Wednesday, March 19, 2008

The wages of complacency in defining "Medical Informatics" as a specialty

Over recent months I’ve been exploring roles back in applied HIT, having been a CMIO (Medical Director of IT, now called "Chief Medical Informatics Officer") in decidedly applied settings in the “olden days” a decade ago.

One common feature of the conversations I’ve had was that I’ve left these interviews with a sense of unease and annoyance, but was unclear why. It is only recently that I’ve been able to identify a common theme.

Imagine a seasoned neurosurgeon, interviewing for department chair, in the following interview scenario:

Candidate: I’m here interviewing for chair of the department of neurosurgery.

CIO: Well, you have an interesting background and have done many varied things. Were you aware that it’s important to be able to bring doctors into consensus? Tell us about how you intend to do that. Have you ever brought doctors into consensus?

IT project leader: How would you deal with pharma detail people? I don’t see that on your resume.

Finance: Billing is important. From your background, I’m not sure you understand billing. Tell us about your experience in that area.

Other doc: How would you go about treating meningitis? Can you actually do that? Have you ever done an LP?

While the scenario is absurdist, in effect I believe it summarizes metaphorically what I’ve been experiencing.

The hospital interviews I’ve been having are unlike anything I experienced in seeking clinical roles. They have even been a significant step down from some of the difficult ones I’ve had in pharma, where at least there is an understanding that holding an MD/Informatics title means the person understands something about biomedical research and computing.

In other words, I find that the designation of having studied Medical Informatics seems to confer no “fides” on a leadership role in applied Health IT (HIT) in hospitals. I’ve found myself interrogated about abilities and accomplishments in HIT as if “Medical Informatics” was being parsed as “Hsfapfwllerw”, i.e., meaningless, and as if past accomplishments were imagined or exaggerated. I find line items on a resume that say “led difficult HIT projects, managed staff, managed budgets” seem to mean little or are negated under the umbrella of the “Medical Informatics” title.

I find myself being asked frivolous questions on fundamental issues to which my reply really should be:

“Have you actually read my resume? Do you know what medical informatics is, and have you bothered to look before this interview?”

I’ve been preached to and patronized about HIT project issues by IT personnel and other non-clinical personnel, based upon what they seem to have read in their throwaway journals (e.g. “Advance for Health Information Executives”), as if I didn’t know anything about the area; as if IT staff were the clinical IT experts and I, an intern.

Another common finding is that materials I provide both pre- and post-interview on Medical Informatics (e.g., web links to my sites) are largely ignored, as I track my web sites by IP and can see from where they’re being read - or not.

Interviews of seasoned professionals in well-understood domains should not be like this. In my role interviewing doctoral-level faculty candidates for my college, we never, for example, asked them or challenged them if they understood basic tenets of information/library science, as if they were undergraduates. To do so would have been both unthinkable and alienating. Instead, we sought to have candidates tell us about their specific areas of expertise and how that could fit our needs. The assumption was that by being invited, we understood they were a competent professional.

Yet in medical informatics I’ve started to dread interviews, due to the absurdist scenario above, the need to present myself as someone who "gets it" regarding HIT, and the need to provide remedial education in an interview setting to confused people.

The weaknesses in societal understanding of the term “Medical Informatics”, therefore, are unhelpful to people who’ve expended the time and treasure acquiring the credentials and who wish to work in applied HIT.

This phenomenon impairs the ability of the Medical Informatics profession to contribute to and steer HIT in the service of medicine, and to help healthcare organizations avoid commonplace, expensive errors regarding clinical IT projects they can ill afford.

I am assuming this phenomenon is not just part of a larger phenomenon of dumbing-down in healthcare, of cost-cutting and institutionalized mediocrity.

This really needs to change.

-- SS

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