Noted medical informatician and past contributor to Linux Medical News Scot Silverstein writes on the AMIA clinical information system working group forum: ‘…Don Lindberg in 1969: “computer engineering experts per se have virtually no idea of the real problems of medical or even hospital practice, and furthermore have consistently underestimated the complexity of the problems�in no cases can [building appropriate clinical information systems] be done, simply because they have not been defined with the physician as the continuing major contributor and user of the information” (Lindberg DAB: Computer Failures and Successes, Southern Medical Bulletin 1969;57:18-21). In Collen’s book of the history of medical informatics, other pioneers in clinical IT gave similar advice (e.g., Octo Barnett’s “Ten Commandments” in 1970).

In other words, insights that are making it into print in short vignettes in JBI in 2005 were apparently well-recognized 35 years prior…’ The text of Silverstein’s full announcement including a request for participation in a survey on informatician job seeking experiences is enclosed.

The responses in the Journal of Biomedical Informatics to sociologist Ross Koppel’s article “The Role of CPOE Systems in Facilitating Medication Errors”, J Am Med Assoc 2005;293(10) were extremely interesting ( http://www.elsevier.com/framework_products/promis_misc/cpoe.htm ). The recognition in 2005 that “occasional visitors to healthcare cannot fathom the demanding work, much less create IT systems to support it” (Nemeth/Cook) is a key insight that I believe, unfortunately, is not well-understood in the IT vendor/IT operations community. This includes the healthcare provider sector as well as the pharmaceutical sector, which was a significant surprise in my prior informatics role in pharma.

Here is my concern. Don Lindberg in 1969: “computer engineering experts per se have virtually no idea of the real problems of medical or even hospital practice, and furthermore have consistently underestimated the complexity of the problems�in no cases can [building appropriate clinical information systems] be done, simply because they have not been defined with the physician as the continuing major contributor and user of the information” (Lindberg DAB: Computer Failures and Successes, Southern Medical Bulletin 1969;57:18-21). In Collen’s book of the history of medical informatics, other pioneers in clinical IT gave similar advice (e.g., Octo Barnett’s “Ten Commandments” in 1970).

In other words, insights that are making it into print in short vignettes in JBI in 2005 were apparently well-recognized 35 years prior.

My concern is that as long as these insights remain within medical informatics journals as interesting discussions, but do not penetrate the culture of other stakeholders in clinical IT in an actionable manner (and by this, I mean to the C-level officers and strategic decisionmakers), the sociotechnical problems will continue. In the UK, I think the national clinical IT project leaders are beginning to understand this. The article “Terminal Care” (Economist; 7/23/2005, Vol. 376 Issue 8436, http://search.epnet.com/login.aspx?direct=true&db=buh&an=17706218 ) is an example.

A major step towards moving sociotechnical insights in the medical informatics community from scholarly articles to practice will be a greater outside recognition of the field. There is still significant confusion even about the terminology of the informatics disciplines, and only slow acceptance of the terminology recommended by ACMI several years ago (“Training the Next Generation of Informaticians”, Friedman et al, JAMIA May/June 2004).

What I am getting to in all this is the following:

I am planning to conduct a survey on informaticians’ experiences in job-seeking. As some anecdotal examples of the difficulties I’ve heard about:

– an informatician working part-time at a major academic research hospital is denied full-time employment “because he is not a SQL programmer.”

– an informatician was laid off from a major pharma on the basis of “skillset not needed” by a VP of Discovery I.T. (who had no healthcare or biomedical background, by the way). This was the very same informatician who informed the company’s H.R. department of the existence of the field in his work on the company talent management committee, and suggested adding “medical informatics” to their skillsets taxonomy. In that way, the automated resume-parsing software might alert H.R. to informatics “incomings”.

– an informatician is told by the Sr. VP for Biometrics at a major international CRO (clinical research organization) that “there’s nothing in his resume of value to a CRO” and will not even be interviewed.

– an informatician is told by the Executive Director of Adverse Events reporting, who was an FDA official in the same field prior to taking a position at a major pharma, that “medical informatics is not needed in the department.”

– an informatician with significant clinical IT operational experience and study of human-computer interaction issues was turned down by healthcare IT vendor companies because “he didn’t have enough experience” in systems lifecycle software design.

I believe a significant underlying factor in these cases is a confusion about, or lack of understanding of, the discipline of biomedical informatics, especially in the patient domain (i.e., medical/clinical informatics).

If others have had similar experiences in seeking healthcare informatics positions, I would like to hear about them as I formulate a questionnaire for informaticians to collect other examples for a paper.

Regards,

Scot Silverstein
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Scot M. Silverstein, MD
Assistant Professor of Healthcare Informatics and IT
Director, Institute for Healthcare Informatics
College of Information Science and Technology
Drexel University
3141 Chestnut St.
Philadelphia, PA 19104-2875

(215)895-1085
scot.m.silverstein@cis.drexel.edu