How are you a Clinical Informaticist Without an RN or MD?

Clinical Informaticist: When I announce my title at meetings or introduce my role at conferences, it is automatically assumed that I hold an RN or an MD. While this is true for a large percentage of Clinical Informaticists, particularly in the Applied Informatics Focus*, I am the exception. I appreciate that the competency with which I have executed my job in informatics over the past 6 years allows multitudes of coworkers and peers to make this assumption. Faces often belay shock, almost without exception, when I note that my “background” is as a Clinical Informaticist, with a stop as a first responder, not as a MD or RN**. I am often asked, how I still excel at my role without an RN or an MD and wanted to take a moment to speak to that. The goal of this post is to open the minds of institutions that only hire those licenses into informatics positions. I am not here to undermine the value of an RN or MD, all my team-mates possess them and they are a wonderful asset allowing for a shared understanding and a short ramp up time. However, I would like to make the case for expectations, when a candidate comes along with a passion for informatics that doesn’t hold these licenses: Like Me.

I have spent a lot of time ruminating on how I can thrive as a Clinical Informaticist without a career as a Nurse or Physician first. The answer is many things, from an open minded boss, an engaging team and a outgoing personality. Below I have broken down 5 specific ways that I have been able to succeed in my role, without the common background of a medical education.

  1. Embedding — This is the number one reason I have been able to obtain a solid clinical baseline and succeed as a CI. When I first joined the CI team, my boss and I brainstormed the best way for me to quickly gain clinical knowledge as well as understand how clinicians interact with technology. We landed on the idea of embedding me with a residency team. For three months I rounded as part of the team, I watched the new physicians interact with the tools and payed attention to the clinical questions they were asking (and how tech might impact those questions and processes). Since it was a teaching environment, it was welcome when I asked questions and the new residents were more than happy to explain further. The value of this time made a lasting impression on me and I rolled embedding into future large projects that I implemented. For example when I brought the Surgeons live on the electronic Health Record, I worked out of their lounge for many months, allowing them to ask questions of me, and me to see where their challenges were. Trust was built through me constantly being around and scrubbing into cases, this allowed us to speak more frankly to quickly overcome barriers and for me to really understand the ins and outs of their workflow. My key take away from embedding, was the process verbalized is often different then the process performed, shadowing is the best way to get to the bottom of a challenge and build the trust needed to overcome it. I think because I came into CI without being a clinician I was more insistent on the need to embed, which has payed off ten fold.
  2. Teaching — One of the biggest hurdles for me not having a clinical background, was encountered during my weekly physician onboarding classes. Each week, I would get questions such as “How do I order Sliding Scale Insulin?” or “How do I order controlled medications for prescriptions?”. Week one: I didn’t know what Sliding Scale Insulin was, or what medications fell in the controlled substance category. However I always took the physicians email addresses, went home and researched, asked my residents and followed up. I learned enormous amounts from those classes and soon was able to speak to complex workflows when onboarding the residents and new physicians. I never felt that I was letting the physicians down while I was still learning, as I had a robust follow-up loop, and they received in-depth explanations (often with screen-shots and steps) once I had determined the answer. Onboarding all the specialities has allowed me to have a very broad knowledge of service line nuances and quirks. Teaching these workflow and how technology interact with them has required me to know them more in-depth than any other project could.
  3. Not Assuming I Know — This point is two-fold. The first, since I am not an RN or an MD, I never automatically assume that I know, the process or the problem. I feel empowered to ask in depth questions, to explore further discussion when diving to the root of a problem and to follow-up with findings or inquiries as the project progresses. On the other side of things, I often am offered more in-depth explanations or multiple descriptions of the problem, simply due to the fact I don’t have an RN or and MD following my name. Processes and difficulties often do not align across hospitals systems or even clinical service lines, so beginning with a open mind and a questioning attitude has really allowed me to highlight pieces that may have derailed a project later on. This default mindset began with the fact that hospitals were a new place for me, but has held up throughout my career and has really served me well.
  4. Life-long Learner — This is more of a personality trait, however I believe that if you do hire a CI without an RN or an MD, this is a very important asset. Curiosity is a huge part of who I am, It is one of my strengths on Strength-Finder and one of my core values. I enjoy digging until I understand something, and I am a voracious reader. For example, when I was first onboarding as a CI, my manager offered me her nursing textbooks. I think in her mind she meant for reference, however I read them cover to cover. I regularly read blogs, Informatics Journals and the Journal related to my current project, the goal is that I can speak at a high level to things that are important to the clinicians I work with. When I am unsure of something, I never hesitate to ask for more information or to research it when I get home. This intrinsic drive has really allowed me to feel comfortable working with all types of clinicians and to embark on many of the projects I am doing now that have little to no precedent.
  5. Admitting When I don’t Know and Finding the Expert — As I have mentioned, I have no barriers to admitting I don’t know, or that we are probably no doing something in the most efficient way. Once I have recognized that there is an opportunity to improve, I being discovery. Having onboarded so many of the physicians, I begin reaching out the the experts in their fields to see if they have come across the problem we are currently having. I also am lucky enough to have an extended virtual network through my professional homes of AMIA, HIMSS and Twitter, that I use often. I never hesitate to ping a colleague in another system to see how they handled governance or reach out to a speaker who gave a talk on just the solution I am looking for. My love of connecting with people has really allowed me to take a step back when it looks like we are reinventing the wheel or running into walls, and to ask for help. I also take the time to share learnings with those who ask me, so that things we have done well in my system can perpetuate.

While there are many other factors that contribute to my success as a CI without a clinical background, I think the five above are the most concrete and definable. If I had to add a bonus sixth, I would probably say my upbringing as a military kid. This has allowed me to be extremely comfortable in unknown situations, to enjoy digging into projects with many different people of all different job titles and to be happy engaging a multitude of personalities. I also cannot be thankful enough for my team, all of whom ARE RNs and MDs (and a PharmD), who have always been more than happy to explain things I didn’t understand yet.

While I do believe that having an MD or an RN will make a transition into Applied Clinical Informatics easier, I think it is important for hospitals systems to leave them as a “Nice to have” rather than a “required” when hiring. I am lucky that a CI manager took a change on me and hired me anyway when a system was looking for an RN, and I view it as my duty to advocate for those like me that I have come before. My true calling is Informatics, and I am excited to go into work everyday with the goal of helping technology and clinical process work together in the most seamless way.

If you have any questions about this viewpoint, or you are a hiring manager wondering about something, please do not hesitate to contact me. I would love to discuss with you how to help your team thrive! Many of the points listed above can be beneficial to those with clinical backgrounds as well and I would love to hear any additions you might have.

*Research Informatics often have a PhD, but that is true of most research disciplines, my perspective is more on the Applied Side.

** I also have team-members with PharmDs and RTs, but stuck with RN/MD for this pieces as those are the licenses I often see as the requirement for Clinical Informatics jobs in systems similar to mine.