Clinical Informatics Fellowship

The Beth Israel Deaconess Medical Center (BIDMC) Clinical Informatics Fellowship is a two-year ACGME-accredited training program (Accreditation ID: 1392414001). For over 40 years, the training program has trained leaders who transform healthcare through the creative use of information and communication technology. Through real-world exposure to and participation within one of the world's preeminent clinical computing system environments, our fellows learn how to assess the needs of clinicians and patients, refine clinical processes, and design and implement clinical systems. The fellowship consists of didactics, core and elective rotations, and a capstone project. After successfully completing the program, fellows will be eligible to take the Clinical Informatics Board Exam offered by the American Board of Preventive Medicine (ABPM).

Background

Per the ACGME: Clinical informatics is the subspecialty of all medical specialties that transforms health care by analyzing, designing, implementing, and evaluating information and communication systems to improve patient care, enhance access to care, advance individual and population health outcomes, and strengthen the clinician-patient relationship.

Physicians who practice clinical informatics draw from the broader field of biomedical and health information technology (IT) as they apply informatics methods, concepts, and tools to the practice of medicine. Thus, they must understand the culture, boundaries, and complexities of the field. Further, the stakeholders, structures, and processes that constitute the health system affect the information and knowledge needs of health care professionals and influence the selection and implementation of clinical information processes and systems.

Physicians who practice clinical informatics collaborate with other health care and IT professionals and provide consultative services that use their knowledge of patient care combined with their understanding of informatics concepts, methods, and health IT tools to improve clinical practice by:

Leading initiatives designed to enhance health care quality and access by supporting and facilitating care coordination and transitions of care through the procurement, customization, development, implementation, management, evaluation, and continuous improvement of clinical information systems;
Securing the legal and ethical use of clinical information;
Assessing information and knowledge needs of health care professionals and patients;
Characterizing, evaluating, and refining clinical processes;
Analyzing, developing, implementing, and refining clinical decision support systems; and,
Participating in projects designed to use technology to promote patient care that is safe, efficient, effective, timely, patient-centered, and equitable.

Formal Didactics

Through didactics, fellows will learn the fundamentals of health information technology administration and management. The Harvard-associated programs, Beth Israel Deaconess Medical Center, Boston Children’s Hospital, and the Mass General Brigham in collaboration with the Harvard Medical School Department of Biomedical Informatics have developed a certificate to foster cross institution collaboration while also addressing the ACGME training requirements needed for fellowship graduation.

A lecture and lab series consists of a 9-month program divided into four core components:

Full Year
- Tuesday noon lecture series with varying topics and invited speakers.
Fall semester
- BMI 701: An introduction to data science.
- BMI 720: Core and advanced clinical informatics.
Spring semester
- BMI 741: Frontiers of clinical informatics

Some fellows elect to take additional coursework through the following institutions:

The following teaching conferences are available:

Clinical Informatics Fundamentals
Journal Club
Research in Progress

Capstone Project

In addition to the standard didactics, the training experience will culminate in the completion of a capstone project that demonstrates their mastery of clinical informatics.

Projects are designed around the interests and career goals of the individual fellow. Graduates will be prepared to lead health information technology strategy and implementation projects, advance the field’s knowledge base, and train the next generation. Examples of possible scholarly activity include, but are not limited to:

Analysis of existing data marts to understand the clinical use of information systems and the consequences of changes in information systems to clinical outcomes
Interventions as part of the electronic medical record the focus on improving quality of care and patient safety through multidisciplinary teams
Usability testing and design improvement of health information technology interfaces for frontline clinicians
Interventions using consumer health informatics to record and capture patient data and facilitate patient engagement
Development of patient-reported outcomes reporting tools that use patient portals and consumer health informatics to collect store and transmit data to clinicians.

Rotations

Over the two-year fellowship, trainees will complete both core and elective rotations, gaining broad exposure to various aspects of the healthcare enterprise. These experiences will allow fellows to collaborate with diverse team members, explore how different technologies integrate, understand the connections between processes, and observe how data flows across systems.

Core Rotations

Emergency Informatics
Pathology Informatics
Radiology Informatics
Health Care Quality / Quality Improvement
Information Systems
Data Science

Elective Rotations

Public Health / Bio-surveillance
Population Health
Bioinformatics
Patient-Facing Informatics / Consumer Informatics
CyberSecurity
Innovation in technology
Mobile Health IT (mHealth)
Patient Engagement
Patient360 and Data Analytics
Electronic health record app development (SMART on FHIR)
Quality Assurance projects
Vendor selection
TeleMedicine
Health Policy
Behavioral health
Health Equity

Committees

Fellows will participate in the longitudinal governance committee at the medical center during their 24 months of training. This experience offers the opportunity to develop clinical skills and work with frontline clinicians to improve workflow through technology and process engineering. Examples of governance committees that fellows participate in are:

Ambulatory Clinical Information Technology (IT)
Documentation Committee
FastTrack Innovation in Technology
Prescriber Medication Process Committee
Orders Review Process
Patient Portal Committee
Telehealth Committee
OpenNotes Committee
Outpatient governance committee
Inpatient governance committee
Patient health record (patient site) governance committee

Other Educational Opportunities

Epic physician builder course
- BIDMC is an Epic institution. This allows us to send our fellows to the physician builder class offered by Epic.
- Offered during the summer of the first year
Follow the Order Series
- In the Follow the Order series, fellows follow how an order is generated at the point of care and how it is processed and fulfilled downstream. In this series, fellows also learn how EHR's are used in various clinical departments, how they function, and how clinical care processes are supported. The following is an example of some of the sessions in the series:
Ambulatory EHR
Inpatient EHR
Emergency Department Dashboard
Critical Care
Peri-operative and Anesthesia
Radiology / RIS
Clinical Pathology / Laboratory / LIS
Pharmacy
Admit / Discharge / Transfer system (ADT)
Billing and Coding
Data Center
3D Printing / Maker Lab

DCI-specific Resources

The Division of Clinical Informatics at BIDMC (DCI) has access to a number of resources specific to the division. These resources are available for fellows to pursue any academic projects that may be of particular interest. In addition, the DCI faculty has research projects supported by NIH, HHS, private foundations, industry, and international sovereign funds. Fellows can participate in any of these activities and are encouraged to work in these areas as well.

Mimic data set
Mobile Health App Development for InfoSAGE (FHIR)
Mobile Apps to Support Patient Social Needs
Alicanto™ - A Global Learning and Collaboration Platform
- Alicanto Mobile and Web Development
- Alicanto Maternal Health Education
Online learning portal with professionally created video lectures by our faculty. Examples include:
- The Field of Clinical Informatics
- A History of Computing at BIDMC
- Back to the Future: LINC with Tomorrow: 1967 video with Dr. Warner Slack
- Introduction to Databases
- Global Communities of Practice Module
- Health Information Exchange: Clinical Document Architecture Module
- Patient Portals
- Big Data: The Four V's
- Usability of Electronic Health Records Module
- Intro to Natural Language Processing (NLP)

Clinical Work

Fellows typically work in their home clinical department and are jointly onboarded through their home department and the Division of Clinical Informatics, which is part of the Department of Medicine at Beth Israel Deaconess Medical Center. The particular amount of clinical time depends on the clinical duties. As an example, a hospitalist may work 60–70 clinical shifts over the course of a year.

Patient care, when in service, takes priority over everything else in order to provide outstanding clinical care to all patients. It is the expectation that fellows will continue to work, on average, 40 hours per week doing informatics work as part of the fellowship program.

Fellows working clinically are required, like any other fellows, to abide by program policies and ACGME duty hours.

Optional: Obtaining a master's degree

Fellows have the option to obtain a Masters in Biomedical Informatics (MMSc-BMI) offered through the Department of Biomedical Informatics (DBMI) at Harvard Medical School (HMS). The master’s degree consists of course work plus a thesis. The cost of the master’s degree is paid out of pocket by the student or may be covered by a grant. If a student wishes to obtain a master's degree in addition to the fellowship training, United States citizens and permanent residents can apply for stipends, tuition, and travel funds, typically for two- to three-year periods. The Harvard Medical School Department of Biomedical Informatics (DBMI) is in charge of managing a training grant from the National Library of Medicine (NIH) that supports these funded positions. Fellows can also work clinically in their specialty in collaboration with the clinical department.

Application

All physicians who have successfully completed any ACGME-accredited residency, or a Royal College of Physicians and Surgeons of Canada (RCPSC)-accredited, or College of Family Physicians of Canada (CFPC)-accredited residency program located in Canada, are eligible to enroll in any ACGME-accredited clinical informatics fellowship program.

Per ACGME, fellowship duration is must be 24 months in length. Fellows must complete the program within 48 months of matriculation.

Application process:

September: Applicants apply via ERAS (ACGME ID: 1392414001)
October – November: Applicants are interviewed
November – early December: Applicant enrolls in the match, sponsored by AMIA.
December – Match results

Application - Integrated Training Experience (ITE)

The Integrated Training Experience (ITE) is a two-year track open to (non-pathology) fellows who are currently in another fellowship at Beth Israel Deaconess Medical Center that includes at least one research year. If accepted into the Clinical Informatics fellowship program, and with approval from the American Board of Preventive Medicine (ABPM) and the other certifying board (if relevant), the fellow will be able to combine one research year from the other fellowship with one of the years of a Clinical Informatics fellowship.