Why All Clinicians Should Learn to Code

Coding as an Informatics Pharmacist

I’m an informatics pharmacist that graduated in 2013 but did my PGY-1 in Pharmacy Practice in 2013 and PGY-2 in Pharmacy Informatics in 2014. Thus, I officially started my full-time career as an informatics pharmacist in 2015. I wanted to write about my thoughts on coding and likely share some of my insights along the way as I develop my coding skills because one of the most common questions I get from students interested in informatics is:

“Do I need to learn to code to be an informatics pharmacist?”

My answer is always a resounding, “No”. I certainly think it’s helpful, but I don’t think it’s required. In fact, after 6 years of practicing in pharmacy informatics, I have not once needed to code. However, this answer should be explored further as I also have a coding background and can confidently tell you that it has helped me in my design, build, and implementation of electronic health records (EHR). I’ll quantity my experience below in a few paragraphs, but my sincerest apologies as — I get a bit carried away here with my tangential memories of gaming :).

Previous coding experience

So, when did I first start coding? It’s debatable (don’t @ me), but you can say that I was able to dabble in the foundations of coding in middle school when I was 11 or 12 when I picked up a copy of StarCraft. I really enjoyed designing things and also loved role-playing games (RPGs) at the time so I would use the custom map editor in StarCraft to design mini-RPGs. In doing so, I was first introduced to the concept of “conditions” and “triggers”. You could essentially insert conditions in various places in the map and subsequently create a list of triggers that would occur. So if you wanted to make a group of marines come to support you when you’re at a given checkpoint in the map, it’s just a simple condition: 

If “player enters zone A”. 

Then “move a group of marines from zone B to zone A”. 

A single RPG could have hundreds to thousands of these conditions and triggers — and thus, my interest in “programming” began. 

In high school, we were able to choose different specializations so we could better prepare ourselves for college and consequently our future careers. Unsurprisingly, I chose computer programming. I ended up taking 2 years of C++, a year of Oracle and dabbled in a bit of HTML as I was building out websites for my StarCraft and WarCraft obsessions. Though, after high school is where this all stopped as I switched from computer programming to pharmacy after I finished my first year in college. I did briefly come across a bit of programming during my residency years on my reporting rotations where I worked with SQL via crystal reports and Epic Clarity during my PGY-1 and PGY-2, respectively. But nothing since then. 

So why code now?

Ah yes, great question! Thanks for reminding me. 

So, it’s probably not uncommon that we all learn things in school and think to ourselves, “what’s the point of this?”. Can you relate? The thing is, education at an early age is meant to confer knowledge and to increase your awareness of a given topic. It’s not only until you’re working that you begin to learn to apply certain things that you’ve learned about in the past. After graduating from my MPH in May of 2020, this is something that I personally experienced as well as I constantly had these “ohhh now I understand why” moments during my day job. Plenty of other classmates said the same thing too. Now, it’s easy to see why some master’s programs want their students to have a few years of work experience before matriculation. Anyways…

Long story short (lol) — I didn’t really recognize how applicable learning to code would be for me professionally until the last 2 or 3 years. Aside from the hype around artificial intelligence in healthcare, I’m just fascinated with how much potential there is to tackling the interoperability problems that exist in our healthcare systems. If you didn’t already know, my professional goal in life is to connect all the healthcare data in the world so that patients, if they so choose, can have comprehensive integration of all their health records at their fingertips — regardless of where it’s from(e.g. hospitals, private clinics, insurance, pharmacies, etc). 

To be even more specific (lol x 2), I just finished week 2 in this R Programming course taught by Johns Hopkins University. The R programming course is course 2 of 10 in their data science specialization and I’m just blown away. It’s week 3 of the course and I’ve spent about 15 hours total doing the coursework and going through the coding exercises, but I’ve already learned how to aggregate large volumes of data, remove missing values, and perform multiple types of statistical analysis on it. As I’m working through it, I’m just constantly thinking: 

“The amount of value coding can bring in tackling things like building data warehouses for COVID-19 surveillance is quite high. 

In my day job, I’ve spent a lot of time building the tools to abstract discrete data elements from the EHR and create HL7 C-CDAs for submission to external agencies like the NHSN (reporting arm of CDC). However, to see how easy it was (oversimplification) to grab these types of files from different sources and aggregate them was very rewarding to me. Btw — it was also only 9 lines of code I wrote to perform these functions. 

Parting thoughts

A clinically-trained individual is one thing and a technically-trained individual is another. But as Aristotle once said, "The whole is greater than the sum of its parts". To merge those two skillsets together is a powerful thing. It’s not a novel thought by any means, but I think my perspective has changed a bit from the original thinking above to: 

No, it’s not required, but you — or anyone else in a clinical role — should learn to code. 

Our healthcare system is extremely expensive for the amount of value we get relative to the cost. I’d venture to guess, that the more clinicians we can get to code, the higher our likelihood of finding innovative solutions in tackling the triple aim: improved care experience, improved health of populations, and reduced per capita costs of healthcare.