Review article
Core competencies for clinical informaticians: A systematic review

https://doi.org/10.1016/j.ijmedinf.2020.104237Get rights and content

Highlights

  • This is the first attempt to synthesise core competency requirements of the different health care informatics disciplines.

  • We identify the common skills and competencies shared among these disciplines.

  • We provide a series of recommendations for generating competencies and designing course curricula.

Abstract

Background

Building on initial work carried out by the Faculty of Clinical Informatics (FCI) in the UK, the creation of a national competency framework for Clinical Informatics is required for the definition of clinical informaticians’ professional attributes and skills. We aimed to systematically review the academic literature relating to competencies, skills and existing course curricula in the clinical and health related informatics domains.

Methods

Two independent reviewers searched Web of Science, EMBASE, ERIC, PubMed and CINAHL. Publications were included if they reported details of relevant competencies, skills and existing course curricula. We report findings using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.

Results

A total of 82 publications were included. The most frequently used method was surveys (30 %) followed by narrative descriptions (28 %). Most of the publications describe curriculum design (23 %) followed by competency definition (18 %) and skills, qualifications & training (18 %). Core skills surrounding data, information systems and information management appear to be cross-cutting across the various informatics disciplines with Bioinformatics and Pharmacy Informatics expressing the most unique competency requirements.

Conclusion

We identified eight key domains that cut across the different sub-disciplines of health informatics, including data, information management, human factors, project management, research skills/knowledge, leadership and management, systems development and evaluation, and health/healthcare. Some informatics disciplines such as Nursing Informatics appear to be further ahead at achieving widespread competency standardisation. Attempts at standardisation for competencies should be tempered with flexibility to allow for local variation and requirements.

Introduction

Health informatics is a multidisciplinary field that combines computer and information sciences with a health focus [1]. The number of informaticians (those practising informatics) is growing, with an estimated 25–50 thousand informaticians in the UK’s National Health Service (NHS) alone [2].

The purpose of this systematic review is to collate and synthesise the literature relating to the key competencies/skills and educational course requirements of biological and healthcare-related informatics disciplines. In this context, a competency can be considered to be the input which consists of skills, traits and knowledge, whereas a competence refers to the output (i.e. work performance) [3].

Previous reviews on informatics competencies (e.g. [4,5]) have either included little synthesis of the results, were semi-systematic rather than fully systematic in nature, or only covered a single informatics discipline. There has been significant development of competencies and associated curricula led by the US with earlier work by [[5], [6], [7]] culminating in the formation of Clinical Informatics training programmes in the US. Much of this work has been carried out by the American Medical Informatics Association (AMIA). Work has also been carried out from an international perspective regarding Health Informatics in developing countries. A systematic review of reviews (n = 11) was carried out in 2013 by [8] that focused on Health Informatics in developing countries. The review called for more research/development of methods, tools and guidelines. The authors cite a lack of available quality resources in this context. There has been comparatively little output from a UK perspective. The review presented here contributes to the existing literature by adding a UK perspective and by covering multiple informatics disciplines to synthesise over-arching competencies. It also identifies competencies that are shared or unique to specific sub-disciplines. Additionally, the present review updates the literature in this fast-moving area.

There are many different groups carrying out informatics activities throughout the bio-health domains, including clinical, health, bio, pharmacy and nursing informatics. In addition, many professionals do what might be described as the work of an informatician but hold different job titles. Douglas Fridsma, former president and COE of the American Medical Informatics Association (AMIA) discusses this in an editorial piece about the changing names applied to the field of informatics over the years [9]. Fridsma discusses the overlap between informatics and data science and how these similarities can be operationally defined via the development of core competencies [9].

Greenhalgh and Macfarlane [3] advocate the use of an iterative approach for the analysis of complex issues such as competency definition. This review forms one stage in a larger project which also includes job posting analyses, semi-structured expert interviews and a digital survey, building on initial work carried out by the UK’s Faculty of Clinical Informatics (FCI) around the definition of Clinical Informatics [10]. The FCI’s phase 1 report highlighted that the consulted experts expressed a preference for a single overarching competency framework [2]. The report also stipulates that a balance should be struck between the professional attributes of informaticians that are generic enough to include all potential clinical informatics disciplines, but granular enough to develop a meaningful and usable competency framework [2].

The present systematic literature review was carried out to explore the overlap (and areas of difference) between the different informatics disciplines as summarised in Box 1.

This review addresses the following research questions:

  • RQ1: What are the common core skills and competencies across the medical and health informatics domains?

  • RQ2: To what extent do the core skills and competencies vary by level and type of education and training?

Section snippets

Methods

The review protocol was based on findings from the FCI’s phase 1 report [2] and the PRISMA statement [11,12].

Results

A total of 12,688 publications were retrieved, reduced to 10,044 after removal of duplicates in Mendeley (Table 3) and 8760 items following removal of duplicates in Covidence.

Fig. 1 provides an overview of the number of items screened at different stages. Eighty-two items were included in the final review.

Discussion

This is the first review to examine the core competencies and design of curricula for health-related informatics disciplines using a systematic approach and providing data synthesis. We identified eight competencies and skills that cut across the different sub-disciplines: (i) data, (ii) information management, (iii) human factors, (iv) project management, (v) research skills/knowledge, (vi) leadership and management, (vii) systems development and evaluation, and (viii) health/healthcare.

Many

Conclusion

Cross-cutting informatics competencies are focused mainly around data, information management, human factors, project management, research skills/knowledge, leadership and management, systems development and evaluation, and health/healthcare. There is a need for standardised baseline competencies that are flexible enough to be adapted for local need. The disciplines with the most variation appear to be Bioinformatics and Pharmacy Informatics, with the former requiring knowledge of genetics,

Authors’ contributions

AD wrote the manuscript and carried out the review and analysis/synthesis of literature. Both AD and JM screened the title and abstracts of all papers yielded by the literature search as well as the full text of the final included papers. GM supervised the project and JM and GM both reviewed the manuscript and made edits and suggested changes.

Role of funding source

The Faculty of Clinical Informatics (FCI) commissioned this work, which is related to the generation of a core competency framework for Clinical Informatics

Ethics committee approval

Ethical approval was not required for this systematic literature review

Declaration of Competing Interests

The authors received a grant from the Faculty of Clinical Informatics (FCI) to carry out this work.

Acknowledgements

The authors would like to thank the Faculty of Clinical Informatics (FCI) for funding this work

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