Tuesday, March 31, 2009

The Genesis of the 10x10 Course

The 10x10 ("ten by ten") program was launched in 2005 by the American Medical Informatics Association (AMIA) and Oregon Health & Science University (OHSU). The genesis for the program came when then-President of AMIA, Dr. Charles Safran, called for at least one physician and one nurse in each of the 6000 hospitals in the US to have some training in medical informatics. At the same time, AMIA was looking to develop e-learning materials for training in medical informatics, but found that vendors were proposing unaffordable fees.

At that time, the biomedical informatics distance learning program at OHSU was mature and included an introductory course that I had been teaching on-line for nearly a decade. I proposed to AMIA that we re-package this course into a standalone course that included an in-person session at the end (not present in the OHSU course) that brought participants together for interaction and additional learning. Based on Dr. Safran's numbers and my knowledge of the scalable capacity of the distance learning course, I proposed that we name the program 10x10, embodying the aim of training 10,000 individuals in medical informatics by the year 2010.

The training would of course not be limited to physicians and nurses, nor would it be limited to US citizens. AMIA and OHSU negotiated a mutual non-exclusivity agreement, in which AMIA could accredit other educational institutions to offer 10x10 courses and OHSU would continue to own its intellectual property and use it for other initiatives besides 10x10.

The first cohort of 44 students completed the course in 2005. In addition to the "standard" offering of the course being offered to coincide with the in-person session at the end coinciding with an AMIA spring or fall meeting, a number of special offerings have been developed, tailored to specific audiences. These include:
  • California Health Care Foundation (2006) - California physicians
  • American College of Physicians (2007) - internal medicine physicians
  • Scottsdale Institute (2007) - an organization of innovative health care systems
  • Mayo Clinic (2007 and 2008) - senior nursing executives, embedded in a larger program centered around health care quality
  • Society for Technology in Anesthesiology (2008) - anesthesiologists
  • American College of Emergency Physicians (2008) - emergency medicine physicians
In addition, AMIA received a grant from the Centers for Disease Control and Prevention (CDC) in 2008 to organize education for public health professionals in public health informatics in 2008. Part of the grant went to providing the tuition for some of those professionals to enroll in several 10x10 offerings, including OHSU's.

By the end of 2008, a total of 582 people had completed the OHSU offering of the AMIA 10x10 course. While far short of the goal of 10,000, the capacity of course could handle many more people.

Students in 10x10 have come not only from the US, but also from many other countries, including Canada, Argentina, Hong Kong, Kuwait, Pakistan, Israel, and Thailand. One of the original students from Argentina, Dr. Paula Otero, translated the course into Spanish and has delivered it to 380 individuals across Latin America.

The course has also inspired federal legislation in the US, leading to the "10,000 Trained by 2010 Act," introduced by Rep. David Wu (D-OR). The bill was passed by the US House in the 110th Congress (2007-2008) but did not have a Senate sponsor. It has been introduced in the 111th Congress, and elements of it have been incorporated into the American Recovery and Reinvestment Act of 2009, aka, the economic stimulus package.

A demo version of the introductory graduate course from which 10x10 is derived can be accessed at the URL:
From this page, log in with the following:
Username: bmi_demo
Password: format

More information about 10x10 can be found on the AMIA web site at:
Information about the most current OHSU offering is at:

A number of papers have been written about the 10x10 program:
Hersh, W. and Williamson, J. (2007). Educating 10,000 informaticians by 2010: the AMIA 10×10 program. International Journal of Medical Informatics, 76: 377-382.
Feldman, S. and Hersh, W. (2008). Evaluating the AMIA-OHSU 10x10 program to train healthcare professionals in medical informatics. AMIA Annual Symposium Proceedings, Washington, DC. American Medical Informatics Association. 182-186.
Otero, P., Hersh, W., et al. (2007). Translation, implementation and evaluation of a medical informatics distance learning course for Latin America. MEDINFO 2007 - Proceedings of the Twelfth World Congress on Health (Medical) Informatics, Brisbane, Australia. IOS Press. CD-ROM P421.
Hersh, W. (2007). The full spectrum of biomedical informatics education at Oregon Health & Science University. Methods of Information in Medicine, 46: 80-83.

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