With this formal acceptance of clinical informatics as a subspecialty, the medical education infrastructure is catching up with the rise of the physician informaticist's role within healthcare organizations. The role was growing rapidly even before the federal government accelerated the use of computers in hospitals and office-based practices with the electronic health records' incentive payment program under the American Recovery and Reinvestment Act of 2009.
Shortliffe said 488 people took the first board exam, which was given at multiple sites across the country in October. The number taking the exam “was at least twice as many as the ABPM expected,” he said. The pass rate of nearly 90%—423 earned the certification—is within the normal range of other board examinations, he said.
Members of this first class (and those likely to follow for the next four years) are experienced physician informaticists who won't have to meet a new two-year fellowship requirement in clinical informatics accredited by the Accreditation Council for Graduate Medical Education.
“Many of the university hospital-based programs are beginning to prepare for fellowships to do this subspecialty training,” said Shortliffe, who is a part-time faculty member at Arizona State University and an adjunct professor of public health in the division of quality and medical informatics at Weill Cornell Medical College, New York. “The effort is to get them started in 12 to 24 months to get a cadre of graduates in the next five years.” Many of these programs include the option for people to get a master's degree, he said.
The National Library of Medicine is funding 18 advanced programs in clinical informatics, though none yet is focused on the ACGME's expectations for an accredited fellowship.
In 2009, when Shortliffe took over leadership at AMIA, he picked up the work of his predecessor, Dr. Don Detmer, who launched the board certification drive in 2005 after a town hall discussion at the AMIA annual meeting about the benefits of a formal informatics training and certification program.
“Eyebrows were raised,” Shortliffe said, when a unique feature of this program was first discussed: that clinical informatics should be a crosscutting subspecialty under multiple medical specialties. But since today's physician informaticists are drawn from the the entire spectrum of the medical profession, “the logic was clear,” Shortliffe said.
Dr. Raymond Aller, director of informatics in the pathology department at the University of Southern California's Keck School of Medicine, is among another group, which earned certification by the American Board of Pathology. The ABP jointly hosted the clinical informatics certification exam with the ABPM, the only other board to do so. The ABP does not publish lists of its diplomates. “This is a subject very near and dear to my heart,” said Aller, who has been an informaticist since medical school in 1974.
Aller was one of five members of a committee appointed by the pathologists' board in 1991 that tried and failed to launch an informatics specialty board exam. “No one nixed the idea,” Aller said. “But when you have to write four or five hundred questions that assess clinical judgment, it's tough, even in a field that's well-defined, like math, but in a field that it's not very well delineated what the body of knowledge is, it's very difficult.”
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