Years ago, I used to get asked on a regular basis, What is Medical/Biomedical/Health Informatics? To answer this question, I created a Web site that attempted to answer it. Later on, I added some voice-over-Powerpoint lectures, which also provided me the opportunity to demonstrate the technologies we use in our distance learning program at Oregon Health & Science University (OHSU). In 2007, the site was accepted for listing in the Association of American Medical College (AAMC) online medical educational resource, MedEdPortal.
Keeping a site like this up to date is no small feat, especially at a time like this, when many people in the field are very busy carrying out work related to the Health Information Technology for Clinical and Economic Health (HITECH) Act. As readers of previous postings in this blog know, I have been very busy leading OHSU's contributions to the HITECH Workforce Development Program.
For this reason, the site had grown out of date, with its last major update in 2009, when the HITECH Act had just been passed. I am pleased to announce that I have now updated the lecture and references on the site to include not only everything related to HITECH, but also advances in other areas of biomedical and health informatics, including bioinformatics, information retrieval, and telemedicine.
The site still includes my voice-over-Powerpoint lectures, which have now expanded to about 2 hours and 40 minutes, but are still divided into seven segments. On almost every slide, I could go into even more detail. If nothing else, this site will hopefully whet peoples' appetites for the 10x10 program, the OHSU graduate program, or other programs.
The educational methods I use on this site mirror my on-line teaching. I have always found great value in voice-over-Powerpoint lectures, especially using the Articulate tool that provides the slides and sound in Flash format and also allows easy navigation among the slides. I also provide MP3 files of the slide audio (one MP3 per segment) as well as PDF files of the slides themselves (one PDF per segment). In addition, I provide another PDF that has references to all of the papers, reports, books, and other citations in the lecture. The site also contains a list of key textbooks as well as links to some of my papers and to important organizations and other sites for the field.
I look forward to receiving feedback from people and take full responsibility for any errors in any of the materials I have produced.
Showing posts with label HITECH. Show all posts
Showing posts with label HITECH. Show all posts
Monday, September 5, 2011
Saturday, February 19, 2011
Accolades for the Informatics Professor and His Blog
I have had the opportunity to publish and speak in some high-profile venues lately, and my blog and my book have received some honors. For the sake of the reader, however, I will roll all of my "bragging" into just this single post.
Let me start with publishing, where I have been invited to make some commentaries on various aspects of informatics. One of these was a contribution to a series of commentaries on the HITECH program in the prestigious journal Nature. (Subscription required for HTML and PDF versions.)
Another was an invitation to write an editorial accompanying a study on the development of registries in chronic kidney disease in the journal, Clinical Journal of the American Society for Nephrology (subscription required).
I have also be invited to talk on panels at a couple of high-profile meetings. One talk was on a panel at the AcademyHealth National Health Policy Conference (February 7-8, Washington, DC). The panel was focused on workforce issues, with speakers addressing different aspects of the healthcare workforce issue. Naturally I was invited to speak on informatics issues, describing the ONC Health IT Workforce Program as well as informatics competencies for modern healthcare professionals (slides).
Another talk is on a panel at this week's HIMSS Annual Conference on the ONC Health IT Workforce Program. I will speak about the Health IT Curriculum Development Centers Program (slides). OHSU serves not only as one of the five Curriculum Development Centers but also the National Training & Dissemination Center tasked with disseminating the curricular materials via a Web site and training community college faculty in their use.
I am also pleased to report that the Informatics Professor blog has been recognized by three sites that rate blogs:
Let me start with publishing, where I have been invited to make some commentaries on various aspects of informatics. One of these was a contribution to a series of commentaries on the HITECH program in the prestigious journal Nature. (Subscription required for HTML and PDF versions.)
Another was an invitation to write an editorial accompanying a study on the development of registries in chronic kidney disease in the journal, Clinical Journal of the American Society for Nephrology (subscription required).
I have also be invited to talk on panels at a couple of high-profile meetings. One talk was on a panel at the AcademyHealth National Health Policy Conference (February 7-8, Washington, DC). The panel was focused on workforce issues, with speakers addressing different aspects of the healthcare workforce issue. Naturally I was invited to speak on informatics issues, describing the ONC Health IT Workforce Program as well as informatics competencies for modern healthcare professionals (slides).
Another talk is on a panel at this week's HIMSS Annual Conference on the ONC Health IT Workforce Program. I will speak about the Health IT Curriculum Development Centers Program (slides). OHSU serves not only as one of the five Curriculum Development Centers but also the National Training & Dissemination Center tasked with disseminating the curricular materials via a Web site and training community college faculty in their use.
I am also pleased to report that the Informatics Professor blog has been recognized by three sites that rate blogs:
- Top Professors of Math & Science Blogs
- Forty-Six Health Care Blogs for Professionals
- 50 Resources for Students Attending Online Health Information Schools
Friday, February 18, 2011
Welcome to Oregon, President Obama and Mr. Otellini
Today I will have the opportunity to attend President Obama's visit to Intel Corp. in Portland, Oregon. While I will just be among the crowd, I would love the opportunity to talk with both of them, and will post my comments of what I would say in this blog entry.
President Obama, I want to thank you for the opportunity afforded by the HITECH Act in your stimulus legislation. I wish we could have you over to visit Oregon Health & Science University (OHSU), where we have put the $5.8 million awarded to us under the HITECH Act to good use. It is an investment in human capital that is building the workforce of future professionals who will lead the "meaningful use" of electronic health records (EHRs) to improve the quality and safety of healthcare. On time and on budget, we are not only one of nine universities training these professionals from around the country, but also one of five universities developing curricular materials for shorter-term community college programs. In the latter program, we also serve as the National Training & Development Center, training and supporting community college faculty in use of the materials and disseminating them via a secure Web site. We have also enhanced the scope of the program by building a curriculum around the VistA EHR system from the Veteran's Administration. This system is another exemplary federal project that has drastically improved healthcare delivery by the VA, and now will provide additional value in training future health information technology professionals in using and configuring EHRs.
To Intel Corp., namely Mr. Paul Otellini, CEO, I would love the opportunity to show off the work being done by a local university, OHSU, in your company's own backyard here in Oregon. I would relish the opportunity to work with your company more to increase economic development and create high-skill, high-paying jobs in Oregon. I have written in this blog, a local tech blog, and even our local newspaper, the Oregonian, about the potential that exists in Oregon for synergy among companies, an innovative healthcare system, and a world class academic program in biomedical informatics at OHSU to create an economic cluster around health information technology. Investing in students, research, and companies could pay off well for our region.
Postscript: I had an enjoyable time visiting Intel and hearing President Obama speak. I managed to get a front row seat and was able to shake the President's hand afterwards. Of course I took pictures and posted some of them on Facebook. I still would love the opportunity to address either the President or Mr. Otellini about the issues raised above.
President Obama, I want to thank you for the opportunity afforded by the HITECH Act in your stimulus legislation. I wish we could have you over to visit Oregon Health & Science University (OHSU), where we have put the $5.8 million awarded to us under the HITECH Act to good use. It is an investment in human capital that is building the workforce of future professionals who will lead the "meaningful use" of electronic health records (EHRs) to improve the quality and safety of healthcare. On time and on budget, we are not only one of nine universities training these professionals from around the country, but also one of five universities developing curricular materials for shorter-term community college programs. In the latter program, we also serve as the National Training & Development Center, training and supporting community college faculty in use of the materials and disseminating them via a secure Web site. We have also enhanced the scope of the program by building a curriculum around the VistA EHR system from the Veteran's Administration. This system is another exemplary federal project that has drastically improved healthcare delivery by the VA, and now will provide additional value in training future health information technology professionals in using and configuring EHRs.
To Intel Corp., namely Mr. Paul Otellini, CEO, I would love the opportunity to show off the work being done by a local university, OHSU, in your company's own backyard here in Oregon. I would relish the opportunity to work with your company more to increase economic development and create high-skill, high-paying jobs in Oregon. I have written in this blog, a local tech blog, and even our local newspaper, the Oregonian, about the potential that exists in Oregon for synergy among companies, an innovative healthcare system, and a world class academic program in biomedical informatics at OHSU to create an economic cluster around health information technology. Investing in students, research, and companies could pay off well for our region.
Postscript: I had an enjoyable time visiting Intel and hearing President Obama speak. I managed to get a front row seat and was able to shake the President's hand afterwards. Of course I took pictures and posted some of them on Facebook. I still would love the opportunity to address either the President or Mr. Otellini about the issues raised above.
Saturday, February 5, 2011
HITECH: Improving Healthcare Through Data and Action
Every now and then, I am asked to give an overview of the Health Information Technology for Economic and Clinical Health (HITECH) Act of the American Recovery and Reinvestment Act (ARRA, also known as the “economic stimulus bill”). The centerpiece of HITECH is a plan to vastly expand the adoption and “meaningful use” of electronic health records (EHRs) [1], based on a growing body of research demonstrating that EHRs, especially when combined with clinical decision support (CDS), can improve the quality, safety, and coordination of healthcare [2, 3]. Similar to other areas related to technology and/or healthcare, the US has become a laggard in the adoption of EHRs, falling behind most other developed countries [4].
HITECH provides up to $27 billion for eligible professionals and hospitals to receive incentives for achieving the meaningful use of EHRs [5]. Meaningful use is a critical concept. The goal of HITECH is not just to put computers into physician offices and on hospital wards, but rather to use them toward five goals for the US healthcare system: improve quality, safety and efficiency; engage patients in their care; increase coordination of care; improve the health status of the population; and ensure privacy and security. As such, every criterion in meaningful use (e.g., drug-drug interaction checking) must tie back to a healthcare goal (e.g., improve quality, safety and efficiency).
Government funds for HITECH incentives will be distributed through the public Medicare and Medicaid reimbursement systems. Depending on choice of funding through Medicare or Medicaid, eligible professionals can receive $44,000-$63,000, while eligible hospitals can receive $2-9 million between 2011 and 2018. The main purpose of these incentive funds is to cover the costs of investment in EHR systems. It is anticipated that further costs will become part of the "costs of doing business" for healthcare.
The HITECH legislation recognizes that incentives alone will not be enough to achieve all the goals of meaningful use. As such, HITECH allocates an additional $2 billion for various human and organizational infrastructure elements to attain its mandates. A critical portion of this infrastructure is the ability to achieve health information exchange (HIE), which is the secure flow of data to wherever it is needed for patient care, including across traditional business and other boundaries in the healthcare system [6]. About $547 million is allocated to states for HIE development.
Another critical piece of the infrastructure is the provision of technical support to achieve meaningful use. This is done with the allocation of about $677 million to 62 regional extension centers that are providing a variety of forms of assistance, mainly to small primary care practices [7].
An additional portion of the required infrastructure is a competent professional workforce to develop, implement, and train users of EHR and related systems. It has been estimated that the HITECH agenda will require an additional 50,000 professionals trained in fields such as biomedical informatics and health information management [8]. About $118 million has been allocated for both short-term training programs in community colleges as well as longer programs mostly at the graduate level in universities. My institution, Oregon Health & Science Univeristy, is playing a major role in this program.
The HITECH legislation also recognizes that additional research and development is required. As such, $60 million has been allocated to establish four collaborative research centers focusing on the topics of security and health information technology, patient-centered cognitive support, health care application and network design, and secondary use of EHR information. A related funding initiative is the Beacon Communities Program, which has funded about $250 million for 17 advanced demonstration projects “shine the light” forward.
Just as meaningful use connotes that EHR adoption is not just about installing computer technology in clinical settings, there are related initiatives in the United States that will synergize with the substantial HITECH investment. One initiative from the Institute of Medicine aims to develop the “learning health care system” that learns from the growing volume of captured data what does and does not work in healthcare [9]. This is closely related to the growing push for “comparative effectiveness research” that aims to compare tests, treatments, and other medical activities in head-to-head studies carried out in real-world settings [10]. This infrastructure will also likely contribute to the growing push for translational research, as exemplified by funding for the Clinical & Translational Science Award (CTSA) program of the National Institutes of Health [11].
Taken collectively, all these programs from HITECH to ACA, the learning healthcare system, and CTSA provide a vision of a new healthcare system that learns from its successes and changes based on its mistakes. This vision uses data as the critical enabler of coordinating, measuring, and researching care. HITECH is indeed a grand experiment, and it is likely be that some elements of this experiment will succeed whereas others fail. But in the end, the healthcare system should benefit this unprecedented investment in information systems, human capital, and goals for improving health.
References
1. Blumenthal D, Launching HITECH. New England Journal of Medicine, 2010. 362: 382-385.
2. Garg AX, Adhikari NKJ, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J, et al., Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. Journal of the American Medical Association, 2005. 293: 1223-1238.
3. Goldzweig CL, Towfigh A, Maglione M, and Shekelle PG, Costs and benefits of health information technology: new trends from the literature. Health Affairs, 2009. 28: w282-w293.
4. Schoen C, Osborn R, Doty MM, Squires D, Peugh J, and Applebaum S, A survey of primary care physicians in eleven countries, 2009: perspectives on care, costs, and experiences. Health Affairs, 2009. 28: w1171-1183.
5. Blumenthal D and Tavenner M, The “meaningful use” regulation for electronic health records. New England Journal of Medicine, 2010. 363: 501-504.
6. Vest JR and Gamm LD, Health information exchange: persistent challenges and new strategies. Journal of the American Medical Informatics Association, 2010. 17: 288-294.
7. Maxson E, Jain S, Kendall M, Mostashari F, and Blumenthal D, The regional extension center program: helping physicians meaningfully use health information technology. Annals of Internal Medicine, 2010. 153: 666-670.
8. Hersh W, The health information technology workforce: estimations of demands and a framework for requirements. Applied Clinical Informatics, 2010. 1: 197-212.
9. Eden J, Wheatley B, McNeil B, and Sox H, eds. Knowing What Works in Health Care: A Roadmap for the Nation. 2008, National Academies Press: Washington, DC.
10. Murray RK and McElwee NE, Comparative effectiveness research: critically intertwined with health care reform and the future of biomedical innovation. Archives of Internal Medicine, 2010. 170: 596-599.
11. Zerhouni EA, Translational research: moving discovery to practice. Clinical Pharmacology and Therapeutics, 2007. 81: 126-128.
HITECH provides up to $27 billion for eligible professionals and hospitals to receive incentives for achieving the meaningful use of EHRs [5]. Meaningful use is a critical concept. The goal of HITECH is not just to put computers into physician offices and on hospital wards, but rather to use them toward five goals for the US healthcare system: improve quality, safety and efficiency; engage patients in their care; increase coordination of care; improve the health status of the population; and ensure privacy and security. As such, every criterion in meaningful use (e.g., drug-drug interaction checking) must tie back to a healthcare goal (e.g., improve quality, safety and efficiency).
Government funds for HITECH incentives will be distributed through the public Medicare and Medicaid reimbursement systems. Depending on choice of funding through Medicare or Medicaid, eligible professionals can receive $44,000-$63,000, while eligible hospitals can receive $2-9 million between 2011 and 2018. The main purpose of these incentive funds is to cover the costs of investment in EHR systems. It is anticipated that further costs will become part of the "costs of doing business" for healthcare.
The HITECH legislation recognizes that incentives alone will not be enough to achieve all the goals of meaningful use. As such, HITECH allocates an additional $2 billion for various human and organizational infrastructure elements to attain its mandates. A critical portion of this infrastructure is the ability to achieve health information exchange (HIE), which is the secure flow of data to wherever it is needed for patient care, including across traditional business and other boundaries in the healthcare system [6]. About $547 million is allocated to states for HIE development.
Another critical piece of the infrastructure is the provision of technical support to achieve meaningful use. This is done with the allocation of about $677 million to 62 regional extension centers that are providing a variety of forms of assistance, mainly to small primary care practices [7].
An additional portion of the required infrastructure is a competent professional workforce to develop, implement, and train users of EHR and related systems. It has been estimated that the HITECH agenda will require an additional 50,000 professionals trained in fields such as biomedical informatics and health information management [8]. About $118 million has been allocated for both short-term training programs in community colleges as well as longer programs mostly at the graduate level in universities. My institution, Oregon Health & Science Univeristy, is playing a major role in this program.
The HITECH legislation also recognizes that additional research and development is required. As such, $60 million has been allocated to establish four collaborative research centers focusing on the topics of security and health information technology, patient-centered cognitive support, health care application and network design, and secondary use of EHR information. A related funding initiative is the Beacon Communities Program, which has funded about $250 million for 17 advanced demonstration projects “shine the light” forward.
Just as meaningful use connotes that EHR adoption is not just about installing computer technology in clinical settings, there are related initiatives in the United States that will synergize with the substantial HITECH investment. One initiative from the Institute of Medicine aims to develop the “learning health care system” that learns from the growing volume of captured data what does and does not work in healthcare [9]. This is closely related to the growing push for “comparative effectiveness research” that aims to compare tests, treatments, and other medical activities in head-to-head studies carried out in real-world settings [10]. This infrastructure will also likely contribute to the growing push for translational research, as exemplified by funding for the Clinical & Translational Science Award (CTSA) program of the National Institutes of Health [11].
Taken collectively, all these programs from HITECH to ACA, the learning healthcare system, and CTSA provide a vision of a new healthcare system that learns from its successes and changes based on its mistakes. This vision uses data as the critical enabler of coordinating, measuring, and researching care. HITECH is indeed a grand experiment, and it is likely be that some elements of this experiment will succeed whereas others fail. But in the end, the healthcare system should benefit this unprecedented investment in information systems, human capital, and goals for improving health.
References
1. Blumenthal D, Launching HITECH. New England Journal of Medicine, 2010. 362: 382-385.
2. Garg AX, Adhikari NKJ, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J, et al., Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. Journal of the American Medical Association, 2005. 293: 1223-1238.
3. Goldzweig CL, Towfigh A, Maglione M, and Shekelle PG, Costs and benefits of health information technology: new trends from the literature. Health Affairs, 2009. 28: w282-w293.
4. Schoen C, Osborn R, Doty MM, Squires D, Peugh J, and Applebaum S, A survey of primary care physicians in eleven countries, 2009: perspectives on care, costs, and experiences. Health Affairs, 2009. 28: w1171-1183.
5. Blumenthal D and Tavenner M, The “meaningful use” regulation for electronic health records. New England Journal of Medicine, 2010. 363: 501-504.
6. Vest JR and Gamm LD, Health information exchange: persistent challenges and new strategies. Journal of the American Medical Informatics Association, 2010. 17: 288-294.
7. Maxson E, Jain S, Kendall M, Mostashari F, and Blumenthal D, The regional extension center program: helping physicians meaningfully use health information technology. Annals of Internal Medicine, 2010. 153: 666-670.
8. Hersh W, The health information technology workforce: estimations of demands and a framework for requirements. Applied Clinical Informatics, 2010. 1: 197-212.
9. Eden J, Wheatley B, McNeil B, and Sox H, eds. Knowing What Works in Health Care: A Roadmap for the Nation. 2008, National Academies Press: Washington, DC.
10. Murray RK and McElwee NE, Comparative effectiveness research: critically intertwined with health care reform and the future of biomedical innovation. Archives of Internal Medicine, 2010. 170: 596-599.
11. Zerhouni EA, Translational research: moving discovery to practice. Clinical Pharmacology and Therapeutics, 2007. 81: 126-128.
Thursday, September 30, 2010
New Talk and Department Web Site
This week I had the opportunity to kick off our OHSU Biomedical Informatics Conference Series that takes place on Thursdays at 11:30 am. I presented an overview of the HITECH program, OHSU's role in it, and how it impacts not only clinical informatics, but other areas of informatics as well, such as bioinformatics, clinical research informatics, public health informatics, and consumer health informatics. A video of the talk and PDF of my slides (with references) are available.
We also launched our new department web site this week. All of our old URLs still work, including those to the site and to information about our ONC scholarship funding.
We also launched our new department web site this week. All of our old URLs still work, including those to the site and to information about our ONC scholarship funding.
Friday, August 27, 2010
More Information Available on Meaningful Use
In my initial post on the final rules for meaningful use, I mentioned a number of other resources to describe the rules. Since last month, a number of other new readable sources of information have appeared.
Dr. Blumenthal's overview of HITECH in the New England Journal of Medicine has been officially published.
Readers of this blog know of my enthusiasm for the Geek Doctor, HITECH Answers, and Mr. HIStalk sites, but another source of information on meaningful use I value highly is Computer Sciences Corp.. They have not only issued "updates" on a variety of topics, including meaningful use, certification, and others, but also have established a Meaningful Use Community.
The Health Affairs blog has a post by the Obama Administration's two major leaders for health IT, Drs. Blumenthal and Berwick.
Another interesting post in that blog comes from Kevin Weiss and Sheldon Horowitz of the American Board of Medical Specialties. They note that the five healthcare goals for meaningful use overlap significantly with the six core competencies for physician maintenance of certification developed several years ago. They advocate that the meaningful use goals be aligned with maintenance of certification for physicians. I would agree that being able to use information and IT systems is an essential skill for the 21st-century physician (or any healthcare professional for that matter, and even for patients, researchers, policy makers, and others).
Naturally, during a monumental time like this, there are some express concerns. As typically happens, some argue the adoption of EHRs is moving too fast (American Hospital Association, Huffington Post Investigative Fund, and the Washington Times [the full breadth of the political spectrum!]) while others advocate it is moving too slow (The Leapfrog Group).
I maintain that no one really knows the right pace to move forward. We need to maintain flexibility, adjusting our plans when necessary. But inaction is not an option either. I do agree this has elements of a grand experiment whose outcome we will know only many years, lives, and dollars from now. But just as a I feel about healthcare reform, the status quo is not tenable, and action is required. Translating ideals among competing financial and other interests is always a messy task, but it is not reason for inaction.
Dr. Blumenthal's overview of HITECH in the New England Journal of Medicine has been officially published.
Readers of this blog know of my enthusiasm for the Geek Doctor, HITECH Answers, and Mr. HIStalk sites, but another source of information on meaningful use I value highly is Computer Sciences Corp.. They have not only issued "updates" on a variety of topics, including meaningful use, certification, and others, but also have established a Meaningful Use Community.
The Health Affairs blog has a post by the Obama Administration's two major leaders for health IT, Drs. Blumenthal and Berwick.
Another interesting post in that blog comes from Kevin Weiss and Sheldon Horowitz of the American Board of Medical Specialties. They note that the five healthcare goals for meaningful use overlap significantly with the six core competencies for physician maintenance of certification developed several years ago. They advocate that the meaningful use goals be aligned with maintenance of certification for physicians. I would agree that being able to use information and IT systems is an essential skill for the 21st-century physician (or any healthcare professional for that matter, and even for patients, researchers, policy makers, and others).
Naturally, during a monumental time like this, there are some express concerns. As typically happens, some argue the adoption of EHRs is moving too fast (American Hospital Association, Huffington Post Investigative Fund, and the Washington Times [the full breadth of the political spectrum!]) while others advocate it is moving too slow (The Leapfrog Group).
I maintain that no one really knows the right pace to move forward. We need to maintain flexibility, adjusting our plans when necessary. But inaction is not an option either. I do agree this has elements of a grand experiment whose outcome we will know only many years, lives, and dollars from now. But just as a I feel about healthcare reform, the status quo is not tenable, and action is required. Translating ideals among competing financial and other interests is always a messy task, but it is not reason for inaction.
Monday, August 2, 2010
Update on ONC workforce projects
Although summer is historically "down time" in academia, this summer has been anything but down. Like many people in the health IT arena, I have been busy with our Office of the National Coordinator for Health IT (ONC)-related projects, taking advantage of what colleague Paul Tang calls the "opportunity of a generation." In this post, I thought I would take the opportunity to provide an update on the ONC workforce development programs in which OHSU is heavily involved.
As I reported in April, OHSU received grants in two of the four workforce programs. One of the programs in which we received a grant is part of three interrelated programs. These programs collectively aim to rapidly build the front-line workforce to achieve the EHR adoption goals of the HITECH legislation. The project OHSU is involved in is the Curriculum Development Centers Program, where five universities (OHSU, Columbia, Duke, Johns Hopkins, and UAB) are developing instructional materials for another program, the Community College Consortia to Educate Health Information Technology Professionals Program. The latter program is funding five regional consortia to deliver short-term six-month certificate programs that focus on six workforce roles that ONC envisions as required to achieve the HITECH agenda. About 80-85 community colleges are in the five regional consortia, all of whom are developing short-term certificate programs around the workforce roles, which will commence this fall.
Since literally the day the grant was awarded, the curriculum development centers have been hard at work, first planning and now implementing the first version of the instructional materials. (Two additional versions of the curriculum will follow on during the two years of the project.) The five universities are each developing four "components," which are roughly equivalent to semester-long courses, for a total of 20. Each community college will free to use all, some, or none of the instructional materials we are developing. ONC has designated a "set table" of these components for six workforce roles to which the community college certificate programs will teach.
The OHSU Curriculum Development Center is further designated as the National Training and Dissemination Center (NTDC). We have the additional tasks of training the community college in the use of the materials and developing a dissemination Web site to host them and collect feedback. A major part of the training task will be a training event that will be held next week (August 9-11) in Portland. About 250 community college faculty will attend the event to receive training in the use of the materials. The event will also feature other sessions on education-related issues, such as implementing distance learning in health IT and how to manage classes that comprise students with it backgrounds and students with healthcare backgrounds.
The dissemination Web site will host the materials that all community college faculty from the 80-85 community college partners can access. They will be able to use the materials "out of the box" or mix and match pieces of them with other curricula at their institutions. All of the materials are distance learning-oriented, not only slides and lesson plans but also voice-over-slide narrations.
Another project that the Curriculum Development Centers project touches on is the Competency Examination for Individuals Completing Non-Degree Training Program, which will assess the competencies attained by graduates in the community college programs for the six workforce roles.
OHSU is also involved in the fourth and final workforce development program, the University-Based Training (UBT) Program. This program will fund longer (but still short-term) study in six additional workforce roles in university settings. OHSU is one of nine universities or consortia thereof (OHSU, Colorado, Columbia, Duke, George Washington, Indiana, Johns Hopkins, Minnesota, and Texas Tech) that will be using the grant to subsidize students in Type 1 (less than one year) and Type 2 (1-2 year) programs.
OHSU is implementing the UBT grant as a source of financial aid for our existing graduate programs. More information can be found on our web site, which has a new redirection URL, www.informatics-scholarship.info. Type 1 students are funded to complete our Graduate Certificate Program in one year, while Type 2 students will be funded to complete the Master of Biomedical Informatics (MBI) program in 18 months of full-time study. As OHSU is on an academic quarter system, with four quarters of equal length, Type 1 students will need to take an average of two classes per quarter to complete the program in one year. This is more than the typical student in the program who works full-time and would find more than one course at a time challenging. The MBI program requires 52 credits, with 46 in courses (about 16 three-credit courses) and six in a capstone project. To do the MBI in 18 months will require full-time enrollment over six consecutive quarters. While the regular MBI program can be done on-line (with students required to complete two on-campus short courses during their studies), ONC-funded students will need to be on-campus students.
The OHSU UBT grant will allow 135 Graduate Certificate and 13 MBI students to be funded over three years. We have completed two cycles of applications already for the certificate program and one for the master's program. Twelve students started the certificate program in the summer term. We have also offered funding to 41 certificate and 8 master's students to start in the fall. Another round of certificate program applications will take place in the fall for admission in the winter quarter and continue every quarter until the funding is exhausted. A second round of master's degree applications will take place for the fall of 2011.
We are also adding other features to the program for ONC-funded students. They will be required to do a practicum (certificate students, one quarter) or internship (MBI students, 2-3 quarters, and can comprise the capstone project if accompanied by a write-up). Distance students will be required to arrange their own practicum experiences, with our guidance. We are working with healthcare organizations, industry, regional extension centers, and others to make these experiences available. We are also putting in place a career counseling service for these students.
Now that the final rules for meaningful use are out, the state health information exchanges and regional extension centers are being launched, research and demonstration are funded by the SHARP and Beacon programs respectively, and the academic programs for workforce development are starting up, all of the major pieces of HITECH are in place. The grand experiment is beginning! Projects like this never quite turn out as you expect, but I am certain that healthcare will be better from all of this, and I am quite confident that a more robust educational infrastructure will emerge from the workforce development programs.
As I reported in April, OHSU received grants in two of the four workforce programs. One of the programs in which we received a grant is part of three interrelated programs. These programs collectively aim to rapidly build the front-line workforce to achieve the EHR adoption goals of the HITECH legislation. The project OHSU is involved in is the Curriculum Development Centers Program, where five universities (OHSU, Columbia, Duke, Johns Hopkins, and UAB) are developing instructional materials for another program, the Community College Consortia to Educate Health Information Technology Professionals Program. The latter program is funding five regional consortia to deliver short-term six-month certificate programs that focus on six workforce roles that ONC envisions as required to achieve the HITECH agenda. About 80-85 community colleges are in the five regional consortia, all of whom are developing short-term certificate programs around the workforce roles, which will commence this fall.
Since literally the day the grant was awarded, the curriculum development centers have been hard at work, first planning and now implementing the first version of the instructional materials. (Two additional versions of the curriculum will follow on during the two years of the project.) The five universities are each developing four "components," which are roughly equivalent to semester-long courses, for a total of 20. Each community college will free to use all, some, or none of the instructional materials we are developing. ONC has designated a "set table" of these components for six workforce roles to which the community college certificate programs will teach.
The OHSU Curriculum Development Center is further designated as the National Training and Dissemination Center (NTDC). We have the additional tasks of training the community college in the use of the materials and developing a dissemination Web site to host them and collect feedback. A major part of the training task will be a training event that will be held next week (August 9-11) in Portland. About 250 community college faculty will attend the event to receive training in the use of the materials. The event will also feature other sessions on education-related issues, such as implementing distance learning in health IT and how to manage classes that comprise students with it backgrounds and students with healthcare backgrounds.
The dissemination Web site will host the materials that all community college faculty from the 80-85 community college partners can access. They will be able to use the materials "out of the box" or mix and match pieces of them with other curricula at their institutions. All of the materials are distance learning-oriented, not only slides and lesson plans but also voice-over-slide narrations.
Another project that the Curriculum Development Centers project touches on is the Competency Examination for Individuals Completing Non-Degree Training Program, which will assess the competencies attained by graduates in the community college programs for the six workforce roles.
OHSU is also involved in the fourth and final workforce development program, the University-Based Training (UBT) Program. This program will fund longer (but still short-term) study in six additional workforce roles in university settings. OHSU is one of nine universities or consortia thereof (OHSU, Colorado, Columbia, Duke, George Washington, Indiana, Johns Hopkins, Minnesota, and Texas Tech) that will be using the grant to subsidize students in Type 1 (less than one year) and Type 2 (1-2 year) programs.
OHSU is implementing the UBT grant as a source of financial aid for our existing graduate programs. More information can be found on our web site, which has a new redirection URL, www.informatics-scholarship.info. Type 1 students are funded to complete our Graduate Certificate Program in one year, while Type 2 students will be funded to complete the Master of Biomedical Informatics (MBI) program in 18 months of full-time study. As OHSU is on an academic quarter system, with four quarters of equal length, Type 1 students will need to take an average of two classes per quarter to complete the program in one year. This is more than the typical student in the program who works full-time and would find more than one course at a time challenging. The MBI program requires 52 credits, with 46 in courses (about 16 three-credit courses) and six in a capstone project. To do the MBI in 18 months will require full-time enrollment over six consecutive quarters. While the regular MBI program can be done on-line (with students required to complete two on-campus short courses during their studies), ONC-funded students will need to be on-campus students.
The OHSU UBT grant will allow 135 Graduate Certificate and 13 MBI students to be funded over three years. We have completed two cycles of applications already for the certificate program and one for the master's program. Twelve students started the certificate program in the summer term. We have also offered funding to 41 certificate and 8 master's students to start in the fall. Another round of certificate program applications will take place in the fall for admission in the winter quarter and continue every quarter until the funding is exhausted. A second round of master's degree applications will take place for the fall of 2011.
We are also adding other features to the program for ONC-funded students. They will be required to do a practicum (certificate students, one quarter) or internship (MBI students, 2-3 quarters, and can comprise the capstone project if accompanied by a write-up). Distance students will be required to arrange their own practicum experiences, with our guidance. We are working with healthcare organizations, industry, regional extension centers, and others to make these experiences available. We are also putting in place a career counseling service for these students.
Now that the final rules for meaningful use are out, the state health information exchanges and regional extension centers are being launched, research and demonstration are funded by the SHARP and Beacon programs respectively, and the academic programs for workforce development are starting up, all of the major pieces of HITECH are in place. The grand experiment is beginning! Projects like this never quite turn out as you expect, but I am certain that healthcare will be better from all of this, and I am quite confident that a more robust educational infrastructure will emerge from the workforce development programs.
Friday, July 30, 2010
Core competencies of meaningful use for people, organizations, and systems
As an educator, I often think of competencies, which are the knowledge, skills, and attitudes we hope that students obtain from the education we deliver. As I think about competencies related to meaningful use (MU), I see that there are competencies not only that people must have, but also organizations and even the information systems they are deploying. The final MU rules make it clear that there are a number of competencies that people, organizations, and systems must have to succeed with the HITECH agenda.
The list of MU criteria and what must be done to implement them are a veritable textbook of clinical informatics. They also include some additional competencies from other sub-areas of biomedical and health informatics as well.
Clearly the major competency area for MU is clinical informatics. Individuals, their organizations, and their information systems must have a thorough understanding of most of the tenets of clinical informatics. A list of what competencies are needed and why includes the following:
There are more competencies that one must have across for all uses of health information technology and the even-larger field of biomedical and health informatics. Nonetheless, competency in MU is something that all people, organizations, and systems that deal with health must know about. Many must master it, not only to achieve the short-term objectives and funding of HITECH, but also to provide a patient-centered, evidence-based, and cost-effective healthcare system for the 21st century.
The list of MU criteria and what must be done to implement them are a veritable textbook of clinical informatics. They also include some additional competencies from other sub-areas of biomedical and health informatics as well.
Clearly the major competency area for MU is clinical informatics. Individuals, their organizations, and their information systems must have a thorough understanding of most of the tenets of clinical informatics. A list of what competencies are needed and why includes the following:
- Clinical data, e.g., demographics, vital signs, problem lists, medications, structured data, advance directives
- Clinical decision support - rules, drug-drug and related checks, medication reconciliation
- Computerized provider order entry
- Health information exchange
- Privacy and security
- Healthcare quality
- Organizational and project management
- Standards and interoperability - e.g., HL7, ICD-9, SNOMED, LOINC, CCR/CCD, etc.
There are more competencies that one must have across for all uses of health information technology and the even-larger field of biomedical and health informatics. Nonetheless, competency in MU is something that all people, organizations, and systems that deal with health must know about. Many must master it, not only to achieve the short-term objectives and funding of HITECH, but also to provide a patient-centered, evidence-based, and cost-effective healthcare system for the 21st century.
Tuesday, July 20, 2010
Meaningful Use Rules Finalized!
July 13, 2010 was, at least for those of us in the informatics field, a historic day: the release of the Stage 1 meaningful use rules by the Office of the National Coordinator for Health IT (ONC) and the Center for Medicare and Medicaid Services (CMS). These rules define explicitly what healthcare professionals and hospitals must do to quality for the incentive funding under the HITECH Act. As I have written before, the meaningful use framework is an excellent construct, enshrining the notion that HITECH is not just about adopting technology, but rather insuring it gets used in ways that benefit human health. As much as we love technology, we can never lose sight of the notion that, at least in healthcare, the goal of its use is to improve the care that people get. We do not always succeed at that, but it should always be what motivates us.
The final rules also demonstrate some other positive attributes about people, organizations, and governments. Most critical of these was that ONC and CMS listened, recognizing that the initial proposed rules were a little too much, too soon. So they dialed back, but not to the point of making the criteria too easy, which could have effectively turned the program into a government boondoggle, i.e., a subsidy for healthcare organizations. The whole ONC process has been very open and deliberate, involving many thoughtful people and organizations.
So what do the rules actually say? Before we get into the details, let's step back and look at the big picture. It is estimated that if every eligible professional and hospital meets the criteria, the cost of the program will be about $27 billion. When you add in the additional $2 billion invested in infrastructure (regional extension centers, HIE funding for the states, SHARP research projects, Beacon demonstration projects, and workforce development), the total cost will be $29 billion. That is no small sum of money, but is one of the those situations where the market would be unlikely to bring about this change. True to the American Recovery and Reinvestment Act (ARRA) from where it was legislated, the program certainly has created jobs and will likely create more.
As always with health IT, you can find a great deal information about the rules on the Web. One place to start, especially if you have a lot of time on your hands, is the full text of the final meaningful use rule (officially called the CMS Electronic Health Record Incentive Program, which also has an official Web site) and the final standards rule (officially called the Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology). However, for those of us with other things to do than read federal rules documents hundreds of pages long, concise early summaries are available from a number of places, including:
The rules are now organized so that in order to achieve meaningful use, an EP or EH must achieve 14 (EH) or 15 (EP) core rules and then five additional menu rules. There are also some additional twists on the menu rule. For example, some of them apply only to EPs while others apply only to EHs. In addition, one of the menu items selected must be a public health measure. This means that EPs must submit data to an immunization registry or syndromic surveillance registry, while EHs must submit to either of these or a reportable lab registry. However, if a state or regional public health agency is not prepared to accept such data, the EP or EH will not be penalized.
The 14-15 core measures must be achieved by all EPs and EHs in order to qualify for incentive payments. These include:
The final rules also demonstrate some other positive attributes about people, organizations, and governments. Most critical of these was that ONC and CMS listened, recognizing that the initial proposed rules were a little too much, too soon. So they dialed back, but not to the point of making the criteria too easy, which could have effectively turned the program into a government boondoggle, i.e., a subsidy for healthcare organizations. The whole ONC process has been very open and deliberate, involving many thoughtful people and organizations.
So what do the rules actually say? Before we get into the details, let's step back and look at the big picture. It is estimated that if every eligible professional and hospital meets the criteria, the cost of the program will be about $27 billion. When you add in the additional $2 billion invested in infrastructure (regional extension centers, HIE funding for the states, SHARP research projects, Beacon demonstration projects, and workforce development), the total cost will be $29 billion. That is no small sum of money, but is one of the those situations where the market would be unlikely to bring about this change. True to the American Recovery and Reinvestment Act (ARRA) from where it was legislated, the program certainly has created jobs and will likely create more.
As always with health IT, you can find a great deal information about the rules on the Web. One place to start, especially if you have a lot of time on your hands, is the full text of the final meaningful use rule (officially called the CMS Electronic Health Record Incentive Program, which also has an official Web site) and the final standards rule (officially called the Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology). However, for those of us with other things to do than read federal rules documents hundreds of pages long, concise early summaries are available from a number of places, including:
- An article in New England Journal of Medicine (NEJM) by Dr. David Blumenthal, National Coordinator
- Postings by Dr. John Halamka (Geek Doctor) on the meaningful use and standards rules, along with the beginnings of a frequently asked questions (FAQ) list
- A succinct overview from the Mr. HISTalk blog
- Use certified EHR technology in a meaningful manner
- Use certified EHR technology connected in a manner that provides for health information exchange to improve the quality of care
- Using certified EHR technology, the provider submits information on clinical quality measures
- Provide clinical decision support
- Support physician order entry
- Capture and query information relevant to healthcare quality
- Exchange electronic health information with, and integrate such information from, other sources
- Medicare: Physicians, Osteopathic Physicians, Dentists, Podiatrists, Optometrists, Chiropractors
- Medicaid: Physicians, Pediatricians, Dentists, Certified Nurse Midwives, Nurse Practitioners, Physician Assistants operating at an FQHC/RHC
- Medicare: hospitals paid under inpatient prospective payment system, critical acess hospitals; within the 50 states or DC
- Medicaid: acute care hospitals, childrens' hospitals
The rules are now organized so that in order to achieve meaningful use, an EP or EH must achieve 14 (EH) or 15 (EP) core rules and then five additional menu rules. There are also some additional twists on the menu rule. For example, some of them apply only to EPs while others apply only to EHs. In addition, one of the menu items selected must be a public health measure. This means that EPs must submit data to an immunization registry or syndromic surveillance registry, while EHs must submit to either of these or a reportable lab registry. However, if a state or regional public health agency is not prepared to accept such data, the EP or EH will not be penalized.
The 14-15 core measures must be achieved by all EPs and EHs in order to qualify for incentive payments. These include:
- Record patient demographics (sex, race, ethnicity, date of birth, preferred language, and in the case of hospitals, date and preliminary cause of death in the event of mortality) data - More than 50% of patients’ demographic data recorded as structured
- Record vital signs and chart changes (height, weight, blood pressure, body - mass index, growth charts for children) - More than 50% of patients 2 years of age or older have height, weight, and blood pressure recorded as structured data
- Maintain up-to-date problem list of current and active diagnoses - More than 80% of patients have at least one entry recorded as structured data
- Maintain active medication list - More than 80% of patients have at least one entry recorded as structured data
- Maintain active medication allergy list - More than 80% of patients have at least one entry recorded as structured data
- Record smoking status for patients 13 years of age or older - More than 50% of patients 13 years of age or older have smoking status recorded as structured data
- For individual professionals, provide patients with clinical summaries for each office visit; for hospitals, provide an electronic copy of hospital discharge instructions on request - Clinical summaries provided to patients for more than 50% of all office visits within 3 business days; more than 50% of all patients who are discharged from the inpatient department or emergency department of an eligible hospital or critical access hospital and who request an electronic copy of their discharge instructions are provided with it
- On request, provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies, and for hospitals, discharge summary and procedures) - More than 50% of requesting patients receive electronic copy within 3 business days
- Generate and transmit permissible prescriptions electronically (does not apply to hospitals) - More than 40% are transmitted electronically using certified EHR technology
- Computer provider order entry (CPOE) for medication orders - More than 30% of patients with at least one medication in their medication list have at least one medication ordered through CPOE
- Implement drug-drug and drug-allergy interaction checks - Functionality is enabled for these checks for the entire reporting period
- Implement capability to electronically exchange key clinical information among providers and patient-authorized entities - Perform at least one test of EHR’s capacity to electronically exchange information
- Implement one clinical decision support rule and ability to track compliance with the rule - One clinical decision support rule implemented
- Implement systems to protect privacy and security of patient data in the EHR - Conduct or review a security risk analysis, implement security updates as necessary, and correct identified security deficiencies
- Report clinical quality measures to CMS or states - For 2011, provide aggregate numerator and denominator through attestation; for 2012, electronically submit measures
- Implement drug formulary checks - Drug formulary check system is implemented and has access to at least one internal or external drug formulary for the entire reporting period
- Incorporate clinical laboratory test results into EHRs as structured data - More than 40% of clinical laboratory test results whose results are in positive/negative or numerical format are incorporated into EHRs as structured data
- Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach - Generate at least one listing of patients with a specific condition
- Use EHR technology to identify patient-specific education resources and provide those to the patient as appropriate - More than 10% of patients are provided patient-specific education resources
- Perform medication reconciliation between care settings - Medication reconciliation is performed for more than 50% of transitions of care
- Provide summary of care record for patients referred or transitioned to another provider or setting - Summary of care record is provided for more than 50% of patient transitions or referrals
- Submit electronic immunization data to immunization registries or immunization information systems - Perform at least one test of data submission and follow-up submission (where registries can accept electronic submissions)
- Submit electronic syndromic surveillance data to public health agencies - Perform at least one test of data submission and follow-up submission (where public health agencies can accept electronic data)
- Record advance directives for patients 65 years of age or older - More than 50% of patients 65 years of age or older have an indication of an advance directive status recorded
- Submit of electronic data on reportable laboratory results to public health agencies - Perform at least one test of data submission and follow-up submission (where public health agencies can accept electronic data)
- Send reminders to patients (per patient preference) for preventive and follow - up care - More than 20% or patients 65 years of age or older or 5 years of age or younger are sent appropriate reminders
- Provide patients with timely electronic access to their health information (including laboratory results, problem list, medication lists, medication allergies) - More than 10% of patients are provided electronic access to information within 4 days of its being updated in the EHR
Sunday, May 23, 2010
Meaningful Use: A Highly Useful Construct for Informatics
Whatever does happen with the ARRA/HITECH programs in the long run, one value to come out of the entire process is the construct of "meaningful use." In the next month or two, we will hear how meaningful use is operationalized in its first (2011) stage. Two more stages will follow in 2013 and 2015, and later in this decade we will know if the meaningful use of the electronic health record (EHR) has improved healthcare and people's health.
But I must give credit to whoever "invented" the construct of meaningful use. It is a brilliant way to think about the implementation of health information technology. I would also argue that it drives home the distinction between informatics and information technology (IT) that I have written about elsewhere, with the former focused on the goal of making "meaningful use" of the technology of the latter.
I have been asking around to see to whom we can attribute the invention of meaningful use. I will stand corrected if I find out the term was used before this, but it appears that it was first coined in a bill introduced in the 2007-2008 Congress, H.R. 6898: Health-e Information Technology Act of 2008. The bill was never passed but proposed the idea of "incentive payments to physicians and inpatient hospitals that meaningfully use a certified health information technology system." HR 6898 was introduced by Pete Stark, and has much verbiage from what eventually went into ARRA/HITECH. (Given the meaning that Stark’s name has in other contexts, it is indeed interesting that he could have been associated with the origination of the term!)
The idea behind meaningful use is simple: The goal is not to merely put computers and EHRs in physician's offices and in hospitals, but rather to make sure that they are implemented in ways that improve individual and population health. As HITECH has been operationalized, there are five underlying goals for meaningful use:
The definition is further modified that certified EHR technology be used, and that these certified EHRs be connected for health information exchange and able to submit information on quality measures, but that is just a modifier to the core construct. In the weeks and months ahead, we will see meaningful use operationalized, but I hope that we do not lose sight of how excellent of a construct it is for thinking about the value of HIT.
But I must give credit to whoever "invented" the construct of meaningful use. It is a brilliant way to think about the implementation of health information technology. I would also argue that it drives home the distinction between informatics and information technology (IT) that I have written about elsewhere, with the former focused on the goal of making "meaningful use" of the technology of the latter.
I have been asking around to see to whom we can attribute the invention of meaningful use. I will stand corrected if I find out the term was used before this, but it appears that it was first coined in a bill introduced in the 2007-2008 Congress, H.R. 6898: Health-e Information Technology Act of 2008. The bill was never passed but proposed the idea of "incentive payments to physicians and inpatient hospitals that meaningfully use a certified health information technology system." HR 6898 was introduced by Pete Stark, and has much verbiage from what eventually went into ARRA/HITECH. (Given the meaning that Stark’s name has in other contexts, it is indeed interesting that he could have been associated with the origination of the term!)
The idea behind meaningful use is simple: The goal is not to merely put computers and EHRs in physician's offices and in hospitals, but rather to make sure that they are implemented in ways that improve individual and population health. As HITECH has been operationalized, there are five underlying goals for meaningful use:
- Improve quality, safety and efficiency
- Engage patients in their care
- Increase coordination of care
- Improve the health status of the population
- Ensure privacy and security
The definition is further modified that certified EHR technology be used, and that these certified EHRs be connected for health information exchange and able to submit information on quality measures, but that is just a modifier to the core construct. In the weeks and months ahead, we will see meaningful use operationalized, but I hope that we do not lose sight of how excellent of a construct it is for thinking about the value of HIT.
Saturday, April 24, 2010
The Dust Settles on HITECH Funding for Development of the Health Information Technology Workforce
One of the elements deemed essential for "meaningful use" of health information technology (HIT) as legislated in the Health Information Technology for Economic and Clinical Health (HITECH) Act of the American Recovery and Reinvestment Act (ARRA) was an adequately trained professional workforce. Section 3016 tasked the Office of the National Coordinator for Health IT (ONC) will developing programs to meet the needs for this workforce. Of the $2 billion allocated for HIT infrastructure in HITECH (to support the awarding of $36-40 billion in incentives for electronic health record adoption), a total of $118 million was allocated to four programs for workforce development.
The focus of this funding was on short-term training to develop professionals in 12 job roles (described in the Funding Opportunity Announcements and reproduced in an earlier posting in this blog). An analysis by ONC estimated a need for an additional 51,000 personnel above and beyond the existing HIT workforce. The bulk of these individuals fall into six of the job roles that will be trained in community colleges, while the remainder in the other six job roles will be trained in universities.
Three of the programs are focused on the community college training:
Community College Consortia to Educate Health Information Technology Professionals Program - This $70 million program establishes five regional consortia of 70 community colleges that will develop short-term certificate programs to train 10,000 individuals per year in the six community college job roles. Programs are expected to enroll their first students, most of whom will bring backgrounds in healthcare or information technology, by September 30, 2010.
Curriculum Development Centers Program - Because many of the community colleges in the new consortia do not have existing HIT educational programs, $10 million has been allocated to five universities with graduate-level educational programs to collaboratively develop (with community college partners) HIT curriculum for 20 components (topics). Members of the community college consortia will be able to use the components in whole (as courses) or in part. One of the five centers (Oregon Health & Science University) is additionally funded to serve as the National Training and Dissemination Center that will archive and distribute the curricula, train community college faculty in its use, and collect feedback to facilitate its improvement.
Competency Examination for Individuals Completing Non-Degree Training Program - Northern Virginia Community College has been provided a $6 million grant to develop and provide initial administration of a set of HIT competency examinations focused on the six community college job roles.
The fourth program is focused on university-based training:
Program of Assistance for University-Based Training - This $32 million training grant funds education of individuals in the six job roles requiring university-level training at nine universities (or consortia of universities). The funded programs will be able to use the funding as financial aid for students in their existing, mostly graduate-level, programs. The emphasis of the funding will be on short-term certificate programs delivered via distance learning, training about 500 individuals per year. While the focus of the program is on training individuals who will work in health care settings, some of the programs will also be training personnel to work in public health settings.
Taken together, these programs represent an unprecedented investment in HIT education and professional development. My hope is that not only will the individuals trained in these programs find rewarding careers in healthcare and public health organizations, regional extension centers, governments, and companies, but that biomedical/health informatics and related HIT disciplines will achieve more visibility as career options when the funding ends. Similar to information professionals in other industries, the need for these individuals will not go away when the HITECH funding ends.
The focus of this funding was on short-term training to develop professionals in 12 job roles (described in the Funding Opportunity Announcements and reproduced in an earlier posting in this blog). An analysis by ONC estimated a need for an additional 51,000 personnel above and beyond the existing HIT workforce. The bulk of these individuals fall into six of the job roles that will be trained in community colleges, while the remainder in the other six job roles will be trained in universities.
Three of the programs are focused on the community college training:
Community College Consortia to Educate Health Information Technology Professionals Program - This $70 million program establishes five regional consortia of 70 community colleges that will develop short-term certificate programs to train 10,000 individuals per year in the six community college job roles. Programs are expected to enroll their first students, most of whom will bring backgrounds in healthcare or information technology, by September 30, 2010.
Curriculum Development Centers Program - Because many of the community colleges in the new consortia do not have existing HIT educational programs, $10 million has been allocated to five universities with graduate-level educational programs to collaboratively develop (with community college partners) HIT curriculum for 20 components (topics). Members of the community college consortia will be able to use the components in whole (as courses) or in part. One of the five centers (Oregon Health & Science University) is additionally funded to serve as the National Training and Dissemination Center that will archive and distribute the curricula, train community college faculty in its use, and collect feedback to facilitate its improvement.
Competency Examination for Individuals Completing Non-Degree Training Program - Northern Virginia Community College has been provided a $6 million grant to develop and provide initial administration of a set of HIT competency examinations focused on the six community college job roles.
The fourth program is focused on university-based training:
Program of Assistance for University-Based Training - This $32 million training grant funds education of individuals in the six job roles requiring university-level training at nine universities (or consortia of universities). The funded programs will be able to use the funding as financial aid for students in their existing, mostly graduate-level, programs. The emphasis of the funding will be on short-term certificate programs delivered via distance learning, training about 500 individuals per year. While the focus of the program is on training individuals who will work in health care settings, some of the programs will also be training personnel to work in public health settings.
Taken together, these programs represent an unprecedented investment in HIT education and professional development. My hope is that not only will the individuals trained in these programs find rewarding careers in healthcare and public health organizations, regional extension centers, governments, and companies, but that biomedical/health informatics and related HIT disciplines will achieve more visibility as career options when the funding ends. Similar to information professionals in other industries, the need for these individuals will not go away when the HITECH funding ends.
Wednesday, April 7, 2010
OHSU Awarded $5.8 Million to Expand Health Information Technology Education
The "holding pattern" (see last post) has ended, and most of the ARRA/HITECH funding has now been awarded. Last week, OHSU received word that two grants for curriculum development and student financial aid from ARRA Section 3016 Health IT Workforce Development will be funded. In the near future, I will share more information and thoughts about the workforce funding programs, their implications for informatics education and the profession, and some of the other ARRA/HITECH-funded programs. In the meantime, however, I share below the text of the press release from OHSU.
04/07/10 Portland, Ore.
Oregon Health & Science University has been awarded $5.8 million in American Recovery and Reinvestment Act (ARRA) funds to advance the widespread adoption and meaningful use of health information technology (HIT) by educating professionals to work in this rapidly growing field.
The funding is provided in two competitively awarded grants. One will directly support the education of about 150 additional students over three years in OHSU’s biomedical informatics graduate program while establishing additional capacity that will meet the ongoing needs of an expanded work force. The other award will establish a national dissemination resource for health IT curricula at OHSU.
The stimulus funds, awarded by the Office of the National Coordinator for Health Information Technology, will enable OHSU to help educate the estimated 50,000 professionals needed to convert the entire country to electronic health records by the year 2014. The recovery act authorizes an estimated $40 billion to achieve this goal.
“We are delighted to be able to contribute to the national initiative to educate the health IT professional work force that will be required to lead the widespread adoption of electronic health records,” says William Hersh, M.D., professor and chairman of OHSU’s Department of Medical Informatics and Clinical Epidemiology. “This work force is a key requirement for achieving ‘meaningful use’ of health information technology that will help to improve the quality and safety of health care while lowering its costs.”
Through this recovery act funding, OHSU will provide financial aid for nearly 140 new students to enroll in and complete the university’s online Graduate Certificate Program in Biomedical Informatics. The funding also will allow at least 12 students to enroll in and complete OHSU’s on-campus master's degree program. All financial aid under this grant is for students in graduate-level programs requiring a minimum of a bachelor’s degree for admission.
Students receiving financial aid will be required to choose among six career paths:
• Clinician/public health leader
• Health information management and exchange specialist
• Health information privacy and security specialist
• Research and development scientist
• Programmers and software engineer
• Health IT sub-specialist
The eight-course graduate certificate program is entirely online and and can be completed in two to three academic quarters. Students who are funded through this program will receive support for their tuition expenses and must complete its requirements within one year.
The master’s degree program requires about 1½ years of full-time study. The funding will not only provide these students with tuition support, but includes a stipend and student health insurance.
“Biomedical informatics is a growing field with opportunities for people with a variety of backgrounds, especially in health care, computer science and information technology,” added Hersh. “Although this funding is focused on training professionals to implement electronic health records, there are numerous other career opportunities in such areas as personal health records, telemedicine, clinical and translational research, and bioinformatics.”
The National Training and Dissemination Center will support a total of five Curriculum Development Centers, one of which will be housed at OHSU. Together, the five centers will develop curricula for the five community college consortia being established to train community college students in HIT. These curricula will also be made available to institutions of higher education throughout the nation. The National Training and Dissemination Center will house the curricula on a dedicated Web site, train community college faculty in its use, and collect and disseminate feedback on its content.
The Curriculum Development Center at OHSU is a partnership between OHSU and four local community colleges — Portland Community College, Mt. Hood Community College, Lane Community College and Umpqua Community College.OHSU and community college faculty will collaborate to tailor the curricula for community college students.
OHSU is an established national leader in health information technology education. Its existing educational programs are among the largest in the country, and it has led many innovations, such as the 10x10 (“ten by ten”) program in partnership with the American Medical Informatics Association, which aims to train 10,000 health care professionals in biomedical informatics by the year 2010.
Students will be able to enroll in the new programs this fall. More information about student financial aid opportunities will be available on the OHSU Department of Medical Informatics and Clinical Epidemiology Web site in early May. In the meantime, for descriptions of the Graduate Certificate and Master’s degree programs or to sign up to receive further information when it becomes available visit: http://www.ohsu.edu/dmice.
04/07/10 Portland, Ore.
Oregon Health & Science University has been awarded $5.8 million in American Recovery and Reinvestment Act (ARRA) funds to advance the widespread adoption and meaningful use of health information technology (HIT) by educating professionals to work in this rapidly growing field.
The funding is provided in two competitively awarded grants. One will directly support the education of about 150 additional students over three years in OHSU’s biomedical informatics graduate program while establishing additional capacity that will meet the ongoing needs of an expanded work force. The other award will establish a national dissemination resource for health IT curricula at OHSU.
The stimulus funds, awarded by the Office of the National Coordinator for Health Information Technology, will enable OHSU to help educate the estimated 50,000 professionals needed to convert the entire country to electronic health records by the year 2014. The recovery act authorizes an estimated $40 billion to achieve this goal.
“We are delighted to be able to contribute to the national initiative to educate the health IT professional work force that will be required to lead the widespread adoption of electronic health records,” says William Hersh, M.D., professor and chairman of OHSU’s Department of Medical Informatics and Clinical Epidemiology. “This work force is a key requirement for achieving ‘meaningful use’ of health information technology that will help to improve the quality and safety of health care while lowering its costs.”
Through this recovery act funding, OHSU will provide financial aid for nearly 140 new students to enroll in and complete the university’s online Graduate Certificate Program in Biomedical Informatics. The funding also will allow at least 12 students to enroll in and complete OHSU’s on-campus master's degree program. All financial aid under this grant is for students in graduate-level programs requiring a minimum of a bachelor’s degree for admission.
Students receiving financial aid will be required to choose among six career paths:
• Clinician/public health leader
• Health information management and exchange specialist
• Health information privacy and security specialist
• Research and development scientist
• Programmers and software engineer
• Health IT sub-specialist
The eight-course graduate certificate program is entirely online and and can be completed in two to three academic quarters. Students who are funded through this program will receive support for their tuition expenses and must complete its requirements within one year.
The master’s degree program requires about 1½ years of full-time study. The funding will not only provide these students with tuition support, but includes a stipend and student health insurance.
“Biomedical informatics is a growing field with opportunities for people with a variety of backgrounds, especially in health care, computer science and information technology,” added Hersh. “Although this funding is focused on training professionals to implement electronic health records, there are numerous other career opportunities in such areas as personal health records, telemedicine, clinical and translational research, and bioinformatics.”
The National Training and Dissemination Center will support a total of five Curriculum Development Centers, one of which will be housed at OHSU. Together, the five centers will develop curricula for the five community college consortia being established to train community college students in HIT. These curricula will also be made available to institutions of higher education throughout the nation. The National Training and Dissemination Center will house the curricula on a dedicated Web site, train community college faculty in its use, and collect and disseminate feedback on its content.
The Curriculum Development Center at OHSU is a partnership between OHSU and four local community colleges — Portland Community College, Mt. Hood Community College, Lane Community College and Umpqua Community College.OHSU and community college faculty will collaborate to tailor the curricula for community college students.
OHSU is an established national leader in health information technology education. Its existing educational programs are among the largest in the country, and it has led many innovations, such as the 10x10 (“ten by ten”) program in partnership with the American Medical Informatics Association, which aims to train 10,000 health care professionals in biomedical informatics by the year 2010.
Students will be able to enroll in the new programs this fall. More information about student financial aid opportunities will be available on the OHSU Department of Medical Informatics and Clinical Epidemiology Web site in early May. In the meantime, for descriptions of the Graduate Certificate and Master’s degree programs or to sign up to receive further information when it becomes available visit: http://www.ohsu.edu/dmice.
Wednesday, March 17, 2010
The Health IT Holding Pattern (or Calm Before the Storm?)
Despite all the frenzy over HITECH, a large part of the health IT community seems to be in a holding pattern. Maybe it is the calm before the storm. Hospitals and physician practices are waiting for the final criteria for meaningful use now that the comment period has ended. (More on those in a moment.) Researchers and innovators are waiting to hear respectively about their SHARP and Beacon proposals, while educators are waiting to hear about their workforce development proposals.
For those interested in workforce-related issues, such as certification, the press has not been quiet. A recent article by Joseph Conn described where things with a focus on physician certification, while another article by Bruce Bollag describes the ONC workforce funding initiatives in more detail.
In the meantime, a number of groups have put forth thoughtful critiques of the interim rules for meaningful use. The entirety of comments can be seen at Regulations.gov. It will be interesting to see how ONC and CMS take these into account and what modifications they make. Here are some published letters from some of the more prominent organizations:
For those interested in workforce-related issues, such as certification, the press has not been quiet. A recent article by Joseph Conn described where things with a focus on physician certification, while another article by Bruce Bollag describes the ONC workforce funding initiatives in more detail.
In the meantime, a number of groups have put forth thoughtful critiques of the interim rules for meaningful use. The entirety of comments can be seen at Regulations.gov. It will be interesting to see how ONC and CMS take these into account and what modifications they make. Here are some published letters from some of the more prominent organizations:
- A group of 96 physician associations
- American Medical Informatics Association (AMIA) comments on the CMS NPRM and ONC IFR
- American Health Information Management Association (AHIMA)
- Association of American Medical Colleges (AAMC) comments on the CMS NPRM and ONC IFR
- Consumer Partnership for eHealth
- eHealth Initiative
- American Hospital Association
- American Academy of Family Physicians
- Premier (insurance group purchaser)
- Medical Group Management Association
- HIMSS EHR (Vendor) Association comments on the CMS NPRM and ONC IFR
- Combined comments from the Markle Foundation, the Center for American Progress, and the Engelberg Center for Healthcare Reform of the Brookings Institute on the CMS NPRM and the ONC IFR
- General clinical informatics
- Emergency medicine physicians (in partnership with the American College of Emergency Physicians)
- Dietitians (in partnership with the American Dietetic Association)
Saturday, February 27, 2010
Informatics Professor Postings Motivate Articles and Talks
Some items of interest motivated by prior postings from the Informatics Professor blog!
First, OHSU published one of its ongoing advertisements in the Opinion section of a recent Sunday Oregonian about healthcare reform that featured my views on how biomedical informatics will enable information use to improve healthcare quality, safety, and cost (as described in a prior blog posting). The views are consistent with OHSU's eight principles for healthcare reform, one of which is, "Supports more effective deployment of information technology, including but not limited to portable electronic health care records."
Second, the university published a piece that described my trip and Health Affairs article that motivated my prior post on "global truths."
Finally, I was recently invited to give a talk at the University of Michigan, where I gave a talk motivated by another recent post about informatics now living in a HITECH world. There are links to a video of my talk as well as my slides with references.
First, OHSU published one of its ongoing advertisements in the Opinion section of a recent Sunday Oregonian about healthcare reform that featured my views on how biomedical informatics will enable information use to improve healthcare quality, safety, and cost (as described in a prior blog posting). The views are consistent with OHSU's eight principles for healthcare reform, one of which is, "Supports more effective deployment of information technology, including but not limited to portable electronic health care records."
Second, the university published a piece that described my trip and Health Affairs article that motivated my prior post on "global truths."
Finally, I was recently invited to give a talk at the University of Michigan, where I gave a talk motivated by another recent post about informatics now living in a HITECH world. There are links to a video of my talk as well as my slides with references.
Thursday, December 31, 2009
A New Year's Moment to Reflect
The year 2010 will mark my 20th year at Oregon Health & Science University (OHSU). I arrived at OHSU in 1990 as a newly minted Assistant Professor, fresh out of a three-year medical informatics fellowship in Boston that followed my medical training (medical school and internal medicine residency in Chicago). I have seen a great deal of change in our field since my tenure in it began, but I don't believe there has been anything quite like this past year, 2009.
I remember quite vividly as 2009 began. While I was excited at the election of our new president and his fresh hope for change, I was more than a little concerned about the onset of the economic recession and its impact on the finances of OHSU. Based on what we were hearing, I was having some serious doubts about the viability of OHSU and our Department of Medical Informatics & Clinical Epidemiology, as cuts to the small but essential amount of support (about 5% of our overall budget) we received from the university looked threatened. Furthermore, the potentially draconian cuts in other departments greatly threatened institutional morale.
Within a month or two of the new year, however, a different picture began to emerge. Something called the American Recovery and Reinvestment Act (ARRA, also known as the economic stimulus package) had just come to be, and within it, something called the Health Information Technology for Economic and Clinical Health (HITECH) Act promised unprecedented new support for health information technology (HIT). I even played a small role in the development of ARRA, contributing a few words that made it into what became Section 3016, the portion legislating support for health IT workforce development, working with the staffs of my Congressman David Wu and one of my state's Senators, Ron Wyden. (ARRA has also greatly benefited some, but not all, of the other departments at OHSU.)
In addition to new acronyms that are now household names (at least for those of us in informatics), such as ARRA and HITECH, new phrases appeared in the vernacular, mostly notably "meaningful use." As an educator and frequent speaker on the topic, the constant unveiling of new details made it a challenge to keep all my slides up to date.
The year of unprecedented activity came to a head in the last month of 2009. The trickle of funding opportunity announcements (FOAs)turned into a torrent, with the Office of the National Coordinator for Health IT (ONC) laying out its implementation of the vision of HITECH. The tight mid to late January deadlines for these FOAs released in December led a colleague to quip that ONC stood for the "Office of No Christmas" (to which I added, "Office of No Chanukah" for those of a different religious persuasion). Like many, I have spent a good deal of this year's Christmas break working on proposals for the FOAs.
On the second to the last day of the month and year, ONC, along with the Centers for Medicare and Medicaid Services (CMS), released the Notice of Proposed Rulemaking (NPRM) for the "meaningful use" criteria that will guide the distribution of financial incentives for EHR adoption under HITECH. Further released was the interim final rule (IFR) on Standards & Certification Criteria, the initial set of standards, implementation specifications, and certification criteria for the interoperability, functionality, utility, and security of health IT. A good starting point for digesting all the information associated with these is the ONC news release and overview. From these, you can link to a fact sheet on the IFR.
Readable and succinct summaries are also available from CMS about the program in general, the meaningful use standards, the meaning of certified electronic health records, and the requirements for incentive funding in the Medicare and Medicaid programs. No doubt a number of summaries will appear in the coming days; two good ones to start come from the venerable blogs HisTalk and Geek Doctor.
Also released on that day was an article in the New England Journal of Medicine by the National Coordinator of ONC, Dr. David Blumenthal, that gives a succinct, big-picture overview of HITECH. Dr. Blumenthal's article makes clear that if 2009 was the planning year, then 2010 will be the implementation year. We will see the finalization of the meaningful use criteria, the launching of the regional extension centers, the start-up of a number of other programs, and the initiation of the education and training programs to ramp up the necessary workforce to make it all happen.
Another event of 2010 will be the finalization of healthcare reform legislation. I have avoided expressing my views on healthcare reform this blog (considered out of scope!), but I agree with those who say there was more "reform" and transformation of healthcare in ARRA (courtesy of HITECH) than anything that will emerge out of the legislation due to be reconciled by the House and Senate in early 2010. I do agree, however, with those who see the imperfect legislation that will emerge from that process as a "foot in the door" to more meaningful healthcare reform in the years ahead. It will not be a smooth or painless process.
So ONC has now put its proverbial cards on the table, and it is very clear how they plan to implement HITECH. There probably is not a single person in the field who agrees with everything they are doing, but it is very clear that the health IT agenda in the US will be driven by the ONC agenda. A huge natural experiment is about to take place, and I for one am excited to be a "subject" in it!
Happy New Year to all.
I remember quite vividly as 2009 began. While I was excited at the election of our new president and his fresh hope for change, I was more than a little concerned about the onset of the economic recession and its impact on the finances of OHSU. Based on what we were hearing, I was having some serious doubts about the viability of OHSU and our Department of Medical Informatics & Clinical Epidemiology, as cuts to the small but essential amount of support (about 5% of our overall budget) we received from the university looked threatened. Furthermore, the potentially draconian cuts in other departments greatly threatened institutional morale.
Within a month or two of the new year, however, a different picture began to emerge. Something called the American Recovery and Reinvestment Act (ARRA, also known as the economic stimulus package) had just come to be, and within it, something called the Health Information Technology for Economic and Clinical Health (HITECH) Act promised unprecedented new support for health information technology (HIT). I even played a small role in the development of ARRA, contributing a few words that made it into what became Section 3016, the portion legislating support for health IT workforce development, working with the staffs of my Congressman David Wu and one of my state's Senators, Ron Wyden. (ARRA has also greatly benefited some, but not all, of the other departments at OHSU.)
In addition to new acronyms that are now household names (at least for those of us in informatics), such as ARRA and HITECH, new phrases appeared in the vernacular, mostly notably "meaningful use." As an educator and frequent speaker on the topic, the constant unveiling of new details made it a challenge to keep all my slides up to date.
The year of unprecedented activity came to a head in the last month of 2009. The trickle of funding opportunity announcements (FOAs)turned into a torrent, with the Office of the National Coordinator for Health IT (ONC) laying out its implementation of the vision of HITECH. The tight mid to late January deadlines for these FOAs released in December led a colleague to quip that ONC stood for the "Office of No Christmas" (to which I added, "Office of No Chanukah" for those of a different religious persuasion). Like many, I have spent a good deal of this year's Christmas break working on proposals for the FOAs.
On the second to the last day of the month and year, ONC, along with the Centers for Medicare and Medicaid Services (CMS), released the Notice of Proposed Rulemaking (NPRM) for the "meaningful use" criteria that will guide the distribution of financial incentives for EHR adoption under HITECH. Further released was the interim final rule (IFR) on Standards & Certification Criteria, the initial set of standards, implementation specifications, and certification criteria for the interoperability, functionality, utility, and security of health IT. A good starting point for digesting all the information associated with these is the ONC news release and overview. From these, you can link to a fact sheet on the IFR.
Readable and succinct summaries are also available from CMS about the program in general, the meaningful use standards, the meaning of certified electronic health records, and the requirements for incentive funding in the Medicare and Medicaid programs. No doubt a number of summaries will appear in the coming days; two good ones to start come from the venerable blogs HisTalk and Geek Doctor.
Also released on that day was an article in the New England Journal of Medicine by the National Coordinator of ONC, Dr. David Blumenthal, that gives a succinct, big-picture overview of HITECH. Dr. Blumenthal's article makes clear that if 2009 was the planning year, then 2010 will be the implementation year. We will see the finalization of the meaningful use criteria, the launching of the regional extension centers, the start-up of a number of other programs, and the initiation of the education and training programs to ramp up the necessary workforce to make it all happen.
Another event of 2010 will be the finalization of healthcare reform legislation. I have avoided expressing my views on healthcare reform this blog (considered out of scope!), but I agree with those who say there was more "reform" and transformation of healthcare in ARRA (courtesy of HITECH) than anything that will emerge out of the legislation due to be reconciled by the House and Senate in early 2010. I do agree, however, with those who see the imperfect legislation that will emerge from that process as a "foot in the door" to more meaningful healthcare reform in the years ahead. It will not be a smooth or painless process.
So ONC has now put its proverbial cards on the table, and it is very clear how they plan to implement HITECH. There probably is not a single person in the field who agrees with everything they are doing, but it is very clear that the health IT agenda in the US will be driven by the ONC agenda. A huge natural experiment is about to take place, and I for one am excited to be a "subject" in it!
Happy New Year to all.
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