Ten Years of 10x10 ("Ten by Ten")

The completion of the most recent offering of the 10x10 ("the by ten") course at this year's American Medical Informatics Association (AMIA) 2014 Annual Symposium marks ten years of existence of the course. Looking back to its inauspicious start in the fall of 2005, the 10x10 program has been a great success and remains a significant part of my work life. It has not only cemented for my passion and love for teaching, but also gives me great motivation to keep up-to-date broadly across the entire informatics field.

For those who are unfamiliar with the 10x10 course, it is a repackaging of the introductory course in the OHSU Biomedical Informatics Graduate Program. This is the course taken by all students who enter the clinical informatics track of the OHSU program and aims to provide a broad overview of the field and its language. The course has no prerequisites, and does not assume any prior knowledge of healthcare, computing, or other topics. The course has ten units of material, with the graduate course spread over ten weeks and the 10x10 version decompressed to 14 weeks. The 10x10 course also features an in-person session at the end to bring participants together to interact and present project work. (The in-person session is optional for those who might have a hardship in traveling to it.)

The AMIA 10x10 program was launched in 2005 when AMIA wanted to explore online educational offerings. When the cost for development of new materials was found to be prohibitive, I presented a proposal to the AMIA Board of Directors for adapting the introductory online course I had been teaching at Oregon Health & Science University (OHSU) since 1999. Since then-President of AMIA Dr. Charles Safran was calling for one physician and one nurse in each of the 6000 US hospitals to be trained in informatics, I proposed the name 10x10, standing for "10,000 trained by 2010." We all agreed that the course would be mutually non-exclusive, i.e., other universities could offer 10x10 courses while OHSU could continue to employ the course content in other venues.

The OHSU course has, however, been the flagship course of the 10x10 program, and by the end of 2010, a total of 999 had completed it. We did not reach anywhere near that vaunted number of 10,000 by 2010, although probably could have had that many people come forward, since distance learning is very scalable. After 2010 the course continued to be popular and in demand, so we continued to offer "10x10" and have done so to the present time.

This year now marks the tenth year that the course has been offered, and some 1837 people have completed the OHSU offering of 10x10. This includes not only general offerings with AMIA, but those delivered to various partners, including the American College of Emergency Physicians, the Academy of Nutrition and Dietetics, the Mayo Clinic, the Centers for Disease Control and Prevention, the New York State Academy of Family Physicians, and others. The course has also had international appeal as well, with it being translated and then adapted to Latin America by colleagues at Hospital Italiano of Buenos Aires in Argentina as well as being offered in its English version, with some local content and perspective added, in collaboration with Gateway Consulting in Singapore. Additional international offerings have been sponsored by King Saud University of Saudi Arabia and the Israeli Ministry of Health.

All told, the OHSU offering of the 10x10 program has accounted for 76% of the 2406 people who completed various other 10x10 courses. The chart below shows the distribution of the institutions offering English versions of the course.

The 10x10 course has also been good for our informatics educational program at OHSU. As the course is a replication of our introductory course in our graduate program (BMI 510 - Introduction to Biomedical and Health Informatics), those completing the OHSU 10x10 course can optionally take the final exam for BMI 510 and then be eligible for graduate credit at OHSU (if they are eligible for graduate study, i.e., have a bachelor's degree). About half of the people completing the course have taken and passed the final exam, with about half of them (25% of total) enrolling in either our Graduate Certificate or Master of Biomedical Informatics program. Because our graduate program has a "building block" structure, where what is done at lower levels can be applied upward, we have had one individual who even started in the 10x10 course and progressed all the way to obtain a Doctor of Philosophy (PhD) from our program.

As I said at the end of the 2010, the 10x10 program will continue as long as there is interest from individuals who want to take it. Given the continued need for individuals with expertise in informatics, along with rewarding careers for them to pursue in the field, I suspect the course will continue for a long time.