The American Medical Informatics Association could establish a medical subspecialty in applied clinical informatics in two to three years, thanks in part to a $300,000 Robert Wood Johnson grant that will help lay the foundation for defining the subspecialty and establishing its training requirements.
Helping lead the effort is Benson Munger, an associate professor at the University of Arizona at Tucson's Department of Emergency Medicine, who said it will take about 18 months to develop those documents. After that, American Board of Medical Specialties President and Chief Executive Officer Stephen Miller said the application will be reviewed by a committee on certification, which will pass on its recommendation to the ABMS board of directors, before a final vote by the ABMS Assembly. Miller said the process would probably take nine to 12 months.
According to the AMIA, the certification of an informatics subspecialty will help physicians "maximize the effectiveness of their investment in information technology and in so doing maximize impact on safety, quality, effectiveness and efficiency of care."
Miller said he has had informal talks with AMIA President and CEO Don Detmer and he encouraged AMIA to pursue the certification.
"I think we would welcome their submission when it comes," Miller said. "Information is essential to the practice of scientific medicine, and it should help patient care because it will enhance patient communication."
In the past, a new subspecialty typically would be sponsored by one of the existing 24 medical-specialty boards represented within the ABMS, and both Miller and Munger said internal medicine is perhaps the most likely sponsor for informatics. But Munger also noted that the most recent subspecialty to be established—hospice and palliative medicine, which was approved last October—had 10 sponsors, and he expects informatics to have multiple sponsors as well.
Nevertheless, Munger—who was the executive director of the American Board of Emergency Medicine between 1979 and 1999 and helped get emergency medicine accepted as the ABMS' 23rd specialty—said sponsorship would be the third step in the process, and that the definition and training requirements need to be established first.
"Once that's done, I think the expectation would be to invite all the boards to come and talk about it and see if they're interested in it," Munger said, although he added that one board would play the role of an administrative sponsor. "If 10 boards are interested, there could be 10 different certifications, but they'd all be based on the same training standards. If you want someone to do these things, how would you train them? What is the curriculum? What are the resources and experiences they need."
But again, Munger said, first things first.
"The challenge is that the subspecialty of medical informatics itself really doesn't have a set of core standards that are completely developed," he said. "If you were to go to different people in the field and ask them to define it, you’d probably get a number of different answers. But, once you can define it, you can train someone to do it."
Nursing already has an informatics-related specialty certification, and Munger said looking at their requirements will be a good place to start.
"I think there will be a lot to be gained by looking at that," he said. "Our intent is to include that in the discussion."
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