Thinking of applying for or starting an ACGME Certified Fellowship in Clinical Informatics? Understanding the requirements and expectations can be a bit overwhelming at first, so we’ve decided to break it down for you in a easier to understand format. In this article, we’ll cover:
- How ACGME defines clinical informatics
- The basic (mostly administrative) requirements for a fellowship program
- The curriculum/learning objectives of the fellowship including:
- Patient Care and Procedural Skills
- Medical Knowledge
- Practice Based Learning and Improvement
- Interpersonal and Communication Skills
- Professionalism
- Systems Based Practice
- Fellows’ Scholarly Activities
If you’re interested in the original document, hop on over to the ACGME at this website to check out the full 30 page document.
How ACGME Defines Clinical Informatics
To ACGME, clinical informatics is:
“the subspecialty of all medical specialties that transforms health care by analyzing, designing, implementing, and evaluating information and communication systems to improve patient care, enhance access to care, advance individual and population health outcomes, and strengthen the clinician-patient relationship.”
To become a clinical informaticists, ACGME outlines the following ways in which clinical informaticists can improve clinical practice. The skills required to do so include:
- leading initiatives designed to enhance health care quality and access by supporting and facilitating care coordination and transitions of care through the procurement, customization, development, implementation, management, evaluation, and continuous improvement of clinical information systems
- securing the legal and ethical use of clinical information
- assessing information and knowledge needs of health care professionals and patients
- characterizing, evaluating, and refining clinical processes
- analyzing, developing, implementing, and refining clinical decision support systems
- participating in projects designed to use technology to promote patient care that is safe, efficient, effective, timely, patient-centered, and equitable
Basic Requirements for a Fellowship Program
We’re going to oversimplify here….so if you really need a deeper background in the ACGME requirements for now, be sure to read the whole document. Most of this stuff is administrative. We’ll be going over it in more detail in the future, but for now here’s what you need to know:
- Programs must be 24 months in length and completed within 48 months of matriculation
- The sponsoring institution is responsible for the program and ensuring the program director has the proper support needed for the program
- The clinical informatics program and and participating site must agree with each other on how the program will be run. A Program Letter of Agreement must be renewed at least every 5 years.
- A single program director who is qualified (currently certified in CI, required experience/education, licensed, etc) is responsible for the administration and maintenance of an environment conductive to fellow’s educational needs.
- There must be a sufficient number of qualified faculty (currently certified in CI or with “acceptable” qualifications, licensure, etc.) that maintain an environment with active research.
- There must be enough administrative and technical capabilities in place to support the program.
- There must enough resources for fellows including classrooms, internet, educational aids, work space, an EHR/clinical information system to work with, etc.
- There must be access to medical information and reference materials in print or electronic format.
- The program director must comply with the criteria for resident eligibility and fellowship eligibility
- The program can’t take in more fellows than they can handle. Transfer students’ experiences must be vetted and verified.
- Programs must regularly evaluate fellow performance, faculty performance, and the program performance in a timely manner.
- Programs must maintain a professional, responsible, and safe atmosphere for patients & minimize any transitions in their care.
- Programs must ensure alertness and mitigate fatigue of program participants.
- Programs must properly supervise program participants.
- Programs must base clinical responsibilities on PGY-level, patient safety, fellow education, severity and complexity of patient condition, and available support services.
- Programs must maintain an environment that maximizes effective communication and is conducive to teamwork.
- Programs must limit hours worked/on-call to those outlined by ACGME.
- Fellows must participate in planning and conducting conferences.
- Assignments should be clearly defined, have written descriptions, have a particular focus, and provide fellows with exposure to different types of clinical and health information systems.
The “Educational Program” Requirements
Now let’s get to the good stuff. The curriculum. What is it that ACGME wants clinical informatics fellows and residents to learn?
The educational program must provide:
- Overall educational goals for the program, which the program must make available to fellows and faculty Competency-based goals and objectives for each assignment at each educational level, which the program must distribute to fellows and faculty at least annually, in either written or electronic form
- Regularly scheduled didactic sessions
- Delineation of fellow responsibilities for patient care, progressive responsibility for patient management, and supervision of fellows over the continuum of the program
Patient Care and Procedural Skills
- Fellows must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
- Fellows must demonstrate competence in the leverage of information and communication technology to:
- incorporate informatics principles across the dimensions of health care including, health promotion, disease prevention, diagnosis, and treatment of individuals and their families across the lifespan
- use informatics tools to improve assessment, interdisciplinary care planning, management, coordination, and follow-up of patients
- use informatics tools, such as electronic health records or personal health records, to facilitate the coordination and documentation of key events in patient care, such as family communication, consultation around goals of care, immunizations, advance directive completion, and involvement of multiple team members as appropriate
- use informatics tools to promote confidentiality and security of patient data
- Fellows must demonstrate skill in fundamental programming, database design, and user interface design
- Fellows must demonstrate competence in project management and software engineering related to the development and management of IT projects that are pertinent to patient care
- Fellows must demonstrate competence in the identification of changes needed in organizational processes and clinician practices to optimize health system operational effectiveness
- Fellows must demonstrate competence in the analysis of patient care workflow and processes to identify information system features that will support improved quality, efficiency, effectiveness, and safety of clinical services
- Fellows must demonstrate competence in the assessment of user needs for a clinical information or telecommunication system or application
- Fellows must combine an understanding of informatics concepts, methods, and health IT to develop, implement, and refine clinical decision support systems
- Fellows must evaluate the impact of information system implementation and use on patient care and users
Medical Knowledge
- Fellows must be able to competently perform all medical, diagnostic, and surgical procedures considered essential for the area of practice
- Fellows must demonstrate knowledge in:
- fundamental informatics vocabulary, concepts, models, and theories
- the health care environment, to include how business processes and financial considerations, including resourcing information technology, 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
- process improvement or change management for health care processes
- information system management skills, including project management, the life cycle of information systems, the constantly evolving capabilities of IT and health care, and the technical and non-technical issues surrounding system implementation
- the impact of clinical information systems on users and patients
- strategies to support clinician users and promote clinician adoption of systems
- clinical decision design, support, use, and implementation
- 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
- risk management and mitigation related to patient safety and privacy
Practice-based Learning and Improvement
- Fellows must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning.
- Fellows are expected to develop skills and habits to be able to meet the following goals:
- identify strengths, deficiencies, and limits in one’s knowledge and expertise
- set learning and improvement goals
- identify and perform appropriate learning activities
- systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement
- incorporate formative evaluation feedback into daily practice
- locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems
- use information technology to optimize learning
- participate in the education of patients, families, students, fellows and other health professionals
Interpersonal and Communication Skills
- Fellows must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. Fellows are expected to:
- communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds
- communicate effectively with physicians, other health professionals and health related agencies
- Fellows must demonstrate the ability to serve as a liaison among IT professionals, administrators, and clinicians
- work effectively as a member or leader of a health care team or other professional group
- act in a consultative role to other physicians and health professionals
- maintain comprehensive, timely, and legible medical records, if applicable
Professionalism
- Fellows must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.
- Fellows are expected to demonstrate:
- compassion, integrity, and respect for others
- responsiveness to patient needs that supersedes self-interest
- respect for patient privacy and autonomy
- accountability to patients, society and the profession
- Fellows must demonstrate the ability to recognize the causes and prevention of security breaches and their consequences to the individual, the system, the organization, and society at-large
- sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation
- sensitivity to the impact information system changes have on practice patterns, and on physician-patient relations and physician work-life balance
Systems-based Practice
- Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.
- Fellows are expected to:
- work effectively in various health care delivery settings and systems relevant to their clinical specialty
- coordinate patient care within the health care system relevant to their clinical specialty
- incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care as appropriate
- advocate for quality patient care and optimal patient care systems
- work in interprofessional teams to enhance patient safety and improve patient care quality
- participate in identifying system errors and implementing potential systems solutions
- Each fellow must demonstrate the ability to recognize one’s own role and the role of systems in prevention and disclosure of medical error
- identify, evaluate, and implement systems improvement based on clinical practice or patient and family satisfaction data in personal practice, in team practice, and within institutional settings
- demonstrate knowledge of the various settings and related structures for organizing, regulating, and financing care for patients
- analyze the impact of business strategies on health information technology
- analyze patient care workflow and processes
- identify information system features that will support improved quality, efficiency, effectiveness, and safety of clinical services
- identify potential unintended consequences of new system and process implementation, as well as changes to existing systems and processes
- demonstrate awareness of issues related to patient privacy
- query and analyze data repositories/warehouses
Scholarly Activities
- Fellows should participate in scholarly activity. Scholarly activity should include at least one of the following:
- peer-reviewed funding and research
- publication of original research or review articles
- presentations at local, regional, or national professional and scientific society meetings
So if you’re ready to start learning all of these concepts or starting to groom a curriculum to meet these criteria, congratulations and good luck. We’ll be posting what we feel is a good sample curriculum in the future, so stay tuned. In the meantime, please subscribe to our mailing list for updates and news.