April 11, 2022

What is Clinical Informatics?

Read the Video Transcript

- Hi, everybody. Aloha. This is an ACEP sponsored informational session related to Clinical Informatics. And what is Clinical Informatics? I'm gonna ask the participants to introduce themselves. Dr. Benjamin Slovis, you go first.

- Thank you. My name's Ben Slovis. I'm an emergency physician located in Philadelphia at Thomas Jefferson University and I am a board-certified clinical informaticist, the title of medical information officer in my enterprise.

- [Dr. Baker] Dr. Ryan Kring.

- Hi, I'm Ryan Kring. I'm an emergency physician. I'm an active duty Air Force officer, currently stationed at Joint Base Andrews in Maryland. I also work part-time at the Johns Hopkins system at Suburban Hospital in Bethesda, Maryland. And I'm a graduate of Beth Israel Deaconess Medical Center's emergency medicine residency in Boston, Massachusetts. And I'm interested in Clinical Informatics and looking forward to learning more from these experts in the field.

- And you're probably, in contrast to the other two of us, you're a recent grad. What year did you finish?

- Yes, I finished my residency in 2018. So, I'm a little over three years out of my residency training at this point.

- Okay. That's good. And I'm Mark Baker, clinical practice in Hawaii and also board-certified in Clinical Informatics, active with ACEP. I'm the medical informatics director for the hospital that I work at. My goal was that if we're gonna use a computer, we need to be able to use it as well as possible. Ryan, what questions do you have?

- Yeah, starting with Dr. Slovis. What advice do you have for an emergency physician, who's interested in getting into the field of Clinical Informatics?

- So, well, I think, first, we should define what Clinical Informatics is, if that's okay, because I think that there's a massive misunderstanding of what Clinical Informatics is and isn't. The truth is that it's an unbelievably broad field, even more so when you consider the definition of biomedical informatics of which Clinical Informatics is a subset. But I think it's really important to acknowledge that, while many clinical informaticists are doctors who like to tinker with computers, that is not the definition of Clinical Informatics. Bill Hersh, who's one of the forefathers of Clinical Informatics has a definition, but I have a modified version that I like to think of, which is informatics the science or the study of the generation transmission storage and regurgitation of information. And you can manipulate that in multiple different ways. You know, in the classic example, in a clinical setting, we think of clinical informaticists as being people who help us with the electronic health record. And that's not necessarily the pure definition of it because implementation science is its own special field. But clinical informaticists in the purest sense are sometimes physicians, sometimes nurses, sometimes with no medical background, but for our context, physicians, who are interested in, as Mark said, helping the computer work for us. There is a fundamental theorem of Clinical Informatics that anything a human can do, theoretically, a human plus a computer can do better, which might ruffle some people's feathers, but the idea here is that humans are really good analytical thinkers. We're really good at concepts. We're really good at deduction. What we're not really good at is doing the same thing over and over and over and over again, or sifting through massive and massive amounts of information. Computers are actually really good at that, those two things. So together, we actually can do, hypothetically, and in some contexts, in reality, better work than the individual would do alone. So to answer your question, I think emergency physicians are perfect specialists for Clinical Informatics because there's no other specialty where sometimes, and I hate to fall into this stereotype, but so many life and death situations sometimes are made with rapid decision making with very limited information. And so, it's the perfect context for making the computer work better for you, could actually lead to significant outcomes. How do emergency physicians wanna get involved? 'Cause I think that was your original question after my very long answer, and then I'll let Mark chime in, too, and I apologize. There's a number of different ways at this point right now in informatics, if you wanna become board-certified, you need to do an ACGME-accredited fellowship. That doesn't mean you need to do a fellowship to be involved. What you need to be is interested in problem solving, interested in workflows, and interested in improvement. And I'll stop babbling now.

- That's great. Thank you.

- I believe every single emergency department should have somebody who has dedicated themselves to being the liaison between the IT staff and the physician.

- It makes a lot of sense. You know, as I'm learning more about this field, one of my roles where I'm working now is I'm the medical director of the ED that I work for with the Air Force and one of the things that interest me in this field was, we were having a lot of problems with our EMR. The order sets were not intuitive and it took a long time to order things. So I was able to go through and edit them and customize them to our patient population and to the setting that we work in and even just a minor change like that, improved things, in terms of patient throughput, and decreasing errors in orders, and things like that that have improved patients safety and working just a little bit better for the docs that I work with and for. That was something that really appealed to me. It sounds like Clinical Informatics is a field that works well with the skillset of emergency physician. Some of the things we've talked about, you know, as someone who did not do a ACGME-accredited informatics fellowship and I'm a few years out of residency now, what opportunities might there be for an emergency physician who's interested in expanding their professional activities into the informatics field? Dr. Baker, maybe you could give me some ideas there.

- Sure. ACEP has an informatic section and that's a great opportunity to network. In terms of training, look into the ACEP sponsored AMIA 10x10 informatics course, and this article is by a physician whose last name is also Baker, who took the course and describes how it changed her career. The 10x10 course would be the first thing.

- I would just agree with you. So I took the AMIA 10x10 course. It was actually... And I took the one in conjunction with ACEP. There are other versions of it. And it was my introduction to Clinical Informatics as well. I was exposed first in residency and when I asked, "What can I do to learn more?" I was directed to the 10x10 course and it's a really great background.

- It's directed towards emergency physicians once a year, but Ben said, you don't have to do the ACEP sponsored one.

- Sounds like a way to get into the field, even though I'm out of residency and sort of, now in my clinical practice outside of training. It's good to know that there are opportunities even for people who have not necessarily missed the boat, in terms of you're doing a fellowship right out of residency. So, that's good to know. Does the 10x10 course, is that offer a gateway into achieving a board certification or is that primarily through accomplishing a fellowship?

- The American Board of Preventive Medicine has actually extended the grandfathering period through 2025. What that means is that, if you can prove you have practiced 25% Clinical Informatics for three out of the last five years, you could submit your eligibility to the board and potentially take the board exam and become board-certified in Clinical Informatics up until 2025. I actually did a National Library of Medicine funded biomedical informatics research fellowship. Those fellowship programs are still available for any emergency physician who's interested in biomedical informatics research. It does make you board-eligible and allow you to gain much of the knowledge and really focus more on a research career. If one was not interested in research, one might be more inclined to take the traditional ACGME fellowship pathway. And you don't need a certification to practice Clinical Informatics. Who knows what the future will bring as far as requirements. I can imagine a world where, if one wanted to become a CMIO or chief medical information officer of a hospital, eventually one day board certification may be a prerequisite, but even then, I'm not confident that that will be anytime soon.

- If you Google American Board of Preventive Medicine Clinical Informatics, you'll find out whether or not you can be board-certified.

- There are other certifications. AMIA actually has a Clinical Informatics certification. It's geared more towards non-clinicians, but clinicians can seek that certification.

- It sounds like there's some really great options for people in any stage of their clinical practice and their clinical training. That's great to hear. One additional question, what has been your favorite or most impactful project in Clinical Informatics that you've worked on with your hospital or your ED?

- I love that question. For me personally, the one that I became most invested in was with the opioid epidemic, our ability to combat the opioid epidemic. We went in and looked at all of the presets in the electronic health record. Utilizing some third party analytics software, assessed how people were prescribing opioids. So we went in, we deleted everything, and preset everything to three days, 10 tablet. But we saw significant reduction in prescribing of opioids. Then what we did was, we did it everywhere, and that was what was novel and fun. That got the attention of the leadership of the enterprise who said, "Well, can we do this everywhere and just set everything to a default of three days, 10 tablets?" People didn't think. They just clicked. They didn't care if it was seven days, 40 tablets or three days, 10 tablets. They just needed to get the patient their prescription for their fracture and out the door. It's had a meaningful impact and there's always more we can do. Sorry, my alarm went off. That was a project that with a very simple informatics-driven intervention has led to meaningful outcomes.

- And that's what's so appealing to me with this field, is that you're doing relatively minor changes to something, but it's having implications, not only if you're day-to-day in your emergency department, but also implications on a public health level. That's a really cool project. That's really neat.

- And no popups. No popups, which is another important part of it.

- I would say, for me, the most impactful thing was helping our four hospital system go live. The EHR vendor that we're using said to me, "We've got this new thing we've called order sets, but they're not really designed for the ED. They're for inpatient use." Looked at them and I thought, "I can make these work."

- Very cool. It's amazing, the wide variety of things that you can do.

- The other educational opportunity, if you go to the AMIA website, you look at informatics academic programs. You can do a search on top and all the way down to nine pages of different programs.

- One other thing we should mention is for those that are still in training for emergency medicine residents, there are also opportunities. So, EMRA has an informatics interest group that collaborated with, in the past, part of the ACEP informatics section. They've got some great resources. The EMRA fellowship guide has a list of informatics fellowships. There are a number of informatics fellowships across the country. Quite a few of them sponsored by a department of emergency medicine. If one were to become interested in this field, either during residency or maybe even after, and wanted to pursue fellowship, you don't need to be in a emergency medicine sponsored program. It's sponsored by the American Board of Preventive Medicine. So any specialty with the exception of pathology, who has their own route to informatics certification, can go to any program. But I imagine emergency medicine physicians may be interested in going to one that's sponsored by a department of emergency medicine. So, there are a number of those.

- Good to know. I think those are all the questions that I had. Any other topics that would be helpful to discuss for someone who's interested in the field of Clinical Informatics?

- Join the ACEP informatics section and do a 10x10 course, then see where you want go from there.

- That's my plan. Sounds good.

- My message would just be that there's preconceived notion that emerge that informaticists are just computer scientists. That's not at all true. Your skillset is augmented by interest in computer science, but it's not a requirement. The analogy I like to use is that, and I know some people get frustrated by this, but the emergency physician as the jack of all trades, master of none. It's not true. We're masters of resuscitation. But that being said, we know a little bit about lots of different specialties, right? Well, informatics is kind of the jack of all trades of the physician plus model. You have to know EBM, you have to know a little bit about operations, you have to know research, you have to know view of the overall healthcare system. And so, it's a really great application of the world of healthcare. And you can focus on varying sub context within the specialty, but it's so much more than the label that we generally get as "the IT guy", which is just not true.

- Agreed.

- It sounds like it's a field that really fits well with emergency medicine and gives you the opportunity to use a lot of the skills that you have from a leadership standpoint, to research, evidence-based medicine, and operations, quality improvement, really hits a lot of the things that we are really talented in, really experts at. Thank you very much.

- Aloha. You guys know shaka?

- There's nothing Philly other than "see youse guys later".

- There you go.

- I'm gonna go get some john at Wawa.

- Ryan, you're muted.

- Guess I need to work on my informatics skills.

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