- What is Medical InfIn the practice of medical informatics, a physician works not only with technology, but he or she also develops clinical guidelines using formal medical terminology.ormatics?
- Ultimately integrating it with applied communication systems across a variety of platforms, including nursing, dentistry, pharmacy, and public health.
- The depth of biomedical informatics includes investigation, modeling, simulation, and experimentation, from molecules to individuals and from biological to social systems.
The field of medical informatics offers more to physicians than clinical practice. Whether a physician chooses to work in a field outside of direct patient care right out of school, or they choose to leave clinical practice later in their career due to burnout, there are a multitude of options available for physicians looking to make a competitive wage and continue contributing to medicine.
Some physicians have chosen to further specialize in areas such as wound care. Physicians choosing this direction often have the opportunity to make their own schedule, and to work relatively autonomously out of their home, rather than reporting daily to an office. Others may choose to enter academia, research, finance, or become expert witnesses, health writers, or healthcare consultants.
Regardless, the growing field of medical informatics, often called biomedical informatics or bioinformatics, is a highly-plausible option for anyone looking to make a transition in his or her career, as such a change can drastically change the course of a person’s life.
What is Medical Informatics?
Yet another burgeoning field for physicians, medical informatics gives the physician a chance to merge their medical expertise with technology in a way that improves medical practice and patient care.
In the practice of medical informatics, a physician works not only with technology, but he or she also develops clinical guidelines using formal medical terminology – ultimately integrating it with applied communication systems across a variety of platforms, including nursing, dentistry, pharmacy, and public health.
This is a rapidly-transforming medicine which is producing insight into the causes and cures of diseases, as well as offering vastly new career opportunities. The American Medical Informatics Association has suggested this term has quickly become outdated, saying:
“The informatics community typically uses the term health informatics to refer to applied research and practice of informatics across the clinical and public health domains. Medical informatics is an earlier term, no longer routinely used, outdated by the growth of bioinformatics.”
The depth of biomedical informatics includes investigation, modeling, simulation, and experimentation, from molecules to individuals and from biological to social systems. In other words, it attempts to bridge the gap between basic and clinical research into healthcare enterprise. Others see the confusion around key terms and offer more simplified definitions.
Enrico Coiera, professor at Australia’s Macquarie University, offers the simple explanation of medical informatics as a discipline practiced by medical doctors who are “trying to make a difference in the way health care is delivered through the smart use of information science.”
The Story of One Physician’s Career Pivot
After leaving a career as a surgeon and moving into wound care, Dr. Christopher Leonard is currently working with Vohra Wound Physicians to bring data analytics and machine learning to post-acute care. Vohra Wound Physicians is a growing physician-led business that has embraced medical informatics as a means of testing, tracking, and providing better patient care. Leonard is currently the chief information officer at Vohra.
In the early part of his career, Leonard was frustrated by how scattered the process of documentation and information sharing was between departments throughout the hospital. Looking back at the flow charts used in the ER, he came to realize how important those were in reducing the amount of creative energy required to reproduce the same functions over and over again for tactics that could be accomplished through protocol.
In the mid-2000’s, just after residency, Leonard found the early electronic health record (EHR) applications made his practice a little easier than trying to root through mounds of paper. It was the era of the PDA (personal digital assistant) where people had versions of a handheld device with separate software applications. In the midst of his initial clinical practice, Leonard was becoming intrigued by how this growth in digital technology could have an impact on medicine.
While practicing in a rural area, Leonard modified the processes in the area, including his own intake forms in the emergency room. He also worked with the pharmacists to create a better flow of information between departments. His practice grew in the area, as he specialized in wound care as a general surgeon. As this happened, it became obvious there was no centralized or organized process from facilities or private practices that were referring patients.
Biomedical Informatics and Remote Wound Care Physicians
During this time, Leonard was contacted by a headhunter who asked about his interest in working with a large wound care specialty group. The practice was already using a proprietary EMR and had developed a business around physicians practicing in remote locations, who then built practices in local communities. The physicians would make their own schedule and provide wound care in the facilities where patients were living.
This model reduced costs for the patient and freed the primary care physicians’ schedule who couldn’t necessarily make “house calls” to long-term care facilities. It also gave the primary care physician a partner they could trust whose expertise lay in the treatment of chronic wounds. Within long-term care facilities, wounds are highly regulated by Centers for Medicare and Medicaid Services (CMS). Chronic wounds are also the aim of many civil lawsuits, 87% of which are found in favor of the plaintiff. There are many other benefits to using this framework, including:
- No cost to the facility
- Backup documentation
- The patients are not bussed out eating up per diem benefits
- The patients received expert care in-house
- Medicare Part B is charged directly by the treating wound care specialist
- Healthcare costs to the facility and Medicare are lower
- Wounds heal faster under the expert care of the specialist
Leonard was intrigued by the healthcare model Vohra was using, and he realized he had developed his own practice in a similar fashion. He continued to communicate with the group, giving frequent suggestions and asking questions. Leonard soon joined Vohra as a physician, and then transitioned into a role in the corporate office where he began working with medical communication as well as the documentation remote physicians were using in their practice.
Documentation is Key to a Medical Informatics Approach
One of the first things Leonard addressed at Vohra was how the remote physicians were picking the codes to appropriately document and bill in the long-term care space. Since the arena is strictly regulated, the physicians need to produce the right documentation to meet requirements. As Leonard describes:
“The long-term care space needs very specific documentation … they need everything to match up very, very specifically. Not only do you have to be sure that the rule sets are right for the clinicians on the front end, but what’s produced has to be very, very specific.”
The initiation of the new program was successful for the company, and the remote physicians who were able to speak to someone could help with an expert perspective, understanding the challenges professionals were facing in the field. These initial changes fed into some of the changes made by the Minimum Data Set (MDS) used for documentation in long-term care, which is the standard means of documenting patient care. In the MDS, there is also section on documenting skin issues, including both long-term and chronic wound care.
Overcoming Wound Healing Obstacles with AI and Medical Informatics
To avoid challenges faced by physicians, Leonard theorized that logic and augmented intelligence could be added to the electronic record Vohra used to help physicians write appropriate notes in the field that met the MDS criteria. In collaboration with a creative programmer and with feedback from the remote physicians, Leonard developed a system that helped improve documentation to meet regulation standards.
While the implementation of the new AI has been a success for Vohra and other, similar wound care practices, the field still has a long way to grow. It’s still new, and technologies are rapidly improving year-over-year. With any luck and determination, the important field of biomedical informatics will soon be a major clinically-used field, and it will greatly benefit patient outcomes everywhere.