The Accreditation Council for Graduate Medical Education (ACGME) defines clinical informatics as "the subspecialty of all medical specialties that transforms health care by analyzing, designing, implementing, and evaluating information and communication systems to improve patient care, enhance access to care, advance individual and population health outcomes, and strengthen the clinician-patient relationship."

The clinical informatics (CI) fellowship at OHSU was one of the first to be established in the nation – we took our first CI fellows in 2014.  At OHSU, CI is a subspecialty of internal medicine (we are administratively governed by the IM RC at ACGME) and housed within the Department of Medicine, but we accept applicants from all medical specialties.

The fellowship provides physicians with training in clinical informatics that will enable them to achieve board certification in clinical informatics, and meet the milestones defined by ACGME. But beyond these goals, the fellowship program aims to train physicians to successfully embark on their careers as clinical informaticists, and assists them acquire the critical skills needed succeed in this career. Graduates of our programs have become informatics leaders in their organizations, and have been successful in academic and community healthcare settings, as well as in industry.

When we envisaged and deployed the fellowship program, we wanted to ensure that the framework of the program architecture rested on five fundamental pillars, namely:

• a strong focus on formal informatics training as rotations and didactics
• superior scholarly activities including research, QI projects, scheduled meetings and grand rounds
• ensuring that fellows acquire leadership skills
• allowing fellows to continue practicing in their clinical specialty to maintain their competency as physicians
• fostering an environment that balances work and life interests appropriately throughout the duration of the fellowship.

Also, OHSU has a large graduate informatics education program, and features one of the most extensive and robust informatics course catalogs in the nation. CI fellows participate in formal didactic learning with other students in the Biomedical Informatics Graduate program, with fellows from several other CI fellowship programs that also use OHSU distance learning course materials for the didactic component of their programs.

Vishnu Mohan, MD, MBI, Program Director
Lynne Schwabe, Program Coordinator
 

Clinical informatics rotations

Fellows rotate through a number of clinical informatics rotation at OHSU Hospital and Clinics and our partner institutions, including the Portland VA Medical Center, Hillsboro Medical Center, and OCHIN (a large health information and innovation network serving more than 10,000 clinicians). They work in different clinical informatics operational settings and play an ongoing role in designing, implementing and optimizing institutional projects. Our fellows are Epic certified physician builders and gain broad exposure to both the front end as well as back-end functionality of EpicCare at OHSU and OCHIN. At the VA they are exposed to the unique environment that allows large-scale data analytics and healthcare IT infrastructure that is nationwide in its breadth and scope.

The ultimate outcome of the clinical informatics experience is a project and leadership portfolio that allows our CI fellows to demonstrate to future employers the type and quality of work they have completed.

Program Tracks

Our program features two tracks, a “traditional” operational track, as well as an “academic” research track.  Both tracks are 2 years in duration, and primarily differ in the second year of training.  The operational track is the default and designed to train well-rounded clinical informaticists who are effective in the healthcare operational setting. This is best accomplished by two years of operational rotations. The research track is designed to allow trainees to gain a more detailed understanding of the informatics research environment, for careers as faculty in academic medical centers (especially if they are expected to successfully compete for extramural research funding in their field) or in any informatics career where research or research-like activities will be a primary professional focus.  This is best accomplished by a focus on scientific endeavor in the second year. The research track also allows our CI fellowship training to be more easily blended with other clinical specialty training at OHSU that also feature a research year. Differences between the two tracks are detailed in the table below.

Leadership Development

Leadership development includes both formal training coupled with mentorship by informatics leaders at OHSU, the VA and OCHIN. Formal training options available to fellows include participation in leadership experiences offered by OHSU such as the Pathways to Leadership Program, training in LEAN improvement methodology, participation and leadership of rapid process improvement events and projects, and completion of the Institute for Healthcare Improvement (IHI) web-based instructional modules on quality improvement. Fellows also attend regularly scheduled clinical informatics management meetings at OHSU, informatics committee meetings, and Health Information Committee meetings.

Didactic Clinical Informatics Education

Fellows are expected to participate in learning experiences that aim to provide mastery of the core content of the field and enables them to successfully pass the clinical informatics board certification after completing the program.

The default educational experience will be the OHSU Graduate Certificate in Biomedical Informatics program, which provides which provides 21 credits of coursework (7 three-credit courses). In consultation with the program director, fellows also have the opportunity to pursue a master's degree instead of the certificate. Fellows will also have the opportunity to be involved in clinical informatics education for medical students, residents, and other clinicians. The OHSU Graduate Certificate Program provides fellows with the knowledge that prepares them for the board certification exam at the end of their fellowship. Tuition is waived for all fellows who take courses while training in the CI fellowship program at OHSU.

Formal Learning Activities

Rather than follow the traditional "noon conference" model of didactic face-to-face learning prevalent in most clinical fellowship programs, fellows participate in an "academic day" of didactic learning, including OHSU Informatics Conferences, Clinical Informatics Grand Rounds, regularly scheduled Fellows Meetings, and at the Clinical informatics Journal Club organized by the program. They also engage in the clinical informatics equivalent of a "chief of service" rounds, which offers them unique opportunities to interact with faculty. The typical academic schedule is here below.

Clinical Practice

Fellows will also be expected to maintain about 20% FTE practice in their primary clinical specialty. At OHSU, CI fellows engage in independent practice in their primary clinical specialty, i.e., work as attending physicians. The program will work with the fellow to find a suitable practice setting.

Check out more information about the fellowship