Friday, February 21, 2014

ONC Health IT Curriculum Materials Are Moving

One of the most enduring artifacts from of the Health Information Technology for Economic and Clinical Health (HITECH) Act may well be the Office of the National Coordinator (ONC) Health Information Technology (HIT) Curriculum. I noted last year that the funding for the ONC health IT curriculum had ended, so the materials are no longer being updated. However, they still have value, and OHSU has continued to maintain the National Training and Dissemination Center (NTDC) Web site where they are currently housed. With OHSU's ability to fund the site ending, I am pleased to report that the materials will find an archival home in the AMIA Knowledge Center, where they will continue to be freely available. Around the end of February, the NTDC Web site itself will be retired.

Detailed documentation is available within the materials themselves, with a set of overview pages available from the links in the upper right portion of the main screen on the AMIA site. I have also provided overviews of the materials in past blog postings from 2012 and 2011. ONC still provides an overview of the program that created the materials on its Web site.

It is important to remember the main audience for these materials is educators, even though they are used by many others. But the materials are more designed to be fashioned by teachers into courses than to be used directly, even though many people do the latter.

The uncompressed size of the final (Version 3) materials is 11.2 gigabytes, contained in 18,072 files. 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!). 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.

The curricular materials consist of 20 components, each of which is comparable in depth to a college course. The components are subdivided into 8-12 units, each of which contain a variety of activities appropriate to the topic, including voice-over-Powerpoint narrated lectures, references, suggested readings, exercises, and more. All of the files for each unit are organized into .ZIP files for ease of downloading, and even further, all unit .ZIP files are bundled into a single component .ZIP file for ease of mass downloading.

The topic areas of the 20 components are:
  1. Introduction to Health Care and Public Health in the U.S.
  2. The Culture of Health Care
  3. Terminology in Health Care and Public Health Settings
  4. Introduction to Information and Computer Science
  5. History of Health Information Technology in the U.S.
  6. Health Management Information Systems
  7. Working with Health IT Systems
  8. Installation and Maintenance of Health IT Systems
  9. Networking and Health Information Exchange
  10. Fundamentals of Health Workflow Process Analysis & Redesign
  11. Configuring EHRs
  12. Quality Improvement
  13. Public Health IT
  14. Special Topics Course on Vendor-Specific Systems
  15. Usability and Human Factors
  16. Professionalism/Customer Service in the Health Environment
  17. Working in Teams
  18. Planning, Management and Leadership for Health IT
  19. Introduction to Project Management
  20. Training and Instructional Design
Each component also contains a blueprint document that provides an overview of the learning objectives and content for each unit. All of the components also have an instructor's manual that provides more detailed information, including listing of authorship and teaching information. The full set of blueprints have been rolled into a single PDF file and are available on the ONC Web site.

Three of the components are "lab" components that make use of an educational version of the Veteran's Administration (VA) VistA EHR. A version of VistA that runs under various versions of Microsoft Windows is provided on the Web site, courtesy of the VA. This version runs under the open-source GT.M version of M.

The materials are distributed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License. This means that all users of the curriculum can use, share, and adapt the materials but must attribute the originator of work, use the materials only for non-commercial purposes, and share any changes made under same license. Per the ONC, universities own the intellectual property for their components.

I am hopeful that continued usage of the materials will occur, and that some academic programs will undertake innovations with them. One example of an innovation is their organization into a Massive Open Online Course (MOOC) by the Health Informatics Forum. It may be possible that we, AMIA, and others might someday find additional funding to maintain, update, and expand the materials as well. But for now, they remain a valuable resource to the HIT community.

Thursday, February 20, 2014

Another Informatics Book!

Sure enough, shortly after my last post on the myriad of new informatics books that have come out lately, another one appears. This is also a general biomedical informatics textbook and, like the Shortliffe book, I have a chapter on information retrieval in this book as well.

But this book is in Spanish! Edited by my colleagues, Drs. Melchor Sánchez-Mendiola and Adrián Israel Martínez-Franco, this book provides a Spanish-language overview of biomedical informatics [1]. I adapted my chapter on information retrieval (or, as one would say in Spanish, recuperate información, or RI) for their audience, and then Dr. Martínez-Franco translated it into Spanish [2]. I had the opportunity to visit Drs. Sánchez-Mendiola and Martínez-Franco last year and was able to see up close the impressive work they have done in informatics curriculum development in the Faculty of Medicine at the Universidad Nacional Autónoma de México (UNAM), which they described in an article in Journal of the American Medical Informatics Association last year [3].

Below is a photo of myself holding the two new biomedical informatics books!


1. Sánchez-Mendiola, M and Martínez-Franco, AI, Eds. (2014). Informática Biomédica, 2a Edición. Mexico City, MX, Elsevier.
2. Hersh, W (2014). Estrategias Para Recuperar Información. In Informática Biomédica, 2a Edición. M. Sánchez-Mendiola and A. Martínez-Franco. Mexico City, MX, Elsevier: 75-85.
3. Sánchez-Mendiola, M, Martínez-Franco, AI, et al. (2013). Development and implementation of a biomedical informatics course for medical students: challenges of a large-scale blended-learning program. Journal of the American Medical Informatics Association. 20: 381-387.

Thursday, February 13, 2014

Books Are Not Dead, Especially Informatics Books

An article last fall in The New Republic noted that the book industry has not quite followed the music and film-camera industries in being disruptively innovated out of their traditional products [1]. Book publishing certainly has changed, but neither the decomposition of music albums into single songs has not happened with books, nor has the transition from a physical to digital medium undermined the basic economic model of books. Yes, the book industry has been transformed, particularly the role of brick-and-mortar booksellers. However, as this article points out, books themselves are still selling strong.

I have always been a book lover, one of those types who buys more books than he can possibly read. One can easily see this by walking into my work or home office, and finding the shelves lined with books. I run the gamut, from a small collection of antique medical books to rows of more recent volumes to those using the Kindle app (and other book apps) on my Mac, iPad, and iPhone.

I am also frequently asked to recommend textbooks in informatics. Certainly the most common, but not the only request is for an overview textbook. In recent years, that question comes qualified with "something I can use to study for the informatics board exam." But I do get requests for books on other topics and used in other contexts.

The last few months have seen a flurry of new books on informatics topics. Not only brand new editions of venerable general texts, but the publishing of new topics as well. I even have chapters in some of these books. I would therefore like to take the rest of this post to the describe the recently updated books, my contributions to them, and other relevant specialty books.

When one thinks of the single most comprehensive book in the field, they are no doubt thinking about the "Shortliffe book" that, in its new fourth edition, is edited by Drs. Edward Shortliffe and James Cimino [2]. One of the challenges with what we also sometimes call "Ted's book" is that the gap between editions has been longer than one might hope for in a rapidly advancing field. But the fourth edition is out now, and reflects the modern theory and practice of biomedical informatics. I have had a chapter in this book since the second edition on the topic of "Information Retrieval and Digital Libraries" [3].

This book went to press shortly after the death of an early legend of the informatics field, Dr. Homer Warner, of the University of Utah. This volume is dedicated to Homer, and there is a fascinating figure in the Preface that outlines the training descendants of all authors in the book, who can be traced back to Homer (including myself, through my fellowship mentor Dr. Robert Greenes, who in turn was mentored by Dr. Octo Barnett, who connected directly to Homer).

There is also another general book about the field that has come into its own through its now sixth edition, which is the volume edited by Dr. Robert Hoyt and Ann Yoshihashi [4]. This book has a more applied focus than the Shortliffe book, but has been an easy yet comprehensive read, especially in the gap between the third and fourth edition of the latter. Last year, when people wanted a single volume to prepare for the clinical informatics board exam, after advising people that one book could not cover the entire field in enough depth for the exam, I recommended Dr. Hoyt's book as a starting point. For this year's exam, of course, people will have updated versions of this book and Ted's book from which to choose. I have two chapters in the Hoyt book, one solo-authored on healthcare data analytics [5] and a second on evidence-based medicine co-authored with Dr. Hoyt [6]. The book also has a Web site that provides additional materials and provides links to obtaining the book in various paper and electronic formats. The Web site also features a link to a PDF of my analytics chapter.

In addition to these two general books, there are many specialty books of note, some of which have just been published or refreshed with new editions. The following discussion is not exhaustive, but does cover books I believe are helpful in gaining knowledge about aspects of the field.

Among the new books are those from the Springer Health Informatics series, which is the largest single series of informatics books by any publisher. This series includes the Shortliffe book. There are a couple other new and noteworthy books in this series. One is on informatics education and is edited by Dr. Eta Berner [7]. The other is the second edition of the series' volume on public health informatics, which is edited by Drs. JA Magnuson and Paul Fu [8]. In the Berner book, I have a couple chapters on the Office of the National Coordinator for Health IT (ONC) Workforce Development Program [9] and on the 10x10 ("ten by ten") program [10]. In the Magnuson and Fu volume, I have a chapter that places public health informatics in the larger context of biomedical and health informatics [11].

This series also includes my own book about information retrieval (from 2009, in its third edition, and which has an associated Web site of updates and errata) [12] and a couple informative volumes about standards, one from Tim Benson focused on standards generally [13] and another from standards expert and OHSU student Keith Boone focused more specifically on Clinical Document Architecture [14].

Some other informatics books of note from other publishers include a volume on informatics methods [15], an online-only volume devoted to translational bioinformatics [16], and a text on pathology informatics [17]. The latter actually covers informatics beyond just pathology, so is almost a general textbook, and some of its content appeared to be present in questions on the recent clinical informatics subspecialty board exam.

Finally, another category of books worth noting is those devoted to explaining healthcare systems, particularly the US system. These books can be very valuable to those entering the informatics field without substantial clinical backgrounds. One book started as a primer written by a couple medical students, Elisabeth Askin and Nathan Moore, and provides a succinct overview of the US healthcare system [18]. The other book, written by journalist TR Reid, is an excellent comparative overview of the different approaches to healthcare systems around the world [19].

As I noted at the onset of this posting, books are still viable, and the informatics-related book-publishing enterprise is thriving. Books are still an important means of conveying bodies of knowledge, and I suspect will continue to be, even if the medium of them continues its transition from paper to electronic form.


1. Hughes, E (2013). Books Don't Want to Be Free - How publishing escaped the cruel fate of other culture industries. The New Republic, October 21, 2013, 22-24.
2. Shortliffe, EH and Cimino, JJ, Eds. (2014). Biomedical Informatics: Computer Applications in Health Care and Biomedicine (Fourth Edition). London, England, Springer.
3. Hersh, WR (2014). Information Retrieval and Digital Libraries. In Biomedical Informatics: Computer Applications in Health Care and Biomedicine (Fourth Edition). E. Shortliffe and J. Cimino. New York, NY, Springer: 613-641.
4. Hoyt, RE and Yoshihashi, A, Eds. (2014). Health Informatics: Practical Guide for Healthcare and Information Technology Professionals, Sixth Edition. Pensacola, FL,
5. Hersh, WR (2014). Healthcare Data Analytics. In Health Informatics: Practical Guide for Healthcare and Information Technology Professionals, Sixth Edition. R. Hoyt and A. Yoshihashi. Pensacola, FL,
6. Hoyt, RE and Hersh, WR (2014). Evidence-Based Medicine & Clinical Practice Guidelines. In Health Informatics: Practical Guide for Healthcare and Information Technology Professionals, Sixth Edition. R. Hoyt and A. Yoshihashi. Pensacola, FL, 323-350.
7. Berner, E, Ed. (2014). Informatics Education in Healthcare: Lessons Learned. London, England, Springer.
8. Magnuson, JA and Fu, PC (2014). Public Health Informatics and Information Systems. New York, NY, Springer.
9. Hersh, WR (2014). Informatics for the Health Information Technology Workforce. In Informatics Education in Healthcare: Lessons Learned. E. Berner. London, England, Springer: 93-107.
10. Hersh, WR (2014). Online Continuing Education in Informatics: The AMIA 10 × 10 Experience. In Informatics Education in Healthcare: Lessons Learned. E. Berner. London, England, Springer: 109-120.
11. Hersh, WR (2014). Context and Value of Biomedical and Health Informatics. In Public Health Informatics and Information Systems. J. Magnuson and P. Fu. New York, NY, Springer: 37-46.
12. Hersh, WR (2009). Information Retrieval: A Health and Biomedical Perspective (3rd Edition). New York, NY, Springer.
13. Benson, T (2012). Principles of Health Interoperability HL7 and SNOMED (Health Information Technology Standards), Second Edition. New York, NY, Springer.
14. Boone, KW (2011). The CDA Book. New York, NY, Springer.
15. Sarkar, IN (2014). Methods in Biomedical Informatics: A Pragmatic Approach. London, England, Academic Press.
16. Kann, M and Lewitter, F, Eds. (2013). Translational Bioinformatics. San Francisco, CA, Public Library of Science.
17. Pantanowitz, L, Tuthill, JM, et al., Eds. (2011). Pathology Informatics: Theory and Practice. Chicago, IL, American Society for Clinical Pathology.
18. Askin, E (2012). The Health Care Handbook. St. Louis, MO, Washington University School of Medicine.
19. Reid, TR (2010). The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. New York, NY, Penguin Books.

Monday, February 10, 2014

Seeking Input: Evidence Report for Health Information Exchange

Last fall, I reported that the Pacific Northwest Evidence-based Practice Center (EPC), housed in the Department of Medical Informatics & Clinical Epidemiology (DMICE) at Oregon Health & Science University (OHSU), had been awarded a contract from the Agency for Healthcare Research & Quality (AHRQ) to carry out an evidence report (also known as a systematic review) on the topic of health information exchange (HIE). I am Principal Investigator of the project.

AHRQ has a process in its Effective Healthcare Program for insuring public input into its evidence reports. The first step is called "topic refinement," and the investigators develop draft key questions that the systematic review will address that are derived from the AHRQ Scope of Work for the project. The next step is to have a public comment period for the draft key questions before the actual systematic review process begins. We have reached the public comment period in our project, which will remain open through February 26, 2014. The draft key questions and forms for commenting will be available during the open comment period at the following URL:

Please comment at the AHRQ site and not as a reply to this posting. We encourage constructive comments and suggestions on the draft questions, which are listed below for convenience. After the topic refinement begins, we will begin the work of the systematic review that will aim to both identify where evidence currently exists as well as define gaps where further research is required.

Draft Key Questions

1. Is health information exchange (HIE) effective in improving clinical (e.g., mortality and morbidity), economic (e.g., costs and resource use, the value proposition for HIE) and population (e.g., syndromic surveillance) outcomes?
Does effectiveness vary by type of HIE?
Does effectiveness vary by health care settings and systems?
Does effectiveness vary by IT system characteristics?
What evidence exists that the lack of HIE leads to poorer outcomes?

2. What harms have resulted from HIE? (e.g., violations of privacy, errors in diagnosis or treatment from too much, too little or inaccurate information, or patient or provider concerns about HIE)
Do harms vary by type of HIE?
Do harms vary by health care settings and systems?
Do harms vary by the IT system characteristics?

3. Is HIE effective in improving intermediate outcomes such as patient and provider experience, perceptions or behavior; health care processes; or the availability, completeness, or accuracy of information?
Does effectiveness in improving intermediate outcomes vary by type of HIE?
Does effectiveness in improving intermediate outcomes vary by health care settings and systems?
Does effectiveness in improving intermediate outcomes vary by IT system characteristics?
What evidence exists that the lack of HIE leads to poorer intermediate outcomes?

4. What is the current level of use and primary uses of HIE?
Do level of use and primary uses vary by type of HIE?
Do level of use and primary uses vary by health care settings and systems?
Do level of use and primary uses vary by IT system characteristics?

5. How does the usability of HIE impact effectiveness or harms for individuals and organizations?
How usable are various types of HIE?
What specific usability factors impact the effectiveness or harms from HIE?

6. What facilitators and barriers impact implementation of HIE?
Do facilitators and barriers that impact implementation vary by type of HIE?
Do facilitators and barriers that impact implementation vary by health care settings and systems?
Do facilitators and barriers that impact implementation vary by IT system characteristics?

7. What facilitators and barriers impact use of HIE?
Do facilitators and barriers that impact use vary by type of HIE?
Do facilitators and barriers that impact use vary by health care settings and systems?
Do facilitators and barriers that impact use vary by IT system characteristics?

8. What factors influence sustainability of HIE?