Mapping the AMIA Clinical Informatics Core Content into the OHSU Biomedical Informatics Curriculum

One of the most exciting developments in the clinical informatics field in recent years has been its designation as a new medical subspecialty. Even if one is not a physician, the professional recognition of the work of clinical informatics is important. Hopefully we will see others who work professionally in informatics achieve comparable professional recognition. Indeed, AMIA has established an Advanced Interprofessional Informatics Certification Task Force to explore the best approaches for certification of non-physician informaticians.

Another valuable outcome of the clinical informatics certification process was the development of the core content for the clinical informatics subspecialty (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. http://jamia.bmj.com/content/16/2/153.full.pdf+html.). This content is by no means limited to physicians and should serve as the basis for the curricular content for all clinical informatics programs.

We recently undertook an analysis of the curricular content in our Biomedical Informatics Graduate Program at Oregon Health & Science University (OHSU) to see how our existing courses mapped into the AMIA core content. We were pleased to discover that just about everything in it is covered by one or more courses in our master's degree program. We are planning to undertake a more detailed analysis in the future to make sure our curricular materials are covered adequately and reflect the most state-of-the-art content. But in the meantime, I am pleased to report that we will be ready to provide education for certification in the field when such programs are ready to be launched. The results of this analysis can be viewed in this PDF file.

Search Industry Track at SIGIR 2012

Although the entirety of the ACM SIGIR 2012 conference, from tutorials to cutting-edge research, will be of interest to those concerned with search systems and algorithms, the Industry Track on the Wednesday (August 15) of the conference will likely be of most interest to those in “tech” industry. In the Industry Track, a series of speakers from all of the major search vendors, most of whom are also sponsors of the conference, will present on their latest works. More information on this track is available, as is information on the conference itself from a local perspective.

The opening speaker of the Industry Track will be Eric Brown of IBM Research, who will present an overview of IBM’s Watson and the DeepQA technology upon which it is built, and explore future applications of this technology. Another speaker will be Andrei Broder of Google, who will discuss the growing field of “computational advertising,” i.e., how algorithms use the context of the user and his or her search terms to display the most appropriate “sponsored” pages. Also speaking will be Daniel Rose of A9.com, a subsidiary of Amazon.com, who will discuss the “democratization” in their new CloudSearch service.

Among the other speakers will be search industry veteran, Sue Dumais of Microsoft, who famously said in 2007 that if search was still using user-entered text boxes in ten years that she should be fired from her job. She will describe the twin problems of putting user context into search as well as putting search into the user’s context. (We are halfway there in 2012 and still using search boxes; maybe someone will ask if she worries for her job!)

Other Industry Track speakers will include John O’Neil of Attivio (Entity Sentiment Extraction Using Text Ranking), Ilya Segalovich of Yandex (Making Web Search More User-Centric: the State of Play and the Way Ahead), and Azarias Reda and colleagues at LinkedIn (Related Searches at LinkedIn).

The track will wrap up with the 2012 Industry Panel consisting of four distinguished panelists who will be asked to represent the likely viewpoint of a particular group or “vertical” while responding to a series of questions notified in advance.  Trystan Upstill of the Search Quality Team at Google will represent “large scale web search”; Jerome Pesenti, Chief Scientist at Vivisimo / IBM, will represent “enterprise search”; Krishna Gade, Engineering Manager at Twitter will represent “real-time and social search.” Stephen Robertson, Emeritus Professor at City University, London and Microsoft Research will represent “academic research” and Diane Kelly, University of North Carolina Chapel Hill and author of an influential monograph on user-involved evaluation, will take the all-important perspective of “users.”  The audience, too, will have their say!

Update on the OHSU ONC University-Based Training Grant

Just as the end of the ONC Health IT Curriculum project is in sight, so is the end of the ONC University-Based Training (UBT) Program. OHSU's UBT grant to train 135 Graduate Certificate and 13 Master of Biomedical Informatics (MBI) students is entering its home stretch.

We have filled all of our UBT slots available for funding, which means that no further students will be funded by this mechanism. We have graduated about half of those who entered the program, i.e., 65 (of 135) Graduate Certificate students and 5 (of 13) MBI students. The remainder will graduate by the end of the grant in June, 2013. As noted in an earlier posting (and additionally below), we have had many success stories from our graduates.

Between the new careers we have enabled our graduates to have, as well as the new positions we have been able to create for faculty and staff in the program, I have no qualms in saying our program is a "job creator."

The UBT program has also been invaluable to the larger OHSU biomedical informatics educational program. It has provided resources allowing the expansion of services by our program, including a practicum and internship program as well as career counseling. In fact, a major goal for our program in the coming year is to find a way to sustain the infrastructure that the ONC grant has allowed us to develop.

Another notable accomplishment for the program was two of our UBT graduates being invited to attend a special two-day event at the Department of Health and Human Services (HHS) and the White House over June 18-19, 2012. The 200 invited attendees included physicians, other healthcare providers, informaticians, vendors, and government officials. The two OHSU attendees were MBI graduate Larry Bannister and Graduate Certificate graduate Dr. Mark Johnson, both of whom reported back as provided below.

Larry Bannister

Mr. Bannister, working formerly in the IT industry, has a position with the Certification Commission for Health Information Technology (CCHIT) in Chicago, IL as a Test Manager. He reported back from the event:

On the first day of the “festivities” here in D.C., we went to the U.S. Dept. of Health and Human Services (HHS). This is housed in the Hubert J. Humphrey Building, which is just a block away from the White House. We started with a  “meet-and-greet” affair for the participants to mingle and for all of us to meet various ONC officials. I met another Oregonian, Dr. DeOna Bridgeman, and we had our picture taken with Dr. Farzad Mostashari. Pretty cool. I also met another OHSU graduate from the biomedical informatics program, Dr. Mark Johnson, and we compared notes about our experiences in the program. After this, we were ushered into a room where you could imagine many a high-powered press conference was given and we heard interesting things about what the ONC is doing to increase the awareness of health IT. Dr. Mostashari gave a very interesting and motivating speech, which was followed by an appearance and speech by HHS Secretary Kathleen Sebelius. The mood throughout the whole event was very upbeat. I know this is an odd thing to say, but I think these folks really, really like what they are doing and seem to be caught up in the excitement of being part of a “movement.” I guess, since I am an HIT person too, I am as well. And, I might add, it is a bipartisan movement, at least from my perspective. Us Republicans see the benefit of HIT and pin many hopes on it as well.

We ended the day by going to various breakout sessions. The session I went to was on “Interoperability & Exchange.” We ranged all over those topics, but the most interesting thing to me was concerning the S&I Framework. This framework, based on the Direct standard, is basically a process for qualifying various entities that want to become participants in an HIE of some kind. Although they have gone down the road a ways, especially in the east coast states, they are also working on another model, the Nationwide Health Information Network, or NwHIN, which is based on the Exchange standard. The ONC recently issued a governance RFI in which they solicited feedback from the HIT community at large concerning NwHIN, and so they solicited comment from us too. However, it was mostly physicians there, with a few policy wonks and just a few technical folks (like me), so although they solicited feedback on the RFI, what the crowd wanted to talk about was:  1) trust issues as the basis of success for HIE’s, 2) payment models that held back most MDs and hospitals from getting on board, and 3) for those MDs and organizations that were onboard, how the current Direct project was so lame and cumbersome (their experience being with portals a.k.a. HISPs). Anyway, they urged everyone to read the “66 questions”  from the RFI and chip in their two cents. I think that is a very good thing for any HIT person to do, as well, since it will probably affect us in the future. After the session broke up we continued to talk amongst ourselves for at least a half hour – everyone was so interested in what others were doing.

On the second day we went to the White House. On that day, ONC announced that over 110,000 eligible physicians and over 2400 eligible hospitals had received meaningful use incentive payments. It was an interesting experience, just getting into the White House. The meeting was held in one of the three (or is it four?) buildings that make up the White House, i.e., the Eisenhower Executive Office Building. Security was tight getting in, just as you would expect, but we had to wait outside in stifling heat and humidity for a while since there were so many of us to process through. My suit was pretty wrinkled and sweaty before I finally sat down in the air-conditioned room where we had our meeting. Just as the day before, we heard some opening comments by Dr. Mostashari and other ONC/HHS officials, but then we had a town-hall session where people from the audience were given time at the microphone and had their say. Dr. Mostashari moderated this and kept us on task and on time.

The topics ranged all over the place so I can’t focus on any one in particular, but they mainly focused on HIE experiences, usability, and war stories. Here are just a few that I took notes on:

• “All RHIOs are not the same” was the opening comment. One MD from Colorado complained about how his HIE experience was dismal and expensive and wondered what could be done better
• A number of physicians related success stories about how they made HIEs work well. Dr. Larry Garber from Massachusetts related how their EHR interfaced to 5 different hospitals, multiple health plans and specialty practices and did such magical things as automatically incorporate both labs and notes from a patient’s ER visit into their medical record
• There seemed to be just as many stories about how peer-to-peer interfaces came up faster and worked better as there were stories concerning coordinated HIE efforts using Exchange.
• A number of calls for standards for things as diverse as: vendor-neutral medical record exchange; history & physical documentation; a single HL7 standard that meant the same thing to everyone;  a standard for alerts and finally, usability standards.
• A number of different funding models for HIE were discussed:  government funding models, payer-funded models and shared payer-physician-vendor split funding models, to name a few.
• Most interesting to me was the story of a group practice that had created a large general –purpose, table-oriented templating system that was easily customizable to produce notes/documentation at any level of detail for each provider’s requirements for their medical documentation.
• Usability popped up again when someone called on vendors to consider usability issues at the very earliest stages of system design and then there was a short diversion into the “geek gap”.  Someone said that EHRs shouldn’t be designed by “propeller heads” (which even though I’m a software engineer, I heartily agree with) but rather, it has to be a well-coordinated, collaborative process.

Anyway, I could not take notes on all that was being said – I was just fascinated and caught up in the moment so often.  It was great and I left feeling really jazzed about the future of this field. There are some exciting times ahead and I’m glad to be part of this thing, myself.

Mark Johnson

Dr. Johnson was formerly a Staff Physician in Critical Care Medicine at the University of Wisconsin Hospital and Clinics. Since obtaining his Graduate Certificate at OHSU, he has joined the Carle Clinic in Urbana, IL as a critical care physician and informatician. Dr. Johnson reported:

It was both an honor and a humbling experience attending events at the White House, ONC, and HHS.  With recent completion of a critical care fellowship at University of Wisconsin-Madison, and a Graduate Certificate in clinical informatics at OHSU (funded by the ONC), I have been uniquely positioned to be a clinician leader in the realm of health IT and the ICU. This led to multiple job offers and acceptance of my dream job (combining health IT and critical care) near family and my alma mater in Urbana, IL. I was thrilled to share my story with others around the nation.

During the flight to DC, I wrote down some of my hopes and worries about the trip. Hoping to: connect with others, share thoughts on redesigning the healthcare system, be a part of the national health IT agenda and synchronize my own career with the timetable and aligned goals. Worried that: I may not fit in, be behind the times, and be too closely tied to a single vendor.

On June 18th, I arrived at the HHS building and mingled with other “Health IT Vanguards,” as the ONC dubbed us. There I met Larry Bannister, another OHSU trainee, and heard about how he was able to retool, combining his IT experience and biomedical informatics training to secure a position at CCHIT, an important entity in the health IT world. I also met a young surgical trainee from Duke, a primary care physician from Oregon, and others. The room had a lot of energy from the “Vanguards” as well as the ONC leadership. I was excited to meet Dr. Farzad Mostashari, National Coordinator for Health IT, and share my story. I thanked him (and ONC) for the training grant.

Next, we were ushered to an auditorium, with speeches from Dr. Mostashari and the Secretary of HHS, Kathleen Sebelius. I was impressed that they seemed tapped into what was going on around the nation. Dr. Mostashari spoke about us as vanguards and our ability to “walk through walls”, to breakthrough barriers to get things done. And he spoke about aiming toward a “healthcare system that does right,” noting, “we don’t always do it right but we always try to do it right.” Secretary Sebelius spoke about how government creates conditions, and creates paths, and that we should share our stories so that others may follow our paths, and to “keep pushing forward.”

These speeches were followed by media training, on how to effectively share our stories with the media. Breakout discussions capped of the event at HHS, and I attended the “Leveraging Health IT for Quality Improvement” discussion. Here I highlighted that there was much knowledge in the room, and across health systems (in regards to how best implement health IT), but there was no system to share this knowledge. Also that ONC can serve as a lever/feedback mechanism to the vendors.

The next morning was the main event at the White House complex. Here was a broader speech by Dr. Mostashari, panelists from around the nation, and a lively Q&A session. Key topics discussed included health information exchange, usability, vendor relations, and “moving beyond the data.” Key quotes that I wrote down included from a vendor “we want ONE standard,” and “ONC needs to hold their [vendor’s] feet to the fire.” From a health IT clinician “culture eats strategy for lunch.” From Dr. Mostashari re: HIE “lots of different models work,” we need to stop “hand fitting pipes,” and set “common rules of the road.”

In summary, the event was enlightening in how government works, what the nation’s agenda is moving forward, and a first-hand sample of what is going on around the country. Most of my hopes leading up to the event were realized and the worries were allayed. I was thrilled to be a part of the event, and feel called to continue working toward a health system that does right. This adventure continues locally in my new position in Urbana, IL and will unfold as I build on my ONC funded training at OHSU.

Below are pictured two of the ONC Health IT Vanguards, Mr. Bannister (left) and Dr. Johnson (right).

The entire ONC Workforce Development Program has been beneficial to our students, our program, and our country. I recently had the opportunity to write an overview of the ONC Workforce Development Program two years into the program for the HIMSS Clinical Informatics Insights publication.

Postscript: The White House visit by the OHSU students was also covered in the online School of Medicine News.

Where Do OHSU Biomedical Informatics Students Live?

We have always known that OHSU students in the distance learning biomedical informatics program live all over the country, and the world, but thanks to Dr. David Dorr and Kelly Jones-Weir, we now have a graphical depiction of their distribution across the United States. Each dot (star) in the figure below represents where one student lives.

The concentration of dots in the Portland area represents an interesting phenomenon. We have a number of what we call "local distance" students in the program, who are people that live in the Portland area yet are enrolled in our distance program. For the most part, these individuals prefer the flexibility that the on-line courses offer. Some may have jobs or other obligations during the day when on-campus classes are offered. One nice aspect is that they take part in other program activities, such as our local research conferences and other events.

In addition to students from the US, we also have students from a number of different countries. Some of these students come to Oregon to study but others are distance learning students (who even come on-campus for our hybrid short courses, as all master's students must do). The countries with one or more students in the program include:

• Argentina
• Australia
• Canada
• Egypt
• India
• Israel
• Kuwait
• New Caledonia
• Saudi Arabia
• Singapore
• Thailand
• United Kingdom
• Zimbabwe

While our program is somewhat US-centric, since those who practice informatics in the US must understand the nuances (some might say craziness) of the US healthcare system, I have also noted in the past that many informatics problems and solutions are global in their nature.