Is your health information system ailing? Clinical informaticians to the rescue

(This article is also being shared via the internal OHSU School of Medicine newsletter InsideSOM, and is written by Jennifer Smith, OHSU Senior Communications Lead.)

OHSU School of Medicine’s clinical informatics fellowship leads the nation in a new field

“I code like a neurologist.”

If your first idea of a pediatric neurologist does not conjure a physician who brings a coder’s affection for technical solutions to clinical practice, you have not met Amelia Drace, M.D., M.S.C.I.

Dr. Drace is a first-year clinical informatics fellow at OHSU. OHSU’s was among the first programs approved by the Accreditation Council for Graduate Medical Education (ACGME) for fellowship training in the clinical informatics subspecialty. Now, the three-year-old program is one of the largest of its kind in the nation.

Clinical informatics is unique in that physicians from any specialty can pursue it. “We are different from other clinical subspecialties,” said Vishnu Mohan, M.D., M.B.I., F.A.C.P., F.A.M.I.A., program director. “Physicians who go through our program not only develop skills that have to do with technology and data science, but also those that relate to managing people and projects. Additionally, their informatics skills are enhanced by their established skills in patient care.”

It is a relatively new field for physicians. Dr. Drace caught the bug for computer coding as an undergraduate student when a friend taught her web design. It remained a hobby throughout medical school, but she did not see the potential for clinical informatics as a specialty until well into her GME training at Washington University in St. Louis.

“In residency, I realized a lot of the clinical tools were difficult to navigate and the user experience was not strong,” she said. “I saw an opportunity to leverage my interest in coding by taking a design approach to information technology tools in health care.”

She is finding an outlet for her diverse interests in the OHSU program. “It’s great to meet people like me, and be in an environment with physicians that think the way you do and get bothered by the same things you do,” said Dr. Drace.

History of a new subspecialty

The American Board of Medical Specialties first approved clinical informatics as a subspecialty of all physician specialties in 2011. In 2013, the American Board of Preventive Medicine began offering board certification and six OHSU School of Medicine faculty members became board-certified “clinical informaticians” that year.

Now, physicians seeking this board certification must complete a 24-month ACGME-approved fellowship in clinical informatics. The Department of Medical Informatics and Clinical Epidemiology administers the clinical informatics program. Known for excellence in all things informatics, the department has been a leader in distance learning for biomedical informatics. In fact, six of the country’s 35 programs send their fellows to take the online courses offered by OHSU.

“DMICE offers a broad spectrum of online courses for our graduate certificate, masters and PhD informatics programs, and we leveraged our expertise and the breadth of our extensive course catalog when we designed didactics for clinical informatics fellows. Other programs soon saw the advantages of outsourcing their didactic learning to OSHU. The experience of learning together has been great for all fellows who participate in our courses, because it allows them to progress as a virtual cohort,” said Dr. Mohan, who is also associate professor of medical informatics and clinical epidemiology, OHSU School of Medicine, and chair of the American Medical Informatics Association program directors community.

When the American Medical Informatics Association set out to create competencies for this new fellowship, OHSU stepped up to the challenge. William Hersh, M.D., F.A.C.M.I., F.A.M.I.A., F.A.C.P., professor and chair of medical informatics and clinical epidemiology, was essential to this effort.

Although the clinical informatics subspecialty is relatively new, OHSU has offered a graduate program, funded in part by an NIH training grant, in biomedical informatics for over two decades. It has also pioneered online learning in the informatics field since 1999. The program has nearly 700 alumni, many of whom work for health systems, industry, and academic medical centers.

Clinical informatics is part of the medical education continuum. Thanks in large part to Dr. Hersh and colleagues, medical informatics is a thread in the YOUR M.D. competency-based curriculum. House officers in other specialties do informatics projects and collaborate with the clinical informatics fellows. And, the OHSU clinical informatics program was one of the first in the country to issue Maintenance of Certification (MOC-II) credits for continuing medical education.

Part technical expert, part clinician

Dr. Mohan explained that the field of informatics explores how data flow, but also how clinicians and patients use them. “As an internist I am acutely aware of the clinician-patient interaction, and how clinicians interact with each other and with patients’ families. But as an informatician, I see the entire interconnected web of technology and people and the intricate network of information that flows all around us,” he said.

Logically, the electronic health record is a common focus for informatics experts. They have a unique perspective on how to improve care delivery with technology, while also humanizing what is a commonly cited source of stress for clinicians. For example, Jeff Gold, M.D., professor of medicine, and medical informatics and clinical epidemiology, OHSU School of Medicine, conducts research through simulation on how clinicians use Epic in order to improve their experience, as well as improve EHR training and software. He has collaborated with Dr. Mohan in this area. Learn more in this 2018 Professionalism Week presentation.

One of the executive positions clinical informaticians strive for is that of chief health information officer. At OHSU, Cort Garrison, M.D., M.B.A., fills the leadership role. He is also associate director of the clinical informatics fellowship program. Dr. Garrison is helping implement “sprints” throughout clinics in the OHSU Practice Plan. His systems approach to a clinic workflow allows him to see solutions to the everyday stressors experienced by a busy physician, medical assistant or practice manager. Ultimately, sprints aim to increase clinician engagement and well-being.

Alumni of the clinical informatics fellowship are putting their skills to work for the growing OHSU health system. Ani Chintalapani, M.D. F ’18, is now a clinical informaticist at Tuality Healthcare and a member of the Tuality Division of Hospital Medicine. He was integral to the Epic go-live at Tuality, providing “elbow support” to physicians getting to know the EHR and being a liaison between clinicians and the information technology group.

Dr. Chintalapani said learning the importance of systematic and evidence-based approaches to solutions during his OHSU clinical informatics training prepared him well for his current role. “IT in health care is still very much a human endeavor,” he said. “Your ability to succeed in this field depends on how well you can connect with people and navigate an organizational landscape.”

The go-live means the OHSU and Tuality EHR will ultimately integrate seamlessly, making for better patient care and an enhanced clinician experience – something any clinical informatician is happy to see.


More about the OHSU clinical informatics fellowship program

  • Launched in 2015
  • Celebrated its first graduates in June 2017
  • Six fellows at any given time (a two-year program)
  • Open to physicians in any board-certified specialty
  • Program fellows maintain up to 20 percent FTE in their primary clinical specialty