Clinical Informatics Board Specialty Certification for Physicians: A

Clinical Informatics Board Specialty Certification for Physicians: A Global View

Adi V. Gundlapalli

a, b

, Aditya V. Gundlapalli

, William W. Greaves

, Denece Kesler

Peter Murray

, Charles Safran

, Christoph U. Lehmann

University of Utah School of Medicine and

VA Salt Lake City Health Care System, Salt Lake City, UT, USA

Utah County Academy of Sciences, Orem, UT, USA,

American Board of Preventive Medicine, Chicago, IL, USA,

University of New Mexico School of Medicine, Albuquerque, NM,USA,

International Medical Informatics Association, Geneva, CH,

Harvard Medical School, Boston, MA, USA,

Vanderbilt University, Nashville, TN, USA

Abstract

Clinical informatics workforce development is a high priority

for medicine. Professional board certification for physicians is

an important tool to demonstrating excellence. The recent

recognition of clinical informatics as a subspecialty board in

the U.S. has generated interest and excitement among the U.S.

informatics community. To determine the extent of similar

programs in countries around the world, we performed litera-

ture searches with relevant keywords and internet searches of

websites of informatics societies around the world for men-

tions or descriptions of certifications and reviewed publicly

available sources. The U.S. certification was prominent in the

recent published literature. Germany and Belgium have long-

standing certifications with South Korea and Sri Lanka con-

sidering similar programs. This is the first global view of clin-

ical informatics board certification for physicians. Training

and certification for non-physician informatics professionals

in allied areas are widespread. Official recognition and certi-

fication for physicians and all informatics professionals rep-

resents a key component of capacity building and a means of

addressing the shortage of a skilled informatics workforce.

Wider adoption of certification programs may further attract-

ing talent and accelerate growth of the field.

Keywords:

Clinical informatics, board certification, physicians, informat-

ics workforce.

Introduction

There is a global need for sustaining and growing the infor-

matics workforce. A key aspect of fostering interest and at-

tracting talented candidates is to provide opportunities for

training and career advancement in the field. Voluntary ‘certi-

fication’ of professionals is a highly-visible quality indicator

and a tool to improve physician recognition. Professionals

from diverse backgrounds such as nursing, pharmacy, clinical

medicine, and computer science work in the field of clinical or

health informatics. While there are many opportunities for

certifications in allied fields such as information technology

and information systems, there are fewer opportunities in the

field of informatics. In the U.S., nursing informaticians have

had a certification program [1, 2] and there are efforts under-

way to establish an interprofessional certification [3]. While

physicians are eligible to apply for certification pursued by

informatics professionals, there are limited opportunities ex-

clusively designed for physicians.

Specialty training and “certification” by a professional board

after graduating from medical school represents a path for

physicians to demonstrate expertise and dedication in a specif-

ic area of clinical medicine. This common route for physicians

practicing in the US exists in comparable pathways in Africa,

Asia, Americas, Australia, and Europe. Well-recognized board

certification pathways exist in most countries for clinical spe-

cialties such as internal medicine, family practice, surgery,

pathology, or radiology. Many countries offer subspecialties

in medical and surgical fields. These pathways are considered

important and in the US have become essential for practicing

clinical medicine, hospital staff privileges, faculty appoint-

ments in schools of medicine and to establish appropriate cre-

dentials and qualifications with healthcare purchasers [4].

Clinical informatics was recognized in 2011 as a medical sub-

specialty in the U.S. for physicians. The modern seeds were

sown in 2005 during a town hall meeting conducted by the

American Medical Informatics Association (AMIA) [5]. Sub-

sequent development of the core content and fellowship re-

quirements by leading informatics professionals [6, 7] formed

the foundation of the recognition of clinical informatics as a

distinct subspecialty [8, 9]. The subspecialty certification is

co-sponsored by the American Board of Preventive Medicine

and the American Board of Pathology. Until 2017, it is avail-

able to any physician who possesses a license to practice and

an unexpired board certification in any other specialty from

the American Board of Medical Specialties and can demon-

strate more than 25% clinical informatics efforts for three of

the last five years.

One of the motivations for the U.S. subspecialty certification

was the recognition that informatics is now considered an es-

sential component to the practice, education, and research as-

pects of all medical specialties and subspecialties [10, 11]. It is

anticipated that in the short-term, the ability to show compe-

tency and expertise in this new field will act as a catalyst for

the training and recruitment of experts to advance clinical in-

formatics in hospitals and practices. In the long term, certifica-

tion should allow for uniformity and standardization in train-

ing for physicians and prepare expert clinical informaticians.

It is reasonable to assume that the desire and need to have

qualified physician informatics specialists to fill positions

such as chief medical/health informatics officers, directors of

clinical informatics, and physician leads of EHR implementa-

tions will increase in the future.

With the excitement generated by the U.S. board certification

[8], we sought to review existing data on the status of clinical

informatics as a specialty or subspecialty for physicians out-

side the US. The hypothesis was that countries with well-

established informatics infrastructure will have similar certifi-

cation programs for physicians.

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This article is published online with Open Access by IOS Press and distributed under the terms

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doi:10.3233/978-1-61499-564-7-501

501

Methods

Literature Search

We used combinations of the following keywords for litera-

ture searches: “clinical informatics”, “health informatics”,

“biomedical informatics”, “specialty” or “subspecialty”,

“board certification”, “physicians”, “doctors” to search Pub-

Med, Medline, Scopus, Web of Science, World Cat, CINAHL

and Google Scholar. These databases were accessed through

the University of Utah intranet.

Internet Search of Informatics Society Web Sites

A listing of member societies of the International Medical

Informatics Association (IMIA) was reviewed as of November

30, 2014 from the IMIA website [12]. Brief descriptions of the

member societies as listed on the IMIA page were first re-

viewed. Subsequently, individual society websites were ac-

cessed and contents reviewed for evidence of clinical infor-

matics certifications or qualifications with an emphasis on

physicians. Websites in languages other than English were

reviewed using the automatic translation feature of either

Google Chrome or Bing through Internet Explorer. Complying

with rules for good scientific practice, all webpage screenshots

or pdf versions used for this publication were archived.

Informal Discussions with Informaticians at International

Meetings

The authors discussed the topic of board certification in clini-

cal informatics for physicians with informatics professionals

at the 2014 Asia Pacific Association of Medical Informatics

(APAMI) held in New Delhi, India in early November 2014

and at the Annual Symposium of the American Medical In-

formatics Association (AMIA) in Washington, DC in mid-

November 2014.

Results

Results of Literature Search

In reviewing the literature, the concept of an informatics sub-

specialty is not entirely new and was raised as early as 1985

and 1993 [13, 14]. The forward looking vision of Kunstaetter

in 1985 is impressive [14]: “The medical profession has to

become directly involved by establishing and supporting med-

ical informatics as a new specialty. To do otherwise would be

equivalent to leaving the practice of radiology to physicists or

medical therapeutics to the pharmaceutical industry.”

The search of databases yielded few relevant results related to

clinical informatics board certification for physicians; as

shown in Table 1, most of the recent papers were related to the

US experience [5-11, 15]. The papers trace the history of the

US board certification from concept to setting requirements to

administration of the examination. The US certification gener-

ated considerable excitement in the US physician informatics

community. The next step in this process is the establishment

and sustenance of accredited fellowship programs for clinical

informatics that will train the next generation of clinical phy-

sician informaticians.

During the literature search for clinical informatics certifica-

tion, we noted separate pathology informatics training for

pathologists in the US [16-18]. It is important to note that

pathologists are eligible to apply for the US subspecialty

board certification in clinical informatics.

Roger France et al review the certification process in exist-

ence in Belgium for physicians since an official ministerial

decree was passed in 2001 by the Belgian parliament [19].

The criteria for being designated a “Physician Specialist in

Health Data Management” in Belgium include being a li-

censed physician and requirements for formal coursework and

practical training (each one year) and presentation of an origi-

nal dissertation. There are no published articles regarding the

success and challenges of this program nor an estimate of the

number of physicians who hold this certification.

Two articles describe a “supplement medical informatics”

qualification for German physicians first approved in 1991

[20, 21]. This qualification requires 1.5 years of formal

coursework and practical experience that has to be certified by

the physicians’ institutional leadership. For this certification,

we were unable to find published data on the number of phy-

sicians who hold this certification.

South Korea has established a formal training program in bi-

omedical informatics for physicians [22]. The 18-month pro-

gram leads to Certified Physicians in BioMedical Informatics

(CPBMI), certified by the Korean Society of Medical Infor-

matics (KOSMI). Kim anticipates that the next step would be

to establish a board certification in biomedical informatics

similar to the US program. There are numerous academic

training programs (degree and non-degree granting) that are

open to physicians with recommendations for standards and

accreditation [23-25]. Several countries offer certification and

recognition processes for informatics professionals including

physicians [26, 27].

Table 1. Results of database searches for literature pertaining

to clinical informatics board certification specifically for

physicians (see text for combinations of keywords used)

Databases

Relevant articles from

manual review of main

search and ‘related search-

es’ (and top 100 results

from Google Scholar)

PubMed, Medline, Scopus,

Web of Science, World Cat,

CINAHL and Google Scholar

Applicable specifically to

physician certification: US

related [5-11, 15]; World:

[19-22]

Results of Internet Search of Informatics Society Web

Sites

A review of the brief descriptions of the member societies

charters on the IMIA website revealed training and career de-

velopment of informatics professionals as an often cited goal

with no specific mentions of certification specifically for phy-

sicians.

We reviewed the websites of 58 member societies of informat-

ics listed on the IMIA website and 5 regional member associa-

tions. Countries listed as “Corresponding members” did not

have websites listed. As shown in Table 2, most were amena-

ble to review by virtue of being in English or translated using

either Google Chrome or Bing. Information on certification

specifically for physicians was noted on the US site (Ameri-

can Medical Informatics Association, AMIA). Information on

the German site matched the literature search [20, 21], as did

the link to the certification for physicians on the South Korean

site [22]. There was no mention of the certification available

in Belgium on their website. All other accessible websites had

no mention of certification specifically for physicians.

A.V. Gundlapalli et al. / Clinical Informatics Board Specialty Certiﬁcation for Physicians: A Global View502

Many countries offer certification for all informatics profes-

sionals and physicians would likely be eligible for those train-

ing and certification processes. Examples include the UK,

Australia, and Canada.

The IMIA website and those of the Asia Pacific Association of

Medical Informatics, European Federation for Medical Infor-

matics, and Pan African Health Informatics Association yield-

ed no information on certification specifically for physicians.

The Regional Federation of Health Informatics for Latin

America and the Caribbean website did not load and the Mid-

dle East Association for Health Informatics had no website

listed.

Results of Informal Discussions with Informaticians

A meeting with the President of the Health Informatics Socie-

ty of Sri Lanka resulted in our being alerted to the existence of

the Specialty Board in Biomedical Informatics in that country

at the Postgraduate Institute of Medicine at the University of

Colombo and the possibility of a board certification for physi-

cians in informatics in the near future (personal communica-

tion, Prof. Vajira H. W. Dissanayake). In performing internet

searches on this topic, the Sri Lankan society on the IMIA

webpage briefly mentions a master’s course in biomedical

informatics offered by the Specialty Board in Biomedical In-

formatics that is specifically offered for medical doctors and

dentists in Sri Lanka [28].

Informal discussions with members of the editorial boards of

the Applied Clinical Informatics journal and the International

Journal of Medical Informatics at the 2014 AMIA Annual

Symposium indicated no board certification pathways in clini-

cal informatics for physicians in Brazil or Australia.

Discussion

Over the years, clinical informatics has had a significant im-

pact on the practice of medicine. Demand for increasing quali-

ty and efficiency, while decreasing costs and errors, requires

an informed and well-trained workforce in clinical informat-

ics. As in any field, we face challenges in recruiting and re-

taining talented professionals to clinical informatics.

Table 2. Review of International Association of Medical Informatics member society websites for information on clinical informatics-

related board certification opportunities and pathways specifically for physicians

Continent Results/Comments

Africa

Cameroon, Kenya, Mali, Nigeria, South Africa: No information on clinical informatics board certifica-

tion for physicians

Burundi, Côte d'Ivoire, Ghana, Malawi, Togo: No website listed

Americas

Canada, Chile, Cuba, Uruguay: No information on clinical informatics board certification

for physicians

Argentina, Mexico, Peru: Website failed to load

Brazil: Page could not be translated

Colombia: No website listed

USA: Information on US board certification for physicians

Asia

China, Hong Kong, India, Japan, Pakistan, Philippines, Singapore, Taiwan, Thailand: No information

on clinical informatics board certification for physicians

Israel: No website listed

Sri Lanka: Website failed to load

Iran, Saudi Arabia: Website under construction

South Korea: Link to certification for physicians in Biomedical Informatics

Australia

Australia, New Zealand: No information on clinical informatics board certification for physicians

Europe

Belgium, Croatia, Czech Republic, Great Britain, Greece, Hungary, Finland, France, Ireland, Norway,

Romania, Slovenia, Spain, Switzerland, Sweden, The Netherlands, Turkey, Ukraine: No information on

clinical informatics board certification for physicians

Austria: Page could not be translated

Bosnia and Herzegovina, Italy: Page failed to load

Germany: Medical informatics certification specifically for physicians

A formal certification process with subsequent tangible bene-

fits such as official acknowledgement and recognition of ex-

cellence, qualification for a named position of authority and

possibly monetary benefits would go a long way in attracting

and retaining professionals to this field.

Physicians are an integral part of the clinical informatics team

that consists of dedicated professionals from various disci-

plines. While physicians are likely satisfied to be recognized

for their knowledge, skills, and experience in informatics, it

would also be important to recognize those that have achieved

A.V. Gundlapalli et al. / Clinical Informatics Board Specialty Certiﬁcation for Physicians: A Global View 503

official board certification in their chosen field. In this con-

text, the US clinical informatics subspecialty board certifica-

tion fulfills a long awaited aspirational need and has generated

much excitement and discussion [29, 30].

With the news of the recent U.S. certification, we set out to

find other similar programs in countries worldwide. As with

the U.S., short- and long-term training and degree granting

programs exist for informatics in many countries and these are

open to physicians. It was more challenging to determine if

there are programs that are reserved and specifically designed

for physicians.

Our hypothesis that countries with well-established informat-

ics infrastructure will have similar certification programs for

physicians was not validated. It was interesting to note that the

US is the latest to join a very short list of countries such as

Germany and Belgium that have had programs equivalent or

similar to US board certifications for physicians in the field of

clinical informatics for many years. With South Korea and Sri

Lanka actively considering similar programs, there appears to

be an opportunity for other countries to consider and organize

their training to offer similar recognition. The motivations and

tangible returns will likely vary for different countries as will

the infrastructure, logistics, social and political will to estab-

lish such programs.

We acknowledge several limitations of our study. Key word

searches of online literature databases may be incomplete

based on filtering for English language articles and choice of

keywords. Our search would have missed the non-English

literature. The automatic translation of non-English language

websites was not independently verified by those familiar with

the language and thus we may have missed references to board

certification pathways. There were some sites that were not

amenable to translation from their native language.

As this topic generates more interest among the international

informatics community, there may also be opportunities to

formally engage the IMIA member societies in dialog regard-

ing certification opportunities and pathways for physicians.

This could be conducted via email, online, or in-person sur-

veys at international informatics meetings. IMIA might even

serve as an authority on certification for member societies.

We encourage and request individuals with knowledge and

experience with training and certification programs exclusive-

ly tailored for physicians in different countries to email us

with details. We also encourage stewards of national informat-

ics societies to email us with details of clinical informatics

related certifications and qualifications for physicians in their

countries. It would be important to have an exhaustive and as-

complete-as-possible inventory of such programs so that best

practices, motivations and lessons learned could be shared

among informatics professionals.

Acknowledgements

We wish to acknowledge our international informatics col-

leagues who freely discussed this topic with the authors at

various informatics meetings. We wish to appreciate the ef-

forts of prominent informatics leaders from AMIA who

worked tirelessly to pursue the US board certification and the

American Board of Preventive Medicine for taking the lead to

make the certification a reality. We thank Marjorie Carter (VA

Salt Lake City Health Care System) for editorial and format-

ting assistance. There was no specific grant funding for this

project.

The views expressed in this article are those of the authors and

do not necessarily reflect the position or policy of the US De-

partment of Veterans Affairs, the United States government,

the American Board of Preventive Medicine, the International

Medical Informatics Association, or our respective universi-

ties.

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Address for correspondence

Adi V. Gundlapalli, MD, PhD, MS

Associate Professor

Departments of Internal Medicine and Biomedical Informatics

University of Utah School of Medicine

Chief Health Informatics Officer

VA Salt Lake City Health Care System

[email protected]

A.V. Gundlapalli et al. / Clinical Informatics Board Specialty Certiﬁcation for Physicians: A Global View 505