Friday, June 24, 2011

Public Rollout of the ONC Health IT Curriculum

This week was a major milestone for the Office of the National Coordinator for Health IT (ONC) Health IT Curriculum project. The curricular materials that were developed for the 82 community college programs to rapidly expand the health IT workforce were released to all educators and the public at large. In this posting, I will provide the context for this project and describe what it is not before delving into the details of what the curriculum contains.

The ONC Health IT Curriculum is one of four programs in the overall ONC Workforce Development Program. The overall program was specified by Section 3016 of the Health Information Technology for Economic and Clinical Health (HITECH) Act, the portion of the American Recovery and Reinvestment Act (ARRA), also known as the federal stimulus bill. ONC operationalized the program by designating 12 workforce roles, with six to be educated in the six-month community college programs and six to be educated in 1-2 year programs in universities. The primary audience for the curricular materials are the community college programs.

Five universities were funded under the $10 million project as Curriculum Development Centers: Oregon Health & Science University (OHSU), Columbia University, Duke University, Johns Hopkins University, and University of Alabama-Birmingham. Each center prepared four components each. One university, OHSU, was additionally funded to serve as the National Training & Dissemination Center (NTDC), given the additional tasks of developing the dissemination Web site, training community college faculty in use of the materials, capturing feedback, and providing technical support. The curricular materials are now available for download by the public on the NTDC Web site, although the feedback and support functions are limited to the 82 community colleges.

The curricular materials are not a certificate or degree program out of the box. Rather, the content should be thought of more like a library (or, to use the words of ONC Chief Science Officer Charles Friedman, PhD, a "buffet") from which educators can pick and choose content for their courses. The materials alone will not substitute for formal education, as good education still requires teachers, mentors, and fellow learners with whom to interact (whether in-person or on-line). However, the matierlals will be a valuable resource for a wide variety of educational activities in health IT. As the director of a graduate program in biomedical informatics, I know that OHSU will adopt some of these materials in its own graduate-level educational program (just as some of the curricular content came from our existing program).

The curricular materials consist of 20 components, each of which is comparable in depth to a college course. The components are subdivided into 8-12 units, each of which contain a variety of activities appropriate to the topic, including voice-over-Powerpoint narrated lectures, references, suggested readings, exercises, and more. 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
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 also contains a blueprint document that provides an overview of the learning objectives and content for each unit. All of the components also have an instructor's manual that provides more detailed information, including listing of authorship and teaching information. The full set of blueprints have been rolled into a single PDF portfolio and are available on the ONC Web site.

Three of the components are "lab" components that make use of an educational version of the Veteran's Administration (VA) VistA EHR. A version of VistA that runs under various versions of Microsoft Windows is provided on the Web site, courtesy of the VA. However, this version will not be usable by everyone, as it requires a license for the Intersystems Cache environment, which is freely available to academic institutions but not others. Nonetheless, the materials will still be valuable to others who can adapt the exercises for other EHR systems.

All told, the curricular materials are a comprehensive resource. The entire collection of material is 7.5 gigabytes in size (6.75 gigabytes compressed) in 12,339 files. The 20 components contain 213 units, 460 lectures (some units have more than one lecture), 8913 slides, and 125.9 hours of lecture audio. In the collection are 460 Powerpoint files, 460 MP3 files, 465 PDF files, and 1346 Microsoft Word files.

We call this publicly available version of the curricular materials Version 2. It has been available to the ONC Community College Consortium for two months, and supersedes the original Version 1 provided to consortium members last year. The materials are distributed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License. This means that all users of the curriculum can use, share, and adapt the materials but must attribute the originator of work, use the materials only for non-commercial purposes, and share any changes made under same license. Per the ONC, universities own the intellectual property for their components.

The support for the public rollout of the curricular materials will be minimal. This is in part because the funding does not have the resources to provide that support but also because these materials are aimed at educators who will adapt them into their own courses and other educational activities.

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.

The final program in the is the University-Based Training (UBT) program, which funds training in the other six workforce roles deemed to require longer training at the university level. Nine universities or consortia thereof, including OHSU, were funded under this program. As noted elsewhere, OHSU recently had its first graduates from its UBT program, with many more in the pipeline.

The Curriculum Development Centers and ONC do not plan to rest on our laurels. We know there are many areas where Version 2 can be improved, and fortunately the two-year project includes additional funding to provide for a Version 3 that will be delivered in 2012. A planning process is underway to improve the content and technical aspects of Version 2, along with reducing its gap and overlaps.

It has been gratifying to be part of this project, which has consumed a great deal of my life since the project began in April, 2010. I have enjoyed all of the roles I have played, as Director of the NTDC, Director of the OHSU Curriculum Development Center, and author of several units. I will look forward to feedback about Version 2 and suggestions for enhancements in Version 3. How to sustain the curriculum once the ONC funding ends is also a key concern.

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