1. 1 © 2013 Charles Safran Clinical Informatics Subspecialty Charles Safran, MD Chief, Division of Clinical Informatics, Beth Israel Deaconess Medical Center Associate Professor of Medicine, Harvard Medical School 21 August 2013

2. 2 © 2013 Charles Safran Hollerith1890 Nash1953 Ledley & Lusted1959 Telemedicine1959 Cornell Medical Index1959 Warner H1961 Collen M1963 Lindberg DA1963 LINC1964 Barnett GO1965 Slack WV1966 Weed LL1967 Gabrieli E1968 Bleich HL1968 MUMPS1969 Greenes RA1969 Pryor TA1969 Gardner RM1970 Blois MS1971 Ball M1971 Scherrer JR1971 Kulikowski1972 HELP1972 Simborg D1972 Fries J1972 Hammond E1973 Peterson H1973 El Camino1974 Clayton P1974 MYCIN1976 Shortliffe E1976 COSTAR1976 Present Illness1976 McDonald C1977 Stead W1977 Zielstorrf R1977 Safran C1977 TRIMIS = CHCS1978 VA DHCP1980 Degoulet P1980 PaperChase1982 Brennan P1983 Bakker A1983 Bazis HIS1983 A brief (and incomplete) timeline of Clinical Informatics The term Clinical Informatics first mentioned 1983

3. 3 © 2013 Charles Safran Clinical Informatics Clinical informatics applies concepts, methods and tools that enable the optimal use of information and knowledge to measurably improve patient care. Clinical informaticians transform health care by analyzing, designing, implementing, and evaluating information and communication systems that enhance individual and population health outcomes, improve patient care, and strengthen the clinician-patient relationship. Clinical informaticians are at the intersection of clinical processes and business processes and communication & information technology Clinical informatics is applied -- interventional Clinical Processes Information Technology Business Processes

4. 4 © 2013 Charles Safran Clinical Informatics A subset of Biomedical Informatics Integrative professional healthcare domain Benefit from formal training and certification

5. 5 © 2013 Charles Safran CI Subspecialty timeline 2004 AMIA calls for training 6000 physicians and 6000 nurses 2005 AMIA town meeting 2007 RWJF grant to AMIA 2008 Core and Training documents created 2009 Core and Training documents published 2009 ABPM Board Agrees to Propose CI as a subspecialty to ABMS (works with AMIA to draft proposal and present it to the other specialty boards) 2010 All ABMS Specialty Boards agree to support ABPM proposal for CI as subspecialty 2010 Pathology joins Preventive Medicine as a cosponsor 2011 ABPM and AMIA jointly present CI subspecialty proposal to ABMS subcommittee that reviews all proposals for new subspecialty certifications 2011 ABMS approves CI as subspecialty 2011 ABPM, as sponsoring board to oversee CI subspecialty, begins process to create exam 2012 ABPM and AMIA begin planning for MOC process that will be in place by the time the first diplomats complete their certification in the CI subspecialty Fall 2013 CI exam offered

6. 6 © 2013 Charles Safran Core Content for the Subspecialty of Clinical Informatics. Reed Gardner, J Marc Overahge, Elaine B Steen et al JAMIA 2009 16: 153-157 Program Requirements for Fellowship Education in the Subspecialty of Clinical Informatics Charles Safran, M Michael Shabot, Benson S Munger, et al. JAMIA 2009 16: 158-166 Guiding Documents

7. 7 © 2013 Charles Safran Gardner RM, Safran C. Chapter 10. Clinical Informatics - Curricula for a New Medical Subspecialty. in Informatics Education in Healthcare: Lessons Learned. Ed Eta S. Berner, Ed.D. Publisher: Springer-Verlag, London, Ltd. 2013. Lessons Learned

8. 8 © 2013 Charles Safran Building the Exam

9. 9 © 2013 Charles Safran 3.5. Information System Lifecycle 3.5.1. Institutional governance of clinical information systems 3.5.2. Clinical information needs analysis and system selection 3.5.2.1. Methods for identifying clinician information system needs 3.5.2.2. Assessment of clinical process changes that will be required 3.5.2.3. Elements of a system requirements specification document (e.g., technical specifications, intellectual property, patents, copyright, licensing, contracting, confidentiality, specific organizational needs such as user training and support) 3.5.2.4. Risk analysis and mitigation 3.5.2.5. The costs of health information and communications technologies 3.5.3. Clinical information system implementation 3.5.3.1. Elements of a system implementation plan 3.5.3.2. Models of user training and support processes that can meet clinician needs 3.5.3.3. Processes and mechanisms that obtain and respond to clinician feedback 3.5.4. Clinical information system testing, before, during and after implementation 3.5.5. Clinical information system maintenance 3.5.5.1. Disaster recovery and downtime 3.5.5.2. Clinical information system transitions and decommissioning of systems 3.5.6. Clinical information system evaluation 3.5.6.1. Outcomes relevant to the clinical goals and quality measures 3.5.6.2. Qualitative and quantitative methods for evaluating clinical information systems 3.5.6.3. Evaluation plan design Breakdown of Core Content

10. 10 © 2013 Charles Safran You accept a position as CMIO at a hospital with multiple stand alone information systems. Your first task should be to: A. Develop a strategic information plan B. Design a clinical data repository C. Build trust with the clinical leadership D. Implement evidence-based guidelines A Sample Question

11. 11 © 2013 Charles Safran CarterElectronic Health Records DegouletIntroduction to Clinical Informatics ElkinTerminology and Terminological Systems FriedmanEvaluation Methods GreenesClinical Decision Support Kotter Leading Change O’Carrol Public Health Informatics PaynePractice Guide to Clinical Computing Pantanowitz Pathology Informatics Shortliffe Biomedical Informatics Van BemmelHandbook of Medical Informatics Wagner Health Care Informatics Systems References for Best Answers

12. 12 © 2013 Charles Safran Reflections Consensus on “best” answer often difficult Guiding documents more important than the experts who created the documents realized Writing multiple choice questions seemed un- natural to test some concepts like leadership No one textbook covered all the “core” content Process of exam writing is dynamic and a learning experience

13. 13 © 2013 Charles Safran Charles_Safran@Harvard.Edu 1330 Beacon Street Brookline MA 02446