Sounding Board: Career Makeover: Medicine Moves to IT

Most physicians choose clinical medicine because they want to make a positive impact on patients’ health. Tom Wessel, MD, is no exception. And that’s the reason he left the bedside.

"I saw that through information technology (IT), I could improve clinical care for more patients than I could through one-on-one practice,” says Wessel, who left his family medicine practice four years ago to become Medical Information Officer at Spartanburg Regional Healthcare System in Spartanburg, SC. Wessel joined an increasing number of physicians who straddle the clinical information technology divide as clinical informaticians (or “informaticists”). The demand for physicians with expertise in informatics is being fueled by the widespread adoption of electronic medical records (EMRs) and the recognition of the critical role of IT in patient safety. The result has been new career possibilities for informaticssavvy clinicians. “Virtually every hospital, clinic, physician office, or other healthcare provider organization will in some way utilize [IT] solutions in the coming years and will need healthcare professionals versed in informatics to assist with the implementation, use, and success of these systems,” said American Medical Informatics Association (AMIA) President and CEO Don Detmer, MD, in an article in the December 2006 ACP Observer.

Physician leadership is a critical factor in the successful implementation of healthcare IT projects, which ensures that physicians like Wessel will remain at the forefront of clinical IT design and adoption. For this reason, the chief medical information officer (CMIO) has become a key executive in many healthcare organizations. The CMIO has been aptly described as the person “at the nexus of executive, medical, and technology leadership,” according to the November 2006 issue of Radiology Today.

Simply the Best

A study published in 2006 in the Journal of the American Medical Informatics Association, identified the ideal CMIO as someone who is: “credible as a good clinician and not viewed as a ‘techie doctor’ who is only knowledgeable about computers; an effective communicator across services and disciplines; an effective consensus builder; and knowledgeable of hospital operations.” Of the five prominent CMIOs interviewed for this study, four continue to provide part-time patient care. All had been involved in a clinical IT project prior to assuming their current roles, and every one of them possesses executive leadership skills and experience. Only one, however, had completed a full-time medical informatics training program.

Although the CMIO may be an organization’s most visible informatician, there are many other opportunities available to physicians with interest and expertise in informatics. “I think there’s a range of opportunity. There’s definitely an emerging role for clinicians who want to make it their primary career activity, who really want to transition,” says William Hersh, MD, Professor and Chair, Department of Medical Informatics and Clinical Epidemiology at Oregon Health and Science University (OHSU).

But Hersh foresees a wider range of potential involvements: “Everything from the clinician who essentially is going to change his or her career so that informatics is their primary job responsibility to more intermediate liaison positions... where they’re still predominantly a practitioner but they have enough informatics skills that they can serve as liaison” between the clinical and IT departments.

Wessel agrees that a good introductory position for physicians interested in informatics is as a part-time liaison between clinicians and IT staff . He suggests that physicians who have extensive clinical experience will likely bring the most to such a position, since these clinicians are often best qualifi ed to communicate their colleagues’ needs to IT leaders and developers. The tradeoff , he cautions, is the need to balance clinicians’ expectations with what is actually available.

David Hall, MD, began in such a part-time IT liaison role, but soon found a transition to full-time informatics irresistible. Hall, an internist-pediatrician, left his practice to become Physician Informatics Specialist for OSF Healthcare in Peoria, IL. He saw informatics as a field that, although still in its infancy, would ultimately change the way that healthcare is practiced. Says Hall, “To be part of this opportunity was something I couldn’t pass up. I knew I would regret it if I did.”

In his current position, Hall works to enhance the enterprise’s EMR system, develop standardized order sets in anticipation of a projected computerized provider order entry (CPOE) rollout, and analyzes data from OSF’s seven hospitals to craft quality improvement initiatives. He summarizes his activities as “providing clinical expertise to a very technical world.”

Minimum Requirements

What skills do interested physicians need to successfully transition to a career in clinical informatics? According to Hersh, “Physician-IT leaders need… a baseline understanding of the technology, but that’s only a part of it. Th ey also need to have organizational skills, political skills. They must be able to work with people, and possess knowledge of informatics and what the major issues are in informatics— standards and interoperability of systems and other national initiatives.” Many physicians will likely find themselves inadequately prepared, however, since most of these skills are ignored in traditional medical education. Fortunately, help is available.

Wessel recommends involvement in AMIA, an organization dedicated to the development and application of biomedical and health informatics in support of patient care, teaching, research, and healthcare administration. AMIA offers a variety of educational resources and networking opportunities to its members. In fact, Wessel initially joined the organization so he could associate with other physicians who were also doing what he wanted to do. Membership helped him evaluate if a similar role would be a good fit for him. One particularly popular resource for new and potential physician informaticians is AMIA’s “10x10” training initiative. Hersh is one of the originators of the program, and is the course director of the “10x10” program at OHSU.

According to Hersh, “The course came about because the AMIA recognized that there are not enough clinician leaders in hospitals and other healthcare settings who can be that link between the clinical and the IT.” AMIA created the program with a goal of training 10,000 healthcare professionals in IT by the year 2010 (hence the term “10x10”). The courses, now also offered for credit by several other universities in partnership with AMIA, are conducted online, followed by a one-day, interactive, in-person session. 10 x 10 participants receive a broad introduction to informatics, including subjects such as personal health management; electronic and personal health records; health information exchange; standards and terminology; healthcare quality and error prevention; public health/population informatics; and translational bioinformatics. Participants are taught to develop solutions to problems in real-world settings (ideally their own) guided by established informatics principles.

Registration Begins Now

The National Library of Medicine sponsors a week-long biomedical informatics course each spring and fall at the Marine Biological Laboratory at Woods Hole, MA. This course is an excellent resource for physicians seeking to increase their knowledge and understanding of the field of medical informatics, as well as to meet and interact with other professionals in the field. Course participants receive an intensive introduction to all areas of clinical

informatics, taught by internationally recognized faculty from across the country.

Alumni of the course routinely cite its influence on their professional careers and on their involvement in a broad range of activities related to medical informatics. The Association of Medical Directors of Information Systems is another professional organization specifically for physicians interested in and responsible for healthcare IT. This

organization also offers symposia, a listserv, an online journal, online presentations, and networking opportunities. In addition some specialty organizations, such as the American Academy of Family Practice (AAFP) and the American College of Physicians (ACP), sponsor online informatics-related resources for their members.

Clinicians seeking more extensive training may be interested in a certifi cate or masters degree program in medical informatics or public health informatics. Increasing numbers of these programs are available in part or almost completely online, making them accessible to working professionals. Tanu Pandey, MD, practiced internal

medicine for fi ve years before enrolling in the Masters in Public Health Informatics program at the University of Illinois at Chicago. She chose the program, offered online, as a “route to expand my skills into public health, health

policy and administration, and clinical informatics.” Pandey, who “loves clinical practice too much to leave it completely,” says that enrolling in the program “was an awesome decision.” And although she doesn’t currently have any specific job in mind, she hopes her preparation will allow her to eventually combine her passion for clinical practice with her interest in IT.

Where can one find the ideal informatics job? Prospective candidates may want to start in their own backyards and explore opportunities at their current institutions. Hersh suggests resources such as AMIA’s online job bank. He also notes that headhunting firms are starting to either specialize in this area or add it to their repertoire, and

predicts that this trend will grow. Are there difficulties that a physician might anticipate when leaving clinical

practice for a job in informatics? The prospect of leaving the bedside represents a difficult dilemma for most physicians. Wessel was no exception. He took comfort from the American Medical Association’s (AMA) book, Leaving the Bedside, which helped him realize, “I wasn’t the only physician considering this.”

Wessel also mentions the ambiguous role in which informaticians may be viewed. “Other physicians may no longer see you as one of them, and IT professionals may view you as a person with authority but without any IT knowledge.” Hall found that he had to adjust to working within a “completely different workflow and environment” than when he practiced clinical medicine. “It’s definitely more of a business lifestyle than a physician

lifestyle. It’s quite different from what I had envisioned myself doing, for sure.” Hall offers the following advice to physicians considering making the move to IT: “Much of what I did in internal medicine involved delayed gratifi cation, such as reducing a patient’s risk of a myocardial infarction.Informatics is along those lines. You have to keep an eye on its promise for the future and where you’re heading.”

G. Stephen Nace: The Path Less Traveled

My interest in computing began with an introductory BASIC programming course I took in college. Then, as a resident in internal medicine, I renewed my interest in computing with an early Texas Instruments hobbyist computer. That was followed by a string of machines as the technology and prices improved. By the time I began practice as a nephrologist, I was familiar with the early electronic records systems then being used in the care of dialysis patients. I began writing simple database applications to help me manage my own patients, and started extending the system that was available in our dialysis unit. I attended some database programming seminars and continued developing simple EMRs.

When the Internet “happened,” I became an early adopter, by creating a website with links to online patient education material. Although I participated in the information systems committees of the integrated delivery system with which I was affiliated, I wanted to further expand my involvement in clinical informatics. For me, a career shift into academics was the best way to accomplish this.

I left private practice four years ago for my current position as a full-time faculty member in the Department of Medicine at the University of Illinois College of Medicine at Peoria. Here I have had ample opportunities to expand my interest and training in informatics by developing projects within the department and with the hospital and medical school. At the same time, I’m able to teach principles of clinical information management to residents and students, continue clinical practice, and develop a research program. With funding from the Agency for Healthcare Research and Quality, my colleague, Dr. Jim Graumlich, and I are evaluating the ability of health information technology to facilitate information transfer between physicians, pharmacists, and patients at transitions of care. For me, this has been the perfect position at this point in my career. I couldn’t be happier.

G. Stephen Nace, MD, is a member of MD Net Guide’s Editorial Board. He is also Assistant Professor of clinical medicine and Program Director at the Department of Medicine, University of Illinois College of Medicine in Peoria, IL.