Scientific Abstract - Image Department Management & Administration

Bridging the Leadership Gap Between Imaging, Clinical, and IT Personnel in an Informatics Fellowship

Authors:

Siddiqui Adeel, MBBS, Johns Hopkins Hospital; Gorkem Sevinc; Cleo Maehara; Paul G. Nagy, PhD, CIIP, FSIIM

Background:

The boundary between imaging, clinical and information technology (IT) personnel is undeniable and growing. This big disconnect is caused by many reasons including but not limited to cultural differences and lack of a deep understanding of the other groups’ work. This gap has direct and indirect impact on quality and safety of patient care.

While it is crucial to have professionals with information technology skills, medical professionals must also be involved in the design and implementation processes. To successfully achieve their goals, an IT department must have good leadership and active involvement of all the users in the implementation process.

Despite this need of well trained informaticians at all levels within the healthcare system, the number of both clinical and imaging informatics fellowships are few in number nationwide. Moreover, a standard curriculum has yet to be established. Such a curriculum should not only allow for the student to focus on their area of research, but also provide the student with a basic overall knowledge regarding the intricacies of information technology.

We developed a Clinical Informatics Leadership Program with a diverse class of students. This program provides technical and management training to physicians in building clinical leaders that can leverage information technology to transform healthcare. This program also offers clinical understanding to IT professionals in building IT clinical champions that can lead their organization in large clinical projects, change management, requirements gathering, etc. The students come from diverse backgrounds and involve (though not limited to) fellows and residents from different departments, radiology technologists, IT professionals and nurses.

The program approaches training on three levels. Didactic lectures are given each week as part of a discussion on how to transform healthcare. Each student is also required to complete a practicum of exercises that will develop their skills in bridging the culture barrier. Lastly, each student is required to lead a project to improve the organization’s ability to deliver care.

Evaluation:

The fellowship runs over a ten-month period and involves lectures and projects. The diverse lectures are given by physicians, the CIO, CMIO, CISO of our organization, CMIOs from other organizations, vendors, established engineers and more. The students have interaction with software developers, information technology professionals, and business leaders trying to adapt new innovations in information technology into healthcare. Students learn how to bridge cultural barriers between information technology and the clinical environment in order to better communicate within a healthcare enterprise. Physician participants are expected to take the ABII or AMIA certification and complete a peer review manuscript during the one-year program.

Furthermore, the course introduces medical and IT professionals to six sigma business practices, an approach that has been integrated throughout the curriculum. This gives students an opportunity to manage quality initiatives through a systematic review process. It also introduces many health care professionals to ideas that while widespread in business and other practices are new to health care.

Lecture topics span 4 main topics and subsequent subtopics:

  1. Research
  2. Management
  3. Human Computer Interface Design
  4. Technical
    1. Technology Assessment
    2. Interoperability Topics
    3. Systems Management

Fellows need to follow a practicum in addition to attending a national meeting and submitting a manuscript to a peer reviewed publication. The practicum requires that each fellow pick at least six tasks from the following list and complete within one year. The task has to be new to the fellow and cannot be an ongoing process already in the works. Each fellow has to pick at least one task from General Exercises, one from profession-specific exercises and one from Group Exercises. For the group exercises, a physician and an IT professional will be paired up. All fellows are required to attend at least three IT Leadership Committee meetings.

General

  1. Perform an architectural review exercise.
  2. ITIL systems management capability maturity gap analysis.
  3. Be involved in a vendor purchasing decision making matrix.
  4. Involvement in a vendor engineering relationship.
  5. Database analytics exercise (Learn SQL and Google Analytics).
  6. Configure a content management system (CMS) to build a virtual community.
  7. Build a survey and gather data for a project from all users.

Physicians/Clinicians Only

  1. Shadow an IT Clinical Operations person for a day; make suggestions on how to provide support better.
  2. Shadow Radiology IT Help Desk for a day; make suggestions on how to provide help better.
  3. Build a simple PACS solution using open source interfaces.
  4. User Champion for a software upgrade.
  5. Take part in IT training of physicians on systems (RIS/PACS).

IT Professionals Only

  1. Shadow a radiology resident, nurse, technologist and create a document including workflow maps of user interaction of clinical IT systems (UML) as well as an observations report.
  2. Present a technology lecture topic to the class to test their ability to communicate complex topics to clinical personnel.

Group

  1. Create a software requirements and use cases document.
  2. Create a software testing and deployment document.
  3. Take part in the interview process of a new hire for operational IT.
  4. Help organize CIIP Study Group, present topic and carry out a presentation.

Discussion:

The Johns Hopkins Clinical Leadership in Informatics is an attractive option for radiologists in training and other health IT experts, as it serves as an introduction to the complex IT framework of the enterprise, and offers close interaction with the key people involved. One of the greatest challenges of a health informatics expert is the ability to effectively understand and communicate important needs before issues become critical, and the program addresses this core leadership trait from the outset. The integration of six sigma into the curriculum is a stand out example of how students can develop strategies to keep themselves and others focused on what is most important to quality improvement.

By encouraging global participation, the program has attracted nurses, physicians, IT experts, and other allied health professionals throughout the hospital. This not only greatly increases participants understanding of systems based practices in the IT context, but trains students to build a foundation of communication before projects can move forward.

The practicum exercises expand on these concepts and gives students the choice to focus on aspects of informatics that are more central to their scope of practice. Most, if not all of the practicums involve some sort of teamwork. It is not enough that a student has a project interest, but they must learn to mobilize others to help them in this endeavor. The lectures serve as a way for students to see not only the big picture of the IT enterprise, but to help facilitate cooperation and teamwork between the many participants.

Conclusion:

Informatics fellowships have yet to establish a standard nationwide curriculum. Such a curriculum should not only allow for the student to focus on their area of research, but also provide the student with a basic overall knowledge regarding the intricacies of radiology information technology. There should be deep integration among the class so that the imaging informatics fellows, clinical informatics fellows, and Health IT experts do not end up speaking different languages. There should be an emphasis on leadership skills along with integration of modern day business practices (i.e. six sigma). The Johns Hopkins Clinical Informatics Leadership Program establishes what has been a successful framework for educating informatics professionals across the healthcare enterprise.

References:

  1. Branstetter BF 4th, Bartholmai BJ, Channin DS. Reviews in radiology informatics: establishing a core informatics curriculum. J Digit Imaging. 2004 Dec;17(4):244-8.
  2. Gardner RM, Overhage JM, Steen EB, Munger BS, Holmes JH, Williamson JJ, Detmer DE; AMIA Board of Directors. Core content for the subspecialty of clinical informatics. J Am Med Inform Assoc. 2009 Mar-Apr;16(2):153-7. Epub 2008 Dec 11.

Keywords:

  • Informatics syllabus
  • Informatics fellowship
  • Six sigma
  • Clinical informatics fellowship
  • Imaging informatics fellowship
  • Informatics curriculum
  • Leadership skills