Our patient (a health care system) comes to us with a Chief Complaint (I want to install an EMR).
We gather a little more specific information by taking a History of Present Illness (Why do you want to install an EMR? Improved safety? Decrease cost? Improve quality? Integrate inpatient and outpatient care? And so on.)
We take some Past Medical History (What systems have you worked with before? Any successful implementations? Failed ones?)
We do the ROS (How do you sit in the market? Market share? Referral areas and types? What are the financials? What is the culture overall?
What academic relationships do you have? What is your system's relationship to the community? And so on.)
Then, we do the Physical Exam (Current state analysis and documentation. Palpate the database. Auscultate the medical staff.)
We develop a Differential Diagnosis (Major processes that could be impacted and possible solutions.)
We work with the patient (health system) to determine what a good health outcome would be for them (Future state model).
We come to agreement on a treatment plan (Implementation roadmap and project plans) that will reach that future state.
Then we operate (implement) and, hopefully, are lucky enough to provide ongoing care (continued improvements).
So, I still practice medicine. When I was a neurosurgeon I cared for multi-system organisms (people).
As a clinical informaticist, my patients are multi-organism systems. But, they are still my patients.
And, sitting in the ED on a Saturday night of a CPOE go-live, I would observe that CPOE implementation is exactly like clipping an aneurysm - hours and hours of boredom randomly interspersed with moments of stark terror.
So that's my two cents on the practice of Applied Clinical Informatics.
This resonates with me and is close to the points I made in a guest posting over at Healthcare
IT Today "A Day in the Life of a CMIO. WHat's your experience - what makes a good healthcare informaticist?