Health Informatics Series Part 4: How I studied for (and passed!) the Clinical Informatics Boards

I wanted to write this post because when I first started studying for boards I couldn’t really find that much information on it as the test was only a few years old and relatively few people had taken it. (Currently there are only 1,863 board certified informaticists). This is in contrast to taking the ABIM board where people have been taking the test for decades. Thankfully, I was able to connect with others through my network who were able to provide guidance. For that kindness, I want to pay it forward to folks who are currently preparing to take the test.

For candidates coming in through fellowship, I think the formal curriculum, competencies and didactics will be very helpful in preparing for the board. I was a grandfathered candidate and didn’t have formal training (CI fellowships were only beginning to get started as I was preparing for the test so I’m self-trained). It was helpful that as part of the grandfathering process the Board vetted my application to see if they thought I had garnered enough knowledge and experience to take the test and their approval of my application gave me more confidence that I could pass.

The content of the boards can be found here at the American Board of Preventative Medicine web site (“Clinical Informatics Content Outline”): https://www.theabpm.org/become-certified/exam-content/clinical-informatics-content-outline/ . As you can see, the content reflects the diverse and hybrid skill sets of informaticists. Like all boards, pay attention to the content weighting and focus on studying the sections you might not be as familiar with, especially the ones not formally taught in med school or on the job.

Like studying for any boards, studying for the CI board requires focus and time commitment. I began reading two months before the test and I had a two week period of intense review (used 10 vacation days). Definitely make sure you carve out dedicated study time for review. Some concepts will be very familiar to you, and others will be relatively new and you need time to understand and internalize.

I took the AMIA board review course, which I highly highly highly recommend. The instructors are really experienced and practicing physician informaticists who really care about the field and helping everyone learn and do well and I really appreciated that. I reviewed the course notes 3x and knew them cold. I also read all the recommended readings. The course is available in person and online and it’s the same content. I opted for the in person because I wanted to meet other physician informaticists. I’m 1/6000 people at the health department but the only physician informaticist so I was curious what other physician informaticists taking the test were like. (Turns out many people taking the the test were CMIO’s and/or people who had 15-40 years of experience. Again, there were very few fellowships before and during the time I was taking the test).

I love learning more and more about the field and part of my job is to keep up with industry trends so I am constantly reading articles on different parts of the field, from programs to policy, to the state and trajectory of current technologies as well as emerging technologies. No one except the test writers really know what’s on the test so it’s important to keep up to speed on current and emerging concepts and trends-anything is fair game.

Also, for concepts that are new or seem hypertechnical, doing a quick Wikipedia search (good for summaries) and/or Google search can be super helpful. Sometimes I would Google terms and read several different definitions of a term to make sure I understood it. The repetition and seeing things from different angles also helps with memory.

The main book I used for review was the Finnell and Dixon “Clinical Informatics Study Guide”. (Read it twice. First for understanding and underlining key points, second for review after reviewing AMIA course notes twice). It was relatively concise and very comprehensive. If you have more time, the Shortliffe Biomedical Informatics book is a staple textbook.

After reading the review book and reviewing the course notes, I also made myself a short fast fact study sheet of important concepts, definitions, and terms for each content section in the content outline.

As with all boards, do questions! I did all the AMIA questions and made sure to read all the explanations, even if I answered the question correctly. I also added any new tidbits of information to my study sheet.

Last, the day before and day of the test I reviewed my study sheet.

Feel free to adapt this guide to your study style. If you study better in groups and know other folks taking the test, assemble one. Or put it out there that you are looking for a study partner.

If anyone would like to share any tips, books, and resources they used, please leave a comment below.

As always, my blog posts reflect my opinions and experiences and not those of my employer or any other affiliations

Health Informatics Series Part 3: What I love most about my work

-Impact at a population level

As a doctor you generally see one patient at a time and over the course of a year that scales up to seeing a population of patients. In public health, it starts at thinking about health at a population level and how changes at that level will ultimately affect individuals

-Teaching 

I’ve always loved teaching and I’ve tutored since high school. Now I’m able to offer students, residents, and other doctors the opportunity to see what health Informatics is about with my elective. I also get to teach my nonmedical colleagues about health and medicine.

-Working in a team and with different teams

I love that I can work independently but that I’m also part of a team. I get to work with junior and senior analysts, programmers, billers, and other physicians. I also get to interface with different teams who work in Strategy, IT, Communications, Quality Improvement, Policy or who specialize in particular health issues like HIV, Cancer, Family Child Health etc. The internist in me likes variety and I also get to learn from the other teams.

-I get to use different parts of my brain

I get to flex the analytical, strategic, clinical, and design/creative parts of my brain. I plan, analyze, and make things. I help co-author reports, newsletters, research. I visit provider offices to help think about QI, workflow, staff training and clinical outcomes. I work with folks at all levels from interns in college to directors at on different teams or at different organizations.

-Provide a physician’s perspective

I always think about the health of and impact on patients, but I also am able to provide a physician’s perspective on things, from document review to administrative burden to how changes could potentially impact workflow.

-Community 

I like being part of a community that works in healthcare. We share resources, wins, and challenges. We could’ve picked any other field but we chose this one.

-Opportunity to challenge myself and learn new things 

My blog is called “Just Curious” because I like learning things and asking questions. I also like taking what I’ve learned and applying that knowledge to solve real world issues. The best part of my day is knowing I’ve made a difference for someone by giving them info they needed, helping someone save time or other resources in some way, or help by listening and guiding someone as they work towards a solution to their specific issue.

-Focus on solving present problems but also building towards the future 

I think it’s important to be able to set systems up today so that they will positively influence what our future looks like, from the experiences people have in healthcare, to lightening analytic load by thinking about how to meaningfully collect data and minimize the work needed for data cleaning

As always, my blog posts reflect my opinions and experiences and not those of my employer or any other affiliations

Health Informatics Series Part 2: What types of Informaticists are there? Where do they work? What skills are needed?

Types of Informaticists 

Informaticists tend to have hybrid skill sets with expertise in healthcare, health information technology, and/or healthcare business, operations and management. Some enter the field starting out in healthcare and learn more about the tech aspects (like me) and some start out in tech and gain interest in health and healthcare. I’ve seen a lot of current CMIO’s who have Bachelor degrees in biomedical engineering, computer science, or computer engineering and later went to med school or those who did the traditional medical pathway and then worked at the VA or National Library of Medicine on informatics projects, or those who became project leads on hospitals transitioning from paper to EMR. These CMIO/CIO/CXO/Directors etc have 20, 30, 40 years of experience and helped shape what the field is today.

Informaticists coming in from the clinical side bring their medical expertise and real world clinical experience. They understand workflow and workflow challenges. They also understand the flow of information. Though not necessarily a biller, computer programmer or a health IT tech, they understand those roles and may have some of those skill sets and/or work with folks that have those roles.

From tech side I see folks with deep knowledge in analytics, programming, engineering and who are willing and able to learn about health and the delivery of healthcare. I also would add that everyone understands what it’s like to be a pt.

Clinical and nonclinical work experience are equally important. Technology is now a required pillar in every industry and it’s helpful to have people who are familiar with it and can help leverage it as a tool to solve healthcare’s most pressing and ominous issues.

Places to work 

Informaticists work in all areas of healthcare. I see informaticists in hospitals, outpatient settings, research, consulting, nonprofits, government, startups, Big Tech, academia, think tanks, medical societies, in public and global health, etc. Their titles may not explicitly say “informaticist” but the work they do is very much informatics.

Helpful skills to have:  

-Domain expertise-healthcare and/or tech

-Understanding technical and clinical concepts if starting as an expert in one domain (proficiency will develop as you grow)

-Work well with others and alone-You will interface with individuals from a variety of backgrounds

-Communication skills- You will be translating information for different audiences and teaching new concepts

-Change management-You will be working on new things that may never have been done before.

-Project Management

-Time management skills -often you might be the only one with this blended expertise and you will be involved in many projects, workgroups and activities

-Able to tolerate risk and rapidly changing environment.

-Leadership

-Commitment to Life long learning-The field changes rapidly and keeping up to speed involves reading, webinars, conferences, learning new tools and technologies, practicing informatics, and talking to others in the field. Plus keeping up with clinical guidelines.

Health Informatics Series Part 1: What is Health Informatics? What is Clinical Informatics?

I’ve received a lot of emails, inquiries, LinkedIn requests, and conversational questions from folks about Informatics, my experiences, and pathways to entry so I’ve decided to write a series on the topic. I’m a physician informaticist with startup and public health experience but I will also include general content as well.

First, let’s start with some definitions:

Informatics (USF definition)

“At its core, informatics is the science of information and all its aspects – storage, how it’s processed, communicated and used. It is mainly thought of today as computerized information, but can also apply to information stored, communicated and used on paper, audio tape or even in someone’s brain.”

Biomedical Informatics (AMIA definition)

“BMI is the core scientific discipline that supports applied research and practice in several biomedical disciplines, including health informatics, which is composed of clinical informatics (including subfields such as medical, nursing, and dental informatics) and public health informatics (sometimes referred to more broadly as population informatics to capture its inclusion of global health informatics”

Health Informatics (US NLM definition)

Health informatics is the interdisciplinary study of the design, development, adoption, and application of IT-based innovations in healthcare services delivery, management, and planning.

There are also other breakouts in informatics including: bioinformatics, nursing informatics, pharmacy informatics, consumer health Informatics, research informatics, translational informatics etc.

I found this AMIA white paper to be very helpful when trying to understand the broader concepts and breakouts in informatics (first link is the paper, second is the diagram):

J Am Med Inform Assoc. 2012 Nov-Dec; 19(6): 931–938. https://dx.doi.org/10.1136%2Famiajnl-2012-001053

Health IT (Health IT.gov definition)

“is a broad concept that encompasses an array of technologies. Health IT is the use of computer hardware, software, or infrastructure to record, store, protect, and retrieve clinical, administrative, or financial information.”

Digital Health (I’m quite fond of the Wiki definition)

“is the convergence of digital technologies with health, healthcare, living, and society to enhance the efficiency of healthcare delivery and make medicines more personalized and precise. The discipline involves the use of information and communication technologies to help address the health problems and challenges faced by people under treatment.These technologies include both hardware and software solutions and services, including telemedicine, web-based analysis, email, mobile phones and applications, text messages, wearable devices, and clinic or remote monitoring sensors. Generally, digital health is concerned about the development of interconnected health systems to improve the use of computational technologies, smart devices, computational analysis techniques, and communication media to aid healthcare professionals and their clients manage illnesses and health risks, as well as promote health and wellbeing.

A lot of people use these terms interchangeably and there is often overlap, so what I suggest is asking questions about the focus of work, what day-to-day work is like, population served, tools used, level of technical proficiency required, past projects and percentage of time spent in different domains of work.

Some helpful links to informatics societies that can offer a wealth of information:

Healthcare and Information Management and Systems Society (HIMSS) https://www.himss.org/

American Medical Informatics Association (AMIA) https://www.amia.org/

American Health Information Management Association (AHIMA) https://www.amia.org/

International Medical Informatics Association (IMIA) https://imia-medinfo.org/wp/

College of Healthcare Information Management Executives (CHIME) https://chimecentral.org/

As always, my blog posts reflect my opinions and experiences and not those of any of my employer or any affiliations.

 

My 2019 Reading List

I’m a bibliophile and I learn a lot from what I read. I read for fun, but I also read with a growth mindset. This year I want to learn more business concepts and refresh my memory on some old friends. I also am very interested in leadership concepts, tools and advice. If you have any recommendations, please feel free to share, I love learning from the best.

(Also kudos to the New York Public Library for supporting education and learning. I found all these books as texts or e-books.)

  • According to Kotler : the world’s foremost authority on marketing answers your questions / Philip Kotler.
  • Blogging for dummies / by Amy Lupold Bair.
  • Sometimes you win, sometimes you learn : life’s greatest lessons are gained from our losses / John C. Maxwell.
  • Shopper marketing : how to increase purchase decisions at the point of sale / editors: Markus Stahlberg & Ville Maila.
  • The checklist manifesto : how to get things right / Atul Gawande.
  • Build your dream network : forging powerful relationships in a hyper-connected world / J. Kelly Hoey.
  • MBA [electronic resource] : 10 instant MBA lessons / Infinite Ideas, with Nicholas Bate. / Infinite Ideas, with Nicholas Bate
  • Warren Buffett and the interpretation of financial statements : the search for the company with a durable competitive advantage / Mary Buffett and David Clark.
  • Understanding Michael Porter : the essential guide to competition and strategy / Joan Magretta.
  • The visual MBA : two years of business school packed into one priceless book of pure awesomeness / Jason Barron, MBA.
  • The real life MBA : your no-BS guide to winning the game, building a team, and growing your career / Jack and Suzy Welch.
  • The ten-day MBA : a step-by-step guide to mastering the skills taught in America’s top business schools / Steven Silbiger.
  • The Wall Street MBA : your personal crash course in corporate finance / Reuben Advani.
  • The 30 day MBA in international business : your fast track guide to business success / Colin Barrow
  • PM Crash Course, A guide to what REALLY matters when managing projects/ Rita Mulcahy

 

Connect with me on Twitter @doctorcharlene

Connect with me on Linkedin- Charlene Ngamwajasat

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A technical switch from ICD-9 to ICD-10, why it matters

Oct 1 marked the day when many healthcare institutions, insurers, CMS (Center for Medicare and Medicaid Services) switched over from International Classification of Diseases 9 (ICD-9) to International Classification of Diseases 10 (ICD-10). Much heralded in some circles (Europe, Asia and Africa implemented ICD-10 decades ago) and sometimes referred to as healthcare’s version of Y2K in others, it has come about with years of delay, angst, optimism and controversy.

The switch to ICD-10 from ICD-9 isn’t just an increase in the number of codes by tens of thousands (17,000->~68,000), it is an upgrade that is long overdue (ICD-10 was created in 1990). The benefits of ICD-10 include:

  • an improvement in clinical documentation- new updated terminology, inclusion of laterality, illness severity
  • better ability to capture the scope of clinical care and outcome indicators
  • more appropriate re-imbursement (electronic record and evidence of care)
  • added value to technology and health reform initiatives as healthcare moves towards coordinated care models and value-based cost-efficient care
  • better ability to conduct public health surveillance

The downsides of ICD-10 are the costs of implementation and that despite delays, some providers and institutions still aren’t prepared for the system upgrade, which can translate into coding errors, re-imbursement dips, delays in procedure or testing authorizations, and even insurance denials for patients. Fortunately enough, CMS has instituted a one year grace period for claims submitted on or after October 1, but only if the codes submitted for a particular diagnosis are classified under the correct family of codes. As for individual payers, they may have their own set of rules when it comes to incorrectly coded claims.

ICD-10 is a stepping stone into ICD-11, set to be released by 2017. Expectations of when the U.S. will adopt ICD-11 are to date, unknown.

The Founder’s Apprentice, CEO’s Take Note

magician-delete

Credit: CC Pixabay

The concept of apprenticeship isn’t new, in fact the concept of learning a trade from a master craftsmen is quite old (from sushi to stone masonry). What is new is it’s formal application and position in entrepreneurship.

To be clear, an apprentice isn’t necessarily an intern or someone who is 20 years old (though s/he could be). S/he may be forty and looking to change careers or pivot despite the associated challenges. S/he is someone who is interested in a trade and wants to learn the craft from someone with many years of experience (or a knowledge equivalency). S/he is willing to work hard, do any task that is given, and act as the eyes, ears, and hands for her boss-mentor-teacher. She’s passionate about the field, the job, and the opportunity to use her innate skill set and those she has acquired to ramp things up. She’s courageous and resilient, challenges are seen as opportunities, and intellectual curiosity takes precedence over status quo-based procedures. Titles don’t matter, the opportunity to learn, create and change the trajectory of her life and others does.

For founders and CEO’s (of companies large and small), it’s about the injection of fresh energy into the company. It’s about working with someone who has a lot to learn (teaching moments) but is highly motivated and excited about the work that is being done (something you can’t teach). It’s about having a sounding board that is distinct from the “only positive news” bubble. It’s also about paying things forward.

So how does one go about finding an apprentice? The likely case is that s/he will find you. An entrepreneurial apprentice will make you take note of her/him. S/he may not fit into any one job description or have a linear work history, but s/he will exude motivation, passion and purpose.

Put out an ad. Put out a challenge. Make the it known that the once-in-a-lifetime opportunity is available. Ask her questions. Why is she passionate about the field? Why does she want to work with you? What does she want to learn/what can you teach her? What has she noticed about what you’re doing (both good and bad) and how would she change things if she was in your position? What does she believe/know that no one else does?

Challenge yourself. Take on an apprentice. Great people are at the core of any great business, why not continue that legacy?