Staying Current

Clinical informatics professionals must remain current with rapid changes in technology, expectations, payment methods, organizational management, and regulations. Fundamental principles in medicine, psychology, computer science, informatics, and economics will serve as a vital foundation; the application of these principles through people, organizations, data, processes, and technologies will change with rapidity. Clinical informatics professionals must remain current to understand and implement meaningful next steps as their organizations evolve. This currency can only be obtained through professional engagement with the broader informatics community and through study of new findings and innovations. Like clinical medicine and many other fields, the body of literature in informatics is growing far too rapidly to remain current in every professional interest. To face the challenges ahead, informatics professionals must employ a range of technologies and resources to collaborate and learn across the many applicable disciplines.

Body, Home, and Community

Sensors worn on the person (e.g., smartwatches), sensors in the home, and community-based resources are providing new data and connecting individuals in ways that promise to improve care. The rapid growth of mobile devices that can be worn or integrated into the immediate environment satisfies a need most humans have for connection and convenience. Through these devices, families and clinicians can develop greater insights into behaviors and, through social networks and other resources, connect individuals sharing common health interests. These resources often originate from commercial products and not from traditional healthcare delivery systems. Their availability is also providing new opportunities for health plans and other stakeholders to participate in care.

Clinical Teams

Healthcare delivery is a collaborative activity involving many individuals playing myriad roles. Clinical informatics often emphasizes the role of physicians, nurses, pharmacists, and other staff acting in concert to ensure that key clinical tasks are performed. Only recently have clinical informatics systems begun to model the complex interactions of the team supporting care in the home. Most posthospitalization care and most chronic care management require coordination across teams working from delivery organizations and both the formal and informal teams delivering care in the home. This degree of coordination requires targeted communication and maintenance of both a care record and a care plan.

Basics of Computers

Foundational knowledge of informatics includes a basic understanding of the operation of computers. This includes hardware design and function, programming, and networking basics. Although few clinical informatics professionals will personally design computers or write large programs, every professional should have an understanding of the capabilities and limitations of current information technology. Informatics professionals need basic familiarity with computer structure and function. Also, understanding programming and aspects of computer control and query language gives foundational knowledge of what is doable and what is not doable. Computers are composed of hardware and software. Hardware is the physical devices, and software is the operating instructions.

Policies, Laws, Regulations, Contracts, and Procedures

Healthcare in the United States is heavily regulated; a host of often-confusing policies, laws, and regulations impact care delivery and care reimbursement. Because of the breadth of society’s health issues; the diversity of personal, religious, philosophical, or societal goals; and the conflicts that arise among concerned stakeholders, policies or their execution through procedures are almost always controversial. Policies are positions, statements, and courses of action that reflect an organization’s goals and values and are the products of government, business, or other authorities. Collectively, the arguably undue complexity of these regulatory efforts place enormous burdens on both those who develop clinical systems and those who must use them. Clinical informatics professionals must understand these complexities and seek ways of simplifying care and administrative processes.

Researchers

Formal research efforts are traditionally managed by trained professionals pursuing systematic investigations seeking improvements based on more rigorous data. An abundance of clinical data liberates research from selected academic institutions and invites broader participation by healthcare professionals. Local registries can allow for informal local analysis and advanced data integration and sharing initiatives can support national and even international research collaborations. Successful approaches rely on enforcement of data standards, application of privacy-protecting technologies, and use of ontologies and other data-mapping tools to ensure reliable interpretation of clinical data. Randomized clinical trials may remain the gold standard, but other, less costly data management approaches can provide many insights with scale and rapidity.

Population Health Management

As systems become more capable of transmitting and aggregating data, new analytic methods promise both a deeper understanding of population needs and new ways of bringing actionable data to the point of care. These techniques will be critical as payment for care migrates from fee-for-service models to episodic and risk-based bundles. The growing integration of data measuring social determinants will help both delivery and public health professionals gain new insights into richer, more meaningful, and more effective means of care. The combination of new data, new analytics, and technologies capable of penetrating to every point of decision-making promise to foster innovative and meaningful approaches to patient care.

Enabling Technologies

Enabling technologies are products and processes that complement more established techniques based on the electronic health record by broadening and easing the process of data collection. Often, these technologies are used to provide more effective means of communication among patients and providers, collect data from home and body sensors, and store data in more accessible ways, all seeking to improve the process or performance of our healthcare system. These include a host of devices and processes that connect providers, connect patients to providers, and add data outside the healthcare enterprise to the personal health record. This has the promise of further improving healthcare.

Data Science

Data science is the study of how analytics techniques can be applied to large and diverse data sets. This field is emerging because of the availability of massive data sets in both consumer and health sectors, new machine learning and other analytics requiring large-scale computation, and the vital need to identify risk factors, trends, and other relationships not apparent when applying traditional analytics methods to smaller structured data sets. In some organizations, the primary role of a clinical informatics professional no longer is focused on how electronic health records are used in healthcare delivery but instead is focused on how patient encounter information can be collected efficiently, aggregated with information from other encounters or sources, and analyzed to improve our understanding of how population studies can improve the care of individuals. Such an understanding is critical to improving care quality and lowering healthcare costs.

Large-Project Management

Clinical information systems are complicated and highly interdependent with other operational technologies. They are costly in acquisition, implementation, and operation. The consequences of a poor system cascade to the work and performance of every individual affected by system performance. Effective project management and project governance are essential. Even if electronic health records or other clinical systems are fairly mature, every upgrade, replacement, or enhancement may have unintended consequences. Hence, project management never fully ceases, and project governance is an ongoing effort. This chapter focuses on large-project management, specifically the inception, creation, execution, and assessment of plans of the magnitude of an electronic health record (EHR) installation or conversion.