Tuesday, March 19, 2013

ONC Health IT Curriculum: Funding Ends, Materials Remain Available

The end of March, 2013 will mark a major change to a project to which I have devoted a great deal of my professional life over the last few years, which is the Office of the National Coordinator for Health IT (ONC Health IT Curriculum project. This project began in April, 2010, when five universities were awarded funding to each produce four out of a total of 20 "components" (comparable to courses) for the curricular materials whose primary audience would be the ONC Community College Consortia, although we would later expand this to all of higher education providing educational programs in informatics and health IT. Oregon Health & Science University (OHSU) was awarded additional funding to serve as the National Training and Dissemination (NTDC), tasked with developing mechanisms for disseminating the curricular materials, providing technical support, and training community college faculty in their use.

First things first for those who may have worries: The curricular materials will continue to be available on the NTDC Web site, which I plan to maintain with funding from my own department through the end of 2013. In the meantime, ONC is also developing a transition plan to house the materials on their Web site. The materials have also shown up in various other places, as is allowed under the Creative Commons license that we adopted, and of course anyone is free to download and use them under the terms of that license. The best description of this third and final version of the curriculum is in a previous blog posting of mine, with some additional notes (mainly on the new version of the VistA for Education system) provided in another posting.

A more serious challenge for the ONC Health IT Curriculum is how to maintain and update the materials going forward. After the grant funding ends this month, our support for the materials will end. This not only means the end of the online support we have provided, but also that no errors or other problems will be fixed when drawn to our attention. Of course, this does mean that others cannot update and improve their own copies of the materials (since we provide all source materials for download); it is just that the NTDC will no longer be able to correct problems and upload fixes to the source content.

Another problem is that as of now, there is no definitive plan for updating of the materials, which means they will gradually become out of date over time. (We did manage to get them updated for Stage 2 of meaningful use but have not been able to update the privacy and security materials for the revisions to HIPAA released in January, 2013.)

Nonetheless, the materials will still be valuable in that they provide a foundation for educators and others who can then update them as they adapt them for their own purposes. In essence, this is the main contribution of the project, which is to provide a higher foundation from which many who teach informatics and health IT can draw. The primary audience for this project always has been educators, and the materials, even if they have some "bugs" or become somewhat out of date, will still provide a base upon which others can build. The materials may also be able to help educational institutions stand up new programs (or enhance existing ones) more easily.

It may well be that there will be resources in the future to allow updating and even expansion of the materials. But for now, educators and everyone else will have plenty to work with, and I am confident that motivated teachers and others will be able to make effective use of the materials.

Saturday, March 9, 2013

Other (Non-Physician) Certifications in Informatics, Health Information Technology, and Related Areas

Although the physician subspecialty certification has received the lion's share of the attention when it comes to certification of professionals in informatics, there are actually a great deal of other certification options for other professionals who work in informatics, health information technology (HIT), and related areas. While I am playing a big role in several aspects of the physician certification process, I believe that appropriate professional recognition is important for all who work in informatics. This is demonstrated by the demographics of the enrollment in our informatics educational program at Oregon Health & Science University (OHSU), where only about 30% of the students are physicians.

A number of people, including students in our educational program, have written me lately to ask about these certifications. That has led me to do some research to try to come up with a list and analysis to make sense of it all. I will use this post to provide a list of all certifications in informatics and related areas of which I am aware, and provide some commentary on gaps and limitations.

This process also raises the issue of just how important certification is or should be in our field. In all honesty, I am not sure. It is likely that the real determination of its value will come from employers and others who "vote with their dollars" by making certification part of their hiring and/or promotion criteria. I am not aware that this has happened yet on any widespread basis. In the case of the physician subspecialty, I am certain it will be years before being "board-certified" in clinical informatics will really matter in getting hired or advancing in one's career. But I am equally certain that it eventually will matter a great deal.

From this perspective, let us review what I have learned about certifications in informatics and related disciplines. A first finding is that the certifications fall into two broad categories, which are those that require formal education or training to be eligible to take the certification exam and those that do not.

The certifications requiring formal specific education are in nursing informatics and in health information management (HIM). (And, in a few years, in the new medical subspecialty.) The certification in nursing informatics is provided by the American Nursing Association (ANA). Eligibility for the certification requires having a bachelor's degree in nursing or a "relevant field," along with specified practice and educational experience in both nursing and informatics.

The HIM field has two certifications that require formal education in programs certified by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM). These certifications, and the required minimum education, include:
The HIM field also has other certifications that do not require specific education and are focused on specific job functions:
There are a number of other certifications that do not require specific formal education. These certifications are mostly in technical areas and use the "health information technology" moniker.

The Healthcare Information & Management Systems Society (HIMSS) has had a certification called the Certified Professional in Healthcare Information & Management Systems (CPHIMS) that has been in existence for about a decade. I actually took the CPHIMS exam (and passed!) when it first came out. It is billed as a professional certification program for healthcare information and management systems professionals.

HIMSS also has created a new Certified Associate in Healthcare Information & Management Systems (CAHIMS), which is designed for emerging professionals within the industry (i.e., with five or less years of experience). This certification is said to demonstrate knowledge of HIT and management systems, and aims to facilitate entry-level HIT careers. It is also designed to be a career pathway to the CPHIMS credential.

Another certification is the HITPro Program, which was developed as part of the Office of the National Coordinator for HIT (ONC) Workforce Development Program. There are six certifications based on the six HIT workforce roles designated by ONC, which has also funded short-term training programs in community colleges, although the HITPro exams can be taken by anyone. The six workforce roles covered by the exams include:
  • Practice workflow and information management redesign specialists
  • Clinician/practitioner consultants
  • Implementation support specialists
  • Implementation managers
  • Technical/software support
  • Trainers
The curriculum for the HITPro exams is based on another ONC-funded project, which is the ONC Curriculum Development Centers Project in which I have had substantial involvement. The curricular materials are freely available for download from the ONC National Training and Dissemination Center (NTDC). In addition, an exam guide for these exams (as well as the CompTIA exam described below) was recently published.

There are two companies that offer a combination of both training programs or materials, along with certification exams. The first of these is Health IT Certification, which offers certification in four areas, along with (optional) training for each:
  • CPHIT - Certified Professional in Health Information Technology
  • CPEHR - Certified Professional in Electronic Health Records
  • CPHIE - Certified Professional in Health Information Exchange
  • CPORA - Certified Professional in Operating Rules Administration
The second company offering both training materials and certification is CompTIA, which provides many IT-related certifications and has recently added the CompTIA Healthcare IT Technician among its certification offerings. This certification covers the knowledge and skills required to implement and support HIT systems in a variety of clinical settings. The CompTIA Web site states that the Healthcare IT Technician certification exam covers "regulatory requirements, organizational behavior, IT operations, medical business operations, and security." The "recommended experience" for the exam is the baseline CompTIA A+ certification or 500 hours of hands-on technical experience in HIT.

Of course, all of the certifications that have been developed, including the clinical informatics physician subspecialty, still leave out some major elements of the informatics workforce. One of these in particular is the group of advanced informatics professionals who have master's and doctoral degrees or other advanced training in informatics. This group includes physicians who are not eligible for the subspecialty, other healthcare professionals who work in informatics, and others who hold advanced degrees or have had advanced training in the field. I have noted in previous postings that AMIA has established a plan for advanced interprofessional informatics certification of other individuals with doctoral degrees, including healthcare doctorates as well as PhDs and other doctoral degrees. I am not aware of official plans of anyone to certify master's-level informaticians, but it would not surprise me to see CAHIIM or even AMIA take the lead on that at some point soon.

This posting has shown that there are clearly many certifications for informatics and related areas. While it is not clear how much employers value or require these certifications, we do know that employers do have a desperate need for skilled talent, perhaps best exemplified by the report last year from the College of Health Information Management Executives (CHIME). This report concluded that the shortage of people with appropriate skills and experience was one of the critical challenges hindering the successful implementation of HIT projects. However, a common complaint heard among new graduates of HIT educational programs is that most positions they desire require experience, which many do not have, since they are just entering the field. Whether formal certifications will hedge against lack of experience is not clear.

Another perspective is to share my own approach to making hiring decisions in my academic department, where I am involved in hiring both those who work in informatics and HIT as well as those who do not (e.g., administrative staff). For each job search, every candidate brings a set of attributes. One of those attributes is their formal education and training. Another is experience in the work and/or setting that the job will entail. There are other factors, such as interviews and recommendations. All hirers apply some sort of calculus, not necessarily a purely quantitative one, to choose the "best" candidate for a given position.

Why is this relevant to informatics certification? It is relevant because in the early days of certification, whether for physicians or others, certification will be one of many attributes considered by a hirer. Other attributes will include experience, and many HIT and informatics personnel bring substantial experience, even if they have little or no formal education or training or any type of certification.

A final perspective I can share is a common question I am asked, which is whether someone should seek formal training in informatics. As the head of an educational program in the field, I obviously have a bias in favor of education. But I do tell those who ask this question that their formal education will be one of those attributes in the calculus of people who may hire them. Everything else being equal (which in reality almost never happens), a job candidate with a credential in informatics (e.g., master's degree, certificate, even the 10x10 course) will have a leg up over someone who does not.

There are clearly many certifications for different people and skills levels in informatics and HIT. It is likely that certification will play a growing role in an individual maintaining competitiveness in the job market. Of course, like all "knowledge fields," informatics will continue to evolve, as we already see the focus shift from implementation to use of data. Therefore the real key for anyone working in informatics is to keep up with the changes and new directions for the field.

Friday, March 1, 2013

Invitation to Join the OHSU Informatics Discovery Lab

As the value of informatics is demonstrated throughout healthcare, personal health, research, and public health settings, there is a growing need for collaboration among academia, industry, healthcare delivery organizations, public health agencies, and others. Academic programs will lose their relevance if its efforts are not aligned with the greater advancement of the disciplines in which they work. There are very high expectations that wide deployment of informatics will significantly improve healthcare and biomedical research from where we are now. This will not be possible without academia closely collaborating with companies, health-related organizations, healthcare delivery systems, public health agencies, and other health stakeholders.

Our department already looks outward as a essential characteristic of our large educational program.  Through our students and graduates, we disseminate knowledge, best practices, and research that advances and improves our understanding of our field. However, as I have written over the years in this blog, another local blog, and our local newspaper, our academic program at Oregon Health & Science University (OHSU) must move beyond its historical work of research funded primarily by federal research grants and education funding by tuition and training grants. We also need to make this move from a business sense, increasing revenue diversification in order to insure the longevity and financial viability of the program.

To this end, we are rolling out a new initiative that we are calling the OHSU Informatics Discovery Lab (IDL). The IDL will be a collaborative environment where students, teachers, and researchers, as well as representatives from healthcare delivery organizations, industry, and philanthropy, can partner to:
  • Foster highly relevant informatics research focused on real-world problems
  • Uncover commercially viable informatics opportunities
  • Accelerate informatics innovation and deployment
  • Provide companies and employers greater access to a faculty with both broad and deep informatics expertise and a well-trained informatics workforce pool
  • Expand the number and variety of informatics practicum and internship opportunities available for students
  • Make available informatics educational opportunities beyond traditional certificate and degree programs for current professionals, members of industry, and others requiring deeper informatics education and experience
The IDL will include informatics scientists, implementers, educators, and students with a unique combination of training, experience, and skills. Areas of expertise already include:
  • Healthcare analytics
  • Workflow redesign
  • Qualitative and quantitative evaluation methodologies
  • Natural language processing, machine learning, and information retrieval
  • Biomedical terminologies, ontologies, and coding
  • Biomedical data structure, representation, and normalization
The talent and skills of the IDL will allow us to bring a wide-ranging, multidisciplinary methodology to problem solving to apply the right approach to the problem. The figure below depicts our methodology.

There are a large variety of problems that need to be solved in health and biomedicine; however, focus is essential to successfully concentrate effort to solve specific problems. We have selected the following challenge areas not only for their importance, but also for their strong fit with our department's unique competencies. Specific projects within these areas will be identified and implemented based on our partners’ needs and interests:
  • Predictive Analytics for Healthcare Process Redesign
  • Usability for EHR Data and Users
  • Population management and Care Coordination Information Systems
  • Mobile Telemedicine
  • Precision Medicine
  • Enhancing Search in Biomedicine
A challenge for launching and sustaining the IDL is of course its business model. Possible partnership models we are exploring include:
  • Supporters. Philanthropic donors who help fund lab research activities gain wider access to the lab’s research, facilities, faculty, and staff. Supporters are eligible for a lab-wide NDA, which allows discussion of lab innovations as a whole, instead of on a per-project basis. Supporters are also eligible to send their employees to the lab for sabbaticals and other learning development experiences.
  • Sponsored Research. This includes specific projects of interest to both the commercial partner and the mission of the lab. These projects are funded by the commercial partner and managed and executed by the lab in collaboration with the partner, based on a project-specific statement of work and deliverables.
  • Fee for Service. Sponsoring organization require DMICE to provide certain services that is strictly generation of data or analysis for a set fee with no ownership of IP by OHSU.
  • Collaborative Development. This model comprises exploratory problem-solving intended to create shared intellectual property.
  • Consulting. Partners may access the expertise and experience of the lab for small, focused advisement, direction, evaluation, and feedback on their projects or areas of interest.
  • Company Start-up. Faculty can contemplate to start companies that can either provide unique resource, services and/ or develop products that have tangible IP to address an unmet need.
  • Product/Software Development. In partnership with companies jointly develop software and also be a beta testing site.
  • Custom Education. Tailoring OHSU's informatics educational assets for new and innovative purposes.
  • Clinical Trial design. Outcomes research and patient information analysis.
There will be many benefits to IDL partners, including:
  • Oregon and OHSU are national leaders in healthcare reform. OHSU is Oregon’s largest academic health center, with Oregon and OHSU having the right population size and scope to test and implement new health care ideas and approaches. 
  • Access to resources and collaborative faculty expertise from bench to bedside to policy in medicine, nursing, dentistry, and public health informatics. Leverage significant existing investments and dedicated resources focused on biomedical and health informatics research and education at OHSU, including other public and private funding supporting our work. 
  • Health simulation environments, analytical models, health management platforms, and domain expertise on deploying marketable technologies for use in the multi-billion dollar health sector. 
  • Invaluable community benefit gained by demonstrating the translation of information into meaningful knowledge to cure disease and save lives. 
  • Access to health informatics students and post-doctoral fellows. 
  • Corporate partner company employees are eligible to use the IDL for sabbaticals and other learning development experiences. 
  • Corporate partners are eligible for OHSU Corporate Catalyst Program benefits (donations of $25,000+). 
The IDL development effort is being led by Aaron M. Cohen, MD, MS, Associate Professor and Director of Commercial Partnerships and Collaboration in the Department of Medical Informatics & Clinical Epidemiology (DMICE) at OHSU. Dr. Cohen has been the recipient of several grants from the National Institutes of Health and others, applying text mining and machine learning to problems in biomedicine. Before joining OHSU, Aaron was employed at Intel Corporation as a Senior Staff Software Engineer and Software Architect where he led the development of video teleconferencing systems, 3D browser media, and multimedia and telephony standards. The IDL will be guided by an external steering committee representing the Lab’s many stakeholders: DMICE students and alumni; biomedical researchers; healthcare delivery organizations; healthcare information technology vendors; entrepreneurs and technology transfer experts; and philanthropic organizations.

We look forward to getting feedback and potential partners to work with us as we roll out the IDL. We invite you to join us on this journey.