Interprofessional clinical informatics education and practice: Essentials for learning healthcare systems worldwide

Introduction

Ensuring health for all is a challenge worldwide, encompassing such issues as access, chronic care, infectious diseases, affordability, and/or social determinants. The learning health system (LHS) describes new knowledge to advance health as a natural by-product of the care experience (Institute of Medicine [IOM], 2011; Friedman et al., 2015). Transformational technologies and informatics as well as the necessity of an interprofessional team approach have been employed to make substantial progress in building the professional infrastructure to advance health. While this progress is illustrated with the work reported in the informatics-themed issue in this journal (e.g. Aungst & Belliveau, 2015; Brault, Therriault, St-Denis, & Lebel, 2015; Curran et al., 2015; Rajamani, Westra, Monsen, LaVenture, & Gatewood, 2015), the gaps in adequate informatics expertise and workforce and extensive opportunities to build and study interprofessional team care including informaticians are clear. Additional gaps include expanded data, diverse workforce, and improvement science-based care processes seeking precision care.

Expanded data

Individuals and populations are healthy where there is access to decent shelter, meaningful employment, nutrition, supportive social environments as well as access to essential healthcare services. Depending on where one lives and works as a health professional, challenges may vary considerably. For example, when one compares the USA to other major health systems of economically developed nations, America comes up short in terms of health status despite the reality that its aggregate investments in health and social services are essentially equivalent. Health status suffers because this country invests nearly twice as much on hospital and medical services as it does on effective social services. America’s challenge is to improve its healthcare services across geographic areas and diverse populations while shifting its investments into better balance with needs for social services, affecting the social determinants of health. Elsewhere, developing economies are challenged by the double burden of traditional infectious diseases as well as significant increases in vehicular trauma and diabetes as a result of movement from traditional health to newer economic investments. Still other nations or regions face a variety of opportunities for improving performance that are unique to them or to a cluster of environments similar to theirs. In some, resources may need to shift to better management of chronic illnesses as a result of a rising population of aged citizens.

Regardless of one’s location on earth, the times are characterised by transformational information and communications technology and astonishing medical and health discoveries alongside concomitant social disruption and failed nations in some parts of the world. Compounding the challenge, medical discovery relating to genomics is shifting clinical care towards “precision medicine” with a focus at the molecular level while most clinical care is still based primarily on organs and organ systems. All of these factors empower the need for expanded range of data types that represent more complete dimensions of individual, family, organisation, and community, and population health. The need for data that represent the breadth of interprofessional care is acute. Interprofessional care, spanning genomics to social determinants of health to public health, is essential for health. Consequently, informatics expertise is needed to ensure that the data representing interprofessional care is included in electronic health records (EHRs). Likewise, these data must be included as a meaningful component of precision medicine.

Diverse workforce

While we continue to lack an adequate workforce of biomedical and health informaticians to address the challenges we face, substantial progress has been made in creating a professional infrastructure necessary for long-term success. In 2008, an international group of informaticians met for a week at the Rockefeller Center in Bellagio, Italy, for a conference entitled “Making the e-Health Connection” (The Rockefeller Foundation, 2008). Many insights from that conference remain fresh today. Further, in December 2010, a European/United States eHealth (2010) “Cooperation Memorandum of Understanding” was signed and a Global Workforce Working Group came into existence.

The central outcome of the Institute of Medicine’s (2003) education summit was its listing of five core competencies for all health professionals going forward. These competencies include the following: working in interprofessional teams, continuously improving quality, practising evidence-based care, putting the patient and community at the centre, and utilising informatics (Institute of Medicine, 2003). We know that health professionals across the world can improve the health status of individuals and communities through better coordination and collaborative efforts. Since 2003, the Interprofessional Education Collaborative (https://ipecollaborative.org/) has made progress on the first four constructs. At the same time, utilising informatics has lagged primarily due to a paucity of sufficiently capable faculty and limitations in EHRs their systems. While the infrastructure has improved recently as have basic informatics skills in health professionals, similar progress is lacking in the number of more highly expert biomedical and health informaticians. This situation must change over the next decade.

As the professional home for biomedical and health informaticians, AMIA (known as the American Medical Informatics Association—www.amia.org) is actively leading in the creation of advanced interprofessional informatics certification for health professionals to address this critical resource constraint by crafting the informatics essentials for those who will lead the creation and ongoing implementation of better information and communications focused on individuals and populations. The effort began a decade ago with development of a new subspecialty certificate in clinical informatics for those physicians currently holding a valid specialty certificate in one of the recognised medical specialties. (Detmer & Shortliffe, 2014).

In 2014, an initiative led by AMIA to advance clinical informatics for the entire healthcare team took shape. With conceptual support from leadership of the Interprofessional Education Collaborative, a partnership under the aegis of AMIA was created which includes representatives of the American Association of Colleges of Nursing (AACN), the American Academy of Osteopathy (AAO), the American Association of Colleges of Pharmacy (AACP), the Association of Schools and Programs in Public Health (ASPPH), the Radiological Society of North America (RSNA), the American Dental Education Association (ADEA), and the Academy of Nutrition and Dietetics (AND). Further, clinical informaticians from backgrounds in computer and library sciences plus non-boarded physician informaticians along with other health professions will soon have a clear professional pathway ahead. Today, this AMIA-led interprofessional work group is creating the core content for this essential workforce.

With an equivalent examination in clinical informatics soon capable of reaching across all healthcare disciplines, education programmes and entry-level informaticians are much more likely to approach their work collaboratively. Current plans are for the examination entity to be formed in 2017 with the initial examinations in 2018. While the primary focus for this interprofessional effort is on the United States, serious global interest in this initiative has been expressed. As a result, AMIA plans (Gadd, Delaney, Marin, Greenwood, & Williamson, 2016) to pursue this interprofessional informatics effort both for the US and elsewhere. Obviously, international models will need to be adjusted for varying environments with special needs. Further, as precision medicine develops, translational bioinformaticians will work collaboratively to help integrate these advances into the care of individuals and populations. Potentially, structured educational programmes and certification for research informaticians may develop as well.

Improvement science-based care processes

This abstract vision for interprofessional practice and education will only result in concrete action at the personal and community levels if our interprofessional informatics teams understand and adopt the requirements essential for progress in changing complex adaptive health and healthcare systems. The emerging science of improvement science identifies six core principles driving this process. The objective is to offer precision care that matches precision medicine. These are as follows: (1) make the work problem specific and user centred; (2) address variation in performance as the core objective; 3) understand how the current system produces its outcomes; (4) refine measures for care and performance aimed at scaling success; (5) anchor practice improvement in disciplined inquiry; and (6) accelerate improvements through networked communities (Institute for Healthcare Improvement (IHI), 2016; Carnegie Foundation, 2016). Improvement science to achieve precision care empowers a clarion call for care coordination. Bates (2015) clearly articulates those gaps in interprofessional care coordination which can be addressed when informatics is joined to improvement science. These include medication reconciliation, tracking of laboratory tests, communication across care settings especially with complex patients, interprofessional plans of care, referrals, and a heightened level of embracing the patient as care partners.

Concluding comments

Hallmarks for success in care environments include an intense focus at any given time on only a few key issues demanding change, flexibility to allow those on the front lines to make the needed innovations and adjustments to care processes and/or systems while measures of progress become better refined and older measures and regulations drop out. These adjustments will occur through a combination of evolving systems of integrated healthcare and public health activities combined with ongoing measurement of progress. The informatics special issue of the journal represented an important step as informaticians look to innovate better ways to think and act interprofessionally. Moreover, the special issue represented a commitment of interprofessional education and collaborative practice initiatives to engage in the core essential import of biomedical health informatics. While I highly support these efforts, I further challenge professionals to look forward to even more empowered health and healthcare through expanded data, diverse workforce engaging among other informal caregivers and clearer personal responsibility for health, and improvement science-based processes.

Declaration of interest

The author reports no conflicts of interest. The author alone is responsible for the content and writing of this article.