Download PDF
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

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
› Author Affiliations Funding None.
› Further Information
Also available at
    Permissions and Reprints

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]



Publication History

Received: 14 May 2024

Accepted: 06 June 2024

Accepted Manuscript online:
07 June 2024

Article published online:
21 August 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Jen MY, Mechanic OJ, Teoli D. Informatics. Updated 4 September 2023. In: StatPearls. Treasure Island, FL:: StatPearls Publishing;; 2024
    Google Scholar
  • 2 Del Beccaro MA, Jeffries HE, Eisenberg MA, Harry ED. Computerized provider order entry implementation: no association with increased mortality rates in an intensive care unit. Pediatrics 2006; 118 (01) 290-295
    CrossrefPubMedGoogle Scholar
  • 3 Han YY, Carcillo JA, Venkataraman ST. et al. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics 2005; 116 (06) 1506-1512 [ Erratum in: Pediatrics. 2006 Feb;117(2):594. PMID: 16322178]
    CrossrefPubMedGoogle Scholar
  • 4 Longhurst CA, Parast L, Sandborg CI. et al. Decrease in hospital-wide mortality rate after implementation of a commercially sold computerized physician order entry system. Pediatrics 2010; 126 (01) 14-21
    CrossrefPubMedGoogle Scholar
  • 5 Sittig DF, Ash JS, Zhang J, Osheroff JA, Shabot MM. Lessons from “Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system”. Pediatrics 2006; 118 (02) 797-801
    CrossrefPubMedGoogle Scholar
  • 6 Yan AP, Zipursky AR, Capraro A, Harper M, Eisenberg M. Pediatric emergency department sepsis screening tool accuracy during the COVID-19 pandemic. Pediatrics 2022; 150 (01) e2022057492
    CrossrefPubMedGoogle Scholar
  • 7 Yan A, Parsons C, Caplan G. et al. Improving guideline-concordant thromboprophylaxis prescribing for children admitted to hospital with COVID-19. Pediatr Blood Cancer 2023; 70 (02) e30112
    CrossrefPubMedGoogle Scholar
  • 8 Yarahuan JKW, Kisvarday S, Kim E. et al. An algorithm to assess guideline concordance of antibiotic choice in community-acquired pneumonia. Hosp Pediatr 2024; 14 (02) 137-145
    CrossrefPubMedGoogle Scholar
  • 9 Spooner SA. Council on Clinical Information Technology, American Academy of Pediatrics. Special requirements of electronic health record systems in pediatrics. Pediatrics 2007; 119 (03) 631-637
    CrossrefPubMedGoogle Scholar
  • 10 Lustig J, Gotlieb EM, Deutsch L. et al. American Academy of Pediatrics: Task Force on Medical Informatics. Special requirements for electronic medical record systems in pediatrics. Pediatrics 2001; 108 (02) 513-515
    CrossrefPubMedGoogle Scholar
  • 11 Lehmann CU. Council on Clinical Information Technology. Pediatric aspects of inpatient health information technology systems. Pediatrics 2015; 135 (03) e756-e768
    CrossrefPubMedGoogle Scholar
  • 12 Goldstein RL, Anoshiravani A, Svetaz MV, Carlson JL. Providers' perspectives on adolescent confidentiality and the electronic health record: a state of transition. J Adolesc Health 2020; 66 (03) 296-300
    CrossrefPubMedGoogle Scholar
  • 13 Parsons CR, Hron JD, Bourgeois FC. Preserving privacy for pediatric patients and families: use of confidential note types in pediatric ambulatory care. J Am Med Inform Assoc 2020; 27 (11) 1705-1710
    CrossrefPubMedGoogle Scholar
  • 14 Xie J, McPherson T, Powell A. et al. Ensuring adolescent patient portal confidentiality in the age of the cures act final rule. J Adolesc Health 2021; 69 (06) 933-939
    CrossrefPubMedGoogle Scholar
  • 15 Xie J, Hogan A, McPherson T, Pageler N, Lee T, Carlson J. Creating a guardrail system to ensure appropriate activation of adolescent portal accounts. Appl Clin Inform 2023; 14 (02) 258-262
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Sethness JL, Golub S, Evans YN. Adolescent patient portals and concerns about confidentiality. Curr Opin Pediatr 2023; 35 (04) 430-435
    CrossrefPubMedGoogle Scholar
  • 17 Agostino H, Toulany A. Considerations for privacy and confidentiality in adolescent health care service delivery. Paediatr Child Health 2023; 28 (03) 172-183
    CrossrefPubMedGoogle Scholar
  • 18 Our Software | Epic. ( n.d. ). Accessed 18 June 2024 at: www.epic.com/software/
    PubMedGoogle Scholar
  • 19 Webber E, Schaffer J, Willey C, Aldrich J. Targeting pajama time: efforts to reduce physician burnout through electronic medical record (EMR) improvements. Pediatrics 2018;142(01):
    PubMedGoogle Scholar
  • 20 Pageler NM, Webber EC, Lund DP. Implications of the 21st Century Cures Act in Pediatrics. Pediatrics 2021; 147 (03) e2020034199
    CrossrefPubMedGoogle Scholar
  • 21 Donnelly LF, Scheinker D, Pageler N, Shin AY. Correlation between an independent electronic health record and external ranking of children's hospitals. Sci Res 2021; 13 (02) 81-89
    PubMedGoogle Scholar
  • 22 Kim E, Van Cain M, Hron J. Survey of clinical informatics fellows graduating 2016-2024: experiences before and during fellowship. J Am Med Inform Assoc 2023; 30 (10) 1608-1613 [ Erratum in: J Am Med Inform Assoc. 2023 Sep 26; PMID: 37386768; PMCID: PMC10531187]
    CrossrefPubMedGoogle Scholar
  • 23 Desai S, Mostaghimi A, Nambudiri VE. Clinical informatics subspecialists: characterizing a novel evolving workforce. J Am Med Inform Assoc 2020; 27 (11) 1711-1715
    CrossrefPubMedGoogle Scholar
  • 24 Kissel AM, Maddox K, Francis JKR. et al. Effects of the electronic health record on job satisfaction of academic pediatric faculty. Int J Med Inform 2022; 168: 104881
    CrossrefPubMedGoogle Scholar
  • 25 Rajendram R, Mikhail M, Garrels K, Rosenfield D, Jessa K. Preparing the next generation of paediatricians: the importance of clinical informatics education. Paediatr Child Health 2023; 28 (06) 331-332
    CrossrefPubMedGoogle Scholar
  • 26 Mai MV, Luo BT, Orenstein EW, Luberti AA. A model for clinical informatics education for residents: addressing an unmet need. Appl Clin Inform 2018; 9 (02) 261-267
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 The Accreditation Council for Graduate Medical Education. Pediatrics Milestones. Published 2021 . Accessed 20 September 2021 at: https://www.acgme.org/portals/0/pdfs/milestones/pediatricsmilestones.pdf
    PubMedGoogle Scholar
  • 28 Pediatrics AB of. General Pediatrics Content. Published 2017 . Accessed 20 September 2021 at: https://www.abp.org/sites/abp/files/gp_contentoutline_2017.pdf
    PubMedGoogle Scholar
  • 29 ACGME Program Requirements for Graduate Medical Education in Pediatrics. Published July 1 2023 . Accessed 10 May 2024 at: https://www.acgme.org/globalassets/pfassets/reviewandcomment/320_pediatrics_rc_022023.pdf
    PubMedGoogle Scholar
  • 30 Pathology Milestones. Published February 2019 . Accessed 10 May 2024 at: https://www.acgme.org/globalassets/pdfs/milestones/pathologymilestones.pdf
    PubMedGoogle Scholar
  • 31 The Accreditation Council for Graduate Medical Education. Internal Medicine Milestones. Published 2020 . Accessed 20 September 2021 at: https://www.acgme.org/portals/0/pdfs/milestones/internalmedicinemilestones.pdf
    PubMedGoogle Scholar
  • 32 Longhurst CA, Pageler NM, Palma JP. et al. Early experiences of accredited clinical informatics fellowships. J Am Med Inform Assoc 2016; 23 (04) 829-834
    CrossrefPubMedGoogle Scholar
  • 33 Palma JP, Hron JD, Luberti AA. Early experiences with combined fellowship training in clinical informatics. J Am Med Inform Assoc 2020; 27 (05) 788-792
    CrossrefPubMedGoogle Scholar
  • 34 American Academy of Pediatrics. Council on Clinical Information Technology (COCIT). Accessed 27 September 2021 at: https://www.aap.org/en/community/aap-councils/clinical-information-technology/
    PubMedGoogle Scholar
  • 35 Patel TN, Chaise AJ, Hanna JJ. et al. Structure and funding of clinical informatics fellowships: a national survey of program directors. Appl Clin Inform 2024; 15 (01) 155-163
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 Feldman SS, Hersh W. Evaluating the AMIA-OHSU 10 × 10 program to train healthcare professionals in medical informatics. AMIA Annu Symp Proc 2008; 2008: 182-186
    PubMedGoogle Scholar
  • 37 Hersh W, Williamson J. Educating 10,000 informaticians by 2010: the AMIA 10 × 10 program. Int J Med Inform 2007; 76 (5–6): 377-382
    CrossrefPubMedGoogle Scholar
  • 38 Yan AP, Mousseau S. The training and credentialing of physician informaticists in Canada. Can Med Educ J 2022; 13 (05) 111-113
    PubMedGoogle Scholar