Clinical Informatics for Emergency Physicians - Part 2

Getting Involved in Clinical Informatics

A patient’s blood culture turns positive the day after discharge from the emergency department (ED). A laboratory technologist calls the ED to report the critical result, but waits on hold until a clinician is free to take the call. Afterwards, this clinician, who never saw the patient during their original ED visit, has to review what was done and contact the patient while continuing to care for new arrivals.

This is a common approach to managing critical results, but it comes with many points of failure and delay which can be improved through the electronic health record (EHR). For example, an automated workflow can route the result directly to a designated follow-up clinician and notify the patient through the portal. The clinician can review the chart and reach the patient by secure message and/or phone. The automation allows the EHR to automatically document that the follow-up happened, making it easier to collect data on the outcomes for this workflow, and spares lab and ED staff the manual labor it takes to find someone to call the patient to follow-up.

Informatics in Quality, Research, and Operations

Designing the automated alert routing is only one step in improving this clinical workflow. The hospital’s lab and ED have to agree on how the new workflow will work, coordinate the cut-over to the new workflow, and decide on what measures indicate a successful go-live. For example, a randomized trial at MGH found that automated alerts shortened the time from critical result identification to treatment in hospitalized patients.¹

Designing and evaluating workflows like this is the bread and butter of an informaticist, but also dovetails with the work performed by quality and patient safety, research, and operations. Careers in clinical informatics can start in one of these domains and migrate over to informatics, and vice versa as well. If you already work with your department’s quality, research, or admin groups, you have a starting point for a career in informatics.

Training in Clinical Informatics

For those exploring how clinical informatics can fit into their career, there are various training opportunities that range from virtual coursework to a full-time fellowship.

The American Medical Informatics Association (AMIA) offers a structured introduction through its 10x10 program. The course covers topics including artificial intelligence, clinical decision support, and interoperability. It combines online lectures, readings, discussion, and self-assessment with a session at an AMIA meeting. It costs $2000 for AMIA members, and $2400 for non-members.²

Most EHR vendors offer builder training that teaches clinicians to configure tools and use their EHR’s analytics features. Initial training can be expensive, but some health systems cover the cost so they can have trained physician builders work with analysts and clinical leaders to improve and maintain workflows.³

Epic offers a four-part Physician Builder curriculum online and at its training center in Verona, Wisconsin. After completing the core courses, eligible builders can take additional courses without a course fee.⁴

Clinical Informatics Fellowship

If you want to make informatics a larger part of your career, fellowship offers protected time to take on projects across departments and care settings, as well as training like the options above. Fellowship-trained physicians are also able to sit for the clinical informatics board exam, which is now the only way to become board certified in the specialty.⁵

Eligibility and Structure

Clinical Informatics fellowship is accredited by the Accreditation Council for Graduate Medical Education (ACGME), making it a two year commitment.⁶ The majority of time is protected for projects and training; most programs set aside around 20% clinical time for fellows to practice in their primary specialty.

Clinical Informatics is a non-clinical fellowship, and so most programs accept applicants from a range of specialties.⁵ Emergency medicine applicants can be competitive applicants, since shift work makes it easy to schedule a low number of clinical shifts, sometimes on evenings, weekends, or overnights, leaving room for informatics work during normal business hours.

Fellowships based at a freestanding children’s hospital are the exception, as they usually do not staff general emergency medicine (GEM) physicians. However, pediatric emergency medicine (PEM) physicians will be more competitive, and GEM physicians open to a dual PEM-clinical informatics fellowship experience may be accepted at these programs.⁷

Curriculum

Many fellowships use block rotations to give fellows experience in ambulatory, inpatient, and emergency medicine contexts. Each setting has its own workflows, usually curated by their own analyst and clinical informatics teams. Programs may also offer dedicated blocks in clinical decision support and analytics, and will also provide plenty of elective time to work on longitudinal projects.⁵

Some rotations also bring fellows into contact with vendors and industry partners. On an interoperability project, a fellow might help develop data pipelines for an outside application, or they may pilot an AI product by working with early adopters to identify use cases, ensure safety, and monitor update after launch.

Graduate coursework is often included, and can count toward an MS or MPH. Some programs cover full tuition for a master’s. Fellowships also usually sponsor EHR builder training.⁸

From Fellowship to Board Certification

Fellowship graduates can take the Clinical Informatics board exam through the American Board of Preventive Medicine (ABPM).⁹ Physicians used to be able to take the board exam through the practice pathway, but this option is no longer available.^10,11 Now, only fellowship graduates can sit for the board exams. Board certification is increasingly sought after for informatics job positions, such as department informatics director or hospital clinical informatics leadership positions. For those interested in making clinical informatics a major aspect of their career, pursuing fellowship is a compelling route forward.

Applicants apply through the Electronic Residency Application Service (ERAS) and register separately for the AMIA Clinical Informatics Fellowship Match, since AMIA runs its match independently of the National Resident Matching Program (NRMP).¹² AMIA’s prospective-applicant guide explains the fellowship pathway. Its academic directory lets applicants find program websites and filter by fellowship type and ACGME accreditation.^5,13

Bibliography

1. Kuperman GJ, Teich JM, Tanasijevic MJ, et al. Improving response to critical laboratory results with automation: results of a randomized controlled trial. J Am Med Inform Assoc. 1999;6(6):512-522. doi:10.1136/jamia.1999.0060512
2. American Medical Informatics Association. AMIA 10x10: introduction to biomedical informatics and artificial intelligence. Accessed November 7, 2026. https://amia.org/education-events/10x10-virtual-courses/introduction-biomedical-informatics-ai
3. Liang WH, Hoffman JM, McNeely L, Proctor S, Orenstein EW. Toward a provider builder maturity model to empower clinicians to actively participate in electronic health record design. Appl Clin Inform. 2025;16(2):418-428. doi:10.1055/a-2512-9647
4. Epic Systems Corporation. Epic Training. Accessed November 7, 2026. https://training.epic.com/
5. American Medical Informatics Association. Applying to a clinical informatics fellowship. Accessed November 7, 2026. https://amia.org/careers-certifications-informatics/clinical-informatics-subspecialty/clinical-informatics-fellowship/prospective-applicants
6. Accreditation Council for Graduate Medical Education. ACGME program requirements for graduate medical education in clinical informatics. Accessed November 7, 2026. https://www.acgme.org/globalassets/pfassets/programrequirements/2026-prs/381_clinicalinformatics_2026.pdf
7. American Medical Informatics Association. Eligibility considerations for clinical informatics fellowship. Accessed November 7, 2026. https://amia.org/membership/academic-forum/amia-clinical-informatics-fellowship-match/eligibility-considerations
8. Chamala S, Keefer MS, McGuire T, et al. Achieving ACGME clinical informatics fellowship accreditation: a chronicle of our institution’s journey. Appl Clin Inform. 2025;16(4):1171-1183. doi:10.1055/a-2680-5920
9. American Board of Preventive Medicine. Clinical informatics. Accessed November 7, 2026. https://www.theabpm.org/become-certified/subspecialties/clinical-informatics/
10. American Board of Preventive Medicine. Clinical informatics certification. Accessed November 7, 2026. https://support.theabpm.org/hc/en-us/articles/27803816644763-Clinical-Informatics-Certification
11. American Board of Preventive Medicine. Additional requirements for subspecialty certificates. Accessed November 7, 2026. https://www.theabpm.org/about-us/additional-requirements-for-subspecialty-certificates/
12. American Medical Informatics Association. AMIA clinical informatics fellowship match. Accessed November 7, 2026. https://amia.org/membership/academic-forum/amia-clinical-informatics-fellowship-match
13. American Medical Informatics Association. Informatics academic programs. Accessed November 7, 2026. https://amia.org/careers-certifications-informatics/informatics-academic-programs

About the author
Gregory Han is a PGY-4 emergency medicine resident at New York-Presbyterian Hospital (Cornell and Columbia) and a rising Clinical Informatics fellow at NYU. His research and career interests are in EHR usability, quality improvement, and health equity. Prior to residency, he completed medical school at Weill Cornell Medical College.