"We need more of all of it," said John Holmes, chairman of the education committee at the American Medical Informatics Association and professor of medical informatics at Pennsylvania Universitys School of Medicine. "There is a real dearth of people trained as informaticians."
Holmes said he himself felt the pinch while pulling together academic research teams. Laura Gunn, recruiting manager at Capgemini Health, said finding people with the right training and experience was difficult.
The push for EMRs (electronic medical records) and the establishment of ONCHIT (the Office of the National Coordinator for Health Information Technology) are widely expected to increase this demand. "We desperately need more programs producing more skilled individuals to meet future demand," said Joseph Hales, director of information systems/medical informatics and a professor of medical informatics at the University of Utah.
"National initiatives like POE [physician order entry] require skilled, trained, experienced, applied people on the ground implementing these systems, and skilled, trained, knowledgeable, theoretical people building innovative systems that work. We dont have enough of either to address the growth of EMRs at the pace suggested by Dr. [David] Brailer [the national health IT coordinator] or by other initiatives."
Still, no one I spoke with felt that masters and certificate programs were at their capacity. Even schools with the most-recognized names may have less than a dozen doctoral students. Though competition for these spots can be fierce, the number of them is usually limited by funding issues.
Holmes said informatics does not yet have the prominence that other post-graduate programs enjoy. "People think that its the same as a computer scientist. Theres still a name-recognition, discipline-specific problem."
Thats one reason a degree from an established program is important, Holmes said. "It provides a known entity, a recognition factor," he said, particularly for graduates from NLM (National Library of Medicine)-supported programs
Right now, OHSU (Oregon Health and Science University) has fewer than half a dozen doctoral students and about 60 students in academic and professional masters tracks. In addition, more than 250 students have enrolled in an online certificate program, though not all of them take classes every year and many have no intention of completing all of the required courses, said William Hersh, department chairman of medical informatics and clinical epidemiology at OHSU.
Though Stanford University has proportionally more doctoral students, most are in masters and certificate programs. These people are very likely to have already earned a clinical health degree and to have some experience working in the field. Usually, theyve enrolled from a personal sense that a better understanding of informatics will enhance their professional abilities. At both Stanford and OHSU, the majority of students pay their own tuition. Only a fifth to a third are sponsored by their employers.
"If you look at the job ads for hospitals, they dont say need informatics training. But that will soon be the exception," Hersh said. While not every person in a hospital IT department needs a degree in informatics, he said, informatics training will be essential for the leaders.
In fact, being thrust into a leadership position is what drives some of OHSUs students into the masters program. "We get a lot of people who take a chief medical information officer [position] and suddenly realize they need to know something," Hersh said. "Everything has become a lot more mainstream. All of a sudden, all the leadership of health care is interested in electronic health records, and every educated person needs to get on the Internet."
"The recognition of its value is the real difference; 10 years ago, we were trying to get physicians to look up information on the Internet," he said. About five years ago, AAMC (American Association of Medical Colleges) included informatics in its medical school projects, said Eta Bruner, professor of health informatics at the University of Alabama in Birmingham.
Another important change is physicians growing sophistication with computers. Larry Fagan of Stanford runs a popular, weeklong course in medical informatics. "In the early short course, just about when the Web was becoming popular, the exercise we did in the lab was about searching. Now, just about everybody can search," Fagan said.
"Now, we talk about security and XML and some of the internal parts of whats happening behind a Web page." While most physicians know how to use computers, he said, they dont know whats going on behind the scenes, and that could limit their ability to shape technology to their practice and vice versa.
One benefit of training, he said, is that "when someone says I wish the computer could do this for me, they can understand the capabilities and know whether something is easy or hard."
But that increased computer use means an increased need to develop ways to use technology optimally. There seems to be a growing consensus that the people best able to do this are neither clinicians nor programmers, but informaticians.
Yet even the informaticians cant always put their finger on what, exactly, informatics is. Next week: How Academics Are Struggling to Define Informatics