10 Essential Clinical Informatics Skills*

There is a pressing need to educate health care workers in the basic skills needed to operate the computer tools they will encounter in the workplace. However, simply teaching practising clinicians to use IT is not enough. Just as the ability to suture does not make one a surgeon, the ability to surf the Web does not imply that one understands the principled use of information. Having basic computer skills is not the same as being skilled in the management of information, which is fundamental to good medical practice¹.

Every clinician needs to understand the principles of data interpretation, the logical foundations of the diagnostic process, and the management of uncertainty in clinical knowledge.² They need to know that the problem-oriented medical record is just an information instrument, to know when it is appropriate and when other formulations might be better choices. The dynamics of communicating with patients and with colleagues are altered when the exchange moves from a face-to-face interaction to the telephone, e-mail, voicemail or video.³ For the health care worker understanding the implications of using one medium rather than another is central to developing effective communication skills.

These disparate elements of informatics were once taught piecemeal, there is now a growing consensus about the essential information skills needed by clinicians and medical informatics is appearing in more curricula as a distinct subject.⁴ A proposal for 10 essential clinical informatics skills is provided below to give flesh to these ideas and to stimulate debate about the role of informatics in medical education.

Clinicians should be able to:

• Understand the dynamic and uncertain nature of medical knowledge and know how to keep personal knowledge and skills up-to-date
• Search for and assess knowledge according to the statistical basis of scientific evidence
• Understand some of the logical and statistical models of the diagnostic process
• Interpret uncertain clinical data and deal with artefact and error
• Analyse and structure clinical decisions in terms of risks and benefits
• Adapt and apply clinical knowledge to the individual circumstances of patients
• Access, assess, select and apply a treatment guideline; adapt it to local circumstances; and communicate and record variations in treatment plan and outcome
• Structure and record clinical data in a form appropriate for the immediate clinical task, for communication with colleagues, or for epidemiological purposes
• Select and utilize the most appropriate communication method for a given task (eg, face-to-face conversation, telephone, e-mail, video, voice-mail, letter)
• Structure and communicate messages in a manner most suited to the recipient, task and chosen communication medium.

The computer, the telephone, the Web, video -- these, and all that is still to come, are unquestionably powerful tools. Used badly, they waste time and money, and dehumanise our interactions with each other. Used well, guided by a clear understanding of basic informatics principles, they are neither to be feared, loved nor loathed. They are simply to be used. In the next century, the study of informatics will become as fundamental to the practice of medicine as anatomy has been to the last.  

* This paper is based upon: E. Coiera, Medical informatics meets medical education: There's more to understanding information than technology, Medical Journal of Australia 1998; 168: 319-320

Complete address of author:

Enrico Coiera MB BS PhD
Professor, Faculty of Medicine,
Adjunct Professor School of Computer Science and Engineering
University of New South Wales
Sydney NSW 2052
Australia
ewc@pobox.com

Ó 1999 Dean F. Sittig

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