The Core Content for Clinical Informatics defines the boundaries of the discipline and informs the Program Requirements for Fellowship Education in Clinical Informatics. The Core Content includes four major categories: fundamentals, clinical decision making and care process improvement, health information systems, and leadership and management of change. The AMIA Board of Directors approved the Core Content for Clinical Informatics in November 2008.
The Core Content for a medical subspecialty defines the boundaries of the discipline and informs the Program Requirements for Fellowship Education. Program Requirements identify the knowledge and skills that must be mastered through the course of fellowship training and specify accreditation requirements for training programs.1 The American Board of Medical Specialties considers these two documents along with other requirements and factors when deciding whether to establish a new medical subspecialty. The Core Content for Clinical Informatics is the result of a two-year national development process initiated by the American Medical Informatics Association and supported by the Robert Wood Johnson Foundation.2 In November 2008, the AMIA Board of Directors approved both the Core Content and Program Requirements for clinical informatics.
Definition and Description of the Subspecialty
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.
Clinical informaticians use their knowledge of patient care combined with their understanding of informatics concepts, methods, and tools to:
assess information and knowledge needs of health care professionals and patients,
characterize, evaluate, and refine clinical processes,
develop, implement, and refine clinical decision support systems, and
lead or participate in the procurement, customization, development, implementation, management, evaluation, and continuous improvement of clinical information systems.
Physicians who are board-certified in clinical informatics collaborate with other health care and information technology professionals to promote patient care that is safe, efficient, effective, timely, patient-centered, and equitable.
As illustrated in Figure 1, clinical informatics encompasses three spheres of activity:
clinical care (i.e., the provision of clinical services to an individual patient),
the health system (i.e., the structures, processes, and incentives that shape the clinical care environment; this includes major health domains such as public health, population health, personal health, health professional education, and clinical research, in addition to clinical care),
information and communications technology (i.e., the tools that enable the efficient capture, delivery, transmission, and use of data, information, and knowledge and the knowledge of how to apply those tools effectively).
Clinical informaticians work at the intersection of these three domains, and must demonstrate mastery of:
the field of informatics,
the health care environment, including how business processes influence health care delivery and the flow of data among the major domains of the health system,
how information systems and processes enhance or compromise the decision making and actions of health care team members,
re-engineering health care processes,
fundamental information system concepts, including the life cycle of information systems, the constantly evolving capabilities of information technology and health care, and the technical and nontechnical issues surrounding system implementation,
how clinical information systems impact users and patients, how to support clinician users, and how to promote clinician adoption of systems,
evaluation of information systems to provide feedback for system improvement,
leadership in organizational change, fostering collaboration, communicating effectively, and managing large scale projects related to clinical information systems.
The core content for the subspecialty of clinical informatics comprises four major categories that must be mastered.
The first core content category comprises basic knowledge that provides clinical informaticians with a common vocabulary and understanding of the environment in which they function.
Clinical informaticians draw from the broader field of biomedical and health informatics as they apply informatics methods, concepts, and tools to the practice of medicine. Thus, they must understand the culture, boundaries, and complexities of the field. Further, the stakeholders, structures, and processes that constitute the health system affect the information and knowledge needs of health care professionals and influence the selection and implementation of clinical information processes and systems. The flow of data, information, and knowledge among the various domains of the health system also creates important challenges for clinical informaticians as many of the data used in public health, personal health management, and clinical research originate in the clinical domain and reside in clinical information systems.
Clinical Decision Making and Care Process Improvement
The second core content category comprises knowledge and skills that enable a clinical informatician to implement effective clinical decision making systems and participate in the development of clinical processes that support effective, efficient, safe, timely, and equitable patient-centered care.
A primary goal of clinical informaticians is to strengthen clinical decision making by health care professionals and patients and to support and improve clinical care processes. This goal depends on implementing systems that support clinical objectives and, when necessary, identifying changes needed in clinical processes to take full advantage of clinical information system capabilities.
A range of theoretical and practical issues must be addressed in the development and implementation of clinical decision support tools. The cognitive and scientific underpinnings of medical decision making must be understood to capitalize on information system capabilities in improving clinical processes. Design of robust clinical information systems and processes relies upon knowledge management principles in acquiring, generating, representing, modeling, and maintaining information to support clinical decision making. Further, to achieve the full benefits of information systems and processes, clinical informaticians must be able to conceptualize improvements in clinical processes and decision making and collaborate with their clinical colleagues as well as information technology professionals to implement changes in the information systems and clinical processes.
Health Information Systems
The third core content category comprises knowledge and skills that enable a clinical informatician to participate in the development or selection of an information system for clinicians, prepare clinicians before implementation and support them during implementation and ongoing operation of a clinical information system, and evaluate the effectiveness of a system in meeting clinical needs.
Clinical informaticians need to assess the advantages and disadvantages of various technological approaches and determine the best fit for the clinical environment. They also need a common vocabulary and shared knowledge base to collaborate with information technology personnel. Since the quality of clinical data directly affects the effectiveness of information systems and clinical decision support tools as well as the reliability of clinical research that depends on those data, clinical informaticians work with interdisciplinary teams to ensure that the data used to make clinical decisions meet state-of-the-art standards.
Information systems are not limited to hardware and software; they include people, processes, and policies that support the use of the technology. Thus, clinical informaticians must address these components as part of system analysis (planning) and implementation. System evaluation is required to determine whether a clinical information system is meeting its goals. Clinical informaticians need to understand the full range of issues related to evaluation so that they can determine the appropriate evaluative methods and provide feedback for successful information system implementation and use.
There are myriad health information systems and these systems are constantly evolving. Thus, the Core Content identifies the common elements of health information systems used in different clinical settings and does not include an exhaustive list of clinical information systems.
Leadership and Management of Change
The fourth core content category comprises knowledge and skills that enable clinical informaticians to lead and manage changes associated with the introduction and adoption of clinical information systems.
Successful implementation of information systems requires behavioral, cultural, and social change within an organization. Thus, clinical informaticians require knowledge and skills in understanding and analyzing organizational culture, planning organizational change, building and working in effective multidisciplinary teams, and leading information system development and implementation. Clinical informaticians must be able to listen, understand needs, articulate plans, explain rationales, inform constituents, report results, and foster collaboration. They must relate clinical information system needs and plans to larger organizational strategic goals and be proficient in project management to oversee the implementation of new systems and processes.
Fundamentals: The basic knowledge that provides clinical informaticians with a common vocabulary and understanding of the environment in which they function.
The discipline of informatics
Definitions of informatics
History of informatics (e.g., evolution of health records)
Domains/subspecialties of informatics
Careers in informatics
Current and future challenges for informatics
Key informatics concepts, models, and theories
Clinical informatics literature
Critical analysis of informatics literature
International clinical informatics practices
Ethics and professionalism
Legal and regulatory issues
The Health System
Determinants of individual and population health
Primary domains, organizational structures, cultures, and processes
Health care delivery
Education of health professionals
The flow of data, information, and knowledge within the health system
Policy & regulatory framework
Health economics and financing
Forces shaping health care delivery
Institute of Medicine quality components
Clinical Decision Making and Care Process Improvement: The knowledge and skills that enable a clinical informatician to implement effective clinical decision making systems and participate in the development of clinical processes that support effective, efficient, safe, timely, equitable, and patient-centered care.
Clinical Decision Support
The nature and cognitive aspects of human decision making
Utility and preference assessment
Cost effectiveness analysis
Test characteristics (e.g., sensitivity, specificity, predictive value)
Application of clinical decision support
Types of decision support (e.g., alerts, reminders, prompts)
Users of decision support (including clinicians and patients)
Implementing, evaluating, and maintaining decision support tools
Transformation of knowledge into clinical decision support tools
Knowledge management and maintenance
Legal, ethical, and regulatory issues
Quality and safety issues
Supporting decisions for populations of patients
Evidence-based Patient Care
Implementation of guidelines as clinical algorithms
Information retrieval and analysis
Critical analysis of biomedical literature
Clinical Workflow Analysis, Process Redesign, and Quality Improvement
Methods of workflow analysis
Principles of workflow re-engineering
Quality improvement principles and practices
Health Information Systems: The knowledge and skills that enable a clinical informatician to participate in the development or selection of an information system for clinicians; prepare clinicians prior to implementation and support them during implementation and ongoing operation of a clinical information system; and evaluate the effectiveness of a system in meeting clinical needs.
Information Technology Systems
Data and control structures
Software development methods (e.g., agile, waterfall, spiral, rapid prototyping)
Information systems design and analysis (e.g., logical schema, normalization/denormalization, process modeling)
Systems (e.g., distributed, centralized, relational, object oriented, warehouses/data marts)
The HIPAA Security Rule and other government regulations
Virtual private networks
Manipulation (e.g., querying, SQL, reporting)
Representation and types
Data mining and knowledge discovery
Technical approaches that enable sharing data
Integration versus interfacing
Dealing with multiple identifiers
Anonymization of data
Human Factors Engineering
Models, theories, and practices of human-computer (machine) interaction (HCI)
HCI Evaluation, usability testing, study design and methods
Interface design standards and design principles
Health Information Systems and Applications
Types of functions offered by systems
Types of settings where systems are used
Electronic health/medical records systems as the foundational tool
Clinical Data Standards
Standards development history and current process
Data standards and data sharing
Nomenclatures, vocabularies, and terminologies
Ontologies and taxonomies
Information System Lifecycle
Institutional governance of clinical information systems
Clinical information needs analysis and system selection
Methods for identifying clinician information system needs
Assessment of clinical process changes that will be required
Elements of a system requirements specification document (e.g., technical specifications, intellectual property, patents, copyright, licensing, contracting, confidentiality, specific organizational needs such as user training and support)
Risk analysis and mitigation
The costs of health information and communications technologies
Clinical information system implementation
Elements of a system implementation plan
Models of user training and support processes that can meet clinician needs
Processes and mechanisms that obtain and respond to clinician feedback
Clinical information system testing, before, during and after implementation
Clinical information system maintenance
Disaster recovery and downtime
Clinical information system transitions and decommissioning of systems
Clinical information system evaluation
Outcomes relevant to the clinical goals and quality measures
Qualitative and quantitative methods for evaluating clinical information systems
Evaluation plan design
Leading and Managing Change: The knowledge and skills that enable clinical informaticians to lead and manage changes associated with implementing clinical information systems and promoting adoption by health professionals.
Leadership Models, Processes, and Practices
Dimensions of effective leadership
Governance (e.g., processes; responsibility versus authority)
Effective Interdisciplinary Teams
Human resources management (e.g., hiring, performance reviews and feedback, professional development, termination)
Team productivity and effectiveness (e.g., articulating team goals, defining rules of operation, clarifying individual roles)
Group management processes (e.g., nominal group, consensus mapping, Delphi method)
Managing group deliberations
Effective presentations to groups
Effective one-on-one communication
Writing effectively for various audiences and goals
Developing effective communications program to support system implementation
Project management tools (non-software specific)
Informatics project challenges
Balancing competing priorities
Strategic and Financial Planning for Clinical Information Systems
Establishing mission and objectives
Action planning and strategy implementation
Capital and operating budgeting
Principles of managerial accounting
Evaluation of planning process
Assessment of organizational culture and behavior
Change theories (e.g., precede-proceed, social influence theories, complex adaptive systems)
Change management strategies
Strategies for promoting adoption and effective use of clinical information systems