![Post image for Patient interaction with the iPad and the disconnect between health IT and medicine [iPad Makes the Rounds: Part 3]](http://cdn.imedicalapps.com/wp-content/uploads/2010/06/l_926_654_112A0108-8840-4E0A-B41F-2BE4FC6759EE.jpeg)
Please describe your job as a “Chief Information Architect”
I design the software the Division of Clinical Informatics builds, which includes both a cloud based electronic health record and a physician licensing system, along with software to support various research projects. I also run the software development group for the Division of Clinical Informatics. The key difference between just a development manager of a software company and clinical informatics, is that I am also a practicing physician and a programmer. Just like a “real” architect, who has to be able to talk to the prospective home owners who have a vision of what their home should be, and the builder who is a technical expert in construction, this is what a Chief Information Architect has to do with providers and programmers. I am fellowship trained in medical informatics, having done my fellowship at the NYU School of Medicine/Bellevue, before joining the division here at Beth Israel Deaconess Medical Center.
What do you think is the biggest disconnect between the “IT world” and “clinical practice”.
As a physician (who came from the IT/Software world) and a fellowship trained informatician, I am trained to bridge this gap. This is the scariest shortage in the US right now, in that many of the hospitals and practices which are about to spend the billions in ARA funds to put in HIT, may have IT services, but without informaticians the systems will not match the practice’s workflows, which puts lives and money at risk. When you see our ED dashboard which was written by Larry Nathanson who trained in our fellowship program, it is an airtight match to the clinical and business processes of the ED operations (and evolves as their practice does), as it was written by him who is a physician who practices with it daily in the ED. The same can be said for our systems up on the wards (WebOMR/POE) which were designed by physicians who practice here, and continue to evolve as our practice does.
Informatics is where the business processes intersect with the clinical process, and this is the gap that exists between IT and the care process in most institutions. This is not to say that IT is not critical to this process and without them nothing would actually work of course, but only a provider (nurses, physicians, etc…) can inform the software design process for clinical applications. We are very spoiled at this institution as our IT is staffed by numerous informaticians such as John Halamka (CIO) who also trained in our fellowship program and Larry Markson (VP of Development), both physicians and programmers, and our systems were designed by in house informaticians. Our systems were designed primarily to support patient care between a patient and provider, not financial data gathering, and as such are really stellar systems. We also wisely invested in all of our core clinical applications being platform agnostic web applications, which made iPad use seamless.
How do you think physicians can best bridge this gap?
The art of informatics is being able to talk to programmers and non-technical providers and be able to talk to each group natively. Over the last 2 years I have written around 50,000 lines of code personally, and had thousands of patient encounters. This is really the push behind AMIA’s 20-by-20 program, as the world (and US critically) is very short of informaticians. I think in the future informatics will have to join the medical curriculum and be a section of the boards (it is becoming a specialty under each of the boards separately).
I think the NLM funding for informatics fellowships should be raised, as the need is much greater than the current training pipeline can deliver. The masters in bioinformatics that many universities are granting are not as useful as they are not mostly for providers, such as practicing nurses and physicians, and bioinformatics is not clinical informatics. These are best trained at fully credentialed clinical informatics fellowships. We have trained both senior nurses and physicians in our program.
This concludes our interview with Dr. Feldman. We hope you enjoyed it and that you agree with us that he brings great insights into the possibilities for mobile devices for mobile physicians.
What has been your experience using smart phones and tablets for patient care ? We would love to hear stories from actual physicians, please send them to us on our contact page.
1 2
