Journal:Beyond information retrieval and electronic health record use: Competencies in clinical informatics for medical education

Full article title	Beyond information retrieval and electronic health record use: Competencies in clinical informatics for medical education
Journal	Advances in Medical Education and Practice
Author(s)	Hersh, William R.; Gorman, Paul N.; Biagioli, Frances E.; Mohan, Vishnu; Gold, Jeffrey A.; Mejicano, George C.
Author affiliation(s)	Oregon Health & Science University, Portland, OR, USA
Year published	2014
Volume and issue	2014 (5)
Page(s)	205—212
DOI	10.2147/AMEP.S63903
ISSN	1179-7258
Distribution license	Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported
Website	https://www.dovepress.com/

Abstract

Physicians in the 21st century will increasingly interact in diverse ways with information systems, requiring competence in many aspects of clinical informatics. In recent years, many medical school curricula have added content in information retrieval (search) and basic use of the electronic health record. However, this omits the growing number of other ways that physicians are interacting with information that includes activities such as clinical decision support, quality measurement and improvement, personal health records, telemedicine, and personalized medicine. We describe a process whereby six faculty members representing different perspectives came together to define competencies in clinical informatics for a curriculum transformation process occurring at Oregon Health & Science University. From the broad competencies, we also developed specific learning objectives and milestones, an implementation schedule, and mapping to general competency domains. We present our work to encourage debate and refinement as well as facilitate evaluation in this area.

Keywords: curriculum transformation, clinical decision support, patient safety, health care quality, patient engagement

Introduction

Physicians and medical students have been using health information technology (HIT) for decades. During this time, the role of HIT has changed dramatically from a useful tool for data access and occasional information retrieval to a ubiquitous presence that permeates health care and medical practice in myriad ways. As the use of HIT has accelerated and the underlying science of biomedical and health informatics has advanced, medical education has lagged behind, leaving physicians and students alike to learn largely on their own how to make use of these tools. While some medical schools have introduced limited aspects of biomedical informatics into their curricula, most of this is focused on training to perform basic tasks such as accessing knowledge resources or basic use of an electronic health record (EHR).

Twenty-first century clinicians face a much more digital world than their predecessors. The quantity of biomedical knowledge continues to expand, with an attendant increase in the primary scientific literature. Secondary sources that summarize this information proliferate as well, not only for use by clinicians but also by patients and consumers. Programs such as the “meaningful use” financial incentives of the Health Information for Technology and Clinical Health Act require comprehensive adoption and use of the EHR. Patients, especially the aging “baby boomer” generation, want to interact with the health care system the same way they interact with airlines, banks, and retailers, ie, through digital means using technologies such as the personal health record. Patients, payers, and purchasers demand more accountability in health care quality, safety, and cost, leading to an expectation of measurement and reporting of quality of care as a routine part of participation in new delivery mechanisms such as primary care medical homes and accountable care organizations. At the same time, telemedicine applications extend the reach of health care systems and clinicians in both rural and urban settings. Ideally, for all of these applications, patient data must move readily across organizational boundaries via health information exchange, while privacy and confidentiality are protected. The growing quantity of clinical and administrative data in these systems also affords an opportunity for advanced analysis that can enable better deployment of resources and coordination of care, facilitation of personalized and precision medicine, and advancement of clinical and translational research. Together, these advances are moving health care toward the global vision of the learning health system put forth by the Institute of Medicine (IOM).

The importance of these developments is further evidenced by the recent establishment of a new medical subspecialty of clinical informatics. Practicing physicians are now beginning to become board-certified in this new subspecialty, with fellowship programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) to soon be established. This underscores the need for medical students to be introduced to the concepts and competencies of this new medical subspecialty as part of the undergraduate curriculum.

In this paper, we describe our work to expand the undergraduate medical curriculum to include a comprehensive set of competencies in clinical informatics. We go beyond the usual focus on information retrieval from knowledge sources and data access through the EHR, aiming to address the expanded and diverse roles of HIT in contemporary health care delivery, personal health, public health, and clinical and translational research. We describe the development of a novel biomedical informatics curriculum that is being implemented within a comprehensive transformation of the undergraduate curriculum at our institution. Our future plans include evaluation of the impact of this work, and we encourage others to participate in this evaluation and refinement process.

Previous work developing competencies in informatics

The need to include biomedical informatics in medical education has been recognized in previous publications of competencies, curricula, and other learning materials for informatics. One early, high-profile resource was part of the Medical Student Objectives Project of the Association of American Medical Colleges, which framed proposed objectives in terms of five key roles of physicians: clinicians, life-long learners, educators, researchers, and managers. Although current medical students believe these objectives are important to their education, uptake of these objectives has been modest.

More recently, the Alliance for Clinical Education issued a policy statement calling for competencies related to the EHR,14 although also noting that many challenges to implementing such competencies exist.15 Others have also noted the challenges to education about the EHR, citing problems analogous to those of clinicians incorporating EHRs into practice, such as integration into workflows, and concerns about unanticipated and undesirable impacts.16 It is clear, however, that competencies in the use of the EHR are aligned with more general physician educational competencies,17,18 and that informatics curricula can be incorporated into undergraduate medical training19,20 and evaluated.21

14.

Hammoud MM, Dalymple JL, Christner JG, et al. Medical student documentation in electronic health records: a collaborative statement from the Alliance for Clinical Education. Teach Learn Med. 2012;24(3):257–266.

15.

Hammoud MM, Margo K, Christner JG, Fisher J, Fischer SH, Pangaro LN. Opportunities and challenges in integrating electronic health records into undergraduate medical education: a national survey of clerkship directors. Teach Learn Med. 2012;24(3):219–224.

16.

Ellaway RH, Graves L, Greene PS. Medical education in an electronic health record-mediated world. Med Teach. 2013;35(4):282–286.

17.

Tierney MJ, Pageler NM, Kahana M, Pantaleoni JL, Longhurst CA. Medical education in the electronic medical record (EMR) era: benefits, challenges, and future directions. Acad Med. 2013;88(6):748–752.

18.

Pageler NM, Friedman CP, Longhurst CA. Refocusing medical education in the EMR era. JAMA. 2013;310(21):2249–2250.

19.

Silverman H, Cohen T, Fridsma D. The evolution of a novel biomedical informatics curriculum for medical students. Acad Med. 2012;87(1):84–90.

20.

Milano CE, Hardman JA, Plesiu A, Rdesinski RE, Biagioli FE. Simulated electronic health record (Sim-EHR) curriculum: teaching EHR skills and use of the EHR for disease management and prevention. Acad Med. 2014;89(3):399–403.

21.

Reis S, Sagi D, Eisenberg O, et al. The impact of residents’ training in Electronic Medical Record (EMR) use on their competence: report of a pragmatic trial. Patient Educ Couns. 2013;93(3):515–521.

Notes

This presentation is faithful to the original, with only a few minor changes to presentation. In several cases the DOI and PubMed ID was missing and was added to make the reference more useful.