AQuarter-CenturyofInnovationinInformaticsEducationatOHSU:HistoryandLessonsLearned
WilliamHersh,MD,FACP,FACMI
ProfessorandChairDepartmentofMedicalInformatics&ClinicalEpidemiology
SchoolofMedicineOregonHealth&ScienceUniversity
Portland,OR,USAEmail:[email protected]: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:[email protected]: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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