William Hersh, MD, Professor and Chair, OHSU
Blog: Informatics Professor
Twitter: @williamhersh
While the clinical informatics physician subspecialty has been an excellent way to recognize the value of the informatics profession [1], there are clearly many important other professionals in the informatics field who deserve the same professional recognition for their knowledge and skills in using data and information to improve health and healthcare. A further step in that evolution took place recently with the unveiling of the Advanced Health Information Certification (AHIC) by the American Medical Informatics Association (AMIA).
More details about the process can be found in three papers published in Journal of the American Medical Informatics Association and made freely available on the AMIA Web site. These papers describe the rationale and process for developing the certification [2], the eligibility requirements for it [3], and an explanation on how it fits in the larger perspective of the field [4]. The AHIC is viewed as a specialization in informatics beyond one’s initial health professional training. The latter training must be at the master’s or professional doctorate level, such as an MD, PharmD, Master of Nursing, etc.. This pathway will also provide an alternative for physicians who are not eligible for the medical subspecialty, i.e., who do not have an active primary specialty certification. This includes those who never attained a formal specialty in their medical training as well as those who discontinued the practice of medicine and allowed their primary board certification to lapse. It also includes osteopathic physicians (DOs), although these physicians will eventually be eligible for the physician subspecialty as the merger between the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA) is implemented and AOA programs achieve ACGME accreditation.
To be eligible for AHIC, an individual with a health professional master’s or higher must also have a master’s degree or higher from an accredited informatics program and professional experience applying informatics to healthcare. The accreditation of informatics educational programs will be based on AMIA’s recently becoming a member of the Commission on Accreditation for Health Informatics and Information Management (CAHIIM), which is in the process of revising its health informatics accreditation standards. Similar to the physician subspecialty, a “grandfathering” period will allow individuals to achieve certification from educational programs deemed “acceptable” that are not yet accredited. There will also be a temporary pathway for those with no formal informatics education at all who are long-time practitioners, i.e., have 36 months of informatics experience over a five-year period that has been completed within the past 10 years. Those who obtain a PhD in an informatics-related field will also be eligible, even if they do not have formal health professional training.
One way AMIA hopes to see the process viewed is as analogous to the physician certification. In particular, those certified by AHIC are expected to be have advanced training in a healthcare profession in addition to formal training and experience in informatics.
AMIA will also establish an entity to develop the certification exam, which will likely be aligned with the physician subspecialty certifying exam. The content for the certification exam will be based on an update of the core content for the physician subspecialty, which itself needs update since it has not been revised since it was published in 2009 [5]. (I have always believed that there is little in the core content of the physician subspecialty that is truly specific to physicians. There really need not be any, since informatics is agnostic and complementary to one’s healthcare field.)
As with the physician subspecialty, I am highly supportive of the new certification and its professional recognition of all who work in the field professionally. Our Biomedical Informatics Graduate Program at Oregon Health & Science University (OHSU) will certainly aim to align with it. (We are currently accredited under the original CAHIIM health informatics process but will transition to the new one when we are able to do so.)
Despite my optimism and support for AHIC, I do have one concern, which is the requirement to have a master’s degree in a health profession. I understand the rationale for aligning the AHIC with the physician subspecialty in requiring advanced training in both informatics and a health profession. At some level, this makes sense, and I have long advocated that informatics is primarily a health profession. However, this leaves out those with master’s degrees in applied informatics who do not also have a master’s degree in a health profession. That excludes those with pre-informatics training in non-health professional fields, such as computer science, life sciences, and health administration. It also leaves out health professionals whose health field has a bachelor’s degree as a terminal degree. I am not aware of any evidence that shows those with a healthcare master’s are any better operational informaticians than those without such a degree, nor do I know that potential employers share the view that they are different. Interestingly, those who obtain a PhD in informatics are not subject to this requirement, even though their degree is a research degree, i.e., less applied and less likely to have courses about the healthcare system.
There is no question that informaticians working in healthcare settings need to have a solid understanding of the healthcare system. Indeed, most applied informatics master’s programs (including ours at OHSU) have courses about the healthcare system, and are encouraged to obtain practical experiences in healthcare settings. I worry that this process may cleave professional informatics master’s programs in two, with those who are eligible for AHIC and those who are not, despite having nearly the exact same training. Many current and former OHSU master’s graduates without formal clinical backgrounds have developed successful careers in applied health or clinical informatics. The AMIA leadership has vowed to consider other certifications for these types of individuals.
Nonetheless, the AHIC will be a great accomplishment for the field when it is fully implemented over the next year or two. The recognition brought on by certification of individuals will advance the profession as a whole and consolidate the important contributions that informaticians bring to 21st century healthcare and other health-related activities.
References
1. Detmer, DE and Shortliffe, EH (2014). Clinical informatics: prospects for a new medical subspecialty. Journal of the American Medical Association. 311: 2067-2068.
2. Gadd, CS, Williamson, JJ, et al. (2016). Creating advanced health informatics certification. Journal of the American Medical Informatics Association. 23: 848-850.
3. Gadd, CS, Williamson, JJ, et al. (2016). Eligibility requirements for advanced health informatics certification. Journal of the American Medical Informatics Association. 23: 851-854.
4. Fridsma, DB (2016). The scope of health informatics and the Advanced Health Informatics Certification. Journal of the American Medical Informatics Association. 23: 855-856.
5. Gardner, RM, Overhage, JM, et al. (2009). Core content for the subspecialty of clinical informatics. Journal of the American Medical Informatics Association. 16: 153-157.
This article post first appeared on The Informatics Professor. Dr. Hersh is a frequent contributing expert to HITECH Answers.