I like to believe that I have made many contributions to the field of biomedical and health informatics over the years, but I suspect the one that will most define my legacy in the field is the conceptualization and implementation of the first and still flagship course of the American Medical Informatics Association (AMIA) 10x10 program. This year marks the 15th year of the course, which has been completed by over 2700 people, dating back to 2005.
For me, the 10x10 course fulfills the three criteria of the Jim Collins' Good to Great hedgehog. I am passionate about the course as a way to disseminate knowledge of the informatics field. I also believe I am well-skilled in my ability to cover the important areas of the field, making them understandable, and giving the big picture and context of why they are important to biomedicine and health. And finally, the course has a revenue stream that enables me to devote a significant amount of my work time to teach it and keep it up to date.
I have always enjoyed teaching at the introductory level, introducing people to the field. The introductory course that comprises 10x10 came from an introductory course I first taught in the MPH program at Oregon Health & Science University (OHSU), Public Health 549, starting in the early 1990s. When we launched our informatics master’s degree program in 1996, that course became Medical Informatics 510 and it has served as the introductory course (now called Biomedical Informatics 510, or BMI 510) in our Biomedical Informatics Graduate Program to this day. The course has also been taken by students in other disciplines, including medicine, nursing, basic biomedical sciences, public health, and more.
I maintain a Web page that describes the course. It includes a link to the AMIA site where one can register for the next offering. I recently updated my chapter about the course in newly published second edition of Eta Berner's informatics education in healthcare book (Hersh W, Online Continuing Education in Informatics - the AMIA 10x10 Experience, in Berner ES (ed.), Informatics Education in Healthcare: Lessons Learned, 2nd Edition, New York: Springer, 2020, 251-262).
It would probably be a fascinating study to do a word analysis of my slides in the course. It would be interesting to see when various terms came into being used, such as “health information exchange” or “machine learning,” and which ones have faded away, such as “meaningful use.” It might also be interesting to see terms whose frequency have decreased and re-emerged over time, such as “artificial intelligence.” The image below shows a word cloud of the syllabus of the latest offering of the course.
The 10x10 course came about when then-President of AMIA Charles Safran called in 2005 for at least one physician and one nurse in each of the 6000 or so hospitals in the US to be trained in informatics. He asked directors of informatics education programs such as myself how many more students their programs could take. Many said they could increase 2-3 fold. However, as OHSU had already been teaching online since 1999, I told him that with enough lead time, we could expand and educate “all of them.” Rounding off some numbers, I came up with the name 10x10, indicating we could train 10,000 people by the year 2010. Ten thousand people did not show up, although I genuinely believe we could have handled that many with enough advance planning.
We also structured the 10x10 course so that those wanting to get academic credit for the OHSU BMI 510 course and pursue further study in the OHSU Biomedical Informatics Graduate Program. About 10-15% of those taking the course have chosen this option, pursuing the OHSU Graduate Certificate or Master of Science degree. Two of them ended up working all the way to a PhD. Others transferred the credits to educational programs at other institutions.
I offer the course three times a year with AMIA, with the four-month course starting each December, April, and July. The course includes an optional face-to-face session at the end of the course, where those completing the course meet those they have been studying with for the last several month and present their small course projects. I also provide special offerings with other groups, such as the American College of Emergency Physicians and Gateway Consulting in Singapore. The latter has been offered with my colleague KC Lun, PhD and includes 310 of the course's 2700 graduates. I have enjoyed my many trips to Singapore for the in-person session at the end of the course and have come to know the country, its stellar healthcare system, and its strong health IT environment well. I have also provided offerings in Thailand, Israel, Saudi Arabia, United Arab Emirates, and South Africa.
The 10x10 course is part of the fabric of my career. I have an offering of the course running almost all the time and do not foresee stopping this activit I enjoy so much any time soon. I am gratified that it has been an entry point into the informatics field for many of them.