Tuesday, September 4, 2012

What is "DMICE," a "Track," a "Certificate?" The Jargon of the OHSU Informatics Program

In my paper that gave my definitions of the terminology of the biomedical and health informatics (BMHI) field, I noted the challenge of how confusing all the jargon could be. I realize now that this problem is exacerbated by the additional jargon we add on top of it in our educational program at Oregon Health & Science University (OHSU). Unfortunately, the complexity of our program makes there no simple solution, and the best approach is to try to define the jargon as simply and succinctly as possible.

So let me start with the first sub-question in the title of this post: What is DMICE? DMICE is the Department of Medical Informatics & Clinical Epidemiology, which is one of 26 academic departments in the School of Medicine at OHSU. A public university in the state of Oregon focused mostly on the health sciences, OHSU has Schools of Medicine, Nursing, and Dentistry, along with a School of Pharmacy administered jointly with Oregon State University. DMICE sits among other more traditionally named departments in the OHSU School of Medicine, such as Medicine, Surgery, and Medical & Molecular Genetics. As Chair of DMICE, I report to the Dean of the OHSU School of Medicine.

As in most departments in universities, DMICE has a wide variety of educational and research programs. One of those is the Biomedical Informatics Graduate Program. This is the umbrella term used to describe all of the educational programs dealing with informatics and related disciplines in DMICE. The program is offered at graduate level, i.e., students must have a baccalaureate degree to be admitted.

The Biomedical Informatics Graduate Program features several tracks, each of which represent a focus of study within BMHI. The tracks are partially overlapping, representing our view that our overall program is focused on the larger BMHI, even though students and professionals work within specific areas of the field.

Before there were tracks in the program, the original focus of the program was in clinical informatics, which was originally called medical informatics. We prefer to call this portion of the program the clinical informatics track now, which indicates its broader focus beyond informatics related to the work of medical doctors. Clinical informatics includes other branches of healthcare and even areas beyond the healthcare system, such as consumer health informatics. The clinical informatics track of our program focuses on informatics delivered mainly at the level of individual, whether in the role of a patient or as a consumer outside of the healthcare system.

The second track of our program, the bioinformatics and computational biology (BCB) track, has more of a focus on informatics at cellular and molecular level. The term bioinformatics refers to a focus on genomics and related areas, while the computational biology term indicates a strong emphasis on computational methods.

We recently added a third track to the program, the health information management (HIM) track. There is actually substantial overlap between HIM and clinical informatics, recognizing that HIM is evolving from management of paper records to electronic records. HIM has a different history from informatics as a so-called allied health profession, but it is increasingly moving toward electronic data systems in healthcare, i.e., clinical informatics. Our HIM track is accredited by the Commission on the Accreditation of Health Informatics and Information Management (CAHIIM), and students completing the program are eligible to sit for the Registered Health Information Administrator (RHIA) credential.

One of the advantages of the system of tracks is the ability to add additional tracks. I would like to see us add in the future a track for public health informatics, which would certainly have overlap with the clinical informatics and probably the others as well.

The tracks in our programs offer various degrees and certificates. One degree offered by all of the tracks is the Master of Science (MS). This was the original degree offered by the program and is a traditional research master's degree, which culminates in a thesis. The clinical informatics and HIM tracks also offer a non-thesis master's degree, sometimes referred to as a professional master's degree, the Master of Biomedical Informatics (MBI). The MBI has the same curriculum as the MS but replaces the master's thesis with a less-intensive capstone project. We also allow the capstone project to be an internship experience where the student gains real-world experience in an operational setting, such as a healthcare organization or a company.

Perhaps one of the lesser understood credentials in our program is the Graduate Certificate, which is offered in the clinical informatics and HIM tracks. Unlike master's degrees (which actually vary greatly but represent a generally known quantity), certificates between and even within different fields vary substantially. In many disciplines, the term Graduate Certificate is coming to represent a graduate-level educational experience that is not quite as much as a master's degree. In some universities, a Graduate Certificate is part of a continuing education or professional development program, sometimes even distinct from the graduate program. In our program, the Graduate Certificate is properly viewed as a subset of our master's degree (even though the eight three-credit one-quarter courses are enough to be a master's degree in some institutions). Students in the Graduate Certificate program take the same courses as those in the master's degree, only fewer of them.

The Graduate Certificate was developed when we first started offering distance learning courses in what we then called medical informatics. We thought that many of the students in our program who already had doctoral degrees would not be interested in a whole master's degree. Over time we did find that some were interested in a master's degree, so eventually expanded the distance learning offerings to that level.

Our graduate program also offers a Doctor of Philosophy (PhD) program in the clinical informatics and BCB tracks. (In reality, someone in the HIM track could progress to the PhD level in the clinical informatics track.) Just as the Graduate Certificate is a subset of the master's degree program (for the clinical informatics and HIM tracks), the master's degree programs are in turn a subset of the PhD program. We call the master's curriculum within the PhD the knowledge base, to which students add advanced research courses and a dissertation.

Because the higher-level programs are supersets of the more basic programs, we call this the building-block model of our program, indicating that students can start at the entry level for a given track and potentially progress all the way to the PhD (if their career goals warrant). The following figure depicts the building-block model of the program.

We also offer fellowship programs at both the predoctoral (PhD student) and postdoctoral (those with a doctoral degree already, who usually pursue a master's degree as a fellow) levels. Those who are fellows are mostly funded by training grants and other scholarships. Our main training grant is funded by the National Library of Medicine (NLM), a institute within the National Institutes of Health (NIH). In some ways, the fellowship program is a form of financial aid, as except for the funding provided and a work area, we treat fellows no different from other students.

There is some additional jargon from our program to round out this discussion. One is the 10x10 ("ten by ten") course. The 10x10 course is a program we started in partnership with our professional association, the American Medical Informatics Association (AMIA), in 2005. Its name was based on an estimated need to train 10,000 physicians and nurses (one each in all of the 5000+ US hospitals) in informatics by the year 2010. Of course we encouraged others, even non-healthcare professionals, to enroll in the course. The reason for mentioning the course here is that its curriculum is identical to the introductory course in the OHSU clinical informatics and HIM track, BMI 510 - Introduction to Biomedical & Health Informatics. In fact, those who complete the 10x10 course (which is a continuing education course) can optionally take the BMI 510 final exam and, if they obtain a grade of B or better, receive credit for BMI 510 in our graduate program. About 30% of the 1300+ people who have completed the 10x10 course have done so, and many have gone to further courses in the program. In fact, because of the building-block model, some of have progressed up from the Graduate Certificate to the master's degree programs and in two cases all the way to the PhD program.

Another item of jargon is the clinical informatics subspecialty. This refers to the new subspecialty for physicians that was recognized by the American Board of Medical Specialties in 2011. While plans for the certification process and training programs are still under development, this will represent a career pathway for physicians that gives professional recognition for the work they do in informatics. Unlike any other subspecialty in medicine, it will be available to physicians from all primary specialties, such as Medicine, Surgery, Radiology, and Pathology.

I hope this post clarifies and demystifies some of the confusing jargon of the informatics field and the educational program at OHSU. There is no easy answer to simplifying all this terminology, since there are so many distinct paths and credentials within the field. The approach is to try to understand it all from a comprehensive framework like the one I laid out here.


  1. The Graduate Certificate is difficult to explain to peers and potential employers- and I have one!
    We need a better explanation and appreciation for this level of education and expertise.

    1. Thanks Joel, and I agree with you. My preferred explanation of the Graduate Certificate for our program is a subset of the master's degree that includes the core of informatics. The credential is designed mainly for those who already have enough other credentials (e.g., MD or other doctoral degree), although we have plenty of graduates without further advanced degrees who have become CIOs and other health IT leaders.