Sunday, July 9, 2017

Kudos for the Informatics Professor, Winter/Spring 2017

As always, I have had the ongoing opportunity to publish, speak, and otherwise disseminate information about the informatics in the new year since my last “kudos” posting last fall.

One accolade I received was election as an inaugural member of the International Academy of Health Sciences Informatics (IAHSI). Informatics leaders from around the world voted to establish the initial membership of 121 leaders from around the world. I was delighted to be among the inaugural group who will be inducted during the 16th World Congress on Medical and Health Informatics (Medinfo 2017) in Hangzhou, China in August, 2017.

I am also pleased to report on a major accomplishment of the Oregon Health & Science University (OHSU) Biomedical Informatics Graduate Program, of which I am Director, received notice of renewal of its NIH National Library of Medicine (NLM) Training Grant in Biomedical Informatics & Data Science. The grant will provide $3.8 million to fund PhD and postdoc students in the program over the next five years.

During this time I also had the opportunity to publish a chapter in an important new book published by the American Medical Association, which I have already written about (Hersh W, Ehrenfeld J, Clinical Informatics, in Skochelak SE and Hawkins RE (eds.), Health Systems Science, 2017, 105-116).

I also gave a number of talks during this time, including one at the Data Day Health event in Austin, TX on January 15, 2017. The title of my talk was, Big Data Is Not Enough: People and Systems Are Needed to Benefit Health and Biomedicine.

I gave another talk at an interesting conference devoted to the challenges of the electronic health record. The conference, The Patient, the Practitioner, and the Computer, took place in Providence, RI on March 17-19, 2017. The title of my talk was, Talk, Failure to Translate: Why Have Evidence-Based EHR Interventions Not Generalized? This talk laid the groundwork for my subsequent blog posting published in this blog as well as The Health Care Blog.

Finally, I also had the opportunity to lead a couple of webinars. One was for the H3ABioNet Seminars series of the Pan African Bioinformatics Network for H3Africa, which took place on April 18, 2017 and covered the same topic as the Data Day Health talk described above.

The other Webinar, Implementing Clinical Informatics in the MD Curriculum and Beyond, was delivered to the Association of Faculties of Medicine of Canada on June 13, 2017.

Monday, July 3, 2017

Eligibility for the Clinical Informatics Subspecialty: 2017 Update

Some of the most highly viewed posts in this blog have been those on eligibility for the clinical informatics subspecialty for physicians, the first in January, 2013 and updates in June, 2014 and March, 2016. A noteworthy event occurred last November when the "grandfathering" period was extended to 2022.

One of the reasons for these posts has been to use them as a starting point for replying to those who email or otherwise contact me with questions about their own eligibility. After all these years, I still get such emails and inquiries. While the advice in the previous posts is largely still correct, there have been a number of small changes, most notably the extension of the grandfathering period. There are still (only) two boards that qualify physicians for the exam, the American Board of Preventive Medicine (ABPM) and the American Board of Pathology (ABP). ABP handles qualifications for those with Pathology as a primary specialty and ABPM handles those from all other primary specialties. (Kudos to ABPM for finally updating and improving their Web site!)

The official eligibility statement for the subspecialty is essentially unchanged from the beginning of the grandfathering period and is documented on the ABPM and ABP Web sites. As clinical informatics has been designated a subspecialty of all medical specialties, this means that physicians must be board-certified in one of the 23 primary specialties (such as Internal Medicine, Family Medicine, Surgery, Radiology, etc.). Those who have let their primary board specialty lapse or who never had one are not eligible to become board-certified in the subspecialty. They must also have an active and unrestricted medical license in one US state.

For the first ten years of the subspecialty (through 2022), the "practice pathway" or completing a "non-traditional fellowship" (i.e. one not accredited by the Accreditation Council for Graduate Medical Education, or ACGME) will allow physicians to "grandfather" the training requirements, i.e., take the exam without completing a formal fellowship accredited by the ACGME. The practice pathway requires that a physician have "practiced" clinical informatics for a minimum of 25% time for three of the last five years. Time spent in formal informatics education is credited at one-half of practice, meaning that a recent master's degree or other educational program should be sufficient to achieve board eligibility. The non-traditional fellowship allows board eligibility by completing a non-ACGME accredited informatics fellowship, such as one sponsored by the National Library of MedicineVeteran's Administration, or others. The ABPM Web site implies, but does not explicitly state, that a master's degree program will qualify one via this pathway as well. A number of physicians have achieved board eligibility (and subsequent certification) by completing the Master of Biomedical Informatics program we offer at Oregon Health & Science University (OHSU).

As always, I must provide the disclaimer that ABPM and ABP are the ultimate arbiters of eligibility, and anyone who has questions should contact ABPM or ABP. I only interpret their rules.

One bit of advice I always give to any physician who meets the practice pathway qualifications (or can do so by 2022) is to sit for the exam before the end of grandfathering period. After that time, the only way to become certified in the subspecialty will be to complete a two-year, on-site, ACGME-accredited fellowship. While we were excited to be the third program nationally to launch a fellowship at OHSU, it will be a challenge for those who are mid-career, with jobs, family, and/or geographical roots, to up and move to become board-certified.

Starting in 2023, however, the only pathway to board eligibility will be via an ACGME-accredited fellowship. There are now nearly 30 such fellowships. But starting in 2023, board certification for physicians not able to pursue fellowships will become much more difficult. There are many categories of individuals for whom getting certified in the subspecialty after the grandfathering period will be a challenge:
  • Those who are mid-career - I have written in the past that the age range of OHSU online informatics students, including physicians, is spread almost evenly across all ages up to 65. Many physicians transition into informatics during the course of their careers, and not necessarily at the start.
  • Those pursuing research training in informatics, such as an NLM fellowship or, in the case of some of our current students, in an MD/PhD program (and will not finish their residency until after the grandfathering period ends) - Why must these individuals also need to pursue an ACGME-accredited clinical fellowship to be eligible for the board exam given such comparable levels of informatics training, even if it will be somewhat less clinical?
  • Those who already have had long medical training experiences, such as subspecialists with six or more years of training - Would such individuals want to do two additional years of informatics when, as I recently pointed out, it might be an ideal experience for them to overlay informatics and their subspecialty training?
There will be one other option for physicians who are not eligible for board exam, which will be the Advanced Health Informatics Certification (AHIC) being developed by AMIA. This certification, according to current plans, will be available to all practitioners of informatics who have master's degrees in both a health profession and informatics, or a PhD in only informatics. This will also provide a pathway for physicians who are not eligible for the board certification pathway. I am looking forward to AMIA releasing its detailed plans for this certification, not only for these physicians but also other practitioners of informatics.

As I have also stated before, I also hold out hope for the ideal situation for physician-informaticians, which in my opinion will be our own specialty or some other certification process. The work of informatics carried out by physicians is unique and not really dependent on their initial clinical specialty (or lack of one at all). I still believe that robust training is required to be an informatician; I just don't believe it needs to be a two-year, in-residence experience. An online master's degree or something equivalent, with a good deal of experiential learning in real-world settings, should be an option. The lack of these sorts of options will keep many talented physicians from joining the field. Such training would also be consistent with the 21st century knowledge workforce that will involve many career transitions over one's working lifetime.