Update on the ONC Curriculum Development Centers Program

I recently posted an update about one of our Office of the National Coordinator for Health Information Technology (ONC) projects, the Oregon Health & Science University (OHSU) offering of the ONC University-Based Training (UBT) program, and promised an update to follow on our other grant, the Curriculum Development Centers program. The latter is a $10 million program for five universities – Columbia University, Duke University, Johns Hopkins University, Oregon Health & Science University (OHSU), and University of Alabama-Birmingham – to develop curricular materials for the 82 community colleges delivering short-term training for six of the 12 ONC-defined workforce roles. One university, OHSU, was provided additional funding to serve as the National Training & Dissemination Center (NTDC) that is additionally tasked with developing a Web site for dissemination of the materials, training community college faculty in their use, and capturing and distributing feedback collected from community college faculty.

As with the UBT program, the Curriculum Development Centers have been funded since April, 2010. Since that time, substantial progress has been made. The first version of the curriculum was delivered to the community colleges in two halves, one in August, 2010 and the other in October, 2010. Because of the tight timeline of the curriculum deliverables and the start-up of the community college programs, it was decided to not disseminate Version 1 beyond the five community college consortia overseeing the 82 member colleges. This also led to the decision for Version 2 to be delivered relatively quickly, in the spring of 2011, and mainly be an incremental update focused on improving the clarity and technical quality without making any major content overhaul. It was also decided that Version 2 would be the release promised in the original Request for Proposals (RFP) to be made available to all institutions of higher learning, which for all practical purposes means the general public. This public roll-out will take place in the summer of 2011.

Recall that the community college short-term training programs are focused on six of the 12 workforce roles that ONC has deemed necessary to help eligible professionals and hospitals achieve meaningful use of the electronic health record (EHR). (The other six workforce roles are trained by the UBT program.) Each of the 82 community colleges can offer certificates in one to six of the workforce roles, while the consortium to which it belongs must offer all six across their region.

The curriculum consists of 20 components, each of which is comparable to a college-level course (which of course can vary widely based on the length, depth of material, background of students, and other factors). The components are not called courses because it is up to the community colleges to turn them into actual courses in their programs. The colleges can use the materials “out of the box,” with little or no modification, or they may modify them as they desire for the needs of their programs.

ONC and the Curriculum Development Centers also developed a “set table” consisting of a matrix of curriculum components and workforce roles to guide community college programs in using components to train for particular workforce roles. The matrix specified the core set of components for each workforce role for two types of student backgrounds, healthcare and information technology.

Each component has a “blueprint,” which provides learning objectives and a detailed overview of the content. Each component is broken down into 8-15 units, which correspond roughly (though variably) to one week of a course. Each unit typically consists of learning objectives, a narrated slide lecture (delivered as Powerpoint slides, MP3 audio files, and narrated voice-over-Powerpoint Flash files), references, exercises, and other materials. (The blueprint for Version 1 on the ONC Web site will soon be replaced by the one for Version 2.)

The topic areas of the components are: 

1. Introduction to Health Care and Public Health in the U.S.
2. The Culture of Health Care
3. Terminology in Health Care and Public Health Settings
4. Introduction to Information and Computer Science
5. History of Health Information Technology in the U.S.
6. Health Management Information Systems
7. Working with Health IT Systems*
8. Installation and Maintenance of Health IT Systems*
9. Networking and Health Information Exchange
10. Fundamentals of Health Workflow Process Analysis & Redesign
11. Configuring EHRs*
12. Quality Improvement
13. Public Health IT
14. Special Topics Course on Vendor-Specific Systems
15. Usability and Human Factors
16. Professionalism/Customer Service in the Health Environment
17. Working in Teams
18. Planning, Management and Leadership for Health IT
19. Introduction to Project Management
20. Training and Instructional Design

Components 7, 8, and 11, denoted with an asterisk* above, are “lab” components that provide hands-on instruction. These components make use of a fully functioning version of the Veteran’s Administration VistA EHR that is included with the curricular materials and can be installed under most flavors of Windows (as well as some Windows virtual machines that run under MacOS and Linux).

Another program in the ONC Workforce Development Program related to the project is the Competency Examination, a project led by Northern Virginia Community College. There are six exams, with one for each of the six community college-trained workforce roles. Each exam consists of 125 multiple-choice questions, to be taken in three hours and graded on a pass-fail basis. At least 80% of exam questions come from the curriculum components. Beta versions of the six exams became available on May 20, 2011, with the final versions to be ready in September. The exam is free to consortia member college graduates through their schools.

As noted above, Version 2 will be released to all institutions of higher education in July, 2011. The details of how to access the materials will be provided at that time. For this release, the Curriculium Development Centers adopted a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License. This means all users of the curriculum can use, share, and adapt the materials but must attribute originator of work, use the materials only for non-commercial purposes, and share any changes made under same license. Per the original RFA, universities own the intellectual property for their components.

The Curriculum Development Centers have also started planning for the third and final version that will likely be released in early 2012. Planning for this version is underway. Unfortunately, there is not now any plans for continued funding, at least by ONC, beyond the project end in April, 2012. It is conceivable that some sort of open-source approach could be adopted to keep the curriculum going, but I do not see the resource continuing to be viable without some investment, at least in its infrastructure. Nonetheless, I am pleased overall with the project and I believe it will be an enduring contribution to the biomedical and health informatics community. I am looking forward to Version 3 and whatever opportunities there are to continue the project beyond it.

Physician Certification in Informatics

I am frequently asked about the status of certification of physicians in informatics. I did touch on this topic briefly in my posting on informatics opportunities for physicians last fall, but let me address the question of certification in more detail in this posting.

The motivation for physician certification in informatics is to recognize the growing stature and need for professional expertise of physicians who spend a significant amount of their time performing informatics-related duties. This includes not only the growing role of the Chief Medical Informatics Officer (CMIO), but other jobs where a physician draws on his or her expertise at the intersection of medicine and informatics.

The "gold standard" for any type of certification of physicians is board certification. There are currently 24 specialty boards (e.g., internal medicine, family medicine, pediatrics, surgery, radiology, preventive medicine, etc.), most of which have subspecialty boards as well (e.g., cardiology, hematology/oncology, and general internal medicine in internal medicine). Some subspecialties, such as geriatrics and palliative medicine, are offered by more than one specialty board. This will be the model for the clinical informatics subspecialty, and in fact the goal will be for it to be offered by all 24 specialty boards.

A comprehensive overview of the rationale and plan for developing the clinical informatics subspecialty was published in early 2010 by Detmer et al. [1]. This paper described the development of medical specialties and subspecialties generally and in the context of the new proposed subspecialty of clinical informatics. A more recent overview of the status board specialties was published last year and included mention of the proposed one for clinical informatics [2].

The proposal to establish the clinical informatics subspecialty was developed by the American Medical Informatics Association (AMIA) and submitted to the ABMS in 2010. The lead board submitting the proposal was the American Board of Preventive Medicine (ABPM), which has since been joined by the American Board of Pathology. The proposal had its first "reading" in early 2011, with a second reading and possible vote coming in September, 2011.

Certification in clinical informatics will work like any other multi-board subspecialty. To become certified, a physician will need to meet certain training requirements and then pass a certification exam. In the early years (usually the first five years of a specialty's existence), those with a certain level of experience will be able to "grandfather" in on the training requirements in a "practice track" and certify by passing the exam only. Those training after the initial practice track period will be required to complete some sort of fellowship in the specialty. The practice track requirements for clinical informatics will be determined after the ABMS approves the subspecialty and will likely apply to those with some defined level of time and depth of experience in clinical informatics settings.

If the ABMS proposal is approved, the ABPM will begin development of a certification exam, which will likely become available in the fall of 2012 for those meeting the practice track requirements. The next step will be to define the requirements for clinical fellowships in clinical informatics and their accreditation by the Accreditation Committee for Graduate Medical Education (ACGME), which accredits residency and specialty fellowship training programs.

Papers published in JAMIA in 2009 laid out the details of the core curriculum [3] and training requirements [4] for the subspecialty. These were developed over a two-year process, funded by a grant to AMIA in 2007 from the Robert Wood Johnson Foundation. Two task forces were convened to address the core curriculum and training requirements. (I was a member of the latter.) These task forces led to the ABMS proposal that is currently under review.

Even though the process for establishing the subspecialty is well-defined, a number of questions remain. One question is how many healthcare organizations and others will require their physician-informatician practitioners to be certified. Another question, very critical to academic informatics units, is what will be the role for formal didactic education, especially that offered by distance learning. Programs such as ours at OHSU have been a popular vehicle for physicians and others to become informatics practitioners. The distance learning aspect has been especially valuable, as many clinicians enter informatics careers after they have established their clinical careers. The graduate-level education approach has been validated by the strong uptake of these programs as well as the more recent funding for them though the Office of National Coordinator for Health Information Technology (ONC) University-Based Training (UBT) Program, including the OHSU offering. I am hopeful that ACGME will adopt flexibility in the clinical informatics fellowship program educational programs, including possibly allowing organizations like OHSU to provide the coursework portion of the training requirements in settings where a large educational infrastructure is not available.

Professional recognition is important for any discipline, especially within medicine. This includes the growing number of informatics practitioners. Within medicine, the best approach to professional recognition is formal board certification. To that end, I look forward to seeing the specialty approach develop and thrive. As I am personally still board-certified in internal medicine, I hope to be able to become subcertified in clinical informatics myself.

References

[1] Detmer, D., Munger, B., et al. (2010). Clinical informatics board certification: history, current status, and predicted impact on the medical informatics workforce. Applied Clinical Informatics, 1: 11-18.
[2] Cassel, C. and Reuben, D. (2011). Specialization, subspecialization, and subsubspecialization in internal medicine. New England Journal of Medicine, 364: 1169-1173.
[3] Gardner, R., Overhage, J., et al. (2009). Core content for the subspecialty of clinical informatics. Journal of the American Medical Informatics Association, 16: 153-157.
[4] Safran, C., Shabot, M., et al. (2009). ACGME program requirements for fellowship education in the subspecialty of clinical informatics. Journal of the American Medical Informatics Association, 16: 158-166.

First Year of the OHSU University-Based Training (UBT) Program

It has been a little over a year since Oregon Health & Science University (OHSU) was awarded two grants from the Office of the National Coordinator for Health IT (ONC) Workforce Development Program. Activity on these projects has been a major part of the work in our department, and certainly of my time, over this period. In this posting, I will report on our University-Based Training (UBT) Program. In a later posting, I will report on our work on the other funded project, the Curriculum Development Centers/National Training & Dissemination Center Program.

OHSU was one of nine universities (or consortia thereof) awarded a UBT grant. We have met all of our goals and timelines so far for the project. The gist of our funded proposal was to enroll students into our Graduate Certificate and Master of Biomedical Informatics (MBI) programs, with additional course requirements based on the specific ONC workforce roles. As OHSU is on an academic quarter system, Graduate Certificate (classified by ONC as Type 1) students are expected to complete the program in an accelerated part-time status in four quarters (one year) while MBI (classified by OC as Type 2) students are expected to complete the Master's program in six quarters (one and a half years) as full-time students. We were awarded $3.08 million to fund 135 Type 1 and 13 Type 2 students over three years through 2013. The "ad" on this page links to the Web page describing the program.

We accepted 12 Type 1 students to start in the summer quarter of 2010, with 11 of those students expected to graduate in June, 2011, along with two additional students who completed the program in an accelerated manner. We will also have one Type 2 student graduating in June, 2011. These 14 graduates will be eligible (and encouraged!) to attend the OHSU June 6, 2011 Commencement.

We have an additional 74 Type 1 students in the pipeline who started the program in the fall (34), winter (26), and spring (14) quarters. These students, along with eight Master's students, are for the most part on track to graduate on time.

The students we have accepted have a great deal of geographic and occupational diversity. Similar to our distance learning program in general, our UBT students reside all across the United States. (We actually have distance learning students living in 40 states as well as six countries.) Our UBT students reside in 20 different states, with some over-representation in our region, probably reflecting proportions of applicants. Those states with more than one student in our UBT program include:

• Oregon - 39 (49%)
• Washington - 7 (9%)
• California - 4 (5%)
• New York - 4 (5%)
• Texas - 3 (4%)
• Maryland - 3 (4%)
• Tennessee - 2 (3%)
• Utah - 2 (3%)
• Virginia - 2 (3%)
• Minnesota - 2 (3%)
• Wisconsin - 2 (3%)

Our students also come from many diverse career backgrounds. While the majority come from healthcare fields, a decent-sized minority do not, and some have highly technical backgrounds who are coming to learn how information technology is applied in healthcare settings. The backgrounds with more than one representative include:

• Medicine (Physician) - 16 (20%)
• Nursing - 13 (16%)
• Business/Management - 10 (13%)
• Liberal Arts/Humanities - 6 (8%)
• Computer Science - 6 (8%)
• Public Health - 4 (5%)
• Biochemistry/Biology/Chemistry - 4 (5%)
• Finance/Accounting - 2 (3%)
• Health Information Mgmt - 2 (3%)
• Healthcare Management/Administration - 2 (3%)

Our students also have a variety of highest degrees, with over half having a graduate-level degree already. The distribution of highest degrees is as follows:

• Bachelors - 34 (44.1%)
• Masters - 24 (31.1%)
• MD - 16 (20.8%)
• PhD - 3 (3.9%)
• Other healthcare doctorate - 1 (1.3%)

One of the challenges we have faced is the competitive admissions process. We have had many more qualified applicants than we have funded positions for, so we have not been to fund some highly qualified applicants. The rate of acceptance has been 34 out of 162 (21.0%) for the fall, 26 out of 102 (25.5%) for the winter, and 14 out of 73 (19.2%) for the spring.

Moving forward, we are on track to have an additional 34 Type 1 graduates at the end of the summer quarter in early September, 2011. On September 9-10, OHSU plans to hold an informatics program reunion event, celebrating the 15 year anniversary of our first informatics degree program and the first graduates of our UBT program. Additional students will graduate later this year and into 2012, including our initial cohort of MBI students.

All told, we have committed 78 of our 135 (57.8%) Type 1 slots and eight of our 13 (61.5%) Type 2 slots. We are taking the summer quarter off for new admissions and will be admitting Type 1 and Type 2 students starting again in the fall quarter. We will award the rest of our funded slots during the 2011-2012 academic year, aiming to have everyone complete the program by the end of grant in April, 2013. During this time, our existing program is still operational, and those not awarded UBT funding can still enroll as self-funded students.

We have also implemented practicum (for Graduate Certificate students) and internship (for Master's students) programs . These programs are being administered by an Internship Coordinator whom we have hired. Students are required to find their own practicum or internship, although we help them however we can. The hosting organizations so far include health care organizations, regional extension centers, and vendors.

Another hire is our career counselor, who will help students identify and apply for jobs. We also hope this individual will collaborate with the internship coordinator as well as lay the foundation for continued relationships with employers beyond the end of the UBT funding.

All told, we are pleased with what we have accomplished in the ONC UBT program. We hope this will lead to a sustainable increased interest in biomedical informatics education and careers beyond the end of the grant itself.

Professional Science Masters: The Direction for Masters-Level Professional Degrees in Informatics?

This week, the Department of Medical Informatics & Clinical Epidemiology (DMICE) of Oregon Health & Science University (OHSU) is hosting a regional workshop focused on Professional Science Masters (PSM) degrees and programs. While attendees will come from across the Pacific Northwest, the Oregon University System (OUS) is moving forward with development of a statewide program. We are interested in exploring whether our Master of Biomedical Informatics (MBI) might fit the bill to transform into a PSM. For more information on what a PSM is, see their Web site.

PSM programs are professional science degrees with three additional attributes:

1. "Plus" courses that provide the student skills for working in industry settings, such as business and management, writing and communications, and others
2. A rigorous internship program that replaces the traditional master's thesis or capstone
3. Guidance by an external advisory committee from industry that oversee the curriculum and/or participate in the internship program

DMICE offers graduate-level programs in the field of biomedical informatics. Although we are not formally a PSM, our existing programs, especially our MBI degree, have many of the attributes required of a PSM, namely the "plus" courses, an internship program, and an external advisory committee. We changed an MBI program requirement last year that allows a structured internship to be acceptable as the program capstone.

We were actually exploring the PSM option when the large amount of funding from American Recovery & Reinvestment Act (ARRA) for investment in health information technology came along and sidetracked these efforts. Of course, our Office of the National Coordinator for Health IT (ONC) University-Based Training (UBT) grant has many conceptual overlaps with the PSM concept, with its goal of producing informatics professionals who will develop, implement, and lead electronic health record (EHR) adoption in healthcare settings.

Of course, our informatics program is focused on more than EHR adoption, even though that is the largest need. But there are plenty of other critical needs for informatics in health and biomedicine, including in genomics, clinical and translational research, public health, consumer health, and even other clinical applications, such as telemedicine. As the UBT program reaches a steady state, and with it winding down in 2013, we are now reconsidering again the transformation of the program to an official PSM. This week's workshop will help inform our next steps.

Overview of the OHSU Biomedical Informatics Program

People sometimes ask me for a big picture overview of all the programs available in the Biomedical Informatics Graduate Program in the Department of Medical Informatics & Clinical Epidemiology (DMICE) at Oregon Health & Science University (OHSU). I provide that in this posting.

Biomedical informatics is the field that uses information and related technologies to advance individual health, healthcare, public health, and biomedical research. Students enter with a variety of backgrounds and upon graduation take jobs in a diverse array of settings, including healthcare organizations, industry, research labs, and public health agencies. The OHSU program has offerings along many dimensions.

One dimension is the degree/certificate type:

• Doctor of Philosophy (PhD) in Biomedical Informatics
• Master of Science (MS) in Biomedical Informatics
• Master of Biomedical Informatics (MBI)
• Graduate Certificate (GC) in Biomedical Informatics

A second dimension is the program track:

• Clinical Informatics (CI) - focus on health care, individual health, and public health
• Bioinformatics and Computational Biology (BCB) - focus on computational aspects of genomics and molecular biology, especially their relation to human health
• Health Information Management (HIM) - focus on Registered Health Information Administrator (RHIA) certification

A third dimension is whether the program is on-campus (oc) or on-line (ol), although the two can be co-mingled, especially by local students in the Portland area. The GC program can be done completely on-line, while the MBI program done on-line requires the student to take two on-campus "short" (one week) courses.

The following table shows the degree/certificate and track dimensions, with each cell indicating whether or not the program is offered on-campus or on-line.

Track Degree	CI	BCB	HIM
PhD	oc	oc
MS	oc	oc	oc
MBI	oc/ol	oc	oc/ol
GC	oc/ol		oc/ol

Where does the 10x10 ("ten by ten") program fit into this? The 10x10 curriculum is essentially equivalent to the introductory course (BMI 510) in the CI and HIM tracks.

More information is available on our program Web site: http://www.ohsu.edu/informatics/