Health Informatics

By Toria Shaw Morawski, MSW, TIGER Initiative Liaison, Senior Manager,

Professional Development, HIMSS

According to Yuri Quintana, PhD, of Harvard University, global health

informatics “is a growing multidisciplinary field that combines research
methods and applications of technology to improve [global] healthcare
systems and outcomes.” This multidisciplinary field focuses on
competency and curricula development in the benefit of education reform,
fostering interprofessional community development, and gaining workforce
development inroads.

This guide aims to acquaint those learning about the field with a direct
conduit on where to locate and how to leverage the tools and resources
available. We hope you will find this information to be of value and that you
will disseminate what you discover and learn throughout the global
healthcare ecosystem. Together, may we always strive to “foster a learning
community of diverse stakeholders that embrace shared values to drive
innovation and technology regardless of where one is located.”

In This Guide
Understanding Health Informatics Core Competencies
Aligning Core Health Informatics Competencies
Workforce Development

Understanding Health Informatics Core Competencies

By Johannes Thye, MA, Faculty of Business Management and Social
Sciences, University of Applied Sciences Osnabrück, Germany; Consortium
member of the EU*US eHealth Work Project

The term core competence is a rather vague concept that should be classified.
Core competencies can be understood as a broadly specialised system of
skills, abilities or knowledge necessary to achieve a specific goal. Core
competencies also include behaviour that includes emotional, social and
cognitive aspects. It is evident that it is not only about knowledge, but also
about abilities, skills and behaviour. Ultimately, it is a combination of
cognitive, motivational, moral and social skills that align to fulfil
requirements, solve tasks and problems or achieve goals through
the necessary knowledge and actions.

With regard to health informatics, these core competencies are not simply the
transfer of knowledge about the use of a specific application, but rather the
development of knowledge in order to use information technology (IT)
sensibly and to give IT a meaning. In healthcare, there are also specific core
competencies related to medical or nursing activities. Furthermore, the
treatment of patients is interprofessional, in this sense, informatics core
competencies in healthcare basically cover different disciplines and
professions. Thus, health IT is interprofessional by nature and must be
reflected in education and training. Especially core competencies such
as communication and leadership are of great importance for successful
interprofessional cooperation.

What Kind of Core Competencies Exist?

Core competencies can be divided into different domains such as IT
principles, ethical and legal issues, systems life cycle management, medical
technology or management. These can be subdivided into a technology,
application or management focus, and the addition of interpersonal skills can
also be derived. In a more detailed subdivision of management, the core
competences of the individual areas such as strategic management, project
management or the principles of management thus derived. Furthermore, core
competencies can also be defined according to different levels, such as the
Bloom taxonomy. The following table shows in summary the health
informatics core competencies developed and derived for the TIGER
International Competency Synthesis Project’s Recommendation Framework
2.0.

Source: Towards the TIGER International Framework for

Recommendations of Core Competencies in Health Informatics 2.0:
Extending the Scope and the Roles
Interprofessional Competencies
As mentioned above, health IT as well as the treatment of patients is
interprofessional by nature. There are always differences in the need for
digital skills in the various health professions, yet there is also a large
common overlap between the professions.

Professions working in direct patient care (such as physicians, nurses or

therapists) share many common competencies such as documentation, quality
management or information and knowledge management. Other professions
such as IT engineers and chief information officers or IT engineers and
executives also have a large overlap in their competencies. In particular,
communication and leadership are of special importance to all occupational
groups in healthcare in order to support interprofessional cooperation.

The aim is to integrate health informatics core competencies into the

traditional training, curricula and courseware (at all educational levels) and to
prepare the teachers as gatekeepers and multipliers in education. Finally, the
common core competencies can also be used for collaborative education
between the professional groups.

Aligning Core Health Informatics Competencies

By Marisa L. Wilson, DNSc, MHSc, RN-BC, CPHIMS, FAMIA, FAAN,
Associate Professor/ Interim Chair, University of Alabama at Birmingham; a
HIMSS TIGER International Task Force Member

Our lives are spent interacting with technology and the data and information
produced. The flow of our lives, both personal and professional, have been,
and will continue to be, impacted by technology implementation. The
changes that occur from the interactions of people, processes, technology and
data can be supportive or destructive. Much of that divergence stems from
how the technology and data are used. The move toward a supportive process
requires users who are competent and ethical in the use of devices,
information systems, data management and technology mediated interaction.

Banking, retail, communications, entertainment, education, and now

healthcare, have all been transformed by technology implementations. What
has not necessarily happened with the transformations, particularly in
healthcare, is the positive optimization of those implementations. The
healthcare organizational and operational changes needed to ensure
technologies and data improve the interactions with patients and consumers
has been diminished by often the lack of fully competent users. Full
beneficial use requires proficient and competent point of care professionals.
Moreover, healthcare systems are particularly risk adverse and the clinicians
who interact with the patients and consumers require knowledgeable
engagement in implementations to ensure minimal negative outcomes.

In addition, there is internal and external pressure for healthcare systems to

improve and learn in order to make care more efficient, effective and
satisfying all within the context of a technology rich environment. In order to
accomplish these tasks and create that learning health system with the tools
and processes available, healthcare students and current providers must be
educated to utilize the tools to form data, information and knowledge to fuel
the learning cycle within the system.

However, there is an issue. Healthcare providers often receive poor or

nonexistent education in informatics and the use of information technology to
advance care during their professional formation.

Competencies Needed
Nearly two decades ago, the Institute of Medicine produced five core
competencies that all health professionals should possess regardless of
discipline to meet the needs of the 21st century healthcare systems. They are:

1. Apply quality improvement

2. Employ evidence-based practice
3. Provide patient centered care
4. Utilize informatics
5. Work in interdisciplinary teams

Each individual profession’s overseeing association has taken on the task of

trying to lay out its professions expected informatics and IT competency set,
to a more or less successful outcome. We will explore just three, starting with
nursing which has the most defined list.

Nursing

The American Association of College of Nursing (AACN) took these

competency expectations and incorporated them into the Essentials. In
nursing education, expectations of nurse graduates at the bachelors, masters
and doctoral levels delineate informatics and IT competent use as essentials.
This set of essentials, however, date back to 2006 and are being re-envisioned
to meet the needs of the industry today. Therefore, detailed specifics related
to the measurable sub competencies will not be presented here.

However, what remains of these re-envisioned essentials will include

informatics and IT as a key domain and a set of core competencies. Domain
8, Informatics and Healthcare Technologies, will contain actionable and
measurable competency expectations for many graduates of U.S. nursing
schools for which the school will be responsible to provide to the students. At
this writing, the categories of competencies in Domain 8 fall into the
following:
 1. Demonstrating the use of information and communication technologies
and informatics processes to deliver safe nursing care to diverse
populations in a variety of settings
2. Understanding how the various information and communication
technology tools used in the care of patients, communities, and
populations
3. Use information and communication technologies in accordance with
ethical, legal, professional and regulatory standards, and workplace
policies in the delivery of care
4. Use information and communication technology to support chronicling
of care and communication among providers, patients, and all system
levels

Medicine

Physicians, like there nurse team members, will also need to interact
competently with IT and informatics processes. Although no unified
documentation on expected informatics competency for general medical
education is available through the American Association of Medical Colleges
(AAMC), the Accreditation Council for Graduate Medical Education
(ACGME) does lay out the program requirements for fellowship in clinical
informatics for graduates of ACGME accredited programs as also outlined
through the American Medical Informatics Association (AMIA). For all
medical education, a group from Oregon Health & Science University did
document specific learning objectives and milestones to support developing
informatics competent medical practitioners. These competencies were
developed through a consensus agreement between the group of six faculty.

The team offered multiple competencies across the continuum of medical

education. Among them are:

1. Apply personalized/precision medicine

 2. Engage in quality measurement selection and improvement
3. Engage patients to improve their health and care delivery through the
use of personal health records and patient portals
4. Find, search and apply knowledge-based information to patient care
5. Maintain professionalism through the use of information and
technology tools
6. Participate in practice-based research
7. Protect patient privacy and security
8. Provide clinical care via telemedicine
9. Use and guide implementation of clinical decision support
10. Use health information exchange (HIE) to identify and access
patient information across settings
11. Use information technology to improve patient safety

Pharmacy

As with other interprofessional team members, pharmacists are also expected

to demonstrate competency using IT and informatics processes to impact
better outcomes. However, going back nearly a decade, it was noted that the
education provided for the student to achieve competence, despite inclusion
in Accreditation Council for Pharmacy Education Standards and Guidelines,
as a requirement was found to be inconsistent. More recently, it appears
that there is work to refine and revise those competencies.

The pharmacist informatics task force of the American Academy of Colleges

of Pharmacy (AACP) used 11 sources and faculty feedback to create a
revision. This revision lists the following domains with detailed, aligned
competencies:

1. Emerging Technologies
2. Health Care and Clinical Biomedical Informatics
3. Interoperability and Standardization
 4. Legal and Regulatory
5. Patient Outcomes
6. Practitioner Development and Education

A Gap
Those responsible for educating or training the students or current providers,
despite mandates to do so, are themselves often lacking in knowledge, skills
and attitudes so that there is not a transference of knowledge and skill that
results in a demonstrable competency. As an example, the AACN reports that
the average age of nursing faculty with a doctoral degree for positions of
professor, associate professor and assistant professor were 62.4, 57.2, and
51.2 years.

These faculty members were most likely not educated about informatics
during their own time in school and perhaps not even during clinical
practices. This results in an informatics skill and competency gap among
graduates. For nursing, this significant gap has been identified by the HIMSS
TIGER (Technology Informatics Guiding Education Reform) initiative,
the European Commission’s EU*US eHealth Work Project, and the
Nursing Knowledge Big Data Science Education Work Group.

Substantiating the Gap

To substantiate and justify the size of the gap, the EU*US Work Project
Consortium, funded by the European Commission’s Horizon 2020 innovation
grant program, issued a survey to over 1,000 targeted respondents to measure
the need, supply and trends that support necessary workforce skills and
competencies. Over 1,000 responses were returned from 51 countries around
the world. Respondents represented all of the healthcare professions involved
in health IT and represented the full spectrum of the healthcare workforce.
A synthesis of results pointed to several major gaps related to training and
skills, the top four address:

1. Availability of courses and programs

2. Lack of knowledge and skills of faculty and educators
3. Lack of knowledge and skills of providers and caregivers
4. Quality and quantity of training materials. Moreover,
research identified the pressure placed on universities to deliver
eHealth education in a curriculum wide approach for which the
universities are struggling to meet the needs for applicable and novel
learning opportunities.

A Solution and Resources

Given the serious need to have health professionals and graduating health
professional students competent in the provision of quality and safe care
using IT and informatics processes, faculty and educators providing the
knowledge, skills and attitudes on the topics must themselves be competent.
Moreover, given that there are not enough health professionals with formal
informatics education and training to take on this challenge, support must be
provided to those who currently interact with the profession and the students.

TIGER International Competency Synthesis Project

The TIGER International Competency Synthesis Project’s Global Health

Informatics Competency Recommendation Frameworks provide a
comprehensive and compiled core set of international and interprofessional
informatics competencies for nursing and other healthcare professionals.

Framework 1.0 is nursing centric and lays out two sets of core competency
tables. In the first grouping, there are expected nursing informatics
competencies that align with direct patient care, quality management,
coordination, management and IT roles a nurse may hold. These
competencies align with the AACN Essentials including the re-envisioned
version. The second, more expanded set, align with all health professions
across multiple levels. This expanded set contains four domains under which
multiple competencies align:

1. Biostatistics and technology

2. Data, information and knowledge
3. Information exchange and information sharing
4. Management in informatics

Resources

As stated previously, despite all of this competency work and the

expectations across various health professions, there is a significant gap. The
gap is exacerbated by the knowledge, skills and attitudes of those currently
teaching and educating. So, rigorous support and guidance has to be provided
to those educators and faculty. There are tools to help, including the
following.

Global Health Informatics Competency Recommendation Framework 1.0

(nursing) + 2.0 (interprofessional): This describes the framework with all
the domains and competencies. A review of this document will demonstrate
an alignment with the core informatics expectations of the AACN, AAMC,
ACGME and AAPC.

Health IT Competencies Tool & Repository (HITComp): This web-based

tool that lets you explore specific competencies, sub competencies across
roles and education. It is aligned with the Global Health Informatics
Competency Frameworks and serves as a detailed companion guide.
Interactive Education Demonstrator Modules: These modules provide
instructional videos on the foundational curriculum, HITComp
and cybersecurity focused on targeted malware attacks.

Skills Knowledge and Assessment Development Framework (SKAD) is

a questionnaire focused on self-assessment to better understand personal
digital literacy skills.

Today, more than ever, there is a major need to improve the informatics
competency and skills of not only of the healthcare workforce but of those
who teach and guide them. These tools offer an opportunity to address the
gap in both areas.

Workforce Development
By Hank Fanberg MBA, CPME, FHIMSS, Instructor, Digital Health and
Informatics, the University of New Orleans; a HIMSS TIGER Member

Look at any position open announcement and you’ll find a section with the
header of “qualifications,” “desired skills, knowledge and abilities,” or
something similar. This is how an employer informs applicants of the skills
and knowledge necessary to perform the responsibilities of the position.
These are the competencies the employer seeks in individuals that apply for
the job.

As noted above, a competency is the capability to apply or use a set of related

knowledge, skills and abilities required to successfully perform critical work
functions or tasks in a defined work setting. Competencies often serve as the
basis for skill standards that specify the level of knowledge, skills and
abilities required for success in the workplace, as well as potential
measurement criteria for assessing competency attainment.
Just as companies seek to employ persons with skills and competencies in a
given area, educators are also concerned with competencies. An educational
institution would define competencies as “a general statement detailing the
desired knowledge and skills of student graduating from a course or
program.”

Is education strictly for intellectual development or to prep people for the

workforce? One goal of education is to produce citizens who can think
critically and have knowledge. A competent critical thinker may be necessary
yet insufficient for being competent at work. Knowledge for knowledge’s
sake is important. It is possible to learn many things and become well
educated. This may not, however, readily translate into workplace
competencies.

Demonstrating competency is not simply performing well on tests and other

knowledge evaluation activities. It’s rooting out the core areas of knowledge
a student must demonstrate for mastery, that they understand the material,
have studied and applied the content to certain situations or learnings and that
they have mastered the material and can now be called competent. These two
forces—the competency needs of employers and the competency content of
an educational course of study—should overlap, but they are different.

A competency demonstrates proficiency. Competency denotes “having the

knowledge, skills and ability to perform or do a specific task, act or job
(Mastrian & McGonagle, 13). Informatics competency would be the
knowledge, skills and ability to perform specific informatics tasks. A number
of national and international groups work to identify core informatics
competencies. Competencies are not just a one-time thing. They are
continually evaluated in the field and by educators. Each sector has its
version of competencies and include:

 Academic competencies
  Industry-wide competencies
 Management competencies
 Personal effectiveness competencies
 Workplace competencies

We can see that academic/educational competencies are separate from

workplace competencies. Yet the two must work in tandem, each informing
the other so that education enables competencies when one transitions from
education to the workforce. They form a feedback loop and as innovative
processes and advances are adopted in the work environment; the academic
arena must adapt its competency model to fulfill the ever-changing
competency needs of employers. This is absolutely true for health
informatics. They are yin and yang; one cannot do without the other.

A Multidisciplinary Field
Informatics uses data to solve all manner of problems—little problems such
as the best way to stack items in a truck to bigger issues like tracking
COVID-19 to see who has been exposed and who has not. The common
element is data—its collection, its aggregation and its sorting into
meaningful, useful information.

This multidisciplinary field exists at the intersection of healthcare,

information science, computer science and technology. Health Informatics
is "the interdisciplinary study of the design, development, adoption and
application of IT-based innovations in healthcare services delivery,
management and planning. It also involves using health information systems
in collecting, storing, retrieving, analyzing and utilizing healthcare
information for a variety of purposes. It requires that the health informaticist
be proficient in the language of health and healthcare, health IT tools and
standards, systems design, project management, human factors and perhaps
most importantly, collaboration with all the medical professionals,
administrators and others that rely upon health information and technology in
performing their duties and responsibilities. Critical thinking and
communication skills are just as important as the other skills for the health
informaticist. The health informaticist focuses on the end users and tailoring
systems to satisfy their needs.

Before the computer era, medical science relied upon the basic sciences and
the bench scientists—biology, chemistry, anatomy, physiology and others—
to advance knowledge. The addition of computer science and data science to
the practice of medicine gave the healer clinical decision-support tools new
ways to record their patient interactions, and provide on-demand access to
their professional body of knowledge. Researchers had access to data faster
and more accurately than ever before.

The Health Information Technology Advisory Committee Act within the

American Recovery and Reinvestment Act of 2009 provided funding for
doctors and hospitals to adopt electronic medical records in the U.S. Recently
we’ve seen more than 85% of physicians and more than 95% of hospitals
use an EMR.

Now we have the tools to better support practitioners’ responsibilities such as

finding all the diabetic patients in the practice who have not had an A1C test
in the past three months versus having to search through paper records until
they found those patients. This one simple example demonstrates how
informatics impacts the quality and outcomes of medicine. And it is the
health informaticist who plays a critical role in the design, delivery and
experience of the end user.

As computational power and capability continues to grow, and as the

collection, assemblage and analysis of data becomes more necessary, the
world of health informatics opens up, and its needs from the workplace then
form a feedback loop with education.
Demand for Health Informaticists

According to the U.S. Department of Labor’s Bureau of Labor Statistics,

health informatics will experience a 22% job growth between 2012 and
2022. The salary for these positions exceeds $100,000. Variety and
opportunity are vast for those interested in pursuing a career in the field.
Keep in mind that many of these jobs require skills from different disciplines.
Many of these positions remain open longer than the average meaning that
opportunities abound for the well prepared.

Health Informatics Branches

The field has many branches. There are multiple paths to follow, including
that of data scientist (although data science is considered a related and
overlapping discipline). The need for competent health informaticists and
data scientists is growing exponentially. Additionally, the amount of data
produced by the healthcare industry is expected to grow exponentially,
creating opportunities aplenty in the following areas and others:

 Clinical Informatics
 Consumer Health Informatics
 Nursing Informatics
 Pharmacy Informatics
 Public Health Informatics

1. Clinical Informatics

Professionals working in clinical informatics use data to support clinical

decision making. A clinical informaticist may serve in a multitude of roles,
depending on the size of the healthcare setting.

2. Consumer Health Informatics

Consumer health informatics roles involve protecting consumer health.

3. Nursing Informatics

The American Nurses Association defines the position as overseeing the

integration of data, information and knowledge to support decision-making
by patients and their healthcare providers. Nurses with technological skills
may want to consider looking for a job in this field. While the Bureau of
Labor Statistics does not track nurse informaticists specifically, the demand
for computer systems analysts—a role with comparable skills—is expected
to grow faster than other occupations over the next few years.

4. Pharmacy Informatics

Pharmacy informatics involves using data in the process of supplying

medication. Demand for pharmacy informatics is growing rapidly due to the
wide spread use of electronic prescribing and EMRs.

5. Public Health Informatics

Public health informaticists concern themselves with the health of

populations. Some people in this field prepare for threats such as antibiotic
resistant infections and biological attacks. Public health informatics jobs are
found in hospitals, government agencies or private businesses.

Healthcare has always been data driven. As more and more data are created
the need for health informaticists with the mix of proficiencies in
communication, computer science and clinical capabilities will be in great
demand for years to come. Using data and computer systems has the huge
potential for improving quality, improving the user experience and lowering
costs and is one of the few areas in healthcare where providers, insurers and
policymakers of both parties agree. This is also one of the areas of consistent
job growth. The opportunities are there. Now go after those proficiencies.
The views and opinions expressed in this content or by commenters are those
of the author and do not necessarily reflect the official policy or position of
HIMSS or its affiliates.