Saturday, September 28, 2013

ONC Funding for the OHSU Informatics Program: Coming to an End

It almost seems like yesterday when I woke up on the morning of April 2, 2010 to find out that OHSU had been awarded $5.8 million for two health information technology (HIT) workforce development grants by the office of the National Coordinator for HIT (ONC), one to serve as the lead among five universities in developing the national HIT curriculum for community college programs and the other for funding students in the University-Based Training (UBT) program aiming to accelerate the growth of the HIT workforce.

Now it is hard to believe that next week, at the end of this month, the second of our two grants will end, and our program will no longer have any direct funding from ONC. (The curriculum development grant ended in March. And technically while we have through the end of December to continue graduating students, the funding portion of the grant is ending on September 30, 2013.)

Overall, I am proud of the work we accomplished with this funding and the contributions we made to the field. While the curricular materials are sitting in a static mode on our Web site, they are still freely available and provide a foundation for anyone wishing to develop an educational program in HIT. In addition, the materials have found many uses beyond the community college programs, including in our own graduate program at OHSU. Before long, however, the materials will require updating before making use of them, but in their current state, they still do prevent someone from having to start from scratch. I hold faint hope that some mechanism to update and extend them will emerge.

I am likewise proud of what we accomplished in the UBT program. We not only launched many HIT careers, but also added some functionality to our own informatics educational program that we plan to maintain, namely a practicum/internship program and a career development service. Some of our best stories are published here, here, and here.

It is somewhat fitting that this time period coincides with a new book released in the Springer Health Informatics series about informatics education [1]. Edited by colleague Dr. Eta Berner, the book features a number of chapters on a variety of topics, including two written by myself, one on the ONC workforce program [2] and the other on the 10x10 program [3]. We also recently published a journal paper evaluating the ONC HIT curriculum materials with its primary users, who were community college faculty [4].


1. Berner, E, Ed. (2014). Informatics Education in Healthcare: Lessons Learned. London, England, Springer.
2. Hersh, WR (2014). Informatics for the Health Information Technology Workforce. Informatics Education in Healthcare: Lessons Learned. E. Berner. London, England, Springer: 93-107.
3. Hersh, WR (2014). Online Continuing Education in Informatics: The AMIA 10 × 10 Experience. Informatics Education in Healthcare: Lessons Learned. E. Berner. London, England, Springer: 109-120.
4. Mohan, V, Abbott, P, et al. (2013). Design and evaluation of the ONC health information technology curriculum. Journal of the American Medical Informatics Association: Epub ahead of print.

Saturday, September 14, 2013

A 20th Century Model of Education for a 21st Century Profession? OHSU Response to ACGME Draft Requirements for Clinical Informatics Fellowship Programs

As noted last month, the Accreditation Council for Graduate Medical Education (ACGME) released draft requirements for clinical informatics fellowship programs in late July, with a 45-day comment period that ended last week. A group from Oregon Health & Science University (OHSU), including myself, some other informatics faculty, our Senior Associate Dean for Education, and our Associate Dean for Graduate Medical Education submitted a response to ACGME.

The bottom line, as the title of this post says, is that the proposed ACGME approach really applies an increasingly outdated 20th century model of medical training to the vibrant 21st century subspecialty of clinical informatics. There is no question that clinical informatics training, like any other training, requires knowledge, skills, and experience. But the standard time-based, in situ approach to training likely will not build the capacity needed or provide a pathway that many who seek to join this profession can take.

One irony of this sort of approach is that OHSU was just awarded one of 11 grants from the American Medical Association (AMA) in their Accelerating Change in Medical Education initiative. Three schools, including OHSU, have as one of their aims for the grant to move medical education from a time-based to competency-based approach. There is no reason why every medical student has to spend exactly four years in school. Some may have backgrounds that allow them to accelerate their pace, which will be helpful as the need for physicians grows due to aging baby boomers and healthcare reform.

In a posting last year, I expressed concern about a time-based, in situ approach, which not only may limit the growth of capacity in the subspecialty, but also lock out a pathway to the profession for those who cannot disrupt work, families, or other aspects of their lives to uproot their lives to pursue a site-based clinical informatics subspecialty. OHSU has trained many physicians and others who have gone on to successful informatics careers using a mostly distance-based approach.

There are other problems that our response noted as well. A key one is the limitation of programs being administratively linked to the six specialties of Anesthesiology, Emergency Medicine, Medical Genetics, Pathology, Pediatrics, or Preventive Medicine. While this does not mean that physicians of any specialty will not be allowed to participate in a fellowship, we expressed concerns programs may be beholden to the affiliated specialty, either philosophically or fiscally, who may impose demands that could compromise the clinical informatics training experience. In addition, it may be difficult for trainees of specialties outside the affiliated one to pursue clinical work in their own specialty within the fellowship in a given institution that has a fellowship linked to a specific specialty.

We also expressed concern that clinical informatics fellows might not be able to practice their specialty as attending-level physicians and bill for their work. Being able to bill for practice in their primary specialty will be important not only for fellows’ maintaining clinical skills in their primary specialty but also for financial viability of the fellowship program.

We will eagerly await the ACGME response to ourselves and others who replied to their draft. In the meantime, planning will move forward for a clinical informatics subspecialty fellowship at OHSU. We also hope to work with other programs who seek help in providing educational content in their programs.