Dr. Natalie Pageler is a pediatric critical care doctor who shifted her focus to clinical informatics. Natalie now has a much broader reach as a physician as she gets to help more physicians do their job in helping patients get better. Let’s talk about this newer specialty!
If you would like to know more about Clinical Informatics, check out the American Medical Informatics Association. For more podcast resources to help you with your medical school journey and beyond, check out Meded Media.
Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.
[01:17] Interest in Clinical Informatics
Natalie did an undergrad degree in Engineering Physics, so she had that science and engineering background. But clinical informatics wasn’t even a thing back then.
Then when she was doing her fellowship in pediatric critical care, she got introduced to some informatics work from their chief medical information officer. She ended up doing a master’s degree in Medical Education, focusing on clinical decision support in the computer systems as a form of just-in-time education.
She got introduced to clinical informatics during her pediatric intensive care fellowship and ended up doing a master’s in medical education. She was interested in the systemic nature of clinical informatics. At the pediatric critical care level, she was taking care of patients one at a time. She loved the connection with the patients and the families. But she would often see bigger systemic issues.
And so, she wanted to address that larger systemic level to affect multiple patients at one time. Then she realized that one of the ways that could help support that change was through information systems.
When she graduated from fellowship, she took over the clinical decision support subcommittee. Shortly thereafter, their hospital decided to switch vendors for their EHR. They had a huge implementation project to put in their new EHR, which helped her get fully immersed in clinical informatics. At the same time, clinical informatics became a board-certified specialty, which she sat ofor.
[04:18] The Frustrations Around the EHR System
Natalie says that when they started implementing EHRs, everybody was so excited about the potential standardized practice to eliminate errors. And yet, there were so many changes and so many unintended consequences. The systems were just not developed or designed as well as they could be and it generated a lot of frustration.
This is the reason they need more physicians to get involved in this field so they can develop systems into what they should be.
Natalie defines applied clinical informatics as the implementation, optimization, and critical evaluation of our health information systems and communication systems. And the goal is to improve patient safety, quality of care, and ultimately, patient outcomes.'We need people who are well immersed and trained in clinical medicine and in the informatics side, and to eally design these systems in the way that they they should be.”Click To Tweet
[07:20] Traits that Lead to Being a Good Clinical Informaticist
Natalie says Clinical Informatics is a very complicated field. An affinity for computers and science help, but there is so much more to it. And we need leaders who will become experts in implementation science and change management. They need to understand processes, usability, and people computer interface.'Informatics is – people, process, and technology. And the people part of it is by far the largest part of that.'Click To Tweet
You have to like thinking at a systemic level and like creating and facilitating large, systemic procedural, or process changes. You have to be focused on improving the quality of healthcare delivery and the safeguards for ensuring patient safety. You have to think about improving efficiency and experience, and having those as your drivers.
[09:10] Percentage of Clinical Work as a Clinical Informaticist'The clinical informaticist is a new breed a physician leader that will continue to grow in scope and in popularity.'Click To Tweet
Natalie explains there’s a wide range of different careers in clinical informatics. There are some people who have given up clinical practice altogether and are focused completely on their clinical informatics career. There are those doing mostly clinical time with just a little bit of informatics time.
Natalie thinks it’s great to have a combination of both early on in your career. Going over to the systemic level and being able to affect change for multiple patients and families can be a nice break from patient care, which can sometimes be exhausting.
Additionally, both sides feed each other. It gives you credibility in a leadership role when you’re using these systems on the clinical side. And on the clinical side, you can see so many opportunities to fix the systems.
[11:55] The Training Path
With the first fellowship that started in 2014, there are now 51 fellowships across the nation. After medical school and your clinical residency in any field, you can do a two-year clinical informatics fellowship.'Anybody who was board eligible in any clinical specialty can go into this two-year clinical informatics fellowship.'Click To Tweet
The clinical informatics fellowship is focused on the leadership development, the acquisition of knowledge around our information systems, and applied operational clinical informatics projects. All that while still maintaining 20% clinical time so you can maintain your clinical skills.
[13:24] Taking Calls
If you’re a chief medical information officer, you are probably going to be up on those weekends when you’re upgrading your entire EHR. Or if something suddenly goes down, you are definitely going to be called if it’s impacting clinical care.
There are times when Natalie is out rounding at three in the morning because of some big change in their system. And she’s trying to support end-users and support the team. But it is definitely not the frequent all-night ICU call that other do. So it’s usually a much better lifestyle from that perspective.
[14:38] Message to Future Physicians'Some core clinical informatics principles will become more and more a part of medical education.'Click To Tweet
Natalie encourages everybody to do a clinical informatics rotation if you can during residency. That way, you will understand more about the systems that are supporting you.
She adds it’s important to realize that this exists as a field. There are people that are getting formal training in how to develop and optimize our information systems and our communication systems.
Therefore, make sure that you know who your local clinical informaticist are. Understand there are some basics of decision support, electronic order sets of unintended consequences, and automation bias. Natalie believes it’s important for the everyday practitioner to understand so that they’re using their systems correctly.
Natalie highly recommends doing a rotation and engaging in some core clinical informatics training as part of your med school or residency. And so, at least you have that basic understanding of how our systems are designed and how they work.
There are a variety of ways to get involved. First off, check out the American Medical Informatics Association. It’s a great way to start learning about the field and learning about some of the great work that’s going on.
Get some exposure to computer programming and statistics. Get involved in quality improvement and process improvement. There’s a lot of formal training in those areas today and there’s a lot of overlap between clinical informatics and those fields.
[18:24] What She Wished She Knew Before Getting Into This Field
Natalie says she wished she knew the field existed. The fact that the field now has a formalized training path is amazing. And so, she’s urging people to share this information so medical students and residents know about the field early. That way, they can explore and decide if this is the right field for them.
Just seeing how much of a wide range of different areas their fellows get exposed to, and how much knowledge they acquire in the two years is amazing. Natalie learned a lot of it through experience as she had to learn things the hard way.'Explore early and decide if this is the right training path for you.'Click To Tweet
[19:39] The Most and Least Liked Things
Natalie likes the fact that they’re able to make a big systemic change. Whether that’s improving something for patients or for providers or making their day better. Either way, it’s a great feeling of accomplishment.
Natalie prides on how her team has been doing a ton of work around adolescents. They share information appropriately with adolescents and their families and ensure adolescent confidentiality in the patient portal. It’s a very niche area that is hugely important for those populations.
She also loves the team aspect of informatics since you are constantly working in a collaborative team.
On the flip side, what she likes the least are the long hours and long days of meetings. There will be days where she has to do 12 hours or so of meetings.
[21:44] Final Words of Wisdom'Health care is changing dramatically and our health information systems are going to continue to play a larger and larger role in how we effectively and meaningfully deliver care.'Click To Tweet
Natalie urges students to understand the basics of this field and understand how this field and its specialist will continue to affect healthcare delivery in the future.
Consider whether or not this is the right field for you and reach out to other other folks in the field to learn more and to get some experiences. So you can decide whether you want to pursue this as a career.