Saturday, March 21, 2015

When Bad Governments Happen to Good People

One of the most enjoyable aspects of my job is the opportunity to visit many different countries to collaborate with colleagues and friends in all sorts of informatics settings. I have written before that informatics is a field of global truths, and the benefits and challenges of implementing information systems in healthcare settings are universal across the world. Mixing healthcare and information technology no matter what kind of health system or technology infrastructure a county has.

Some of the countries I visit have governments whose policies and/or actions I consider disagreeable. How do I rectify this? The main way I do is recognize that those who invite me are doing so to share ideas and activities around informatics. As we are part of the larger biomedical and health community, we are driven by the creed that drives all health professions, which is to improve the health of individuals and populations. We do this in informatics by focusing on effort to improve health through better use of data, information, and knowledge.

There are certainly places I visit colleagues where the policies of their particular government are not agreeable to me. On the other hand, I do not always agree with the policies of my own government in the United States, although I do cherish our political system that lets me speak out about it, which is not always the case in places I visit. In any case, my view on visiting countries where I have wonderful colleagues but whose government I find disagreeable is that I do not need to to support a particular government if I am going to interact with my colleagues who live in that country. As my own country's track record in international relations is far from perfect, I can engage in honest discussion when the topic of politics arises. While I do not overtly criticize the governments who policies and actions with which I disagree, I will not hesitate to speak my opinion when asked.

Another tension I sometimes experience concerns religion. My view of religion is that I respect all religions and honor their traditions, even those traditions that are at odds with what I believe is fair and just. (For example, the rights of women and local minorities.)

One additional positive thing I have noted in my travels is that an activity that seems to bridge people around the world is technology, in particular the Internet. The access to facts and ideas that the Internet allows is enabling, and there is a common bond from rich countries to poor ones now that the Internet has become so ubiquitous everywhere on the planet.

While there is very little in the world that one individual can change, I will continue enjoying my travels around the world, especially in advancing the cause of improving health and healthcare through informatics. I will share both my knowledge and my attitude that when the right people are given the right tools, good outcomes can result.

Wednesday, March 18, 2015

Advice for Physicians in Training Seeking a Clinical Informatics Fellowship

Lately I have received requests for advice from physicians in training asking what they can do to make themselves more competitive for clinical informatics fellowship positions. In some sense these are similar to the emails I receive from established physicians asking about eligibility for the clinical informatics subspecialty here and now. To provide answers to the established physicians most efficiently, I prepared a blog post that I send them to as a reply to get them started in thinking about their eligibility. I am now doing likely in having a generic reply to physicians in training, and it is actually similar to another posting of mine from last year that provided advice to any young person seeking a career in informatics.

Let me then focus specifically on the physician in training who is considering pursuing formal training in clinical informatics, since I have increasingly been receiving emails with this question. My advice is really not much different from what anyone might advise a physician seeking training in any specialty or subspecialty. It is, however, important for potential trainees to remember that starting in 2018, fellowships accredited by the Accreditation Council for Graduate Medical Education (ACGME) will be the only pathway to achieve board certification in the new subspecialty.

As for advice, first and foremost, someone seeking formal training in clinical informatics should understand the field and its role in healthcare.  He or she should understand how informatics differs from information technology (IT), computer science, and related areas. The potential informatician should also be aware of the kinds of work that informatics professionals perform and the types of jobs into which they are hired.

A second critical piece of advice is to get involved in some informatics activity in their current medical school or residency program. It need not be a high-profile research project that gets published, but any activity that gives him or her an opportunity to perform and to be able to describe the application of informatics in a healthcare setting that provided value to someone, whether a physician, other healthcare professional, researcher, patient, or even a health system. While it would be ideal for the activity to be a medical school or residency rotation, it could also be volunteer activity. Whatever is done, he or she should be able to describe the work, who benefitted from it, and what principles of informatics it applied.

Another recommendation I can give is to become involved in some sort of professional organization or activity. While participating in a national organization such as the American Medical Informatics Association (AMIA) may be impractical, he or she can try to become involved in a local or regional organization. In Oregon, for example, we have an active local Health Information Management Systems Society (HIMSS) chapter. There are also national as well as local medical societies and other professional organizations that also carry out informatics activity.

A final bit of advice is to choose a fellowship that aligns with one's career goals. The clinical informatics subspecialty fellowship is focused on training for operational informatics work. Those more interested in a research career, especially if training in a medical specialty is not desired, should consider something like the National Library of Medicine (NLM)-sponsored research fellowships, which Oregon Health & Science University (OHSU) offers along with 13 other universities. Our clinical informatics subspecialty fellowship is just one of a family of educational programs in biomedical and health informatics offered by OHSU, and there might be other training options to consider.

In essence, those interested in clinical informatics should understand the field, get involved in it, and connect with professional associations. This advice is really little different from what one might advise someone seeking a career in almost any field. Such activity demonstrates a commitment to the field that will strengthen the application of someone who is seeking a fellowship in clinical informatics.

Sunday, March 15, 2015

Opportunity for Public Input into Evidence Report on Health Information Exchange

In the fall of 2013, I reported on a new project for which OHSU had been awarded a contract to carry out a systematic review of the evidence base for health information exchange (HIE). This project was funded under the Agency for Healthcare Research and Quality (AHRQ) Effective Healthcare Program. Our Department of Medical Informatics & Clinical Epidemiology (DMICE) houses one of the 12 Evidence-Based Practice Centers (EPCs) funded by the AHRQ to create evidence reports on a variety of healthcare topics.

I am pleased to report that the project is just about complete, and those who are interested in it can actually contribute. As is the case with all AHRQ evidence reports, a draft of the report has been posted for public comment. I encourage interested people to download the draft report and provide comments.

While there have unfortunately been two other systematic reviews to appear in the last few months [1,2], our report, based on AHRQ EPC protocols for evidence reports, will hopefully be more comprehensive and have used a more inclusive process. One of those processes is a period of public comment (simultaneous with formal peer review). The public comment period has just started and will be open until April 8, 2015. We look forward to constructive comments that will help improve the final report, which will be available in a few months.


1. Rudin, RS, Motala, A, et al. (2014). Usage and effect of health information exchange: a systematic review. Annals of Internal Medicine. 161: 803-811.
2. Rahurkar, S, Vest, JR, et al. (2015). Despite the spread of health information exchange, there is little evidence of its impact on cost, use, and quality of care. Health Affairs. 34: 477-483.