Subject: 10 Essential Clinical Informatics Skills
On a more serious note see
http://www.informatics-review.com/thoughts/skills.html
10 Essential Clinical Informatics Skills*
Enrico Coiera MB BS PhD
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There is a pressing need to educate health care workers in the basic skills
needed to operate the computer tools they will encounter in the workplace.
However, simply teaching practising clinicians to use IT is not enough.
Just
as the ability to suture does not make one a surgeon, the ability to surf
the Web does not imply that one understands the principled use of
information. Having basic computer skills is not the same as being skilled
in the management of information, which is fundamental to good medical
practice1.
Every clinician needs to understand the principles of data interpretation,
the logical foundations of the diagnostic process, and the management of
uncertainty in clinical knowledge.2 They need to know that the
problem-oriented medical record is just an information instrument, to know
when it is appropriate and when other formulations might be better choices.
The dynamics of communicating with patients and with colleagues are altered
when the exchange moves from a face-to-face interaction to the telephone,
e-mail, voicemail or video.3 For the health care worker understanding the
implications of using one medium rather than another is central to
developing effective communication skills.
These disparate elements of informatics were once taught piecemeal, there
is
now a growing consensus about the essential information skills needed by
clinicians and medical informatics is appearing in more curricula as a
distinct subject.4 A proposal for 10 essential clinical informatics skills
is provided below to give flesh to these ideas and to stimulate debate
about
the role of informatics in medical education.
Clinicians should be able to:
1. Understand the dynamic and uncertain nature of medical knowledge and
know
how to keep personal knowledge and skills up-to-date
2. Search for and assess knowledge according to the statistical basis of
scientific evidence
3. Understand some of the logical and statistical models of the diagnostic
process
4. Interpret uncertain clinical data and deal with artefact and error
5. Analyse and structure clinical decisions in terms of risks and benefits
6. Adapt and apply clinical knowledge to the individual circumstances of
patients
7. Access, assess, select and apply a treatment guideline; adapt it to
local
circumstances; and communicate and record variations in treatment plan and
outcome
8. Structure and record clinical data in a form appropriate for the
immediate clinical task, for communication with colleagues, or for
epidemiological purposes
9. Select and utilise the most appropriate communication method for a given
task (e.g., face-to-face conversation, telephone, e-mail, video,
voice-mail,
letter)
10. Structure and communicate messages in a manner most suited to the
recipient, task and chosen communication medium.
The computer, the telephone, the Web, video -- these, and all that is still
to come, are unquestionably powerful tools. Used badly, they waste time and
money, and dehumanise our interactions with each other. Used well, guided
by
a clear understanding of basic informatics principles, they are neither to
be feared, loved nor loathed. They are simply to be used. In the next
century, the study of informatics will become as fundamental to the
practice
of medicine as anatomy has been to the last.
* This paper is based upon: E. Coiera, Medical informatics meets medical
education: There's more to understanding information than technology,
Medical Journal of Australia 1998; 168: 319-320
1. Coiera E. Guide to medical informatics, the Internet and telemedicine.
London: Chapman and Hall, 1997 ( see also http://www.coiera.com).
2. Haynes RB, Ramsden M, McKibbon KA, et al. A review of medical education
and medical informatics. Acad Med 1989; 64: 207-212.
3. Coiera E, Tombs V. Communication behaviours in a hospital setting -- an
observational study. BMJ 1998; 316: 673-677.
4. Greenes RA, Shortliffe EH. Medical informatics -- an emerging academic
discipline and institutional priority. JAMA 1990; 263: 1114-1120.
Complete address of author:
Enrico Coiera MB BS PhD
Professor, Faculty of Medicine,
Adjunct Professor School of Computer Science and Engineering
University of New South Wales
Sydney NSW 2052
Australia
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