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Appl Clin Inform 2024; 15(04): 689-691
DOI: 10.1055/a-2340-7142
Special Topic on Teaching and Training Future Health Informaticians
Editorial

The Need for Expanded Educational Opportunities in Clinical Informatics for Pediatric Trainees

Authors

  • Adam P. Yan

    1   Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
    2   Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada

  • Julia Yarahuan

    3   Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
    4   Division of Hospital Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, United States

  • Jonathan D. Hron

    5   Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States
    6   Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States

Funding None.
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Pediatric Clinical Informatics

Clinical informaticians use their skills to design, implement, and evaluate clinical information systems and tools.[1] Whether the initiative is transformational or incremental, focus on improving health information systems and tools has been shown to improve patient safety and clinical effectiveness; we expect health information technology (IT) will continue to play a vital role in improving patient safety and quality improvement in the future.[2] [3] [4] [5] [6] [7] [8] As with many things in pediatrics, there are special requirements for pediatric health information systems compared with those used in adult medicine.[9] As recently as 2015, the majority of pediatric providers used an electronic health record (EHR) that lacked important pediatric-specific capabilities, such as: (1) immunization management including immunization decision support, (2) growth tracking including specialized growth curves utilized in neonatology and specialty clinics such as those that care for children with Down syndrome and Noonan syndrome as an example, (3) medication dosing including clinical decision support to assist with dosing by weight and age, (4) laboratory and vital sign interpretation which changes with patient age, and (5) privacy and confidentiality concerns.[10] [11] Privacy and confidentiality considerations for adolescent and young adult patients have become increasingly complex with the uptake of patient portals, the need for institutions to navigate proxy access, and the release of sensitive information.[12] [13] [14] [15] [16] [17] While many of the large commercial EHR vendors have products that address these issues, often the vendor-provided content needs extensive modifications and customization to fit local culture and regulation requiring the expertise of a pediatric clinical informaticist.[18] The absence of these pediatric-specific capabilities may also contribute to physician burnout and frustration.[19]

A robust community of pediatric-focused informaticians is required to support the material complexity associated with pediatric-specific EHR management.[9] [20] [21] However, evidence suggests that there are not enough pediatricians equipped to drive the informatics work required to deliver optimal patient care.[22] [23] As of 2018, only 320 of 1,851 total clinical informaticians are board-certified pediatricians.[22] [23] This number may underestimate the total number of pediatricians practicing as clinical informaticians as some providers may not have opted to become board-certified or may list an alternative specialty in the database. The number of pediatric informaticists is unlikely to increase in the coming years as only 31 individuals who completed clinical informaticist fellowships between 2016 and 2024 listed pediatrics as their primary specialty.[22] This concern is amplified when considering the geographic distribution of clinical informaticians. Eighteen states had 10 or fewer clinical informaticians and 33 states had 2 or fewer practicing informaticians per 1,000 active physicians.[23] Given that pediatricians make up less than 20% of clinical informaticians overall, it is a reasonable assumption that at least several states in the United States do not have a single pediatrician who is board-certified in Clinical Informatics (CI). Without board-certified clinical informaticists, pediatricians and pediatric sub-specialists are less likely to have EHR tools that meet their needs, potentially leading to EHR fatigue and burnout.[24]


Clinical Informatics Education for Pediatric Trainees

Pediatric residency programs cannot assume that trainees will acquire informatics skills without the purposeful integration of these topics into residency education. Pediatric trainees need to understand the benefit of pediatric-specific IT tools, so that they can advocate for the IT resources they need to care for their patients. The American Medical Informatics Association (AMIA) has advocated for making informatics training a mandatory component of all residency programs to ensure that the next generation of physicians is able to appropriately utilize health information systems.[11] Despite the importance of informatics literacy for the effective and safe practice of pediatrics, few pediatric residency programs have a formal CI curriculum.[25] [26] The curriculums that do exist vary but often include mandatory informatics lectures and workshops for all residents or optional electives and longitudinal experiences for those seeking additional exposure to CI. Developing and implementing a CI curriculum within a pediatric residency program has been shown to improve resident engagement in CI projects and knowledge of CI concepts.[25] [26]

To encourage all pediatric programs to develop CI curriculums, and to ensure that all pediatricians have a basic understanding of CI, the importance of CI should be formally recognized by the appropriate accrediting and licensing bodies. The Accreditation Council for Graduate Medical Education's (ACGME) Internal Medicine milestones contain CI-related competencies in the domain of “Digital Health” and the Pathology milestones contain an “Informatics” milestone. In contrast, while the ACGME lists “the application of information technologies and telehealth” as a program requirement, they do not have any pediatric milestones that map to CI skills, and the American Board of Pediatrics (ABP) does not have any CI-related exam content.[27] [28] [29] [30] The ACGME and ABP have pediatric milestones and exam content related to patient safety, quality improvement and ethics, and CI should be included in the ACGME's pediatric milestones and the ABP exam with a similar framework to these topics.[31]


Pediatric Clinical Informatics Fellowships

For pediatricians interested in a more in-depth study of informatics, CI fellowships are available. The first CI fellowships were accredited by the ACGME in 2014.[32] There are now over 50 accredited CI fellowships, including 9 that were accredited through a pediatrics program and others with pediatricians serving in program director roles that may provide specific focus on pediatric clinical information system needs. Pediatric trainees interested in CI need to be board-certified/eligible in pediatrics prior to starting their CI fellowship. Some pediatricians have been successful in combining CI fellowship training with additional subspecialty pediatric training (e.g., infectious disease or critical care).[33] Combined training may allow future subspecialist pediatricians to decrease the total time commitment of training.

During the 2-year CI fellowship, trainees design, implement, and analyze health information systems. The structure of each program is different but many commonalities exist. CI fellows typically rotate through various practice environments to gain an appreciation for the different informatics needs in each setting. Programs typically offer didactic informatics lectures with many programs offering fellows the opportunity to enroll in concurrent graduate degree programs or certificates in informatics. Fellows maintain proficiency in pediatrics or their pediatric subspecialty through longitudinal clinical work. Upon completion of the fellowship, graduates can sit for the American Board of Preventive Medicine's CI examination to gain board certification in CI. Career trajectories for pediatric CI graduates include academia, industry, and research. Low recruitment of pediatricians into CI fellowships may leave many children's hospitals without expertise in pediatric CI.


The Future of Pediatric Clinical Informatics

The American Academy of Pediatrics' Council on Clinical Information Technology (COCIT) has a mandate to develop, implement, spread, and promote health IT to improve child health.[34] Working together, COCIT, ACGME, and AMIA can ensure that enough pediatricians are trained in CI by (1) increasing trainee awareness of and interest in CI, (2) increasing pediatric trainees' knowledge of core CI concepts, and (3) supporting the careers of future pediatric informaticists. First, to increase trainee awareness of and interest in CI, pediatric residency programs should integrate CI content into all phases of medical training through the creation of formal CI curriculums, optional CI rotations, and optional local hospital-based CI interest groups to allow motivated trainees to gain exposure to CI and to network. Second, to increase pediatric trainees' knowledge of core CI concepts, the ACGME should recognize CI skills as a core competency for pediatric residency completion and the ABP could consider including CI content on board examinations in keeping with milestones from peer specialties like Internal Medicine where CI skills are reflected in established milestones. Finally, to support the careers of future pediatric informaticists, residency programs, COCIT, and AMIA can identify and encourage pediatric trainees with an interest in CI to seek further CI training and expand the number of pediatric CI fellowship programs and positions. To secure sustainable training opportunities for pediatric trainees in CI, appropriate funding to support trainees is required. As some CI programs fund their fellowship using clinical billings of their fellows, advocating for increased pediatric service reimbursements may increase the ability of CI fellowships to sustain the training of pediatricians in CI.[35] Creative partnerships between AMIA, COCIT, and industry should be considered to create grant funding to support trainees interested in CI. Given the paucity of literature regarding the factors influencing pediatricians to pursue CI training, additional work should be done to better characterize this issue and to test interventions to improve CI literacy and training uptake among pediatricians. Through these collaborative interventions, we can grow the pediatric CI work force ensuring that all institutions that care for infants, children, or adolescents have individuals with the skills and drive to improve pediatric health information systems. While this article focuses on training pediatric clinical informaticists, many other specialties face similar issues nurturing expertise in CI within their specialties and could take a similar approach outlined here to improve trainee CI exposure and education.[35-37] There may be additional considerations not explored in this article in terms of barriers to training pediatric clinical informaticists beyond the United States of America.[38]



Conflict of Interest

None declared.


Address for correspondence

Adam Paul Yan, MD, MBI
555 University Avenue
Toronto, Ontario
Canada   

Publication History

Received: 14 May 2024

Accepted: 06 June 2024

Accepted Manuscript online:
07 June 2024

Article published online:
21 August 2024

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