Clinical informatics moves toward certification

The role of medical informatics in healthcare is rapidly expanding, as is the use of information technology itself. What is not moving rapidly—at least to an outside observer—is an already 5-year-old effort by institutional medicine that has perhaps another three years to go before creating a program of subspecialty board certification in clinical informatics.

To insider Don Detmer, however, what would appear to some as a glacial pace is actually “moving amazingly fast, as far as these things go” given that medical boards and medical education organizations “move very, very slowly.”

A recent eight-page article, “Clinical informatics board certification: History, current status, and predicted impact on the clinical workforce,” which appears in the online journal, Applied Clinical Informatics, gives an update on the effort. Detmer, the past president and former CEO of the American Medical Informatics Association, is its lead author.

If all goes well, according to Detmer's estimates, final approval of the clinical informatics subspecialty initiative could come from American Board of Medical Specialties as soon as this fall with development of the initial certification examination to be completed by the summer of 2012 at the earliest and by that fall at the latest. The first exams might be administered by the fall of 2012 and the first subspecialty certificates issued in January 2013, again, by Detmer's estimates.

The training programs for the required fellowship in clinical informatics will be accredited by the Accreditation Council for Graduate Medical Education.

For the first five years of the program, however, experienced medical informaticists could be grandfathered out of the training requirements, but would have to apply for, sit and pass the exam to receive certification in their clinical informatics subspecialty. After five years, the training and testing components would apply to everyone, Detmer said.

There are 24 medical specialty boards overseeing as many primary medical specialties and 121 medical subspecialties. The American Board of Preventive Medicine agreed last summer to become the home medical specialty board for the clinical informatics subspecialty, with AMIA serving as its designated adviser. Under the program envisioned by AMIA, each of the 24 primary medical specialties should be able to create a clinical informatics subspecialty.

The ABPM is going to sponsor it and manage it for all the boards, but there will be collaborative and cooperative agreements between that board and all the other boards, Detmer said. Surgeons, for example, will be issued a subspecialty by the American Board of Surgery, not the ABPM, he said.

“Almost every single board is interested in making sure that their people will be able to be certified if they underwent training and sat for the exam,” he said.

Details of the training programs have yet to be worked out, but Detmer said he envisions a curriculum with a subject matter core that would be universal across all training programs and informatics elements specific to the subspecialty.

There are a number of reference marks in the history of medial informatics for the ongoing clinical subspecialty effort, but Detmer, now a senior adviser to the AMIA, wrote in the article that a launching point was the goal set by then-President George W. Bush in 2004 that most Americans would have access to an electronic health record in a decade.

Detmer observed that the informatics community quickly recognized “that the U.S. healthcare system was sorely lacking the informatics savvy workforce sufficient in number and knowledge to accomplish this goal.”

The article said these growing workforce demands “dictated that it was time for clinical informatics to evolve from an avocational or part-time activity of self-identified informaticians to a fully professional career track with training, standards, codes of ethics and certification.”

Work by AMIA toward a board certification program in clinical informatics can be traced back to a town hall discussion at the AMIA annual meeting in 2005, when a group conclusion was reached that social benefits could be derived from formal training and certification, according to history of the effort in an earlier article by Detmer that appeared in the AMIA journal.

The AMIA board began hunting for funding for the program and in 2007 obtained a grant from the Robert Wood Johnson Foundation to develop guidelines on core content and training program requirements, which were subsequently drafted and approved by the AMIA board in late 2008.

William Hersh is a physician, professor and chairman of the Department of Medical Informatics and Clinical Epidemiology in the School of Medicine at Oregon Health & Science University, which has a certificate program in clinical informatics with about 200 enrollees and a full master's degree program in clinical informatics with typically 30 to 40 enrollees.

While a formal degree in medical informatics is “still not an absolute requirement” for placement in positions in clinical informatics—Hersh volunteers he does not have one—and experience remains the most common passport in the informatics field, “there is no question that interest is increasing, that more and more hospitals are interested in hiring people like this.”

Hersh said medical college informatics programs should have little difficulty in adapting to the formal educational requirements of the new clinical informatics subspecialties.

In his keynote speech last week to the Healthcare Information and Management Systems Society convention in Atlanta, David Blumenthal, head of the Office of the National Coordinator for Health IT at HHS, talked about federal funds under the American Recovery and Reinvestment Act of 2009, also known as the stimulus law, going toward health IT workforce development. Much of the money will be used to train 40,000 or more health IT workers through community college certificate programs, “but we are also training at a higher level as well.”

That includes $32 million in grants “to establish university-based certificate and advanced degree health IT training programs and $6 million dollars to develop a health IT competency examination program.”

What do you think? Write us with your comments at [email protected]. Please include your name, title and hometown.