Ten essential clinical informatics skills

ENRICO COIERA
Faculty of Medicine, University of New South Wales, Sydney, Australia

Information skills are basic to good medical practice. 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. Understanding the implications of using one medium rather than another is central to developing effective communication skills as these communication options become commonplace in the community.

Keywords: medical informatics, communication, information technology (IT)

J.R.Coll.Surg.Edinb., 44, August 1999, 269-70

INTRODUCTION

Medical informatics is the name now given to the study of clinical information and communication processes. It is the rational study of the way we think about patients, and the way that treatments are defined, selected and developed. It is the study of how medical knowledge is created, shaped, shared and applied. Ultimately, it is the study of how we organise ourselves to create and run healthcare organisations.There is a pressing need to educate health care workers in the basic skills needed to operate the computer tools they encounter in the workplace. However, simply teaching practising clinicians to use information technology (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.

CLINICAL INFORMATICS SKILLS

Having basic computer skills is not the same as being skilled in the management of information, which is fundamental to good medical practice.¹ For example, every clinician needs to understand the principles of data interpretation, the logical foundation diagnosis, and the management of uncertainty in clinical knowledge.² They should know that the problem-oriented medical record is just an information instrument, when it is appropriate to use it, and when other formulations are better choices. Communication skills are also needed in handling clinical information. The message received is always influenced by the medium chosen to deliver it. Consequently, the dynamics of communicating with patients and with colleagues are altered when the exchange moves from a face-to-face interaction to the telephone, Email, voice-mail 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. However, there is now a growing consensus about the essential information skills needed by clinicians. Medical informatics is thus appearing in more curricula as a distinct subject.⁴ To add to this momentum, the NHS has recently published a report that presents a core set of informatics elements for clinical education.⁵ 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:

So, the computer, the telephone, the Web, video - these, and all that is still to come, are unquestionably powerful tools. Used badly, they do indeed 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, and soon that use will be as routine as it is unremarkable. For in the next century, the study of informatics will be as fundamental to the practice of medicine as anatomy was to the last.

ACKNOWLEDGEMENT

Permission to publish this revised and updated article was granted by the Medical Journal of Australia

General principles: Audit, statistics and computing in surgery

REFERENCES

1. Coiera E. Guide to medical informatics, the Internet and telemedicine. London: Chapman and Hall, 1997 (http://www.coiera.com).
2. Haynes RB, Ramsden M, McKibbon KA, Walker CJ, Ryan NC. A review of medical education and medical informatics. Acad Med 1989; 64(4): 207-12
3. Coiera E, Tombs V. Communication behaviours in a hospital setting: an observational study. BMJ 1998; 316(7132): 673-7
4. Greenes RA, Shortliffe EH. Medical informatics -- an emerging academic discipline and institutional priority. JAMA 1990; 263(8): 1114-20
5. Severs M, Pearson C. Learning to Manage Health Information. NHS Executive 1999 (http://www.enablingpp.exec.nhs.uk)

Copyright: This paper is based upon: Coiera E. Medical informatics meets medical education.: There’s more to understanding information than technology. Med J Aust 1998; 168(7): 319-20

Correspondence: Professor Enrico Coiera, Faculty of Medicine, University of New South Wales, Sydney NSW 2052, Australia (Email: ewc@pobox.com)

©1999 The Royal College of Surgeons of Edinburgh, J.R.Coll.Surg.Edinb., 44; 4: 269-70