ONC Grant Provides Financial Aid for Clinical Informatics Education

My last posting noted that Oregon Health & Science University (OHSU) was awarded two grants totaling $5.8 million in American Recovery and Reinvestment Act (ARRA) funds to advance health information technology (HIT) education. In this entry, I will begin to describe the details, especially for those who might be eligible for this funding. This posting contains the initial text of what will be a continually updated page for those interested in the program.

One of the grants is for direct financial aid for students studying in HIT-related fields. In the case of OHSU, this funding will support the education of approximately 150 students over the next three years in OHSU's Biomedical Informatics Graduate Program. These funds will support tuition and fees for about 45 new students per year to enroll in and complete the university's online Graduate Certificate Program in Biomedical Informatics. The funding will also enable two cohorts of around students to enroll in OHSU's on-campus Master of Biomedical Informatics (MBI) Program, including a stipend and student health insurance. This funding is provided via a training grant from the Office of the National Coordinator for Health IT (ONC).

There are some restrictions on this funding beyond the usual program requirements:

1. Students must be U.S. citizens or permanent residents.
2. Students must not have been enrolled in the OHSU or any other informatics or health information technology educational program on or before December 17, 2009 (i.e., current students are not eligible). This restriction does not apply to students who have completed only the OHSU-AMIA 10x10 Program.
3. Students pursuing the Graduate Certificate Program must complete the program within one academic year.
4. Students pursuing the Master of Biomedical Informatics (MBI) Program must enroll as full-time on-campus students to receive the stipend and student health insurance.
5. Students must declare one of six job roles defined by ONC and follow a course of study commensurate with that role.

Students who are not eligible or who are interested in other areas of biomedical informatics (such as bioinformatics) should apply to the existing program.

Details of the admissions process are being finalized and applications will be available in mid-May for Fall 2010 admission. Please check this page frequently for more details. By mid-April, this page will include a sign-up form for students who wish to receive email updates on the status of the program.

ONC Program Details

OHSU's eight-course Graduate Certificate Program is entirely online and can be completed in two to four academic quarters. Students who are funded through this program will receive support for their tuition expenses and must complete its requirements within one year. (The Health Information Management Track of the Graduate Certificate Program requires additional courses which will be fully funded under this program.)

The Master of Biomedical Informatics (MBI) degree program requires about 1 1/2 years of full-time study. The funding provides MBI students with tuition support, a stipend and student health insurance.

Students receiving financial aid will be required to choose among six career paths defined by ONC:

• Clinician/public health leader
• Health information management and exchange specialist
• Health information privacy and security specialist
• Research and development scientist
• Programmers and software engineer
• Health IT sub-specialist

Students will be able to enroll in the new programs Fall 2010. More information about applying, degree requirements and financial aid will be available on this page in mid-May, 2010.

More About Our Program

OHSU offers a full range of graduate programs in biomedical informatics for cutting-edge and rewarding careers using information and associated technologies to advance individual health, healthcare, biomedical research, and public health. There are two main tracks in the program: clinical informatics and bioinformatics/computational biology. The clinical informatics track, with the exception of the PhD program, is available via distance learning. Other forms of financial aid, such as our National Library of Medicine Training Grant, are available for full-time on-campus PhD or postdoctoral master's students in both tracks.

Academia = Education AND Research

The American Medical Informatics Association (AMIA) Annual Symposium is clearly the best informatics meeting of the year. It is rigorously academic, so the quality is top-notch, but not too much, so you can glean plenty of practical information as well.

The AMIA symposium is also an opportunity for us because we can showcase our department. As always, our faculty and students will pepper the program with great papers, panels, and posters. In addition, the annual OHSU banquet is a gratifying display of the energy and passion of our program, not to mention quite fun. I look forward to this year's meeting in San Francisco later this month.

This meeting always give me a chance to reflect on the importance of a comprehensive academic program that values both education and research. A vibrant graduate-level program cannot thrive without both. Being at the cutting edge of research allows faculty to be the knowledge and thought leaders in their respective areas.

This was borne out a couple years ago when we hosted a focus group that assembled a number of what we call "local distance" students, which are students who live in the Portland area but prefer to enroll in our on-line program. We wanted to know why they preferred that instead of coming "up the hill" to the OHSU campus. The answers were obvious in retrospect: they appreciate the convenience of being able to carry out their studies at their preferred hours (usually evenings and weekends) and they did not want to deal with the hassle of driving to and parking on our campus (which everyone knows can be a pain, at least during regular working hours).

There was, however, another interesting finding that came from the focus group. These students told us they were drawn to our program not only because of its local connection, but also because they valued the faculty and their leadership roles in the field, especially their research. Even though they were unlikely to become researchers themselves, or for some to even do research, they believed it was important to obtain their education in a department that was known for being a leader in research as well.

As always, I look forward to catching up with students, alumni, and old friends at the AMIA meeting.

Informatics Education: A Final Common Pathway

As readers of this blog know from my other writings, the field of biomedical and health informatics is heterogeneous and diverse. The types of jobs performed by informaticians range from the highly technical to those that are more people and organizational in nature. The entire spectrum is vitally important. A unifying common element of these jobs is that they are somehow related to the use of information, often aided by technology, to improve individual health, health care, public health, and biomedical research.

I am also delighted to report that US News & World Report still considers informatics be one of its "ahead of the curve" careers. There is a Web page devoted to it, where I recently posted a comment.

• http://www.usnews.com/articles/business/best-careers/2008/12/11/ahead-of-the-curve-health-informatics-specialist-2009.html
• http://www.usnews.com/articles/business/best-careers/2008/12/11/ahead-of-the-curve-health-informatics-specialist-2009/comments/

As any director of an informatics education program can tell you, teaching informatics is a challenge. You have physicians, other health care professionals, computer scientists, health information managers, and many others sitting (virtually and in classrooms) alongside each other. Furthermore, many are adult learners, already having completed their primary education and often having substantial work experience.

Of course, educating such a diverse group can also be a real joy. Most of these individuals are very smart and highly motivated. I learn a great deal from them, and they require me to keep a step ahead in my knowledge.

Because of all this, I think of informatics education as a "final common pathway" for many individuals who bring diverse backgrounds, interests, and talents to the field. Such individuals will be uniquely qualified to develop, implement, and lead health IT, especially in the coming years.

It is hard to fathom this education not taking place at the graduate level. I recognize there are growing numbers of community college and undergraduate programs in informatics, but I tend to view these as one of the many pathways leading to that final common one. Most of the associate and baccalaureate programs in informatics are really IT programs with some health-related content added. This does not mean they cannot be of value to individuals or make contributions in health care settings, but such individuals are not likely to "practice" informatics as we normally define it.

I suspect that the informatics profession and its education will become more standardized in the coming years, especially as we see certification of individuals, with the commensurate accreditation of programs.

Learning about Informatics and Health IT at OHSU

The interest in health IT and biomedical informatics continues to grow, fueled no doubt by federal policy efforts and the economic stimulus plan. One result is that many people have inquired to me about opportunities to learn more about the biomedical informatics field at OHSU. To that end, I am going to describe the options in this posting. If you have further questions, feel free to contact me individually.

OHSU's programs are open to people of all career backgrounds. Our programs have served a wide diversity of people over the years, including those with backgrounds in health care (e.g., medicine, nursing, hospital administration, etc.), IT (e.g., computer scientists, IT professionals, etc.), and many other areas (e.g., health administration, business, public health, law, etc.). There is room for everyone in the big tent of informatics!

While our certificate and degree programs are at the graduate level (i.e., you need to have a bachelor's degree), our 10x10 ("ten by ten") course is open to anyone, even those who do not have a bachelor's degree.

An excellent way to get a broad-based introduction to the field is our on-line introductory biomedical informatics course. This course is offered in a number of flavors, and there are upcoming opportunities for you to enroll. Whatever path you take through the course, you can (assuming you are eligible for graduate study) get credit in our graduate program and be eligible to take more courses in our program if you are interested.

The introductory course is completely on-line and has been completed by about 1000 individuals in the last decade. It covers all the major aspects of biomedical and health informatics, with a focus on informatics applied to health care. It is offered using a variety of asynchronous distance learning teaching modalities, so you do not need to be present on-line at any specific time, although you do need to keep up with the work during the academic term.

One way to take the course is through our regular graduate program. OHSU is on an academic quarter system. Due to continued demand, the introductory course has been offered every academic quarter. The next offering is over the summer quarter, which runs from June 22 to September 11. The course will be offered again in the fall quarter, which runs from September 28 to December 13. To take the course by this pathway, you need to enroll in the OHSU Graduate Certificate program, which is open to anyone with a bachelor's degree. For more information, follow this link to our department Web site and click on the link to the Prospective Students Portal on the lower right:
http://www.ohsu.edu/dmice/

Another option to take essentially the same course is via the AMIA 10x10 program. This version of the course is offered in partnership with the American Medical Informatics Association (AMIA). The course is taught in the same on-line, asynchronous manner. It is offered over a slightly longer time period (decompressed with some "off" weeks) and adds an in-person session at the AMIA Annual Symposium, where all the students come together to meet and engage in additional learning. The AMIA Annual Symposium is one of the leading health IT meetings and will be held this year in San Francisco from November 14-18. Registration is already open for the next offering of the 10x10 course, which begins on July 30th and runs until the AMIA meeting. For more information, visit:
http://www.amia.org/10x10/partners/ohsu/
Or:
http://www.billhersh.info/10x10-2009.html

If you successfully complete the 10x10 course (and are eligible for graduate study), you can then get credit for the BMI 510 course in our graduate program. Once you are enrolled in the program, you can take additional courses. There is also a relatively easy pathway to advance beyond our Graduate Certificate into our master's degree program (and even the PhD program).

Here is a detailed outline of the introductory course content:

1. Overview of Field and Problems Motivating It
1.1 What is Health/Bio/Medical Informatics?
1.2 A Discipline Whose Time Has Come
1.3 Who Does Biomedical Informatics?
1.4 Problems in Health Care Motivating Biomedical Informatics
1.4 Seminal Documents and Reports
1.5 Resources for Field - Organizations, Information, Education

2. Biomedical Computing
2.1 Types of Computers
2.2 Data Storage in Computers
2.3 Computer Hardware and Software
2.4 Computer Networks
2.5 Software Engineering
2.6 Challenges for Biomedical Computing

3. Electronic Health Records
3.1 Clinical Data
3.2 History and Perspective of the Health (Medical) Record
3.3 Potential Benefits of the Electronic Health Record
3.4 Definitions and Key Attributes of the EHR
3.5 EHR Examples
3.6 Nursing Informatics

4. Clinical Decision Support; EHR Implementation
4.1 Historical Perspectives and Approaches
4.2 Medical Errors and Patient Safety
4.3 Reminders and Alerts
4.4 Computerized Provider Order Entry (CPOE)
4.5 Implementing the EHR
4.6 Use and Outcomes of the EHR
4.7 Cost-Benefit of the EHR

5. Standards and Interoperability; Privacy, Confidentiality, and Security
5.1 Standards: Basic Concepts
5.2 Identifier and Transaction Standards
5.3 Message Exchange Standards
5.4 Terminology Standards
5.5 Privacy, Confidentiality, and Security: Basic Concepts
5.6 HIPAA Privacy and Security Regulations

6. Secondary Use of Clinical Data: Personal Health Records, Health Information Exchange, Public Health, Health Care Quality, Clinical Research
6.1 Personal Health Records
6.2 Health Information Exchange
6.3 Public Health Informatics
6.4 Health Care Quality
6.5 Clinical Research Informatics

7. Evidence-Based Medicine and Medical Decision Making
7.1 Definitions and Application of EBM
7.2 Interventions
7.3 Diagnosis
7.4 Harm and Prognosis
7.5 Summarizing Evidence
7.6 Putting Evidence into Practice
7.7 Limitations of EBM

8. Information Retrieval and Digital Libraries
8.1 Information Retrieval
8.2 Knowledge-based Information
8.3 Content
8.4 Indexing
8.5 Retrieval
8.6 Evaluation
8.7 Digital Libraries

9. Imaging Informatics and Telemedicine
9.1 Imaging in Health Care
9.2 Modalities of Imaging
9.3 Digital Imaging
9.4 Telemedicine: Definitions, Uses, and Barriers
9.5 Efficacy of Telemedicine

10. Translational Bioinformatics
10.1 Translational Bioinformatics - The Big Picture
10.2 Overview of Basic Molecular Biology
10.3 Important Biotechnologies Driving Bioinformatics
10.4 Clinical Genetics and Genomics
10.5 Bioinformatics Information Resources
10.6 Translational Bioinformatics Challenges and Opportunities

11. Organizational and Management Issues in Informatics
11.1 Organizational Behavior
11.2 Organizational Issues in Failure and Success of Informatics Projects
11.3 Change Management

New York Times Article on Field, Profession, and Education

There is an excellent article about the emerging informatics profession and training for it in the Sunday, April 12 New York Times by Christine Larson:
http://www.nytimes.com/2009/04/12/jobs/12starts.html

This is a well-written article that describes the emerging informatics profession in these times of the Obama stimulus package and its health information technology adoption incentives. However, as newspaper reporters often do, she got a few things slightly wrong. This does not, however, detract from the overall article, which gets across the message well.

One thing slightly wrong was her quote of me, "The health I.T. people run the servers and install software, but the informatics people are the leaders, who interpret and analyze information and work with the clinical staff." First, I would not use the word "health" in front of the phrase "I.T. people" because "health I.T." is often used synonymously with the applications of informatics, such as electronic health records and clinical decision support systems. It is the I.T. people who do run the servers and install software, but the jobs of informaticians are not limited to being leaders and working with clinicians. Those with training in informatics can perform many other jobs in the health I.T. setting, such as project management, training, implementing quality or safety projects, and much more that involves knowledge of both I.T. and health care.

The reporter also states that some institutions have added programs within the last four years. OHSU's first degree program was actually launched in 1996, and we have been teaching via distance learning since 1999.

While the reporter rightly notes that educational programs "can bear a bewildering variety of names," I would not agree that medical and biomedical informatics are the same, nor that they only "focus on data that doctors need for treating patients." I would argue that they focus on more than just those things. Likewise, I would not completely agree with the definition that health informatics "programs often emphasize clinical data and health records." However, I do completely concur with her statement, "Even among programs with the same name, the emphasis may vary."

As most people know, I consider the terms "biomedical and health informatics" or "biomedical informatics" to be the broad umbrella terms. Subsumed under those are "medical informatics" or "clinical informatics," which refer to informatics applied in the clinical setting. "Health informatics" is somewhat orthogonal, which may also involve a focus on non-clinical aspects of informatics, such as personal health. One thing is certain: Our field needs to end this bewilderment and standardize our definitions!

Nonetheless, I believe this reporter did an excellent job overall, and it is great to see an article on our field and emerging profession in a prominent paper like the New York Times.

These are exciting times for Biomedical Informatics!

These are exciting times for the field of biomedical informatics. On the clinical side, the health care field is taking seriously the impact that information technology can have on health care quality, safety, and cost. Patients are increasingly empowered by increased access to information to maintain and improve their health. On the biomedical research side, advances in genomics and proteomics are revolutionizing approaches to health and disease. The world of biomedical research has fundamentally changed. Biological experiments now generate mass amounts of data, and researchers are required to interact with databases and other information resources. Biomedical informatics plays a key role in clinical and research areas. There is a great need both for informatics researchers to conceptualize and develop new applications and for informatics professionals to implement and disseminate them.

Biomedical informatics is the field devoted to improving human health, health care, and biomedical research through optimal use of information, usually with the aid of information technology (IT). As government, health care, and biomedical research leaders recognize its value, there are growing opportunities for careers in a diverse array of jobs, some of which are highly technical and others that focus on people and organizational issues insuring its most effective use.

President Barack Obama has made the use acceleration of health IT a key part of his “Reinvestment and Recovery Act of 2009,” stating, “To improve the quality of our health care while lowering its cost, we will make the immediate investments necessary to ensure that within five years, all of America’s medical records are computerized … It just won’t save billions of dollars and thousands of jobs – it will save lives by reducing the deadly but preventable medical errors that pervade our health care system.” (http://www.whitehouse.gov/agenda/economy/)

In biomedical research, the role in informatics in the discovery of new tests and treatments to improve health is equally acclaimed. The Web site of the National Institutes of Health, the US government agency that funds biomedical research, notes, “Modern biomedical scientists use computers and robots to separate molecules in solution, read genetic information, reveal the three-dimensional shapes of natural molecules like proteins, and take pictures of the brain in action. All of these techniques generate large amounts of data, and biology is changing fast into a science of information management. There is no way to manage these data by hand. What researchers need are computer programs and other tools to evaluate, combine, and visualize these data.” (http://nihroadmap.nih.gov/bioinformatics/)

These statements, and the growing commitment by the government, health care institutions, and research funding agencies, show that the future is bright for the high-skill, high-paying jobs available in biomedical informatics. There is an extreme diversity of jobs available, such as:

• Using electronic health records and other sources of data to measure and improve the quality of health care and to facilitate the conduct of biomedical research
• Serving as the bridge between the IT and clinical professionals in health care settings to insure IT systems are easy to use and provide the most useful data to clinicians, administrators, and researchers
• Analysis of genomic and clinical data to determine the role of genes in human health, to ascertain the risk of developing disease, and to predict the response to different treatments
• Deploying telemedicine and telehealth systems to bring medical expertise to the point of need
• Coordinating the information systems and data within them for state and local public health agencies

Oregon is a leader in health IT. Not only do many its major health systems have advanced health IT and biomedical informatics infrastructures, but it is also a leader in the education and training of biomedical informatics professionals. The Biomedical Informatics Education Program at Oregon Health & Science University (OHSU) is one of the largest in the country. Its graduate programs feature master’s and PhD degrees with the opportunity to focus on bioinformatics (informatics in bioscience and genomics) or medical informatics (informatics in health care). Its 200+ alumni have obtained jobs in a wide variety of industry, academic, and health care settings. The program’s faculty are leading researchers and thought leaders in the field.

Although students in the OHSU biomedical informatics program most commonly have backgrounds in computational/mathematical or life/health sciences, there are opportunities for virtually all types of students who are motivated to learn and contribute to working in and advancing the field. Students can pursue a tailored course of study commensurate with their interests and background while having access to cutting-edge research and/or experiences in local industry, health care settings, or biomedical research labs.

For more information, visit our Web site at:
http://www.ohsu.edu/dmice/

Or contact me:
William Hersh, MD
Professor and Chair
Department of Medical Informatics & Clinical Epidemiology
Oregon Health & Science University
hersh@ohsu.edu
www.billhersh.info

I look forward to your thought and comments on my postings!

Bill