to define informatics and health information technology. BMC Medical Informatics & Decision Making, 2009. 9: 24. http://www.biomedcentral.com/1472-6947/9/24/.
3.     Schwartz A, Magoulas R, and Buntin M, Tracking labor demand with online job postings: the case of health IT workers and the HITECH Act. Industrial Relations: A Journal of Economy and Society, 2013. 52: 941–968.
4.     Anonymous, Demand Persists for Experienced Health IT Staff. 2012, College of Healthcare Information Management Executives: Ann Arbor, MI, http://www.cio-chime.org/chime/press/surveys/pdf/CHIME_Workforce _survey_report.pdf.
5.     Detmer DE and Shortliffe EH, Clinical informatics: prospects for a new medical subspecialty. Journal of the American Medical Association, 2014. 311: 2067-2068.
6.     Friedman CP, A 'fundamental theorem' of biomedical informatics. Journal of the American Medical Informatics Association, 2009. 16: 169-170.
7.     Friedman CP, What informatics is and isn't. Journal of the American Medical Informatics Association, 2012. 20: 224-226.