“OHSU Informatics: State of the Program”

okay why don't we get started thank you everyone is as most of you know I usually introduce the speaker so i will introduce the speaker which happens to be me even though I'm the speaker even though I'm the department here I'm always worried if everyone's going to if anyone's going to show up so I appreciate you coming to listen to me so as all of you who have been here know that during the academic year we have our weekly conference on Thursdays and sometimes for one reason or another we may not have it other times it may get moved like for example we have another speaker coming tomorrow because Friday's the day that he happens to be available so sometimes people come at different times but we do try to have this conference each week and sometimes we designate the conference as an IDL talk and informatics discovery lab which I'll talk briefly about X I guess starting next year these occasional meetings of these conferences will be our clinical informatics grand rounds but they'll all be open to everyone and will encourage people to come as the fellows and faculty know we expect attendance at these conferences and we do though stream them so there is some number of people out there listening and the streaming is mainly for people who who can't be on campus so people who are our distance learning students or other people either locally around portland or beyond can come to can can still take part in our conference we have a hashtag d mice come that people can tweet in questions at us and so we usually designate a recipient so I think Deb is either on her phone or computer and actually have my phone here on Twitter if all else fails so I thought and I've done this intermittently over time but I thought maybe be good to to do it at the beginning of each year to give an overview of where I see the field going and the program going it's it's just well it's not opinion I actually try to cite things but it's just my view of where things are and I will try to leave a little time for QA people want to add things embellish things disagree with me then well happy to have you happy to have that so I guess by way of introduction most of you know me on my bill Hirsch I'm the head of the department I can actually now add another to my two long list of designations a diplomat in clinical informatics from the American Board of preventive medicine and I'll talk a little bit about the just a very little bit because it's only a small part of the larger informatics universe about the new sub specialty for physicians as always my slides are in a PDF with all my references cited on my website and as you know I I like to blog and take advantage of other social media so the agenda for today is to give kind of an update overview of the state of the field to launch the conference series as I've already mentioned about attendance expectations we also have a vanity URL so there's no longer that long URL that to get to the streaming so we'll we'll find out the statistics afterwards how many people are actually listening and people should tweet with the hashtag that can also tweet to our main Twitter account okay so what about the state of the field well I really honestly believe that the field has really changed tremendously in the last five years or so there's been a number of things not the least of which has been the HITECH Act but informatics really is different now than it was I was talking to someone yesterday I've actually worked in this building now for 24 years or twenty three years I've been here for 24 years and actually in a couple years I saw Chris out there we're going to be celebrating our 25-year anniversary of the building but really there have been some profound events in informatics that have really changed things probably most significant just maybe in terms of the sheer number of dollars has been the HITECH Act the 30 billion dollar investment in electronic health records but it's not limited the clinical informatics the continued accuracy and reduced cost of sequencing and probably even more important that translation into clinical medicine of the CTSA program the clinical and translational science reward program which has really galvanized the area of clinical research informatics the patient-centered outcomes Institute or P Cory that is funded actually by Obamacare and it's providing hundreds of millions of dollars of investment including these new clinical data research networks and there's new developments in the offing will I can share a little news although were were semi embargoed from NIH talking about the big data to knowledge program of which we've been awarded some grants and also other work going on for example on bringing informatics to clinicians and clinical education so you all know some of many of you've seen this slide or variants of this slide in in 2009 when the American Recovery and Reinvestment Act was introduced there was the part of it that put up to 27 billion or really about 30 billion dollars for adoption of electronic health records including the awarding of grants and a two billion dollar investment including 118 million for Workforce 5.8 million of which came to this department and those were the those were the golden days a few years ago but that that that money's all gone although we've managed to continue on since then and it's had a significant impact most hospitals now ninety-four percent have an electronic health record although not all of them use it as with as much functionality as they could over three quarters of us physicians use electronic health records I those of you who have taken five ten have seen the other graphs about how much the u.s. is a laggard but the u.s. is actually catching up now in just in terms of adoption and this provides other opportunities that many of us are interested in myself included it various secondary use of clinical data whether it's personal health records quality measurement predictive analytics clinical and translational research public health surveillance ultimately supporting this notion of the learning health system unlike many other industries in healthcare we we don't do a good job of learning from what we do and part of the reason why we historically haven't done that well because we wrote things down on paper and never saw it again other than maybe when the patient came back but we have opportunities for these things though there's lots of challenges there's also a growing evidence base there's you know controversy about what evidence supports the value of health information technology there's various listservs that Amy runs that have debates about this topic but if you look at the scientific evidence base for the efficacy of health information technology whether you look at it by category of what the health IT is starting trying to do or even break it into the meaningful use criteria there is evidence that supports health information technology the problem the problem is that it's been challenging translating that efficacy into effectiveness efficacy being the evaluation of something in very controlled situations effectiveness being you know putting it out there for the world to try and so there's a lot of challenges and we heard earlier this week from dr. Robert wah the president of the AMA who pointed to this report that was commissioned by the AMA last year they looked at things causing dissatisfaction and in the work of physicians and EHRs electronic health records was right up there at the top there was also a study in a magazine medical economics that surveyed physicians about electronic health records and complaints about their poor functionality their high costs all of the emphasis on meaningful use meeting those criteria so they could get the incentive funding and there was just a study a few weeks ago it was by Clem McDonald some of you know it was unfortunately it was sexy a full study and jama made them compress it down to a research letter so they had to leave a lot of things out but basically they asked the large number of internal medicine physicians various questions about electronic health records and the the soundbite that came out of it is that sixty percent of them reported electronic health records increasing their time now you could put a more positive spin on that say well for forty percent of them actually something like twenty three percent said actually save them time others were neutral but clearly there are aspects of electronic health records especially when they're not implemented properly that do slow people down and impede their workflow there's also concerns about safety I they're important and we can't sweep them under the rug although we also have to remember all the other issues about safety in healthcare safety related to paper records and the fact that records get lost errors get made and there's no chance with things like clinical decision support to fix them and this has led to the safer guides that Joan and others in the field have produced to help lead to say poor implementation and there's also the concern about the lack of adherence we have all these electronic health records but they don't talk to each other there are standards to do that there are interoperability standards there was a report by this group called Jason which is this group of scientists that the government Commission's to do various reports lamenting that we haven't achieved the the promise of electronic health records in part because we have not enforced standards as well as we could and I wrote in my blog a few weeks ago pointing to a couple examples of situations i've been in we're essentially people spend a lot of time and effort unscrambling eggs when you take for example a laboratory report pull it out of a database print it in a document print that document on a piece of paper and turn it into a scanned PDF and then actually talking about hiring someone to OCR that PDF back to the data you know back to the discrete data elements which to me I think probably most of you is seems like a waste of money anyway so we still even though we've had widespread adoption there's still a lot of challenges that we face meanwhile there has also been lots of advances in genomics bioinformatics all the related areas dr. wah from the AMA also showed this slide which shows how the cost of sequencing genomes has come down faster than Moore's Law for a while it was adhering to Moore's law and now it's been even faster although it's tapered off a little bit and who knows whether that's a trend or not but aiming for this thousand-dollar genome goal and many believe that once we reach that thousand dollar goal that it will be something that we can do on ordinary people and I think for those of us who work in medical centers the real excitement about gene sequencing and uncovering genomic variants and identifying phenotypes associated with them is the ability to actually use that information in an actionable way Shannon mcqueeney always talks about the importance of genomic information being actionable and probably the project that has done the most with this some of you are familiar with the emerge project that the E&M stand for electronic medical records and this paper was published recently that listed out all of the areas where finding from the emerge project has actually led to some clinically actionable information some of them are being implemented in clinical decision support rules and electronic health records their table lists about can't remember the number 80 or so of these genomic markers that in various diseases and conditions and so forth so we're actually reaching the point where the genomics bioinformatics is is really translating into clinical medicine and I think that that's and exciting advance this also raises a lot of issues for electronic health records dan Macy's who has been here from time to time some of you know him has talked about what we're going to need to do to electronic health records when we have this genomic information in actionable formats how much of it goes into the medical record itself how much of it goes into other systems what do we do when even if the the genome is static when we learn something about a new variant that's associated with a disease or with the response to treatment will you know how do we update the medical record how do we maybe get that information to the clinician I there's there's a lot of unsolved issues but those unsolved issues are potentially interesting research projects for people to take on and another person who's written about this some of you know Justin star in talking about again what do we put in the electronic health record what goes into these ancillary systems and how they interact with each other and that's a ripe area especially for programs that are strong in both clinical informatics and bioinformatics just some of the other drivers that we've seen in of informatics it's older than five years it's actually more like about eight or nine years old now but the CTSA program clinical and translational science award which are awards to 60 or so academic medical centers including ohsu in fact we were actually funded in the very first round and this it's been clear from the get-go xai should have put this in my slide but the original RFA request for applications use the word informatics something like 30 times informatics is a very important component of the CTSA program until recently actually I served as director of our informatics program within CTSA were ohs us in the process of hiring a chief research informatics officer who will assume that role in Rob shop in the interim is filling that role but that one thing that the CTSA program has done is facilitated these clinical data repositories this paper by McKenzie who actually works for one of our former graduates Peter at u-dub anyways many institutions now are pulling data out of their electronic health record into these data repositories some data more than others things like problem list demographics it's like ninety-five percent down to things like orders is more like twenty percent but most research oriented medical centers are creating these big data repositories data warehouses that provide opportunities for research and other things related informatics and really the CTSA program has galvanized this whole area of clinical research informatics many a number of faculty myself Judy Logan others who have been involved in clinical research informatics i mentioned p corey at the beginning this is another opportunity they've had a lot of focus on on methods and one of the big activities of P Corey are these clinical research data networks that were rolled out in in different places around the country there is one in Oregon some of you might be familiar with ocean and they're collaborating with others and so these clinical research data networks or CDR ends will start to collect large amounts of information on large numbers of people large amounts of data and then there's new opportunities coming down the pike big data which depending on the day i think is hype or is really important but I think this whole related area and unfortunately just like with informatics with all of our different labels of informatics you know clinical medical bio etc this field has this as well because some people talk about data analytics data science they're they're all interrelated but I i I'm not the only person others noted i remember a couple years ago when people started asking me well what are the opportunities going to be in clinical informatics when we're done implementing electronic health records are there going to be any jobs left to do and i said actually that's when the interesting work is going to start will actually be able to do interesting things with this data actually improve health care improve people's health and so forth many people have thought about clinical data I with some colleagues a couple years ago wrote or last year wrote some papers about some of the caveats and the opportunities and NIH has recognized this area as well and we have been awarded so i can say that in public but nih just doesn't yet want us to say a real lot there next week they're going to announce the whole bd2k program the funding of the big centers but we were awarded a couple grants that one is on development of open educational materials somewhat similar some of you are familiar with the project one of the big projects we had with the hitech act with the development of the health IT curriculum in fact our grant actually proposed to use that exact same format to in essence add big data materials to the ONC health IT curriculum so we've been funded to do that and then also myself but David door Melissa handle Shannon also funded to develop a skills course that I'm sure will be of interest to too many of you so you'll hear more about that going forward and importantly informatics takes p ball and there have been tremendous opportunities and I'm confident that there will continue to be there does not appear to be any abatement in the growth and this is actually an area of interest because I started asking around 2005-2006 as our educational programs were going what are the needs and there no one had documented anything and that led sometimes your studies that get cited the most and get the most attention are not what you would consider to be your best science i did this relatively simple analysis of but finding as you go to the higher hymns stage of adoption that there's actually more need for health IT professionals and we actually estimated 41,000 would be needed as we started implementing things like clinical decision support and computerized provider order entry I think I can actually say with a straight face that this had some influence of that little section 30 16 of the HITECH Act that put money into health IT workforce development in fact senator Wyden Ron Wyden from Oregon and his staff were instrumental in adding that part to the bill and I had a few phone conversations and that's the only place in the entire hitech act where the word informatics occurs so I think we were success but the and the interesting thing is that we actually were wrong we underestimated I'll show you on the next slide the it's actually more like about 60,000 that the growth of jobs in health IT and these are well-paying jobs there was just a report that came out from this website health IT jobs com and if you look at the different types of jobs and the salaries that they pay one can make a good living doing informatics and and that's important for us you guys are spending your your time and some of you your money in our educational program and we hope that will be a good investment and I think the data points in that direction and in fact there XE are still shortages there was a well sited study from chime and organization of healthcare CIOs in 2012 that said 71 percent had staff shortages that could jeopardize a project and fifty-eight percent said that that would affect their ability to meet the meaningful use criteria and qualify for those incentive dollars and hims has continued to do these work for surveys and pretty much the same kind of picture many organizations are planning to hire and they're concerned about shortages and not only healthcare organizations but also vendors most of this is in clinical informatics but in i think in other areas of informatics too we've seen no lack of interest in people who want to hire including hiring our graduates so this is the figure i like to show that it would be nice if this were updated because it only goes to 2011 but between when i published my study and 2011 and i don't really know how to explain that little dip but the point is that i feel good to say that we underestimated the number of people who would be hired into health IT jobs just a few comments about the physician sub-specialty about thirty percent of our students are physicians so and I'm one myself so it it's an important area most of you know the story it started in 2009 when a mia put forth a proposal to the American Board of Medical Specialties calling for a sub-specialty of all medical specialties some might have hoped that it would just become its own specialty but that that's a really politically difficult thing to do but in any case some a mia put forth our curriculum training requirements and in 2011 it was approved there are many different specialty boards the American Board of preventive med step forward and said will be the home administrative home for this but again it's a specialty of it's a sub specialty of all specialties last year the first certification exam was awkward I'll talk about the qualifications in the next slide and ninety-one percent of people past including a couple of us in this room and can now say that were board-certified I probably would have been embarrassed if I had not passed the test but I actually can say that a at their of these 455 about 40 of them are either graduates or current students in our program and actually I feel good about this several that Maxie scored higher than I did so they did well and we prepared them well and then this year when you start moving into this medical specialty sub specialty kind of model you start getting into all of the ways that medical training is done which is different from graduate school and we're sort of used to more of a graduate school model but the Accreditation Council for graduate medical education released its rules and actually we found out just last week that we're now the third program in the country to receive initial accreditation and we'll be starting i'll mention that a little bit and the slide after this but just a few details about the sub specialty typically when there's a new medical specialty or sub specialty there's already people that have been practicing in that area and so there's this grandfathering period where you don't have to do formal training if you do enough practice so if you practice informatics 25% time within the last five years or do what they call a non-traditional fellowship which in our case means something like an NLM fellowship or VA you or it turns out as we found out they were accepting of having a masters and you are board certified in a primary specialty then you can become board eligible so that's how those of us who took the test last year weibull to pass it now this it's good I think for those of us in in the field who are positions that there's this pathway but it actually creates challenges things because it's a sub-specialty of these different specialties that there's a paper by Don detmer who some of you know in JAMA earlier this year just about some of the fragmentation issues also the funding issues the typical approach as as most of you know when one is a resident or a fellow in a clinical setting is that you get paid in part because you're contributing to the clinical mission and you could certainly argue that clinical informatics fellows are contributing to the clinical mission I mean hopefully our fellows will be contributing to ohs use mission but they don't do things you can build for like an internal medicine physician who sees patients in the clinic or in the hospital or a surgeon who does procedures so there's all kind and then also clinical all clinical training is more around these rotations rather than courses and so I've coined the term which has gotten a little cash a about fitting square pegs into round holes another issue is that by requiring a two year full-time fellowship for these physicians is that we may choke off career paths because many physicians pursue informatics axially many healthcare people not not just physicians and informatics pursue gravitate into informatics over the course of their career and so by saying that now you have to do a two-year on the ground fellowship it's difficult to do that if you're you know 45 years old and have a job and a family and so forth which our distance learning program actually been a nice alternative for so i think i think there's there there's going to have to be some adjustment of this along the way fortunately ohsu hospital and clinics has stepped up and agreed to fund the fellows the initial fellows and also some from the VA will they maintain that commitment there is some requirement for actually maintaining their practice but CMS which is which funds a lot of fellowships has all these rules about what fellows can do fellows actually can't bill although they can work in the clinic and see patients and the attending physician can bill and then of course we spend so much time talking about these the fellowship model stuff like that and of course informatics is not only for physicians and in fact a Mia is exploring certification brothers and what that's going to look like if you actually look at the clinical informatics content outline that was published it was published in Jamie in 2009 and went in with the American Board of Medical Specialties proposal there's really not much that's specific to positions it's actually just a nice outline of all the topics in clinical informatics actually joan joan was a little bit involved in that so it has a good stuff on people and organizational issues in fact the board exam actually used the unintended consequences a few times so reflecting jones impact on the field anyways it'll be interesting to see what happens with with all this when we look at starting to certify other people in clinical informatics or even other areas of informatics it's probably going to get messy okay so that's just my kind of high-level overview state of the field I know I didn't cover everything and I probably focused in in some areas more than others but I only have an hour to do this whole talk and I want to leave time question so let me just make a few comments about the state of the program which i think is very good running academic programs is never not challenging pardon the double negative but you know with budgets and and NIH grant funding leveling off and actually all of the interest in informatics has spawned a lot of competitors who have seen how successful we've been and other programs have been in informatics and they're now trying to emulate us and so but our research programs are doing well are were undertaking other new innovations such as the informatics discovery lab which most you know about and I'll make a few comments about and our educational programs are doing well we had that large infusion of money from the HITECH Act which are vastly increased our number of students mostly in the distance program but because it was stimulus money that money ended and we kind of come back down to pretty much where we were before our existing tracks are doing well our new programs are developing and also something that is of interest it's being led by the physician side of the field but again it's not really limited to physicians is being involved in informatics education for clinicians and others so I apologize to the faculty if your name isn't on this list but I always keep a slide of all of our research expertise it's basically the whole field and I try to put names but anyways just all of the different areas where we have expertise I mean we are certainly one of the broadest fields in informatics and even put in the clinical epidemiology folks as well so this is I'm not going to go through all this but we have a lot of expertise around here which is great for students who are looking for projects and I think it's something we should be proud of so i'm gonna i'm going to toot our horn and maybe my horn a little bit here but some of you know Alison McCoy who works with Dean siddig someone for a different field had developed a way of going through google scholar and identifying all the people in a field and what their h-index is and for those of you who've never taken my information retrieval course where you would learn what h-index was it's basically a measure of how many citations to your work how many of your how many of your papers have been cited that many times and so we we're on the all-star list here of all these people and I need to get convinced the rest of some of the other faculty to get on this list but and over time the younger folks will percolate up the h-index does kind of correlate with years in the field so that's why I Joan and I our highest but but even youngsters i noticed that julie managed to get herself but that's a great start you know i'm confident your number will grow and one of my projects for this year is to get everyone to create a google scholar profile so you'll end up on this list somewhere so if you and if you look through the list there's plenty of ohsu representation most of the other programs that we know well are there also i myself have been involved in some new projects and my new collaborator a new adjunct faculty member steven woo is is here also who brings expertise and a connection to the Mayo Clinic or text processing work and I like to lump this project in with all of our recent Big Data funding we're actually going to be creating a corpus of a hundred thousand patient records five million actual records or documents of and then apply it to one specific task though certainly there is opportunities to apply to other tasks but apply to a specific task of cohort identification identifying people who are potential candidates for clinical studies and and some of you I've talked here before about the trek medical records track it's a it's an extension of that but to me this is exciting not only because it's a new grant a new project but and also for the first time gets us working with large amounts of data and and all the issues because this is data with the pH I with protected health information so it needs to be kept very secure and needs IRB approval for everything in anything you do with it but but this is exciting to probably Erin will talk more about the informatics discovery lab in another talk but this is a really important initiative for the program for variety of reasons and it's not being driven solely by economics but certainly as grant funding gets tighter academic departments need to look to other sources to maintain the work they do but but i think the real more important aspect of it is that it gives us an opportunity for to move our work out into the real world to make it more relevant we're really good in academia coming up with new ideas and getting them to work and writing about them and then they may just sit there but now we'll have an opportunity to push things out we have a number of ongoing discussions with some companies some some that you've heard of and will be interacting with them in different ways and and one of the first projects out of this which most of you know about is our partnership with epic which is the first time that epic has actually agreed to do informatics work with with the program epic has no troubles with doing with having people user system for capturing patient data for research and things like that but actually doing informatics work and both using epic in in our courses the new version of 513 that Vishnu teaches and also looking at it for research so so I think this is going to become a big a big activity of the department going forward our educational programs are doing well I actually probably need to update this map because it's a couple years old but that just represents dots of where our distance learning students live and one of these days I'm going to overlay that where we're all the other great informatics programs are and show that we have a presence in those towns as well we now have six hundred and five degrees and certificates awarded to 558 individuals so we have a very large alumni base we also have people who can it come back for more we're one of the 14 LM funded fellowship programs are Fogerty grant with argentina's unfortunately coming to an end and it's not clear that they're going to continue that program we also get fellowship funding from the VA and we're also known for our innovations including the ten by ten program of which Don Denver once said is the most successful initiative that amy has ever undertaken really started in 2005 when a mia wanted to get into online learning and we actually had BMI 510 and it was really essentially BMI 510 becoming this thing called 10 by 10 that was edit its goal 10,000 trained by 2010 we actually had about a thousand people do it by 2010 but because the interest was so much we've continued it and there's now about 1,800 people who have done 10 by 10 and probably about fifteen or twenty percent of them have subsequently enrolled in our graduate program mostly in the online program though some of them came and some of them have even when did their way up all the way to our PhD program dr. McCormick back there and so we're known for these sorts of things that and and another I mentioned before that our our clinical informatics fellowship for position has been accredited and there we're actually going to be playing innovative roles as well for example some of the other places that have launched clinical informatics fellowships are actually going to be using our online courses for their fellow so some of you know Chris longhurst from Packard Children's Hospital at Stanford so he's launched the Stanford clinical informatics fellowship that was actually the first one that was accredited and their fellows are taking a HS you courses I had them in my 510 course over the summer and now Vishnu has them and others of you will get to know them as well and there's other programs that are planning to do that so that's another way that we we can contribute another area that that's been a great interest to me is informatics for clinicians we really won't be successful in informatics if everything is just us doing informatics and even though today's medical students come in very savvy with their phones and they you know know how to type a few words into Google they don't know informatics and there's a lot to learn to be a 21st century physician or really any kind of clinician about informatics to finding the right information using an electronic health record well being involved in clinical decision support quality measurement telemedicine things like that so ohsu so I actually started advocating this at ohsu about 1995 or so I've been here five years still in the system professor and people would always see that's a good idea but you know not in my course not in my course and in in fact it was probably that probably was a boon to the graduate program because we've never had any resistance and in developing our graduate program because no one around here really competes with us but in the medical school curriculum you compete with surgery and anatomy and pediatrics and everyone else for for real estate in the medical school curriculum but we have a new senior associate dean George Makano some of you know him and we also have a like every medical school goes through a curriculum revision like every 10 or 15 years so we're doing that now we also got funded by this grant from the AMA which historically hasn't really been interested in medical education but they're more interested now and so all of these factors have sort of formed this kind of critical mass and our focus has really been on trying to develop competencies for what students need to do in informatics and again not just you know being able to navigate through their smartphone but really the kinds of things we do so I know you probably can't read this but we actually published this paper that has actually gotten a lot of interest about this competency set that we developed for well although it's for medical students but pretty much everything here is Jermaine to any anyone who's a clinical student using electronic health record searching clinical decision support understanding health information exchange quality measurement patient engagement through personal health records and patient portals things like that all these things are going to impact clinicians in the 21st century and we're actually developing curricula for medical students that will teach them these sorts of things so okay well it's good i finished about when i wanted to because i want to leave some time for her comments but the just kind of in conclusion so things are going well but there are continued challenges everything from the current state of our clinical systems our electronic health records being suboptimal to the challenges of research funding and our educational programs keeping up with the field sometimes in some fields educational programs kind of lag behind where the field is but i don't think that's the case with us in any of the tracks informatics is still the place to be so it's the area where we can do good work and make a career out of it and feel good about what we're doing contribute to people's health to the health care system and and research so i will stop at that point and open up the floor to questions let me just remind people because we record this and there's people listening to push the little button and hold it down on the microphone or if people are listening out there in cyberspace to send us by twitter is there anything on the twitter feed yeah okay any other comments yeah it's james thank you um the simulation lab that we all get a tour of the other night what initiatives are we working on with the sim lab and how might that be expanded yeah great question and and on my list of the gazillion things that our faculty does simulation is listed in there there's an interesting story behind that Jeff gold has become the leader in that area and vishnu 'he's working with him right when we got the first when we got the ONC funding Jeff I don't know read about it somewhere and came and said you know I've got all of these critical care fellows who miss things in plain sight in epic taking care of patients you know what can I do about it so I said well you know let's let's try to document it and and we actually did a little study that was published and then he got interested in that area some funding opportunities came along and all of a sudden our EHR simulation program was built and so Jeff is also involved in the curriculum with the medical students so obviously if you're going to simulate the clinical environment part of that environment includes the electronic health record and all the data and and that's very much a part of that simulation center which if you toured it you saw you know well I mean there's actually some interesting informatics just around simulation itself but all of the rooms have computers the even the out patient rooms have the computers that are hanging there so everything from teaching people the best way to use a computer in exam room so there's lots of involvement with with us and that any other questions Oh what the heck the little question why there's so much you know focus on the clinical informatics fellowship but you mentioned a little bit about Amyas desire to certify other practitioners it seems that the majority of clinical practitioners and informatics won't in the long run fit into that little bucket of people who can do clinical fellowship so the actual population of people who will probably be needed in the field and working won't fall into that so do you have anything else you could say about that yeah well the soap want one of the downsides to kind of going the medical sub specialty route is that that means you have to have a medical subset you have to have a medical specialty I actually luck out lucked out in this regard in that I got certified in internal medicine at a time when people got lifetime certifications you know you pass the board exam you're certified for life even though we have to do continuing education and all that but that's all changed in medicine and so people need to keep up their clinical side and it can be difficult especially like if you're in primary care so so one group of physicians who are kind of left out well there's physicians are a number of positions are left out of this process because either they're not certified or they discover informatics in the middle of their career and then of course again informatics not only about physicians so there's all these other people so it's going to be interesting to see what comes out of this amia process you know another issue is do you do people need to be certified in informatics you know one form one way that people get certified in a career is that they get a credential like a degree a master's degree a PhD health care though has always been this sort of certification oriented and this did this isn't medicine I mean this is nursing and pharmacy and physical therapy and everything else so it'll be interesting to see what kind of certification process develops and what kind of training requirements there will be for it because it's going to be you know they call it the advanced interprofessional informatics certification so it's going to be many different professions so I don't imagine that they're actually going to be able to prescribe certain fellowships because it just might not work for nurses or physical therapists or whoever so it remains to be seen what that's going to be it also remains to be seen how important it's going to be to have that clinical informatics certification credential are someone not going to hire you because you don't have it you know what if you have other advanced training and informatics or experience and so forth so I you know I think there's I think there's a lot of unanswered questions and I think we'll we'll see over time how it all plays out you know their other you know the the previous last new medical specialty was emergency medicine because people they're never people worked in emergency departments but they were internists and surgeons and anesthesiologists it took a while for it to be certainly in urban areas to be required to be an emergency physician and even in some areas there just aren't emergency position so we'll see yeah my bill I think in academic departments we've got research missions and teaching missions and an operational missions and I'm curious about for the people that you're seeing now who are interested in the informatics clinical informatics sub-specialty are you seeing them cluster into any of those areas for what they want to be when they grow up because I'm curious what you're seeing and also how that impacts that actually a fish department DBS drifting toward one or the other because of that yeah they're mostly mostly people who interested in operational areas because like if you look at departments if you look at clinical departments in medical schools like a department of ophthalmology I mean all of you guys are certified in ophthalmology you know to do your ophthalmology practice and whereas the academic the academic work that you do you're not really certified per se you know you have your formal informatics training but so its certification is typically more sort of fitness to perform in some sort of operational role so for that reason a lot of the you know initial cohort of people certified our chief medical informatics officers and things like that and then some academics like us who make sure that we want to get certified because we want to run programs or otherwise get recognized for what we do but but the large majority are interested in operational roles and academic informatics always has this kind of challenging relationship with kind of service versus academia you know we're we're not the IT department we actually shouldn't be the IT department we can help the IT department but you know I think that there's always this kind of tension between how much you know sometimes that we get invited to collaborate on grant proposals because they basically think we're the IT person and that often doesn't work out well but it's a challenge and this is actually challenged in the bioinformatics world to how much you know knowledge and scientific work do you bring to the project you know as opposed to being the kind of you know person who keeps the software up and running okay well and let me ask dev one last time if there's any incoming cost of Twitter feed it we when we first started doing it we got a lot more comments but we have you and now okay well thank you all for for listening and I appreciate you coming and we have a number of other interesting speakers plans starting tomorrow Andre crush nick is an expert in usability which is another important area in the field so thank you

One Comment

  1. Adil Ahmed said:

    Excellent talk, very informative

    June 29, 2019

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