The interest in health IT and biomedical informatics continues to grow, fueled no doubt by federal policy efforts and the economic stimulus plan. One result is that many people have inquired to me about opportunities to learn more about the biomedical informatics field at OHSU. To that end, I am going to describe the options in this posting. If you have further questions, feel free to contact me individually.
OHSU's programs are open to people of all career backgrounds. Our programs have served a wide diversity of people over the years, including those with backgrounds in health care (e.g., medicine, nursing, hospital administration, etc.), IT (e.g., computer scientists, IT professionals, etc.), and many other areas (e.g., health administration, business, public health, law, etc.). There is room for everyone in the big tent of informatics!
While our certificate and degree programs are at the graduate level (i.e., you need to have a bachelor's degree), our 10x10 ("ten by ten") course is open to anyone, even those who do not have a bachelor's degree.
An excellent way to get a broad-based introduction to the field is our on-line introductory biomedical informatics course. This course is offered in a number of flavors, and there are upcoming opportunities for you to enroll. Whatever path you take through the course, you can (assuming you are eligible for graduate study) get credit in our graduate program and be eligible to take more courses in our program if you are interested.
The introductory course is completely on-line and has been completed by about 1000 individuals in the last decade. It covers all the major aspects of biomedical and health informatics, with a focus on informatics applied to health care. It is offered using a variety of asynchronous distance learning teaching modalities, so you do not need to be present on-line at any specific time, although you do need to keep up with the work during the academic term.
One way to take the course is through our regular graduate program. OHSU is on an academic quarter system. Due to continued demand, the introductory course has been offered every academic quarter. The next offering is over the summer quarter, which runs from June 22 to September 11. The course will be offered again in the fall quarter, which runs from September 28 to December 13. To take the course by this pathway, you need to enroll in the OHSU Graduate Certificate program, which is open to anyone with a bachelor's degree. For more information, follow this link to our department Web site and click on the link to the Prospective Students Portal on the lower right:
http://www.ohsu.edu/dmice/
Another option to take essentially the same course is via the AMIA 10x10 program. This version of the course is offered in partnership with the American Medical Informatics Association (AMIA). The course is taught in the same on-line, asynchronous manner. It is offered over a slightly longer time period (decompressed with some "off" weeks) and adds an in-person session at the AMIA Annual Symposium, where all the students come together to meet and engage in additional learning. The AMIA Annual Symposium is one of the leading health IT meetings and will be held this year in San Francisco from November 14-18. Registration is already open for the next offering of the 10x10 course, which begins on July 30th and runs until the AMIA meeting. For more information, visit:
http://www.amia.org/10x10/partners/ohsu/
Or:
http://www.billhersh.info/10x10-2009.html
If you successfully complete the 10x10 course (and are eligible for graduate study), you can then get credit for the BMI 510 course in our graduate program. Once you are enrolled in the program, you can take additional courses. There is also a relatively easy pathway to advance beyond our Graduate Certificate into our master's degree program (and even the PhD program).
Here is a detailed outline of the introductory course content:
1. Overview of Field and Problems Motivating It
1.1 What is Health/Bio/Medical Informatics?
1.2 A Discipline Whose Time Has Come
1.3 Who Does Biomedical Informatics?
1.4 Problems in Health Care Motivating Biomedical Informatics
1.4 Seminal Documents and Reports
1.5 Resources for Field - Organizations, Information, Education
2. Biomedical Computing
2.1 Types of Computers
2.2 Data Storage in Computers
2.3 Computer Hardware and Software
2.4 Computer Networks
2.5 Software Engineering
2.6 Challenges for Biomedical Computing
3. Electronic Health Records
3.1 Clinical Data
3.2 History and Perspective of the Health (Medical) Record
3.3 Potential Benefits of the Electronic Health Record
3.4 Definitions and Key Attributes of the EHR
3.5 EHR Examples
3.6 Nursing Informatics
4. Clinical Decision Support; EHR Implementation
4.1 Historical Perspectives and Approaches
4.2 Medical Errors and Patient Safety
4.3 Reminders and Alerts
4.4 Computerized Provider Order Entry (CPOE)
4.5 Implementing the EHR
4.6 Use and Outcomes of the EHR
4.7 Cost-Benefit of the EHR
5. Standards and Interoperability; Privacy, Confidentiality, and Security
5.1 Standards: Basic Concepts
5.2 Identifier and Transaction Standards
5.3 Message Exchange Standards
5.4 Terminology Standards
5.5 Privacy, Confidentiality, and Security: Basic Concepts
5.6 HIPAA Privacy and Security Regulations
6. Secondary Use of Clinical Data: Personal Health Records, Health Information Exchange, Public Health, Health Care Quality, Clinical Research
6.1 Personal Health Records
6.2 Health Information Exchange
6.3 Public Health Informatics
6.4 Health Care Quality
6.5 Clinical Research Informatics
7. Evidence-Based Medicine and Medical Decision Making
7.1 Definitions and Application of EBM
7.2 Interventions
7.3 Diagnosis
7.4 Harm and Prognosis
7.5 Summarizing Evidence
7.6 Putting Evidence into Practice
7.7 Limitations of EBM
8. Information Retrieval and Digital Libraries
8.1 Information Retrieval
8.2 Knowledge-based Information
8.3 Content
8.4 Indexing
8.5 Retrieval
8.6 Evaluation
8.7 Digital Libraries
9. Imaging Informatics and Telemedicine
9.1 Imaging in Health Care
9.2 Modalities of Imaging
9.3 Digital Imaging
9.4 Telemedicine: Definitions, Uses, and Barriers
9.5 Efficacy of Telemedicine
10. Translational Bioinformatics
10.1 Translational Bioinformatics - The Big Picture
10.2 Overview of Basic Molecular Biology
10.3 Important Biotechnologies Driving Bioinformatics
10.4 Clinical Genetics and Genomics
10.5 Bioinformatics Information Resources
10.6 Translational Bioinformatics Challenges and Opportunities
11. Organizational and Management Issues in Informatics
11.1 Organizational Behavior
11.2 Organizational Issues in Failure and Success of Informatics Projects
11.3 Change Management
Sunday, May 24, 2009
Monday, May 11, 2009
Crossing the Health IT People Chasm
I was recently at a dinner with Dr. Mark Leavitt, Chairman of the Certification Commission for Health Information Technology (CCHIT), who noted that the gap between the American Recovery and Reinvestment Act (ARRA) vision for health information technology (HIT) and our current status comes down to people. We have the technology already, and the money now with ARRA, but we still need the people, from the clinicians who will use the systems to the administrators who will fund them and the HIT professionals who will develop and implement them.
To borrow from the parlance of one of the early Institute of Medicine (IOM) reports that spurred health care's interest in HIT, we have a "chasm" between where we currently are and where we need to be.
A partial bit of good news is that some people are starting to do things to cross this chasm. Clearly one place we need to start is with the ultimate users of HIT, the clinicians and others in the health care trenches. We need to make it easy for them to use systems, not only to get data in and out, but also to use them to improve their practices by measuring quality and improving it by acting on the deficiencies they uncover. We also need to make it easier for administrators and others who run health care systems to make the investments in them, knowing they will benefit the care delivered and the bottom line.
And of course, another area where we need people is my passion, which is the HIT workforce. Unfortunately, most people still don't know exactly what biomedical and health informatics is all about. Some people who work in the field don't even agree with each other on its definition. Nonetheless, I believe that most people who do know about the field will agree that its work is absolutely essential to pull off the goals for HIT in the ARRA legislation. This is part of the reason for Section 3016 in the stimulus bill, which calls explicitly for a well-trained informatics workforce to carry out the health IT adoption elsewhere in the bill.
One challenge for the field of biomedical and health informatics is the heterogeneous nature of careers and education in the field. People who are called informaticians perform a variety of jobs from the highly technical development and implementation of hardware and software to the more people-oriented tasks of project management and institutional leadership. As such, there is no single career or educational pathway in this field.
But there is one attribute that defines people who call themselves informaticians, which is that they understand health care, IT, and the uniqueness that occurs at their intersection. This was pointed out in an article in the New York Times recently, which featured a quote from myself about how informatics was different from IT in being more focused on information and how it is used to improve health care than technology.
While most education in this field has historically been at the graduate level, combining careers in health professions, IT professions, and others, it is key to pay attention to the pipeline of the community colleges, undergraduate institutions, and others. We need to get the word out about the great opportunities and the career satisfaction that comes from working in this field. I would be interested in hearing from others on how to do that.
To borrow from the parlance of one of the early Institute of Medicine (IOM) reports that spurred health care's interest in HIT, we have a "chasm" between where we currently are and where we need to be.
A partial bit of good news is that some people are starting to do things to cross this chasm. Clearly one place we need to start is with the ultimate users of HIT, the clinicians and others in the health care trenches. We need to make it easy for them to use systems, not only to get data in and out, but also to use them to improve their practices by measuring quality and improving it by acting on the deficiencies they uncover. We also need to make it easier for administrators and others who run health care systems to make the investments in them, knowing they will benefit the care delivered and the bottom line.
And of course, another area where we need people is my passion, which is the HIT workforce. Unfortunately, most people still don't know exactly what biomedical and health informatics is all about. Some people who work in the field don't even agree with each other on its definition. Nonetheless, I believe that most people who do know about the field will agree that its work is absolutely essential to pull off the goals for HIT in the ARRA legislation. This is part of the reason for Section 3016 in the stimulus bill, which calls explicitly for a well-trained informatics workforce to carry out the health IT adoption elsewhere in the bill.
One challenge for the field of biomedical and health informatics is the heterogeneous nature of careers and education in the field. People who are called informaticians perform a variety of jobs from the highly technical development and implementation of hardware and software to the more people-oriented tasks of project management and institutional leadership. As such, there is no single career or educational pathway in this field.
But there is one attribute that defines people who call themselves informaticians, which is that they understand health care, IT, and the uniqueness that occurs at their intersection. This was pointed out in an article in the New York Times recently, which featured a quote from myself about how informatics was different from IT in being more focused on information and how it is used to improve health care than technology.
While most education in this field has historically been at the graduate level, combining careers in health professions, IT professions, and others, it is key to pay attention to the pipeline of the community colleges, undergraduate institutions, and others. We need to get the word out about the great opportunities and the career satisfaction that comes from working in this field. I would be interested in hearing from others on how to do that.
Sunday, May 3, 2009
EHRs on the Ground in Rural Oregon
I recently had the opportunity to participate in a discussion about practical health IT and EHR issues on the ground with several physician practices that participate in the Oregon Rural Practice-based Research Network (ORPRN). It is always extremely interesting for me to hear about real physicians and others who are trying to make this technology work. It is an effective antidote to participating in too many high-minded theoretical discussions, and an opportunity to test those theories against reality.
This entry is a summary of the minutes from a phone call I participated in with ORPRN members in February, 2009 concerning their health IT and EHR status. All of the participants have given me their approval to mention their names and comments. At the end, I will summarize the major themes discovered by Dr. LJ Fagnan of OHSU and myself.
This group is somewhat atypical, in that they represent practices that have agreed to participate in the rural practice-based research network. The fact that most have adapted EHRs sets them apart from average practices!
Topic of the phone call: Health Information Technology (HIT) in your practice – what do you have, what do you need, where do you go for assistance, how do you support your HIT needs?
William Hersh, MD, OHSU Department of Medical Informatics and Clinical Epidemiology Chair led the discussion about the representation of HIT in the economic stimulus package with an eye toward how Oregon can be positioned to receive stimulus dollars. There will be $17 billion in Medicare/Medicaid billing incentives and $2 billion toward standards development, IT workforce development, and other aspects of HIT infrastructure. Dr. David Blumenthal of Harvard has been appointed the new National Coordinator for HIT, so programs are likely to start being announced soon. A recent article by Dr. Blumenthal in the New England Journal of Medicine gives his views on a number of HIT issues. Finally, Dr. Hersh described the need for standards among electronic health/medical records (EHRs/EMRs) for helping to collect data for research.
Jon Schott, MD -Eastern Oregon Medical Clinic – Baker, OR
His practice has been using Centricity for 5 years. Local IT support is challenging as the clinic overwhelmed the capabilities of the local person. They now have IT support through Portland. The cost of the Centricity first cost about $5,000/seat and now is at $16,000, and so they feel trapped with the software.
Karl Ordelheide, MD -Lincoln City Medical Center
7 practitioners: IM-3, FP-2, Gyn-1, PA-1
Lincoln City, OR. Pop: 7000
His practice has been using Practice Partner since 2003. They have a one-way interface with medical manager office management system for demographics and with Meditech for lab, x-ray and hospital narrative reports. Also have interface to upload data to CDEMS Registry. There have been no changes to Practice Partner’s licensing fees and it is an affordable package. They have also had difficulty getting IT support to keep the system up and running; they are constantly behind. They bought the module for e-prescribing and it is not working. The company has apologized that it doesn’t work and cannot do anything more for them. Dr. Ordelheide’s group needs someone to dedicate time and energy to getting the module running. They also need someone to bring on new technology, to customize and set up the software and each box. In addition, communication with other systems is important.
Elizabeth Powers, MD - Winding Waters Clinic
Founded 1972, operates with 2 full-time MDs (Family Medicine), 1 part-time MD (Internal Medicine), 1 full-time NP (Family Medicine) and 1 part-time NP (Pediatrics).
Location - Enterprise OR with a satellite clinic in Wallowa, OR
Serves all of Wallowa County, population 6,991
Their practice involves 3 doctors and 2 NPs. They do not have an EHR, though do have electronic billing and e-prescribing. The hospital uses an EHR and allows their use of PAC for radiology and labs, but otherwise they use paper. They have wanted to switch to an EHR, but the two largest hurdles are: 1) Cost and logistics of installing the software, and 2) Finding an EHR that can talk to other systems. It would seem to be more feasible to use a personal health record instead. When referring patients to specialists, which they often do, will have to print to get the records to the specialists. A large benefit to having an EHR would be its function as a tool to manage population health. Currently they are tracking patient databases in Excel.
J. Bruin Rugge, MD, MPH -OHSU Scappoose
Founded in 1998 – 4 MDs (all FM) – 2 PAs – 2 FNP
Scappoose OR, population 6,500
Have been using OCHIN EPIC since 9/26/06
Sole source of health care for Scappoose OR, a community of 6,500 – see all ages and individuals from all backgrounds; and we provide the full scope of Family Medicine.
They use Epic through OCHIN (EHR for Safety Net clinics), though they have a more stripped-down version of Epic. He stated that the clinical outcome is not influenced by the charting method, and that providing excellent care can happen with paper charting. They do use e-prescribing, and have had problems. Also, being part of OCHIN, only so many seats are available for clinicians to use at a time, and he has had to try logging in multiple times in order to get into the record. The system has also gone down, and clinicians have had to log reports using hand-written forms that are later transcribed or scanned. He has noticed his workload taking on many more secretarial duties related to data entry and data housekeeping. When labs are received from outside sources, there is a considerable lag until it is scanned into the system, and often it may not be in the section he would anticipate finding it. One benefit is that when patients transfer care from another Safety Net Clinic to his that their records are available in the system.
Albert Thompson, MD
Practice—founded in 1982 with 1 provider, ABFP
Location Pacific City, unincorporated, primary drawing area ~ 4000. Lincoln City secondary area, ~10k
They have used SOAPWare for 10 years, and are using a hybrid version of it. He began using an installation that is all electronic as of December. He would like to use a different EHR, but it is too expensive to change systems currently. He is dissatisfied with SOAPWare for a variety of reasons, including that it lacks some basic functionality Microsoft Office users are accustomed to, like double-clicking to select text. However, the EHR has been extremely helpful for medication management, and he could not imagine going back to paper refills. SOAPWare is also an excellent report-writing tool and provides a patient instructions form with an assessment and plan that is very useful. Each encounter takes quite a bit of typing, and when his data entry demands increased, his patient count decreased. Currently they fax prescriptions to pharmacies and have not yet explored e-prescribing. Inter-connectivity is lacking and switching to Practice Partner is too expensive. They do have an IT specialist and the practice administrator also has IT skills that keeps their systems functional.
Robert Law, MD -Dunes Family Health Care, Reedsport, OR
Currently 5 family physicians (4 are partners), an FNP, and a PA-c.
Clinic uses paper charts, though they also use tele-radiology quite a bit, which they can access through the internet. They also use electronic billing. He and his colleagues suffer from EMR envy as they have wanted to get an EMR for 10 yrs, but the cost is daunting and they do not have the capital for licensing and implementation, though they do have the necessary hardware. Access to an IT person is also a serious limitation as they currently subcontract to the single person who maintains the hospital. There is not money in the budget to hire another person to fill that role. For population management, they have created registries using diagnostic data in their electronic billing records, and this has worked well for management and quality improvement. Overall, they are poised to make the leap, but have not yet done it.
Scott Graham, MD
Started practice August 1999. Solo practice in which he hired a FNP 5 years ago. Family Practice. Rural community, Population 1800.
He falls into the same category as Dr. Law. Their hospital and clinics continue to explore the option, but nothing has really been closely looked at. IT is a big concern. A program that communicates with each clinic and the hospital is another road block and cost is a huge concern. There is interest, but we are not excited about spending more money, hiring more staff, seeing less patients, having to spend more time at a computer and less with patients, and the headache of EMR, yet. He is not convinced this would be an easy transition and until something comes along that is user friendly and not so expensive, so they are sticking with paper.
Some discussion that followed those presentations:
Hersh – Epic has encouraged its customers like OHSU to work with smaller practices to use the software, as Epic doesn’t focus on the smaller market. This could be a good solution in some cases. Overall, the barriers presented by the Steering Committee members are not unknown in the HIT world, and all can be solved with resources. Dr. Tom Yackel, the Chief Health Information Officer at OHSU, could provide information related to some issues, including expanding Epic as well as secure email needs.
Fagnan – There is a group from NYC that uses eClinicalWorks for 1,200 clinicians in their area. Perhaps ORPRN could meet with their medical director, Dr. Farzad Mostashari, to explore the possibility of partnering with them and using it. This would provide an alternative to Epic. He also echoed the request by Liz Powers to explore personal health records as an option.
Hersh –The Director of the New York Health Department recently published a paper describing their approach in Health Affairs and ORPRN may wish to talk with him about the work he’s been doing. Dr. Hersh summarized by noting the impressive efforts by practices on the call and recognizing that there were three main challenges: support, costs, and integration of data across systems.
Hersh and Fagnan noted some clear themes from this discussion. There are three major barriers to EHR adoption and use in these small rural physician practices:
1. Cost and return on investment – there are substantial expenses and risks for those expenses in these practices.
2. IT and informatics support – need help both with basic IT as well as clinical issues, yet it is not readily available, especially locally. There are explicit difficulties with e-prescribing as well as decreased number of patients visits per day because of time to document.
3. Lack of interoperability – cannot move data across practices or to centers in larger urban areas. Despite electronic systems, providers must scan in reports and lab results, as there is a lack of interfaces with the local hospital.
Sunday, April 12, 2009
New York Times Article on Field, Profession, and Education
There is an excellent article about the emerging informatics profession and training for it in the Sunday, April 12 New York Times by Christine Larson:
http://www.nytimes.com/2009/04/12/jobs/12starts.html
This is a well-written article that describes the emerging informatics profession in these times of the Obama stimulus package and its health information technology adoption incentives. However, as newspaper reporters often do, she got a few things slightly wrong. This does not, however, detract from the overall article, which gets across the message well.
One thing slightly wrong was her quote of me, "The health I.T. people run the servers and install software, but the informatics people are the leaders, who interpret and analyze information and work with the clinical staff." First, I would not use the word "health" in front of the phrase "I.T. people" because "health I.T." is often used synonymously with the applications of informatics, such as electronic health records and clinical decision support systems. It is the I.T. people who do run the servers and install software, but the jobs of informaticians are not limited to being leaders and working with clinicians. Those with training in informatics can perform many other jobs in the health I.T. setting, such as project management, training, implementing quality or safety projects, and much more that involves knowledge of both I.T. and health care.
The reporter also states that some institutions have added programs within the last four years. OHSU's first degree program was actually launched in 1996, and we have been teaching via distance learning since 1999.
While the reporter rightly notes that educational programs "can bear a bewildering variety of names," I would not agree that medical and biomedical informatics are the same, nor that they only "focus on data that doctors need for treating patients." I would argue that they focus on more than just those things. Likewise, I would not completely agree with the definition that health informatics "programs often emphasize clinical data and health records." However, I do completely concur with her statement, "Even among programs with the same name, the emphasis may vary."
As most people know, I consider the terms "biomedical and health informatics" or "biomedical informatics" to be the broad umbrella terms. Subsumed under those are "medical informatics" or "clinical informatics," which refer to informatics applied in the clinical setting. "Health informatics" is somewhat orthogonal, which may also involve a focus on non-clinical aspects of informatics, such as personal health. One thing is certain: Our field needs to end this bewilderment and standardize our definitions!
Nonetheless, I believe this reporter did an excellent job overall, and it is great to see an article on our field and emerging profession in a prominent paper like the New York Times.
http://www.nytimes.com/2009/04/12/jobs/12starts.html
This is a well-written article that describes the emerging informatics profession in these times of the Obama stimulus package and its health information technology adoption incentives. However, as newspaper reporters often do, she got a few things slightly wrong. This does not, however, detract from the overall article, which gets across the message well.
One thing slightly wrong was her quote of me, "The health I.T. people run the servers and install software, but the informatics people are the leaders, who interpret and analyze information and work with the clinical staff." First, I would not use the word "health" in front of the phrase "I.T. people" because "health I.T." is often used synonymously with the applications of informatics, such as electronic health records and clinical decision support systems. It is the I.T. people who do run the servers and install software, but the jobs of informaticians are not limited to being leaders and working with clinicians. Those with training in informatics can perform many other jobs in the health I.T. setting, such as project management, training, implementing quality or safety projects, and much more that involves knowledge of both I.T. and health care.
The reporter also states that some institutions have added programs within the last four years. OHSU's first degree program was actually launched in 1996, and we have been teaching via distance learning since 1999.
While the reporter rightly notes that educational programs "can bear a bewildering variety of names," I would not agree that medical and biomedical informatics are the same, nor that they only "focus on data that doctors need for treating patients." I would argue that they focus on more than just those things. Likewise, I would not completely agree with the definition that health informatics "programs often emphasize clinical data and health records." However, I do completely concur with her statement, "Even among programs with the same name, the emphasis may vary."
As most people know, I consider the terms "biomedical and health informatics" or "biomedical informatics" to be the broad umbrella terms. Subsumed under those are "medical informatics" or "clinical informatics," which refer to informatics applied in the clinical setting. "Health informatics" is somewhat orthogonal, which may also involve a focus on non-clinical aspects of informatics, such as personal health. One thing is certain: Our field needs to end this bewilderment and standardize our definitions!
Nonetheless, I believe this reporter did an excellent job overall, and it is great to see an article on our field and emerging profession in a prominent paper like the New York Times.
Sunday, April 5, 2009
What is the Right Informatics Training for Me?
An individual considering spending part or all of their working time in health and biomedical informatics may find the decision of what career path and/or educational program to choose somewhat daunting. As I have noted elsewhere [1, 2], this reflects the fact that (a) informatics is still a maturing discipline, (b) there is no standard curriculum, program accreditation, or individual certification, and (c) the role of information technology (IT) in health and biomedicine is still evolving. Nonetheless, there is growing recognition of the need for better use of IT in clinical settings as well as biomedical research.
There is a growing -- though by no means complete -- consensus on the types of jobs performed in informatics. My view, based on the inventory of competencies developed by Covvey et al. [3], is that there are three general levels of informatics practice:
Most current informatics leaders also believe there is a growing need for “local experts” in informatics. As we know that one of the major success factors for an IT project is engagement of the user community, there will be a growing need for those who represent the “users” in a well-informed way.
It should also be noted that the lines between the above categories are fuzzy. The informatics leader at a large medical center may well need (or desire) the breadth of training of an academic informatician. Likewise, the local expert in a community hospital or large clinical practice may also want to have additional training at or near the level of an informatics professional. The amount of expertise among the levels, especially between expert and professional, may really be more of a continuum, with the expert advancing to the professional level as his or her career develops.
With this basic overview of the field, we can now move on to the basic question of this posting: what is the right informatics education for me to pursue? This discussion will emanate from the context of the educational program we have developed at Oregon Health & Science University (OHSU); other programs have some or all of the comparable levels of training.
The programs at OHSU have been developed in a building-block fashion. That is, coursework done at the lower levels can be carried forward to the higher levels. It should be noted that all of the programs at OHSU are currently at the graduate level, i.e., require a bachelor’s degree to enter. While there are some undergraduate informatics programs developing in the US, it is not clear whether the breadth of knowledge and experience can be obtained in a single baccalaureate or associate degree.
OHSU’s informatics programs are available both on our campus and via distance learning. We have successfully offered most of our courses and programs on-line for nearly a decade. Our program has evolved to the point where on-line and on-campus offerings are considered equivalent and are not distinguished on a student’s transcript. Distance learning does not mean “distant” learning. We have standardized on a number of technologies that provide high-quality and interactive education. Our courses are not correspondence courses, and require a reasonable commitment of one’s time for success. Almost all of the course activities are, however, asynchronous, meaning that students can access the material on their schedule as long as they keep up with the overall class.
Most of our courses, whether on-line or on-campus, are three-credit courses. As OHSU is on an academic quarter system, courses are 11 weeks in duration. A three-credit course typically means a commitment of 6-10 hours per week of work. Most courses have activities typical of university courses, with lectures (on-line classes typically use voice over slides), readings, term projects, homework, and examinations. You can access a demo version of the program's introductory course with the login/password bmi_demo/format.
One pathway into the OHSU program is the 10x10 Program. Run in partnership with the American Medical Informatics Association (AMIA), this program aims to train individuals at the Liaison level. The 10x10 moniker comes from a goal to train 10,000 health care professionals by the year 2010 in basic informatics so they can be local experts representing users in their communities. About 15% of people taking 10x10 pursue subsequent study in the OHSU graduate program.
The 10x10 course is an adaptation of the introductory course in the OHSU curriculum, with the addition of a 1-2 day in-person session covering additional material in an interactive manner. As such, the 10x10 course can be used for subsequent credit in the other OHSU programs pending successful completion of the course’s final examination (which is not required to complete 10x10). The topics in the curriculum of the 10x10 course would not surprise most people familiar with the informatics field and include:
OHSU offers two master’s degree programs, which differ only in their culminating project. The Master of Science (MS) in Biomedical Informatics requires a master’s thesis, while the Master of Biomedical Informatics (MBI) is a “professional master’s” and requires a less-intensive capstone project. The master’s degree programs have two “tracks,” one in medical informatics and the other in bioinformatics.
The curriculum for each of the tracks is organized into “domains,” each of which are general curriculum areas and have both required and choices from among a list. The five domains in the medical informatics track are:
More information about the individual programs can be found on the OHSU Department of Medical Informatics & Clinical Epidemiology Web site. The 10x10 program is administered by AMIA and offered twice a year. The Graduate Certificate program has rolling admissions, i.e., students are admitted any quarter to begin classes the following one. The master’s and PhD programs, however, only have admissions once a year to begin in the fall quarter.
OHSU also offers a fellowship program funded by a training grant from the National Library of Medicine (NLM). Additional clinically oriented fellowships are offered in partnership with Kaiser Permanente Northwest (KPNW) and the Veteran’s Administration (VA). Two types of fellowships are available from the NLM training grant:
References
1. Hersh WR, Who are the informaticians? What we know and should know. Journal of the American Medical Informatics Association, 2006. 13: 166-170.
2. Hersh W, Health and Biomedical Informatics: Opportunities and Challenges for a Twenty-First Century Profession and its Education, in IMIA Yearbook of Medical Informatics 2008, Geissbuhler A and Kulikowski C, Editors. 2008, Schattauer: Stuttgart, Germany. 138-145.
3. Covvey HD, Zitner D, and Bernstein R, Pointing the Way: Competencies and Curricula in Health Informatics. 2001, University of Waterloo: Waterloo, Ontario, Canada.
There is a growing -- though by no means complete -- consensus on the types of jobs performed in informatics. My view, based on the inventory of competencies developed by Covvey et al. [3], is that there are three general levels of informatics practice:
- Academic - an individual who does research and/or teaching, typically in an academic center
- Professional - an individual who works in an operational informatics setting for a majority of his or her working time, such as a Chief Information Officer, Chief Medical or Nursing Officer, or Project Manager or Leader
- Liaison - an individual who spends part of his or her working time as a local expert and interfacing with informatics or information technology professionals
Most current informatics leaders also believe there is a growing need for “local experts” in informatics. As we know that one of the major success factors for an IT project is engagement of the user community, there will be a growing need for those who represent the “users” in a well-informed way.
It should also be noted that the lines between the above categories are fuzzy. The informatics leader at a large medical center may well need (or desire) the breadth of training of an academic informatician. Likewise, the local expert in a community hospital or large clinical practice may also want to have additional training at or near the level of an informatics professional. The amount of expertise among the levels, especially between expert and professional, may really be more of a continuum, with the expert advancing to the professional level as his or her career develops.
With this basic overview of the field, we can now move on to the basic question of this posting: what is the right informatics education for me to pursue? This discussion will emanate from the context of the educational program we have developed at Oregon Health & Science University (OHSU); other programs have some or all of the comparable levels of training.
The programs at OHSU have been developed in a building-block fashion. That is, coursework done at the lower levels can be carried forward to the higher levels. It should be noted that all of the programs at OHSU are currently at the graduate level, i.e., require a bachelor’s degree to enter. While there are some undergraduate informatics programs developing in the US, it is not clear whether the breadth of knowledge and experience can be obtained in a single baccalaureate or associate degree.
OHSU’s informatics programs are available both on our campus and via distance learning. We have successfully offered most of our courses and programs on-line for nearly a decade. Our program has evolved to the point where on-line and on-campus offerings are considered equivalent and are not distinguished on a student’s transcript. Distance learning does not mean “distant” learning. We have standardized on a number of technologies that provide high-quality and interactive education. Our courses are not correspondence courses, and require a reasonable commitment of one’s time for success. Almost all of the course activities are, however, asynchronous, meaning that students can access the material on their schedule as long as they keep up with the overall class.
Most of our courses, whether on-line or on-campus, are three-credit courses. As OHSU is on an academic quarter system, courses are 11 weeks in duration. A three-credit course typically means a commitment of 6-10 hours per week of work. Most courses have activities typical of university courses, with lectures (on-line classes typically use voice over slides), readings, term projects, homework, and examinations. You can access a demo version of the program's introductory course with the login/password bmi_demo/format.
One pathway into the OHSU program is the 10x10 Program. Run in partnership with the American Medical Informatics Association (AMIA), this program aims to train individuals at the Liaison level. The 10x10 moniker comes from a goal to train 10,000 health care professionals by the year 2010 in basic informatics so they can be local experts representing users in their communities. About 15% of people taking 10x10 pursue subsequent study in the OHSU graduate program.
The 10x10 course is an adaptation of the introductory course in the OHSU curriculum, with the addition of a 1-2 day in-person session covering additional material in an interactive manner. As such, the 10x10 course can be used for subsequent credit in the other OHSU programs pending successful completion of the course’s final examination (which is not required to complete 10x10). The topics in the curriculum of the 10x10 course would not surprise most people familiar with the informatics field and include:
- Overview of Field and Problems Motivating It
- Biomedical Computing
- Electronic Health Records
- Clinical Decision Support
- EHR Implementation
- Standards and Interoperability
- Privacy, Confidentiality, and Security
- Secondary Use of Clinical Data: Personal Health Records, Health Information Exchange, Public Health, Health Care Quality, Clinical Research
- Evidence-Based Medicine and Medical Decision Making
- Information Retrieval and Digital Libraries
- Imaging Informatics and Telemedicine
- Translational Bioinformatics
- Organizational and Management Issues in Informatics
OHSU offers two master’s degree programs, which differ only in their culminating project. The Master of Science (MS) in Biomedical Informatics requires a master’s thesis, while the Master of Biomedical Informatics (MBI) is a “professional master’s” and requires a less-intensive capstone project. The master’s degree programs have two “tracks,” one in medical informatics and the other in bioinformatics.
The curriculum for each of the tracks is organized into “domains,” each of which are general curriculum areas and have both required and choices from among a list. The five domains in the medical informatics track are:
- Biomedical informatics - core courses in informatics science and applications
- Organizational and management sciences - business and management issues
- Computer science - practical introduction; concepts more important than programming
- Health and biomedicine - for non-clinicians
- Research methods - statistics plus quantitative and qualitative methods
More information about the individual programs can be found on the OHSU Department of Medical Informatics & Clinical Epidemiology Web site. The 10x10 program is administered by AMIA and offered twice a year. The Graduate Certificate program has rolling admissions, i.e., students are admitted any quarter to begin classes the following one. The master’s and PhD programs, however, only have admissions once a year to begin in the fall quarter.
OHSU also offers a fellowship program funded by a training grant from the National Library of Medicine (NLM). Additional clinically oriented fellowships are offered in partnership with Kaiser Permanente Northwest (KPNW) and the Veteran’s Administration (VA). Two types of fellowships are available from the NLM training grant:
- Predoctoral - stipend and tuition support for some students in the PhD program
- Postdoctoral - for those with doctoral (e.g., MD or PhD) degrees who seek advanced training, with or without a degree (although most pursue a master’s degree)
References
1. Hersh WR, Who are the informaticians? What we know and should know. Journal of the American Medical Informatics Association, 2006. 13: 166-170.
2. Hersh W, Health and Biomedical Informatics: Opportunities and Challenges for a Twenty-First Century Profession and its Education, in IMIA Yearbook of Medical Informatics 2008, Geissbuhler A and Kulikowski C, Editors. 2008, Schattauer: Stuttgart, Germany. 138-145.
3. Covvey HD, Zitner D, and Bernstein R, Pointing the Way: Competencies and Curricula in Health Informatics. 2001, University of Waterloo: Waterloo, Ontario, Canada.
Tuesday, March 31, 2009
The Genesis of the 10x10 Course
The 10x10 ("ten by ten") program was launched in 2005 by the American Medical Informatics Association (AMIA) and Oregon Health & Science University (OHSU). The genesis for the program came when then-President of AMIA, Dr. Charles Safran, called for at least one physician and one nurse in each of the 6000 hospitals in the US to have some training in medical informatics. At the same time, AMIA was looking to develop e-learning materials for training in medical informatics, but found that vendors were proposing unaffordable fees.
At that time, the biomedical informatics distance learning program at OHSU was mature and included an introductory course that I had been teaching on-line for nearly a decade. I proposed to AMIA that we re-package this course into a standalone course that included an in-person session at the end (not present in the OHSU course) that brought participants together for interaction and additional learning. Based on Dr. Safran's numbers and my knowledge of the scalable capacity of the distance learning course, I proposed that we name the program 10x10, embodying the aim of training 10,000 individuals in medical informatics by the year 2010.
The training would of course not be limited to physicians and nurses, nor would it be limited to US citizens. AMIA and OHSU negotiated a mutual non-exclusivity agreement, in which AMIA could accredit other educational institutions to offer 10x10 courses and OHSU would continue to own its intellectual property and use it for other initiatives besides 10x10.
The first cohort of 44 students completed the course in 2005. In addition to the "standard" offering of the course being offered to coincide with the in-person session at the end coinciding with an AMIA spring or fall meeting, a number of special offerings have been developed, tailored to specific audiences. These include:
By the end of 2008, a total of 582 people had completed the OHSU offering of the AMIA 10x10 course. While far short of the goal of 10,000, the capacity of course could handle many more people.
Students in 10x10 have come not only from the US, but also from many other countries, including Canada, Argentina, Hong Kong, Kuwait, Pakistan, Israel, and Thailand. One of the original students from Argentina, Dr. Paula Otero, translated the course into Spanish and has delivered it to 380 individuals across Latin America.
The course has also inspired federal legislation in the US, leading to the "10,000 Trained by 2010 Act," introduced by Rep. David Wu (D-OR). The bill was passed by the US House in the 110th Congress (2007-2008) but did not have a Senate sponsor. It has been introduced in the 111th Congress, and elements of it have been incorporated into the American Recovery and Reinvestment Act of 2009, aka, the economic stimulus package.
A demo version of the introductory graduate course from which 10x10 is derived can be accessed at the URL:
http://sakai.ohsu.edu/xsl-portal/site/b6042e92-ea91-442a-af63-d3f882d2e88c
From this page, log in with the following:
Username: bmi_demo
Password: format
More information about 10x10 can be found on the AMIA web site at:
http://www.amia.org/10x10/
Information about the most current OHSU offering is at:
http://www.amia.org/10x10/partners/ohsu/
A number of papers have been written about the 10x10 program:
Hersh, W. and Williamson, J. (2007). Educating 10,000 informaticians by 2010: the AMIA 10×10 program. International Journal of Medical Informatics, 76: 377-382.
Feldman, S. and Hersh, W. (2008). Evaluating the AMIA-OHSU 10x10 program to train healthcare professionals in medical informatics. AMIA Annual Symposium Proceedings, Washington, DC. American Medical Informatics Association. 182-186.
Otero, P., Hersh, W., et al. (2007). Translation, implementation and evaluation of a medical informatics distance learning course for Latin America. MEDINFO 2007 - Proceedings of the Twelfth World Congress on Health (Medical) Informatics, Brisbane, Australia. IOS Press. CD-ROM P421.
Hersh, W. (2007). The full spectrum of biomedical informatics education at Oregon Health & Science University. Methods of Information in Medicine, 46: 80-83.
At that time, the biomedical informatics distance learning program at OHSU was mature and included an introductory course that I had been teaching on-line for nearly a decade. I proposed to AMIA that we re-package this course into a standalone course that included an in-person session at the end (not present in the OHSU course) that brought participants together for interaction and additional learning. Based on Dr. Safran's numbers and my knowledge of the scalable capacity of the distance learning course, I proposed that we name the program 10x10, embodying the aim of training 10,000 individuals in medical informatics by the year 2010.
The training would of course not be limited to physicians and nurses, nor would it be limited to US citizens. AMIA and OHSU negotiated a mutual non-exclusivity agreement, in which AMIA could accredit other educational institutions to offer 10x10 courses and OHSU would continue to own its intellectual property and use it for other initiatives besides 10x10.
The first cohort of 44 students completed the course in 2005. In addition to the "standard" offering of the course being offered to coincide with the in-person session at the end coinciding with an AMIA spring or fall meeting, a number of special offerings have been developed, tailored to specific audiences. These include:
- California Health Care Foundation (2006) - California physicians
- American College of Physicians (2007) - internal medicine physicians
- Scottsdale Institute (2007) - an organization of innovative health care systems
- Mayo Clinic (2007 and 2008) - senior nursing executives, embedded in a larger program centered around health care quality
- Society for Technology in Anesthesiology (2008) - anesthesiologists
- American College of Emergency Physicians (2008) - emergency medicine physicians
By the end of 2008, a total of 582 people had completed the OHSU offering of the AMIA 10x10 course. While far short of the goal of 10,000, the capacity of course could handle many more people.
Students in 10x10 have come not only from the US, but also from many other countries, including Canada, Argentina, Hong Kong, Kuwait, Pakistan, Israel, and Thailand. One of the original students from Argentina, Dr. Paula Otero, translated the course into Spanish and has delivered it to 380 individuals across Latin America.
The course has also inspired federal legislation in the US, leading to the "10,000 Trained by 2010 Act," introduced by Rep. David Wu (D-OR). The bill was passed by the US House in the 110th Congress (2007-2008) but did not have a Senate sponsor. It has been introduced in the 111th Congress, and elements of it have been incorporated into the American Recovery and Reinvestment Act of 2009, aka, the economic stimulus package.
A demo version of the introductory graduate course from which 10x10 is derived can be accessed at the URL:
http://sakai.ohsu.edu/xsl-portal/site/b6042e92-ea91-442a-af63-d3f882d2e88c
From this page, log in with the following:
Username: bmi_demo
Password: format
More information about 10x10 can be found on the AMIA web site at:
http://www.amia.org/10x10/
Information about the most current OHSU offering is at:
http://www.amia.org/10x10/partners/ohsu/
A number of papers have been written about the 10x10 program:
Hersh, W. and Williamson, J. (2007). Educating 10,000 informaticians by 2010: the AMIA 10×10 program. International Journal of Medical Informatics, 76: 377-382.
Feldman, S. and Hersh, W. (2008). Evaluating the AMIA-OHSU 10x10 program to train healthcare professionals in medical informatics. AMIA Annual Symposium Proceedings, Washington, DC. American Medical Informatics Association. 182-186.
Otero, P., Hersh, W., et al. (2007). Translation, implementation and evaluation of a medical informatics distance learning course for Latin America. MEDINFO 2007 - Proceedings of the Twelfth World Congress on Health (Medical) Informatics, Brisbane, Australia. IOS Press. CD-ROM P421.
Hersh, W. (2007). The full spectrum of biomedical informatics education at Oregon Health & Science University. Methods of Information in Medicine, 46: 80-83.
Sunday, March 29, 2009
Certification in Informatics
The current issue of Journal of the American Medical Informatics Association (JAMIA, March-April, 2009) contains several papers related to a process the American Medical Informatics Association (AMIA) is spearheading to establish a medical board sub-certification in clinical informatics (Detmer et al., 2009). I myself was involved in the training requirements paper that will be submitted (Gardner et al., 2009), along with the core curriculum (Safran et al., 2009), to the American Board of Medical Specialties. I note that the core curriculum looks a great deal like the OHSU medical informatics track curriculum of our biomedical informatics graduate program.
As AMIA is not a physician-only organization, another process is underway to establish certification for non-physician doctoral-level certification in clinical informatics. This will include doctoral-level health care professionals (e.g., those with PharmD, DNP, DPT, etc. degrees) as well as those with PhD degrees. At the same time, the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM), which certifies health information management professionals, has announced plans to establish a master's-level credential in health informatics.
What does all of this mean? First, it is important to understand the terminology. Certification applies to individuals, who obtain a credential that certifies their knowledge and skills to perform certain professional tasks, e.g., board certification of physicians, nurses, and other health care professionals as well as in other fields, such as a certified professional accountant (CPA). This is different from accreditation, which applies to educational programs and declares them capable of providing the training of individuals to attain certification. Sometimes programs are accredited without a corresponding formal certification, such as academic programs in public health and computer science.
Certification is usually applied to people in professional positions. It is not usually applied to those who are in academic or research settings. So while a Department of Medicine in a medical school may have its clinical faculty certified to practice medicine, it does not have corresponding certification for its research faculty (or for the non-practicing portion of the jobs of clinical faculty). Certification usually indicates that one has a competency to carry out a professional task, such as practicing medicine. In the case of informatics would most likely apply to those who work in operational settings, such as hospitals, clinics, health centers, and the like.
Certification would add some order to a field now where anyone can call themselves an informatician or offer an academic program. Indeed, there are a growing number of four-year colleges and even community colleges that are beginning to offer baccalaureate and associate degrees in the field. Of course, without a formal certification in informatics, there is no reason why they cannot. However, my own view is that informatics is the synergistic and unique intersection of health sciences, computer sciences, and management sciences, and as such, is difficult to impart with just a baccalaureate or associate degree. This does not mean that those individuals cannot work in health care settings, but rather that to truly do informatics professionally requires a level of training that combines expertise in multiple disciplines, and it is difficult to see how it can be imparted without some amount of graduate study.
Another challenge with certification will depend on how the training requirements are implemented. As many reading this know, I direct one of the largest academic informatics programs in the country, and its distance learning option has been extremely popular and successful. While I do believe that informatics expertise requires real-world experience, we have been able to provide that for those who have sought it in their education. Whatever on-site training requirements emerge, I do hope the educational and/or fellowship experience will allow sufficient flexibility for didactic coursework to be on-line and for hands-on training experience to be available in diverse settings and not necessarily just the sites of academic programs.
The implementation of certification and accreditation will bring a new level of maturity to our field. It will allow informatics professionals to gain the recognition of the important role they play in health and health care organizations. But hopefully it will be implemented in a way that maintains the intellectual, geographical, and other forms of diversity that exist in our field.
References
Detmer, D., Lumpkin, J., et al. (2009). Defining the medical subspecialty of clinical informatics. Journal of the American Medical Informatics Association, 16: 167-168.
Gardner, R., Overhage, J., et al. (2009). Core content for the subspecialty of clinical informatics. Journal of the American Medical Informatics Association, 16: 153-157.
Safran, C., Shabot, M., et al. (2009). ACGME program requirements for fellowship education in the subspecialty of clinical informatics. Journal of the American Medical Informatics Association, 16: 158-166.
As AMIA is not a physician-only organization, another process is underway to establish certification for non-physician doctoral-level certification in clinical informatics. This will include doctoral-level health care professionals (e.g., those with PharmD, DNP, DPT, etc. degrees) as well as those with PhD degrees. At the same time, the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM), which certifies health information management professionals, has announced plans to establish a master's-level credential in health informatics.
What does all of this mean? First, it is important to understand the terminology. Certification applies to individuals, who obtain a credential that certifies their knowledge and skills to perform certain professional tasks, e.g., board certification of physicians, nurses, and other health care professionals as well as in other fields, such as a certified professional accountant (CPA). This is different from accreditation, which applies to educational programs and declares them capable of providing the training of individuals to attain certification. Sometimes programs are accredited without a corresponding formal certification, such as academic programs in public health and computer science.
Certification is usually applied to people in professional positions. It is not usually applied to those who are in academic or research settings. So while a Department of Medicine in a medical school may have its clinical faculty certified to practice medicine, it does not have corresponding certification for its research faculty (or for the non-practicing portion of the jobs of clinical faculty). Certification usually indicates that one has a competency to carry out a professional task, such as practicing medicine. In the case of informatics would most likely apply to those who work in operational settings, such as hospitals, clinics, health centers, and the like.
Certification would add some order to a field now where anyone can call themselves an informatician or offer an academic program. Indeed, there are a growing number of four-year colleges and even community colleges that are beginning to offer baccalaureate and associate degrees in the field. Of course, without a formal certification in informatics, there is no reason why they cannot. However, my own view is that informatics is the synergistic and unique intersection of health sciences, computer sciences, and management sciences, and as such, is difficult to impart with just a baccalaureate or associate degree. This does not mean that those individuals cannot work in health care settings, but rather that to truly do informatics professionally requires a level of training that combines expertise in multiple disciplines, and it is difficult to see how it can be imparted without some amount of graduate study.
Another challenge with certification will depend on how the training requirements are implemented. As many reading this know, I direct one of the largest academic informatics programs in the country, and its distance learning option has been extremely popular and successful. While I do believe that informatics expertise requires real-world experience, we have been able to provide that for those who have sought it in their education. Whatever on-site training requirements emerge, I do hope the educational and/or fellowship experience will allow sufficient flexibility for didactic coursework to be on-line and for hands-on training experience to be available in diverse settings and not necessarily just the sites of academic programs.
The implementation of certification and accreditation will bring a new level of maturity to our field. It will allow informatics professionals to gain the recognition of the important role they play in health and health care organizations. But hopefully it will be implemented in a way that maintains the intellectual, geographical, and other forms of diversity that exist in our field.
References
Detmer, D., Lumpkin, J., et al. (2009). Defining the medical subspecialty of clinical informatics. Journal of the American Medical Informatics Association, 16: 167-168.
Gardner, R., Overhage, J., et al. (2009). Core content for the subspecialty of clinical informatics. Journal of the American Medical Informatics Association, 16: 153-157.
Safran, C., Shabot, M., et al. (2009). ACGME program requirements for fellowship education in the subspecialty of clinical informatics. Journal of the American Medical Informatics Association, 16: 158-166.
Wednesday, March 25, 2009
Health IT provisions of American Recovery and Reinvestment Act of 2009
There is a great deal of excitement in the biomedical informatics field due to the health IT provisions of American Recovery and Reinvestment Act of 2009, also known as the economic stimulus package. There are two main health IT provisions in the economic stimulus package: incentives for “meaningful use” of electronic health records (EHRs) by physicians and hospitals ($17B) and direct grants administered by federal agencies ($2B). No grant programs have been announced yet, but an encouraging sign is the recent appointment of a new National Coordinator for HIT, Dr. David Blumenthal. The are also provisions in other areas of legislation that pertinent to health IT in other areas of the stimulus package, including comparative effectiveness research, NIH and other science funding, and broadband and other infrastructure funding.
The incentives for “meaningful use” of EHRs will be implemented through increased Medicare or Medicaid reimbursement starting in 2011. Non-hospital-based physicians will receive incentives based on Medicare or Medicaid charges, up to $64K. Hospitals will have an incentive base amount of $2M, which is adjusted by the hospital’s number of discharges, Medicare/Medicaid patient mix, up to $9M, and phased down over four years. After 2016, physicians and hospitals begin to have reimbursement penalties for not using EHRs.“Meaningful use” is likely to include CCHIT certification, e-prescribing capability, interoperability standards, and other features.
There are opportunities in this space for software vendors, consultants, health care organizations with existing EHR systems. There are also opportunities for educational programs to train users, implementers, and others.
The stimulus package contains a variety of other funding initiatives that will be led by the Office of National Coordinator for Health IT (ONC) now under the leadership of Dr. Blumenthal. A total of $2B will be distributed to a variety of programs. The legislation does not allocate specific dollar amounts of the specific programs. The ones most pertinent to our program include:
The legislation provides other monies for health IT, some of which will fund biomedical research. There is $8.4 billion for National Institutes of Health for biomedical research. Some of this money is already being allocated, such as the newly announced NIH Challenge Grants program. Most of the money will be funneled to the 30 or so Institutes of the NIH, including the National Library of Medicine (NLM), which funds research and education in biomedical informatics. OHSU is already seeing some of this money in the expansion of our biomedical informatics training grant that will also provide funding for summer internships for both college students and non-research college faculty (e.g., community college and high school teachers).
The legislation also allocates $1.1B for comparative effectiveness research, which it defines as “research studies that compare one or more diagnostic or treatment options to evaluate effectiveness, safety or outcomes.” This money will be distributed by a variety of agencies, not only NIH but also the Agency for Healthcare Research & Quality and the Department of Health & Human Services. This is another area of key strength for OHSU.
The incentives for “meaningful use” of EHRs will be implemented through increased Medicare or Medicaid reimbursement starting in 2011. Non-hospital-based physicians will receive incentives based on Medicare or Medicaid charges, up to $64K. Hospitals will have an incentive base amount of $2M, which is adjusted by the hospital’s number of discharges, Medicare/Medicaid patient mix, up to $9M, and phased down over four years. After 2016, physicians and hospitals begin to have reimbursement penalties for not using EHRs.“Meaningful use” is likely to include CCHIT certification, e-prescribing capability, interoperability standards, and other features.
There are opportunities in this space for software vendors, consultants, health care organizations with existing EHR systems. There are also opportunities for educational programs to train users, implementers, and others.
The stimulus package contains a variety of other funding initiatives that will be led by the Office of National Coordinator for Health IT (ONC) now under the leadership of Dr. Blumenthal. A total of $2B will be distributed to a variety of programs. The legislation does not allocate specific dollar amounts of the specific programs. The ones most pertinent to our program include:
- Sec. 13201 – Establishment of multidisciplinary Centers for Health Care Information Enterprise Integration, led by NIST, but involving other federal agencies, and funding research projects
- Sec. 3012 – Health Information Technology Implementation Assistance, providing matching funds for Regional Health IT Extension Centers
- Sec. 3013 – State Grants to Promote Health Information Technology, providing funding to states to facilitate and expand health information exchange
- Sec. 3015 – Demonstration Program to Integrate IT into Clinical Education, providing grants to develop academic curricula integrating EHRs into clinical education of health professionals
- Sec. 3016 – Information Technology Professionals on Health Care, providing funding for short-term (re-)training in informatics for IT and health care professionals in established educational programs
The legislation provides other monies for health IT, some of which will fund biomedical research. There is $8.4 billion for National Institutes of Health for biomedical research. Some of this money is already being allocated, such as the newly announced NIH Challenge Grants program. Most of the money will be funneled to the 30 or so Institutes of the NIH, including the National Library of Medicine (NLM), which funds research and education in biomedical informatics. OHSU is already seeing some of this money in the expansion of our biomedical informatics training grant that will also provide funding for summer internships for both college students and non-research college faculty (e.g., community college and high school teachers).
The legislation also allocates $1.1B for comparative effectiveness research, which it defines as “research studies that compare one or more diagnostic or treatment options to evaluate effectiveness, safety or outcomes.” This money will be distributed by a variety of agencies, not only NIH but also the Agency for Healthcare Research & Quality and the Department of Health & Human Services. This is another area of key strength for OHSU.
These are exciting times for Biomedical Informatics!
These are exciting times for the field of biomedical informatics. On the clinical side, the health care field is taking seriously the impact that information technology can have on health care quality, safety, and cost. Patients are increasingly empowered by increased access to information to maintain and improve their health. On the biomedical research side, advances in genomics and proteomics are revolutionizing approaches to health and disease. The world of biomedical research has fundamentally changed. Biological experiments now generate mass amounts of data, and researchers are required to interact with databases and other information resources. Biomedical informatics plays a key role in clinical and research areas. There is a great need both for informatics researchers to conceptualize and develop new applications and for informatics professionals to implement and disseminate them.
Biomedical informatics is the field devoted to improving human health, health care, and biomedical research through optimal use of information, usually with the aid of information technology (IT). As government, health care, and biomedical research leaders recognize its value, there are growing opportunities for careers in a diverse array of jobs, some of which are highly technical and others that focus on people and organizational issues insuring its most effective use.
President Barack Obama has made the use acceleration of health IT a key part of his “Reinvestment and Recovery Act of 2009,” stating, “To improve the quality of our health care while lowering its cost, we will make the immediate investments necessary to ensure that within five years, all of America’s medical records are computerized … It just won’t save billions of dollars and thousands of jobs – it will save lives by reducing the deadly but preventable medical errors that pervade our health care system.” (http://www.whitehouse.gov/agenda/economy/)
In biomedical research, the role in informatics in the discovery of new tests and treatments to improve health is equally acclaimed. The Web site of the National Institutes of Health, the US government agency that funds biomedical research, notes, “Modern biomedical scientists use computers and robots to separate molecules in solution, read genetic information, reveal the three-dimensional shapes of natural molecules like proteins, and take pictures of the brain in action. All of these techniques generate large amounts of data, and biology is changing fast into a science of information management. There is no way to manage these data by hand. What researchers need are computer programs and other tools to evaluate, combine, and visualize these data.” (http://nihroadmap.nih.gov/bioinformatics/)
These statements, and the growing commitment by the government, health care institutions, and research funding agencies, show that the future is bright for the high-skill, high-paying jobs available in biomedical informatics. There is an extreme diversity of jobs available, such as:
Although students in the OHSU biomedical informatics program most commonly have backgrounds in computational/mathematical or life/health sciences, there are opportunities for virtually all types of students who are motivated to learn and contribute to working in and advancing the field. Students can pursue a tailored course of study commensurate with their interests and background while having access to cutting-edge research and/or experiences in local industry, health care settings, or biomedical research labs.
For more information, visit our Web site at:
http://www.ohsu.edu/dmice/
Or contact me:
William Hersh, MD
Professor and Chair
Department of Medical Informatics & Clinical Epidemiology
Oregon Health & Science University
hersh@ohsu.edu
www.billhersh.info
I look forward to your thought and comments on my postings!
Bill
Biomedical informatics is the field devoted to improving human health, health care, and biomedical research through optimal use of information, usually with the aid of information technology (IT). As government, health care, and biomedical research leaders recognize its value, there are growing opportunities for careers in a diverse array of jobs, some of which are highly technical and others that focus on people and organizational issues insuring its most effective use.
President Barack Obama has made the use acceleration of health IT a key part of his “Reinvestment and Recovery Act of 2009,” stating, “To improve the quality of our health care while lowering its cost, we will make the immediate investments necessary to ensure that within five years, all of America’s medical records are computerized … It just won’t save billions of dollars and thousands of jobs – it will save lives by reducing the deadly but preventable medical errors that pervade our health care system.” (http://www.whitehouse.gov/agenda/economy/)
In biomedical research, the role in informatics in the discovery of new tests and treatments to improve health is equally acclaimed. The Web site of the National Institutes of Health, the US government agency that funds biomedical research, notes, “Modern biomedical scientists use computers and robots to separate molecules in solution, read genetic information, reveal the three-dimensional shapes of natural molecules like proteins, and take pictures of the brain in action. All of these techniques generate large amounts of data, and biology is changing fast into a science of information management. There is no way to manage these data by hand. What researchers need are computer programs and other tools to evaluate, combine, and visualize these data.” (http://nihroadmap.nih.gov/bioinformatics/)
These statements, and the growing commitment by the government, health care institutions, and research funding agencies, show that the future is bright for the high-skill, high-paying jobs available in biomedical informatics. There is an extreme diversity of jobs available, such as:
- Using electronic health records and other sources of data to measure and improve the quality of health care and to facilitate the conduct of biomedical research
- Serving as the bridge between the IT and clinical professionals in health care settings to insure IT systems are easy to use and provide the most useful data to clinicians, administrators, and researchers
- Analysis of genomic and clinical data to determine the role of genes in human health, to ascertain the risk of developing disease, and to predict the response to different treatments
- Deploying telemedicine and telehealth systems to bring medical expertise to the point of need
- Coordinating the information systems and data within them for state and local public health agencies
Although students in the OHSU biomedical informatics program most commonly have backgrounds in computational/mathematical or life/health sciences, there are opportunities for virtually all types of students who are motivated to learn and contribute to working in and advancing the field. Students can pursue a tailored course of study commensurate with their interests and background while having access to cutting-edge research and/or experiences in local industry, health care settings, or biomedical research labs.
For more information, visit our Web site at:
http://www.ohsu.edu/dmice/
Or contact me:
William Hersh, MD
Professor and Chair
Department of Medical Informatics & Clinical Epidemiology
Oregon Health & Science University
hersh@ohsu.edu
www.billhersh.info
I look forward to your thought and comments on my postings!
Bill
Thursday, March 12, 2009
Welcome to the Informatics Professor Blog
I am Professor and Chair of the Department of Medical Informatics & Clinical Epidemiology (DMICE) at Oregon Health & Science University (OHSU). These are exciting times for our field, with the increased attention to electronic health records by the new Obama administration. Of course, there are exciting things in other areas of the field as well, such as bioinformatics, clinical research informatics, and public health informatics. I hope to use this blog to raise attention to various issues in the field and look forward to your feedback.
William Hersh, MD
www.billhersh.info
William Hersh, MD
www.billhersh.info
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