Academic and nonacademic health informatics (HI) professionals (informaticians) serve
on interprofessional health care teams with other professionals, such as physicians,
nurses, pharmacists, dentists, and nutritionists.[1] Presently, we argue for investing greater attention to the role health informaticians
play on interprofessional teams and the best practices to support this role.
The Role of Health Informaticians on Interprofessional Health Care Teams
In interprofessional health care teams, individuals with distinct professional training
supply unique expertise and work together to solve health care problems.[2]
[3] When these teams span different branches of knowledge or subspecialties, they are
also considered interdisciplinary.[2]
[4] Interprofessional teams in health care are effective because they draw on diverse
expertise to address complex problems in holistic ways.[5]
[6] Interprofessional teams operate in health care facilities, academic institutions,
and community or public health settings.[7] In clinical settings, interprofessional teams provide less fragmented,[8]
[9] higher quality,[9]
[10] safer,[11] and more effective[12]
[13]
[14] care. Interprofessional teams are recommended by the World Health Organization[15]
[16] and the National Academy of Medicine.[17] Further, educational institutions and accreditors,[18] including the Accreditation Committee for Graduate Medical Education (ACGME),[19] embrace interprofessional education (IPE), to prepare health care professionals
“for the world of intercollaborative practice.”[7] In parallel, the National Institutes of Health and others urge interdisciplinary
“team science” in biomedical research.[20]
Are health informaticians considered members of interprofessional teams? Our informal
review of major textbooks,[21]
[22] reports,[7] and articles[1]
[23]
[24]
[25] found no mention of health informaticians as members of interprofessional health
care teams. A published 2013 review described the make-up of interprofessional teams
in 17 articles[26]; informaticians were not included in any (see [Supplementary Material], available in the online version). Furthermore, including HI students in IPE initiatives
appears to be an exception, not the rule.[27]
[28] When HI is mentioned in the literature on interprofessional health care, it is as
a set of tools that “has the capacity to support the work of health care teams”[29] and improve IPE.[30]
We argue that health informaticians have a professional role on teams, apart from
providing direct care.[a] This role should be better defined and communicated to other professions. When a
problem involves data or information, informaticians add value by applying competencies
in “management and use of biomedical information.”[31] This is evident in realms such as evidence-based health care delivery,[32] precision medicine,[33] population health management,[34] public health surveillance,[35] and learning health systems.[36]
[37] Health informaticians are qualified to handle both electronic health records and
larger health care data sets to answer questions, support care delivery, improve quality
and efficiency, and reduce costs.[38] Examples include building or identifying databases or data sets, mining structured/unstructured
data, applying computational procedures, interpreting data/results, and sharing data.
In many other cases, health informaticians add value by applying competencies in “design,
development, adoption, and application of information technology (IT)-based innovations.”[39] Informaticians can develop methodologies and technologies to advance team research,
design tools and networks to facilitate interprofessional collaboration and communication,
and develop standards and terminologies to support system interoperability.[40]
We argue health informaticians are useful members of interprofessional teams in all
stages of problem-solving—problem assessment, solution development, implementation,
and evaluation, as illustrated in [Table 1]. In part, this is because HI education is interdisciplinary, covering health, social,
and technical domains, such as biomedical sciences, computer and data sciences, human
factors and decision-making, and social and behavioral science.[41]
[42] Furthermore, properly trained health informaticians gain interprofessional collaboration
and leadership competencies, including leading and managing change.[41]
[42]
[43] This is evidenced by the inclusion of team competencies in HI accreditation and
board certification requirements.[41]
[44] The American Medical Informatics Association (AMIA) Accreditation Committee, for
instance, lists interprofessional collaborative practice (F9) and leadership (F10)
among its 10 foundational domains of HI.[41] Health informaticians can thus play the role of visionary, innovator, bridge, facilitator,
and evangelist on interprofessional teams.[8] In our experience, one of the most important though undervalued roles informaticians
play on teams is the figurative multilinguistic (symphonic) conductor. This entails sufficiently learning each team member's discipline- or profession-specific
values, norms, practices, vocabularies, theories, and methods to coordinate and translate
between dissimilar members.
Table 1
Example medication safety project with and without health informatician involvement
|
Project phase
|
Health informatician involved
|
No involvement of health informatician
|
|
Situation assessment
|
• Data obtained from health system used to assess the situation
• Simulation and predictive models built to identify most prevalent unsafe medications
• Interviews, surveys, and observations performed to learn patient and clinician information
needs and decision-making process
|
• Key data missing from problem assessment
• Could not prioritize or focus on specific medications
• Clinical priorities emphasized, patient information needs ignored
• Incorrect assumptions made about how individuals make decisions
|
|
Solution development
|
• Solution includes patient- and clinician-facing software changes
• Solution applies rules to target most prevalent unsafe medications
• Decision support solution created using user-centered design and iterative testing
• Solution is interoperable
|
• Software not part of the solution
• Targeting too many medications leads to untenable solution
• Solution does not conform with usability principles, is not usable or acceptable
to end-users
• Solution does not work with existing software and technical infrastructure
|
|
Implementation and evaluation
|
• Intervention deployed and tracked in health system's EHR system
• Medication data mined from EHR, compared pre–post intervention at individual and
group levels
• Informatician presents technical and business plans to leadership
• Key organizational and political constraints successfully navigated
|
• Intervention cannot be deployed to all EHR system users
• Data not available to perform objective pre–post evaluation
• Contradictory technical and business plans written by different individuals
• Failure to consider social (organizational/political) aspects results in unanticipated
resistance
|
Abbreviation: EHR, electronic health records.
A question facing HI and other disciplines is whether teams must include a formally
trained HI professional, rather than someone possessing informatics competencies.
The answer depends on access to health informaticians, availability of HI training
available to noninformaticians, and the ability of the team to cover the breadth of
relevant HI competencies described above. For example, a team should not replace a
health informatician with a software engineer unfamiliar with the health care domain.
Best Practices for Health Informatician Involvement in Interprofessional Teams
Having argued for the need to recognize and define the role of health informaticians
on interprofessional teams, we now turn to best practices for optimizing this role
([Table 2]). Our seven suggested best practices were compiled from the literature and our experience
with interprofessional collaboration and education. We also illustrate how each best
practice was applied in a project addressing the opioid crisis in a university-based
IPE course involving students and faculty coaches representing HI, nursing, medicine,
art and design, and engineering (see [Table 3]). The best practices and recommendations apply to HI students, certified clinical
informaticians, HI researchers, and other HI professionals.
Table 2
Best practices for health informatician involvement in interprofessional teams
|
BP Recommendations
|
|
BP1. Adopt the characteristics of effective teams
• Clear vision and goals[43]
[45]
• Mutual respect and shared values[7]
[41]
• Supportive climate[45]
• Diverse skill mix across team members[45]
• Clear roles and boundaries for each member[43]
[46]
[47]
• Continuous learning and training[45]
[48]
• Formal process for conflict management[49]
[50]
• Practice performance monitoring and feedback, back-up behavior, and adaptation[51]
[52]
|
|
BP2. Practice leadership and followership
• Clearly identify a leader to direct, support, and supervise the team[45]
• Leaders should be appointed or quickly emerge[53]
• The leader should be credible, honest, competent, able to inspire, and able to focus
the team on the vision[41]
• The team must understand the importance and roles of leadership in coordinating
the team's contributions[54] and achieving its goals[41]
• Team members should practice good followership[41]
• Use leadership tools, for example, for planning and performance review[50]
• A team leader establishes a shared belief in the value of collaboration[55]
• Leaders focus, coordinate, and create shared mental models for the team[53]
|
|
BP3. Clearly communicate with the aid of tools
• Communication success begins with shared understanding, mutual respect, and agreed-upon
ground rules[7]
[41]
• Use informatics knowledge to establish effective communication technology and tools[55]
• Use communication tools[50] such as SBAR,[56] Call-Out, Check-Back, and Hand-off
• Err on the side of over- rather than under-communication, for example, making sure
to include all recipients on e-mails
• Create artifacts to summarize and organize information for shared situation awareness
and future reference (e.g., meeting notes, project charters, Gantt charts)
|
|
BP4. Design team meetings for effectiveness and efficiency
• Good meetings are a result of careful planning, attention to participants' needs,
and follow-through[57]
• Use early meetings to establish the team's purpose, goals, members' roles and responsibilities,
meeting and reporting plan, deliverables, and timetable[43]
• Adopt a team meeting framework and recommendations (see Schleyer et al[43] for detail)
• If possible, organize in-person meetings[55]
|
|
BP5. Articulate your skills with respect to health informatics
• Explain to teammates the breadth of HI
• Explain to teammates the specialization(s) within HI represented by HI team members
• Act politely and be forgiving when a team member has incorrect assumptions or perceptions
of your skills: offer gentle corrections with the goal of educating and enhancing
your effectiveness and efficiency in the team
• Inform team members of data needs early in the project lifecycle, to facilitate
future access to health care data[58]
• Ensure team members' understanding and use of proper terminology and techniques
related to health data[58]
|
|
BP6. Develop skills and knowledge in interprofessional teamwork and domains
• Understand roles and values of all team members[7]
[41]
[45]
• Interact with and learn from other professions, being attentive to their languages
and practices[59]
• Seek out interprofessional collaboration and cross-training opportunities before
graduation[60]
• Establish interprofessional collaborative practice culture and team (not individual)
reward systems[30]
• Work to improve team skills such as self-assessment of strengths and weakness, listening,
and managing shared goals, in addition to gaining domain knowledge[62]
|
|
BP7. Ensure health informatics education supports interprofessional collaboration
• Align HI professional education with above best practices[47]
• Offer opportunities for hands-on health care problem solving in interprofessional
teams, using interdisciplinary informatics approaches, with faculty feedback and support[48]
[50]
• Faculty should provide interprofessional opportunities, feedback, and support[48]
[50] as well as themselves come from different disciplines[61]
• Use simulation-based training with real-world scenarios to train HI students for
work environment[48]
• Partner with campus IPE programs
|
Abbreviations: BP, best practice; HI, health informatics; IPE, interprofessional education.
Table 3
Illustration of how the seven recommended best practices were applied in a university-based
interprofessional education course involving students and faculty coaches representing
health informatics, nursing, medicine, art and design, and engineering
|
• BP1. Adopt the characteristics of effective teams
○ Faculty divided teams to promote diverse mix of professions and skills
○ Team leader brought team to early consensus on project scope
• BP2. Practice leadership and followership
○ Leader emerged in the first week, with team consensus and faculty coach approval
○ Team leader created the plan, assigned roles and tasks, and held team members
accountable
○ Leader communicated with outside stakeholders on behalf of the team
• BP3. Clearly communicate with the aid of tools
○ Teams had regular scheduled meetings face-to-face or using online conferencing
system; face-to-face meetings were most effective but more difficult to achieve
○ Teams used online cloud-based storage, for viewing progress and team documents
• BP4. Design team meetings for effectiveness and efficiency
○ Team members agreed to and held each other accountable for regular, in-person
meetings of the entire team
○ Team used meetings for updates on progress and updating the plan
○ Team used resources such as white boards and note-taking to support meetings
• BP5. Articulate your skills with respect to health informatics
○ HI team members corrected team members' assumptions when asked to play a role
outside their HI specialty
○ HI team members provided team mates with an explanation of HI breadth and their
specific skill/knowledge areas
○ HI team members tackled barriers to acquiring data from stakeholders to assess
the situation or test an informatics solution
• BP6. Develop skills and knowledge in interprofessional teamwork and domains
○ HI team members spent extra time learning about the practices and assumptions
of teammates' professions
○ HI team members had to learn professional and clinical jargon
○ HI team members had to learn the realities of health care delivery, which clinical
teammates had gained through hands-on experience
• BP7. Ensure health informatics education supports interprofessional collaboration
○ The IPE course allowed HI students to work with students representing other professions
○ HI students received coaching and education in interprofessionalism, teamwork,
and problem solving
○ Diverse faculty, guest judges, and community stakeholders representing multiple
professions and disciplines provided a guided learning experience
|
Abbreviation: BP, best practice.
Note: See [Supplementary Material] for details about the interprofessional education course.
Best Practice #1—Adopt the Characteristics of Effective Teams
There are multiple evidence-based accounts of the characteristics of effective teams
and how to achieve them,[48]
[63]
[64] listed in [Table 2]. Successful teams set goals, monitor each others' performance, balance workload
between team members, and adapt to deviations.[52]
[65] Health informaticians can make teams more effective by increasing the team's skill
mix and setting clear expectations for their roles and duties relative to their skills.[43] For instance, a health informatician could take the responsibility for data analysis
or management tasks.
Best Practice Implication #2—Practice Leadership and Followership
According to the AMIA's HI core competencies, leadership refers to the “process for
which the output is vision, guidance, and direction.”[41] Leadership facilitates action, in addition to supporting team psychosocial needs,
such as morale, motivation, and confidence.[51] In interprofessional teams, leaders must instill the belief that collaboration adds
value.[55] Likewise, a health informatician leader must convince the team of the value and
applicability of HI. Leaders often hold others accountable and represent the team
to outside stakeholders, meaning HI professionals must learn to interact with decision-makers
who are noninformaticians (e.g., avoiding or explaining informatics jargon). HI competencies
also dictate practicing followership and supporting leaders from other professions.[41] Although traditionally there is one leader, there is theoretical and practical guidance
for shared or distributed leadership approaches.[66]
[67] Shared leadership may be relevant when the health informatician is in charge of
methodological aspects but a clinical professional provides clinical leadership.
Best Practice #3—Clearly Communicate with the Aid of Tools
HI professionals should be skilled in applying the “principles of interprofessional
communication in a responsive and responsible manner that supports a team approach.”[41] Good communication starts with a common language and shared understanding, which
means health informaticians need to learn and respect their teammates' language and
professional identities,[55] while carefully selecting which informatics terms and concepts to introduce. Early
on, communication can be aided by creating artifacts, such as team charters or social
contracts, which explicitly establish expectations for communication, including frequency,
method, and what constitutes timely and respectful responses. As team projects move
forward, other tools and artifacts become more useful, for example, hand-off procedures,
stable communication channels (e.g., mailing lists, chat rooms), and storage space
for team documents (e.g., meeting minutes). A health informatician may need to advise
on appropriate communication technologies, especially when the communication concerns
sensitive patient data, large data sets, or the use of clinical information systems
(e.g., internal messaging).
Best Practice #4—Design Team Meetings for Effectiveness and Efficiency
Despite their bad reputation, team meetings can yield irreplaceable benefits with
careful planning, attention to participants' needs, and follow-through.[57] In the beginning, well-designed meetings help establish the team's purpose, membership,
structure, process, and resources. They are also an opportunity to learn the value
of each team member, beyond their professional titles. This is especially important
when the team has vague or incorrect knowledge of the HI profession. During the course
of project work, meetings provide a forum for reporting progress, planning and replanning,
resolving conflict, team brainstorming and feedback, and relationship building. Schleyer
et al[43] provide a framework and specific guidance for effective and efficient team meetings
for HI professionals, covering topics such as in-person versus electronic meetings,
meeting space and technology, the use of agendas and meeting minutes, and meeting
procedures.
Best Practice #5—Articulate Your Skills with Respect to Health Informatics
HI is itself interdisciplinary, producing professionals with differing subspecializations
and roles.[68] Members of interprofessional health care teams are already dissimilar,[46]
[47] but health informaticians have an added burden of representing a profession lesser
known within the health care community. Specifically, HI has wide-ranging meanings,[69] so team members may have a restricted understanding of their health informatician
teammates, leading to misaligned expectations. For example, an informatician may be
viewed as a “data person” or “technology person”; these are true of some, but not
all. A team member might also have an erroneous understanding of HI, for example,
believing informaticians merely provide “programming” or “tech support.”[b] The breadth of HI has two implications for interprofessional teamwork. First, an
HI professional must be ready to articulate the full extent of HI, for the education
of teammates, and the good of the profession. Second, the HI professional must define
their personal training, experience, and specialization(s) on the continuum of HI
competencies. (Similar considerations apply to working on intraprofessional HI teams.)
A corollary best practice is once the team understands the HI team member's skills,
there is an additional challenge of assigning and supporting an appropriate role for
him or her. This is facilitated by, for example, the ubiquity of information and IT
in health care. However, in our experience, many HI contributions require access to
data, and data may not be readily accessible to or understood by the interprofessional
team. This may be especially common in limited-resource or educational settings, prohibiting
the HI team member from exercising their competencies in data analytics, modeling,
and mining.[41]
[70] Health informaticians are therefore advised to secure as early as possible the resources
they need to play their role on the team.
Best Practice #6—Develop Skills and Knowledge in Interprofessional Teamwork and Domains
At the same time, HI professionals need to understand and respect other professions,
facilitated by IPE and other interprofessional interactions.[41]
[71] Another avenue of learning outside the HI profession is cross-training, which can
range from experiential learning in “real-world” contexts to reading about outside
disciplines.[33]
[72] This is especially important for those health informaticians who have limited clinical
exposure or prior training, and need to work with professionals who have accumulated
clinical experience, vocabularies, and assumptions over such a long time that it is
implicit (i.e., learned intuition). Health informaticians must therefore learn not
only HI skills, but also teamwork and at least the basics of other professions.[59] Similarly, they must find ways to become knowledgeable in their application domains
(e.g., pediatrics, decision-making, artificial intelligence), as must their teammates.
These recommendations can be addressed in part by involving HI students in IPE offerings.
Best Practice #7—Ensure Health Informatics Education Supports Interprofessional Collaboration
Ensuring HI students are trained in interprofessional collaboration is a natural extension
of the preceding best practices and aligned with HI core competencies and foundations.[41]
[73] HI education should engage students to collaborate with other professionals, solve
“real-world” health care challenges, and apply interdisciplinary methodologies.[74] HI programs should strive for both integration with other campus IPE initiatives
and creation of living laboratories for hands-on application of HI competencies.[33]
