Clinical informatics: Medicine’s oldest new frontier

tablet stethoscope clinical informatics
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Clinical Informatics has been around for over forty years, though it remains a relatively new concept to most clinicians. But it touches nearly everything we do as medical providers each day.

As a field, clinical informatics aims to harness the power of information technology for the betterment of patient care through innovative care delivery systems. And by nature a multi-disciplinary practice, it affects all areas of patient care. For instance, electronic health records (EHRs) allow providers to communicate patient information seamlessly between outpatient clinics, emergency departments, the peri-operative space and the inpatient floors.

While the EHR may be the most recognized example of clinical informatics in action in today’s world, health information technology (HIT) is present everywhere you look in the healthcare system. For example:

  • Bed management systems allow hospitals to manage their patient census.
  • Radio frequency identification (RFID) help track patients, providers and equipment.
  • Electronic portals give patients instant access to their medical records.

How did we get here?

While HIT was heralded in the early 21st century as part of the solution to the quality chasm, change has come slowly and with both good and not-so-good results. In 2009, the U.S. government made efforts to stimulate adoption of EHR’s by including the Health Information Technology for Economic and Clinical Health (HITECH) Act in the stimulus bill. This legislation prompted creation of the Centers for Medicare & Medicaid Services Meaningful Use incentive program.

The Affordable Care Act upped the ante even further. With the advent of quality-based payment systems such as accountable care organizations, clinicians and hospitals are more reliant than ever on systems that can measure quality and compliance across care venues and their clinical information systems.

All is not lost

It would be dishonest to say that the road to EHR adoption hasn’t been bumpy. According to two recent surveys, two-thirds of physicians are not satisfied with their EHR; many list the EHR as a major impediment to job satisfaction. These are depressing statistics given the enormous investments of time and money that have been made in HIT in the last five to ten years.

Also, while meaningful use greatly accelerated the adoption of EHRs across the U.S., the promise of improved care and care processes for many patients, doctors and the health system still remains elusive. And some fear that increasing external regulatory forces are stifling innovation where it is badly needed.

As demand for HIT systems has grown, the need (and demand) for clinical informaticians has skyrocketed.

But the truth is that we’ve come a long way. Over the last decade I’ve witnessed the transformation from a healthcare system completely reliant on paper to one that is almost entirely electronic. Illegible prescriptions with frequent errors have been replaced by computerized versions with decision support to help you pick the right dose. Chicken scratch clinic notes have been replaced with electronic notes available instantly to all of a patient’s clinicians and even, in some cases, the patients themselves.

Where do we go from here?

So where does this leave the front line physicians?  Well, take solace in the fact that most data suggest HIT implementations are positively affecting patient care. Much of physicians’ dissatisfaction revolves around clunky user interfaces, poor interoperability and limited understanding of how these systems are positively affecting change. These are problems that should improve over time, just as they have in other technology sectors (think cell phones). As Boston Children’s Hospital chief medical information officer Marvin Harper, MD, says, “Twenty years ago we were trying to figure out how to implement the lab systems. Now we take those for granted and worry about a whole new set of problems.”

Meanwhile, FHIR (pronounced “fire”), a new standard for sharing healthcare information electronically, may vastly improve the exchange of data between healthcare systems. That means that Grandma’s primary care doctor, cardiologist and neurologist may finally all know what each other is up to. Moreover, with patient engagement a major focus of Meaningful Use stage 2 and beyond and the arrival of new mobile EHR platforms (which will help reduce the barriers between patient and clinician), Grandma herself may be able to find out what’s going on with her medical care, too.

Clinical informatics word cloud

In the land of data, the informatician is king!

As demand for HIT systems has grown, the need (and demand) for clinical informaticians has skyrocketed. Recognizing this need, the American Board of Medical Specialties approved clinical informatics as an official medical subspecialty in 2011. Two years later the first board exam was administered through the American boards of preventive medicine and pathology. Since then, nearly 800 physicians have been boarded; another crop will take the exam this month.

There are now more than 10 ACGME-approved fellowships in clinical informatics across the country—with more to come. Any physician who is boarded in a primary specialty can become a clinical informatics fellow. Graduates of these programs use their expertise to help implement and improve EHRs and other clinical information systems, while helping their colleagues use these systems to their fullest potential. They may also go into industry, where they can bring hands on clinical experience to help design new products to further improve patient care.

As we move forward, clinical informaticians must lead the way by engaging other clinicians, vendors and policy makers. We must help our practices and organizations implement and optimize clinical information systems so they become more than just a glorified paper chart, but rather part of a learning healthcare system. Only then will we—and our patients—reap the rewards of our HIT investments.

Jonathan Hron clinical informaticsJonathan Hron, MD, is the director of the Boston Children’s Hospital Clinical Informatics Fellowship and an instructor in pediatrics at Harvard Medical School.

 

 

 

 

 

Boston Children’s Hospital is currently accepting applications for its new clinical informatics fellowship; the deadline for applying is October 31, 2015.

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