Saturday, May 19, 2012

Disruptive Innovation Coming to Higher Education? The Role of Massive Open Online Courses

The notion of disruptive innovation was popularized by Clayton Christensen [1, 2], and is described as change, usually technological, that causes upheaval of an entire industry sector. We have seen plenty of disruptive innovations in the modern digital era, as the marketplace for products such as books, newspapers, photography, banking, and travel has undergone profound change. Who takes pictures using film or regularly walks into a bank anymore? Who does not spend at least part of their reading time doing so on electronic devices, increasingly those held in the hand, such as smartphones or tablets?

There is a certain irony for those of us who work in academic biomedical and health informatics. On the one hand, we are immersed in the technologies that have caused so much disruptive innovation, i.e., computers, the Internet, and the World Wide Web. On the other hand, those of us in academic informatics apply our work at the intersection of two fields that may be the lone remaining holdouts for disruptive innovation, namely healthcare and education.

We can debate in another post whether disruptive innovation will ever come to healthcare. There are some signs, but I am not holding my breath. Recent developments in higher education, however, potentially portend profound change coming. Being in higher education for a livelihood, I naturally have great interest in the consequences of disruptive innovation within it.

This potential disruptive innovation in higher education comes in the form of what some call massive open online courses (MOOCs). This area has received a great deal of attention lately with the foray of some of the leading US universities into this area, namely Stanford, Harvard, and Massachusetts Institute of Technology (MIT). It has garnered attention in the popular media [3-6].

As most readers of this blog know, I have great enthusiasm for online learning. A good deal of my work in the last decade has focused on the fusion of educational technology with biomedical and health informatics [7-10]. However, the result has mostly been education based on the traditional model of the professor teaching and interacting with a relatively modest number of students.

MOOCs change the calculus of online learning in a much more profound way. Stanford computer science professors Andrew Ng and Daphne Koller have been at the forefront, adapting and delivering their courses to massive audiences [4, 6]. They are part of a new technology venture led by Stanford and including several other big-name US universities called Coursera. Not to be left out, Harvard and Massachusetts Institute of Technology have also launched a similar initiative.

Despite their high profiles, these are not the first such initiatives to disseminate high-quality higher education content via the Web. Two other initiatives, Udacity and the Khan Academy, have been doing this for several years. Resources like the University of Pittsburgh Epidemiology Supercourse have been in existence even longer.

Will these MOOCs lead to disruption in higher education? The cynic in me notes that Ng and Koller are not changing the core Stanford product, where a small number of highly smart students pay a substantial amount of money in the form of Stanford tuition for the privilege of being on the Palo Alto campus and getting a degree from Stanford. I also note that these courses are mostly basic courses, and not the more advanced knowledge that might help someone apply this information. The content is "open" in the sense of being available to anyone, but not in the "wiki" sense of being improved upon in a massive way.

But the optimist in me with the goal of spreading knowledge via technology cannot help but be impressed at the uptake and reach of these courses. I certainly enjoy the global interaction I have through the various educational activities in which I take part in on the Internet. Even Facebook can sometimes be a platform for disseminating knowledge and doing what I enjoy most as an educator, which is getting people to both delve into deeper layers of fact as well as apply them in larger contexts and intellectually principled ways.

As is often the case, the ultimate reality will likely fall somewhere in the middle. Clearly the Web provides an unprecedented vehicle for knowledge dissemination. But education is so much more than a student absorbing knowledge. There is also the in-depth application of that knowledge for real-world purposes. I cannot help but wonder, for example, whether the Coursera natural language processing (NLP) course will enable a student to be able to implement a system that can detail with all the nuances of the narrative text generated by clinicians in the electronic health record. One thing that clinical informatics has taught us is the lack of predictability of technological interventions in healthcare settings.

Of course we have shown to our satisfaction at Oregon Health & Science University (OHSU) that pretty much all types of learning can be delivered online. But we have also learned that an education involves more than learning. Early on in our foray into distance learning, I was struck how we had developed, without deliberately trying to do so, a virtual community. When students join our program, they not only get access to our courses, but also our faculty, their student colleagues, and our connections to the larger informatics world, including our connections to industry. Even the staff in our office provide a conduit for their new journey into careers and other activities in the field.

But I am also, in a sense, part of this MOOC world, due to the Office of the National Coordinator for Health IT (ONC) Curriculum Project that has absorbed a great deal of my professional time, effort, and passion over the last couple years. All of this potential for disruptive innovation of informatics education therefore comes at a time of critical juncture for our field. We have been fortunate to have, for the first time in the history of our field, substantial federal investment, not only in the form of subsidized education for students, but also in the development of the ONC curricular materials. The verdict is still out on what impact the curricular materials will have on informatics education and training in the long run. But with the ARRA funding for them winding down, we are at a critical juncture in finding ways to sustain them (if we believe they are important) once the grant for them ends at the end of 2012.

In conclusion, I view the potential for disruptive innovation in higher education as a challenge and an opportunity. While I am not worried it will make my world dissipate like camera film or bank tellers, I do know the ride will be bumpy. But in the end, I am confident that education will be improved and possibly more cost-effective. I am also confident of the continued role I will play in advising students and others about directions and opportunities for our field. And if things ever do settle down, we can move on to the real challenge for disruptive innovation, which is the healthcare industry!


[1] Christensen, C. (1997). The Innovator's Dilemma: When New Technologies Cause Great Firms to Fail. Boston, MA. Harvard Business School Press.
[2] Christensen, C. (2012). Disruptive Innovation, in Soegaard, M. and Dam, R., eds. Encyclopedia of Human-Computer Interaction. Aarhus, Denmark. The Foundation.
[3] Lewin, T. (2012). Instruction for Masses Knocks Down Campus Walls. New York Times. March 4, 2012.
[4] Markoff, J. (2012). Online Education Venture Lures Cash Infusion and Deals With 5 Top Universities. New York Times. April 18, 2012.
[5] Brooks, D. (2012). The Campus Tsunami. New York Times. May 3, 2012.
[6] Friedman, T. (2012). Come the Revolution. New York Times. May 15, 2012.
[7] Hersh, W., Junium, K., et al. (2001). Implementation and evaluation of a medical informatics distance education program. Journal of the American Medical Informatics Association, 8: 570-584.
[8] Hersh, W. and Williamson, J. (2007). Educating 10,000 informaticians by 2010: the AMIA 10×10 program. International Journal of Medical Informatics, 76: 377-382.
[9] Hersh, W. (2007). The full spectrum of biomedical informatics education at Oregon Health & Science University. Methods of Information in Medicine, 46: 80-83.
[10] Hersh, W. (2010). The health information technology workforce: estimations of demands and a framework for requirements. Applied Clinical Informatics, 1: 197-212.

Saturday, May 12, 2012

ONC Health IT Curriculum: Version 3 and Beyond

Although my last update of the ONC Health IT Curriculum project was relatively recently, there is much news to report, warranting another posting. Some background information for understanding some of the details in this posting in available in a prior posting announcing the availability of Version 2 of the curriculum. It should be remembered that while these curricular materials are freely available to anyone, they are really more designed for educators than students. There is nothing to keep any student from anywhere from downloading them, but they are less designed to be a health IT curriculum "out of the box" and more designed for instructors to develop into materials for specific learners, with additional perspectives, exercises, and even wisdom to be added accordingly.

Probably the most important news is the release of Version 3 of the curriculum. This will be the final version of the curriculum released under the original ONC Health Curriculum Development Centers Program grant. Version 3 is available to anyone to freely download from the National Training & Dissemination Center (NTDC) Web site.

The uncompressed size of the Version 3 materials is 11.2 gigabytes, contained in 18,072 files. As noted in the table below, the 20 components of the curriculum contain 9,974 Powerpoint slides and audio lasting over 136 hours (5 days, 16 hours, and 4 minutes, to be precise!). The NTDC search engine for the text-based files contains 38,181 unique words indexed. A manually constructed topical index is also available.

Of course, not all of the curriculum consists of narrated slides. There are also exercises, including those involving hands-on use of an educational version of VistA for Education (VFE), a fully functional version of the VA VistA electronic health record system, which is also included with the materials. A screen shot of VFE is shown below.

Some additional good news is each of the five universities in the program have been awarded a no-cost extension (NCE) to continue work on the project. In the case of OHSU, this will extend our grant through December 31, 2012. During the NCE time period, we will continue to provide support via the NTDC as well as prepare updates of the components for which we are responsible. Another activity during the NCE period will be to enhance VFE, including exploring the option of providing a fully open-source version that runs on all versions of Windows. (The current version requires a license for Intersystems Cache, which is only freely available to educational institutions.)

A final activity of the five Curriculum Development Centers during the NCE period will be to explore options for sustainability of the curricular materials beyond the end of the NCE period. We are investigating options to obtain funding to maintain, support, and extend the materials while continuing to make this resource freely available.

Sunday, May 6, 2012

Spring Renewal in Information Retrieval

Every spring I get a chance to renew my work in information retrieval (IR, also known as search), the area where I first started my research career over two decades ago. My other interests in informatics policy, workforce development, and education, along with my leadership and administrative work, now tend to crowd out the time I devote to IR research and related activity, but I always stay engaged.

The main reason for having my renewal each spring is the teaching of my course in our graduate program, BMI 514/614 - Information Retrieval. At a minimum, this leads me to refresh the updates on the Web site for my book on IR in health and biomedicine. I also often have an opportunity for students to work on projects of mine, especially since the course usually fits well within the annual challenge evaluations of the Text Retrieval Conference (TREC) or ImageCLEF.

This year has been even more of a renewal than most years. Part of the reason is my serving as General Conference Chair of the ACM Special Interest Group in Information Retrieval (SIGIR) 2012 conference, which will be held this August here in Portland. (More in the blog to follow!)

I have also re-engaged in TREC through helping to organize topic development and relevance judgments for the TREC Medical Records Track, which was launched last year to combine aiming to apply IR tools and techniques to retrieval-related problems in electronic health records.

I also recently happened across some fun IR things on the Web. One is ability to create a Wordle from one's scientific publications in the large SciVal collection (see image below). The words that show up largest should surprise no one! Another is the new ability in Google Scholar to set up a profile for one's scientific work, showing most cited works, one's h-index, and other information.