Health informatics: a required skill for 21st century clinicians
BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3043 (Published 12 July 2018) Cite this as: BMJ 2018;362:k3043
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I would suggest that the majority of clinicians are in fact literate in health informatics. However it is Health Informatics Systems that are not literate in health and clinical operations. If an error occurs because the system requires the user to put information in a certain box then that is a system fault not a user fault.
Competing interests: Board member (volunteer) of AIHS (non-profit) which owns and operates the Medical Office Information System (MOIS) electronic medical record
We were involved with the development of sharing records with patients in the early 2000s. Our research has suggested that patient access to records increases patient literacy and increases the time available to doctors.
In the mid 2000s we created a syllabus for doctors to help them to learn about patient access to records and it would be gratifying to see all or some of this syllabus utilised in training students and doctors.
A syllabus for medical students – patients accessing their records
CULTURE, KNOWLEDGE, SKILLS, ATTITUDES, METHODS and ASSESSMENTS
CULTURE
Basic assumptions
Each patient has a vision of what their life should be and they look to others to help them achieve the closest possible match, given various health and other issues. It is a paradigm shift.
Values
Patients and their families and carers are the main resource for living with the consequences of their own diseases.
Norms
“Increasingly, it is patients who are instrumental in providing their own care”, and therefore one task of the clinician is to ensure patients are best equipped to do that efficiently and effectively.
Artefacts
The patient accessed record should, therefore, deal with how best to encourage and enable supported self-care, using the any tools available now and in the future. It should cover working with interactive care plans, information prescriptions, pre-consultation preparation for the patient.
The record should be described as something that is not shared so much as jointly held - a Wiki record where all those involved in achieving the patient's vision contribute to it.
The partnership of trust
Shared responsibilities and disciplines of health and disease management for patients and clinicians
An appropriate audit and review of implementation of care pathways through the health records
Conversations and agreements through the records
Discussions with patients about how their information is recorded and made available to others.
The empowered patient
“power sharing as a skill and a necessity”.
Do as much for themselves as they can
Be able and skilled to ask for help when they need it
To say no to care that they do not need
Competing interests: No competing interests
I agree that Health Informatics is a core skill for 21st century clinicians. It is with exactly this in mind that the new UK Faculty of Clinical Informatics (UK FCI) was recently established under the guidance of the Royal College of Physicians and the Royal College of GPs, on behalf of the Academy of Medical Royal Colleges.
The UK FCI's mission is to become the UK professional membership body for clinical informaticians, with the principal aim of establishing clinical informatics as a recognised and respected profession through the development of professional standards, accreditation and revalidation. This includes health and social care professionals who use their specialist knowledge through data, information and IT to ensure safe, effective and efficient person-centred care.
The Faculty will provide support for clinical informaticians at every stage of their career, providing leadership and promoting the profession. A critical step on the UK FCI's journey will be the development of core competencies and the accreditation of training programmes, to provide a route to membership of the Faculty and a pathway for professional development. The Faculty is hosted by the RCGP and has just recruited its second cohort of fellows.
Email: info@fci.org.uk
Website; https://www.facultyofclinicalinformatics.org.uk/
Competing interests: No competing interests
I whole-heartedly agree that skills in information technology are essential to clinicians. Indeed, the skills that many young clinicians acquire outside of medical school curricula are often ahead of the curve, with programming and computer literacy becoming commonplace. These new skills dovetail with education in evidence-based medicine.
However, our hospitals often lag behind with outdated or ineffective systems. The continuing use of fax machine in the NHS, and the failures of implementation of electronic health records systems in Denmark (Sundhedsplatform) are just two recent examples that spring to mind. Our healthcare systems need informatics skills at every level, including leadership able to understand and evaluate new tools, and involve stakeholders in their implementation. We need a coordinated approach to ensure that technology delivers real improvements to patient care.
Competing interests: No competing interests
Equally important is to have robust governance arrangements in each healthcare organization to ensure that doctors maximize their utilization of IT.
We have read the article of Dr Douglas Fridsma with interest and the recommendations made are highly welcome (1).
All data are not created equally (2). Currently, available health information management systems (HIMS) allow doctors to mainly complete documentation. These systems with time have inevitably become huge reservoirs of data. Unless the right information is analysed and delivered to the right person at the right time these legacy systems remain not fully fit for purpose. Offering clinicians at their disposal: appropriate decision making support in health care settings, proactive differential diagnosis prompts, forecast of emerging diseases, detection of outbreaks, detection of disease prevalence patterns are only a few examples to mention that require more machine intelligence (3,4). Therefore, the scope of these systems at present despite their perceived intelligence is still at its infancy.
Training clinicians to be competent in application based solutions i.e. using the HIMS is always part of the mandatory requirement of any institution using HIMS. This involves training that requires knowledge of data entry. Clinical informatics training as suggested in this editorial may be ideal for all clinicians, however it might not be practical. Clinicians with special interest in IT and who have practical knowledge of informatics, or have experience managing “big data” may be entrusted as being key human resource who can contribute to the advancement of informatics within the institution. Physicians with experience in programming languages C++, Python, or Visual Basic may be aptly placed in developing and managing large clinically relevant databases in their specialities. The idea in informatics is not in knowing how to work on the computer but in making the computer work for you.
Some of the Asian countries have incorporated Informatics practices as a subject along with science subjects as part of their national curricula at High School e.g. Central Board of Secondary Education in India (5), thus keeping them well prepared for the 21st century informatics. It would be encouraging to see future doctors coming out of this system with this skill as part of their repertoire in managing health informatics data (6).There is currently no one stop solution to healthcare informatics as almost all systems manage their databases each running different scripts.
The bottom line is there is ample opportunity for doctors to better utilise the toolkit of informatics to what is in the best interest not only of patient welfare in terms of quality, patient safety and patient experience but also to more cost-effective utilization of healthcare resources (7, 8).when doctors combine their own knowledge with decision support, they can make a better analysis of patient data. A survey of doctors in an NHS Trust has shown that 44% showed no skills in data base software (9).
It would also be helpful if the appraisal process also captures IT capabilities and learning needs of doctors and could be included as part of the quality improvement section within the Medical Appraisal Guide (MAG) toolkit of appraisal (10).Furthermore it could also be included as part of the multi-source feedback (MSF) procedures.
As for the governance framework of the healthcare organisation there is always opportunity to further improve and enhance clinical engagement. There is usually a lead clinician in IT who leads a multi-disciplinary clinical engagement group. Although the group members represent all clinical services but in reality, are the genuine IT clinical needs of each clinical service effectively sought and are they objectively known? It is so crucial that the IT utilisation needs, issues and challenges facing doctors in each clinical speciality are proactively captured, understood and promptly addressed. It is also advised that regular audits of reports produced by the system are continually carried out. This will ensure that correct information was entered in the system.
In the USA, Health Information Technology for Economic and Clinical Health Act (HITECH), was passed in 2009. The legislation mandates that health care providers demonstrate “meaningful use” of health care IT, or face penalties in the form of reduced Medicare payments, beginning in 2014. One of the provisions of the meaningful use guidelines is that hospitals and doctors adopt the use of clinical decision support systems (CDSS).
Intelligent healthcare system is the way forward in technology and Intelligent people trained in clinical informatics allow to design these systems in a way that allow better patient and community healthcare management without compromising patient safety.
1. BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3043 (Published 12 July 2018.
2. AHIMA Work Group. "Defining the Basics of Health Informatics for HIM Professionals"Journal of AHIMA 85, no.9 (September 2014): 60-66.
3. https://www.sciencedaily.com/releases/2015/01/150115122115.htm.
4. Wilson G, Badarudeen S, Godwin A. Real-time validation and presenting cumulative antibiogram using a novel in-house software ABSOFT. Am J Infect Control. 2010 Jun 4. PMID: 20627367 Issue 38/9, 2010
5. https://www.hindustantimes.com/class-of-2018/the-myths-and-realities-of-...
6. https://academic.oup.com/jamia/article/7/6/550/737445
7. https://wolterskluwer.com/company/newsroom/news/health/2015/01/doctors-w...
8. https://www.bmj.com/rapid-response/2011/10/27/more-support-needed-doctor...
9. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1471-1842.2004.00492.x
10. https://www.england.nhs.uk/medical-revalidation/appraisers/mag-mod/.
Competing interests: No competing interests