Sunday, April 12, 2009

New York Times Article on Field, Profession, and Education

There is an excellent article about the emerging informatics profession and training for it in the Sunday, April 12 New York Times by Christine Larson:

This is a well-written article that describes the emerging informatics profession in these times of the Obama stimulus package and its health information technology adoption incentives. However, as newspaper reporters often do, she got a few things slightly wrong. This does not, however, detract from the overall article, which gets across the message well.

One thing slightly wrong was her quote of me, "The health I.T. people run the servers and install software, but the informatics people are the leaders, who interpret and analyze information and work with the clinical staff." First, I would not use the word "health" in front of the phrase "I.T. people" because "health I.T." is often used synonymously with the applications of informatics, such as electronic health records and clinical decision support systems. It is the I.T. people who do run the servers and install software, but the jobs of informaticians are not limited to being leaders and working with clinicians. Those with training in informatics can perform many other jobs in the health I.T. setting, such as project management, training, implementing quality or safety projects, and much more that involves knowledge of both I.T. and health care.

The reporter also states that some institutions have added programs within the last four years. OHSU's first degree program was actually launched in 1996, and we have been teaching via distance learning since 1999.

While the reporter rightly notes that educational programs "can bear a bewildering variety of names," I would not agree that medical and biomedical informatics are the same, nor that they only "focus on data that doctors need for treating patients." I would argue that they focus on more than just those things. Likewise, I would not completely agree with the definition that health informatics "programs often emphasize clinical data and health records." However, I do completely concur with her statement, "Even among programs with the same name, the emphasis may vary."

As most people know, I consider the terms "biomedical and health informatics" or "biomedical informatics" to be the broad umbrella terms. Subsumed under those are "medical informatics" or "clinical informatics," which refer to informatics applied in the clinical setting. "Health informatics" is somewhat orthogonal, which may also involve a focus on non-clinical aspects of informatics, such as personal health. One thing is certain: Our field needs to end this bewilderment and standardize our definitions!

Nonetheless, I believe this reporter did an excellent job overall, and it is great to see an article on our field and emerging profession in a prominent paper like the New York Times.

Sunday, April 5, 2009

What is the Right Informatics Training for Me?

An individual considering spending part or all of their working time in health and biomedical informatics may find the decision of what career path and/or educational program to choose somewhat daunting. As I have noted elsewhere [1, 2], this reflects the fact that (a) informatics is still a maturing discipline, (b) there is no standard curriculum, program accreditation, or individual certification, and (c) the role of information technology (IT) in health and biomedicine is still evolving. Nonetheless, there is growing recognition of the need for better use of IT in clinical settings as well as biomedical research.

There is a growing -- though by no means complete -- consensus on the types of jobs performed in informatics. My view, based on the inventory of competencies developed by Covvey et al. [3], is that there are three general levels of informatics practice:
  • Academic - an individual who does research and/or teaching, typically in an academic center
  • Professional - an individual who works in an operational informatics setting for a majority of his or her working time, such as a Chief Information Officer, Chief Medical or Nursing Officer, or Project Manager or Leader
  • Liaison - an individual who spends part of his or her working time as a local expert and interfacing with informatics or information technology professionals
Do you need to be a clinician to be trained and effective in a job in informatics? Do you need to know computer programming? The answers are no and no! Informatics is a very heterogeneous field, and there are opportunities for individuals from all types of backgrounds. One thing that is clear, however, is that the type of informatics job you assume will be somewhat dependent on your background. Those with health care backgrounds, particularly medicine or nursing, are likely to draw on that expertise for their informatics work in roles such as a Chief Medical or Nursing Officer. Those who do not have health care backgrounds still have plenty of opportunity in the field, but are more likely to end up in the wide variety of other jobs available, everything from a local project leader to a Chief Medical or Nursing Officer.

Most current informatics leaders also believe there is a growing need for “local experts” in informatics. As we know that one of the major success factors for an IT project is engagement of the user community, there will be a growing need for those who represent the “users” in a well-informed way.

It should also be noted that the lines between the above categories are fuzzy. The informatics leader at a large medical center may well need (or desire) the breadth of training of an academic informatician. Likewise, the local expert in a community hospital or large clinical practice may also want to have additional training at or near the level of an informatics professional. The amount of expertise among the levels, especially between expert and professional, may really be more of a continuum, with the expert advancing to the professional level as his or her career develops.

With this basic overview of the field, we can now move on to the basic question of this posting: what is the right informatics education for me to pursue? This discussion will emanate from the context of the educational program we have developed at Oregon Health & Science University (OHSU); other programs have some or all of the comparable levels of training.

The programs at OHSU have been developed in a building-block fashion. That is, coursework done at the lower levels can be carried forward to the higher levels. It should be noted that all of the programs at OHSU are currently at the graduate level, i.e., require a bachelor’s degree to enter. While there are some undergraduate informatics programs developing in the US, it is not clear whether the breadth of knowledge and experience can be obtained in a single baccalaureate or associate degree.

OHSU’s informatics programs are available both on our campus and via distance learning. We have successfully offered most of our courses and programs on-line for nearly a decade. Our program has evolved to the point where on-line and on-campus offerings are considered equivalent and are not distinguished on a student’s transcript. Distance learning does not mean “distant” learning. We have standardized on a number of technologies that provide high-quality and interactive education. Our courses are not correspondence courses, and require a reasonable commitment of one’s time for success. Almost all of the course activities are, however, asynchronous, meaning that students can access the material on their schedule as long as they keep up with the overall class.

Most of our courses, whether on-line or on-campus, are three-credit courses. As OHSU is on an academic quarter system, courses are 11 weeks in duration. A three-credit course typically means a commitment of 6-10 hours per week of work. Most courses have activities typical of university courses, with lectures (on-line classes typically use voice over slides), readings, term projects, homework, and examinations. You can access a demo version of the program's introductory course with the login/password bmi_demo/format.

One pathway into the OHSU program is the 10x10 Program. Run in partnership with the American Medical Informatics Association (AMIA), this program aims to train individuals at the Liaison level. The 10x10 moniker comes from a goal to train 10,000 health care professionals by the year 2010 in basic informatics so they can be local experts representing users in their communities. About 15% of people taking 10x10 pursue subsequent study in the OHSU graduate program.

The 10x10 course is an adaptation of the introductory course in the OHSU curriculum, with the addition of a 1-2 day in-person session covering additional material in an interactive manner. As such, the 10x10 course can be used for subsequent credit in the other OHSU programs pending successful completion of the course’s final examination (which is not required to complete 10x10). The topics in the curriculum of the 10x10 course would not surprise most people familiar with the informatics field and include:
  • Overview of Field and Problems Motivating It
  • Biomedical Computing
  • Electronic Health Records
  • Clinical Decision Support
  • EHR Implementation
  • Standards and Interoperability
  • Privacy, Confidentiality, and Security
  • Secondary Use of Clinical Data: Personal Health Records, Health Information Exchange, Public Health, Health Care Quality, Clinical Research
  • Evidence-Based Medicine and Medical Decision Making
  • Information Retrieval and Digital Libraries
  • Imaging Informatics and Telemedicine
  • Translational Bioinformatics
  • Organizational and Management Issues in Informatics
The remainder of the programs build on the introductory course or 10x10. The Graduate Certificate program focuses on the core of biomedical informatics. After the introductory course, students take more advanced courses in areas such as clinical systems, information retrieval, and organizational behavior and management. They can also take additional electives as well as pursue practicum projects in their own communities. The Graduate Certificate program requires 24 credits, or eight three-credit courses, for graduation.

OHSU offers two master’s degree programs, which differ only in their culminating project. The Master of Science (MS) in Biomedical Informatics requires a master’s thesis, while the Master of Biomedical Informatics (MBI) is a “professional master’s” and requires a less-intensive capstone project. The master’s degree programs have two “tracks,” one in medical informatics and the other in bioinformatics.

The curriculum for each of the tracks is organized into “domains,” each of which are general curriculum areas and have both required and choices from among a list. The five domains in the medical informatics track are:
  • Biomedical informatics - core courses in informatics science and applications
  • Organizational and management sciences - business and management issues
  • Computer science - practical introduction; concepts more important than programming
  • Health and biomedicine - for non-clinicians
  • Research methods - statistics plus quantitative and qualitative methods
The PhD program is a purely on-campus program, although PhD students can take individual courses that are offered on-line. Courses taken at lower levels of study are part of the PhD program “knowledge base” and can be carried forward into the program. The PhD program requires advanced study culminating in a dissertation consisting of independent research. All PhD students are supported with a tuition waiver, stipend, and benefits from training or research grants.

More information about the individual programs can be found on the OHSU Department of Medical Informatics & Clinical Epidemiology Web site. The 10x10 program is administered by AMIA and offered twice a year. The Graduate Certificate program has rolling admissions, i.e., students are admitted any quarter to begin classes the following one. The master’s and PhD programs, however, only have admissions once a year to begin in the fall quarter.

OHSU also offers a fellowship program funded by a training grant from the National Library of Medicine (NLM). Additional clinically oriented fellowships are offered in partnership with Kaiser Permanente Northwest (KPNW) and the Veteran’s Administration (VA). Two types of fellowships are available from the NLM training grant:
  • Predoctoral - stipend and tuition support for some students in the PhD program
  • Postdoctoral - for those with doctoral (e.g., MD or PhD) degrees who seek advanced training, with or without a degree (although most pursue a master’s degree)
The Kaiser and VA fellowships are for postdoctoral clinicians only and have a clinical service component.


1. Hersh WR, Who are the informaticians? What we know and should know. Journal of the American Medical Informatics Association, 2006. 13: 166-170.
2. Hersh W, Health and Biomedical Informatics: Opportunities and Challenges for a Twenty-First Century Profession and its Education, in IMIA Yearbook of Medical Informatics 2008, Geissbuhler A and Kulikowski C, Editors. 2008, Schattauer: Stuttgart, Germany. 138-145.
3. Covvey HD, Zitner D, and Bernstein R, Pointing the Way: Competencies and Curricula in Health Informatics. 2001, University of Waterloo: Waterloo, Ontario, Canada.