Connecting the Dots of Medicine and Data

By CHRISTINE LARSON

13 april 2009--RUSS CUCINA, 37, lives a double life. For two months of the year, he practices internal medicine, treating patients at the UCSF Medical Center in San Francisco. The rest of the year, he helps the hospital develop its electronic medical records and other data systems.

As a medical doctor who also has a master’s degree in biomedical informatics, Dr. Cucina has a foot in both worlds — medicine and technology — and can bridge the sometimes daunting gap between them.

“I’m the glue between the I.T. enterprise and the clinical leadership,” said Dr. Cucina, the hospital’s associate medical director of information technology. “Because I have the vocabulary of both sides, I can serve as translator between them.”

Such translators, known as “health informatics specialists,” typically have expertise in medical records and claims, clinical care and programming.

“The health I.T. people run the servers and install software, but the informatics people are the leaders, who interpret and analyze information and work with the clinical staff,” said William Hersh, chairman of the department of medical informatics and clinical epidemiology at Oregon Health and Science University.

The federal government’s economic stimulus package is dedicating $19 billion to speeding the adoption of electronic health records, so demand for health informatics specialists is skyrocketing. “My rough estimate is that we need about 70,000 health informaticians,” said Don E. Detmer, president and chief executive of the American Medical Informatics Association, a nonprofit industry group.

Health informatics specialists usually start as computer programmers or as doctors, nurses, pharmacists or health record administrators. After earning a graduate degree in health informatics, they may move into midlevel or senior positions at hospitals, doctor’s offices, insurance companies, pharmaceutical companies or other organizations concerned with health data.

Amen Amusan, 36, of Minneapolis, works for a technology company developing programs to help hospitals analyze claims data. After receiving an undergraduate degree in computer science, she enrolled in a health informatics master’s program at the University of Minnesota.

When she finished her degree in December 2007, she took a job paying almost 50 percent more than her previous one. (The big bump was only partly because of her degree; she also moved from a nonprofit to a for-profit company.) “I was getting two or three calls a day from recruiters and going on interviews every day,” she said.

Midlevel jobs, like those for clinical analysts or informatics analysts, typically pay around $70,000 a year, according to the association, but salaries can be much higher at senior levels like that of chief clinical information officer. Other senior level jobs, which sometimes require a Ph.D., include leadership roles at medical device, life science or insurance companies.

Consulting firms are also hiring health informatics experts to serve their health care clients. “A lot of hospitals have to hire external consultants to do the work because they’re constrained by the availability of resources,” said Hui Cao, 31, of New York, a senior consultant at Deloitte, who earned her doctorate in biomedical informatics at Columbia University.

Currently, there are no educational, licensing or credential requirements for health informaticians. Still, training programs are proliferating. Within the past four years, St. Louis University, the University of Minnesota and Oregon Health and Science University have all added master’s programs or certificates in health informatics.

At the same time, many universities are offering short courses or certificate programs to train working health care providers or programmers in informatics. Some schools are adding associate degrees or undergraduate majors.

These programs can bear a bewildering variety of names. Typically, “medical” or “biomedical” informatics programs focus on data that doctors need for treating patients. “Bioinformatics” programs stress biological or genetic data, while “health informatics” programs often emphasize clinical data and health records. Even among programs with the same name, the emphasis may vary.

“You can’t tell by the title what these programs are truly offering,” warned Claire Dixon-Lee, executive director of the Commission on Accreditation for Health Informatics and Information Management Education, which accredits academic programs offering degrees in health informatics. “Students have to truly look closely at what courses are being taught.”

IT takes more than technical skills and an understanding of health care to succeed as a health informatician. Diplomacy skills are crucial in connecting two potentially contentious groups: doctors and programmers.

Dr. Cucina tries to head off conflict and help both sides avoid errors. He once caught a well-intentioned mistake in an electronic medical record design that would have been glaringly obvious to any physician. If he hadn’t gently suggested a correction, he said, “it would have been an embarrassment to the entire medical record project that would be hard to live down.”

Fortunately, he said, heading off such problems and creating a system that works well for both sides can be highly rewarding. When he does his job right, he said, “we can create a common vision for health care information technology.”