Mohammad Al-Ubaydli and Robin Mann describe current developments in developing this specialty as a profession
Medical informatics in the United Kingdom is entering a challenging period. The NHS in England is preparing to launch five of the largest computer systems the world has ever seen . Challenging, not only because of the technical complexities of introducing electronic records and booking and prescribing systems into clinical practice, but also because the human issues of education and change management have so far received little attention and less resources.
Previous information technology (IT) developments in the NHS have tended to support management and financial processes, but the current aim is to have medical records systems that support clinical care for patients. Achieving this requires a detailed understanding of how information flows to support health and health care, while also understanding clinical practice. This is the realm of the medical informatics specialty: a profession well established in the United States, but still gestational in the United Kingdom. The NHS Information Authority (NHSIA) has started to develop the career infrastructure for the health informatics profession . Wales and Scotland have similar developments, and the discussion here is relevant across borders.
In this article, we discuss the profession, its importance, and its future.
What is medical informatics?
All medical professionals manage information. Whether it’s reading a journal, writing a textbook, taking history from a patient, discussing a case with a colleague, implementing guidelines, filling out a cremation form, or learning a surgical procedure, our understanding and use of medical information is critical to our role.
Yet one of the commonest concerns among doctors is information overload. Failure to keep track can lead to clinical errors, which can in turn affect care for patients. Medical informatics aims to improve care for patients by improving the accuracy, speed, and reliability of clinical information flow, ensuring that the right information is in the right place at the right time.
A specialist registrar was seeing a new patient in a busy rapid access chest pain clinic. As usual he scanned the previous notes to get a feel for the patient’s existing problems before calling him in. The patient described a sharp pain that was independent of exercise, and since there were no risk factors the doctor felt able reassure the patient that it was unlikely to be his heart. Before he had the chance to offer a routine exercise test, the patient asked why the doctor didn’t think his previous quadruple bypass was relevant. It transpired that he had suffered a myocardial infarction with similar pain while staying with relatives in a different region. The discharge letter had been filed with the nursing record in the rear packet of the notes. The doctor felt embarrassed because he had not taken a complete history, and it took a further 20 minutes to regain the patient’s confidence. The delay meant that the remaining patients had to wait longer than necessary.
This example highlights the problems of running a busy clinic. There is simply not enough time to take a rigorous history from each patient, and the record should contain accurate, complete, and reliable summary information. With electronic records systems that link across organisations, either directly or via a common information spine, it should be possible to have access to the complete medical record. It is important that the information is presented in a useable format. During a clinical review, a balance is required between previous records being comprehensive and being comprehensible. Achieving this balance requires both medical and informatics skills, and this is one area where specialists in medical informatics are needed.
Who are medical informatics specialists?
Many “informaticians” begin their path into the specialty by developing their own small scale electronic systems to solve local problems, such as providing accurate patient lists or automated discharge summaries. Others become interested when they see the power of information technology. This is why GPs are often the trailblazers in the United Kingdom: the average length of an appointment with a GP is only possible because of the supporting technology, and many GPs use a computer during the consultation that contains the entire medical record.
What do medical informatics specialists do?
Informaticians understand and manage clinical information as it flows through the healthcare system. Information technology, and clinical systems, are powerful tools, but are only part of the solution.
Software and stethoscopes
So how much do they have to know about computers? One information specialist famously said: “Medical informatics is as much about computers as cardiology is about stethoscopes” . Most cardiologists do not know, or need to know, how to build a stethoscope, and most informaticians do not know, or need to know, how to write a software program. On the other hand, many cardiologists are passionate about stethoscopes and understand which models are best for auscultating different patients. Every medical student’s training in assessing the cardiovascular system requires competency with the stethoscope.
Likewise, informaticians understand the difference between different software systems, the part that software plays in the information flow, and have good computer literacy as a tool in their trade.
What informaticians will end up doing all day is still under debate, as the discipline is still dynamic and evolving. The government published a human resources strategy for health informatics professionals, which helps to clarify what the NHS regards as a “health informatician.” In the past “medical” informatics was used interchangeably with “health” informatics. But a medical informatician is now dually specialised—with both medical and informatics qualifications (see below).
A diverse bunch
Currently, medical informaticians work in a diverse range of areas. Some operate at the fringes of the NHS and spend more time on informatics than they do on their clinical workload. They may be involved in the IT industry or act as management consultants. Others are ordinary doctors who become involved in the procurement of local electronic records systems. Other medical informaticians get stuck into the politics of health information and try to keep the emphasis on supporting care for patients and clinical processes rather than finance and management. Some are developing standards to ensure that different systems can talk to each other and share clinical information across traditional boundaries, without compromising laws and guidance on confidentiality.
There is a developing view that one of medical informaticians’ most important future roles will be to bring the different sorts of health informatician together so that relevant information is provided at the point of care to improve that care. This is likely to entail a diverse range of skills including teaching and change management as well as a knowledge of electronic records systems. These information specialists may also wish to continue to do clinical sessions to keep up to date and ensure that their informatics work is always directly relevant to local practices.
They can also look at the changes in clinical workflow and provide the software solutions that could support these new processes. Clinicians could seek the advice of an informatician before starting a audit project to discuss the techniques and pitfalls of data collection and interpretation.
Education and training
It is likely that future level of registration will depend on a combination of practical experience and formal education and training. Many universities now have part time masters courses and offer diplomas in medical and health informatics, and have undergraduate courses in health information management (www.bmis.org/courses.html). The Open University offers a distance learning module on knowledge, information, and care.
Although many of the courses are appropriate for training health informaticians, they are also of interest to “ordinary” clinicians. All doctors will need to improve their skills in informatics with the introduction of electronic records. The Royal College of Physicians has developed a training package for all junior doctors that introduces those informatics concepts that are essential for the new age of information in healthcare, and the NHSIA has adopted the European computer driving licence as the basic reference standard for IT skills for NHS staff.
Many courses follow the curriculum laid out in Learning to manage health information—a theme for clinical education. This document carries the unprecedented support of 30 statutory and professional bodies including the Academy of Medical Royal Colleges, the BMA, and the GMC.
Becoming more professional
The United Kingdom already has several organisations that deal with health informatics, including the British Medical Informatics Society (BMIS) and the British Computer Society’s Health Informatics Committee.
Professional bodies have recognised the importance of informatics: The Academy of Medical Royal Colleges has an information group; the Royal College of Surgeons in Edinburgh has an academic faculty of medical informatics; and the Royal College of Physicians in London has a health informatics unit.
Last year’s “Pathways to Professionalism” conference led to the formation of the UK Council for Health Informatics Professions (UKCHIP). This body will provide a similar function to the GMC by keeping a register of health informatics professionals.
Like other clinicians who have minimal contact with patients (for example, public health doctors) these doctors are looking at the impact of revalidation on their careers. This has led to discussions about developing a faculty of medical informatics allied to one or more royal colleges.
We have highlighted ways in which medical informatics is developing as a profession in the United Kingdom and explained how some doctors have become medical informaticians. Future medical informaticians will follow a more structured career path. Opportunities are becoming more frequent so in the meantime we suggest reviewing the references cited in this article and studying for a relevant higher qualification in medical informatics.
UK Council for Health Informatics Professions (www.ukchip.org)—UKCHIP is a newly formed body to develop professionalism in health informaticians.
1 – Department of Health. National IT programme www.doh.gov.uk/ipu/programme/index.htm.
2 – NHS Information Authority. Project to develop functional maps and occupational standards for health informatics www.nhsia.nhs.uk/nhid/pages/histandards/fmaps_makeup.asp
4 – Department of Health Making information count—a human resource strategy for health informatics professionals London: DoH, 2002.
5 – Royal College of Physicians Laying the foundations for good medical practice—a generic training programme for SHOs London: RCP, 2003. www.rcplondon.ac.uk/college/layingthefoundations/index.asp
6 – NHS Information Authority European computer driving licence www.ecdl.nhs.uk
7 – NHS Information Authority Learning to manage health information—a theme for clinical education London NHSIA, 1999.
8 – Pathways to Professionalism Workshop, London 31 July 2002. www.nhsia.nhs.uk/def/pages/conf_archive/pphi_0702.asp
Published on the 13th of September 2003 in the
British Medical Journal careers section