Informatics Training: Why Do We Keep Missing This?
On March 9, 2020, the Office of the National Coordinator for Health Information Technology (ONC) finalized a historic rule that fulfilled many of the provisions in the 21st Century Cures Act aimed at advancing our nation’s health information technology and reducing clinician burnout. However, their initiatives on improving the usability of electronic health records (EHRs) falls short of the larger problem: a lack of informatics training. Solutions designed to reduce burnout attributable to EHRs are usually focused on either federal policy or the EHR vendor, but never on the individuals that actually design, build, and implement these systems. Existing health informatics training programs are inadequate and contribute to the clinician burnout epidemic. Our elected officials should be focusing on policy that upskills our informatics workforce.
My thought is that existing solutions have predominantly focused on federal policy or health information technology (IT) vendors, but never the frontline workers: the informaticists. Despite the amount of pressure federal policies place on health information technology vendors to make their tools more user friendly, EHRs are highly configurable and poorly trained informaticists can easily negate all of the work done by health IT vendors at the local level.1,2 I also believe that we are still learning how to develop and implement effective informatics training programs. Widespread adoption of EHRs is still relatively new and it was not until passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009 that this technology began to take off in the United States. In fact, in a recent review of health informatics training programs, it was determined that they do not currently meet the standards needed by healthcare systems today.3 This is not a surprise when one of the key issues that were identified include a lack of agreement by multiple informatics organizations on the core set of competencies required of informaticists.3 I also think it is important that informaticists have some level of clinical training before specializing in information technology as they will be designing the tools that clinicians use. Unfortunately, informatics is not commonly embedded into the curriculums of our professional schools (e.g. pharmacy) and future informatics pharmacists end up learning on the job.4 Though, even if clinicians did receive informatics training during their professional education, the lack of access and training to proprietary tools from health IT vendors makes it difficult to cement their didactic coursework.3
As the clinician burnout crisis continues to brew, we really should be upskilling an informatics workforce that can tackle the technology challenges in our healthcare world today. Given the historic policy solutions that have been aimed at tackling this, politicians should be made aware of these issues and draft legislation that can better address the burnout issue.
References
Committee on Systems Approaches to Improve Patient Care by Supporting Clinician Well-Being, National Academy of Medicine, National Academies of Sciences, Engineering, and Medicine. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. Washington, D.C.: National Academies Press; 2019:25521. doi:10.17226/25521
Zhang Z, Franklin A, Walji M, Zhang J, Gong Y. Developing Analytical Inspection Criteria for Health IT Personnel with Minimum Training in Cognitive Ergonomics: A Practical Solution to EHR Improving EHR Usability. AMIA Annu Symp Proc. 2014;2014:1277-1285.
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):p10. doi:10.5430/jha.v5n5p10
Fox BI, Flynn AJ, Fortier CR, Clauson KA. Knowledge, Skills, and Resources for Pharmacy Informatics Education. Am J Pharm Educ. 2011;75(5):93. doi:10.5688/ajpe75593