Building Informatics Competencies: A Missed Opportunity

Clinician burnout has been one of the most widely discussed public health issues ever since the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 20091. The rapid and widespread adoption of electronic health records (EHRs) in the United States have been heavily criticized for eroding the patient-provider relationship, increasing documentation burden to fulfill Meaningful Use legislation, and decreasing the autonomy previously experienced by providers2. Unsurprisingly, EHRs have been identified as one of the key predictors in the burnout epidemic3.

As the evidence builds for associating EHRs and clinician burnout, three key areas have been recognized by a recent report from the Office of the National Coordinator (ONC) for Health Information Technology on strategies to reduce burden related to EHRs: documentation burden, usability, and interoperability4. The 74-page report goes into detail about the issues and expands on potential solutions ranging from revamping payment policy (e.g. evaluation & management codes) to encouraging software vendors to design more intuitive systems. However, a key stakeholder in this discussion appears to be missing: the informaticians implementing these EHRs.

To assist the nation in implementing EHRs, HITECH provided $120 million in funding towards training health informatics professionals5. Unfortunately, it would appear as though the existing informatics workforce fails to meet the expectations and demands of our current electronic environment5,6. More importantly, one may question whether we are ready to tackle the three aforementioned areas given the inadequacy of our existing workforce. The complete omission of this issue within the ONC report is also quite concerning. Albeit, creating and designing informatics curricula is not a simple task and developing competent healthcare informaticians is even more difficult. While there are many challenges that can be discussed, three are worthy to mention. The first of which is defining the core competencies required of health informatics professionals6. As evidenced by multiple groups attempting to tackle this issue including the Technology Informatics Guiding Education Reform (TIGER), ONC, and the American Medical Informatics Association (AMIA) to name a few, this issue still persists6. Secondly, the pace at which technology advances adds to this complexity6. Lastly, one of the key challenges is the heterogeneity of the trainees knowledge and skills5. While information technology professionals may possess the technical skills, they lack the clinical competencies. Similarly, while clinicians possess medical knowledge, they lack the technical skills. Even if different tracks are created to better align with a trainee’s background, the current vendor-dominated landscape makes it difficult to allow practical training opportunities in which the vendor’s software could be used for practice and skills development5.

In conclusion, while there have been monumental and directed efforts towards reforming reimbursement policy and vendor solutions, there have been an extremely dismal amount of attention towards increasing the knowledge, skills, and education of the individuals that build, maintain, and optimize these information systems. In my opinion, this appears to be a missed opportunity and one that will hopefully be recognized as a gap and addressed soon.

References

1. Colicchio TK, Cimino JJ, Del Fiol G. Unintended consequences of nationwide electronic health record adoption: Challenges and opportunities in the post-meaningful use era. J Med Internet Res. 2019;21(6):1-9. doi:10.2196/13313

2. Shanafelt TD, Dyrbye LN, Sinsky C, et al. Relationship Between Clerical Burden and Characteristics of the Electronic Environment With Physician Burnout and Professional Satisfaction. Mayo Clin Proc. 2016;91(7):836-848. doi:10.1016/j.mayocp.2016.05.007

3. Gardner RL, Cooper E, Haskell J, et al. Physician stress and burnout: the impact of health information technology. J Am Med Informatics Assoc. 2018;26(December 2018):106-114. doi:10.1093/jamia/ocy145

4. The Office of the National Coordinator for Health Information Technology. Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs.; 2020. https://www.healthit.gov/sites/default/files/page/2018-11/Draft Strategy on Reducing Regulatory and Administrative Burden Relating.pdf. Accessed March 2, 2020.

5. Khairat S, Sandefer R, Marc D, Pyles L. A review of biomedical and health informatics education: A workforce training framework. J Hosp Adm. 2016;5(5). doi:10.5430/jha.v5n5p10

6. Sapci AH, Sapci HA. Teaching Hands-On Informatics Skills to Future Health Informaticians: A Competency Framework Proposal and Analysis of Health Care Informatics Curricula. JMIR Med Informatics. 2020;8(1):e15748. doi:10.2196/15748