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 new specialty was launched in 2013, with physicians already working in the field able to sit for the certification exam conducted by the American Board of Preventive Medicine (ABPM) by meeting prior practice requirements. Over time, this "grandfathering" pathway will be discontinued, and only those physicians completing an ACGME-accredited fellowship will be board-eligible. OHSU was the third program in the country to receive accreditation.

The clinical informatics fellowship at OHSU is administered by the Department of Medical Informatics and Clinical Epidemiology (DMICE) and is affiliated with the Department of Medicine. Physicians of all medical specialties may apply, and eligibility for subspecialty certification is not limited to any particular medical specialty.

This fellowship provides physicians with training in clinical informatics that will enable them to achieve board certification in the new subspecialty of 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 informaticians, and assists them acquire the critical skills needed succeed in this career.  We anticipate that graduates of our programs will eventually become informatics leaders in their organizations, and the program provides a significant framework to allow them to achieve this goal.

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, we did not intend that this new fellowship replace any existing OHSU informatics fellowship or other informatics educational program;instead we built it as a new addition to the OHSU family of informatics educational opportunities that includes a graduate program, a research fellowship funded by training grants from the NLM and other sources, and clinical fellowships offered by the Portland VA and Kaiser Permanente Northwest. This tight integration with the diverse and very active academic informatics department here at OHSU is one of the fellowship program's greatest strengths.

DMICE has a large educational component, and features one of the most extensive and robust informatics course catalogs in the nation. Clinical informatics fellows participate in formal didactic learning with other DMICE students, and with fellows from several other CI fellowship programs that also use OHSU distance learning course materials for the didactic portion of their programs.

Vishnu Mohan, MD, MBI, Program Director
William Hersh, MD, Department Chair and Associate Program Director
Cort Garrison, MD, Associate Program Director, OHSU Chief Health Information Officer
Lynne Schwabe, Program Coordinator
Andrea Ilg, Program Manager

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 and OCHIN, a large health information and innovation network serving more than 10,000 clinicians. They work in different clinical informatics operational setting and play an ongoing role in designing, implementing and optimizing institutional projects. Fellows will have broad exposure to both the front end as well as back end functionality of EpicCare at OHSU and OCHIN and VistA at the Portland VAMC. Fellows will gain broad proficiency in Epic and VistA use. If necessary, the program will assist the fellow in obtaining necessary Epic certification.

The ultimate outcome of the clinical informatics experience is a project and leadership portfolio that will allow the fellow to demonstrate to future employers the type and quality of work he/she has completed. The components of the portfolio will be a series of goal-directed projects that demonstrate the effectiveness of the fellow in real-world experience.

Sample Rotation Block Schedule

Leadership development

Leadership development consists of 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 their 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 classroom 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 may optionally pursue a master's degree that is a superset of the Graduate 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.

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 half-day" of didactic learning, including weekly OHSU Informatics Conferences, monthly Clinical Informatics Grand Rounds, regularly scheduled Fellows Meetings (which includes non-ACGME Fellows at DMICE), and at the Clinical informatics Journal Club organized by the Department. They also engage in the clinical informatics equivalent of a "chief of service" rounds, which offers them unique opportunities to interact with faculty.

Typical academic day schedule

Clinical practice

Fellows will also be expected to maintain about 20% FTE practice in their primary clinical specialty. The program will work with the fellow to find a suitable practice setting.