Clinical Informatics Fellowship
In 2011, Clinical Informatics (CI) was recognized as a subspecialty by the American Board of Medical Specialties (ABMS). For more information on Clinical Informatics as a Medical Subspecialty, see Medical Subspecialty Board of Clinical Informatics. In 2014, the Accreditation Council for Graduate Medical Education (ACGME) published its official CI Fellowship Program Requirements Document.
- 1 Program Duration
- 2 Program Administration
- 3 Program Personnel
- 4 Fellowship Eligibility
- 5 Educational Program Outline
- 6 Fellow Scholarship Expectation
- 7 Fellow Clinical Responsibility
- 8 Fellowship Program Evaluation
- 9 Fellowship Program Funding
- 10 ACGME Accredited Fellowships
- 11 Fellowship Program Collaboration
- 12 Sources and Useful Resources
- 13 Sources and Useful Resources (rev1)
CI fellowship program must be 24 months (2 years) in length and must be completed by the fellow within 48 months.
CI fellowship programs must be administratively integrated within one of the following ACGME residency programs:
Therefore, CI fellowship programs can be reviewed by a Residency Review Committees (RRC) from any of the above listed specialties. CI fellowship programs do not require their own RRC.
A single program director is held accountable for the operation of the CI fellowship program and must possess the following qualifications:
1. documented administrative, educational, and specialty expertise within clinical informatics that is acceptable to the RRC;
2. current board-certification in Clinical Informatics, or in a subspecialty that is acceptable to the RRC;
3. current medical licensure and medical staff appointment; and
4. at least 3-5 years of experience in Clinical Informatics education, research, and practice.
There must be at least 2 faculty members who are qualified to instruct, supervise, and support the fellows.
Physician faculty must maintain current medical licensure and be either board-certified in Clinical Informatics or have appropriate qualifications acceptable to the RRC. Two years of experience in Clinical Informatics is recommended for physician faculty but it is not a core requirement.
Nonphysician faculty must retain appropriate institutional appointments and possess the appropriate qualifications within their respective field.
The program director and faculty members should devote at least 2 full-time equivalents (FTE) towards program administration and education.
A program coordinator must provide sufficient administrative, technical, and clerical support to the fellowship program.
CI fellowships are open to licensed physicians who have completed an ACGME accredited residency program or a Royal College of Physicians and Surgeons of Canada (RCPSC) or a College of Family Physicians of Canada (CFPC) accredited residency program located in Canada. Applicants must also be board-certified or board-eligible in their primary specialty.
If an applicant does not meet one of the requirements above, the RRC may grant an exception to an exceptionally qualified applicant who meets a specific criteria outlined in the CI Fellowship Eligibility Document.
Eligible applicants may apply to any ACGME accredited CI fellowship program regardless of their primary specialty.
Educational Program Outline
A CI fellowship program (1) must have clearly delineated competency-based goals and objectives that are made available to fellows and faculty on an annual basis and (2) must have regularly didactic sessions, which can be taught locally or through distance education programs.
The most widely used distance program is offered through Oregon Health & Science University, which offers a graduate certificate program in CI that is closely mapped to the Educational Competencies and Core Content.
EDUCATIONAL COMPETENCIES are based on the 6 core ACGME competencies:
1) Patient care and procedural skills - Fellows should be competent in leveraging information and communication technology across the dimensions of healthcare to improve patient care processes and outcomes.
2) Medical knowledge - Fellows must demonstrate knowledge of principles and theory of informatics as well as application of this knowledge to patient care.
3) Practice-based learning and improvement - Fellows must develop skills and habits that promote lifelong learning.
4) Interpersonal and communication skills - Fellows must demonstrate effective communication skills that allow them to serve as liaisons between healthcare providers and information technologists.
5) Professionalism - Fellows must be committed to carrying out professional responsibilities and adhering to ethical principles as well as being able to recognize and prevent security breaches while showing sensitivity to the impact of information system changes.
6) Systems-based practice - Fellows must be aware and responsive to the large context of the healthcare system by recognizing their role in care coordination, cost awareness, identification of system errors and should identify and improve the impact of systems on clinical care.
CORE CONTENT for Clinical Informatics are based on 4 fundamentals:
1) Fundamentals - Fellows must acquire the basic knowledge that provides clinical informaticians with a common vocabulary and understanding of the environment in which they function.
2) Clinical decision making and care process improvement - Fellows must obtain the knowledge and skills that enable a clinical informatician to implement effective clinical decision making systems and participate in the development of clinical processes that support effective, efficient, safe, timely, equitable, and patient-centered care.
3) Health information systems - Fellows must gain the knowledge and skills that enable a clinical informatician to participate in the development or selection of an information system for clinicians; prepare clinicians prior to implementation and support them during implementation and ongoing operation of a clinical information system; and evaluate the effectiveness of a system in meeting clinical needs.
4) Leadership and management of change - Fellows must learn the knowledge and skills that enable clinical informaticians to lead and manage changes associated with implementing clinical information systems and promoting adoption by health professionals.
Fellow Scholarship Expectation
CI Fellows are expected to participate in scholarly activity, which includes at least one of the following:
1) peer-reviewed funding and research; or
2) publication of original research or review articles; or
3) presentations at local/regional/national professional and scientific society meetings.
Fellow Clinical Responsibility
CI Fellows are required to maintain their clinical skills for the duration of a CI fellowship.
It may be performed in the fellow’s primary specialty area of practice.
It must be based on PGY-level, patient safety, fellow education, severity and complexity of patient illness/condition.
Current fellows spend anywhere from 10-30% of their time fulfilling their clinical responsibilities.
Fellowship Program Evaluation
CI fellowship programs are required to conduct semi-annual assessments of a fellow's performance by a Clinical Competency Committee comprised of at least 3 program faculty. CI Milestones are used to evaluate fellows.
Fellows must evaluate program faculty at least annually.
Ongoing evaluation of the fellowship program must be conducted by at least 2 faculty and 1 fellow who comprise the Program Evaluation Committee.
Fellowship Program Funding
The Center of Medicare and Medicaid Services (CMS) normally subsidies a portion of physicians in training at most ACGME institutions. However, this does not completely apply to CI fellowships. Under the current financial model, Clinical Informaticians cannot bill CMS for services rendered.
As of October 2015, funding for CI fellowship programs has come from academic medical centers, sponsoring institutions, and charitable donations. Lehmann, C. U., et al. have engaged CMS regarding a "viable financial model" that will sustain and support Clinical Informatics fellowship training for the future.
ACGME Accredited Fellowships
In July, 2014, the CI fellowship at Stanford was the first program in the nation to become ACGME accredited. See press release here.
Subsequent CI fellowship programs that received ACGME accreditation:
University of Illinois at Chicago (UIC) was the second CI fellowship to receive ACGME accreditation.
Fellowship Program Collaboration
On September 24, 2015, the UIC Clinical Informatics fellowship program hosted the first Virtual Case Conference for CI Fellows. The CI fellows from UIC presented on the topic of the "Analysis of Patient Care Workflows." The use of Sage2 and Google Hangout allowed for a successful collaboration among the 40 participants from 13 different institutions across the nation.
Sources and Useful Resources
1. ACGME Program Requirements for Graduate Medical Education in Clinical Informatics 
2. Frequently Asked Questions: Clinical Informatics 
Submitted by Veena Goel, M.D.
Sources and Useful Resources (rev1)
4. Gardner, R. M., et al. "Core Content for the Subspecialty of Clinical Informatics." Journal of the American Medical Informatics Association : JAMIA 16.2 (2009): 153-7. 
5. Lehmann, C. U., et al. "Clinical Informatics Fellowship Programs: In Search of a Viable Financial Model: An Open Letter to the Centers for Medicare and Medicaid Services " Applied clinical informatics 6.2 (2015): 267-70. 
6. Safran, C., et al. "Program Requirements for Fellowship Education in the Subspecialty of Clinical Informatics." Journal of the American Medical Informatics Association : JAMIA 16.2 (2009): 158-66. 
Submitted by J Edward B. Maddela, MD