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Medical Informatics: A Career for Librarians
by William Hersh
Librarians have always played a significant role in health care. The plight of librarians in health care has recently attracted renewed attention with a debate over a new health care professional dubbed the "informationist." (See the January, 2002 Journal of the Medical Library Association.)
As in many fields, the growth of end-user searching tools has allowed relatively inexperienced users to obtain access to essentially all the clinical information previously available only to those who worked in libraries. As it becomes clear that clinicians have frequent information needs (on the order of two questions per three patients), economics alone dictate that librarians will be unable to take part in most clinical information- seeking. However, there are still many opportunities for librarians in health care. One way for librarians to broaden their knowledge and skills is to seek training in medical informatics.
What Is Medical Informatics?
The field of medical informatics is concerned with the acquisition, storage, and utilization of information in health care, usually (but not always) involving the application of information technology. It is a broad, multidisciplinary field, covering electronic medical records, access to knowledge-based information and digital libraries, digital imaging systems, telemedicine, clinical decision support, and more. A good resource to start learning about the field is the web site of the American Medical Informatics Association.
The boundaries of medical informatics are fuzzy. Because of this, there is no common medical informatics curriculum, nor any common job that anyone with training in the field could hold. The lack of a common skill set and curriculum is different from librarianship or medicine, where there are basic skills that all individuals who have a library science or medical degree can be expected to have.
Where Does Training Occur?
Most training in medical informatics is provided by the dozen programs funded by the National Library of Medicine (NLM). A majority of trainees in these programs are postdoctoral, often but not always having M.D. degrees. A growing number of programs also offer academic degrees, either at the master's or doctoral level. A few of these programs, including ours at Oregon Health & Science University (OHSU), offer fellowships for librarians, designed to serve as mid- career sabbaticals providing new perspectives and hopefully leading to new career accomplishments.
There are additional routes for medical informatics training that do not require residence at an NLM-funded program, as well as a growing number of institutions without NLM funding that offer degree programs in medical informatics. Another pathway to training in medical informatics is the short course, with the offerings by NLM and Stanford University best-known. A more recent phenomenon is the development of distance learning programs in medical informatics, such as the Graduate Certificate Program offered by OHSU.
What Is Covered In a Program?
The OHSU Master of Science program gives a guide. Our program has courses in four major areas: medical informatics, health and medicine, computer science, and quantitative methods. The medical informatics courses cover the core of the field. An introductory survey course broadly covers the main areas of information and information technology applications in health care. A follow-on course, Clinical Systems, covers the issues surrounding patient- based information in health care, with particular focus on the electronic medical record. A third core course, Information Retrieval, focuses on knowledge-based information, including the use of resources likely to be of great use by librarians, such as MEDLINE and evidence-based compendia. The OHSU program might be somewhat anomalous in having an entire course on Information Retrieval, but most programs cover at least the basics in this area.
There are additional required courses in the medical informatics area. Courses in Organizational Behavior & Management and Project Management teach students how to function in organizations and work as teams. A scientific writing course insures that students are capable of written communication. There are also electives in the medical informatics area, such as security and confidentiality, implementation of clinical systems, and individual research or practicum experiences arranged by the student.
The health and medicine area of the curriculum covers clinical medicine topics for those without clinical backgrounds. This area of the curriculum also includes a course in ethical, legal, and social issues in informatics required of all students.
As with most medical informatics training programs, computer science is a required element of the curriculum. We believe that while few of our graduates will become programmers (unless they had programming skills prior to entering the program), all of them should have a fundamental understanding of the computer science issues most relevant to medical informatics. They should also be able to converse as colleagues with programmers and other technicians who work with information technology. A recent survey of our graduates, few of whom do significant computer programming, validated the value of this portion of their education.
The final area of the curriculum is quantitative methods. The goal of this portion of the curriculum is to provide skills and understanding in carrying out research and analyzing clinical data. After a first course in biostatistics, a second course covers the fundamentals of research design. A third course is devoted to outcomes research, surveying the variety of ways that the outcomes of clinical care are analyzed and compared.
The full Master of Science degree is not necessary for entry into the field. OHSU offers an eight-course subset of the master's program, the Graduate Certificate program, which includes many of the above courses (omitting clinical medicine, computer science, and statistics). This program can serve as a distance-learning entry path for those who wish to enter the field and not relocated, and courses taken via this route can be applied for the master's degree program. The on-campus library fellowship program is another pathway into the field, providing the ability to take an individualized set of courses and work on a project of appropriate scope and interest.
Many librarians have become contributors and leaders in the field of medical informatics. Some have pursued faculty positions, particularly if they already have doctoral training. Others have become leaders in health science library settings. Some have even succeeded in the commercial sector. The librarians who have graduated from our program have certainly done well in finding new and challenging employment.
William Hersh, M.D. is Professor and Head, Division of Medical Informatics & Outcomes Research, Oregon Health & Science University.