Journal:Development of a core competency framework for clinical informatics

Full article title	Development of a core competency framework for clinical informatics
Journal	BMJ Health & Care Informatics
Author(s)	Davies, Alan; Mueller, Julia; Hassey, Alan; Moulton, Georgina
Author affiliation(s)	University of Manchester, University of Cambridge, The Faculty of Clinical Informatics, Health Data Research UK
Primary contact	alan dot davies at ucl dot ac dot uk
Year published	2021
Volume and issue	28(1)
Article #	e100356
DOI	10.1136/bmjhci-2021-100356
ISSN	2632-1009
Distribution license	Creative Commons Attribution-NonCommercial 4.0 International
Website	https://informatics.bmj.com/content/28/1/e100356
Download	https://informatics.bmj.com/content/bmjhci/28/1/e100356.full.pdf (PDF)

Abstract

Objectives: Up to this point, there has not been a national core competency framework for clinical informatics in the U.K. Here we report on the final two iterations of work carried out towards the formation of a national core competency framework. This follows an initial systematic literature review of existing skills and competencies and a job listing analysis.

Methods: An iterative approach was applied to framework development. Using a mixed-methods design, we carried out semi-structured interviews with participants involved in informatics (n = 15). The framework was updated based on the interview findings and was subsequently distributed as part of a bespoke online digital survey for wider participation (n = 87). The final version of the framework is based on the findings of the survey.

Results: Over 102 people reviewed the framework as part of the interview or survey process. This led to a final core competency framework containing six primary domains with 36 subdomains containing 111 individual competencies.

Conclusions: An iterative mixed-methods approach for competency development involving the target community was appropriate for development of the competency framework. There is some contention around the depth of technical competencies required. Care is also needed to avoid professional burnout, as clinicians and healthcare practitioners already have clinical competencies to maintain. Therefore, how the framework is applied in practice and how practitioners meet the competencies requires careful consideration.

Introduction

The healthcare sector in many countries is facing increasing demand as people live longer and healthier lives. The public’s expectation of healthcare is also increasing and is tempered by various financial constraints. The healthcare sector has lagged behind other sectors regarding its adoption and use of digital technology. In the U.K., the Topol review was carried out to assess how the healthcare workforce can be prepared for the digital future. The review makes many recommendations on the use of genomics technology, robotics, artificial intelligence (AI), and digital medicine, including the training and education of healthcare professionals in such areas. At the cutting edge of this digital upskilling of the workforce are informaticians from clinical, health, and social care disciplines.

The American Medical Informatics Association (AMIA) defines clinical informatics as "the application of informatics and information technology to deliver healthcare services." The U.K. Faculty of Clinical Informatics (FCI) defines a clinical informatician as someone who "uses their clinical knowledge and experience of informatics concepts, methods, and tools to promote patient and population care that is person-centred, ethical, safe, effective, efficient, timely, and equitable."

As of yet there are no U.K.-based overarching competency frameworks aimed at multiple informatics disciplines. Existing frameworks tend to focus on specific domains such as nursing informatics or bioinformatics. The U.K. FCI was created to provide support for clinical informaticians, including those with clinical roles in the health and social care domains applying informatics in practice. It is the intention of the FCI to provide and accredit competencies for informaticians. This includes accreditation of the U.K.’s National Health Service (NHS) Digital Academy program which aims to create digital leaders for the digital transformation of the NHS. The present study forms part of a program commissioned by the FCI to create a national competency framework for clinical informaticians in the U.K.

Competency describes the behaviors, characteristics, skills, attitudes, and knowledge application used to successfully achieve something. Competence therefore is the achievement of a single competency or multiple competencies. A core competency framework describes the essential set of competencies required to achieve competence in a specific area. Many competency frameworks aimed at various clinical informatics disciplines currently exist, such as the ELIXIR (European Life-science Infrastructure for Biological Information) and TIGER (Technology Informatics Guiding Education Reform) frameworks for bioinformaticians and nurses. This paper reports on the methods used to generate and refine the U.K. FCI’s Core Competency Framework (CCF), which covers the core competencies required to develop clinical informaticians’ professional competencies, and to provide a process for the FCI to provide accreditation for training and education programs and individual clinical informaticians.

Background

The Core Competencies Project spanned two primary phases. The first part of the work explored the definition of the professional attributes of a clinical informatician. The FCI carried out the first phase of the work (Figure 1), which consisted of three reports based on (1) discovery, (2) validation, and (3) consultation around the output competences of a clinical informatician. This included defining clinical informatics, clinical informaticians, inclusivity, professional boundaries, and the functional domains (scope) of clinical informatics practice. This work was carried out using qualitative methods (e.g., interviews) with the faculty’s membership. The second phase (reported in this paper) involved an iterative process consisting of three separate iterations. The first iteration involved the combination of findings from both academia and industry in the form of an analysis of over 50 informatics job postings and a systematic literature review which explored the commonality of informatics competencies across different clinical informatics domains (such as medicine, nursing, pharmacy). Following synthesis of this information, an initial draft competency framework was generated, which was then presented to 15 informatics experts in one-to-one semi-structured interviews and adapted following feedback. The amended version was presented for wider evaluation through a digital survey with 87 participants. In light of the survey results, the final version of the competency framework was updated and disseminated publicly on the FCI’s website.

Figure 1. Overview of the core competencies project. The focus of this paper is the reporting of the final two iterations and dissemination from phase 2, as seen in the darker highlighted section.

Notes

This presentation is faithful to the original, with only a few minor changes to presentation. A few grammar and spelling errors were also corrected. In some cases important information was missing from the references, and that information was added.