Clinical Informatics Fellows Vital to Future of Value-Based Care

Monday, December 7, 2020

AMIA calls on CMS to establish novel funding models for medical education in clinical informatics

 

Members of the American Medical Informatics Association (AMIA) Clinical Informatics Program Directors (CIPD) published a Policy Statement in the November issue of Applied Clinical Informatics, calling for federal funding reforms to support the subspecialty of Clinical Informatics. Specifically, the Policy Statement calls on the Centers for Medicare and Medicaid Services (CMS) to consider novel funding structures and programs through its Innovation Center to support Clinical Informatics Fellowship training.

Published on behalf of CIPD, the authors note that Board-certified Clinical Informaticians possess the requisite skills and competencies necessary to the future of medicine by being trained to optimize health IT and being expert in leveraging data for patient care and quality improvement. Board-certified clinical informaticians benefit both patients and payers through identification and reduction of errors, reduced costs, and improved care coordination using health IT. Yet, the sustainability and growth of this new and promising medical subspecialty —and its effect on care delivery—are threatened by outdated and inconsistent funding models that fail to support the education and professional growth of clinical informaticians when compared with other clinical specialties.

In contrast to other physicians who typically focus on the individual patient, most clinical informaticians work at a practice or population level, affecting the care of many patients through their efforts. Further, many solutions developed by informaticians can be transferred to or duplicated at other institutions, increasing the possibility that informaticians may save lives or reduce costs in institutions that they have never visited.

“The future of value-based care hinges on the use of data, but the implementation of EHRs alone has proven insufficient to improve care and reduce costs,” says AMIA Policy Committee Chair and paper author Joseph Kannry, MD. “We must better support clinical informatics training programs so that we can collectively extract value from EHRs to benefit patients, payers, and providers.”

The paper notes that fewer than 100 fellowship positions are available annually for clinical informatics at ACGME-accredited institutions – an accreditation that is required for CMS funding for graduate medical education.

“Considering the informatics expertise needed for the more than 5,500 hospitals in the United States, it becomes apparent that without an increased pipeline of trained and educated informaticians, health care systems will continue to struggle to find the talent needed to implement, maintain, update, and optimize their clinical information systems and data. Subsequently, a lack of appropriately trained and educated clinical informaticians perpetuates underperformance in the pillars of value-based care—patient safety, care quality, and cost reduction,” the authors state.

To address these issues, the authors call on CMS to provide structural and sustained funding for Clinical Informatics fellows through its Innovation Center, CMMI, which has tested and analyzed dozens of innovative funding models. The paper calls for a “multiyear training grant for ACGME-accredited institutions to propose, measure, and report how Clinical Informatics fellows would improve the quality and cost of care.” Second, the paper says CMMI should engage in targeted evaluations to identify the benefits created by participants, who employ trained physicians in clinical informatics and determine average costs savings per program/fellow to CMS. A portion of these savings could then be dedicated to expanding institutional limits of ACGME trainees, with the goal of creating a long-term and sustainable funding model.

“We have entered an era, where the practice of medicine is no longer limited to medical devices and drugs to improve patient outcomes. Clinical Informatics and data are an integral part of the practice of medicine in the 21st century,” says Vishnu Mohan, Immediate Past Chair of AMIA CIPD, and Program Director of Clinical Informatics Fellowship, Medical Informatics and Clinical Epidemiology, OHSU School of Medicine. “Only through structural and sustained funding for clinical informatics fellows will the future, we are striving to achieve, be within reach.”