The Chief Clinical Informatics Officer (CCIO): AMIA Task Force Report on CCIO Knowledge, Education, and Skillset Requirements

Structure and Funding of Clinical Informatics Fellowships: A National Survey of Program Directors

BACKGROUND

In 2011, the American Board of Medical Specialties established clinical informatics (CI) as a subspecialty in medicine, jointly administered by the American Board of Pathology and the American Board of Preventive Medicine. Subsequently, many institutions created CI fellowship training programs to meet the growing need for informaticists. Although many programs share similar features, there is considerable variation in program funding and administrative structures.

OBJECTIVES

The aim of our study was to characterize CI fellowship program features, including governance structures, funding sources, and expenses.

METHODS

We created a cross-sectional online REDCap survey with 44 items requesting information on program administration, fellows, administrative support, funding sources, and expenses. We surveyed program directors of programs accredited by the Accreditation Council for Graduate Medical Education between 2014 and 2021.

RESULTS

We invited 54 program directors, of which 41 (76%) completed the survey. The average administrative support received was $27,732/year. Most programs (85.4%) were accredited to have two or more fellows per year. Programs were administratively housed under six departments: Internal Medicine (17; 41.5%), Pediatrics (7; 17.1%), Pathology (6; 14.6%), Family Medicine (6; 14.6%), Emergency Medicine (4; 9.8%), and Anesthesiology (1; 2.4%). Funding sources for CI fellowship program directors included: hospital or health systems (28.3%), clinical departments (28.3%), graduate medical education office (13.2%), biomedical informatics department (9.4%), hospital information technology (9.4%), research and grants (7.5%), and other sources (3.8%) that included philanthropy and external entities.

CONCLUSION

CI fellowships have been established in leading academic and community health care systems across the country. Due to their unique training requirements, these programs require significant resources for education, administration, and recruitment. There continues to be considerable heterogeneity in funding models between programs. Our survey findings reinforce the need for reformed federal funding models for informatics practice and training.

Applied Clinical Informatics Journal: A Brief History

In 2009, Schattauer Verlag in Stuttgart, Germany first published the Applied Clinical Informatics (ACI) Journal. ACI has served since its inception as an official journal of the International Medical Informatics Association. Later, the American Medical Informatics Association and the European Federation for Medical Informatics named ACI as an official journal. This manuscript describes the history of the journal from its inception to present day including publication measures, challenges, and successes.

Understanding enterprise data warehouses to support clinical and translational research: enterprise information technology relationships, data governance, workforce, and cloud computing

OBJECTIVE

Among National Institutes of Health Clinical and Translational Science Award (CTSA) hubs, effective approaches for enterprise data warehouses for research (EDW4R) development, maintenance, and sustainability remain unclear. The goal of this qualitative study was to understand CTSA EDW4R operations within the broader contexts of academic medical centers and technology.

MATERIALS AND METHODS

We performed a directed content analysis of transcripts generated from semistructured interviews with informatics leaders from 20 CTSA hubs.

RESULTS

Respondents referred to services provided by health system, university, and medical school information technology (IT) organizations as "enterprise information technology (IT)." Seventy-five percent of respondents stated that the team providing EDW4R service at their hub was separate from enterprise IT; strong relationships between EDW4R teams and enterprise IT were critical for success. Managing challenges of EDW4R staffing was made easier by executive leadership support. Data governance appeared to be a work in progress, as most hubs reported complex and incomplete processes, especially for commercial data sharing. Although nearly all hubs (n = 16) described use of cloud computing for specific projects, only 2 hubs reported using a cloud-based EDW4R. Respondents described EDW4R cloud migration facilitators, barriers, and opportunities.

DISCUSSION

Descriptions of approaches to how EDW4R teams at CTSA hubs work with enterprise IT organizations, manage workforces, make decisions about data, and approach cloud computing provide insights for institutions seeking to leverage patient data for research.

CONCLUSION

Identification of EDW4R best practices is challenging, and this study helps identify a breadth of viable options for CTSA hubs to consider when implementing EDW4R services.

The Case for the Anesthesiologist-Informaticist

Health care has been transformed by computerization, and the use of electronic health record systems has become widespread. Anesthesia information management systems are commonly used in the operating room to maintain records of anesthetic care delivery. The perioperative environment and the practice of anesthesia generate a large volume of data that may be reused to support clinical decision-making, research, and process improvement. Anesthesiologists trained in clinical informatics, referred to as informaticists or informaticians, may help implement and optimize anesthesia information management systems. They may also participate in clinical research, management of information systems, and quality improvement in the operating room or throughout a health care system. Here, we describe the specialty of clinical informatics, how anesthesiologists may obtain training in clinical informatics, and the considerations particular to the subspecialty of anesthesia informatics. Management of perioperative information systems, implementation of computerized clinical decision support systems in the perioperative environment, the role of virtual visits and remote monitoring, perioperative informatics research, perioperative process improvement, leadership, and change management are described from the perspective of the anesthesiologist-informaticist.

What Industry Wants: An Empirical Analysis of Health Informatics Job Postings

OBJECTIVES

To describe the education, experience, skills, and knowledge required for health informatics jobs in the United States.

METHODS

Health informatics job postings (n = 206) from Indeed.com on April 14, 2020 were analyzed in an empirical analysis, with the abstraction of attributes relating to requirements for average years and types of experience, minimum and desired education, licensure, certification, and informatics skills.

RESULTS

A large percentage (76.2%) of posts were for clinical informaticians, with 62.1% of posts requiring a minimum of a bachelor's education. Registered nurse (RN) licensure was required for 40.8% of posts, and only 7.3% required formal education in health informatics. The average experience overall was 1.6 years (standard deviation = 2.2), with bachelor's and master's education levels increasing mean experience to 3.5 and 5.8 years, respectively. Electronic health record support, training, and other clinical systems were the most sought-after skills.

CONCLUSION

This cross-sectional study revealed the importance of a clinical background as an entree into health informatics positions, with RN licensure and clinical experience as common requirements. The finding that informatics-specific graduate education was rarely required may indicate that there is a lack of alignment between academia and industry, with practical experience preferred over specific curricular components. Clarity and shared understanding of terms across academia and industry are needed for defining and advancing the preparation for and practice of health informatics.

Domains, tasks, and knowledge for health informatics practice: results of a practice analysis

OBJECTIVE

To develop a comprehensive and current description of what health informatics (HI) professionals do and what they need to know.

MATERIALS AND METHODS

Six independent subject-matter expert panels drawn from and representative of HI professionals contributed to the development of a draft HI delineation of practice (DoP). An online survey was distributed to HI professionals to validate the draft DoP. A total of 1011 HI practitioners completed the survey. Survey respondents provided domain, task, knowledge and skill (KS) ratings, qualitative feedback on the completeness of the DoP, and detailed professional background and demographic information.

RESULTS

This practice analysis resulted in a validated, comprehensive, and contemporary DoP comprising 5 domains, 74 tasks, and 144 KS statements.

DISCUSSION

The HI practice analysis defined "health informatics professionals" to include practitioners with clinical (eg, dentistry, nursing, pharmacy), public health, and HI or computer science training. The affirmation of the DoP by reviewers and survey respondents reflects the emergence of a core set of tasks performed and KSs used by informaticians representing a broad spectrum of those currently practicing in the field.

CONCLUSION

The HI practice analysis represents the first time that HI professionals have been surveyed to validate a description of their practice. The resulting HI DoP is an important milestone in the maturation of HI as a profession and will inform HI certification, accreditation, and education activities.

Transitions from One Electronic Health Record to Another: Challenges, Pitfalls, and Recommendations

OBJECTIVE

We address the challenges of transitioning from one electronic health record (EHR) to another-a near ubiquitous phenomenon in health care. We offer mitigating strategies to reduce unintended consequences, maximize patient safety, and enhance health care delivery.

METHODS

We searched PubMed and other sources to identify articles describing EHR-to-EHR transitions. We combined these references with the authors' extensive experience to construct a conceptual schema and to offer recommendations to facilitate transitions.

RESULTS

Our PubMed query retrieved 1,351 citations: 43 were relevant for full paper review and 18 met the inclusion criterion of focus on EHR-to-EHR transitions. An additional PubMed search yielded 1,014 citations, for which we reviewed 74 full papers and included 5. We supplemented with additional citations for a total of 70 cited. We distinguished 10 domains in the literature that overlap yet present unique and salient opportunities for successful transitions and for problem mitigation.

DISCUSSION

There is scant literature concerning EHR-to-EHR transitions. Identified challenges include financial burdens, personnel resources, patient safety threats from limited access to legacy records, data integrity during migration, cybersecurity, and semantic interoperability. Transition teams must overcome inadequate human infrastructure, technical challenges, security gaps, unrealistic providers' expectations, workflow changes, and insufficient training and support-all factors affecting potential clinician burnout.

CONCLUSION

EHR transitions are remarkably expensive, laborious, personnel devouring, and time consuming. The paucity of references in comparison to the topic's salience reinforces the necessity for this type of review and analysis. Prudent planning may streamline EHR transitions and reduce expenses. Mitigating strategies, such as preservation of legacy data, managing expectations, and hiring short-term specialty consultants can overcome some of the greatest hurdles. A new medical subject headings (MeSH) term for EHR transitions would facilitate further research on this topic.

Commercial Interests in Continuing Medical Education: Where Do Electronic Health Record Vendors Fit?

The Accreditation Council for Continuing Medical Education (ACCME) will not accredit an organization that it defines as a commercial interest, that is an entity that produces, markets, resells, or distributes health care goods or services consumed by, or used on, patients. Thus, commercial interests are not eligible to be accredited organizations offering continuing medical education (CME) credit to physicians. This decision is based on the concern that commercial interests may use CME events to market their products or services to physicians, who then might inappropriately prescribe or administer those products or services to patients. Studies have shown that CME events supported by pharmaceutical companies, for example, have influenced physicians' prescribing behaviors.Currently, however, the ACCME does not recognize electronic health record (EHR) vendors, which are part of a multi-billion-dollar business, as commercial interests, and it accredits them to provide or directly influence CME events. Like pharmaceutical company-sponsored CME events, EHR vendor activities, which inherently only focus on use of the sponsoring vendor's EHR system despite its potential intrinsic limitations, can lead to physician reciprocity. Such events also may inappropriately influence EHR system purchases, upgrades, and implementation decisions. These actions can negatively influence patient safety and care. Thus, the authors of this Perspective call on the ACCME to recognize EHR vendors as commercial interests and remove them from the list of accredited CME providers.

Policy Statement on Clinical Informatics Fellowships and the Future of Informatics-Driven Medicine

Board certified clinical informaticians provide expertise in leveraging health IT (HIT) and health data for patient care and quality improvement. Clinical Informatics experts possess the requisite skills and competencies to make systems-level improvements in care delivery using HIT, workflow and data analytics, knowledge acquisition, clinical decision support, data visualization, and related informatics tools. However, these physicians lack structured and sustained funding because they have no billing codes. The sustainability and growth of this new and promising medical subspecialty is threatened by outdated and inconsistent funding models that fail to support the education and professional growth of clinical informaticians. The Clinical Informatics Program Directors' Community is calling upon the Centers for Medicare and Medicaid Services to consider novel funding structures and programs through its Innovation Center for Clinical Informatics Fellowship training. Only through structural and sustained funding for Clinical Informatics fellows will be able to fully develop the potential of electronic health records to improve the quality, safety, and cost of clinical care.

Integrating the Practical Robust Implementation and Sustainability Model With Best Practices in Clinical Decision Support Design: Implementation Science Approach

Background

Clinical decision support (CDS) design best practices are intended to provide a narrative representation of factors that influence the success of CDS tools. However, they provide incomplete direction on evidence-based implementation principles.

Objective

This study aims to describe an integrated approach toward applying an existing implementation science (IS) framework with CDS design best practices to improve the effectiveness, sustainability, and reproducibility of CDS implementations.

Methods

We selected the Practical Robust Implementation and Sustainability Model (PRISM) IS framework. We identified areas where PRISM and CDS design best practices complemented each other and defined methods to address each. Lessons learned from applying these methods were then used to further refine the integrated approach.

Results

Our integrated approach to applying PRISM with CDS design best practices consists of 5 key phases that iteratively interact and inform each other: multilevel stakeholder engagement, designing the CDS, design and usability testing, thoughtful deployment, and performance evaluation and maintenance. The approach is led by a dedicated implementation team that includes clinical informatics and analyst builder expertise.

Conclusions

Integrating PRISM with CDS design best practices extends user-centered design and accounts for the multilevel, interacting, and dynamic factors that influence CDS implementation in health care. Integrating PRISM with CDS design best practices synthesizes the many known contextual factors that can influence the success of CDS tools, thereby enhancing the reproducibility and sustainability of CDS implementations. Others can adapt this approach to their situation to maximize and sustain CDS implementation success.

A Sociotechnical Framework for Safety-Related Electronic Health Record Research Reporting: The SAFER Reporting Framework

Electronic health record (EHR)-based interventions to improve patient safety are complex and sensitive to who, what, where, why, when, and how they are delivered. Success or failure depends not only on the characteristics and behaviors of individuals who are targeted by an intervention, but also on the technical characteristics of the intervention and the culture and environment of the health system that implements it. Current reporting guidelines do not capture the complexity of sociotechnical factors (technical and nontechnical factors, such as workflow and organizational issues) that confound or influence these interventions. This article proposes a methodological reporting framework for EHR interventions targeting patient safety and builds on an 8-dimension sociotechnical model previously developed by the authors for design, development, implementation, use, and evaluation of health information technology. The Safety-related EHR Research (SAFER) Reporting Framework enables reporting of patient safety-focused EHR-based interventions while accounting for the multifaceted, dynamic sociotechnical context affecting intervention implementation, effectiveness, and generalizability. As an example, an EHR-based intervention to improve communication and timely follow-up of subcritical abnormal test results to operationalize the framework is presented. For each dimension, reporting should include what sociotechnical changes were made to implement an EHR-related intervention to improve patient safety, why the intervention did or did not lead to safety improvements, and how this intervention can be applied or exported to other health care organizations. A foundational list of research and reporting recommendations to address implementation, effectiveness, and generalizability of EHR-based interventions needed to effectively reduce preventable patient harm is provided. The SAFER Reporting Framework is not meant to replace previous research reporting guidelines, but rather provides a sociotechnical adjunct that complements their use.

Reimagining the research-practice relationship: policy recommendations for informatics-enabled evidence-generation across the US health system

The widespread adoption and use of electronic health records and their use to enable learning health systems (LHS) holds great promise to accelerate both evidence-generating medicine (EGM) and evidence-based medicine (EBM), thereby enabling a LHS. In 2016, AMIA convened its 10th annual Policy Invitational to discuss issues key to facilitating the EGM-EBM paradigm at points-of-care (nodes), across organizations (networks), and to ensure viability of this model at scale (sustainability). In this article, we synthesize discussions from the conference and supplements those deliberations with relevant context to inform ongoing policy development. Specifically, we explore and suggest public policies needed to facilitate EGM-EBM activities on a national scale, particularly those policies that can enable and improve clinical and health services research at the point-of-care, accelerate biomedical discovery, and facilitate translation of findings to improve the health of individuals and populations.

Understanding health information management practices in public hospitals in Kuwait

BACKGROUND

Health information technology (IT) solutions can aid healthcare reform efforts, but without proper information management, these efforts are futile. In this study, we used Kuwait as an example of a high per-capita gross domestic product country that faces information management challenges to draw insights that can be generalised to other developed countries.

OBJECTIVE

(i) to uncover the status quo of information management practices in public hospitals and (ii) to offer recommendations to improve them.

METHOD

This study analysed qualitative and quantitative accreditation-related data pertaining to the compliance with the information management standard at all secondary care public hospitals over two accreditation cycles.

RESULTS

Overall, public hospitals had made positive progress in their compliance with the information management standard. However, issues still existed with (i) developing and implementing an information management plan, (ii) involving the appropriate stakeholders in selecting health IT solutions and (iii) access to the Internet by staff and patients.

CONCLUSION

Evidence underscored the importance of proper information management driven by clear centralised strategic plans.

IMPLICATIONS

With the rapid adoption of digital health systems, the role of health information management leaders should not be undervalued. Embracing health IT solutions with strong information management practices can aid healthcare reform efforts.

Trends and characteristics of global medical informatics conferences from 2007 to 2017: A bibliometric comparison of conference publications from Chinese, American, European and the Global Conferences

BACKGROUND

As the second-largest economy in the world, China has invested considerable financial and policy support into hospital informatization since health care reform in 2010. However, the results and experience of such investments have not been compared with relevant research and applications in the United States and Europe.

OBJECTIVES

From the perspective of professional conference proceedings, we comparatively analyzed the current situations, characteristics, hotspots, and trends of medical informatics (MI) development in China, the United States and Europe to help Chinese MI researchers and practitioners summarize their experiences and determine gaps compared to their American and European peers. We also aimed to educate foreign peers about the special contributions of the China MI circle and facilitate multilevel international cooperation.

METHODS

English conference proceedings of the American Medical Informatics Association (AMIA) Annual Symposium (USA), Medical Informatics Europe (MIE, Europe) and World Conference on Medical Informatics (MEDINFO, Global) from 2007 to 2017 were searched within Scopus and Pubmed. Proceedings of Chinese MI conferences (CMIAAS, CHINC, CHITEC, CPMI) (China) were searched within Chinese databases CQVIP, CNKI and WanFang during the same period. The datasets were preprocessed via a Natural Language Processing (NLP) package on Python and were qualitatively and quantitatively analyzed via bibliometric methods.

RESULTS

Overall, 2285, 1601, 1930 and 5431 papers were publicized from the AMIA Symposium (USA), MIE (Europe), MEDINFO (Global) and Chinese MI conferences (China) between 2007 and 2017, respectively, with an H-index of 32, 19, 19 and 3, respectively. The AMIA Symposium, MIE and MEDINFO received submissions from 43, 68 and 80 countries (or regions), respectively, but Chinese MI conferences (CMIAAS, CHINC, CHITEC, CPMI) only received submissions from 3 foreign countries. Author affiliations were quite similar among the AMIA Symposium, MIE and MEDINFO, as 67%, 75% and 70% of authors came from universities/colleges, respectively; 18%, 10% and 11% came from medical institutions, respectively; and 7%, 8% and 10% came from institutes, respectively. In contrast, the majority (54%) of authors in Chinese MI conferences came from medical institutions followed by universities/colleges (17%) and institutes (10%). Of the top 5 authors with the most publications in AMIA Symposium, MIE and MEDINFO, 14/15 of them had medical backgrounds, but only one author from the Chinese MI conferences majored in medicine. Electronic medical records (EMR) were included in the top 10 high-frequency keywords by all four conference groups, but the amount of time that this keyword appeared differed in 2009, 2011, 2012 and 2013, respectively.

CONCLUSIONS

The MI annual conferences are all different among China, the United States and Europe. China lags in the theoretical and discipline bases but has made considerable investments in the past 10 years. China should fully use its second-mover advantage and application advantages and utilize international experiences and cooperation to make stronger contributions to global MI development.

Technology Informatics Guiding Education Reform - TIGER

Background: While health informatics recommendations on competencies and education serve as highly desirable corridors for designing curricula and courses, they cannot show how the content should be situated in a specific and local context. Therefore, global and local perspectives need to be reconciled in a common framework.

Objectives: The primary aim of this study is therefore to empirically define and validate a framework of globally accepted core competency areas in health informatics and to enrich this framework with exemplar information derived from local educational settings.

Methods: To this end, (i) a survey was deployed and yielded insights from 43 nursing experts from 21 countries worldwide to measure the relevance of the core competency areas, (ii) a workshop at the International Nursing Informatics Conference (NI2016) held in June 2016 to provide information about the validation and clustering of these areas and (iii) exemplar case studies were compiled to match these findings with the practice. The survey was designed based on a comprehensive compilation of competencies from the international literature in medical and health informatics.

Results: The resulting recommendation framework consists of 24 core competency areas in health informatics defined for five major nursing roles. These areas were clustered in the domains “data, information, knowledge”, “information exchange and information sharing”, “ethical and legal issues”, “systems life cycle management”, “management” and “biostatistics and medical technology”, all of which showed high reliability values. The core competency areas were ranked by relevance and validated by a different group of experts. Exemplar case studies from Brazil, Germany, New Zealand, Taiwan/China, United Kingdom (Scotland) and the United States of America expanded on the competencies described in the core competency areas.

Conclusions: This international recommendation framework for competencies in health informatics directed at nurses provides a grid of knowledge for teachers and learner alike that is instantiated with knowledge about informatics competencies, professional roles, priorities and practical, local experience. It also provides a methodology for developing frameworks for other professions/disciplines. Finally, this framework lays the foundation of cross-country learning in health informatics education for nurses and other health professionals.

Five Years of Clinical Informatics Board Certification for Physicians in the United States of America

Objectives:  To review the highlights of the new Clinical Informatics subspecialty including its history, certification requirements, development of and performance on the certification examination in the United States.

Methods:  We reviewed processes for the development of a subspecialty. Data from board certification examinations were collated and analyzed. We discussed eligibility requirements in the fellowship as well as practice pathways.

Results:  Lessons learned from the development of the Clinical Informatics subspecialty, opportunities, challenges, and future directions for the field are discussed.

Conclusions:  There remains a need for fellowship programs and creation and maintenance of a professional home for the subspecialty with the American Medical Informatics Association. Ongoing attention to the currency of the core content is required to maintain an examination designed to test the key concepts within the field of Clinical Informatics.

Career Paths of Pathology Informatics Fellowship Alumni

Background:

The alumni of today's Pathology Informatics and Clinical Informatics fellowships fill diverse roles in academia, large health systems, and industry. The evolving training tracks and curriculum of Pathology Informatics fellowships have been well documented. However, less attention has been given to the posttraining experiences of graduates from informatics training programs. Here, we examine the career paths of subspecialty fellowship-trained pathology informaticians.

Methods:

Alumni from four Pathology Informatics fellowship training programs were contacted for their voluntary participation in the study. We analyzed various components of training, and the subsequent career paths of Pathology Informatics fellowship alumni using data extracted from alumni provided curriculum vitae.

Results:

Twenty-three out of twenty-seven alumni contacted contributed to the study. A majority had completed undergraduate study in science, technology, engineering, and math fields and combined track training in anatomic and clinical pathology. Approximately 30% (7/23) completed residency in a program with an in-house Pathology Informatics fellowship. Most completed additional fellowships (15/23) and many also completed advanced degrees (10/23). Common primary posttraining appointments included chief medical informatics officer (3/23), director of Pathology Informatics (10/23), informatics program director (2/23), and various roles in industry (3/23). Many alumni also provide clinical care in addition to their informatics roles (14/23). Pathology Informatics alumni serve on a variety of institutional committees, participate in national informatics organizations, contribute widely to scientific literature, and more than half (13/23) have obtained subspecialty certification in Clinical Informatics to date.

Conclusions:

Our analysis highlights several interesting phenomena related to the training and career trajectory of Pathology Informatics fellowship alumni. We note the long training track alumni complete in preparation for their careers. We believe flexible training pathways combining informatics and clinical training may help to alleviate the burden. We highlight the importance of in-house Pathology Informatics fellowships in promoting interest in informatics among residents. We also observe the many important leadership roles in academia, large community health systems, and industry available to early career alumni and believe this reflects a strong market for formally trained informaticians. We hope this analysis will be useful as we continue to develop the informatics fellowships to meet the future needs of our trainees and discipline.

Chief Information Officer team evolution in university hospitals: interaction of the three ‘C’s (CIO, CCIO, CRIO)

Background

The Chief Information Officer (CIO) and Chief Clinical Information Officer (CCIO) are now established senior roles in hospital practice. With increasing emphasis on optimising use of routine health data for secondary purposes and research, additional skills are required as part of the senior information officer team, particularly in academic health care institutions.

Objective

To present the role of the Chief Research Information Officer (CRIO), as an emerging, and important, component of the senior information team.

Method

We review recent publications describing the composition of the senior information team, including CIO and CCIO roles, and discuss the development of the CRIO as a distinct component of the team, based on the published evidence and our experience.

Results

The CRIO is emerging as an additional senior role in academic healthcare institutions, whose roles include leadership of the informatics strategy and optimisation of routine data collection systems for research data use, in addition to important aspects of research data governance. Such individuals should be senior clinicians with experience in informatics, in addition to having established research expertise and knowledge of research processes, governance and academic networks.

Conclusions

The CRIO is emerging as a distinct senior information leadership role in conjunction with the already established positions of CCIO and CIO, who together, can provide optimal oversight of digital activities across the organisation.

The Emerging Role of the Chief Research Informatics Officer in Academic Health Centers

BACKGROUND

The role of the Chief Research Informatics Officer (CRIO) is emerging in academic health centers to address the challenges clinical researchers face in the increasingly digitalized, data-intensive healthcare system. Most current CRIOs are the first officers in their institutions to hold that role. To date there is very little published information about this role and the individuals who serve it.

OBJECTIVE

To increase our understanding of the CRIO role, the leaders who serve it, and the factors associated with their success in their organizations.

METHODS

The Clinical Research Informatics Working Group of the American Medical Informatics Association (AMIA) conducted a national survey of CRIOs in the United States and convened an expert panel of CRIOs to discuss their experience during the 2016 AMIA Annual Symposium.

RESULTS

CRIOs come from diverse academic backgrounds. Most have advance training and extensive experience in biomedical informatics but the majority have been CRIOs for less than three years. CRIOs identify funding, data governance, and advancing data analytics as their major challenges.

CONCLUSION

CRIOs play an important role in helping shape the future of clinical research, innovation, and data analytics in healthcare in their organizations. They share many of the same challenges and see the same opportunities for the future of the field. Better understanding the background and experience of current CRIOs can help define and develop the role in other organizations and enhance their influence in the field of research informatics.

How is health information technology changing the way we deliver NHS hospital care?

As NHS England and the health system makes further investments in the deployment of health information technology (HIT) across NHS sites, this review article considers some of the benefits HIT can provide in secondary care, including the potential of creating innovation ecosystems.

2016 Year-in-Review of Clinical and Consumer Informatics: Analysis and Visualization of Keywords and Topics

Objectives

The objective of this study was to review and visualize the medical informatics field over the previous 12 months according to the frequencies of keywords and topics in papers published in the top four journals in the field and in Healthcare Informatics Research (HIR), an official journal of the Korean Society of Medical Informatics.

Methods

A six-person team conducted an extensive review of the literature on clinical and consumer informatics. The literature was searched using keywords employed in the American Medical Informatics Association year-in-review process and organized into 14 topics used in that process. Data were analyzed using word clouds, social network analysis, and association rules.

Results

The literature search yielded 370 references and 1,123 unique keywords. ‘Electronic Health Record’ (EHR) (78.6%) was the most frequently appearing keyword in the articles published in the five studied journals, followed by ‘telemedicine’ (2.1%). EHR (37.6%) was also the most frequently studied topic area, followed by clinical informatics (12.0%). However, ‘telemedicine’ (17.0%) was the most frequently appearing keyword in articles published in HIR, followed by ‘telecommunications’ (4.5%). Telemedicine (47.1%) was the most frequently studied topic area, followed by EHR (14.7%).

Conclusions

The study findings reflect the Korean government's efforts to introduce telemedicine into the Korean healthcare system and reactions to this from the stakeholders associated with telemedicine.

Reconciling evidence-based medicine and precision medicine in the era of big data: challenges and opportunities

This era of groundbreaking scientific developments in high-resolution, high-throughput technologies is allowing the cost-effective collection and analysis of huge, disparate datasets on individual health. Proper data mining and translation of the vast datasets into clinically actionable knowledge will require the application of clinical bioinformatics. These developments have triggered multiple national initiatives in precision medicine—a data-driven approach centering on the individual. However, clinical implementation of precision medicine poses numerous challenges. Foremost, precision medicine needs to be contrasted with the powerful and widely used practice of evidence-based medicine, which is informed by meta-analyses or group-centered studies from which mean recommendations are derived. This “one size fits all” approach can provide inadequate solutions for outliers. Such outliers, which are far from an oddity as all of us fall into this category for some traits, can be better managed using precision medicine. Here, we argue that it is necessary and possible to bridge between precision medicine and evidence-based medicine. This will require worldwide and responsible data sharing, as well as regularly updated training programs. We also discuss the challenges and opportunities for achieving clinical utility in precision medicine. We project that, through collection, analyses and sharing of standardized medically relevant data globally, evidence-based precision medicine will shift progressively from therapy to prevention, thus leading eventually to improved, clinician-to-patient communication, citizen-centered healthcare and sustained well-being.

Nursing Informatics Certification Worldwide: History, Pathway, Roles, and Motivation

INTRODUCTION

Official recognition and certification for informatics professionals are essential aspects of workforce development.

OBJECTIVE

To describe the history, pathways, and nuances of certification in nursing informatics across the globe; compare and contrast those with board certification in clinical informatics for physicians.

METHODS

(1) A review of the representative literature on informatics certification and related competencies for nurses and physicians, and relevant websites for nursing informatics associations and societies worldwide; (2) similarities and differences between certification processes for nurses and physicians, and (3) perspectives on roles for nursing informatics professionals in healthcare Results: The literature search for 'nursing informatics certification' yielded few results in PubMed; Google Scholar yielded a large number of citations that extended to magazines and other non-peer reviewed sources. Worldwide, there are several nursing informatics associations, societies, and workgroups dedicated to nursing informatics associated with medical/health informatics societies. A formal certification program for nursing informatics appears to be available only in the United States. This certification was established in 1992, in concert with the formation and definition of nursing informatics as a specialty practice of nursing by the American Nurses Association. Although informatics is inherently interprofessional, certification pathways for nurses and physicians have developed separately, following long-standing professional structures, training, and pathways aligned with clinical licensure and direct patient care. There is substantial similarity with regard to the skills and competencies required for nurses and physicians to obtain informatics certification in their respective fields. Nurses may apply for and complete a certification examination if they have experience in the field, regardless of formal training. Increasing numbers of informatics nurses are pursuing certification.

CONCLUSIONS

The pathway to certification is clear and wellestablished for U.S. based informatics nurses. The motivation for obtaining and maintaining nursing informatics certification appears to be stronger for nurses who do not have an advanced informatics degree. The primary difference between nursing and physician certification pathways relates to the requirement of formal training and level of informatics practice. Nurse informatics certification requires no formal education or training and verifies knowledge and skill at a more basic level. Physician informatics certification validates informatics knowledge and skill at a more advanced level; currently this requires documentation of practice and experience in clinical informatics and in the future will require successful completion of an accredited two-year fellowship in clinical informatics. For the profession of nursing, a graduate degree in nursing or biomedical informatics validates specialty knowledge at a level more comparable to the physician certification. As the field of informatics and its professional organization structures mature, a common certification pathway may be appropriate. Nurses, physicians, and other healthcare professionals with informatics training and certification are needed to contribute their expertise in clinical operations, teaching, research, and executive leadership.