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.

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:

• Top Professors of Math & Science Blogs
• Forty-Six Health Care Blogs for Professionals
• 50 Resources for Students Attending Online Health Information Schools

Finally, I am honored to have my book reviewed by one of my favorite blogs, Keith Boone's Healthcare Standards blog. It turns out that Keith did some work in search earlier in his career and has some poignant things to say about my book (and my blog). I look forward to his book on Clinical Document Architecture due out this spring.

10x10 ("Ten by Ten") at the End of 2010 and Beyond

With the end of 2010 approaching, I am asked with increasing frequency whether we met the goals set out by the 10x10 ("ten by ten") program, which was launched in 2005 with the goal of training 10,000 healthcare professionals in informatics by the year 2010. Now that 2010 is coming to an end, how did we do?

I can say that the program has been an unqualified success. The OHSU 10x10 offerings trained nearly 1000 (999, to be precise) people, with another eight universities training an additional 258 more, for a total of 1257 from 2005-2010. Many of those of completing the program have enhanced their current careers. From the OHSU courses, about 15% pursued additional training in the field. While our numbers did not add up to 10,000, there was clearly value for those who completed the course. The program also helped expand educational capacity in the field generally and highlighted the need that led to legislation such as Section 3016 of the American Recovery and Reinvestment Act (ARRA) and the resulting ONC Workforce Development Program.

The 10x10 courses are offered on-line, with an in-person session at the end that brings participants together face to face. The amount of material in each course is roughly comparable to an introductory three-credit graduate-level course, as shown in the syllabus from the OHSU course. In a demonstration that the Internet knows no boundaries, the course has attracted participants from all corners of the globe, such as Argentina, Hong Kong, Singapore, Israel, Pakistan, South Korea, Saudi Arabia, China, India, and Nigeria. The enthusiasm from Latin America led a group from Hospital Italiano of Buenos Aires to translate the course into Spanish and offer it across Latin America. About 500 individuals have completed this version of the course from a number of Spanish-speaking countries. Another version of the OHSU course has been offered in Singapore four times, with the in-person session held in Singapore.

We absolutely plan to continue the 10x10 program beyond the end of 2010. Two more OHSU offerings started in late 2010, along with a few more from other universities. There are no plans whatsoever to end the program, whose need continues to be demonstrated as increasing numbers of healthcare professionals and hospitals seek to achieve "meaningful use" of electronic health records. Of course, biomedical informatics is about more than meaningful use and EHRs, as demonstrated in the course syllabus.

AMIA has already changed the tag line of the program from "10,000 Trained by 2010" to "Training Next-Generation Informatics Leaders." Maybe we should just say that 10x10 now the program that aims to train 10,000 individuals in biomedical and health informatics without giving a specific deadline. Clearly the need remains.

The end of 2010 is also a time to reflect on how we arrived here. In 2005, Dr. Charles Safran, who was then President of the American Medical Informatics Association (AMIA), began taking an interest in the informatics capacity of healthcare organizations. In a letter to the editor of JAMA, he stated that each hospital in the US should have at least one physician and one nurse trained in informatics. Meanwhile, AMIA was looking to beef up its e-learning offering, but found new development of content would be prohibitively expensive. At the same time, I had already been offering the introductory course in the OHSU Biomedical Informatics Graduate Program on-line for some time. It was apparent that we could repackage the course relatively easily. Building on Charlie's call, I coined the name 10x10, aiming to train 10,000 people within five years, by 2010.

I have thoroughly enjoyed developing and teaching the 10x10 course. It has been personally gratifying to meet so many people who took the course and found it of value. I am delighted that some colleagues from Argentina translated the course to Spanish, as noted above. The course name even made its way into legislation in a bill that passed the US House of Representatives (though not the US Senate), the 10,000 Trained by 2010 Act introduced by Congressman David Wu (D-OR). A demo version is available for those who want to take a look.

Some have asked why the Chair of a department would enjoy teaching the introductory course so much. I take great satisfaction in providing people their first introduction to the field of biomedical and health informatics. I enjoy the give and take with students, including those who challenge me. The 10x10 course and my other educational accomplishments make it clear that these activities are my passion and calling in life.

Update on the ONC Workforce Development Program

It's hard to believe that it has only been a little more than seven months since the Office of the National Coordinator for Health IT (ONC) announced the awardees for its Workforce Development Program. A tremendous amount has been accomplished since the grants were awarded on April 2, 2010. Our department at Oregon Health & Science University (OHSU) has played a substantial role in several aspects of the program.

The ONC Workforce Development Program is devoted to building the professional workforce that will help eligible hospitals and professionals achieve meaningful use of the electronic health records (EHR). The program is based on the need for an estimated 51,000 such professionals who will work in twelve workforce roles. Half of these workforce roles are deemed to be trained in six-month certificate programs in community colleges, while the other half are to be trained in 1-2 years in university-based programs.

The overall program consists of four specific initiatives:
1. Community College Consortia - 84 community colleges, grouped into five regional consortia, have been funded to offer six-month certificate programs in the six community workforce roles.
2. Curriculum Development Centers - Because the community colleges do not have curricula for these programs, five universities have received awards to develop curricular components that are to be developed into courses by the community colleges. One of the five universities (OHSU) was additionally designated the National Training and Dissemination Center (NTDC), tasked with developing the Web site for dissemination of the materials and carrying out training activities for community colleges, including a training event that took place in August, 2010.
3. Competency Examination - An examination to test the competencies gained by graduates of the community college programs for the six workforce roles trained in their programs is being developed.
4. University-based Training (UBT) programs - Additional training funds were awarded to nine universities (including OHSU) for longer-term university-based training.

As noted above, OHSU has been playing a major role in the ONC Workforce Development Program. We are one of the five Curriculum Development Centers and also serve as the NTDC. In addition, we are also one of the nine universities funded under the UBT program.

The work in all of these programs has been substantial over the past seven-plus months. Led by the NTDC, the Curriculum Development Centers have delivered the first version of the 20 curricular components, which are available to the community college programs on the NTDC Web site. The NTDC also put on the training event over August 9-11, 2010 in Portland, OR that brought together over 200 community college faculty, the five Curriculum Development Centers, and some of the ONC leadership.

The Curriculum Development Centers project has spawned another exciting project that will, in the long run, benefit the entire informatics field. This is the development of an educational version of the VA VistA EHR system along with teaching exercises in using and configuring EHRs. The lack of EHR access has always been a problem in informatics education, as vendors have been reluctant to make their systems more readily available. (This is in contrast to companies like IBM and Apple that make development tools available to computer science students for free or at substantial discounts, which makes sense, as it trains a new generation of students in their wares.) This project will rectify this problem and hopefully get vendors to consider ways to be more open with their systems for educational purposes.

OHSU is likewise very busy with its UBT training grant, which will fund 135 Graduate Certificate and 13 Master of Biomedical Informatics over three years. The certificate students are admitted on a rolling basis each quarter (OHSU is on an academic quarter system) and must make the commitment to complete the program in one year. While not requiring full-time study, this pace does require more concentrated commitment than typical part-time students. The program is on-line with no on-campus requirement. We have enrolled 47 certificate students to date and plan to continue admitting 20-30 students per quarter until the funding is completely committed (probably in early 2012). Unfortunately, the number of qualified applicants has vastly exceeded the resources of the grant (about 100 applicants per quarter), although most are offered admission on a self-funded (i.e., paying tuition) basis.

The master's students are admitted in two cohorts, one that started in the fall of 2010 and another that will begin in the fall of 2011. This program is full-time and on-campus.

One novel feature of both programs is the requirement of a practicum (certificate) or internship (master's). We believe that hands-on, real-world experience is essential for learning informatics, even those in on-line programs. We had experience in remote students doing practicums and internships prior to the grant and feel ready to scale up to all of the students funded by the UBT grant. To this end, we have hired a Practicum/Internship Coordinator who will handle the organization and logistics of the program.

We also plan to use the resources of the grant to hire a Career Counselor. This addresses another challenge that informatics programs have faced, which is having the resources to provide career guidance. We have found that generic career advising centers can be helpful to a point, but there is much advice specific to informatics, especially for the students of diverse backgrounds and interests who enroll in our program.

We also hope that in the long run, these enhancements will carry over into our regular program, especially once the ONC UBT grant ends in 2013. I am optimistic that informatics education will continue to be pursued by a variety of students to carry on the work that will not end once the HITECH program finishes. Informatics is and will continue to be a great career option for those wanting to work at the intersection of health disciplines and information technology. As I always say, informatics is more than EHRs, and there will also be continued opportunities in other areas in bioinformatics, other aspects of clinical informatics, public health informatics, and more.

New Data Reiterates Coming Need for Health IT Workforce

A recent survey from the College of Healthcare Information Management Executives (CHIME) provides additional data on the growing need for a skilled health IT workforce, with a particular need in "clinical software implementation and support staff." The survey was administered to healthcare CIOs in September, 2010 and had 182 respondents, representing 13% of CHIME's membership. A summary and full report of the survey are available.

The respondents came from a variety of hospital types and sizes, from large academic centers to small community hospitals. Interesting enough, the biggest needs, more than 20% staff shortages, were found at the big and small institution ends of the spectrum.

The highest proportion of open positions, as noted above, were in clinical software implementation and support staff, with 71% of CIOs reporting openings. The types of positions open included project managers, analysts, application coordinators, report writers, trainers, informatics staff, and technical staff. I really consider all of these positions to be in the realm of "informatics," or at least are positions for which informatics training would prepare one well.

One disappointing finding of the survey was half of the respondents reporting that they did not foresee additional spending on bolstering IT staff. On the other hand, most of the those organizations will be seeking their "meaningful use" incentive dollars, so hopefully their leadership can be convinced to invest in staff.

Healthcare organizations are not the only ones with needs and who are hiring. The EHR vendor Meditech reported that it will be hiring over 800 people in a new facility in Massachusetts. (Note to Oregon economic development leaders: There is opportunity for job creation in this field!)

These data are very consistent with a survey reported by HIMSS last spring, which had a total of 149 respondents. The survey found that 86% of organizations planned to hire additional IT staff in 2010. The areas respondents would most likely hire included implementation support specialists (55%), implementation managers (51%), and technical support (48%). The highest ranked area that organizations felt they lacked qualified candidates was clinical informatics (30%), followed by implementation expert (26%) and software maintenance expert (17%).

Finally, the consulting firm CSC, whose web site of reports on various aspects of meaningful use is one of my favorites, has produced a report on HIT workforce shortages. They summarize the research (including my study that used HIMSS Analytics data), describe the ONC workforce development programs, and discuss the implications to healthcare organizations. The latter include competition for qualified staff, inexperience among those newly trained, leading to lack of those with enough experience to assume leadership roles, attrition, and competition from other HIT tasks, such as ICD-10 implementation, HIPAA issues, and insurance exchanges.

The report's recommendations for overcoming these challenges is "expand, retain, and exploit," i.e., training and developing from within as well as exploring alternatives from outside the organization.

Of course, my advice is to hang tight, and hopefully the graduates from the newly funded ONC workforce development programs, including ours at OHSU, will start to fill the need soon.

Welcoming Unprecedented Numbers to the OHSU Informatics Educational Program

The beginning of the academic year is always an exciting time, and this year is exceptionally exciting, due to the unprecedented enrollment in our program. While numbers do not tell the entire story, they clearly show a field in ascension. While much of the growth is fueled by our University-Based Training (UBT) Grant from the Office of the National Coordinator for Health IT (ONC), there is growth in all areas of our program.

This week we welcomed an total of 95 new students to the OHSU biomedical informatics graduate program. This matriculating class includes 4 PhD, 25 Master's, and 66 Graduate Certificate students. Of the 25 Master's students, 19 are in the clinical informatics track and 6 are in the bioinformatics and computational biology track. Of the 19 in the clinical informatics track, 10 are on-campus and 9 are distance-learning students. Of the 10 on-campus master's students, 8 are funded by our new ONC UBT grant. All of the Graduate Certificate students are distance-learning students, with 36 funded by the UBT grant.

These new students bring our total student body to approximately 350 students who are actively enrolled in the program. This includes 15 PhD, 83 Master's, and approximately 250 Graduate Certificate students. The 8 Master's and 36 Graduate Certificate students starting the UBT program join 12 other Graduate Certificate students who started in the summer quarter. This brings our total UBT enrollment to 56 students. Applications are now being accepted for those who wish to apply for Graduate Certificate UBT funding starting in the winter quarter. We are well on our way to educating 148 students over three years in the UBT grant.

All of these students will aspire to join our alumni, which consists of 272 people who have received 281 degrees, certificates, and fellowships (as of June, 2010). Our program has awarded 5 PhD, 63 Master of Science, and 74 Master of Biomedical Informatics degrees. We have also awarded 120 Graduate Certificates. Many of these alumni work in a variety of health care, industry, academic, and other settings.

I suppose I am biased, but I am incredibly optimistic for the future of biomedical informatics education. This field is truly establishing an identity as leading the charge to improve health, healthcare, biomedical research, and public health through better use of information. This involves not only electronic health records, but also other information systems in areas such as genomics, telemedicine, knowledge management, and clinical and translational research. Because of this, I am confident that our current students will find many rewarding career opportunities in all of these areas. I am also certain that informatics education will continue to be appealing long after the ONC funding ends, as students will be attracted to careers in this growing field in the long run.

Addendum

For those who better visualize numbers in a more tabular form, here is a summary (sorry Blogspot does not allow multiple levels of indenting):

Matriculating class, Fall, 2010 - 95
-PhD -4
-Master's - 25
--6 Bioinformatics Track
--19 Clinical Informatics Track
---10 on-campus (8 UBT)
---9 distance learning
-Graduate Certificate - 66
--(36 UBT)

Total enrollment - about 350
-PhD - 15
-Master's - 83
--60 distance learning
--23 on-campus
-Graduate Certificate - about 250

Alumni (as of June, 2010)
-People - 272
-Fellowships only - 19
-Degrees - 262
--PhD - 5 (2-3 more just about done)
--Master's - 137
---Master of Science - 63
---Master of Biomedical Informatics - 74
--Graduate Certificate - 120

What Others in the Community are Saying About the ONC HIT Workforce Program

Some articles by Joe Conn of Modern Healthcare on the ONC Workforce Development Program:

• 50,000 new health IT workers might be needed
• Working on IT

There has also been a press release and more detailed information from AMIA on the breadth of its member involvement in all of the ONC funded programs.