Thursday, December 29, 2011

Annual Reflections at Year's End: Reveling in the Successes of 2011 and Looking Ahead

It has become a tradition for me in this blog to post an end-of-year message reflecting on the accomplishments (and, in recent times, thrills) of the past 12 months. This posting follows those from the end of 2009 and 2010.

It has indeed been another incredible year for informatics. Unlike past years, however, we have real accomplishments upon which to report, and not just future dreams. Most of my activity this past year has revolved around projects that are part of the Health Information Technology for Economic and Clinical Health (HITECH) Act that aims to achieve "meaningful use" of electronic health records. This has not, of course, been the main focus of everyone in informatics, as explained further below.

The main activity for me this past year has been carrying the projects that were dreamt about in 2009 and funded in 2010. Many of us still remember spending the winter holiday season of 2009 into 2010 writing proposals for the "Office of No Christmas," aka the Office of the National Coordinator for Health IT (ONC). I also remember the thrill a few months later  upon learning that the two proposals I submitted had been funded, one for curriculum development and the other for training students in our graduate educational program.

There is a joke in academia that the downside of getting grants funded is that you actually have to do the work. However, the work of the ONC projects has truly been a labor of love for me. We have pretty much accomplished everything we said we would, and the results are having a mark on the field. The only sad aspect of these projects is that next year at this time, they will be winding down. We are looking at ways to achieve longer-term sustainability of both.

As noted above, however, not all that is informatics is connected to the HITECH Program. Another major source of activity is in the twin realms of clinical research informatics and translational bioinformatics. Much of this work has been enabled by the Clinical & Translational Science Award (CTSA) Program of the National Institutes of Health (NIH). Informatics has been a prominent feature in the CTSA program, leading to the development of tools and techniques that aid in the use of the data to improve the conduct of biomedical research and ultimately human health. The informatics community has also been well-organized within the CTSA framework. Although my own effort in CTSA has diminished somewhat due to the HITECH work, I am still involved in a number of roles, including working on ways to connect informatics to comparative effectiveness research (CER).

Another important area that is likely to emerge in 2012 and beyond is the informatics of personal health. We can only do so much to improve health care delivery and treatment of disease. Our field needs to pay more attention to maintaining health and preventing disease. To this end, I am pleased to see an exciting new funding opportunity from the US National Science Foundation (NSF) on Smart Health and Well-Being. We still have a lot to learn about health promotion and disease prevention. Those of us who do proactively act on maintaining our health are less prevalent than those who react to disease once it occurs. And of course, some disease just cannot be prevented no matter how healthfully we live.

I am also pleased at year's end that I have been able to sustain this blog. I have preferred to maintain this blog less like many excellent blogs that consist of the blogger's (often well-articulated) stream of consciousness. Instead, I prefer fewer but more focused and developed posts about specific topics, more like a newspaper or magazine column. I plan to continue that approach, and already have many planned postings for the weeks and months ahead. I have been so busy this fall that I have not had time to develop them.

I do wish everyone a healthy and prosperous 2012!

Thursday, December 15, 2011

Update on the OHSU University-Based Training (UBT) Program: From the ONC Health IT Buzz Blog

My latest update on the Office of the National Coordinator for Health IT (ONC) University-Based Training (UBT) program brings many great stories to report of graduates obtaining jobs and advancing their careers in the field. We are on track with the numbers we promised ONC we would train in our original proposal for funding, and are pleased to have the added infrastructure that the grant has afforded us. A shortened version of this posting has been adapted for the ONC Health IT Buzz Blog, but I feel compelled to tell the whole story here, keeping the material that ended up on the ONC’s virtual cutting-room floor.

About Our Program

The overall goal of the Oregon Health & Science University (OHSU) biomedical informatics graduate program is to prepare students for operational, research, and leadership roles in the application of information, usually supported by information technology (IT), to improve individual health, health care, public health, and biomedical research. Students funded by the UBT Program are expected to focus on professional and leadership roles in the implementation of the electronic health record (EHR), health information exchange, and quality measurement and improvement.

The OHSU UBT Program offers financial assistance for the Graduate Certificate (UBT Type 1 students) and Master of Biomedical Informatics (MBI) (UBT Type 2 students) programs that have been in existence for nearly ten years. In addition to financial assistance, the UBT funding requires additional specific courses (pertinent to the student’s workforce role, in place of electives) and requires students to complete a practicum (Certificate) or internship (MBI).

In the fall academic quarter of 2011, OHSU matriculated 18 Certificate and 5 MBI students. These new students commit 103 of our 135 (76.3%) Type 1 positions and all 13 (100%) of our Type 2 positions funded by OHSU’s UBT grant. Our total commitment of positions between the two programs is 116/148 (78.4%) students. The competition for funded UBT positions has been intense, especially in the Certificate program, where 327 applications have been received for the 103 committed positions (31.5% acceptance rate). Virtually all of those who have applied to the program are well-qualified, and some who were not funded have chosen to enroll as self-funded (i.e., tuition-paying) students.

The OHSU UBT program offers all six workforce roles covered by the UBT initiative. The most popular workforce roles chosen by students in the OHSU program so far have been clinician/public health leader (52, with 46 clinician and 6 public health), health IT subspecialist (29), health information management (HIM) and exchange (21), programmer/software engineer (6), privacy and security (5), and research and development (3). Of note for the HIM and Exchange role, those completing our Commission on the Accreditation of Health Informatics and Information Management (CAHIIM)-accredited curriculum for this role are eligible to sit for the Registered Health Information Administrator (RHIA) certification exam.

OHSU offers its Certificate and MBI programs both on-line and on-campus. In the UBT program, we chose to have Certificate students complete the program on-line, while MBI students were required to be full-time on-campus students. Both programs are national in scope, with students from 24 different states and the District of Columbia. Slightly over half of the students are from Oregon (54), with the other states with the largest enrollment being California (10), Washington (8), New York (4), Maryland (3), North Carolina (3), Texas (3), and Virginia (3).

Equally diverse as the geography of the students are their degrees and career backgrounds. The highest degrees for students include bachelor’s degrees (44), master’s degrees (43), MD degrees (20), PhD degrees (5), other physician degrees (2 NDs and 1 MBBS). The most common master’s degree is an MBA (9).The occupational background of our students is also heterogeneous. The most common prior careers are medicine (21) and nursing (15). Many other health care professions are represented as well, including public health, pharmacy, nurse midwifery, occupational therapy, physician assistant, speech communications, health information management, and emergency medical technician. Other highly represented occupations include business administration and management (13), computer science and information technology (9), health care administration and management (8), and library and information science (2). The variety of other occupations includes accounting, chemistry, economics, education, law, and mathematics. Three have or previously had faculty positions in higher education.

During the same time that our UBT program has been funding students, non-UBT students have also been matriculating and graduating from our programs. Since the UBT program started in the fall of 2010, 84 non-UBT students have matriculated in our Certificate program. During that same time, 32 Certificate students have graduated. Likewise, since UBT funding started, 50 non-UBT MBI students have matriculated and 13 have graduated.

A total of 25 graduates have completed our UBT Certificate program (18.5% of committed total). Another 15 are finishing up graduation requirements that should be completed before the end of the next academic quarter, while another 20-25 will be graduating at the end of the next quarter. One student has completed the UBT MBI program, with most of the first cohort of 8 students on track to complete the program on time in the spring of 2012.

Of the UBT Certificate graduates, 11 are in the clinician leader workforce role; followed by four in the HIM and exchange role; three each in the public health leader, programmer/software engineer and HIT subspecialist roles; and one in the research and development role. Six of these graduates have chosen to continue their studies by enrolling as part-time students in our MBI program.

All of our UBT graduates, and many of our currently enrolled students, have completed their practicum (Certificate) and internship (MBI) experiences. Project and settings have been diverse, from health care institutions, health information organizations, companies, and federal agencies. Health care institutions where our students have done practicum and internship activities include OHSU, Portland VA Medical Center, OCHIN (a Portland, OR-based organization that provides Epic EHR services to “safety net” clinics in several states), Kaiser Permanente (Portland, OR), Multnomah County Health Department (Portland, OR), Beth Israel Deaconess Medical Center (Boston, MA), Duke University Health System (Durham, NC),  University of Utah Medical Center (Salt Lake City, UT), and Allina Health System (Minneapolis, MN). Health information organizations where students have had experiences include the Oregon HIT Extension Center (OHITEC), the Oregon Health IT Oversight Committee, and the New York Clinical Information Exchange (NYCLIX). Companies where students have had experiences include Healthways (Franklin, TN), Communication Software (Portland, OR), and Siemens Medical Solutions (Malvern, PA). Federal agencies where students have had experiences include ONC and the Department of State Office of Medical Services. Two students have completed virtual projects with the Healthcare Information Management and Systems Society (HIMSS).

About Our Students

A number of our graduates have obtained jobs in the HIT sector, some before they graduated. Some students already had jobs and used the UBT program to move into HIT or advance their careers within it. The backgrounds of these graduates are as diverse as our students, with those having clinical, IT, and other backgrounds obtaining HIT employment.

One early Certificate graduate was Tom Durkin. His previous career was as a schoolteacher, but he noted, “My wife’s solo practice as a physician gave me a window into the challenges of change and empathy for the struggles of HIT implementation.” After completing his practicum with the Oregon HIT Extension Center (O-HITEC), he was hired to recruit members for this regional extension center and to direct additional students doing the same. Additionally, Mr. Durkin will have the opportunity to develop his skills around the practice design and support of the three EHR products offered by OCHIN, the parent organization of O-HITEC. About his educational experience he stated, “The UBT program formed the basis for redirecting my teaching and sales background skills into the HIT field. The knowledge of how providers work combined with the intense depth of study in the EHR and the mandate for its universal adoption through meaningful use led directly to my current position. The OHSU program integrated an international experience through its distance learning course structure. This format provided a foundation for electronic communications that I use with providers throughout Oregon.”

Another early graduate was Edward Carroll. A former IT consultant, Mr. Carroll has taken a position with the Oregon Anesthesiology Group as Project Manager. Among his duties include IT support, implementation of new systems, product development, and process improvement activities. In describing his motivations for pursuing the program, he said, “The IT consulting market in Portland, Oregon was very fragmented and depressed economically. While looking around for a better industry where I could focus my energy and be more successful, I also decided to make that focus about giving back to society. I had been working in IT consulting for the healthcare industry for about 5 years, and decided that healthcare informatics met both criteria very nicely.”

An additional student with an IT background was Larry Bannister, a former software engineer who was the UBT program’s first MBI graduate. After completing his studies in June, 2011, Mr. Bannister immediately obtained a position as Test Manager for the Certification Commission on HIT (CCHIT). About his experience in the program he stated, “The main reason for pursuing a degree in biomedical informatics was to find work. The software engineering field has been decimated and I have been either unemployed or under-employed for a period of 4 or 5 years. I searched for something that would fit my background, as well, i.e., I wanted to utilize my software development and software test experience. I was a pre-med student as an undergraduate and continue to have an interest in the biological sciences. The OHSU program gave me the credibility to say that I have the background and training to do HIT. I had either developed or tested some HIT products in the past but the in-depth study of clinical topics, HIT legislation and HIT in general made me a more believable candidate to potential employers. Also, and most importantly, the networking via OHSU graduates and staff made the important connections that I needed to land my present job.”

Another graduate transitioning from the IT to the HIT industry was Lorraine Bessmer, who recently took a position as Applications Systems Analyst in the Information Security Group at Legacy Health Systems, a Portland, Oregon-based system of hospitals and clinics. She stated, “The Graduate Certificate program gave me the opportunity to expand my horizons and the UBT grant combined with a world-class program at OHSU was the perfect solution. With a full-time and demanding job,  I could not have participated if I had to attend daytime classes. The knowledge and skills I gained during the program particularly in project management and in privacy and security provided me with the tools I needed to be successful in my practicum, which resulted in my job offer. I can say, I ‘wowed’ them.”

Ms. Bessmer further noted, “I was amazed at the enthusiasm and interest the instructors and staff all showed, and how everyone seems to genuinely want to make a difference in the lives of patients by providing clinicians with better tools so they can be more effective. I may sound jaded but this ‘enthusiasm’ was rare in my previous world. When I attended the student orientation last fall, I was amazed at the quality of the instructors and I knew the program was something I wanted to be a part of. I thought, ‘These are my people, I've found them!’”

Another graduate with a previous IT background was Gregg Hoshovsky, who has been hired as an analyst for St. Charles Health Care in Bend, Oregon. He joined the program because his previous job in e-commerce was “outsourced” to a different country. He recalled, “My basic desire was to move away from IT development positions and into healthcare business positions. The courses in this program helped me in understanding the uniqueness and complexities of the health care provider’s work environment. This has given me a better perspective in communicating and working with those professionals and to be in a better position to provide helpful solutions and suggestions for quality improvements. The courses in health care quality and the practice of health care were incredibly valuable for non-health care providers to understand the industry. The more basic classes like organizational behavior, the business of health care and the introduction to health care were helpful to gain a high-level perspective.  I also enjoyed the public health classes.”

Another MBI student with an IT background, Court Fowler, is still a student in the program. However, his internship at OCHIN has led to a part-time job now and the promise of a full-time job upon graduation as a software developer. Mr. Fowler says of the program, “Without exception, all of the professors I have had for my classes have been highly capable, experienced individuals with a depth of knowledge they took pleasure in imparting to students. I have also come to value the Web-based learning management system that helps organize course material and facilitates communication among students and staff.  Like those at other great schools, the program at OHSU provides a wealth of opportunities to which students can apply their efforts, and that hard work is well-rewarded with the credentials and confidence to take on future HIT challenges.”

Two physicians in the program have obtained positions as Chief Medical Information Officer (CMIO). One is Heidi Twedt, MD, the CMIO of Sanford Health in Fargo, North Dakota. She noted, “I became CMIO of Sanford several years ago, and although I had practical knowledge of our system, I lacked formal training in informatics. This led be to your 10x10 (‘ten by ten’) course and then to the UBT Certificate program.” Dr. Twedt hopes to attain certification in the new clinical informatics medical subspecialty and values the (virtual) community nature of the program, stating, “I don't have a large number of colleagues at work to talk with on these issues. I did enjoy the chat rooms and debate occurred in that forum. I just enrolled in my first class towards the MBI.”

William Jennings, MD is CMIO of the Palmetto Health Quality Collaborative in South Carolina. He recalls, “I had a desire to formalize my education at an institution considered by most to be the leader in the field, even if it was 2800 miles away. Logistically, the distance learning program allowed me to continue practicing while formalizing my education. Professionally, it vaulted me in a few months to roles in my organization that had traditionally been obtainable only after 10 or more years of service. The education that I received allowed me to not only achieve these levels in the organization, but allowed me to surpass expectations and grow my responsibilities.”

Another physician, Jodi Kodish-Wachs, MD, serves as a Physician Consultant for Siemens Corp. in Malvern, Pennsylvania. She recalls, “After implementing and utilizing an EHR as Chair of the Department Physical Medicine and Rehabilitation at a VA hospital, the dichotomy of practicing medicine in a university outpatient environment with a 7-year unfulfilled promise of an EHR was frustrating. I sought new opportunities that could satisfy my desire to improve the ability to obtain clinical information at the point of patient contact. I found I have been able to apply knowledge from every class in the UBT program to my role at Siemens. An example includes incorporating approaches from organizational behavior to address physician adoption to influencing the EHR product. The OHSU UBT clinical informatics program has exceeded my expectations.  The expertise and academic openness of the professors is exceptional.    Networking and employment opportunities are abundant.  My new knowledge is directly applicable to both clinical medicine and industry. This led to my transition from clinical practice to employment with a vendor.  I use my new information daily, applying it to the current use and future development of EHR solutions.  My OHSU UBT program experiences have been invaluable to my new career in clinical informatics.”

The success of students with clinical backgrounds is not limited to physicians. Jessica Alexander is a nurse and Certificate student who serves as a nurse informaticist in OHSU Hospital. Another graduate (Certificate), Seana Zagar, works for OCHIN and is a social worker by background who now serves as Manager of Behavioral Health Product Development.

Another graduate working in HIM used the HIM & Exchange curriculum to successfully obtain her RHIA credential. Niki Newland stated, “The HIM program at OHSU has enhanced my professional life. I am staying in my current position as HIM supervisor for Providence Home Health, but have worked with my manager to revise my job description to move toward managing data quality and compliance, coding and coding education, and all parts of the revenue cycle. This directly reflects the work I did as a student at OHSU, and I find myself using the skills I learned while in the program in my work every day. The current role of the Data Quality and Compliance Coordinator is being rolled into my role of HIM Supervisor, and I have been given more responsibility when it comes to organizing and managing data that comes from quality reviews. Because I was pursuing further education and have been so successful at it, I have been granted more opportunities to participate in quality assurance and improvement work, assisting with state, CMS and Joint Commission audits and audit preparation while I was in school, and becoming the point person in Home Health HIM for those audits now that I have graduated and passed the exam.”

An additional graduate with previous experience in the healthcare industry is Jack Dainton, who used the UBT program to advance to a new position with his employer, GlaxoSmithKline (GSK, Park City, UT). Mr. Dainton’s new position title is Corporate Account Manager. The definition of his position is “to enhance the delivery and quality of patient care by providing patient centered care management solutions that will improve disease management outcomes”. He noted, “In this role I am part of a team that is attempting to take the aspects of HIT and social media and figure out how Pharma can work with these entities to interact with prescribers and patients to effectively improve health outcomes. The  original and still current intent of my degree in biomedical informatics was to help me transition into an area of health care that is going to play a defining role in the success of our health care system as it continues to transform.  As it turns out, my current employer, GlaxoSmithKline, also realized value in my education.”

Mr. Dainton further stated about the program, “Many employees within GSK apply for and receive educational tuition reimbursement. My employer was impressed that I applied for and received grant funding from outside of the organization and though that it showed a level of personal development and perspective that further differentiated me from other who are also continuing their education. The funding also allowed me to pursue my certificate in an accelerated fashion by providing the financing that I personally would not have been able to afford.”

He did his practicum experience at the University of Utah Health Information Services Department, noting, “This exposed me to the application of HIT in a very diverse and complex health care system. This knowledge provided me perspective on the challenges involved in maintaining an existing system, while implementing changes to improve the system to meet safety and quality goals.”

Mr. Dainton also said, “What I found most satisfying about the program was the level of passion that all students had in the area of Informatics and the realization that we are being trained in an area that is rapidly evolving and going to have serious impact on the success of the health care system in the US. I was also surprised by the level of bonding and camaraderie that took place with fellow classmates even though we had never met and our relationships were formed and existed primarily on-line or via conference calls. Since the UBT grant program at OHSU required an accelerated learning schedule, I did find the task of balancing my work life with my school commitments to be challenging, but in hind sight, very worth the effort.”

Overall, the OHSU UBT program has been a gratifying experience for students, faculty, and staff alike. There have certainly been some challenges, most notably students trying to complete the Graduate Certificate program in one year, often while holding down a job and/or family commitments, whereas most students usually take twice as long. In addition, not every student has found employment opportunities waiting at the end of their studies. While many new jobs have been created in HIT, graduates are not always a match for what is available where they want to stay living. The depressed economy has also made health care organizations and others cautious about new hiring.

Nonetheless, there are clear opportunities for the future, not only for UBT graduates but for all who are pursuing education and training in informatics. Regardless of the evolution of the HITECH program and health care reform, the health care industry will need to continue its adoption of IT. With the growing need for safety and accountability of health care, information will be a critical component for health care delivery, and no one will be better trained to perform and lead those efforts than those trained in informatics. With the development of the new clinical informatics subspecialty for physicians, and other certifications likely to follow for others in HIT, there will be professional recognition for this work as well.