AQuarter-CenturyofInnovationinInformaticsEducationatOHSU:HistoryandLessonsLearned

WilliamHersh,MD,FACP,FACMI

ProfessorandChairDepartmentofMedicalInformatics&ClinicalEpidemiology

SchoolofMedicineOregonHealth&ScienceUniversity

Portland,OR,USAEmail:hersh@ohsu.eduWeb:www.billhersh.info

Blog:http://informaticsprofessor.blogspot.comTwitter:@williamhersh

ReferencesAnonymous(2008).InformationBehaviouroftheResearcheroftheFuture.London,England,CentreforInformationBehaviourandtheEvaluationofResearch.http://www.jisc.ac.uk/media/documents/programmes/reppres/ggworkpackageii.pdfDetmer,DEandShortliffe,EH(2014).Clinicalinformatics:prospectsforanewmedicalsubspecialty.JournaloftheAmericanMedicalAssociation.311:2067-2068.Feldman,SSandHersh,W(2008).EvaluatingtheAMIA-OHSU10x10programtotrainhealthcareprofessionalsinmedicalinformatics.AMIAAnnualSymposiumProceedings,Washington,DC.AmericanMedicalInformaticsAssociation.182-186.Gadd,CS,Williamson,JJ,etal.(2016).Eligibilityrequirementsforadvancedhealthinformaticscertification.JournaloftheAmericanMedicalInformaticsAssociation.23:851-854.Gadd,CS,Williamson,JJ,etal.(2016).Creatingadvancedhealthinformaticscertification.JournaloftheAmericanMedicalInformaticsAssociation.23:848-850.Greiner,ACandKnebel,E,Eds.(2003).HealthProfessionsEducation:ABridgetoQuality.Washington,DC,NationalAcademiesPress.Hersh,W(2009).Astimulustodefineinformaticsandhealthinformationtechnology.BMCMedicalInformatics&DecisionMaking.9:24.http://www.biomedcentral.com/1472-6947/9/24/Hersh,W,Biagioli,F,etal.(2017).FromCompetenciestoCompetence:Model,Approach,andLessonsLearnedfromImplementingaClinicalInformaticsCurriculumforMedicalStudents.HealthProfessionals'EducationintheAgeofClinicalInformationSystems,MobileComputingandSocialNetworks.A.Shachak,E.BoryckiandS.Reis.Amsterdam,Netherlands,Elsevier:inpress.Hersh,WandWilliamson,J(2007).Educating10,000informaticiansby2010:theAMIA10×10program.InternationalJournalofMedicalInformatics.76:377-382.Hersh,WR(2007).ThefullspectrumofbiomedicalinformaticseducationatOregonHealth&ScienceUniversity.MethodsofInformationinMedicine.46:80-83.

Hersh,WR,Gorman,PN,etal.(2014).BeyondinformationretrievalandEHRuse:competenciesinclinicalinformaticsformedicaleducation.AdvancesinMedicalEducationandPractice.5:205-212.http://www.dovepress.com/beyond-information-retrieval-and-electronic-health-record-use-competen-peer-reviewed-article-AMEPHersh,WR,Junium,K,etal.(2001).Implementationandevaluationofamedicalinformaticsdistanceeducationprogram.JournaloftheAmericanMedicalInformaticsAssociation.8:570-584.Kulikowski,CA,Shortliffe,EH,etal.(2012).AMIABoardwhitepaper:definitionofbiomedicalinformaticsandspecificationofcorecompetenciesforgraduateeducationinthediscipline.JournaloftheAmericanMedicalInformaticsAssociation.19:931-938.Longhurst,CA,Pageler,NM,etal.(2016).Earlyexperiencesofaccreditedclinicalinformaticsfellowships.JournaloftheAmericanMedicalInformaticsAssociation.23:829-834.Otero,P,Hersh,W,etal.(2010).Amedicalinformaticsdistance-learningcourseforLatinAmerica-translation,implementationandevaluation.MethodsofInformationinMedicine.49:310-315.Safran,C,Shabot,MM,etal.(2009).ACGMEprogramrequirementsforfellowshipeducationinthesubspecialtyofclinicalinformatics.JournaloftheAmericanMedicalInformaticsAssociation.16:158-166.Skochelak,SE,Hawkins,RE,etal.,Eds.(2017).HealthSystemsScience.NewYork,NY,Elsevier.Valenta,AL,Meagher,EA,etal.(2016).Coreinformaticscompetenciesforclinicalandtranslationalscientists:whatdoourcustomersandcollaboratorsneedtoknow?JournaloftheAmericanMedicalInformaticsAssociation.23:835-839.Williamson,JJ(2011).EvaluationofAMIA10x10ContinuingEducationInitiative.M.Ed.Master'sThesis,UniversityofVirgina.

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AQuarter-CenturyofInnovationinInformaticsEducationatOHSU:HistoryandLessonsLearned

WilliamHersh,MD,FACP,FACMIProfessorandChair

DepartmentofMedicalInformatics&ClinicalEpidemiologySchoolofMedicine

OregonHealth&ScienceUniversityPortland,OR,USA

Email:hersh@ohsu.eduWeb:www.billhersh.info

Blog:http://informaticsprofessor.blogspot.comTwitter:@williamhersh

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Disclosures

• Norelevantfinancialorcommercialinterestsordisclosurestoreport

• Thatsaid,Iteachinformaticsforaliving

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Learningobjectives• Definethefieldandsub-areasofbiomedicalandhealthinformatics

• Describecompetenciesininformaticsfordifferentlearners

• DiscusstheOHSUinformaticseducationalprograms

• Describethelessonslearnedfrom25yearsofexperience

• Demonstrateexamplesofscholarshipemanatingfromourwork

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Outline

• Definitionsofbiomedicalinformaticsandrelatedtopics

• Competenciesfordiverselearners• AccomplishmentsofOHSUinformaticseducationalprogram

• Lessonslearned

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Whatisbiomedical/clinical/healthinformatics(Hersh,2009)?

• Biomedicalandhealthinformaticsisthefieldconcernedwiththeoptimaluseofinformation,oftenaidedbytechnology,toimproveindividualhealth,healthcare,publichealth,andbiomedicalresearch– Informaticsappliedinamore

focuseddomainis{X}informatics,e.g.,nursing,dental,pathology,primarycare,etc.

• Practitionersofinformaticscalledinformaticians (sometimesinformaticists)

(SUNYBuffalo)

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Informaticshasan“adjectiveproblem”(Hersh,2009)

Informatics=People+Information+Technology

BiomedicalandHealthInformaticsLegalInformatics Chemoinformatics

Bioinformatics(cellularandmolecular)

Clinical(orMedical)Informatics

(person)

{Clinicalfield}Informatics

PublicHealthInformatics(population)

ConsumerHealthInformatics

ImagingInformatics ResearchInformatics

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Informaticsisacorecompetencyforhealthprofessionals

• AccordingtoInstituteofMedicine,modernhealthcareprofessionalsmusthavecompetenceininformaticsaspartoflargergoaltoprovidepatient-centeredcare(Greiner,2003)

• Informaticscompetenceisnotjustcomputerliteracy– The“Googlegeneration” doesnot

necessarilyhavegoodinformationskills(CIBER,2008)

• Clinicalinformaticsisacoredomainof“healthsystemsscience”(Skochelak,2017)

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Importanttomedicineisclinicalinformatics

• In2011,clinicalinformaticsapprovedbyABMSasfirstsubspecialtyofallspecialties(Detmer,2014)– AdministrativehomeisAmericanBoardofPreventiveMedicine

• Firstboardexamofferedin2013– Over1400certifiednow

• Boardeligibilityduringgrandfatheringperiodthroughinitially2017,now2022– AfterwhichonlypathtoboardeligibilitywillbeACGME-accreditedfellowship

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Informaticsisnotjustaboutphysicians

• Informaticsprofessionalscomefromallhealthprofessionsandnon-healthprofessions(e.g.,computerscience,IT,andmore)– AMIAdevelopingHealthInformaticsCertification(AHIC)forotherhealthprofessionalsininformatics(Gadd,2016;Gadd,2016)

• Informaticians playprofessionalandacademicrolesinallmissionsofhealthcareorganizations,industry,andacademia– Research,education,andoperations

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Diversecompetenciesfordiverseroles

• Informaticians• Clinicians• Researchers

• Butsomefoundationalelementsforall

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Corecompetenciesofbiomedicalinformatics(Kulikowski,2012)

Acquireprofessionalperspective

Summarizeandexplainthehistoryandvaluesofthedisciplineanditsrelationshiptorelatedfieldswhiledemonstratinganabilitytoread,interpret,andcritiquethecoreliterature

Analyzeproblems Analyze,understand,abstract,andmodelaspecificbiomedicalproblemintermsofdata,informationandknowledgecomponents

Producesolutions Usetheproblemanalysistoidentifyandunderstandthespaceofpossiblesolutionsandgeneratedesignsthatcaptureessentialaspectsofsolutionsandtheircomponents

Articulatetherationale

Defendthespecificsolutionanditsadvantageovercompetingoptions

Implement,evaluate,andrefine

Demonstrateanabilitytocarryoutthesolution,toassessitsvalidity,anditerativelyimproveitsdesign

Innovate Createnewtheories,typologies,frameworks,representations,methods,andprocessestoaddressbiomedicalandinformaticsproblems

Workcollaboratively Demonstratetheabilitytoteameffectivelywithpartnersfromdiversedisciplines

Disseminateanddiscuss

Communicateeffectivelytoaudiencesinmultipledisciplinesinpersuasivewrittenandoralform

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Competenciesforclinicalinformaticsprofessionals(Safran,2009)

• Searchandappraisetheliteraturerelevanttoclinicalinformatics• Demonstratefundamentalprogramming,databasedesign,anduserinterfacedesignskills• Developandevaluateevidence-basedclinicalguidelinesandrepresenttheminanactionableway• Identifychangesneededinorganizationalprocessesandclinicianpracticestooptimizehealth

systemoperationaleffectiveness• Analyzepatientcareworkflowandprocessestoidentifyinformationsystemfeaturesthatwould

supportimprovedquality,efficiency,effectiveness,andsafetyofclinicalservices• Assessuserneedsforaclinicalinformationortelecommunicationsystemorapplicationand

producearequirementsspecificationdocument• Designordevelopaclinicalortelecommunicationapplicationorsystem• Evaluatevendorproposalsfromtheperspectivesofmeetingclinicalneedsandthecostsofthe

proposedinformationsolutions• Developanimplementationplanthataddressesthesociotechnicalcomponentsofsystemadoption

foraclinicalortelecommunicationsystemorapplication• Evaluatetheimpactofinformationsystemimplementationanduseonpatientcareandusers• Develop,analyze,andreporteffectively(verballyandinwriting)aboutkeyinformaticsprocesses

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Inreality,applicabletoallhealthcareprofessionalstudents.

(Hersh,2014)

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Competenciesforclinicalandtranslationalresearch(Valenta,2016)

• Utilizeinformatics-basedtoolsintranslationalresearchincluding:locaterelevantinformaticstools;selectappropriateinformaticstools;andusethosetoolsinresearchformanagingandanalyzingbiomedicalandhealthinformation

• Describetheessentialfunctionsofthemajorclinicalsystems(eg,theEHRanditsfeedersystems,suchasradiologyandlab)thatarerelevanttoCTSandthechallengestousingthesedataforresearch

• Describetheessentialfunctionsofmajorresearchcomputersystems(eg,clinicaltrialsmanagementsystems,biospecimen managementsystems,researchgrantandfinancemanagementsystems,andresearchservicestrackingsystems)thatarerelevanttoCTS

• Compareandcontrasttheorganizationalrolesandprincipalresponsibilitiesessentialforaccess,management,andgovernanceofdatarelatedtoCTS

• Explaintheroleofhealthinformationtechnologystandardsintheinteroperabilityofresearch,clinical,andadministrativeinformationsystemsandonsecondaryuseofdataforCTS

• Identify,retrieve,andmanagebiomedicalandhealthscienceknowledgethroughliteraturesearchesusingadvancedsearchtechniques(MeSH,PubMed,GoogleScholar,etc.)

• Describetheessentialinformationgeneration,management,analysis,transformation,summarization,andvisualizationmethodsthatapplytoCTSdata,suchas:genomic,proteomicandother“-omics”data;clinicaldata;imagingdata;consumerandpatient-reporteddata;andpopulation-levelandenvironmentalexposuredata

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AccomplishmentsofOHSUinformaticseducationprogram

• Graduateprogram• NIHtraininggrant• Clinicalinformaticsfellowship• Useofdistancelearning• Medicalstudenteducation• Educationforotherlearners

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Biomedicalinformaticsgraduateprogram

• FirstprogramwasMasterofScience,launchedin1996

• Currentdegreeandcertificateprograms(Hersh,2007)– PhD– since2003– Twomaster’sdegrees• MasterofScience– firstprogram• MasterofBiomedicalInformatics– “professional”master’ssince2002

– GraduateCertificate– since2001

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OHSUinformatics– currentdelivery

Degree/CertificateTrack

PhD MS MBI GradCert

ClinicalInformatics On-campusOn-campus

On-line

On-campus

On-line

On-campus

On-lineBioinformatics &ComputationalBiology

On-campus On-campus

Inprocessofsomechanges:• From“tracks”to“majors”• FromMBItoMasterofScienceWithoutThesis• Namechangestoreflectevolutionoffield

• Health&ClinicalInformatics• Bioinformatics&ComputationalBiomedicine

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OHSUinformatics– bythenumbers

738degreesandcertificatesawardedto666peoplesince1998

Internationalcollaborationsin• Egypt• Argentina• Singapore• Thailand• Andmanyinternationalstudentscomingtoor

accessingcoursesfromOHSU

WheredomesticonlinestudentsliveDegree/Certificate Total BCB CIDoctorofPhilosophy 24 6 18MasterofBiomedicalInformatics 206 14 192MasterofScience 88 17 71CertificateProgram 420 0 420Total 738 37 701

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Traininggrantandclinicalfellowship–familyoffellows

• NIH/NationalLibraryofMedicinetraininggrantcontinuallysince1992– Currentlyfunds9predoc (PhD)and4postdoctrainees– Renewedin2017for6th five-yearcycle

• Including2traineesfundedbyNIEHS• ACGME-accreditedClinicalInformaticsFellowshipsince2015– Amongfirst4programslaunched(Longhurst,2016)– Knowledgelearningfromgraduatecourses– 5otherfellowshipprogramsusingouronlinecourses

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Successalsoduetouseofdistancelearning

• Growinginterestledtolaunchingoffirstonlinecoursein1999(Hersh,2001)– BMI510– IntroductiontoBiomedicalInformatics

• Nextdevelopedcredentials– GraduateCertificate• 8-coursesubsetofmaster’s

–Master ofBiomedicalInformatics• Professionalmaster’s,differingmainlyin• On-line,withrequirementof2on-campusshort/hybridcourses

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Useofdistancelearning(cont.)• Hasalsoenabledrepackagingofmaterialincontinuing

educationframework– 10x10(“tenbyten”)course– Adaptationofon-lineBMI510– Partnershipwithprofessionalassociation,AMIA– Namederivedfromgoalofeducatingonephysicianandnursein

eachof6000UShospitalsby2010(Hersh,2007)• Althoughopentoanyonewithanybackground

– Evaluationsshowedhighsatisfactionand,forabout15-20%,pursuitoffurthereducation(Feldman,2008;Williamson,2011)

– 1000completedby2010;continuedinterestsince,withover2300completedtodate

– TranslatedandrevisedinSpanishforLatinAmerica(Otero,2010)

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Othereducationalgrantstoprogram

• 2009– InformaticsTrainingforGlobalHealthtraininggrantbyNIHFogartyInternationalCenterincollaborationwithHospitalItaliano deBuenosAires($1M)

• 2010–ARRAHITECHActforworkforceandcurriculumdevelopment($5.8M)

• 2014– NIHBigDatatoKnowledge(BD2K)Initiative,developmentofopeneducationalresources($1M)

• 2015– UpdateofARRAHITECHcurriculum($1M)

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Teachingclinicalinformaticstomedicalstudents(Hersh,2017)

• Basedoncompetencies• Withstatedlearningobjectives• Deliveredbyappropriatemodality– Largegrouplectureorinteractive– Smallgroupskills– e.g.,EHR,qualitymeasures– Clinicalinformaticspearls(asynchronous7-15minuteonlinelecture)

– Enrichment(optional)– in-depthtopics(EHR),clinicalinformaticscareers

• Eachwithappropriateassessment

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Educationforotherlearners• Clinicalandtranslationalresearchers– CoursesinHumanInvestigationsProgram(HIP)– Mappingofgrant-fundedcurricularmodulestocompetencies• https://dmice.ohsu.edu/bd2k/mapping.html

• Basicsciencegraduatestudents– ParticipatinginCreativeIDEAS

• UndergraduatesatPortlandStateUniversity– Long-standing3+2articulationwithComputerScience– NewerdevelopmentswithSchoolofPublicHealth

• Undergraduatecourseinhealthinformaticsthisyear• Undergraduatedegree?

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Lessonslearned

• Students• Technologyandmodalities• Programandsupport

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Students• Evolutionofanacademicfieldtoaprofessionalone– Parallelschangesinwork,e.g.,home-growntocommercialEHRs

• First-careersvs.career-changers– Entrybymanyintofield,especiallyfromhealthprofessions,afterinitialtraining

• Virtualcommunity– Emergedamongstudentsleadingtoprofessionalconnections,commoninterests,andeven(intwoinstances)marriage

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Students(cont.)

• Moststudents(atleastthoseinourprogram)prefercoursesonline– Evenmanywholivelocally– Nowdifficulttofillclassrooms

• Almostalllearningcanoccurremotely– Alldistancelearningdoesnotneedtobeonline,e.g.,internshipsandpracticums

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Technologyandmodalities

• Inmostfields,technologyreplicatesclassroom– Lectures– Interaction– Assessment

• Technologyhasimproved– AshasOHSUsupportofit

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Lectures• Haveusedvoice-over-Powerpoint formanyyears• Throughsuccessivetools– RealMedia– AdobePresenter– ArticulatePresenter

• Addsasomewhat“activelearning”approachtolectures– Chunkedintosmallersegments– Canstartandstop,re-listen– Canprovideinteraction

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We’vecomealongway?

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ArticulatePresenter– prosandcons

Pro• Besttoolavailable• Worksasplug-into

WindowsPowerpoint• Allowsnarrationoneslide

atatime• Outputsinstandard

formats– FlashandHTML5– MP3audio– Mobile

Con• Expensive• NonativeMacversion(butrunsunderWindowsvirtualmachines)

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Interaction

• Threadeddiscussionforums–Moderationofdiscussionessential

• Real-timevideo– TransitioningfromSakaitoCiscoMeeting

• Virtualprojects– Buildsteamskillsbutchallengesduetootherlifecommitmentsandtimezonedifferences

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Assessment

• Justaboutanythingthatcandoneinpersoncanbedoneononline

• Homeworkassignments– I’vecometolovemultiple-choicequestions

• High-stakesexams– virtualproctoring

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Program

• Can’tignorebusinessaspects• Sakaianditssupporthasbeencritical• Responsetostudentsalsoessential– Rapidresponsetoproblemsandinquiriesimportant,evenifonlyacknowledgementwithfollow-up

– Programpolicyisforfacultytorespondtoallstudentcommunicationsintheircourseswithin2businessdays

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Otherlessons

• Livingtheasynchronouslife• Humanconnectiontolearnersstillessential• Oursuccesshasspawnedcompetitors• Facingcompetitionfromnewmodelsoflearning,e.g.,MOOCS

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Conclusions• FacultyandstaffofDMICEhaveprovidedinnovativeeducationandtrainingleadingtocareersuccessofinformaticsprofessionalsindiversejobsandsettings

• Ofincreasingimportanceisdisseminationofknowledgeandskillsininformaticstootherhealthprofessionalsandthelargerpublic

• Technologyisimportantbutunderstandingofcompetencies,studentneeds,andprogrammanagementismuchmorecritical

• Havealsoachievedscholarshipandgrantfunding

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