Additional OHSU Contributions to Clinical Informatics Subspecialty Training

In addition to having our own clinical informatics fellowship, Oregon Health & Science University (OHSU) will be contributing to training in the subspecialty in other ways. One of main activities by which we will be contributing will be through providing courses in our biomedical informatics distance learning program to other programs. This is actually something we have been doing for a number of other university programs for several years, and now we are excited to do it for clinical informatics fellowship programs.

Our approach will be straightforward, as fellows in other programs will enroll as OHSU distance learning students. In discussion with colleagues directing the programs that will take part, the emerging preference for them appears to be our Graduate Certificate Program, which requires eight academic-quarter three-credit courses. Trainees will take one or two courses at a time. We also hope to enroll students from participating programs as a cohort and provide interactive opportunities for fellows in our program and those from other institutions who take our courses.

We anticipate fellows will be interested in a variety of our courses that are offered online, though have designated five courses as core to their studies, indicated by asterisks below:
BMI 510 - Introduction to Biomedical and Health Informatics*
BMI 512 - Clinical Information Systems*
BMI 513 - Electronic Health Record Laboratory
BMI 514 - Information Retrieval
BMI 515 - Ethical, Legal and Social issues in Biomedical Informatics
BMI 516 - Standards and Interoperability in Healthcare
BMI 517 - Organizational Behavior and Management*
BMI 518 - Project Management*
BMI 519 - Business of Healthcare Informatics*
BMI 520 - Consumer Health Informatics
BMI 521 - Public Health Informatics
BMI 523 - Clinical Research Informatics
BMI 537 - Healthcare Quality
BMI 544 - Databases
BMI 548 - Human-Computer Interaction
BMI 549 - Health Information Privacy and Security
BMI 560 - Design & Evaluation in Health Informatics

In order to help program directors determine the best course of study for their fellows, we have mapped all of our courses to American Board of Preventive Medicine (ABPM) core content in clinical informatics. For each course, the linked document shows whether the core content item is covered by lecture (L), article (A), reading (R), book (B), and/or exercise (E). The first five columns, highlighted in yellow, represent the content of the core courses as defined above. (We offer even more courses than this, some of which are only offered on-campus, but the entire list can be found in our course catalog.)

One question I commonly get from Program Directors concerns our tuition costs. Our tuition schedule for the 2014-2015 academic year is shown in the image below. The full cost for eight three-credit courses in the Graduate Certificate program is about $19,000. We hope to add value to that by facilitating interaction among fellows in our program and others.

I look forward to clinical informatics fellowship programs launching and OHSU playing a role in a number of them. Just as our distance learning program has led to a virtual community forming among our entire student population, I hope that a similar group will emerge among clinical informatics fellows.

OHSU Launches Clinical Informatics Fellowship

I am pleased to announce that Oregon Health & Science University (OHSU) is formally launching its clinical informatics fellowship for physicians. We are now accepting applications for those wanting to start in July, 2014. This fellowship does not replace any of our existing fellowships or other educational programs, which include programs for physicians and non-physicians alike, but is another addition to the OHSU family of informatics educational programs.

The OHSU Clinical Informatics Fellowship will provide physicians with training in clinical informatics that will enable them to achieve board certification in the new subspecialty of clinical informatics. The program will follow the format of the guidelines recently published by the Accreditation Council for Graduate Medical Education (ACGME). The fellowship is currently applying to obtain ACGME accreditation, which will be awarded to programs starting later this year. Fellows will divide their time between informatics project work, didactic courses leading to the awarding of the Graduate Certificate in Biomedical Informatics, and clinical practice in their primary specialty. Per ACGME rules, this is a two-year fellowship that must be done full-time and completed on-site at OHSU.

The fellowship is affiliated with the OHSU Department of Medicine, with additional administrative support provided by the OHSU Department of Medical Informatics & Clinical Epidemiology (DMICE). Physicians of all medical specialties may apply. More information has been posted to the DMICE Web site, including a link to the application form.

As defined by the ACGME, clinical informatics is the subspecialty of all medical specialties that transforms health care by analyzing, designing, implementing, and evaluating information and communication systems to improve patient care, enhance access to care, advance individual and population health outcomes, and strengthen the clinician-patient relationship. Eligibility for subspecialty certification is not limited to any particular medical specialty. The new specialty was launched in 2013, with physicians already working in the field able to sit for the certification exam by meeting prior practice requirements. Starting in 2018, this "grandfathering" pathway will go away, and only those completing an ACGME-accredited fellowship will be board-eligible.

This new fellowship does not replace any existing OHSU informatics fellowship or other informatics educational program. It is a new addition to the OHSU family of informatics educational opportunities that includes a graduate program, a research fellowship funded by training grants from the NLM and other sources, and clinical fellowships offered by the Portland VA and Kaiser Permanente Northwest.

OHSU will also be providing educational content to other clinical informatics fellowship programs around the country through our online educational program. I will provide more information about this in the near future.

Who is Using the ONC Health IT Curriculum?

Who are the users of the Office of the National Coordinator for Health Information Technology (ONC) Curriculum? Clearly one audience is the community colleges who were funded by ONC to develop short-term training programs using the materials (82 originally, perhaps fewer now that ONC funding for the community college programs has ended).

Those of us developing the materials always knew there was a much wider audience for them, and this was borne out recently from a discussion thread on the public listserv of the AMIA Education Working Group. In early 2014, a list member posted a simple query: "Please respond to this message if you are using the educational content developed by ONC. It would be helpful to know what content you are using, the courses, and the name of the academic program."

There were a total of 15 distinct replies, and I collated them, removing all the names of those who posted as well as their institutions. The responses indicated a great diversity of users utilizing the ONC curricular materials in a variety of contexts and in different types of training opportunities:

1. We are using the HIPAA and History material in coursework for Psychiatric and Mental Health Nurse Practitioner (MSN) students.
- Assistant Professor, Nursing Informatics Specialty Coordinator, University

2. I use some materials on standards in a course for translational medicine students.
- Professor, Health Informatics, University

3. We are using some materials for a new health informatics course for allied health undergraduates at a university in Botswana.
- Professor, Epidemiology, University

4. I use the instance of the VA's VistA in an EHR lab course.
- Assistant Professor, Department of Medical Informatics, University

5. I used the material to develop a course on health culture and another on IT security for informatics students.
- Professor, Department of Medicine, University

6. Our Health Informatics Program is using the instance of Vista.
- Professor, Nursing Informatics, University

7. I am using sections for developing a Project Management course.
- Assistant Professor, University

8. We are using elements of Components 1 and 2 in an introductory course on the health care system.
- Instructor, Health Informatics Graduate Program, University

9. I am using portions for a Dental Informatics course in a Dental Hygiene Degree Completion Program.
- Instructor, College

10. I am currently developing a health informatics course for MSN Nursing Administration Students and am planning to use some of the lectures.
- Professor, University

11. I am using the Component 10, Fundamentals of Health Workflow Process Analysis and Redesign, in one-semester, 3-credit-hour, completely on-line course.
- Instructor, University

12. I am using it in several graduate courses: 1) Electronic Health Records - 4 unit course - Masters of Health Informatics, 2) Applied Health Informatics - 4 Unit Course - Masters and PhD in Nursing Science and Leadership, and 3) Applied Health Informatics - 4 unit course - Masters Degree Nurse Practitioner and Physician Assistance courses.
- Associate Adjunct Professor, Health Informatics Graduate Program, University

13. We are using the content in our Introduction to Health Informatics course developed as a first course for certificate and graduate students, incorporating video for several of the content areas across the 15 week modules.
- Associate Professor, University

14. ONC educational content has crossed the Pacific Ocean as well. I have used the following content:
A. Bachelor's Program in Information and Communication Technology (ICT) (Health IT Major)
A.1 Parts of Component 12 Units 1-12 for "Quality in Healthcare Organizations" class in the "Introduction to Health Care Systems" course
A.2 Parts of Component 7 Units 2-3 for "Hospital Services & Management" class in the "Introduction to Health Care Systems" course
A.3 Parts of Component 6 Unit 9 for "Departmental Information Systems and Management Information Systems" class in the "IT for Healthcare Services" course
B. Diploma and Master's Programs in Biomedical and Health Informatics
B.1 Parts of Component 1 Units 1a, 1b, 1c, 7a, for "Overview of Healthcare services" class in the "Fundamentals of Health Care and Medical Terminology" course
B.2 Parts of Component 1 Units 3a, 3b, 3c, 3d, 2c; Component 7 Unit 2a for "Operations in the Clinical Settings" class in the "Fundamentals of Health Care and Medical Terminology" course
B.3 Parts of Component 12 Units 1-12 for "Quality in Health Care Organizations" class in the "Fundamentals of Health Care and Medical Terminology" course
- Instructor, University, Bangkok, Thailand

15. I am teaching a course this semester on clinical decision support systems (required for our MS and PhD programs in Health Informatics), so I have borrowed from several of the components: EHR Component, Unit 2 on CDS; HIE Component, Unit 7 on CDS; HIM Component, Unit 5 on CDS
- Professor, University

One challenge for those using the curriculum is the sheer amount of material. Related to this is the lack of an outline of the entire curriculum. I recently had the opportunity to collate all of the components and units within them into a single outline, which I will include in this posting.

ONC Curriculum Topical Outline

1. Introduction to Healthcare and Public Health in the US
1. Introduction and History of Modern Healthcare in the US
2. Delivering Healthcare (Part 1)
3. Delivering Healthcare (Part 2)
4. Financing Healthcare (Part 1)
5. Financing Healthcare (Part 2)
6. Regulating Healthcare
7. Public Health (Part 1)
8. Public Health (Part 2)
9 Healthcare Reform
10. Meaningful Use

2. The Culture of Healthcare
1. An Overview of the Culture of Healthcare
2. Health Professionals – the People in Healthcare
3. Healthcare Settings – The Places Where Care is Delivered
4. Healthcare Processes and Decision Making
5. Evidence-Based Practice
6. Nursing Care Processes
7. Quality Measurement and Performance
8. Ethics & Professionalism
9. Privacy & Security
10. Sociotechnical Aspects:  Clinicians and Technology

3. Terminology in Health Care and Public Health Settings
1. Understanding Medical Words
2. Integumentary System
3. Musculoskeletal System
4. Blood, Lymphatic and Immune System
5. Cardiovascular System
6. Digestive System
7. Endocrine System
8. Ears, Nose, Throat, Eye and Vision
9. Nervous System
10. Reproductive System
11. Respiratory System
12. Urinary System
13. Public Health and Healthcare System Terminology
14. What is Health Information Management and Technology?
15. Electronic Health Records
16. Standards to Promote Health Information Exchange

4. Introduction to Information and Computer Science
1. Basic Computing Concepts, Including History
2. Internet and the World Wide Web
3. Computer Hardware
4. Computer Software
5. Computer Programming
6. Databases and SQL
7. Networks
8. Security
9. Information Systems
10. Future of Computing

5. History of Health Information Technology in the U.S.
1. Evolution of Health IT: The Early Years
2. Evolution of Health IT: The Modern Era
3. Evolution of Health IT: The HITECH Act
4. Evolution of Public Health Informatics
5. Evolution of Nursing Informatics and HIT Tools Used By Nursing
6. History of Electronic Health Records (EHRs)
7. History of Clinical Decision Support Systems
8. History of CPOE and E-Prescribing
9. History of Health Information Exchange
10. History of Privacy and Security Legislation
11. Software Certification and Regulation
12. History of Mobile Computing
13. History of Telemedicine
14. History of Quality Improvement and Patient Safety
15. Payment-Related Issues and the Role of HIT
16. History of Health IT Organizations

6. Health Management Information Systems
1. What is Health Informatics?
2. Health Information Systems Overview
3. Electronic Health Records
4. Computerized Provider Order Entry (CPOE)
5. Clinical Decision Support Systems
6. Patient Monitoring Systems
7. Medical Imaging Systems
8. Consumer Health Informatics
9. Administrative, Billing, and Financial Systems

7. Working with Health IT Systems (Lab)
1. Introduction & Overview: Components of HIT Systems
2. Under the Hood: Functions of HIT Systems
3. Understanding Information Exchange in HIT Systems
4. The Effective HIT System
5. Fundamentals of Usability in HIT Systems – What Does It Matter?
6. HIT Facilitated Error—Cause and Effect
7. Protecting Privacy, Security, and Confidentiality in HIT Systems
8. HIT System Planning, Acquisition, Installation, & Training:  Practices to Support & Pitfalls to Avoid
9. Potential Issues with Adoption and Installation of an HIT system
10. HIT and Aspects of Patient-Centered Care
11. Health IT in the Future

8. Installation and Maintenance of Health IT Systems (Lab)
1. Elements of a Typical EHR System
2. System Selection – Software and Certification
3. System Selection – Functional and Technical Requirements
4. Structured Systems Analysis and Design
5. Software Development Life Cycle
6. System Security Procedures and Standards
7. System Interfaces and Integration
8. Troubleshooting, Maintenance and Upgrades, and Interaction with Vendors, Developers, and Users
9. Creating Fault Tolerant Systems, Backups, and Decommissioning
10. Developing a Test Strategy and Test Plan
11. Pilot Testing and Full-Scale Deployment

9. Networking and Health Information Exchange
1. ISO Open Systems Interconnection (OSI)
2. Network Media and Hardware Communication Devices
3. National and International Standards Developing Organizations
4. Basic Health Data Standards
5. EHR Functional Model Standards
6. Health Data Interchange Standards
7. Supporting Standards for EHR Applications
8. Enterprise Architecture Models
9. Privacy, Confidentiality, and Security Issues and Standards
10. Health Information Exchange

10. Fundamentals of Health Workflow Process Analysis & Redesign
1. Concepts of Processes and Process Analysis
2. Process Mapping Theory and Rationale
3. Interpreting and Creating Process Diagrams
4. Acquiring Clinical Process Knowledge
5. Process Analysis
6. Process Redesign
7.  Facilitating Meetings for Implementation Decisions
8. Quality Improvement Methods
9. Leading and Facilitating Change
10. Process Change Implementation and Evaluation
11. Maintaining and Enhancing the Improvements

11. Configuring Electronic Health Records (Lab)
1. Migration to an Electronic Health Record System
2. Patient Care Clinical Workflow; Multiple Perspectives of Patient Care (VistA Demo)
3. Implementing Clinical Decision Support (VistA Demo)
4. Building Order Sets (VistA Demo)
5. Creating Data Entry Templates (VistA Demo)
6. Health Summary and Clinical Reminder Reports (VistA Demo)
7. Privacy and Security in the US
8. Meaningful Use and Implementation

12. Quality Improvement
1. Introduction to Quality Improvement and Health Information Technology
2. Principles of Quality and Safety for HIT
3. Introduction to Reliability
4. Reliability and Culture of Safety
5. Decision Support for Quality Improvement
6. Workflow Design
7. HIT Design to Support Teamwork and Communication
8. HIT and Infecting a Patient Safety Culture
9. HIT Implementation Planning for Quality and Safety
10. Measuring Quality
11. Data Quality Improvement
12. Learning from Mistakes. Error Reporting and Analysis and HIT

13. Public Health Information Technology
1. Overview & contribution to public health through Electronic Health Record use
2. Privacy, Confidentiality and Security of Public Health Information
3. Data Standards in Public Health Information Technology
4. Public health enabled electronic health records and the role of public health in health information exchange
5. Epidemiological databases and registries – Public health information tools
6. Biosurveillance, Situational awareness and disaster response
7. Public health reporting, alerts and decision support
8. The potential of public health IT for health promotion and chronic disease prevention
9. Quality Reporting
10. Encouraging adoption/use of population health functions for EHRs and Consumer functions for PHRs

14. Special Topics Course on Vendor-Specific Systems
1. Common commercial electronic health record (EHR) systems used in ambulatory and inpatient care settings
2. Certification of commercial Electronic Health Records (EHRs)
3. How do organizations select an EHR? Lessons from the front lines
4. Electronic Health Record (HER) Functionality
5. System and database architectures used in commercial EHRs
6. Vendor strategies for terminology, knowledge management, and data exchange
7. Assessing decision support capabilities of commercial EHRs
8. EHR Go-live strategies

15. Usability and Human Factors
1. People and technology, studies of technology
2. Requirements engineering
3. Cognition and Human Performance
4. Human factors and healthcare
5. Usability evaluation methods
6. Electronic health records and usability
7. Clinical decision support and usability
8. Approaches to design
9. Ubiquitous Computing
10. Designing for safety
11. Input and selection
12. Information visualization

16. Professionalism/Customer Service in the Health Environment
1. Customer Service in Healthcare IT
2. Professional Behavior in the Healthcare Environment
3. Overview of Communication Relevant to Health IT
4. Key Elements of Effective Communication
5. Regulatory Issues. HIPAA and Standard Precautions
6. Team and Small Group Communication
7. Conflict Resolution
8. Ethical and Cultural Issues Related to Communication and Customer Service
9. Personal Communications and Professionalism

17. Working in Teams
1. Health IT Teams: Examples and Characteristics
2. Forming and Developing a Team for HIT
3. Initial Tools for Teaming: Ground Rules & Action Plans for HIT Team
4. Team Strategies and Tools to Enhance Performance and Patient Safety: TeamSTEPPS
5. Leveraging Integration Techniques: Power of HIT Team Dynamics
6. Articulating Feedback and Feedforward: Tracking Success and Change
7. Leadership: All Members as Leaders – Leaderful Teams
8. Sharing Resources and Information: Tools to Optimize Performance of HIT Teams
9. Positioning for High Performance Teaming:  Challenges and Opportunities in the HIT Environment
10. Barriers to Success:  Reading Early Warning Signs of HIT Team Failure
11. Life Cycle of HIT Teams: Reforming and Repositioning Techniques

18. Planning, Management and Leadership for Health IT
1. Introduction to Leadership
2. The Management and Leadership Distinction
3. Key Concepts Associated with Leadership
4. Effective and Ineffective Leaders
5. Overview of the IT Strategic Planning Process
6. Achieving External Alignment
7. Team and Small Group Communication
8. Conflict Resolution
9. Purchasing and Contracting
10. Change Management

19. Introduction to Project Management
1. Overview of Health IT Projects
2. Project Life Cycles
3. Project Selection and Initiation
4. Project Planning Overview
5. Managing Project Scope
6. Managing Project Time, Cost, and Procurements
7. Managing Project Risk
8. Team Management and Communications
9. Project Monitoring and Control
10. Quality Management
11. Project Closure and Transition

20. Training and Instructional Design
1. Introduction to Training and Adult Learning
2. Needs Analysis
3. Creating a Lesson Plan
4. Selecting and Working with Media
5. Building & Delivering Effective PowerPoint Presentation
6. Assessments
7. Learning Management Systems
8. Web 2.0 and Social Networking Tools