Bob Marshall, MD, MPH, MISM, FAAFP, FAMIA Program Director,

Bob Marshall, MD, MPH, MISM, FAAFP, FAMIA Program Director, DoD/MAMC Clinical Informatics Fellowship INTRODUCTION TO CLINICAL INFORMATICS

Clinical Informatics Outline Definition Major areas of informatics What Informatics is and is not Areas of Informatics Clinical Informatics in depth Professional Organizations Examples of Informatics Expertise

Definition of Biomedical/Health Informatics (BM/HI) 1 of 2 According to the American Medical Informatics Association (AMIA), “Biomedical informatics (BMI) is the interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving, and decision making, motivated by efforts to improve human health.”1 Health Informatics is “the science, the how and why, behind health IT” according to the Centers for Disease Control and Prevention (CDC)2 Practitioners of BMI are usually called Informaticians (sometimes Informaticists) Often, the terms Biomedical Informatics (BMI) and Health Informatics (HI) are used Interchangeably or combined, as in BMHI or BM/HI. 3

Definition of Biomedical/Health Informatics (BM/HI) 2 of 2 "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." Gardner RM et al. Core Content for the Subspecialty of Clinical Informatics (From HIMSS website) “10% medicine, 10% technology, 80% sociology” Homer Warner

Short History of BMHI Informatics began to have an effect in the United States during the 1950’s Homer R. Warner, one of the fathers of medical informatics, founded the Department of Medical Informatics at the University of Utah in 1968 The American Medical Informatics Association was founded in 1988 by the merger of three health informatics organizations In 2002 and 2007, AMIA developed Core Competencies for BMHI the final set was published in 2010 In September, 2011, Clinical Informatics was approved by the Amer. Board of Medical Specialties as a board-certified clinical subspecialty 5

What Clinical Informatics Is We do Try to help folks use clinical systems more efficiently and effectively Voice clinical opinions/perspective on software and hardware selection Match workflow to software/hardware Help improve quality care/patient safety in any setting (by applying bullets 1, 3 & 5) Identify analytics (data/information) and how best to use it clinically (and for research) Serve as a bridge between IT/security folks and clinical end users

What Clinical Informatics Is Not We do not . Run the network Run the EHR, PACS or other clinical systems Configure computers (or ultimately decide what goes on them but we do recommend) Have anything to do with computer security decisions Run the Help Desk

Terminology Informatics Imaging Informatics Research Informatics Legal Informatics Biomedical and Health Chemoinformatics Bioinformatics (molecular) Medical Clinical Informatics (person) Public Health Informatics (population) {Field} Informatics

Major areas of application1: Translational Bioinformatics Clinical Research Informatics Clinical Informatics Consumer Health Informatics Public Health Informatics Population Health Informatics (often grouped under Public Health) 1: American Medical Informatics Association (AMIA)

Applied Clinical Informatics Military Clinical Informaticists generally work in what is called “Applied Clinical Informatics” This focuses on how the clinical informatics tools (EHR’s and such) are used to care for patients In most cases, work in the background to continually improve the systems we all use in patient care

Focus Areas for Clinical Informatics 1 of 2 Clinical Decision Support Computational Science and Analytics Security and Privacy Change Management System Adoption and Implementation IT Infrastructure 11

Focus Areas for Clinical Informatics 2 of 2 Terminology/Taxonomies Interoperability and Standards User Interface/User Experience (UI/UX) & Usability Learning Healthcare Systems/Research Patient Safety/Population Health Knowledge Management Transitions of Care/Disease Management

More Clinical Informatics Areas Imaging informatics (PACS, now areas like pathology and dermatology) Clinical Informatics “X” Informatics (pharmacy, primary care, etc.) or Clinical decision support Population health User experience (development, human factors) Patient engagement mHealth Interoperability and data standards/health information exchange Data reporting/descriptive analytics Data science/predictive/prescriptive analytics Value-based care (comparative effectiveness research)

Clinical Informatics Areas May overlap with: Bioinformatics (genomics) Population health, governance and policy (health informatics) Health information management (HIM) -historically focused on management of medical records. Translational medicine (translational bioinformatics)

Translational Bioinformatics Development of storage, analytic, and interpretive methods to optimize the transformation of increasingly voluminous biomedical data, and genomic data, into proactive, predictive, preventive, and participatory health End product is newly found knowledge that can be disseminated to a variety of stakeholders, including biomedical scientists, clinicians, and patients

Clinical Research Informatics The use of informatics in the discovery and management of new knowledge relating to health and disease Includes management of information related to clinical trials and also involves informatics related to secondary research use of clinical data

Consumer Health Informatics The field devoted to informatics from multiple consumer or patient views These include patient-focused informatics, health literacy and consumer education The focus is on information structures and processes that empower consumers to manage their own health – ex. health information literacy, consumer-friendly language, personal health records, and Internet-based strategies and resources

Public Health Informatics The application of informatics in areas of public health, including surveillance, prevention, preparedness, and health promotion Public health informatics and the related population informatics, work on information and technology issues from the perspective of groups of individuals

Organizations Healthcare Information and Management Systems Society (HIMSS) American Medical Informatics Association (AMIA) Association of Medical Directors of Information Systems (AMDIS) American Board of Preventive Medicine (ABPM)

Informatics Challenges and Goals Demonstrate value Clinical outcomes Financial outcomes/Return on Investment “Billable” service Improve usability Interoperability (standards and platforms) Predictive/prescriptive integration into practice DoD Information assurance (Cybersecurity) Change control (MHS Genesis as model) Portfolio standardization Test and deploy new capabilities Workforce MHS GENESIS Implementation/Optimization

Examples of Informatics Expertise Data Analysis Pretty much every research and/or QI/PI project at MAMC uses CI for data retrieval and analysis Workflow Analysis Health IT Training – GENESIS and other Natural Language Processing Machine Learning/Artificial Intelligence

More Examples Clinical Documentation Improvement AsUType and Dragon Macros HERMES (Survey tool) MHSG Optimization MHSG Implementation (it could have been worse)

Questions