Ritu Raj Tiwari practically beams when he talks about his job. “This is one of the rare instances when you can actually tell that you are going to make a difference in the world,” he says.
Tiwari is the chief architect at Health Fidelity, one of the many companies now transforming the rapidly growing health informatics industry. Experts say the field is growing so rapidly, and has so much potential, that companies are even having a hard time filling all of the open job positions.
“There’s an explosion of opportunities out there,” says Doug Fridsma, president and CEO of the American Medical Informatics Association.
So what is health informatics? At its most basic, it deals with how we collect, analyze and use health information to improve human health and health care in general. That covers a lot of ground, though. Some companies come at informatics by developing ways to collect data, while others focus on analyzing that information—often terabytes of it at a time—and figuring out how to display it in a useful manner. Some players come directly from the health care sector or the insurance industry, while many come from computing or other fields.
What it boils down to, though, is the transformation of health care, both for individual patients and for the broader society. “Innovation is coming from the intersection of these various disciplines,” Fridsma says. “That’s where the real creativity is and why having so many disciplines engaged becomes so exciting.”
People working in health informatics take many potential paths before settling into their careers.
Some people start as technologists but see an opportunity in health care. “These are people who may have been doing something with information technology or hardware development and they want to do something meaningful,” says Paul Resnick, interim director of the informatics program at the University of Michigan.
Others come from the health care industry—doctors, nurses or pharmacists, for example—after adding a background in areas such as statistics or machine learning. “A lot of clinicians find that this is a way for them to make a difference,” Tiwari says.
Knowledge of biology is important to get into the field, but not essential. Instead, many of the experts we spoke with said that it is more important to have an understanding of how the health care industry works, as well as its regulatory framework.
“Invest in an understanding of the health care system,” suggests Resnick. “Take a formal program or engage in self-study so you really understand the Affordable Care Act and what’s in it. Find out how the insurance system works. Understand something about how the FDA process works for new medical devices and how long it takes to get to market. These are the things where, if you already have the engineering skills, you can go to interviews and show that you understand something about the health care context. That’s going to make you very attractive.”
Fridsma says it can help to form a partnership with someone who is already working in informatics or with someone in the clinical community who can help you understand how the rules around how data can and cannot be used in a medical context. He also points to the AMIA’s 10x10 courses, which can help to introduce people from many different backgrounds to the informatics industry. There are also, he says, a growing number of master’s degree programs and certificate offerings to help people make the leap into informatics.
Prepare for Challenges
If you’re looking for a challenging field, you’ve found it.
For one thing, the amount of data produced is huge. Take genomics research, for example. “We currently produce about seven terabytes of genomic data a day,” says Dr. Liz Worthey, director of informatics and software development at HudsonAlpha Institute for Biotechnology. That data flood produces hardware storage challenges, as well as additional challenges in figuring out how to display it on an electronic health record (EHR).
As data moves onto the cloud—“that’s where our industry is headed,” Tiwari says—the industry needs to make sure that it’s secure, accessible and useful. “We have to work out how to make that data available and easily digestible by your physician, who has seven minutes to see you in your doctor’s visit,” Worthy says. The data also needs to be able to move with patients as they move to new cities or new medical practices, an essential element of EHRs.
Mobile technology is an ongoing concern. “The software we develop, it has to run on multiple devices such as iPads and soon on doctors’ phones, because that’s how it’s going to be used by clinicians as they walk around,” Worthey says.
Beyond the clinical context, there’s also a need for people to help develop the next wave of diagnostic devices that people can wear as they go about their daily lives. “That’s an exploding area,” says Resnick. “People are creating new devices to monitor and even intervene when necessary.”
That leads us to the industry’s biggest challenges, and perhaps the areas that will be its most transformative: precision medicine and predictive analytics. For one thing, precision medicine will help to target exactly what treatment or tests a patient needs. This can prevent unnecessary tests and save both patients and hospital systems money—an important element of the Affordable Care Act.
Beyond that, health informatics holds the promise of the ability to anticipate when and where people are likely to get sick so preventative measures can potentially be taken ahead of time. That could come from data in a patient’s genetics or something much broader, such as the simple fact that someone lives in an unsafe neighborhood where it’s difficult to get exercise or access fresh fruit and vegetables. “Knowing that helps me know how to monitor and control your diabetes, because I’ll know something about why it’s such a challenge for you,” says Fridsma. “So, if I want to precisely target an intervention on a diabetic patient in that setting, it’s not just about their genes or their propensity for being fast or slow metabolizers or the like. It’s also about understanding all the other data that’s around them. And I believe that when it comes to health-related data, in the future, there’s likely going to be more data that fits outside of the health care system than we might have within the health care system.”
That’s in the future, but not too far off. “The next five years are going to be transformative, I think,” says Worthey.