Clinical Informatics Board Certification Galvanizes Field

Board certification is the gold standard for any type of physician certification, which is why many feel the American Board of Preventative Medicine’s (ABPM) new clinical informatics subspecialty board certification is a long time coming. 

“I was waiting for this to happen. This gives validity to a specialty developed by innovators and puts an official title on it in the academic sense,” says Pankaj Jandwani, MD, CMIO of MidMichigan Health, Midland, Mich., who is taking the first examination scheduled in October. “It gives a sense of belonging to a field of medicine that is evolving faster than any other field.”

John Lee, MD, medical director of clinical informatics and director of emergency medicine informatics at Edward Hospital & Health Services in Naperville, Ill., who also signed up for the exam, agrees. “‘Newer’ board certifications like emergency medicine and critical care came into their own because changes in technology changed medical practice, requiring the acknowledgment of a new discipline. Likewise, medical informatics has reached a tipping point and critical mass that requires a formal declaration of a specialty.”

“It’s an identified corpus of knowledge for certification and a consensus that these are essential skills people in informatics need to know,” adds Kenneth Ong, MD, CMIO of New York Hospital in Queens.

Qualifications for Mastery

The ABPM certification reflects the growing importance and demand for physicians with professional expertise in informatics. This encompasses not only the responsibilities of CMIOs, but other positions where physicians draw on their expertise in both medicine and informatics.

To achieve eligibility, applicants must obtain primary certification from one of 23 member boards of the American Board of Medical Specialties (i.e., internal medicine or surgery), be a graduate from a U.S., Canadian or other ABPM-accepted medical school and hold an unrestricted license to practice medicine in the U.S. or Canada.

“It is not clear how this will all play out in the long run, since not all physicians will complete a residency and become board-certified in a primary specialty,” says William Hersh, MD, professor and chair of biomedical informatics at Oregon Health & Science University, who is teaching the American Medical Informatics Association’s (AMIA) board review course.

Further, until 2018, all applicants must either:

• Have three continuous years of practice in clinical informatics within the past five years (practice time must be at least 25 percent of an FTE position). Time in an educational program can count as well, but only for half the value of the practice; or
• Successfully complete a minimum 24-month fellowship (i.e., fellowships offered at the National Library of Medicine or Department of Veterans Affairs)

The Accreditation Council for Graduate Medical Education (ACGME) will begin accrediting clinical informatics fellowships in 2015, and starting in 2018, all applicants will be required to complete an ACGME-accredited fellowship.

Some feel the 24-month fellowship could be burdensome, especially for physicians who want to pursue training in informatics mid-career. Hersh describes the requirement as a challenge, especially because he believes there are other ways to obtain good training, such as a graduate degree in informatics that includes a practicum experience. “I think there will still be other educational options, not only for physicians, but for other informatics professionals,” he says.

Jandwani says, as a busy mid-career professional serving as a CMIO, it would be “practically impossible” to complete a fellowship if that were required now.

However, Lee feels the fellowship is appropriate. “The same process existed for other specialties, like emergency medicine, and it has served them well.” Likewise, Ong agrees that the fellowship ensures the competency of the physician in the practice of informatics, which is essential to the delivery of care. “We should not forget this is all about patient care and patient safety,” he says.

Exam Prep

Excitement abounds for the test, which will be a one-day multiple choice examination administered at Pearson VUE Professional Centers at sites in the U.S. and internationally.

Many physicians are participating in the AMIA Clinical Informatics Board Course to prepare for the big day. Approximately 400 people signed up for four in-person courses and an additional 200 people participated in the online course, according to Hersh, who estimates that about 70 to 80 percent of participants plan to take the exam.

While many physicians with informatics expertise are jumping at the chance to take the exam, Lee says some professionals are postponing it because they are too busy with active projects or are further along in their careers and already well-established in the field.

However, many big names in informatics, including Hersh, are planning to take the test. While he teaches the AMIA board course, the ABPM ultimately determines the questions and only has provided a four-page study guide, with an outline of some of the key informatics concepts the exam will tackle, to guide applicants. 

Jandwani says he is a bit nervous taking the exam side by side with the founders and pioneers of the field. “Who wants to take an exam with their teacher?”

However, he feels an ad hoc support group has formed in anticipation of the new test. “That brings me back to my medical school days, when we used to collaborate and prepare for the upcoming tests.”

The Professional Edge

With healthcare reform driving a demand for clinical informatics, in particular to get all providers to achieve Meaningful Use, board certification helps providers identify professionals who can get the job done, Ong says. “Employers want to be able to know that candidates for a CMIO position or director of informatics have the knowledge to succeed. Without a certification, it’s a lot harder to do that.”

The certification also answers questions commonly asked by professionals interested in informatics, Ong says: What knowledge is essential? How can they distinguish themselves when pursuing a high-level position in informatics?

Hersh predicts the certification will increase in value over time. “This will likely be important as informatics grows as a field within healthcare. I presume it will result in increasing career prospects and lead more healthcare organizations to hire such people.”