Friday, December 31, 2010

Reflections at the End of Another Amazing Year for Informatics

Last year, in wrapping up the first year of the Informatics Professor blog, I marveled at how amazing the year of 2009 had been. I noted that the year started with both uncertainty and hope; the former fueled by the recession and the precarious financial state of Oregon Health & Science University (OHSU) due to that recession and the latter driven by the excitement of the election of President Barack Obama and (at least for me) the hope for real change. By the end of 2009, it was clear that profound change had indeed occurred, if not generally then at least in the biomedical and health informatics field.

The hope and change, of course, were driven by the HITECH program with the president's economic stimulus package. At the end of 2009, the path forward was clear: health information technology would be driven by the concept of "meaningful use," and the part nearest and dearest to my heart, education and training, would be driven by the ONC Workforce Development Program, which itself was driven by Section 3016 of the HITECH Act that I played a role in influencing.

I spent the latter days of 2009 and early part of 2010 writing proposals, in particular for the curriculum development program and the university-based training program. With the Funding Opportunity Announcements (FOAs) for these and other programs, such as Beacon, SHARP, and regional extension centers, released in December and due in January, many in the informatics field lamented that ONC stood for the "Office of No Christmas." I spent a good part of my winter break last year working on these proposals. The only enjoyable aspect of the process was that they allowed us to envision how we could implement the educational programs we always dreamed of if we ever had the money, which now it looked like we did.

The most harrowing part of the year was the time between the submission of the proposals and receiving word about funding. As well-positioned as we were to receive these competitively awarded proposals, there was an undercurrent of fear that perhaps we forgot to address some required aspect of the program or that some reviewer felt we had taken the wrong approach. In all honesty, it would have been quite an embarrassment to not be selected for funding, since OHSU's program laid the groundwork for some of the thinking that had emerged surrounding health IT workforce development.

All the agony came to an end on Friday, April 2nd, when I awoke in the morning to find out that both OHSU proposals had been funded. For the curriculum development project, we were not only funded as one of the five curriculum development centers, but also chosen as the lead National Training and Dissemination Center (NTDC). For the university-based training program, we were one of nine programs selected for funding tuition assistance in our graduate program. A common quip in academia is that the downside to getting grants funded is that you then have to do the work. However, this was literally a dream come true. Between both grants, we were funded for $5.8 million to do what we always envisioned we could do if we had the funding. While the short-term emphasis of the funding (due to their being stimulus funds) required us to make some decisions we might otherwise not make, it was still a great position in which to be.

Also on the second to last day of 2009, the preliminary meaningful use rules were released. These were followed by a 60-day comment period, modification of the rules, and the release of the final rules on July 13th. I happened to be in a hotel room in Singapore (10 pm local time, 10 am Eastern time) when listening to their unveiling. While everyone had qualms with this criteria or that criteria, I believe that the majority of people were content with the approach to meaningful use taken by ONC.

With our own projects, we hit the ground running. Out of the gate, the curriculum development project required the most work up front. After a two and a half day workshop in Washington, DC the second week of the grant, we began our long quest that would result in the first version of the curriculum being developed and handed off to the community colleges by the end of October. Being the NTDC, OHSU also had to organize a training event for community college faculty in August and launch a Web site for dissemination of the materials around that time, both of which we did. We even added an aspect to the project of creating an educational version of the VA VistA electronic health record system.

The university-based training grant project was a little slower to get started, but not by much. With funding for 135 Graduate Certificate and 13 master's degree students over three years, our plan was to use the funding mainly as a form of tuition assistance for new students entering the field. We started providing support for students in the summer academic quarter and really ramped up in the fall. The main regret is that we have received two to three times as many qualified applicants as we having funding to accept. A decent proportion of those individuals have enrolled as self-funded students.

While a good proportion of my year was spent around these ONC initiatives, there were other achievements as well. Due to ONC and other funding, the Department of Medical Informatics & Clinical Epidemiology catapulted to second among the 25 departments at OHSU in external funding. We have many other initiatives in comparative effectiveness research, bioinformatics, and related areas. The big challenge for the department in 2011 and beyond is how to consolidate and build upon the success of the stimulus-era funding. I am confident we will find ways to do this, as the need for our disciplines to advance healthcare, personal health, and biomedical research will not diminish even as the federal budget tightens.

The coming year will also be an interesting one for the informatics world. How many eligible professionals and eligible hospitals will achieve meaningful use? What unforeseen bumps in the road will emerge? How will healthcare reform impact the use of health information technology? What will happen to healthcare reform itself? One thing is certain: we will live through exciting times!

I have now been writing this blog for almost two years. I have been pleased to have this type of forum to share my views on various aspects of my work. I am also pleased that others have noticed, not only the 129 people who follow the blog, but also winning awards like being on the list for the 2010 Top Math & Science Professor Blogs Award.

I plan to keep running the blog pretty much like I have been, with a fewer number of more substantive posts than the stream of consciousness approach used by many other blogs. I do hope to branch out a little bit more this coming year beyond workforce and education, as I occasionally did this year.

Friday, December 17, 2010

The Comfort of Connectivity

My family, friends, and colleagues believe I spend way too much time keeping up with my email and related work activities, even when I am on vacation, as I am now. They are probably right, as I type this while on vacation in lovely Oaxaca, Mexico.

Maybe it is because I remember the days when email and Internet connectivity from afar were hit or miss. Now, however, I have to admit that I marvel at the ease of accessing Wi-Fi and even my Verizon smartphone (phone, texting, and Internet on my Droid) from this lovely city that is not exactly at the forefront of technology. I am staying in a mid-range apartment, which has Wi-Fi, as does the Instituto Cultural de Oaxaca, where I am studying Spanish for a couple weeks. (The Droid is a wonderful helper for learning Spanish, as I am using two apps for Spanish-English dictionaries.) Since everything on my Droid works here, I am even able to set up a 3G mobile hot spot in a pinch!

Many eating, coffee, and other establishments have Wi-Fi as well, even the Parque El Llano a couple blocks from our apartment. My Droid has even worked in most of the small villages outside of Oaxaca. Perhaps even more amazing was that some homes in these poor villages actually have broadband Internet.

I truly am trying to take a vacation and only responding to critical emails. I have to admit there is a certain comfort to know that my connectivity is there, even if I am trying to minimize its use. I am reading my emails if for no other reason to not have thousands awaiting my return from this two and a half week vacation.

Of course, my physical and virtual lives are so merged that it would be very difficult to not use my computer and access the Internet, even when on vacation. I certainly enjoy taking pictures with my digital camera and sharing them. I also do a good deal of my news reading these days on-line. And of course there are my many friends and others on Facebook with whom I enjoy interacting. In addition, figuring out the details of visiting tourist sites, restaurants, and other places is greatly facilitated when one has Internet access. So it would be truly difficult if not impossible to completely unplug.

There is literally no place on the planet where the Internet is not accessible these days. In the past few years, I have connected from places such as Zimbabwe and Cuba. While ubiquitous global connectivity has some drawbacks, I firmly believe it is positive overall, and the ease of communication and sharing can foster better relations among peoples of the world.

Wednesday, December 8, 2010

10x10 ("Ten by Ten") at the End of 2010 and Beyond

With the end of 2010 approaching, I am asked with increasing frequency whether we met the goals set out by the 10x10 ("ten by ten") program, which was launched in 2005 with the goal of training 10,000 healthcare professionals in informatics by the year 2010. Now that 2010 is coming to an end, how did we do?

I can say that the program has been an unqualified success. The OHSU 10x10 offerings trained nearly 1000 (999, to be precise) people, with another eight universities training an additional 258 more, for a total of 1257 from 2005-2010. Many of those of completing the program have enhanced their current careers. From the OHSU courses, about 15% pursued additional training in the field. While our numbers did not add up to 10,000, there was clearly value for those who completed the course. The program also helped expand educational capacity in the field generally and highlighted the need that led to legislation such as Section 3016 of the American Recovery and Reinvestment Act (ARRA) and the resulting ONC Workforce Development Program.

The 10x10 courses are offered on-line, with an in-person session at the end that brings participants together face to face. The amount of material in each course is roughly comparable to an introductory three-credit graduate-level course, as shown in the syllabus from the OHSU course. In a demonstration that the Internet knows no boundaries, the course has attracted participants from all corners of the globe, such as Argentina, Hong Kong, Singapore, Israel, Pakistan, South Korea, Saudi Arabia, China, India, and Nigeria. The enthusiasm from Latin America led a group from Hospital Italiano of Buenos Aires to translate the course into Spanish and offer it across Latin America. About 500 individuals have completed this version of the course from a number of Spanish-speaking countries. Another version of the OHSU course has been offered in Singapore four times, with the in-person session held in Singapore.

We absolutely plan to continue the 10x10 program beyond the end of 2010. Two more OHSU offerings started in late 2010, along with a few more from other universities. There are no plans whatsoever to end the program, whose need continues to be demonstrated as increasing numbers of healthcare professionals and hospitals seek to achieve "meaningful use" of electronic health records. Of course, biomedical informatics is about more than meaningful use and EHRs, as demonstrated in the course syllabus.

AMIA has already changed the tag line of the program from "10,000 Trained by 2010" to "Training Next-Generation Informatics Leaders." Maybe we should just say that 10x10 now the program that aims to train 10,000 individuals in biomedical and health informatics without giving a specific deadline. Clearly the need remains.

The end of 2010 is also a time to reflect on how we arrived here. In 2005, Dr. Charles Safran, who was then President of the American Medical Informatics Association (AMIA), began taking an interest in the informatics capacity of healthcare organizations. In a letter to the editor of JAMA, he stated that each hospital in the US should have at least one physician and one nurse trained in informatics. Meanwhile, AMIA was looking to beef up its e-learning offering, but found new development of content would be prohibitively expensive. At the same time, I had already been offering the introductory course in the OHSU Biomedical Informatics Graduate Program on-line for some time. It was apparent that we could repackage the course relatively easily. Building on Charlie's call, I coined the name 10x10, aiming to train 10,000 people within five years, by 2010.

I have thoroughly enjoyed developing and teaching the 10x10 course. It has been personally gratifying to meet so many people who took the course and found it of value. I am delighted that some colleagues from Argentina translated the course to Spanish, as noted above. The course name even made its way into legislation in a bill that passed the US House of Representatives (though not the US Senate), the 10,000 Trained by 2010 Act introduced by Congressman David Wu (D-OR). A demo version is available for those who want to take a look.

Some have asked why the Chair of a department would enjoy teaching the introductory course so much. I take great satisfaction in providing people their first introduction to the field of biomedical and health informatics. I enjoy the give and take with students, including those who challenge me. The 10x10 course and my other educational accomplishments make it clear that these activities are my passion and calling in life.