Friday, October 16, 2009

Informatics Is Not Just For Clinicians

I receive a steady stream of emails from people who are interested in careers and/or education in the biomedical and health informatics field. To the extent I can, I try to reply, giving advice and steering them to more information.

One inquiry I recently received was from someone who has an information technology (IT) background and noted that most of my writings seem to imply that informatics is a profession mainly for those with clinical or other healthcare backgrounds. He noted that I point to research and other observations that clearly show than an understanding of the clinical environment, its thinking, and its workflows are essential for career success in this field.

This individual asked, is there a role for non-clinicians in this field? My reply, as always, was a definite YES! Not only has our workforce research and the experience of others shown that there are plenty of opportunities for work for those who do not have clinical backgrounds, we also know that many of the 250+ alumni of our graduate program, a number of whom are non-clinicians, are gainfully employed.

This is not the first time I had been asked this question. In fact, we felt compelled to write about it several years ago in an issue of our department newsletter, noting even then that were plenty of jobs for non-clinicians in a variety of informatics settings.

However, it is clear that those without healthcare backgrounds must understand clinical environments. They need to understand its operations, it workflows, and even its thinking. But that can be learned, and for many jobs it is sufficient to not have formal training in a healthcare profession.

Now it is true that non-clinicians might end up in different jobs and follow different career paths than clinicians. Of course, that is the case even among the different types of clinicians. The best example of that is the position of Chief Medical Information Officer. This position is almost always filled by a physician. However, there are many other informatics jobs in healthcare settings that other physicians, other healthcare professionals (e.g., nurses, pharmacists, lab techs, healthcare administrators, etc.), and non-clinicians fill.

Some readers of this blog have seen my figure that provides an analogy from Bayesian statistics, i.e., what you do in a career after an informatics education is a function of both what you brought into the education and of what knowledge and skills you gained in the education. Ok, so the analogy is not perfect, but I hope it makes the point that informatics is a large and diverse field, and there are roles for people of many backgrounds who are passionate about using information to improve health.

Monday, October 5, 2009

What Level of Training Is Needed for Health IT and Clinical Informatics Jobs?

There will likely be a large number of jobs that result from the funding in the American Recovery and Reinvestment Act (ARRA, aka the stimulus bill) of 2009 providing incentives for electronic health record (EHR) adoption. Dr. Charles Friedman of the Office of the National Coordinator for Health IT (ONC) recently estimated that 60,000 people will be required for these jobs (PHIN 2009 Meeting Town Hall, September 2, 2009). ONC also recently posted on its Web site a set of job roles and competencies for this massive scaling up of EHR use that was developed in a workshop in August.

One question that arises is, who will provide all this education and training? A number of people have advocated that it be carried out by community colleges. A recent article in Healthcare IT News interviewed two people, a health insurance company executive and a president of a community college association, who advocated for community colleges to play that role.

In a rebuttal commentary, however, I replied that I was not so sure. There is no doubt that plenty of jobs in health IT will be for those educated in community colleges, such as the "informatics technicians" noted in a recent CNN posting about "emerging jobs poised for growth." But this is in distinction to the emerging clinical informatics role, which requires a combination of understanding the clinical environment and its workflows, ability to use advanced information analysis (more so than IT or computer science skills), and a myriad of business and soft skills. As the director of an informatics graduate program, I acknowledge my bias, but I advocated in my commentary that these programs, slightly re-orienting and focusing their curricula, may be better suited for training up this workforce. Since the proposed training must necessarily be short-term, I noted in my commentary that we are re-configuring our Graduate Certificate program into a 6-month program when pursued as a full-time student.

One line of evidence supporting my view comes from the Health IT Compensation Survey (Vendome, 2009). This year's survey features a wealth of data that goes way beyond compensation, and provides an interesting synopsis of the job functions and educational backgrounds of a wide variety of people who work in the industry. They segment those they survey into job setting (i.e., hospital, company, etc.), and across every segment, they subdivide people into leadership, clinical, and non-clinical positions.

Those in hospitals make up the largest segment in the survey, so I will focus on them. Among the leaders, 18% have doctoral or professional degrees, 48% have master's degrees, and all but 4% of the rest have bachelor's degrees. They subdivide the clinical and non-clinical professionals into "high authority" and "low authority." The breakdown of degrees within these groups is:
  • Clinical/High Authority: 34% have doctoral or professional degrees, 29% have master's degrees, and 30% have bachelor's degrees
  • Clinical/Low Authority: 20% have doctoral or professional degrees, 31% have master's degrees, and 35% have bachelor's degrees
  • Non-Clinical/High Authority: 1% have doctoral or professional degrees, 36% have master's degrees, and 38% have bachelor's degrees
  • Non-Clinical/Low Authority: 1% have doctoral or professional degrees, 24% have master's degrees, and 51% have bachelor's degrees
Clearly a majority of health IT professionals, especially those with clinical roles, have at least a bachelor's degree, and many have more. This is not surprising, as effective training for health IT requires expertise in the clinical environment, IT and information skills, and the ability to work with people in organizations. As I note in my commentary, that is a tall order for any educational program, let alone a two-year associate degree.

I do realize that community colleges play a strong role in rapidly adapting to skills needs in communities, and that many of their students are those who have bachelor's or even graduate degrees and return to attain new skills. And there is no question that some of the jobs in health IT will require the kinds of skills that community colleges already teach, such as those in pure IT. I acknowledge that the person hired to harden a server to prevent its security from being compromised probably does not need courses in change management. But many others who work in health IT do!

The reality is that few community colleges have expertise on their faculty in clinical informatics, which is not the mere addition of computer science, health information management, and health care courses as many seem to think. Informatics is what arises at the unique intersection of those areas, and the expertise for teaching it currently resides mostly in graduate-level informatics programs.