Public Rollout of the ONC Health IT Curriculum

This week was a major milestone for the Office of the National Coordinator for Health IT (ONC) Health IT Curriculum project. The curricular materials that were developed for the 82 community college programs to rapidly expand the health IT workforce were released to all educators and the public at large. In this posting, I will provide the context for this project and describe what it is not before delving into the details of what the curriculum contains.

The ONC Health IT Curriculum is one of four programs in the overall ONC Workforce Development Program. The overall program was specified by Section 3016 of the Health Information Technology for Economic and Clinical Health (HITECH) Act, the portion of the American Recovery and Reinvestment Act (ARRA), also known as the federal stimulus bill. ONC operationalized the program by designating 12 workforce roles, with six to be educated in the six-month community college programs and six to be educated in 1-2 year programs in universities. The primary audience for the curricular materials are the community college programs.

Five universities were funded under the $10 million project as Curriculum Development Centers: Oregon Health & Science University (OHSU), Columbia University, Duke University, Johns Hopkins University, and University of Alabama-Birmingham. Each center prepared four components each. One university, OHSU, was additionally funded to serve as the National Training & Dissemination Center (NTDC), given the additional tasks of developing the dissemination Web site, training community college faculty in use of the materials, capturing feedback, and providing technical support. The curricular materials are now available for download by the public on the NTDC Web site, although the feedback and support functions are limited to the 82 community colleges.

The curricular materials are not a certificate or degree program out of the box. Rather, the content should be thought of more like a library (or, to use the words of ONC Chief Science Officer Charles Friedman, PhD, a "buffet") from which educators can pick and choose content for their courses. The materials alone will not substitute for formal education, as good education still requires teachers, mentors, and fellow learners with whom to interact (whether in-person or on-line). However, the matierlals will be a valuable resource for a wide variety of educational activities in health IT. As the director of a graduate program in biomedical informatics, I know that OHSU will adopt some of these materials in its own graduate-level educational program (just as some of the curricular content came from our existing program).

The curricular materials consist of 20 components, each of which is comparable in depth to a college course. The components are subdivided into 8-12 units, each of which contain a variety of activities appropriate to the topic, including voice-over-Powerpoint narrated lectures, references, suggested readings, exercises, and more. The topic areas of the components are: 

1. Introduction to Health Care and Public Health in the U.S.
2. The Culture of Health Care
3. Terminology in Health Care and Public Health Settings
4. Introduction to Information and Computer Science
5. History of Health Information Technology in the U.S.
6. Health Management Information Systems
7. Working with Health IT Systems
8. Installation and Maintenance of Health IT Systems
9. Networking and Health Information Exchange
10. Fundamentals of Health Workflow Process Analysis & Redesign
11. Configuring EHRs
12. Quality Improvement
13. Public Health IT
14. Special Topics Course on Vendor-Specific Systems
15. Usability and Human Factors
16. Professionalism/Customer Service in the Health Environment
17. Working in Teams
18. Planning, Management and Leadership for Health IT
19. Introduction to Project Management
20. Training and Instructional Design

ONC and the Curriculum Development Centers also developed a “set table” consisting of a matrix of curriculum components and workforce roles to guide community college programs in using components to train for particular workforce roles. The matrix specified the core set of components for each workforce role for two types of student backgrounds, healthcare and information technology.
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Each component also contains a blueprint document that provides an overview of the learning objectives and content for each unit. All of the components also have an instructor's manual that provides more detailed information, including listing of authorship and teaching information. The full set of blueprints have been rolled into a single PDF portfolio and are available on the ONC Web site.

Three of the components are "lab" components that make use of an educational version of the Veteran's Administration (VA) VistA EHR. A version of VistA that runs under various versions of Microsoft Windows is provided on the Web site, courtesy of the VA. However, this version will not be usable by everyone, as it requires a license for the Intersystems Cache environment, which is freely available to academic institutions but not others. Nonetheless, the materials will still be valuable to others who can adapt the exercises for other EHR systems.

All told, the curricular materials are a comprehensive resource. The entire collection of material is 7.5 gigabytes in size (6.75 gigabytes compressed) in 12,339 files. The 20 components contain 213 units, 460 lectures (some units have more than one lecture), 8913 slides, and 125.9 hours of lecture audio. In the collection are 460 Powerpoint files, 460 MP3 files, 465 PDF files, and 1346 Microsoft Word files.

We call this publicly available version of the curricular materials Version 2. It has been available to the ONC Community College Consortium for two months, and supersedes the original Version 1 provided to consortium members last year. The materials are distributed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License. This means that all users of the curriculum can use, share, and adapt the materials but must attribute the originator of work, use the materials only for non-commercial purposes, and share any changes made under same license. Per the ONC, universities own the intellectual property for their components.

The support for the public rollout of the curricular materials will be minimal. This is in part because the funding does not have the resources to provide that support but also because these materials are aimed at educators who will adapt them into their own courses and other educational activities.

Another program in the ONC Workforce Development Program related to the project is the Competency Examination, a project led by Northern Virginia Community College. There are six exams, with one for each of the six community college-trained workforce roles. Each exam consists of 125 multiple-choice questions, to be taken in three hours and graded on a pass-fail basis. At least 80% of exam questions come from the curriculum components. Beta versions of the six exams became available on May 20, 2011, with the final versions to be ready in September. The exam is free to consortia member college graduates through their schools.

The final program in the is the University-Based Training (UBT) program, which funds training in the other six workforce roles deemed to require longer training at the university level. Nine universities or consortia thereof, including OHSU, were funded under this program. As noted elsewhere, OHSU recently had its first graduates from its UBT program, with many more in the pipeline.

The Curriculum Development Centers and ONC do not plan to rest on our laurels. We know there are many areas where Version 2 can be improved, and fortunately the two-year project includes additional funding to provide for a Version 3 that will be delivered in 2012. A planning process is underway to improve the content and technical aspects of Version 2, along with reducing its gap and overlaps.

It has been gratifying to be part of this project, which has consumed a great deal of my life since the project began in April, 2010. I have enjoyed all of the roles I have played, as Director of the NTDC, Director of the OHSU Curriculum Development Center, and author of several units. I will look forward to feedback about Version 2 and suggestions for enhancements in Version 3. How to sustain the curriculum once the ONC funding ends is also a key concern.

Update on the ONC Curriculum Development Centers Program

I recently posted an update about one of our Office of the National Coordinator for Health Information Technology (ONC) projects, the Oregon Health & Science University (OHSU) offering of the ONC University-Based Training (UBT) program, and promised an update to follow on our other grant, the Curriculum Development Centers program. The latter is a $10 million program for five universities – Columbia University, Duke University, Johns Hopkins University, Oregon Health & Science University (OHSU), and University of Alabama-Birmingham – to develop curricular materials for the 82 community colleges delivering short-term training for six of the 12 ONC-defined workforce roles. One university, OHSU, was provided additional funding to serve as the National Training & Dissemination Center (NTDC) that is additionally tasked with developing a Web site for dissemination of the materials, training community college faculty in their use, and capturing and distributing feedback collected from community college faculty.

As with the UBT program, the Curriculum Development Centers have been funded since April, 2010. Since that time, substantial progress has been made. The first version of the curriculum was delivered to the community colleges in two halves, one in August, 2010 and the other in October, 2010. Because of the tight timeline of the curriculum deliverables and the start-up of the community college programs, it was decided to not disseminate Version 1 beyond the five community college consortia overseeing the 82 member colleges. This also led to the decision for Version 2 to be delivered relatively quickly, in the spring of 2011, and mainly be an incremental update focused on improving the clarity and technical quality without making any major content overhaul. It was also decided that Version 2 would be the release promised in the original Request for Proposals (RFP) to be made available to all institutions of higher learning, which for all practical purposes means the general public. This public roll-out will take place in the summer of 2011.

Recall that the community college short-term training programs are focused on six of the 12 workforce roles that ONC has deemed necessary to help eligible professionals and hospitals achieve meaningful use of the electronic health record (EHR). (The other six workforce roles are trained by the UBT program.) Each of the 82 community colleges can offer certificates in one to six of the workforce roles, while the consortium to which it belongs must offer all six across their region.

The curriculum consists of 20 components, each of which is comparable to a college-level course (which of course can vary widely based on the length, depth of material, background of students, and other factors). The components are not called courses because it is up to the community colleges to turn them into actual courses in their programs. The colleges can use the materials “out of the box,” with little or no modification, or they may modify them as they desire for the needs of their programs.

ONC and the Curriculum Development Centers also developed a “set table” consisting of a matrix of curriculum components and workforce roles to guide community college programs in using components to train for particular workforce roles. The matrix specified the core set of components for each workforce role for two types of student backgrounds, healthcare and information technology.

Each component has a “blueprint,” which provides learning objectives and a detailed overview of the content. Each component is broken down into 8-15 units, which correspond roughly (though variably) to one week of a course. Each unit typically consists of learning objectives, a narrated slide lecture (delivered as Powerpoint slides, MP3 audio files, and narrated voice-over-Powerpoint Flash files), references, exercises, and other materials. (The blueprint for Version 1 on the ONC Web site will soon be replaced by the one for Version 2.)

The topic areas of the components are: 

1. Introduction to Health Care and Public Health in the U.S.
2. The Culture of Health Care
3. Terminology in Health Care and Public Health Settings
4. Introduction to Information and Computer Science
5. History of Health Information Technology in the U.S.
6. Health Management Information Systems
7. Working with Health IT Systems*
8. Installation and Maintenance of Health IT Systems*
9. Networking and Health Information Exchange
10. Fundamentals of Health Workflow Process Analysis & Redesign
11. Configuring EHRs*
12. Quality Improvement
13. Public Health IT
14. Special Topics Course on Vendor-Specific Systems
15. Usability and Human Factors
16. Professionalism/Customer Service in the Health Environment
17. Working in Teams
18. Planning, Management and Leadership for Health IT
19. Introduction to Project Management
20. Training and Instructional Design

Components 7, 8, and 11, denoted with an asterisk* above, are “lab” components that provide hands-on instruction. These components make use of a fully functioning version of the Veteran’s Administration VistA EHR that is included with the curricular materials and can be installed under most flavors of Windows (as well as some Windows virtual machines that run under MacOS and Linux).

Another program in the ONC Workforce Development Program related to the project is the Competency Examination, a project led by Northern Virginia Community College. There are six exams, with one for each of the six community college-trained workforce roles. Each exam consists of 125 multiple-choice questions, to be taken in three hours and graded on a pass-fail basis. At least 80% of exam questions come from the curriculum components. Beta versions of the six exams became available on May 20, 2011, with the final versions to be ready in September. The exam is free to consortia member college graduates through their schools.

As noted above, Version 2 will be released to all institutions of higher education in July, 2011. The details of how to access the materials will be provided at that time. For this release, the Curriculium Development Centers adopted a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License. This means all users of the curriculum can use, share, and adapt the materials but must attribute originator of work, use the materials only for non-commercial purposes, and share any changes made under same license. Per the original RFA, universities own the intellectual property for their components.

The Curriculum Development Centers have also started planning for the third and final version that will likely be released in early 2012. Planning for this version is underway. Unfortunately, there is not now any plans for continued funding, at least by ONC, beyond the project end in April, 2012. It is conceivable that some sort of open-source approach could be adopted to keep the curriculum going, but I do not see the resource continuing to be viable without some investment, at least in its infrastructure. Nonetheless, I am pleased overall with the project and I believe it will be an enduring contribution to the biomedical and health informatics community. I am looking forward to Version 3 and whatever opportunities there are to continue the project beyond it.

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.

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.

What Level of Training Is Needed for Health IT and Clinical Informatics Jobs?

There will likely be a large number of jobs that result from the funding in the American Recovery and Reinvestment Act (ARRA, aka the stimulus bill) of 2009 providing incentives for electronic health record (EHR) adoption. Dr. Charles Friedman of the Office of the National Coordinator for Health IT (ONC) recently estimated that 60,000 people will be required for these jobs (PHIN 2009 Meeting Town Hall, September 2, 2009). ONC also recently posted on its Web site a set of job roles and competencies for this massive scaling up of EHR use that was developed in a workshop in August.

One question that arises is, who will provide all this education and training? A number of people have advocated that it be carried out by community colleges. A recent article in Healthcare IT News interviewed two people, a health insurance company executive and a president of a community college association, who advocated for community colleges to play that role.

In a rebuttal commentary, however, I replied that I was not so sure. There is no doubt that plenty of jobs in health IT will be for those educated in community colleges, such as the "informatics technicians" noted in a recent CNN posting about "emerging jobs poised for growth." But this is in distinction to the emerging clinical informatics role, which requires a combination of understanding the clinical environment and its workflows, ability to use advanced information analysis (more so than IT or computer science skills), and a myriad of business and soft skills. As the director of an informatics graduate program, I acknowledge my bias, but I advocated in my commentary that these programs, slightly re-orienting and focusing their curricula, may be better suited for training up this workforce. Since the proposed training must necessarily be short-term, I noted in my commentary that we are re-configuring our Graduate Certificate program into a 6-month program when pursued as a full-time student.

One line of evidence supporting my view comes from the Health IT Compensation Survey (Vendome, 2009). This year's survey features a wealth of data that goes way beyond compensation, and provides an interesting synopsis of the job functions and educational backgrounds of a wide variety of people who work in the industry. They segment those they survey into job setting (i.e., hospital, company, etc.), and across every segment, they subdivide people into leadership, clinical, and non-clinical positions.

Those in hospitals make up the largest segment in the survey, so I will focus on them. Among the leaders, 18% have doctoral or professional degrees, 48% have master's degrees, and all but 4% of the rest have bachelor's degrees. They subdivide the clinical and non-clinical professionals into "high authority" and "low authority." The breakdown of degrees within these groups is:

• Clinical/High Authority: 34% have doctoral or professional degrees, 29% have master's degrees, and 30% have bachelor's degrees
• Clinical/Low Authority: 20% have doctoral or professional degrees, 31% have master's degrees, and 35% have bachelor's degrees
• Non-Clinical/High Authority: 1% have doctoral or professional degrees, 36% have master's degrees, and 38% have bachelor's degrees
• Non-Clinical/Low Authority: 1% have doctoral or professional degrees, 24% have master's degrees, and 51% have bachelor's degrees

Clearly a majority of health IT professionals, especially those with clinical roles, have at least a bachelor's degree, and many have more. This is not surprising, as effective training for health IT requires expertise in the clinical environment, IT and information skills, and the ability to work with people in organizations. As I note in my commentary, that is a tall order for any educational program, let alone a two-year associate degree.

I do realize that community colleges play a strong role in rapidly adapting to skills needs in communities, and that many of their students are those who have bachelor's or even graduate degrees and return to attain new skills. And there is no question that some of the jobs in health IT will require the kinds of skills that community colleges already teach, such as those in pure IT. I acknowledge that the person hired to harden a server to prevent its security from being compromised probably does not need courses in change management. But many others who work in health IT do!

The reality is that few community colleges have expertise on their faculty in clinical informatics, which is not the mere addition of computer science, health information management, and health care courses as many seem to think. Informatics is what arises at the unique intersection of those areas, and the expertise for teaching it currently resides mostly in graduate-level informatics programs.