10 June 2008 Output

AMIA Academic Forum Second Annual Conference
American Medical Informatics Association
Hilton Washington DC/Rockville Executive Meeting Center
Rockville, Maryland
Thursday, July 10, 2008

Discussion of Informatics Competencies – July 10, 2008

Individual Workgroup Results

Group 1

In briefing books, on page 28

1.2 Defining the Discipline
For the purpose of this report and further discussion on the issues surrounding competencies, biomedical and health informatics health* informatics is defined as the field that studies and applies information and knowledge in biological research, in the clinical sciences, and in health care delivery, encompassing the structure, discovery, acquisition, integration, management, and optimal use of biomedical knowledge.

• Replace biomedical and health informatics with health* informatics
• Add “and applies” after studies

Health*= molecules to population

Based on the original list in briefing books, on Page 32, we have made the following list:
1. Data Information and Knowledge:
A. Modeling
B. Representation
C. Structure
D. Generation
E. Analysis
F. Manipulation
2. Health* Systems
A. Applications Systems
B. Intelligent Systems
3. Information Systems
A. Information Technologies
B. Sociocultural Systems
B.1. Semiotics
C. System Models
C.1 Models
C.2 System Architectures
Including communication systems
4. Health* Research
5. Health* Education
6. Health* Service
Then create a matrix to encompass the rest, using H.1 – H.9.

Group 2

Based on the original list in briefing books, on Page 32, we have made the following list (focusing only on topic headers, A, B, etc.):
1. Data Information and Knowledge: Conceptual Modeling, Representation and Structure
2. Data Information and Knowledge: Analysis, Inference, Manipulation and Visualization
3. Health Systems: Understanding the Domain
Ecology of health environment (ecological model of health)
Context of health
Continuum of health care system (data flow)
Context of care
4. (“D” through “G” combined) Health Information Technology Systems
Functional and social uses (within the health system overall)
Information methods and tools
Basic knowledge
5. Management and Operations of Health Information Systems
6. Design and Evaluation of Health Information Systems
7. Professional Skills (delete rest of topic title)

Discussion During Report Out

• Vocabulary is an issue. There is a need to create a vocabulary for the aspects of informatics that are unique. Also a need for a common set of definitions for the terms that are used in the competency statements.
• Core competencies need to transcend the informatics specialties.
• Emphasize generic architectural components of systems.
• Algorithmic thinking is a key activity in informatics, but is not readily defined. May fall into the domain of empirical modeling.
• Move Education and Training to Users and Use.
• See Health Systems Research as a special instance of all the other categories.
• Section H may be core competencies for any professional.
• Consider basic knowledge of software development as an area of competence. Many of the pieces discussed are part of software engineering, but are distributed in the different areas.
• Informaticians should be able to develop systems that promote new capabilities, not just respond to current needs.

Key requirement of the competencies – If an individual claiming to be an informatician does not understand a particular concept, then that individual really can’t be considered an informatician (the lack of understanding would seriously hamper their functioning). Use this as a test for appropriateness of competencies.

Group 3

Group 3 chose a Top-Down Approach

Three major types of sciences

• Bio/Health Sciences
• Information Sciences
• Management/Decision Sciences

All three of these headings are comprised of Attitude, Knowledge, and Skills.

A commonality across all three of these headings are:

• Standardization
• Evaluation
• Ethics, Legal, Civic and Culture

Another potential organizing framework is Research, Education and Service.

Organizing competencies in this way emphasizes that they have been taken from other fields. Perhaps the unique aspects of informatics are the glue that holds these sections together.

Under the heading of Bio/Health Sciences, group 3 placed: Health Systems (section 1.2, page 56), Biomedical Research (B4, page 122), and Biomedicine (V, page 157).

Under the heading of Information Sciences, they placed: IT (section D, 3.1, page 58), Information Management (A-1, page 119), Knowledge Generation (A & B, page 32), and HCI (3.2, section G, page 58).

Under Management/Decision Sciences, they placed: Management and Leadership (VII, page 158, also H & I, page 60, and C5, page 123), QI (2.3, page 57), and Decision Science (2.1, 2.2, page 57).

The guidelines they pulled from were the AMIA initiatives, which started on page 32 in the Briefing Book, the Nursing perspective which began on page 153, and the COACH guidelines which began on page 117.

Group 4

Selected a framework that is strongly informed by system development life cycle. The framework defines the major categories of activities and major perspectives associated with health informatics.

Research-- Applied
Strategy-- OPS

Evaluation encompasses the entire chart below and is a factor in all the perspectives and units

Organizational System Perspective
(this includes change management and leadership)
HC Sys, Soc. Sys, and Geographic IS

Roles/Role Perspective
(this includes ethics, privacy, and security)

HCI Function/Goals
(this includes data and communication)

Information Systems
(this includes HIT, DSS and architecture)
Modules and Tools
DIK Evidence
Algorithm Software

Following are examples of potential competencies that fit within the framework described above:

• Leadership skills
• Information retrieval
• Change management

• Effective communication

Systems and Understanding
• HC and clinical flow

Change Manager
• Information generalist
• Champion/educator, “gatekeeper”
• Info-magician
• “Cultural” diagnostician; translator for actionable advice/support
• Operate at the interface

Discussion During Report Out

• May need another layer – cognitive processing. Between Functions and Roles.
• Informaticians generally function in the middle, serving as a translator between the sociocultural aspects on top and the technical aspects on the bottom.
• Increasingly informaticians are being called upon to serve in strategic rather than tactical roles.
• Each workgroup noted that the distinguishing feature of informatics is the way it integrates different skill domains, but in general the workgroups focused on separating the domains in order to define competencies.

Group 5

Our anchor – AMIA Board Defined Domains
1. Clinical informatics
2. Public/population health informatics
3. Translational bioinformatics
4. Clinical research informatics

See page 25 of briefing book for options for organizing competencies

Freethink – Biomedical and Health Informatics are or requires expertise in…

• Health information systems
o Design, development, implementation, management, evaluation, and use
• Integration/bridging
o Unique informatics expertise for other domains
• Standards
• Governance, regulation, compliance
• Evaluation
• Consumer health informatics
• Affective domain that gives its attitudes value
• Value and trust of good data
• Reuse, transparency, and confidentiality of data
o Understanding the limits of data
o Data accuracy and quality
• Aligning data collection with reality of operations and clinical practices/processes
• Data representations, structures, and ontologies
• Workflow and consquences
• Organizational and change management
• Sociotechnical
• Clinical Decision Support
• Imaging
• Telemedicine
• Analysis and visualization of data putting user in context
• Usability of data for humans
• Embrace emerging technologies
• Nanotechologies
• Humility, enthusiasm, ambiguity, and curiosity
• Education and training
• Management and administration
• Data analysis
• Technical skills – need to define which skills, though.
• New methods and new techniques for data analysis
• Policy and politics
• Funding, finance, value, business models, contracts, and RFPs• Foundational domain knowledge, history
o Can one be a domain expert in informatics with foundational domain knowledge?
• Quality and safety
• Project management
• Multi-disciplinary
• Trans-disciplinary
o Fosters teams
o Enables leadership
• Articulation of the field
• Advocates for the field

Report Out
1. Recommend embracing AMIA Board definition of domains to scope this project
a. This captures the spirit of bridging and integrating bio – medical – health informatics
2. Competencies should characterize
a. Affective nature of field
b. Transformational nature of field
c. Integrative nature of field
d. Teams approach embedded in spirit of field

Discussion During Report Out

• What do informaticians add? Appreciation of other areas of knowledge
• To what degree do health informaticians need knowledge of other fields?
• Affirming the essential focus and inclusion of competencies in affect domain.
Data accuracy and use
Value attached to data and information
• Affirm the continuum of the informatics spectrum, from the gene to public health.
• Include competencies related to teams and leadership.
• Need to articulate a common elevator message for the field.

Draft Categories of Knowledge to Use in Defining Core Competencies

Derived by all meeting participants from the ideas developed by each of the workgroups

Health* is defined as the entire spectrum of health, including health care and research, from molecules to population.

• Data, information, and knowledge
o Enumeration/description of data and knowledge (attributes, etc)
o Modeling (including Conceptual modeling)
o Representation
o Structure
o Generation
o Manipulation
o Analysis
o Dissemination
o Inference
o Visualization
o Quality
• Health* Systems
o Ecology of health environment (ecological model of health)
o Context of health
o Assumptions/biases
o Continuum of health care system (data flow)
o Context of care
o Sources and uses of information in health systems
• Information Systems ** (includes communication systems)
o Information technologies
 Functional and social uses (within the health system overall)
 Information methods and tools
 Infrastructure/architecture
 Basic knowledge
o Sociocultural systems
 Management
 Learning (including user training, learning from clinical evidence, learning to manage health)
 Organizational behavior
o Systems models (including life cycle models)
o Human-Computer Interaction, including useability
o Managing life cycle
• Health* Research (both informatics and general)
o Conducting research
o Understanding research
o Supporting research
o Reporting/disseminating research
• Health* Education Methodologies
o Educating health professionals
o Educating the public, patients, etc
o Examples – simulation, tele-education, etc
• Health* Service
o Management and operations
o Financial aspects
o Quality and safety
o Efficiency
o Technology assessment
o Leadership, strategic planning, project management, change management

• Potential Cross-Cutting Categories
o Ethical, Legal, Cultural and Policy Issues and Principles (could be a component of all the competency categories)
o Evaluation (could be a component of all)

Need to define what is meant by Core or Common – is it common knowledge/skills/attitudes that all informaticians should have, and/or knowledge/skills/attitudes which informatics training programs must teach? How do these competencies relate to accreditation programs?

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