https://orcid.org/0000-0002-6189-463X
Abstract
This article reports on the alignment between the foundational domains and the delineation of practice (DoP) for health informatics, both developed by the American Medical Informatics Association (AMIA). Whereas the foundational domains guide graduate-level curriculum development and accreditation assessment, providing an educational pathway to the minimum competencies needed as a health informatician, the DoP defines the domains, tasks, knowledge, and skills that a professional needs to competently perform in the discipline of health informatics. The purpose of this article is to determine whether the foundational domains need modification to better reflect applied practice.
Using an iterative process and through individual and collective approaches, the foundational domains and the DoP statements were analyzed for alignment and eventual harmonization. Tables and Sankey plot diagrams were used to detail and illustrate the resulting alignment.
We were able to map all the individual DoP knowledge statements and tasks to the AMIA foundational domains, but the statements within a single DoP domain did not all map to the same foundational domain. Even though the AMIA foundational domains and DoP domains are not in perfect alignment, the DoP provides good examples of specific health informatics competencies for most of the foundational domains. There are, however, limited DoP knowledge statements and tasks mapping to foundational domain 6—Social and Behavioral Aspects of Health.
Both the foundational domains and the DoP were developed independently, several years apart, and for different purposes. The mapping analyses reveal similarities and differences between the practice experience and the curricular needs of health informaticians.
The overall alignment of both domains may be explained by the fact that both describe the current and/or future health informatics professional. One can think of the foundational domains as representing the broad foci for educational programs for health informaticians and, hence, they are appropriately the focus of organizations that accredit these programs.
INTRODUCTION
In 2018, the American Medical Informatics Association (AMIA) Accreditation Committee (AAC) published an AMIA Board White Paper that presented foundational domains with competency exemplars for curriculum development and accreditation assessment of applied health informatics education at the master’s degree level.1 This paper was part of a joint effort by AMIA and the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM) to move from a content-based accreditation model to a competency-based model. The white paper defined the 10 foundational domains with measurable examples of knowledge, skills, and attitudes for each of those foundational domains. The CAHIIM Health Informatics Accreditation Council (HIAC) used the AAC competency framework to revise the CAHIIM 2010 Standards and Interpretations for Accreditation of Master’s Degree Programs in Health Informatics. The competency-based standards were approved by the CAHIIM Board in June 2017 and updated in 2021 (www.cahiim.org). Programs seeking new accreditation are required to meet the new standards; previously accredited programs were given until January 1, 2021, to comply.
In 2020, AMIA published the results of a formal practice analysis of applied health informatics professionals–a process that started in 2013.2 The resulting delineation of practice (DoP) defines the domains, tasks, knowledge, and skills that a professional needs to perform competently in the discipline of health informatics. The DoP is used by the AMIA Health Informatics Certification Commission (HICC), formed in late 2019, as the basis for its certification exam (https://amia.org/careers-certifications/amia-health-informatics-certification-ahic).
Most professions have close correspondence between the criteria for accreditation of educational programs and the competencies that are tested on a certification exam. In the 2020 DoP paper, AMIA acknowledged the importance of harmonizing the AMIA foundational domains and the DoP.2 To determine the extent of the harmonization or alignment, the AAC undertook the task of systematically mapping the DoP knowledge and tasks to the AMIA foundational domains based on semantic similarity. The objectives were to determine how well the 2 aligned, whether either one was missing 1 or more components from the other, and whether emphases differed across the 2 and to seek initial data to determine whether the foundational domains need modification to better reflect applied practice. This article describes the results of that effort.
METHODS
Description of the foundational domains and the DoP
The foundational domains developed by Valenta et al1 consist of 10 domains as shown in Figure 1. The Venn diagram in Figure 1 shows 3 knowledge domains: F1—Health Sciences, F2—Information Sciences, and F3—Social and Behavioral Sciences. An additional 4 domains as illustrated in the diagram consist of various combinations of the 3 knowledge domains and include knowledge, skills, and attitudes. These domains are as follows: F4—Health Information Technology; F5—Human Factors and Sociotechnical Systems; F6—Social and Behavioral Aspects of Health; and F7—Social, Behavioral and Information Science and Technology applied to Health. The remaining 3 domains (F8—Professionalism; F9—Interprofessional Collaboration and F10—Leadership) span across all domains as shown in Figure 1.
AMIA foundational domains.1
The DoP assessed by Gadd et al2 included 5 domains. The first domain, Foundational Knowledge, only included knowledge statements, but the others included knowledge and task statements. In all, there were 144 knowledge statements and 74 tasks across the 5 domains. Table 1 shows the 5 domains and sample knowledge and task statements.
Domains of practice
| DoP domain | Sample knowledge statement | Sample task statement |
|---|---|---|
| Foundational knowledge | Fundamental informatics concepts, models, and theories | N/A |
| Enhancing health decision-making, processes, and outcomes | Clinical decision support principles and practices | Develop, implement, monitor, and maintain clinical decision support systems |
| Health information systems | Information system implementation procedures | Plan and participate in HIS implementation |
| Data governance, management, and analytics | Artificial intelligence (machine learning, NLP, image recognition) | Employ and deploy advanced and emerging data mining and analytic techniques |
| Leadership, professionalism, strategy, and transformation | Leadership principles, models, and methods | Build support and create alignment for informatics best practices |
| DoP domain | Sample knowledge statement | Sample task statement |
|---|---|---|
| Foundational knowledge | Fundamental informatics concepts, models, and theories | N/A |
| Enhancing health decision-making, processes, and outcomes | Clinical decision support principles and practices | Develop, implement, monitor, and maintain clinical decision support systems |
| Health information systems | Information system implementation procedures | Plan and participate in HIS implementation |
| Data governance, management, and analytics | Artificial intelligence (machine learning, NLP, image recognition) | Employ and deploy advanced and emerging data mining and analytic techniques |
| Leadership, professionalism, strategy, and transformation | Leadership principles, models, and methods | Build support and create alignment for informatics best practices |
Domains of practice
| DoP domain | Sample knowledge statement | Sample task statement |
|---|---|---|
| Foundational knowledge | Fundamental informatics concepts, models, and theories | N/A |
| Enhancing health decision-making, processes, and outcomes | Clinical decision support principles and practices | Develop, implement, monitor, and maintain clinical decision support systems |
| Health information systems | Information system implementation procedures | Plan and participate in HIS implementation |
| Data governance, management, and analytics | Artificial intelligence (machine learning, NLP, image recognition) | Employ and deploy advanced and emerging data mining and analytic techniques |
| Leadership, professionalism, strategy, and transformation | Leadership principles, models, and methods | Build support and create alignment for informatics best practices |
| DoP domain | Sample knowledge statement | Sample task statement |
|---|---|---|
| Foundational knowledge | Fundamental informatics concepts, models, and theories | N/A |
| Enhancing health decision-making, processes, and outcomes | Clinical decision support principles and practices | Develop, implement, monitor, and maintain clinical decision support systems |
| Health information systems | Information system implementation procedures | Plan and participate in HIS implementation |
| Data governance, management, and analytics | Artificial intelligence (machine learning, NLP, image recognition) | Employ and deploy advanced and emerging data mining and analytic techniques |
| Leadership, professionalism, strategy, and transformation | Leadership principles, models, and methods | Build support and create alignment for informatics best practices |
Mapping between the foundational domains and the domains of practice
AAC committee members (listed as authors) conducted the mapping from February 2021 to October 2021 through weekly teleconference meetings. The committee used an iterative process to map the DoP knowledge and task statements to the AMIA foundational domains. Initially, committee members independently mapped the DoP statements to the AMIA foundational domains using the descriptions of the AMIA foundational domains from the paper by Valenta et al1 along with whatever criteria members felt best captured the alignment between a DoP statement and a particular foundational domain. The committee then collectively reviewed the individual mappings by sequentially considering each DoP statement and the members’ individual mapping. During this process, the committee developed 4 guiding principles to ensure consistency: (1) map each DoP Knowledge Statement to 1 and only 1 AMIA foundational domain; (2) for DoP statements that mention more than 1 foundational domain, use the domain at the intersection of the individual domains in Figure 1 to select the AMIA domain that best captures the multiple domains; (3) map DoP statements that mention more than 1 domain to the highest or most inclusive domain; and (4) map statements that do not specifically mention health concepts or skills to F2 (Information Science and Technology) or F3 (Social and Behavioral Science), or their intersection, F5 (Human Factors and Sociotechnical systems). Supplementary Appendix SA shows examples of the mapping and the rationale for the mapping decisions.
After developing the guidelines, the committee used them to review each DoP knowledge or task statement and, by consensus, mapped each statement to an AMIA foundational domain. This was followed by a discussion and cross-checks with previously mapped statements to check consistency. After mapping all the statements, the committee did a final consistency check by grouping the DoP statements by the AMIA foundational domain to which they were mapped. This grouping allowed the committee to review all the DoP statements that were mapped to a single AMIA foundational domain to ensure that all statements were conceptually consistent with that domain and the mapping guidelines. After reviewing the grouped statements, the committee identified a small number of inconsistently mapped statements that were corrected by consensus.
RESULTS
Figure 2 shows the number of DoP knowledge and task statements mapped to each AMIA domain. The light gray portion of each bar shows the number of knowledge statements whereas the dark gray shows the number of task statements. Based on Figure 2, it appears that the foundational domains are unevenly represented in the DoP. As an example, of the 3 foundational domains—F1—Health, F2—Information Science and Technology, and F3—Social and Behavioral Science—there is much more emphasis on F2—Information Science and Technology. This apparent lack of balance, however, is a result of mapping DoP statements that address 2 or more of the foundational domains to the intersection of those domains. Figure 3 addresses this issue by showing how the DoP statements map to the 3 overlapping circles in the Venn diagram of the foundational domains in Figure 1. In Figure 3, the bar for F1—Health includes all statements mapped to F1—Health, F4—Health Information Science and Technology, F6—Social and Behavioral Aspects of Health, and F7—Social, Behavioral and Information Science and Technology Applied to Health, because all those domains include knowledge or task statements involving health. Figure 3 shows that the DoP includes many statements involving health and social science knowledge and tasks, although information technology (IT) still dominates. Note that the bars in Figure 3 are not mutually exclusive; for example, all statements mapped to F7—Social, Behavioral and Information Science and Technology Applied to Health include health, IT, and social science tasks or knowledge so they are included in all 3 bars on the graph.
Distribution of DoP knowledge and task statements by AMIA domain.
Distribution of DoP knowledge and task statements by health, IT, and social domains. The thin white vertical lines separating bars of the same color split each bar into knowledge (the leftmost part of each bar) and task statements.
The Sankey plot in Figure 4 provides a more detailed view of the mapping, showing the distribution and flow of statements across the DoP and the AMIA foundational domains. This plot illustrates that the DoP domains and the AMIA foundational domains do not perfectly align, conceptually. Because there were 10 domains in the foundational domains and only 5 domains in the DoP, it would be expected that the DoP may be broader and include concepts from more than 1 AMIA domain. We found that although the knowledge statements and tasks within a given DoP domain map to 1 AMIA foundational domain, they do not all map to the same AMIA domain. The DoP domains and the AMIA foundational domains in the Sankey plot are sorted from high to low based on the number of DoP statements in the mapping with the vertical extent of each rectangle coding the number of statements. Here, we can see that nearly 50% of the DoP statements were mapped to F2–Information Science and Technology and F4–Health Information Science and Technology.
Sankey plot of the mapping showing the distribution and flow of statements between the DoP and the AMIA domains.
The committee also developed an interactive Tableau® dashboard3 with 2 tabs that contain versions of Figures 2–4 that permit the viewer to highlight and filter statements based on the DoP and AMIA domains. Screenshots are given in Supplementary Appendix SB.
DISCUSSION
The results show that although they are organized differently, the knowledge statements and tasks in the DoP can be aligned to the AMIA foundational domains. In fact, the DoP knowledge and task statements provide good examples of the specific competencies that fall within the framework of the AMIA foundational domains. Course objectives and related student assessments that are based on the DoP knowledge statements and tasks can be mapped to the AMIA foundational domains and justified by the practice analysis. As an example, within any given foundational domain, using the DoP knowledge statements and tasks, 1 or more competency-driven course objectives can be developed, including Bloom’s taxonomy and the level of competency in the Miller Pyramid as adapted for HI.4,5 We provide an example of this in Supplementary Appendix SC: DoP and Learning Objective Pairs. This is consistent with the work of Gadd et al2 showing that the DoP knowledge and task statements are in harmony with the training provided in graduate health informatics programs.
The mapping analyses reveal similarities and differences between curricular needs and the practice experience of health informaticians. This finding is expected as both projects were developed independently and with a different intent. The foundational domains are intended for curriculum development and accreditation assessment; they provide an educational pathway to the minimum competencies needed as a health informatician and were intended to provide a framework for the delineation of HI competencies in education, training, and practice respecting the diversity of perspectives among the sub-disciplines in the field of HI.1 The DoP was based on a survey of employees in the health informatics practice field that was designed to describe the practice of “health informatics professionals.” The results of this survey formed the basis for AMIA’s Health Informatics certification examination.2 Together, these provide a data-driven guideline for future certification, educational and training programs, job descriptions, and possible career paths.
Independent of the number of domains in the DoP knowledge statements and tasks and AMIA foundational domains, there is a fundamental agreement that health informatics lies at the intersection of health, technology, and social sciences, which allowed mapping all DoP knowledge statements and tasks to the AMIA foundational domains. While there is comprehensive coverage of the professional skills and knowledge within foundational domains 8—Professionalism, 9—Interprofessional Collaborative Practice, and 10—Leadership, and the DoP domain 5—Leadership, Professionalism, Strategy, and Transformation, the emphases for the practice and educational sectors is different. Within the DoP, there is an emphasis on health information systems use, leadership, governance, and the application of health informatics concepts in practice, whereas the AMIA foundational domains describe the “minimum” knowledge, skills, and attitudes a health informatics program—independent of its focus—must cover in training future health informatics professionals. Noticeably, there is a paucity of DoP knowledge statements and tasks linking to foundational domain F6—Social and Behavioral Aspects of Health. The importance of this foundation is often ignored—even in HI curricula—despite known associations between social and behavioral determinants and health outcomes. In addition, social and behavioral aspects of health are rarely investigated as part of interventions (informatics or other types) to improve patient outcomes.6
CONCLUSION
The alignment of the DoP knowledge statements and tasks with the AMIA foundational domains may be explained by the fact that both describe the current and/or future health informatics professional. One can think of the foundational domains as representing the broad foci for educational programs for health informaticians and, hence, they are appropriately the focus of organizations that accredit health informatics educational programs. Similarly, certification examinations for informatics professionals should reflect the knowledge and tasks that a praticing informatician knows and does. By mapping the knowledge and task statements from the DoP to the AMIA foundational domains, we have shown a way to harmonize these 2 frameworks.
FUNDING
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
AUTHOR CONTRIBUTIONS
All authors contributed to the mapping, approval of the final results and the final manuscript. Further, TRJ coordinated the mapping, drafted the manuscript, and created the Tableau visualizations; SSF contributed to the visualizations; ESB, ALV, JJ, and SSF contributed to the initial draft and critically reviewed and edited the manuscript.
SUPPLEMENTARY MATERIAL
Supplementary material is available at Journal of the American Medical Informatics Association online.
ACKNOWLEDGMENTS
The authors would like to thank Nancy Roderer for early contributions to this work and comments on the draft paper, along with Jeff Williamson for helping to guide the early work of the committee and providing support and guidance from AMIA throughout the committee’s work. Damian Borbolla currently serves as Health Informatics Director at Wolters Kluwer Health. At the time of his involvement in this article, he held a Primary Faculty position at the Department of Biomedical Informatics at the University of Utah where he maintains an adjunct faculty appointment.
CONFLICT OF INTEREST STATEMENT
None declared.
DATA AVAILABILITY
The data underlying this article, along with all visualizations and dashboards generated from the data are available in its online supplementary material as a Tableau Packaged Workbook. This is an XML format that contains all of the data and interactive visualizations. Any current version of Tableau, including the free Tableau Public7, can open and display the visualizations and underlying data.
