By Neil Versel, contributing editor

November 11, 2008 | WASHINGTON—The American Medical Informatics Association (AMIA) is turning its attention to medical specialty boards in its bid for recognition of clinical informatics as a distinct medical subspecialty, following the approval of detailed plans for physician informatician training and competency.

AMIA board members signed off on two documents, “Core Content for the Subspecialty of Clinical Informatics” and “Training Requirements for the Subspecialty of Clinical Informatics,” late Saturday. Some of the authors discussed the requirements and their strategy here Monday at the organization’s annual meeting.

“I think this is a landscape-changing event for the field of informatics,” says past AMIA board chairman Charles Safran, clinical informatics chief at Beth Israel Deaconess Medical Center in Boston. If AMIA is successful, U.S. physicians would be able to earn true board certification in clinical informatics, on equal footing as radiation oncology, pediatric cardiology, critical care medicine, or any other subspecialty.

“This could be the first subspecialty in medicine that cuts across all 24 [specialty] boards,” says Benson Munger, associate director of the Arizona Emergency Medicine Research Center (Tucson).

But first, AMIA must sell its plan to the American Board of Medical Specialties (ABMS), the Accreditation Council for Graduate Medical Education (ACGME), and individual medical specialty boards.

A timeline shown Monday assumes AMIA will find a sponsoring specialty board early in 2009 and apply for ABMS subcertification by next summer, in time for the ABMS to go through the first of two required readings in September. On this schedule, the earliest ABMS could approve the application is March 2010. Following ABMS subcertification, AMIA would then bring its proposed training program to ACGME no earlier than the second half of 2010 for possible approval in early 2011.

The best-case scenario, according to Munger, would be for subcertification training to begin at accredited medical schools and residency and internship programs by the fall of 2011.

Meanwhile, once ABMS has the application, AMIA would begin developing the subcertification exam for physicians who have completed their medical training. The test could be offered as soon as the board of medical specialties approves the subspecialty.

The AMIA documents, developed with a $300,000 grant from the Robert Wood Johnson Foundation, (see “AMIA to Develop Clinical Informatics as Certifiable Specialty”), says clinical informatics is at the nexus of clinical care, the business processes of health care, and information technology. Clinical informaticians—AMIA’s preferred term—must master a wide range of disciplines, including medical knowledge; informatics; the health care “environment” of delivery systems and data flow; how health-IT affects clinical decision-making, users, and patients; process re-engineering; systems implementation; clinician adoption of IT; and organizational leadership, according to the core content.

“We need to lead and manage change. We need to be there in the clinical environment,” AMIA president and chief executive Don Detmer says.

On the training side, AMIA proposes a two-year fellowship program that must be completed within a four-year span, and any accredited clinical informatics program should have full institutional support. There also is a rotation requirement, to account for at least 15 percent of the training period. Rotations might include shadowing a nursing team, working in a records room, or helping in an IT department.

“I think we’ll need clinical sites to provide the training. We can’t do it in the back room,” says Reed Gardner, retired medical informatics chairman at the University of Utah, who chaired the team that developed the core content.

As with new subspecialties, Munger says there would be a clinical informatics practice track during the first five to seven years after approval for those physicians who did not have access to an accredited training program.