This week we unveiled a five-minute video describing the research and educational programs of the Biomedical Informatics Program at Oregon Health & Science University (OHSU). The easiest way to view the video is via YouTube.
The video features several of the faculty from the program who describe their research and how it synergizes with the educational program. I provide overviews of the biomedical and health informatics field as well as of the OHSU program.
The video was part of AMIA TV, a series of videos broadcast on monitors as well as hotel room television during the recent AMIA 2011 Annual Symposium. Another video features an interview of myself in my role as the Scientific Program Committee Chair for next year's meeting.
Saturday, October 29, 2011
Saturday, October 22, 2011
My AMIA: The Professional and Personal Importance of a Professional Society
I am off this weekend to one of my favorite events of the year, which is the AMIA Annual Symposium. I have attended the Annual Symposium, called by different names over the years, every year since I first entered the biomedical and health informatics field in 1986.That makes this year's AMIA 2011 meeting the 26th consecutive year of attendance for me.
The AMIA meeting serves many purposes for me. First and foremost, of course, is that I get informed and updated on the latest advances in the informatics field. But the value is not limited to the science. Featured speakers and panels give updates on policy and other key happenings. Social and other events allow networking and catching up with old colleagues and friends and making new ones. It is also one of the most exhausting meetings I attend, as all the sessions and other activities keep me busy each day from early morning until late at night.
An organization like AMIA drives home to me how important one's professional organization is in a scientific or professional discipline. Not only do I count my closest colleagues in AMIA, but also many of my best friends. Another critical asset of AMIA is its staff, which is not only incredibly competent, but whom I also include among my most important colleagues and friends. AMIA also gives the support and collaboration for initiatives such as the 10x10 ("ten by ten") program, which former AMIA President Don Detmer has called one of the organization's most successful programs ever.
AMIA is really like a family to me. My colleagues and friends are always there for me, and I was tickled to learn recently that I am the singular person to have attended every AMIA meeting in the 21st century.
Next year's AMIA Annual Symposium will be even more special for me. In my 27th consecutive symposium attended, I will be serving as Scientific Program Committee Chair. This is a great honor but also one that carries significant responsibility. Not only must the program reflect the highest quality scientific presentations, but must also include other events that capture the larger perspective of the field and the role it is playing in improving individual health, healthcare, public health, and biomedical research.
The meeting next year will be made more special by its location in Chicago. While not the first time it has been in the Windy City, it will be special to have the conference I am chairing take place in my home town. Even though I know longer live in Chicago, it is where I grew up and did all of my education and medical training. I am hopeful that some of my family will also be able to attend some of the meeting. I hope everyone else reading this will also consider sharing in the fun as well.
The AMIA meeting serves many purposes for me. First and foremost, of course, is that I get informed and updated on the latest advances in the informatics field. But the value is not limited to the science. Featured speakers and panels give updates on policy and other key happenings. Social and other events allow networking and catching up with old colleagues and friends and making new ones. It is also one of the most exhausting meetings I attend, as all the sessions and other activities keep me busy each day from early morning until late at night.
An organization like AMIA drives home to me how important one's professional organization is in a scientific or professional discipline. Not only do I count my closest colleagues in AMIA, but also many of my best friends. Another critical asset of AMIA is its staff, which is not only incredibly competent, but whom I also include among my most important colleagues and friends. AMIA also gives the support and collaboration for initiatives such as the 10x10 ("ten by ten") program, which former AMIA President Don Detmer has called one of the organization's most successful programs ever.
AMIA is really like a family to me. My colleagues and friends are always there for me, and I was tickled to learn recently that I am the singular person to have attended every AMIA meeting in the 21st century.
Next year's AMIA Annual Symposium will be even more special for me. In my 27th consecutive symposium attended, I will be serving as Scientific Program Committee Chair. This is a great honor but also one that carries significant responsibility. Not only must the program reflect the highest quality scientific presentations, but must also include other events that capture the larger perspective of the field and the role it is playing in improving individual health, healthcare, public health, and biomedical research.
The meeting next year will be made more special by its location in Chicago. While not the first time it has been in the Windy City, it will be special to have the conference I am chairing take place in my home town. Even though I know longer live in Chicago, it is where I grew up and did all of my education and medical training. I am hopeful that some of my family will also be able to attend some of the meeting. I hope everyone else reading this will also consider sharing in the fun as well.
Friday, September 23, 2011
Update: Clinical Informatics Subspecialty Approved
Several months ago, I described the proposal to establish a medical subspecialty in clinical informatics. I am pleased to report that this week, the American Board of Medical Specialties (ABMS) approved the subspecialty, as noted in a news release from AMIA.
Although administered by the American Board of Preventive Medicine, the subspecialty will be available to all physicians who have a primary board certification. The first offering of the examination will likely take place in the fall of 2012 for those who meet the criteria for "grandfathering" of the training requirements. In the long run, physicians wanting to subspecialize in clinical informatics will need to complete formal fellowship training.
The approval of this subspecialty is a recognition of the critical professional role played by clinical informaticians. As information is so critical to 21st century medicine, whether in the need for healthcare to be more accountable for its operations or in the coming complexity of clinical decision-making from the data "tsunami" due to advances in genomics and related areas, there will be increasing need for those who work at the interface of medicine and information systems.
There are a number of uncertainties in this development. For example, what will be the criteria for grandfathering of the training requirements. Also, what career pathway will there be for physicians who are not certified in a primary board or have let that certification lapse? Another concern is what will be the evolving role for graduate-level educational programs, such as our program at Oregon Health & Science University.
Although there are a number of details still forthcoming, this new development is an exciting one for the informatics field. I also hope that there will be other pathways for comparable certification not only for physicians who are not eligible for ABMS certification but also for informatics professionals of other backgrounds, both clinical and non-clinical.
Although administered by the American Board of Preventive Medicine, the subspecialty will be available to all physicians who have a primary board certification. The first offering of the examination will likely take place in the fall of 2012 for those who meet the criteria for "grandfathering" of the training requirements. In the long run, physicians wanting to subspecialize in clinical informatics will need to complete formal fellowship training.
The approval of this subspecialty is a recognition of the critical professional role played by clinical informaticians. As information is so critical to 21st century medicine, whether in the need for healthcare to be more accountable for its operations or in the coming complexity of clinical decision-making from the data "tsunami" due to advances in genomics and related areas, there will be increasing need for those who work at the interface of medicine and information systems.
There are a number of uncertainties in this development. For example, what will be the criteria for grandfathering of the training requirements. Also, what career pathway will there be for physicians who are not certified in a primary board or have let that certification lapse? Another concern is what will be the evolving role for graduate-level educational programs, such as our program at Oregon Health & Science University.
Although there are a number of details still forthcoming, this new development is an exciting one for the informatics field. I also hope that there will be other pathways for comparable certification not only for physicians who are not eligible for ABMS certification but also for informatics professionals of other backgrounds, both clinical and non-clinical.
Sunday, September 11, 2011
More Studies Assessing Quality Improvement Using Electronic Health Records
Earlier this year, the informatics world was abuzz with a study published in Archives of Internal Medicine by Romano and Stafford that found a lack of improvement in healthcare quality measures for patients whose physicians had adopted electronic health records (EHRs) [1]. As I detailed in a posting to this blog, as well as in a co-authored letter to the editor that was published in Archives [2], this study had a number of flaws. My main complaint with the study was that the quality measures assessed were independent of the EHR intervention, hence any association, positive or negative, was indirect at best.
The furor about the paper died down, and most people got back to working on implementing meaningful use. No one disagreed that we need more research on whether EHR systems do improve healthcare quality, including studies with better methodology.
Last month, another study came along. Published in the New England Journal of Medicine (NEJM) by Cebul et al., this study used a somewhat similar methodology to assess 46 practices in the Cleveland area, 33 of which had adopted EHRs [3]. The study assessed the outcomes of 27,207 patients with diabetes mellitus who were followed by a total of 569 providers. The study looked at four process measures and five outcome measures in those diabetic patients, comparing them for providers who had and had not adopted EHRs. Overall composite quality measures were developed for the process and outcome measures, and found to be 35.1% higher in the former and 15.2% higher in the latter. The difference was found to persist across all insurance types and, even more gratifying, for "safety net" clinics that historically see more complicated patients of lower socioeconomic status.
This study did use a roughly similar methodology to the Romano and Stafford study, and as such must be viewed as having a weaker form of evidence than a direct randomized controlled trial (RCT). Of course, in reality, such an RCT would be near impossible to do, i.e., randomizing patients to receive their care from a provider having an EHR or not. We also know that there can be confounders between practices utilizing and not utilizing EHRs.
Nonetheless, this study did have advantages over similar studies done before it, including the Romano and Stafford study. One clear advantage was that the study had complete data on all patients (unlike the Romano and Stafford study that only relied on a data set from the CDC National Center for Health Statistics (NCHS). The researchers also had precise data on the providers, the EHR implementation, and how the quality measures were integrated into the provision of care.
While this new study received a great deal of press, another study that received less press, which was published shortly after the publication of the Romano and Stafford study, should have received more [4]. Although still not an RCT design, this study did use a before-and-after methodology to examine change in compliance with 16 quality measures before and after implementation of a commercial EHR in a large academic internal medicine practice. The results showed improvement after the EHR was implemented.
In an editorial accompanying the Cebul et al. study, Classen and Bates noted that the new NEJM study showed the "meaning in meaningful use" [5]. They correctly point out that implementing EHRs is not what HITECH should be about, but rather showing that the technology can be used to make meaningful improvement in the health of patients whose providers use it. As in most areas of medicine, we cannot wait for the perfect study or studies to answer all questions unequivocally, but the evidence base is growing for the value of informatics, especially when systems are implemented properly.
References
1. Romano, M. and Stafford, R. (2011). Electronic health records and clinical decision support systems: impact on national ambulatory care quality. Archives of Internal Medicine, 171: 897-903.
2. Mohan, V. and Hersh, W. (2011). EHRs and health care quality: correlation with out-of-date, differently purposed data does not equate with causality. Archives of Internal Medicine, 171: 952-953.
3. Cebul, R., Love, T., et al. (2011). Electronic health records and quality of diabetes care. New England Journal of Medicine, 365: 825-833.
4. Persell, S., Kaiser, D., et al. (2011). Changes in performance after implementation of a multifaceted electronic-health-record-based quality improvement system. Medical Care, 49: 117-125.
5. Classen, D. and Bates, D. (2011). Finding the meaning in meaningful use. New England Journal of Medicine, 365: 855-858.
The furor about the paper died down, and most people got back to working on implementing meaningful use. No one disagreed that we need more research on whether EHR systems do improve healthcare quality, including studies with better methodology.
Last month, another study came along. Published in the New England Journal of Medicine (NEJM) by Cebul et al., this study used a somewhat similar methodology to assess 46 practices in the Cleveland area, 33 of which had adopted EHRs [3]. The study assessed the outcomes of 27,207 patients with diabetes mellitus who were followed by a total of 569 providers. The study looked at four process measures and five outcome measures in those diabetic patients, comparing them for providers who had and had not adopted EHRs. Overall composite quality measures were developed for the process and outcome measures, and found to be 35.1% higher in the former and 15.2% higher in the latter. The difference was found to persist across all insurance types and, even more gratifying, for "safety net" clinics that historically see more complicated patients of lower socioeconomic status.
This study did use a roughly similar methodology to the Romano and Stafford study, and as such must be viewed as having a weaker form of evidence than a direct randomized controlled trial (RCT). Of course, in reality, such an RCT would be near impossible to do, i.e., randomizing patients to receive their care from a provider having an EHR or not. We also know that there can be confounders between practices utilizing and not utilizing EHRs.
Nonetheless, this study did have advantages over similar studies done before it, including the Romano and Stafford study. One clear advantage was that the study had complete data on all patients (unlike the Romano and Stafford study that only relied on a data set from the CDC National Center for Health Statistics (NCHS). The researchers also had precise data on the providers, the EHR implementation, and how the quality measures were integrated into the provision of care.
While this new study received a great deal of press, another study that received less press, which was published shortly after the publication of the Romano and Stafford study, should have received more [4]. Although still not an RCT design, this study did use a before-and-after methodology to examine change in compliance with 16 quality measures before and after implementation of a commercial EHR in a large academic internal medicine practice. The results showed improvement after the EHR was implemented.
In an editorial accompanying the Cebul et al. study, Classen and Bates noted that the new NEJM study showed the "meaning in meaningful use" [5]. They correctly point out that implementing EHRs is not what HITECH should be about, but rather showing that the technology can be used to make meaningful improvement in the health of patients whose providers use it. As in most areas of medicine, we cannot wait for the perfect study or studies to answer all questions unequivocally, but the evidence base is growing for the value of informatics, especially when systems are implemented properly.
References
1. Romano, M. and Stafford, R. (2011). Electronic health records and clinical decision support systems: impact on national ambulatory care quality. Archives of Internal Medicine, 171: 897-903.
2. Mohan, V. and Hersh, W. (2011). EHRs and health care quality: correlation with out-of-date, differently purposed data does not equate with causality. Archives of Internal Medicine, 171: 952-953.
3. Cebul, R., Love, T., et al. (2011). Electronic health records and quality of diabetes care. New England Journal of Medicine, 365: 825-833.
4. Persell, S., Kaiser, D., et al. (2011). Changes in performance after implementation of a multifaceted electronic-health-record-based quality improvement system. Medical Care, 49: 117-125.
5. Classen, D. and Bates, D. (2011). Finding the meaning in meaningful use. New England Journal of Medicine, 365: 855-858.
Monday, September 5, 2011
Update of Site, What is Biomedical & Health Informatics?
Years ago, I used to get asked on a regular basis, What is Medical/Biomedical/Health Informatics? To answer this question, I created a Web site that attempted to answer it. Later on, I added some voice-over-Powerpoint lectures, which also provided me the opportunity to demonstrate the technologies we use in our distance learning program at Oregon Health & Science University (OHSU). In 2007, the site was accepted for listing in the Association of American Medical College (AAMC) online medical educational resource, MedEdPortal.
Keeping a site like this up to date is no small feat, especially at a time like this, when many people in the field are very busy carrying out work related to the Health Information Technology for Clinical and Economic Health (HITECH) Act. As readers of previous postings in this blog know, I have been very busy leading OHSU's contributions to the HITECH Workforce Development Program.
For this reason, the site had grown out of date, with its last major update in 2009, when the HITECH Act had just been passed. I am pleased to announce that I have now updated the lecture and references on the site to include not only everything related to HITECH, but also advances in other areas of biomedical and health informatics, including bioinformatics, information retrieval, and telemedicine.
The site still includes my voice-over-Powerpoint lectures, which have now expanded to about 2 hours and 40 minutes, but are still divided into seven segments. On almost every slide, I could go into even more detail. If nothing else, this site will hopefully whet peoples' appetites for the 10x10 program, the OHSU graduate program, or other programs.
The educational methods I use on this site mirror my on-line teaching. I have always found great value in voice-over-Powerpoint lectures, especially using the Articulate tool that provides the slides and sound in Flash format and also allows easy navigation among the slides. I also provide MP3 files of the slide audio (one MP3 per segment) as well as PDF files of the slides themselves (one PDF per segment). In addition, I provide another PDF that has references to all of the papers, reports, books, and other citations in the lecture. The site also contains a list of key textbooks as well as links to some of my papers and to important organizations and other sites for the field.
I look forward to receiving feedback from people and take full responsibility for any errors in any of the materials I have produced.
Keeping a site like this up to date is no small feat, especially at a time like this, when many people in the field are very busy carrying out work related to the Health Information Technology for Clinical and Economic Health (HITECH) Act. As readers of previous postings in this blog know, I have been very busy leading OHSU's contributions to the HITECH Workforce Development Program.
For this reason, the site had grown out of date, with its last major update in 2009, when the HITECH Act had just been passed. I am pleased to announce that I have now updated the lecture and references on the site to include not only everything related to HITECH, but also advances in other areas of biomedical and health informatics, including bioinformatics, information retrieval, and telemedicine.
The site still includes my voice-over-Powerpoint lectures, which have now expanded to about 2 hours and 40 minutes, but are still divided into seven segments. On almost every slide, I could go into even more detail. If nothing else, this site will hopefully whet peoples' appetites for the 10x10 program, the OHSU graduate program, or other programs.
The educational methods I use on this site mirror my on-line teaching. I have always found great value in voice-over-Powerpoint lectures, especially using the Articulate tool that provides the slides and sound in Flash format and also allows easy navigation among the slides. I also provide MP3 files of the slide audio (one MP3 per segment) as well as PDF files of the slides themselves (one PDF per segment). In addition, I provide another PDF that has references to all of the papers, reports, books, and other citations in the lecture. The site also contains a list of key textbooks as well as links to some of my papers and to important organizations and other sites for the field.
I look forward to receiving feedback from people and take full responsibility for any errors in any of the materials I have produced.
Thursday, August 18, 2011
The Passing of a Giant: Senator Mark O. Hatfield (1922-2011)
Oregonians and indeed many Americans of all political stripes mourned the passing last week of a truly great politician whose statesmanship and bipartisanship seem almost like an anachronism in contrast to our current hyper-partisan, 24-hour news cycle-driven political gridlock. Former Oregon Sen. Mark O. Hatfield was a politician who transcended party and ideology and whose work led to true benefit for large numbers of people, not only those living in Oregon.
While many politicians are an abstraction to most people, impacting their lives only in indirect ways, Sen. Hatfield was personal and real in my life. My presence and success at Oregon Health & Science University (OHSU) as well as the flourishing of our Department of Medical Informatics & Clinical Epidemiology (DMICE) have their origins that can be attributed to Sen. Hatfield.
I personally would not be in Oregon were it not for the "earmark" established by Sen. Hatfield for OHSU under the National Library of Medicine (NLM) Integrated Advanced Management Information Systems (IAIMS) program in the 1980s. I know that political earmarks have a bad name now, but the IAIMS earmark to OHSU was an investment that launched nationally prominent programs in biomedical informatics and clinical epidemiology and shows that such investments can bring true and lasting value. From a financial standpoint, the returns on this investment have accrued manyfold times over for OHSU and the Oregon economy. And perhaps more importantly, the scientific accomplishments and training of future generations of professionals and leaders have even larger returns beyond the financial.
Sen. Hatfield may not have been an expert in informatics or clinical epidemiology, as few people were in the 1980s, but his attaching an earmark to the IAIMS initiative shows that in the 1980s, he had the foresight to see the future potential for these fields in health and biomedicine. He was also a tireless crusader for all types of funding for biomedical research as well as higher education throughout his career.
Sen. Hatfield's political views were different but consistent. He truly matched a label we almost never see any more, namely a "liberal Republican." Sen. Hatfield characterized the proper meaning of the word "liberal." He was a proponent of free markets and economic liberty when they made practical sense, but also recognized when they did not, such as in education and health care. He was an advocate for national defense but opposed military adventurism, best exemplified by being a World War II veteran but also an early opponent of the Vietnam War. Sen. Hatfield recognized the proper role of government in a capitalist society, and it is unfortunate that modern opponents of true liberalism have been able to so successfully redefine the word and the political meaning and actions of those who are true liberals.
I did not agree with all of Sen. Hatfield's political positions. For example, his pacifism and reverence for life led him to oppose the reproductive rights of women. However, I can laud him for consistency in his views of truly being "pro" life, not only opposing abortion, but also capital punishment, corporate misbehavior, and military overreach.
Just as Oregon will miss Sen. Hatfield, it is to our country's detriment that there are not more politicians like him, whether they affiliate themselves with the Republican or Democratic Party. I am not sure Sen. Hatfield would be revered by most leaders of the current Republican Party, although unfortunately, most modern Democratic Party leaders would eschew him also. But rejecting statesmen like Sen. Hatfield will only be to our detriment. The real problems of our debt, unemployment, runaway healthcare costs, and many more will only be solved by people and leaders who place political pragmatism over ideology and those who consider all facts instead of their selective interpretation to score political points. Whether Republican or Democratic, we need more people like Sen. Hatfield back in our political system and dialogue, and this is all the more reason why we should truly mourn his passing.
Although I did not know him well, Sen. Hatfield touched my life and enabled my success. For that reason, I will laud him as well as miss him and people like him.
While many politicians are an abstraction to most people, impacting their lives only in indirect ways, Sen. Hatfield was personal and real in my life. My presence and success at Oregon Health & Science University (OHSU) as well as the flourishing of our Department of Medical Informatics & Clinical Epidemiology (DMICE) have their origins that can be attributed to Sen. Hatfield.
I personally would not be in Oregon were it not for the "earmark" established by Sen. Hatfield for OHSU under the National Library of Medicine (NLM) Integrated Advanced Management Information Systems (IAIMS) program in the 1980s. I know that political earmarks have a bad name now, but the IAIMS earmark to OHSU was an investment that launched nationally prominent programs in biomedical informatics and clinical epidemiology and shows that such investments can bring true and lasting value. From a financial standpoint, the returns on this investment have accrued manyfold times over for OHSU and the Oregon economy. And perhaps more importantly, the scientific accomplishments and training of future generations of professionals and leaders have even larger returns beyond the financial.
Sen. Hatfield may not have been an expert in informatics or clinical epidemiology, as few people were in the 1980s, but his attaching an earmark to the IAIMS initiative shows that in the 1980s, he had the foresight to see the future potential for these fields in health and biomedicine. He was also a tireless crusader for all types of funding for biomedical research as well as higher education throughout his career.
Sen. Hatfield's political views were different but consistent. He truly matched a label we almost never see any more, namely a "liberal Republican." Sen. Hatfield characterized the proper meaning of the word "liberal." He was a proponent of free markets and economic liberty when they made practical sense, but also recognized when they did not, such as in education and health care. He was an advocate for national defense but opposed military adventurism, best exemplified by being a World War II veteran but also an early opponent of the Vietnam War. Sen. Hatfield recognized the proper role of government in a capitalist society, and it is unfortunate that modern opponents of true liberalism have been able to so successfully redefine the word and the political meaning and actions of those who are true liberals.
I did not agree with all of Sen. Hatfield's political positions. For example, his pacifism and reverence for life led him to oppose the reproductive rights of women. However, I can laud him for consistency in his views of truly being "pro" life, not only opposing abortion, but also capital punishment, corporate misbehavior, and military overreach.
Just as Oregon will miss Sen. Hatfield, it is to our country's detriment that there are not more politicians like him, whether they affiliate themselves with the Republican or Democratic Party. I am not sure Sen. Hatfield would be revered by most leaders of the current Republican Party, although unfortunately, most modern Democratic Party leaders would eschew him also. But rejecting statesmen like Sen. Hatfield will only be to our detriment. The real problems of our debt, unemployment, runaway healthcare costs, and many more will only be solved by people and leaders who place political pragmatism over ideology and those who consider all facts instead of their selective interpretation to score political points. Whether Republican or Democratic, we need more people like Sen. Hatfield back in our political system and dialogue, and this is all the more reason why we should truly mourn his passing.
Although I did not know him well, Sen. Hatfield touched my life and enabled my success. For that reason, I will laud him as well as miss him and people like him.
Monday, August 1, 2011
Identifying Patients for Clinical Studies from Electronic Health Records: The TREC Medical Records Track
The substantial federal investment devoted to electronic health record (EHR) adoption in the Health Information Technology for Economic and Clinical Health (HITECH) Act brings many potential benefits to health care. In addition to the improved availability of information about patients during the delivery of care is the ability to better “learn” from what we do in health care so we can better understand what works and what does not [1]. This is one aspect of how we will benefit from the secondary use (or re-use) of clinical data in EHRs [2].
Another substantial federal health care-related investment is in “comparative effectiveness research” (CER), which focuses medical research (e.g., clinical trials) on critical health care-related questions in head-to-head comparisons in real-world settings [3]. A total of $1.4 billion of funding in the American Recovery and Reinvestment Act (ARRA) was allocated for CER, with a mandate to establish the Patient-Centered Outcomes Research Institute (PCORI), a public-private entity to prioritize the investment in CER. One of the first products of the government’s CER efforts was a list of the top 100 priority clinical conditions, developed by the Institute of Medicine (IOM), to guide CER efforts and funding at the federal level.
In the meantime, there have been other federal investments in using health IT to facilitate clinical research. One of these is the National Institutes of Health (NIH) Clinical and Translational Research Award (CTSA) program, which funds 60 centers nationwide to facilitate translational research. Another effort comes from the Strategic Health IT Advanced Research Projects (SHARP) Program of the HITECH Act, which funds four priority areas of research in health IT, including the secondary use of clinical (including text) data.
Against this backdrop of government and other investment in health information technology comes a new track in the Text Retrieval Conference (TREC), an annual challenge evaluation hosted by the US National Institute for Standards & Technology (NIST). TREC is a long-standing event that builds “test collections” allowing different approaches to information retrieval (IR) to be assessed in an open and comparable manner. Each year, a number of “tracks” are held within TREC devoted to different aspects of IR, such as Web searching or cross-language IR [4]. While TREC is focused on general IR, there have been some tracks devoted to IR in specific domains, one of which in the past was genomics [5].
This year, TREC has launched a Medical Records Track. With TREC’s focus on IR, the goal of the track is to develop a task that is both pertinent to real-world clinical medicine and within the scope of IR research. The track is fortunate to have received access to a large corpus of medical text that has been de-identified. These documents are organized as visits (or encounters). The de-identification process prevents linking multiple visits for a single patient. The retrieval task in the first year of the TREC Medical Records Track will be one of retrieving cohorts of patients who would fit criteria to participate in clinical studies. The retrieval “topics” will come from the IOM list of CER priority conditions, modified to create unambiguous and an appropriate quantity of retrieved documents. OHSU has received a grant from NIST to organize the topic development and relevance assessment processes of the track.
The documents for the task come from the University of Pittsburgh NLP Repository, a repository of 95,702 de-identified clinical reports available for NLP research purposes. The reports were generated from multiple hospitals during 2007, and are grouped into “visits” consisting of one or more reports from the patient’s hospital stay. Each document is formatted in XML, with a cross-walk table that matches one or more documents to visits. There are a total of 17,199 visits.
Each document contains four sources of information that can be used for the task:
The relevance assessment process will proceed similar to the typical TREC approach. Retrieved documents will be assessed by relevance judges who have clinical backgrounds. They will assess for each topic whether a visit is definitely relevant (patient would meet the criteria to be a subject in a clinical study), possibly relevant (patient might meet the criteria to be a subject in a clinical study), or not relevant (patient would not meet the criteria to be a subject in a clinical study). We will ideally have one person perform all the relevance assessments for a given topic.
I have had the opportunity to be involved in leading a number of IR challenge evaluations over the years, not only in genomics, but also devoted to interactive IR [6] as well as retrieval of medical images [7]. The TREC Medical Records Track is very timely given the growing interest in leveraging the large ongoing investment in EHRs and working toward a learning health system.
References
1. Friedman, C., Wong, A., et al. (2010). Achieving a nationwide learning health system. Science Translational Medicine, 2(57): 57cm29.
2. Safran, C., Bloomrosen, M., et al. (2007). Toward a national framework for the secondary use of health data: an American Medical Informatics Association white paper. Journal of the American Medical Informatics Association, 14: 1-9.
3. Murray, R. and McElwee, N. (2010). Comparative effectiveness research: critically intertwined with health care reform and the future of biomedical innovation. Archives of Internal Medicine, 170: 596-599.
4. Voorhees, E. and Harman, D., eds. (2005). TREC: Experiment and Evaluation in Information Retrieval. Cambridge, MA. MIT Press.
5. Hersh, W. and Voorhees, E. (2009). TREC genomics special issue overview. Information Retrieval, 12: 1-15.
6. Hersh, W. (2001). Interactivity at the Text Retrieval Conference (TREC). Information Processing and Management, 37: 365-366.
7. Hersh, W., Müller, H., et al. (2009). The ImageCLEFmed medical image retrieval task test collection. Journal of Digital Imaging, 22: 648-655.
Another substantial federal health care-related investment is in “comparative effectiveness research” (CER), which focuses medical research (e.g., clinical trials) on critical health care-related questions in head-to-head comparisons in real-world settings [3]. A total of $1.4 billion of funding in the American Recovery and Reinvestment Act (ARRA) was allocated for CER, with a mandate to establish the Patient-Centered Outcomes Research Institute (PCORI), a public-private entity to prioritize the investment in CER. One of the first products of the government’s CER efforts was a list of the top 100 priority clinical conditions, developed by the Institute of Medicine (IOM), to guide CER efforts and funding at the federal level.
In the meantime, there have been other federal investments in using health IT to facilitate clinical research. One of these is the National Institutes of Health (NIH) Clinical and Translational Research Award (CTSA) program, which funds 60 centers nationwide to facilitate translational research. Another effort comes from the Strategic Health IT Advanced Research Projects (SHARP) Program of the HITECH Act, which funds four priority areas of research in health IT, including the secondary use of clinical (including text) data.
Against this backdrop of government and other investment in health information technology comes a new track in the Text Retrieval Conference (TREC), an annual challenge evaluation hosted by the US National Institute for Standards & Technology (NIST). TREC is a long-standing event that builds “test collections” allowing different approaches to information retrieval (IR) to be assessed in an open and comparable manner. Each year, a number of “tracks” are held within TREC devoted to different aspects of IR, such as Web searching or cross-language IR [4]. While TREC is focused on general IR, there have been some tracks devoted to IR in specific domains, one of which in the past was genomics [5].
This year, TREC has launched a Medical Records Track. With TREC’s focus on IR, the goal of the track is to develop a task that is both pertinent to real-world clinical medicine and within the scope of IR research. The track is fortunate to have received access to a large corpus of medical text that has been de-identified. These documents are organized as visits (or encounters). The de-identification process prevents linking multiple visits for a single patient. The retrieval task in the first year of the TREC Medical Records Track will be one of retrieving cohorts of patients who would fit criteria to participate in clinical studies. The retrieval “topics” will come from the IOM list of CER priority conditions, modified to create unambiguous and an appropriate quantity of retrieved documents. OHSU has received a grant from NIST to organize the topic development and relevance assessment processes of the track.
The documents for the task come from the University of Pittsburgh NLP Repository, a repository of 95,702 de-identified clinical reports available for NLP research purposes. The reports were generated from multiple hospitals during 2007, and are grouped into “visits” consisting of one or more reports from the patient’s hospital stay. Each document is formatted in XML, with a cross-walk table that matches one or more documents to visits. There are a total of 17,199 visits.
Each document contains four sources of information that can be used for the task:
- Chief complaint
- Admit diagnosis (as ICD-9 code)
- Discharge diagnosis(es) (as ICD-9 code)
- Report text
- Radiology Reports - 47,555
- History and Physical Exams - 15,721
- Emergency Department Reports - 13,424
- Progress Notes - 8,538
- Discharge Summaries - 7,931
- Operative Reports - 5,032
- Surgical Pathology Reports - 2,877
- Cardiology Reports - 632
- Letter - 1
The relevance assessment process will proceed similar to the typical TREC approach. Retrieved documents will be assessed by relevance judges who have clinical backgrounds. They will assess for each topic whether a visit is definitely relevant (patient would meet the criteria to be a subject in a clinical study), possibly relevant (patient might meet the criteria to be a subject in a clinical study), or not relevant (patient would not meet the criteria to be a subject in a clinical study). We will ideally have one person perform all the relevance assessments for a given topic.
I have had the opportunity to be involved in leading a number of IR challenge evaluations over the years, not only in genomics, but also devoted to interactive IR [6] as well as retrieval of medical images [7]. The TREC Medical Records Track is very timely given the growing interest in leveraging the large ongoing investment in EHRs and working toward a learning health system.
References
1. Friedman, C., Wong, A., et al. (2010). Achieving a nationwide learning health system. Science Translational Medicine, 2(57): 57cm29.
2. Safran, C., Bloomrosen, M., et al. (2007). Toward a national framework for the secondary use of health data: an American Medical Informatics Association white paper. Journal of the American Medical Informatics Association, 14: 1-9.
3. Murray, R. and McElwee, N. (2010). Comparative effectiveness research: critically intertwined with health care reform and the future of biomedical innovation. Archives of Internal Medicine, 170: 596-599.
4. Voorhees, E. and Harman, D., eds. (2005). TREC: Experiment and Evaluation in Information Retrieval. Cambridge, MA. MIT Press.
5. Hersh, W. and Voorhees, E. (2009). TREC genomics special issue overview. Information Retrieval, 12: 1-15.
6. Hersh, W. (2001). Interactivity at the Text Retrieval Conference (TREC). Information Processing and Management, 37: 365-366.
7. Hersh, W., Müller, H., et al. (2009). The ImageCLEFmed medical image retrieval task test collection. Journal of Digital Imaging, 22: 648-655.
Saturday, July 9, 2011
Postscripts: Noteworthy Mentions and Links
This posting is devoted to some postscripts on items covered in prior postings.
First, the public rollout of the Health IT Curriculum, funded by Office of the National Coordinator for Health IT (ONC), has received many mentions in the press. Among the more notable include:
First, the public rollout of the Health IT Curriculum, funded by Office of the National Coordinator for Health IT (ONC), has received many mentions in the press. Among the more notable include:
- "In a rather amazing example of the taxpayers actually getting something for their money…"
- "A trove of free health information technology teaching materials for higher education has been opened…"
- "The Office of the National Coordinator for Health IT has publicly released teaching materials to help develop the nation's health IT work force..."
Sunday, June 26, 2011
National Library of Medicine: An Informatics and Government Agency Exemplar
This week I am off to another meeting I attend every year, which is the National Library of Medicine (NLM) Informatics Training Conference, the annual meeting held for all trainees funded under the NLM Biomedical Informatics Training Grant Program. Also in attendance are program directors and faculty, NLM staff, VA informatics trainees, and a variety of other people. The meeting varies between being held at the NLM and the various sites; OHSU hosted the meeting in 2009.
At a time when Americans increasingly question the function and value of their government and its agencies, the NLM is a shining testament to the good that the public sector can perform. It is hard to imagine a private entity carrying out the mission of NLM, especially as successfully as it has done so.
The NLM is the world's medical librarian, providing an entry way into the biomedical literature for anyone on the planet who types pubmed.gov into a browser. (The Pubmed system provides access to the MEDLINE bibliographic database, which contains the title, abstract, source information, and other metadata about scientific journals articles in biomedicine.) Even though most of the articles referenced in MEDLINE are from commercial publishers and not freely accessible, NLM delivers users to the publishers' electronic doorsteps. The NLM and its talented scientists and developers have pushed the envelope in many other areas as well, from genomics to imaging to public health. The NLM serves not only researchers and clinicians, but also consumers and policy makers.
Another critical role of the NLM is its scientific leadership in the field of biomedical and health informatics. The NLM funds research in informatics as well as the training of future scientists and leaders. While not the only federal agency involved in the use of information technology in health and biomedicine, it is clearly the foundational leader that facilitates the basic research to inform others who apply it.
No small part of the NLM's success is due to its excellent leadership in Donald AB Lindberg, MD, who has guided the Library for over two decades, longer than I and many others have been in the field. Dr. Lindberg has been remarkably prescient over the years. I remember him touting the virtues of the Human Genome Project when I was an NLM informatics trainee in the late 1980s. Subsequently he has been spot on in his seeing the development of new venues for publishing as well as the desire for patients and consumers to access health information online.
The NLM also has longevity. It has an illustrious history, dating back to its inception as the The Library of the Office of the Surgeon General of the Army, led in its early days by John Shaw Billings, MD. This year is the NLM's 175th year anniversary.
I have a great deal of gratitude for the NLM personally. Like many who work in informatics, my career would not be what it is without the help of NLM. I entered the field in a postdoctoral fellowship directly out of my medical training in 1987. The three years of fellowship funded by NLM allowed me to gain knowledge and skills as well as prepare for an academic career in the field. After completing my informatics training, I landed a faculty position at Oregon Health & Science University (OHSU), funded by a grant to OHSU under the Integrated Advanced Information Management Systems (IAIMS) program, an NLM initiative to develop the informatics human and technology infrastructure at academic medical centers. (In the 21st century, these activities are a normal part of doing business at academic medical centers.) The director of the OHSU IAIMS program, who recruited me to that first job, J. Robert Beck, MD, also obtained an NLM informatics training grant at OHSU, of which I now serve as PI and Director.
The NLM has also funded my research over the years, not only providing the resources for my own scientific contributions to the field but also giving me the experience and latitude to develop other aspects of my career. My first grant ever was a First Independent Research Support & Transition (FIRST) Award (also known as an R29). Since then I have had a number of subsequent grants both for research and education of trainees. These projects, from research to teaching, have enabled me to touch the life of countless others who have also achieved success in their careers in the field.
While it is obvious that the US government needs to make some painful decisions about long-term debt control, discretionary expenditures such as those on NLM have been beneficial to many people, not to mention the health of Americans and others around the world. When politicians and policy makers are deliberating, I hope they will consider the value and impact that government agencies like the NLM have made to so many people. I will always be grateful for what the NLM has done for me.
At a time when Americans increasingly question the function and value of their government and its agencies, the NLM is a shining testament to the good that the public sector can perform. It is hard to imagine a private entity carrying out the mission of NLM, especially as successfully as it has done so.
The NLM is the world's medical librarian, providing an entry way into the biomedical literature for anyone on the planet who types pubmed.gov into a browser. (The Pubmed system provides access to the MEDLINE bibliographic database, which contains the title, abstract, source information, and other metadata about scientific journals articles in biomedicine.) Even though most of the articles referenced in MEDLINE are from commercial publishers and not freely accessible, NLM delivers users to the publishers' electronic doorsteps. The NLM and its talented scientists and developers have pushed the envelope in many other areas as well, from genomics to imaging to public health. The NLM serves not only researchers and clinicians, but also consumers and policy makers.
Another critical role of the NLM is its scientific leadership in the field of biomedical and health informatics. The NLM funds research in informatics as well as the training of future scientists and leaders. While not the only federal agency involved in the use of information technology in health and biomedicine, it is clearly the foundational leader that facilitates the basic research to inform others who apply it.
No small part of the NLM's success is due to its excellent leadership in Donald AB Lindberg, MD, who has guided the Library for over two decades, longer than I and many others have been in the field. Dr. Lindberg has been remarkably prescient over the years. I remember him touting the virtues of the Human Genome Project when I was an NLM informatics trainee in the late 1980s. Subsequently he has been spot on in his seeing the development of new venues for publishing as well as the desire for patients and consumers to access health information online.
The NLM also has longevity. It has an illustrious history, dating back to its inception as the The Library of the Office of the Surgeon General of the Army, led in its early days by John Shaw Billings, MD. This year is the NLM's 175th year anniversary.
I have a great deal of gratitude for the NLM personally. Like many who work in informatics, my career would not be what it is without the help of NLM. I entered the field in a postdoctoral fellowship directly out of my medical training in 1987. The three years of fellowship funded by NLM allowed me to gain knowledge and skills as well as prepare for an academic career in the field. After completing my informatics training, I landed a faculty position at Oregon Health & Science University (OHSU), funded by a grant to OHSU under the Integrated Advanced Information Management Systems (IAIMS) program, an NLM initiative to develop the informatics human and technology infrastructure at academic medical centers. (In the 21st century, these activities are a normal part of doing business at academic medical centers.) The director of the OHSU IAIMS program, who recruited me to that first job, J. Robert Beck, MD, also obtained an NLM informatics training grant at OHSU, of which I now serve as PI and Director.
The NLM has also funded my research over the years, not only providing the resources for my own scientific contributions to the field but also giving me the experience and latitude to develop other aspects of my career. My first grant ever was a First Independent Research Support & Transition (FIRST) Award (also known as an R29). Since then I have had a number of subsequent grants both for research and education of trainees. These projects, from research to teaching, have enabled me to touch the life of countless others who have also achieved success in their careers in the field.
While it is obvious that the US government needs to make some painful decisions about long-term debt control, discretionary expenditures such as those on NLM have been beneficial to many people, not to mention the health of Americans and others around the world. When politicians and policy makers are deliberating, I hope they will consider the value and impact that government agencies like the NLM have made to so many people. I will always be grateful for what the NLM has done for me.
Friday, June 24, 2011
Public Rollout of the ONC Health IT Curriculum
This week was a major milestone for the Office of the National Coordinator for Health IT (ONC) Health IT Curriculum project. The curricular materials that were developed for the 82 community college programs to rapidly expand the health IT workforce were released to all educators and the public at large. In this posting, I will provide the context for this project and describe what it is not before delving into the details of what the curriculum contains.
The ONC Health IT Curriculum is one of four programs in the overall ONC Workforce Development Program. The overall program was specified by Section 3016 of the Health Information Technology for Economic and Clinical Health (HITECH) Act, the portion of the American Recovery and Reinvestment Act (ARRA), also known as the federal stimulus bill. ONC operationalized the program by designating 12 workforce roles, with six to be educated in the six-month community college programs and six to be educated in 1-2 year programs in universities. The primary audience for the curricular materials are the community college programs.
Five universities were funded under the $10 million project as Curriculum Development Centers: Oregon Health & Science University (OHSU), Columbia University, Duke University, Johns Hopkins University, and University of Alabama-Birmingham. Each center prepared four components each. One university, OHSU, was additionally funded to serve as the National Training & Dissemination Center (NTDC), given the additional tasks of developing the dissemination Web site, training community college faculty in use of the materials, capturing feedback, and providing technical support. The curricular materials are now available for download by the public on the NTDC Web site, although the feedback and support functions are limited to the 82 community colleges.
The curricular materials are not a certificate or degree program out of the box. Rather, the content should be thought of more like a library (or, to use the words of ONC Chief Science Officer Charles Friedman, PhD, a "buffet") from which educators can pick and choose content for their courses. The materials alone will not substitute for formal education, as good education still requires teachers, mentors, and fellow learners with whom to interact (whether in-person or on-line). However, the matierlals will be a valuable resource for a wide variety of educational activities in health IT. As the director of a graduate program in biomedical informatics, I know that OHSU will adopt some of these materials in its own graduate-level educational program (just as some of the curricular content came from our existing program).
The curricular materials consist of 20 components, each of which is comparable in depth to a college course. The components are subdivided into 8-12 units, each of which contain a variety of activities appropriate to the topic, including voice-over-Powerpoint narrated lectures, references, suggested readings, exercises, and more. The topic areas of the components are:
http
Each component also contains a blueprint document that provides an overview of the learning objectives and content for each unit. All of the components also have an instructor's manual that provides more detailed information, including listing of authorship and teaching information. The full set of blueprints have been rolled into a single PDF portfolio and are available on the ONC Web site.
Three of the components are "lab" components that make use of an educational version of the Veteran's Administration (VA) VistA EHR. A version of VistA that runs under various versions of Microsoft Windows is provided on the Web site, courtesy of the VA. However, this version will not be usable by everyone, as it requires a license for the Intersystems Cache environment, which is freely available to academic institutions but not others. Nonetheless, the materials will still be valuable to others who can adapt the exercises for other EHR systems.
All told, the curricular materials are a comprehensive resource. The entire collection of material is 7.5 gigabytes in size (6.75 gigabytes compressed) in 12,339 files. The 20 components contain 213 units, 460 lectures (some units have more than one lecture), 8913 slides, and 125.9 hours of lecture audio. In the collection are 460 Powerpoint files, 460 MP3 files, 465 PDF files, and 1346 Microsoft Word files.
We call this publicly available version of the curricular materials Version 2. It has been available to the ONC Community College Consortium for two months, and supersedes the original Version 1 provided to consortium members last year. The materials are distributed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License. This means that all users of the curriculum can use, share, and adapt the materials but must attribute the originator of work, use the materials only for non-commercial purposes, and share any changes made under same license. Per the ONC, universities own the intellectual property for their components.
The support for the public rollout of the curricular materials will be minimal. This is in part because the funding does not have the resources to provide that support but also because these materials are aimed at educators who will adapt them into their own courses and other educational activities.
Another program in the ONC Workforce Development Program related to the project is the Competency Examination, a project led by Northern Virginia Community College. There are six exams, with one for each of the six community college-trained workforce roles. Each exam consists of 125 multiple-choice questions, to be taken in three hours and graded on a pass-fail basis. At least 80% of exam questions come from the curriculum components. Beta versions of the six exams became available on May 20, 2011, with the final versions to be ready in September. The exam is free to consortia member college graduates through their schools.
The final program in the is the University-Based Training (UBT) program, which funds training in the other six workforce roles deemed to require longer training at the university level. Nine universities or consortia thereof, including OHSU, were funded under this program. As noted elsewhere, OHSU recently had its first graduates from its UBT program, with many more in the pipeline.
The Curriculum Development Centers and ONC do not plan to rest on our laurels. We know there are many areas where Version 2 can be improved, and fortunately the two-year project includes additional funding to provide for a Version 3 that will be delivered in 2012. A planning process is underway to improve the content and technical aspects of Version 2, along with reducing its gap and overlaps.
It has been gratifying to be part of this project, which has consumed a great deal of my life since the project began in April, 2010. I have enjoyed all of the roles I have played, as Director of the NTDC, Director of the OHSU Curriculum Development Center, and author of several units. I will look forward to feedback about Version 2 and suggestions for enhancements in Version 3. How to sustain the curriculum once the ONC funding ends is also a key concern.
The ONC Health IT Curriculum is one of four programs in the overall ONC Workforce Development Program. The overall program was specified by Section 3016 of the Health Information Technology for Economic and Clinical Health (HITECH) Act, the portion of the American Recovery and Reinvestment Act (ARRA), also known as the federal stimulus bill. ONC operationalized the program by designating 12 workforce roles, with six to be educated in the six-month community college programs and six to be educated in 1-2 year programs in universities. The primary audience for the curricular materials are the community college programs.
Five universities were funded under the $10 million project as Curriculum Development Centers: Oregon Health & Science University (OHSU), Columbia University, Duke University, Johns Hopkins University, and University of Alabama-Birmingham. Each center prepared four components each. One university, OHSU, was additionally funded to serve as the National Training & Dissemination Center (NTDC), given the additional tasks of developing the dissemination Web site, training community college faculty in use of the materials, capturing feedback, and providing technical support. The curricular materials are now available for download by the public on the NTDC Web site, although the feedback and support functions are limited to the 82 community colleges.
The curricular materials are not a certificate or degree program out of the box. Rather, the content should be thought of more like a library (or, to use the words of ONC Chief Science Officer Charles Friedman, PhD, a "buffet") from which educators can pick and choose content for their courses. The materials alone will not substitute for formal education, as good education still requires teachers, mentors, and fellow learners with whom to interact (whether in-person or on-line). However, the matierlals will be a valuable resource for a wide variety of educational activities in health IT. As the director of a graduate program in biomedical informatics, I know that OHSU will adopt some of these materials in its own graduate-level educational program (just as some of the curricular content came from our existing program).
The curricular materials consist of 20 components, each of which is comparable in depth to a college course. The components are subdivided into 8-12 units, each of which contain a variety of activities appropriate to the topic, including voice-over-Powerpoint narrated lectures, references, suggested readings, exercises, and more. The topic areas of the components are:
- Introduction to Health Care and Public Health in the U.S.
- The Culture of Health Care
- Terminology in Health Care and Public Health Settings
- Introduction to Information and Computer Science
- History of Health Information Technology in the U.S.
- Health Management Information Systems
- Working with Health IT Systems
- Installation and Maintenance of Health IT Systems
- Networking and Health Information Exchange
- Fundamentals of Health Workflow Process Analysis & Redesign
- Configuring EHRs
- Quality Improvement
- Public Health IT
- Special Topics Course on Vendor-Specific Systems
- Usability and Human Factors
- Professionalism/Customer Service in the Health Environment
- Working in Teams
- Planning, Management and Leadership for Health IT
- Introduction to Project Management
- Training and Instructional Design
http
Each component also contains a blueprint document that provides an overview of the learning objectives and content for each unit. All of the components also have an instructor's manual that provides more detailed information, including listing of authorship and teaching information. The full set of blueprints have been rolled into a single PDF portfolio and are available on the ONC Web site.
Three of the components are "lab" components that make use of an educational version of the Veteran's Administration (VA) VistA EHR. A version of VistA that runs under various versions of Microsoft Windows is provided on the Web site, courtesy of the VA. However, this version will not be usable by everyone, as it requires a license for the Intersystems Cache environment, which is freely available to academic institutions but not others. Nonetheless, the materials will still be valuable to others who can adapt the exercises for other EHR systems.
All told, the curricular materials are a comprehensive resource. The entire collection of material is 7.5 gigabytes in size (6.75 gigabytes compressed) in 12,339 files. The 20 components contain 213 units, 460 lectures (some units have more than one lecture), 8913 slides, and 125.9 hours of lecture audio. In the collection are 460 Powerpoint files, 460 MP3 files, 465 PDF files, and 1346 Microsoft Word files.
We call this publicly available version of the curricular materials Version 2. It has been available to the ONC Community College Consortium for two months, and supersedes the original Version 1 provided to consortium members last year. The materials are distributed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License. This means that all users of the curriculum can use, share, and adapt the materials but must attribute the originator of work, use the materials only for non-commercial purposes, and share any changes made under same license. Per the ONC, universities own the intellectual property for their components.
The support for the public rollout of the curricular materials will be minimal. This is in part because the funding does not have the resources to provide that support but also because these materials are aimed at educators who will adapt them into their own courses and other educational activities.
Another program in the ONC Workforce Development Program related to the project is the Competency Examination, a project led by Northern Virginia Community College. There are six exams, with one for each of the six community college-trained workforce roles. Each exam consists of 125 multiple-choice questions, to be taken in three hours and graded on a pass-fail basis. At least 80% of exam questions come from the curriculum components. Beta versions of the six exams became available on May 20, 2011, with the final versions to be ready in September. The exam is free to consortia member college graduates through their schools.
The final program in the is the University-Based Training (UBT) program, which funds training in the other six workforce roles deemed to require longer training at the university level. Nine universities or consortia thereof, including OHSU, were funded under this program. As noted elsewhere, OHSU recently had its first graduates from its UBT program, with many more in the pipeline.
The Curriculum Development Centers and ONC do not plan to rest on our laurels. We know there are many areas where Version 2 can be improved, and fortunately the two-year project includes additional funding to provide for a Version 3 that will be delivered in 2012. A planning process is underway to improve the content and technical aspects of Version 2, along with reducing its gap and overlaps.
It has been gratifying to be part of this project, which has consumed a great deal of my life since the project began in April, 2010. I have enjoyed all of the roles I have played, as Director of the NTDC, Director of the OHSU Curriculum Development Center, and author of several units. I will look forward to feedback about Version 2 and suggestions for enhancements in Version 3. How to sustain the curriculum once the ONC funding ends is also a key concern.
Tuesday, June 21, 2011
Informatics Destination: Buenos Aires
I spent part of last week with my friends and colleagues at Hospital Italiano de Buenos Aires (HIBA) in Argentina. The HIBA Department of Health Informatics is truly an international leader in the field, with an internally developed electronic health record (EHR) that serves the needs of the hospital's clinicians, patients, and researchers. HIBA is a large academic medical center in the heart of Buenos Aires and also has a large health maintenance organization (HMO), Plan de Salud, that serves nearly half a million people. It also has a young but growing university.
The HIBA EHR has been in development for over a decade. At a time when the "conventional wisdom" of informatics is to acquire and implement commercial systems, HIBA has built a system tailored to its organization and workflow. Their success is a testament to the vision and leadership of the program's founder, Fernan Gonzalez Bernaldo de Quiros, MD. Dr. Quiros started HIBA's Department of Medical Informatics a decade ago to provide leadership in developing and implement the system, called ITALICA. He has now assumed the role of Vice President for Strategic Planning of HIBA, while Daniel Luna, MD has stepped in to head the department. Now called the Department of Health Informatics, they oversee all aspects of IT at HIBA, including non-clinical applications. An excellent overview of all their work is provided in a Yearbook of Medical Informatics 2009 article: Quiros, F., Luna, D., et al. (2009). Experience in the Development of an In-house Health Information System and the Training Needs of the Human Resources at the Hospital Italiano de Buenos Aires, 147-152, in Geissbuhler, A. and Kulikowski, C., eds. IMIA Yearbook of Medical Informatics 2009. Stuttgart, Germany. Schattauer.
HIBA has also become an international leader in informatics education and training. When the department was established, they also launched a medical informatics residency program. This program has trained the human resources necessary for the success of ITALICA. An emerging leader in the educational program has been Paula Otero, MD.
I first met Dr. Otero in 2004. A year later, she enrolled in the very first offering of the OHSU-AMIA 10x10 course. After the course ended, she proposed to translate the course into Spanish to make it available to a Latin America audience. She and her team successfully translated the course and began offering it across Latin America. While the first version was mostly a direct translation, the course has since diverged from the US-based course to be more specific to health care in Latin America. (For example, very little HIPAA!) For more information, see: Otero, P., Hersh, W., et al. (2010). A medical informatics distance-learning course for Latin America - translation, implementation and evaluation. Methods of Information in Medicine, 49: 310-315.
This initial collaboration set the stage for other collaborative activities. Dr. Otero, Dr. Quiros, and I were involved in the Rockefeller Foundation workshop devoted to building human capacity in health informatics in the developing world in Bellagio, Italy in 2008. We subsequently worked together on the AMIA Global Partnership Program. Dr. Otero has become my Co-Chair in leading the International Medical Informatics Association (IMIA) Working Group on Education.
The crowning achievement of our collaboration was the awarding of a grant from Fogarty International Center of the US National Institutes of Health (NIH). In 2009, we were awarded one of eight grants in Fogarty's Informatics Training for Global Health (ITGH) Program. The stated goal of our project under this funding was to extend our collaboration that had mostly been in clinical informatics into clinical research informatics. HIBA has a strong Institute of Basic Sciences and Experimental Medicine, which includes 31 basic research teams. Many are funded by grants, including some from the NIH.
We proposed in the grant, and have operationalized in the first two-plus years of the project, a plan for short-term, intermediate-term, and long-term training. The short-term training has been focused on clinical researchers, extending the Spanish 10x10 course with modules that teach them how informatics can augment clinical research.
The intermediate training has been more focused on informatics trainees, with a course in clinical research informatics developed by OHSU informatics faculty Judith Logan, MD, MS. This course was taught on-line in OHSU's spring academic quarter to both OHSU and HIBA informatics trainees. Dr. Logan also came on this trip to have an in-person meeting with the HIBA students.
The long-term training has focused on providing postdoctoral fellowship training to HIBA informaticians. At OHSU, we have treated these trainees as if they were fellows on our National Library of Medicine (NLM) training grant. The first two fellows - Damian Borbolla, MD and Vanina Taliercio, MD - have been at OHSU for over a year. A third fellow, Sonia Benitez, MD, will join them later this year. The goal for these trainees is for them to return to Argentina after their training to assume leadership roles in informatics and clinical research.
Dr. Logan and I also had the opportunity to give talks at HIBA (with more details and even an Elluminate recording of the slides and audio). Not only were there about 80 people present in person, another 25 or so listened in via Webcast. Some of the Webcast listeners even asked questions of the speakers. In my talk I provided an overview of the HITECH program for EHR adoption in the US. Dr. Otero translated my slides to Spanish and both the English and Spanish versions, with references, are available on my Web site. An interesting piece of trivia I learned on this trip is that the phrase meaningful use has no direct translation in Spanish. The closest translation is uso significativo. (Which is somewhat ironic, since HIBA is much closer to meaningful use of EHRs than most US hospitals!)
Although we have made substantial progress in our collaboration, the best is yet to come. We will look forward not to our trainees applying their new knowledge and skills to advancing healthcare and clinical research in Argentina, but also to new undertakings, such as a possible jointly developed master's degree.
The HIBA EHR has been in development for over a decade. At a time when the "conventional wisdom" of informatics is to acquire and implement commercial systems, HIBA has built a system tailored to its organization and workflow. Their success is a testament to the vision and leadership of the program's founder, Fernan Gonzalez Bernaldo de Quiros, MD. Dr. Quiros started HIBA's Department of Medical Informatics a decade ago to provide leadership in developing and implement the system, called ITALICA. He has now assumed the role of Vice President for Strategic Planning of HIBA, while Daniel Luna, MD has stepped in to head the department. Now called the Department of Health Informatics, they oversee all aspects of IT at HIBA, including non-clinical applications. An excellent overview of all their work is provided in a Yearbook of Medical Informatics 2009 article: Quiros, F., Luna, D., et al. (2009). Experience in the Development of an In-house Health Information System and the Training Needs of the Human Resources at the Hospital Italiano de Buenos Aires, 147-152, in Geissbuhler, A. and Kulikowski, C., eds. IMIA Yearbook of Medical Informatics 2009. Stuttgart, Germany. Schattauer.
HIBA has also become an international leader in informatics education and training. When the department was established, they also launched a medical informatics residency program. This program has trained the human resources necessary for the success of ITALICA. An emerging leader in the educational program has been Paula Otero, MD.
I first met Dr. Otero in 2004. A year later, she enrolled in the very first offering of the OHSU-AMIA 10x10 course. After the course ended, she proposed to translate the course into Spanish to make it available to a Latin America audience. She and her team successfully translated the course and began offering it across Latin America. While the first version was mostly a direct translation, the course has since diverged from the US-based course to be more specific to health care in Latin America. (For example, very little HIPAA!) For more information, see: Otero, P., Hersh, W., et al. (2010). A medical informatics distance-learning course for Latin America - translation, implementation and evaluation. Methods of Information in Medicine, 49: 310-315.
This initial collaboration set the stage for other collaborative activities. Dr. Otero, Dr. Quiros, and I were involved in the Rockefeller Foundation workshop devoted to building human capacity in health informatics in the developing world in Bellagio, Italy in 2008. We subsequently worked together on the AMIA Global Partnership Program. Dr. Otero has become my Co-Chair in leading the International Medical Informatics Association (IMIA) Working Group on Education.
The crowning achievement of our collaboration was the awarding of a grant from Fogarty International Center of the US National Institutes of Health (NIH). In 2009, we were awarded one of eight grants in Fogarty's Informatics Training for Global Health (ITGH) Program. The stated goal of our project under this funding was to extend our collaboration that had mostly been in clinical informatics into clinical research informatics. HIBA has a strong Institute of Basic Sciences and Experimental Medicine, which includes 31 basic research teams. Many are funded by grants, including some from the NIH.
We proposed in the grant, and have operationalized in the first two-plus years of the project, a plan for short-term, intermediate-term, and long-term training. The short-term training has been focused on clinical researchers, extending the Spanish 10x10 course with modules that teach them how informatics can augment clinical research.
The intermediate training has been more focused on informatics trainees, with a course in clinical research informatics developed by OHSU informatics faculty Judith Logan, MD, MS. This course was taught on-line in OHSU's spring academic quarter to both OHSU and HIBA informatics trainees. Dr. Logan also came on this trip to have an in-person meeting with the HIBA students.
The long-term training has focused on providing postdoctoral fellowship training to HIBA informaticians. At OHSU, we have treated these trainees as if they were fellows on our National Library of Medicine (NLM) training grant. The first two fellows - Damian Borbolla, MD and Vanina Taliercio, MD - have been at OHSU for over a year. A third fellow, Sonia Benitez, MD, will join them later this year. The goal for these trainees is for them to return to Argentina after their training to assume leadership roles in informatics and clinical research.
Dr. Logan and I also had the opportunity to give talks at HIBA (with more details and even an Elluminate recording of the slides and audio). Not only were there about 80 people present in person, another 25 or so listened in via Webcast. Some of the Webcast listeners even asked questions of the speakers. In my talk I provided an overview of the HITECH program for EHR adoption in the US. Dr. Otero translated my slides to Spanish and both the English and Spanish versions, with references, are available on my Web site. An interesting piece of trivia I learned on this trip is that the phrase meaningful use has no direct translation in Spanish. The closest translation is uso significativo. (Which is somewhat ironic, since HIBA is much closer to meaningful use of EHRs than most US hospitals!)
Although we have made substantial progress in our collaboration, the best is yet to come. We will look forward not to our trainees applying their new knowledge and skills to advancing healthcare and clinical research in Argentina, but also to new undertakings, such as a possible jointly developed master's degree.
Monday, June 6, 2011
Commencement Address Representing OHSU School of Medicine Graduate Studies Program
The Commencement & Hooding Ceremony of the OHSU School of Medicine, also known as Graduation, is always an enjoyable time for me. It is gratifying to see another year's class of graduates from our Biomedical Informatics Graduate Program receive their hoods and diplomas. This year we had largest graduating class ever, with six PhDs, 12 students in our two master's programs, and 20 Graduate Certificates. This brings our total number of degrees and certificates awarded up to 336 since the inception of the program in 1996. This commencement we more than doubled our number of PhD graduates (from five to 11), and also saw the first group of graduates from our ONC University-Based Training (UBT) Program.
This year I also was invited to give the Graduate Studies Program faculty address. I was honored to represent the faculty of all of the OHSU School of Medicine graduate programs and share my informatics-tinged wisdom and vision with the larger School of Medicine audience.
Below is the text of my remarks delivered on Monday, June 6, 2011:
After all these years of sitting down in the faculty section of this ceremony, I am honored to be asked to give this address representing the faculty in the graduate programs of the School of Medicine. As some of you know, I direct the graduate program in biomedical informatics, which is the field devoted to the use of data and information, usually but not always aided by computers, to improve personal health, clinical practice, biomedical research, and public health. Like all disciplines, biomedical informatics has a science and methodology that is carried out by its researchers and practitioners, and a new group of graduates are entering the field by completing their studies today.
As the faculty in my program know, Commencement is a very important event for me. With the exception of last year due to an unavoidable conflict, I have attended every Commencement since our biomedical informatics graduate program had its first graduates in 1998. We began with a handful of Master's degrees, but now as of this graduation have over 300 alumni who have attained not only Master's degrees, but also PhDs and Graduate Certificates. Despite 13 years of graduating students, my thrill of seeing graduates of our program has not worn off. I am sure that my fellow graduate program directors feel the same way.
So what advice can I give to those who are graduating with PhDs, Master's degrees, and Certificates in the School of Medicine? I will skip the usual advice, important as it is, to devote your life's work to your profession, to keep a healthy balance of activities outside of work with family and friends, and to act professionally in a world of instant gratification and 24/7 information flow. Instead, I will try to provide some perspective and wisdom from my discipline of biomedical informatics.
I probably do not need to tell graduates, faculty, or even members of the audience that the 21st century is a golden era at the intersection of health sciences with information and computer sciences. It is truly changing what we do as clinicians, researchers, and other professionals who deal with health.
One of the best statements of this vision comes the Institute of Medicine and is the notion of the learning health system. We now truly have the ability to track and measure what we do in health care practice and public health, and drive research questions and answers from it. Our substantial federal investment in electronic health records, along with the growing ability to sequence genes, measure their expression, and analyze the products they produce, is ushering in an unprecedented era to compare and then learn the best approaches not only to treating disease but also keeping us healthy.
It is also critical to remember that no matter from what discipline you are graduating, success in this new era will require skills to use and manage information in ways that did not exist even a decade ago. You must understand the meaning and the limitations that exist with the increasing types and volume of data you collect. You must adhere to data standards so others can build on your work. Those of you working with human data also cannot forget the importance of protecting the privacy of individuals who have graciously permitted you to borrow their data for your work. In addition to skills in managing data, you must also be an expert in searching and accessing the literature and other scientific resources of your field. As if that is not enough, critical thinking and analysis are essential to all of this voluminous amount of data and information.
Another critical challenge to emerge in the 21st century is the need to collaborate across disciplines. The truly vexing problems of health care and public health require an interdisciplinary approach. Basic scientists, clinicians, informaticians, and others must come together to translate basic science into clinical care, to bring the best clinical care to the entire population, and insure that care is delivered with the highest quality and safety. We also need to reform our health care system to provide incentive for coordination and efficiency, not only because it will cost less but also because it will result in better patient outcomes. This will in turn require critical investments in information systems to bring the right information to the right people at the right time.
In closing, no matter what graduate degree or certificate you are receiving today, there are unprecedented opportunities. There may be uncertainties about health care reform, federal research funding, and the economy in general. But there is now unprecedented opportunity to impact health. I wish all graduates here today the best as they embark on their new careers.
(Postscript: The text of this talk also appears on the OHSU School of Medicine Commencement 2011 site.)
This year I also was invited to give the Graduate Studies Program faculty address. I was honored to represent the faculty of all of the OHSU School of Medicine graduate programs and share my informatics-tinged wisdom and vision with the larger School of Medicine audience.
Below is the text of my remarks delivered on Monday, June 6, 2011:
After all these years of sitting down in the faculty section of this ceremony, I am honored to be asked to give this address representing the faculty in the graduate programs of the School of Medicine. As some of you know, I direct the graduate program in biomedical informatics, which is the field devoted to the use of data and information, usually but not always aided by computers, to improve personal health, clinical practice, biomedical research, and public health. Like all disciplines, biomedical informatics has a science and methodology that is carried out by its researchers and practitioners, and a new group of graduates are entering the field by completing their studies today.
As the faculty in my program know, Commencement is a very important event for me. With the exception of last year due to an unavoidable conflict, I have attended every Commencement since our biomedical informatics graduate program had its first graduates in 1998. We began with a handful of Master's degrees, but now as of this graduation have over 300 alumni who have attained not only Master's degrees, but also PhDs and Graduate Certificates. Despite 13 years of graduating students, my thrill of seeing graduates of our program has not worn off. I am sure that my fellow graduate program directors feel the same way.
So what advice can I give to those who are graduating with PhDs, Master's degrees, and Certificates in the School of Medicine? I will skip the usual advice, important as it is, to devote your life's work to your profession, to keep a healthy balance of activities outside of work with family and friends, and to act professionally in a world of instant gratification and 24/7 information flow. Instead, I will try to provide some perspective and wisdom from my discipline of biomedical informatics.
I probably do not need to tell graduates, faculty, or even members of the audience that the 21st century is a golden era at the intersection of health sciences with information and computer sciences. It is truly changing what we do as clinicians, researchers, and other professionals who deal with health.
One of the best statements of this vision comes the Institute of Medicine and is the notion of the learning health system. We now truly have the ability to track and measure what we do in health care practice and public health, and drive research questions and answers from it. Our substantial federal investment in electronic health records, along with the growing ability to sequence genes, measure their expression, and analyze the products they produce, is ushering in an unprecedented era to compare and then learn the best approaches not only to treating disease but also keeping us healthy.
It is also critical to remember that no matter from what discipline you are graduating, success in this new era will require skills to use and manage information in ways that did not exist even a decade ago. You must understand the meaning and the limitations that exist with the increasing types and volume of data you collect. You must adhere to data standards so others can build on your work. Those of you working with human data also cannot forget the importance of protecting the privacy of individuals who have graciously permitted you to borrow their data for your work. In addition to skills in managing data, you must also be an expert in searching and accessing the literature and other scientific resources of your field. As if that is not enough, critical thinking and analysis are essential to all of this voluminous amount of data and information.
Another critical challenge to emerge in the 21st century is the need to collaborate across disciplines. The truly vexing problems of health care and public health require an interdisciplinary approach. Basic scientists, clinicians, informaticians, and others must come together to translate basic science into clinical care, to bring the best clinical care to the entire population, and insure that care is delivered with the highest quality and safety. We also need to reform our health care system to provide incentive for coordination and efficiency, not only because it will cost less but also because it will result in better patient outcomes. This will in turn require critical investments in information systems to bring the right information to the right people at the right time.
In closing, no matter what graduate degree or certificate you are receiving today, there are unprecedented opportunities. There may be uncertainties about health care reform, federal research funding, and the economy in general. But there is now unprecedented opportunity to impact health. I wish all graduates here today the best as they embark on their new careers.
(Postscript: The text of this talk also appears on the OHSU School of Medicine Commencement 2011 site.)
Sunday, June 5, 2011
An Informatics Silver Lining to a Terrible Tragedy
Although the tornado in Joplin, Missouri was a terrible and unfortunate tragedy, there is an interesting little side story related to biomedical informatics. I don't want to make light of the tragedy, particularly the town having its hospital destroyed. However, an article on the St. Louis Today web site tells an interesting sidebar.
Apparently the destroyed hospital made its conversion to electronic health records (EHRs) just three weeks before the tornado. The EHR system did not miss a beat, and remained running during and after the storm. As such, people needing their records accessed were able to have that done when they obtained medical care elsewhere.
This situation brings memories of Hurricane Katrina, where just about all of the hospitals in New Orleans had their medical records rooms, typically in the basements of their facilities, destroyed by the ensuing flooding. The one exception was the New Orleans VA Medical Center, which was able to keep its records intact through the well-known VA EHR system.
Joplin also did have a health information security breach from the tornado. Although unlike most breaches we read about lately, this breach was purely due to non-electronic records, in particular paper records and x-ray films being blown up to 75 miles away.
This story does not alleviate the terrible tragedy of the tornado, nor does it rebut any of the serious challenges to implementing EHRs. It does, however, show one example of the value of electronic data systems in healthcare.
Apparently the destroyed hospital made its conversion to electronic health records (EHRs) just three weeks before the tornado. The EHR system did not miss a beat, and remained running during and after the storm. As such, people needing their records accessed were able to have that done when they obtained medical care elsewhere.
This situation brings memories of Hurricane Katrina, where just about all of the hospitals in New Orleans had their medical records rooms, typically in the basements of their facilities, destroyed by the ensuing flooding. The one exception was the New Orleans VA Medical Center, which was able to keep its records intact through the well-known VA EHR system.
Joplin also did have a health information security breach from the tornado. Although unlike most breaches we read about lately, this breach was purely due to non-electronic records, in particular paper records and x-ray films being blown up to 75 miles away.
This story does not alleviate the terrible tragedy of the tornado, nor does it rebut any of the serious challenges to implementing EHRs. It does, however, show one example of the value of electronic data systems in healthcare.
Thursday, May 26, 2011
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:
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.
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:
- Introduction to Health Care and Public Health in the U.S.
- The Culture of Health Care
- Terminology in Health Care and Public Health Settings
- Introduction to Information and Computer Science
- History of Health Information Technology in the U.S.
- Health Management Information Systems
- Working with Health IT Systems*
- Installation and Maintenance of Health IT Systems*
- Networking and Health Information Exchange
- Fundamentals of Health Workflow Process Analysis & Redesign
- Configuring EHRs*
- Quality Improvement
- Public Health IT
- Special Topics Course on Vendor-Specific Systems
- Usability and Human Factors
- Professionalism/Customer Service in the Health Environment
- Working in Teams
- Planning, Management and Leadership for Health IT
- Introduction to Project Management
- Training and Instructional Design
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.
Monday, May 23, 2011
Physician Certification in Informatics
I am frequently asked about the status of certification of physicians in informatics. I did touch on this topic briefly in my posting on informatics opportunities for physicians last fall, but let me address the question of certification in more detail in this posting.
The motivation for physician certification in informatics is to recognize the growing stature and need for professional expertise of physicians who spend a significant amount of their time performing informatics-related duties. This includes not only the growing role of the Chief Medical Informatics Officer (CMIO), but other jobs where a physician draws on his or her expertise at the intersection of medicine and informatics.
The "gold standard" for any type of certification of physicians is board certification. There are currently 24 specialty boards (e.g., internal medicine, family medicine, pediatrics, surgery, radiology, preventive medicine, etc.), most of which have subspecialty boards as well (e.g., cardiology, hematology/oncology, and general internal medicine in internal medicine). Some subspecialties, such as geriatrics and palliative medicine, are offered by more than one specialty board. This will be the model for the clinical informatics subspecialty, and in fact the goal will be for it to be offered by all 24 specialty boards.
A comprehensive overview of the rationale and plan for developing the clinical informatics subspecialty was published in early 2010 by Detmer et al. [1]. This paper described the development of medical specialties and subspecialties generally and in the context of the new proposed subspecialty of clinical informatics. A more recent overview of the status board specialties was published last year and included mention of the proposed one for clinical informatics [2].
The proposal to establish the clinical informatics subspecialty was developed by the American Medical Informatics Association (AMIA) and submitted to the ABMS in 2010. The lead board submitting the proposal was the American Board of Preventive Medicine (ABPM), which has since been joined by the American Board of Pathology. The proposal had its first "reading" in early 2011, with a second reading and possible vote coming in September, 2011.
Certification in clinical informatics will work like any other multi-board subspecialty. To become certified, a physician will need to meet certain training requirements and then pass a certification exam. In the early years (usually the first five years of a specialty's existence), those with a certain level of experience will be able to "grandfather" in on the training requirements in a "practice track" and certify by passing the exam only. Those training after the initial practice track period will be required to complete some sort of fellowship in the specialty. The practice track requirements for clinical informatics will be determined after the ABMS approves the subspecialty and will likely apply to those with some defined level of time and depth of experience in clinical informatics settings.
If the ABMS proposal is approved, the ABPM will begin development of a certification exam, which will likely become available in the fall of 2012 for those meeting the practice track requirements. The next step will be to define the requirements for clinical fellowships in clinical informatics and their accreditation by the Accreditation Committee for Graduate Medical Education (ACGME), which accredits residency and specialty fellowship training programs.
Papers published in JAMIA in 2009 laid out the details of the core curriculum [3] and training requirements [4] for the subspecialty. These were developed over a two-year process, funded by a grant to AMIA in 2007 from the Robert Wood Johnson Foundation. Two task forces were convened to address the core curriculum and training requirements. (I was a member of the latter.) These task forces led to the ABMS proposal that is currently under review.
Even though the process for establishing the subspecialty is well-defined, a number of questions remain. One question is how many healthcare organizations and others will require their physician-informatician practitioners to be certified. Another question, very critical to academic informatics units, is what will be the role for formal didactic education, especially that offered by distance learning. Programs such as ours at OHSU have been a popular vehicle for physicians and others to become informatics practitioners. The distance learning aspect has been especially valuable, as many clinicians enter informatics careers after they have established their clinical careers. The graduate-level education approach has been validated by the strong uptake of these programs as well as the more recent funding for them though the Office of National Coordinator for Health Information Technology (ONC) University-Based Training (UBT) Program, including the OHSU offering. I am hopeful that ACGME will adopt flexibility in the clinical informatics fellowship program educational programs, including possibly allowing organizations like OHSU to provide the coursework portion of the training requirements in settings where a large educational infrastructure is not available.
Professional recognition is important for any discipline, especially within medicine. This includes the growing number of informatics practitioners. Within medicine, the best approach to professional recognition is formal board certification. To that end, I look forward to seeing the specialty approach develop and thrive. As I am personally still board-certified in internal medicine, I hope to be able to become subcertified in clinical informatics myself.
References
[1] Detmer, D., Munger, B., et al. (2010). Clinical informatics board certification: history, current status, and predicted impact on the medical informatics workforce. Applied Clinical Informatics, 1: 11-18.
[2] Cassel, C. and Reuben, D. (2011). Specialization, subspecialization, and subsubspecialization in internal medicine. New England Journal of Medicine, 364: 1169-1173.
[3] 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.
[4] 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.
The motivation for physician certification in informatics is to recognize the growing stature and need for professional expertise of physicians who spend a significant amount of their time performing informatics-related duties. This includes not only the growing role of the Chief Medical Informatics Officer (CMIO), but other jobs where a physician draws on his or her expertise at the intersection of medicine and informatics.
The "gold standard" for any type of certification of physicians is board certification. There are currently 24 specialty boards (e.g., internal medicine, family medicine, pediatrics, surgery, radiology, preventive medicine, etc.), most of which have subspecialty boards as well (e.g., cardiology, hematology/oncology, and general internal medicine in internal medicine). Some subspecialties, such as geriatrics and palliative medicine, are offered by more than one specialty board. This will be the model for the clinical informatics subspecialty, and in fact the goal will be for it to be offered by all 24 specialty boards.
A comprehensive overview of the rationale and plan for developing the clinical informatics subspecialty was published in early 2010 by Detmer et al. [1]. This paper described the development of medical specialties and subspecialties generally and in the context of the new proposed subspecialty of clinical informatics. A more recent overview of the status board specialties was published last year and included mention of the proposed one for clinical informatics [2].
The proposal to establish the clinical informatics subspecialty was developed by the American Medical Informatics Association (AMIA) and submitted to the ABMS in 2010. The lead board submitting the proposal was the American Board of Preventive Medicine (ABPM), which has since been joined by the American Board of Pathology. The proposal had its first "reading" in early 2011, with a second reading and possible vote coming in September, 2011.
Certification in clinical informatics will work like any other multi-board subspecialty. To become certified, a physician will need to meet certain training requirements and then pass a certification exam. In the early years (usually the first five years of a specialty's existence), those with a certain level of experience will be able to "grandfather" in on the training requirements in a "practice track" and certify by passing the exam only. Those training after the initial practice track period will be required to complete some sort of fellowship in the specialty. The practice track requirements for clinical informatics will be determined after the ABMS approves the subspecialty and will likely apply to those with some defined level of time and depth of experience in clinical informatics settings.
If the ABMS proposal is approved, the ABPM will begin development of a certification exam, which will likely become available in the fall of 2012 for those meeting the practice track requirements. The next step will be to define the requirements for clinical fellowships in clinical informatics and their accreditation by the Accreditation Committee for Graduate Medical Education (ACGME), which accredits residency and specialty fellowship training programs.
Papers published in JAMIA in 2009 laid out the details of the core curriculum [3] and training requirements [4] for the subspecialty. These were developed over a two-year process, funded by a grant to AMIA in 2007 from the Robert Wood Johnson Foundation. Two task forces were convened to address the core curriculum and training requirements. (I was a member of the latter.) These task forces led to the ABMS proposal that is currently under review.
Even though the process for establishing the subspecialty is well-defined, a number of questions remain. One question is how many healthcare organizations and others will require their physician-informatician practitioners to be certified. Another question, very critical to academic informatics units, is what will be the role for formal didactic education, especially that offered by distance learning. Programs such as ours at OHSU have been a popular vehicle for physicians and others to become informatics practitioners. The distance learning aspect has been especially valuable, as many clinicians enter informatics careers after they have established their clinical careers. The graduate-level education approach has been validated by the strong uptake of these programs as well as the more recent funding for them though the Office of National Coordinator for Health Information Technology (ONC) University-Based Training (UBT) Program, including the OHSU offering. I am hopeful that ACGME will adopt flexibility in the clinical informatics fellowship program educational programs, including possibly allowing organizations like OHSU to provide the coursework portion of the training requirements in settings where a large educational infrastructure is not available.
Professional recognition is important for any discipline, especially within medicine. This includes the growing number of informatics practitioners. Within medicine, the best approach to professional recognition is formal board certification. To that end, I look forward to seeing the specialty approach develop and thrive. As I am personally still board-certified in internal medicine, I hope to be able to become subcertified in clinical informatics myself.
References
[1] Detmer, D., Munger, B., et al. (2010). Clinical informatics board certification: history, current status, and predicted impact on the medical informatics workforce. Applied Clinical Informatics, 1: 11-18.
[2] Cassel, C. and Reuben, D. (2011). Specialization, subspecialization, and subsubspecialization in internal medicine. New England Journal of Medicine, 364: 1169-1173.
[3] 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.
[4] 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.
Friday, May 6, 2011
First Year of the OHSU University-Based Training (UBT) Program
It has been a little over a year since Oregon Health & Science University (OHSU) was awarded two grants from the Office of the National Coordinator for Health IT (ONC) Workforce Development Program. Activity on these projects has been a major part of the work in our department, and certainly of my time, over this period. In this posting, I will report on our University-Based Training (UBT) Program. In a later posting, I will report on our work on the other funded project, the Curriculum Development Centers/National Training & Dissemination Center Program.
OHSU was one of nine universities (or consortia thereof) awarded a UBT grant. We have met all of our goals and timelines so far for the project. The gist of our funded proposal was to enroll students into our Graduate Certificate and Master of Biomedical Informatics (MBI) programs, with additional course requirements based on the specific ONC workforce roles. As OHSU is on an academic quarter system, Graduate Certificate (classified by ONC as Type 1) students are expected to complete the program in an accelerated part-time status in four quarters (one year) while MBI (classified by OC as Type 2) students are expected to complete the Master's program in six quarters (one and a half years) as full-time students. We were awarded $3.08 million to fund 135 Type 1 and 13 Type 2 students over three years through 2013. The "ad" on this page links to the Web page describing the program.
We accepted 12 Type 1 students to start in the summer quarter of 2010, with 11 of those students expected to graduate in June, 2011, along with two additional students who completed the program in an accelerated manner. We will also have one Type 2 student graduating in June, 2011. These 14 graduates will be eligible (and encouraged!) to attend the OHSU June 6, 2011 Commencement.
We have an additional 74 Type 1 students in the pipeline who started the program in the fall (34), winter (26), and spring (14) quarters. These students, along with eight Master's students, are for the most part on track to graduate on time.
The students we have accepted have a great deal of geographic and occupational diversity. Similar to our distance learning program in general, our UBT students reside all across the United States. (We actually have distance learning students living in 40 states as well as six countries.) Our UBT students reside in 20 different states, with some over-representation in our region, probably reflecting proportions of applicants. Those states with more than one student in our UBT program include:
Moving forward, we are on track to have an additional 34 Type 1 graduates at the end of the summer quarter in early September, 2011. On September 9-10, OHSU plans to hold an informatics program reunion event, celebrating the 15 year anniversary of our first informatics degree program and the first graduates of our UBT program. Additional students will graduate later this year and into 2012, including our initial cohort of MBI students.
All told, we have committed 78 of our 135 (57.8%) Type 1 slots and eight of our 13 (61.5%) Type 2 slots. We are taking the summer quarter off for new admissions and will be admitting Type 1 and Type 2 students starting again in the fall quarter. We will award the rest of our funded slots during the 2011-2012 academic year, aiming to have everyone complete the program by the end of grant in April, 2013. During this time, our existing program is still operational, and those not awarded UBT funding can still enroll as self-funded students.
We have also implemented practicum (for Graduate Certificate students) and internship (for Master's students) programs . These programs are being administered by an Internship Coordinator whom we have hired. Students are required to find their own practicum or internship, although we help them however we can. The hosting organizations so far include health care organizations, regional extension centers, and vendors.
Another hire is our career counselor, who will help students identify and apply for jobs. We also hope this individual will collaborate with the internship coordinator as well as lay the foundation for continued relationships with employers beyond the end of the UBT funding.
All told, we are pleased with what we have accomplished in the ONC UBT program. We hope this will lead to a sustainable increased interest in biomedical informatics education and careers beyond the end of the grant itself.
OHSU was one of nine universities (or consortia thereof) awarded a UBT grant. We have met all of our goals and timelines so far for the project. The gist of our funded proposal was to enroll students into our Graduate Certificate and Master of Biomedical Informatics (MBI) programs, with additional course requirements based on the specific ONC workforce roles. As OHSU is on an academic quarter system, Graduate Certificate (classified by ONC as Type 1) students are expected to complete the program in an accelerated part-time status in four quarters (one year) while MBI (classified by OC as Type 2) students are expected to complete the Master's program in six quarters (one and a half years) as full-time students. We were awarded $3.08 million to fund 135 Type 1 and 13 Type 2 students over three years through 2013. The "ad" on this page links to the Web page describing the program.
We accepted 12 Type 1 students to start in the summer quarter of 2010, with 11 of those students expected to graduate in June, 2011, along with two additional students who completed the program in an accelerated manner. We will also have one Type 2 student graduating in June, 2011. These 14 graduates will be eligible (and encouraged!) to attend the OHSU June 6, 2011 Commencement.
We have an additional 74 Type 1 students in the pipeline who started the program in the fall (34), winter (26), and spring (14) quarters. These students, along with eight Master's students, are for the most part on track to graduate on time.
The students we have accepted have a great deal of geographic and occupational diversity. Similar to our distance learning program in general, our UBT students reside all across the United States. (We actually have distance learning students living in 40 states as well as six countries.) Our UBT students reside in 20 different states, with some over-representation in our region, probably reflecting proportions of applicants. Those states with more than one student in our UBT program include:
- Oregon - 39 (49%)
- Washington - 7 (9%)
- California - 4 (5%)
- New York - 4 (5%)
- Texas - 3 (4%)
- Maryland - 3 (4%)
- Tennessee - 2 (3%)
- Utah - 2 (3%)
- Virginia - 2 (3%)
- Minnesota - 2 (3%)
- Wisconsin - 2 (3%)
- Medicine (Physician) - 16 (20%)
- Nursing - 13 (16%)
- Business/Management - 10 (13%)
- Liberal Arts/Humanities - 6 (8%)
- Computer Science - 6 (8%)
- Public Health - 4 (5%)
- Biochemistry/Biology/Chemistry - 4 (5%)
- Finance/Accounting - 2 (3%)
- Health Information Mgmt - 2 (3%)
- Healthcare Management/Administration - 2 (3%)
- Bachelors - 34 (44.1%)
- Masters - 24 (31.1%)
- MD - 16 (20.8%)
- PhD - 3 (3.9%)
- Other healthcare doctorate - 1 (1.3%)
Moving forward, we are on track to have an additional 34 Type 1 graduates at the end of the summer quarter in early September, 2011. On September 9-10, OHSU plans to hold an informatics program reunion event, celebrating the 15 year anniversary of our first informatics degree program and the first graduates of our UBT program. Additional students will graduate later this year and into 2012, including our initial cohort of MBI students.
All told, we have committed 78 of our 135 (57.8%) Type 1 slots and eight of our 13 (61.5%) Type 2 slots. We are taking the summer quarter off for new admissions and will be admitting Type 1 and Type 2 students starting again in the fall quarter. We will award the rest of our funded slots during the 2011-2012 academic year, aiming to have everyone complete the program by the end of grant in April, 2013. During this time, our existing program is still operational, and those not awarded UBT funding can still enroll as self-funded students.
We have also implemented practicum (for Graduate Certificate students) and internship (for Master's students) programs . These programs are being administered by an Internship Coordinator whom we have hired. Students are required to find their own practicum or internship, although we help them however we can. The hosting organizations so far include health care organizations, regional extension centers, and vendors.
Another hire is our career counselor, who will help students identify and apply for jobs. We also hope this individual will collaborate with the internship coordinator as well as lay the foundation for continued relationships with employers beyond the end of the UBT funding.
All told, we are pleased with what we have accomplished in the ONC UBT program. We hope this will lead to a sustainable increased interest in biomedical informatics education and careers beyond the end of the grant itself.
Wednesday, May 4, 2011
Professional Science Masters: The Direction for Masters-Level Professional Degrees in Informatics?
This week, the Department of Medical Informatics & Clinical Epidemiology (DMICE) of Oregon Health & Science University (OHSU) is hosting a regional workshop focused on Professional Science Masters (PSM) degrees and programs. While attendees will come from across the Pacific Northwest, the Oregon University System (OUS) is moving forward with development of a statewide program. We are interested in exploring whether our Master of Biomedical Informatics (MBI) might fit the bill to transform into a PSM. For more information on what a PSM is, see their Web site.
PSM programs are professional science degrees with three additional attributes:
We were actually exploring the PSM option when the large amount of funding from American Recovery & Reinvestment Act (ARRA) for investment in health information technology came along and sidetracked these efforts. Of course, our Office of the National Coordinator for Health IT (ONC) University-Based Training (UBT) grant has many conceptual overlaps with the PSM concept, with its goal of producing informatics professionals who will develop, implement, and lead electronic health record (EHR) adoption in healthcare settings.
Of course, our informatics program is focused on more than EHR adoption, even though that is the largest need. But there are plenty of other critical needs for informatics in health and biomedicine, including in genomics, clinical and translational research, public health, consumer health, and even other clinical applications, such as telemedicine. As the UBT program reaches a steady state, and with it winding down in 2013, we are now reconsidering again the transformation of the program to an official PSM. This week's workshop will help inform our next steps.
PSM programs are professional science degrees with three additional attributes:
- "Plus" courses that provide the student skills for working in industry settings, such as business and management, writing and communications, and others
- A rigorous internship program that replaces the traditional master's thesis or capstone
- Guidance by an external advisory committee from industry that oversee the curriculum and/or participate in the internship program
We were actually exploring the PSM option when the large amount of funding from American Recovery & Reinvestment Act (ARRA) for investment in health information technology came along and sidetracked these efforts. Of course, our Office of the National Coordinator for Health IT (ONC) University-Based Training (UBT) grant has many conceptual overlaps with the PSM concept, with its goal of producing informatics professionals who will develop, implement, and lead electronic health record (EHR) adoption in healthcare settings.
Of course, our informatics program is focused on more than EHR adoption, even though that is the largest need. But there are plenty of other critical needs for informatics in health and biomedicine, including in genomics, clinical and translational research, public health, consumer health, and even other clinical applications, such as telemedicine. As the UBT program reaches a steady state, and with it winding down in 2013, we are now reconsidering again the transformation of the program to an official PSM. This week's workshop will help inform our next steps.
Sunday, May 1, 2011
Overview of the OHSU Biomedical Informatics Program
People sometimes ask me for a big picture overview of all the programs available in the Biomedical Informatics Graduate Program in the Department of Medical Informatics & Clinical Epidemiology (DMICE) at Oregon Health & Science University (OHSU). I provide that in this posting.
Biomedical informatics is the field that uses information and related technologies to advance individual health, healthcare, public health, and biomedical research. Students enter with a variety of backgrounds and upon graduation take jobs in a diverse array of settings, including healthcare organizations, industry, research labs, and public health agencies. The OHSU program has offerings along many dimensions.
One dimension is the degree/certificate type:
The following table shows the degree/certificate and track dimensions, with each cell indicating whether or not the program is offered on-campus or on-line.
Where does the 10x10 ("ten by ten") program fit into this? The 10x10 curriculum is essentially equivalent to the introductory course (BMI 510) in the CI and HIM tracks.
More information is available on our program Web site: http://www.ohsu.edu/informatics/
Biomedical informatics is the field that uses information and related technologies to advance individual health, healthcare, public health, and biomedical research. Students enter with a variety of backgrounds and upon graduation take jobs in a diverse array of settings, including healthcare organizations, industry, research labs, and public health agencies. The OHSU program has offerings along many dimensions.
One dimension is the degree/certificate type:
- Doctor of Philosophy (PhD) in Biomedical Informatics
- Master of Science (MS) in Biomedical Informatics
- Master of Biomedical Informatics (MBI)
- Graduate Certificate (GC) in Biomedical Informatics
- Clinical Informatics (CI) - focus on health care, individual health, and public health
- Bioinformatics and Computational Biology (BCB) - focus on computational aspects of genomics and molecular biology, especially their relation to human health
- Health Information Management (HIM) - focus on Registered Health Information Administrator (RHIA) certification
The following table shows the degree/certificate and track dimensions, with each cell indicating whether or not the program is offered on-campus or on-line.
| Track Degree | CI | BCB | HIM |
| PhD | oc | oc | |
| MS | oc | oc | oc |
| MBI | oc/ol | oc | oc/ol |
| GC | oc/ol | oc/ol |
Where does the 10x10 ("ten by ten") program fit into this? The 10x10 curriculum is essentially equivalent to the introductory course (BMI 510) in the CI and HIM tracks.
More information is available on our program Web site: http://www.ohsu.edu/informatics/
Thursday, April 21, 2011
Information Retrieval (Search) in Health and Biomedicine Still "Springs" Eternal
One of my earliest visions of computers in medicine was the ability to type in a question and get an answer. In 1980s, while everyone in informatics was trying to build expert systems, I followed a different dream, of being able to find clinical information seamlessly. In that decade, however, I never could have imagined being able to pull up something called a Web browser, typing in words, and getting back "pages." Especially as I can do now, with something that fits in my pocket, also makes phone calls, and is connected to something I had not yet heard of in the 1980s (before I started my informatics training) called the Internet.
This fascination guided my early research interests in the area of information retrieval. I write about it now because every spring I teach my course on this topic in the OHSU graduate program, BMI 514/614. (Hence the title of this posting.) My interest in this area resulted in dozens of scientific papers and a textbook, currently in its third edition [1]. Despite the marvel I have for today's modern systems, I always have to ask myself, Why didn't I think of the idea of ranking the output (Web pages) by how many other pages pointed to them? Had I thought of that before a couple Stanford graduate students named Brin and Page, my life might be considerably different. Or at least my wealth!
I suppose one is getting up in the years when you marvel at how things are now relative to how you remember them. I certainly recall "searching" when I was in medical school in the 1980s, which involved thumbing through the giant Index Medicus books on long shelves in the library. You would "link" to the full text by walking to a different part of the library where the journals were. If your needs were really critical, you could call on a librarian for help, who would take your request to a special computer that accessed a database somewhere (which happened to be MEDLINE, from the National Library of Medicine).
I actually did my first on-line searching in the 1980s. I was able to access PaperChase, and later Elhill, through dial-up networks, though at a price. For an even heftier price, you could get access to the full text … at least "text" in monospaced font and no figures or images. The world did advance, and by 1998 you could search Pubmed for free. (Al Gore, who actually deserves more credit in this area than his critics deny him, did the first "free" search.)
Now, of course, searching is ubiquitous. You can't even not do it, since most browsers will throw you into a search engine when you type in an invalid Web address (URL) into your browser. And the world not only searches, but searches for health information. The two major periodic surveys of health information searching show that 80% of Internet users have searched for health information for themselves, their family, or their friends [2, 3].
Of course, like many areas of informatics, while use of systems is ubiquitous, not all of the problems of systems are solved. Indeed, a few years ago I wrote a short piece on this topic [4]. As wonderful as today's search systems are, we still have many areas for improvement. In that paper, I identified four areas where grand challenges remained:
References
Hersh, W. (2009). Information Retrieval: A Health and Biomedical Perspective (3rd Edition). New York, NY. Springer.
Fox, S. (2011). Health topics. Washington, DC, Pew Internet & American Life Project. http://www.pewinternet.org/~/media//Files/Reports/2011/PIP_HealthTopics.pdf.
Taylor, H. (2010). "Cyberchondriacs" on the Rise? Those who go online for healthcare information continues to increase. Rochester, NY, Harris Interactive. http://www.harrisinteractive.com/vault/HI-Harris-Poll-Cyberchondriacs-2010-08-04.pdf.
4. Hersh, W. (2008). Ubiquitous but unfinished: grand challenges for information retrieval. Health Information and Libraries Journal, 25(Suppl 1): 90-93.
This fascination guided my early research interests in the area of information retrieval. I write about it now because every spring I teach my course on this topic in the OHSU graduate program, BMI 514/614. (Hence the title of this posting.) My interest in this area resulted in dozens of scientific papers and a textbook, currently in its third edition [1]. Despite the marvel I have for today's modern systems, I always have to ask myself, Why didn't I think of the idea of ranking the output (Web pages) by how many other pages pointed to them? Had I thought of that before a couple Stanford graduate students named Brin and Page, my life might be considerably different. Or at least my wealth!
I suppose one is getting up in the years when you marvel at how things are now relative to how you remember them. I certainly recall "searching" when I was in medical school in the 1980s, which involved thumbing through the giant Index Medicus books on long shelves in the library. You would "link" to the full text by walking to a different part of the library where the journals were. If your needs were really critical, you could call on a librarian for help, who would take your request to a special computer that accessed a database somewhere (which happened to be MEDLINE, from the National Library of Medicine).
I actually did my first on-line searching in the 1980s. I was able to access PaperChase, and later Elhill, through dial-up networks, though at a price. For an even heftier price, you could get access to the full text … at least "text" in monospaced font and no figures or images. The world did advance, and by 1998 you could search Pubmed for free. (Al Gore, who actually deserves more credit in this area than his critics deny him, did the first "free" search.)
Now, of course, searching is ubiquitous. You can't even not do it, since most browsers will throw you into a search engine when you type in an invalid Web address (URL) into your browser. And the world not only searches, but searches for health information. The two major periodic surveys of health information searching show that 80% of Internet users have searched for health information for themselves, their family, or their friends [2, 3].
Of course, like many areas of informatics, while use of systems is ubiquitous, not all of the problems of systems are solved. Indeed, a few years ago I wrote a short piece on this topic [4]. As wonderful as today's search systems are, we still have many areas for improvement. In that paper, I identified four areas where grand challenges remained:
- Content - getting diverse users to the right information for the right task
- Indexing - developing better metadata to get searchers to that proper content
- Linkage - allowing navigation across multiple resources, even those of different publishing entities
- Access - making access as open as possible but still being protective of intellectual property
References
Hersh, W. (2009). Information Retrieval: A Health and Biomedical Perspective (3rd Edition). New York, NY. Springer.
Fox, S. (2011). Health topics. Washington, DC, Pew Internet & American Life Project. http://www.pewinternet.org/~/media//Files/Reports/2011/PIP_HealthTopics.pdf.
Taylor, H. (2010). "Cyberchondriacs" on the Rise? Those who go online for healthcare information continues to increase. Rochester, NY, Harris Interactive. http://www.harrisinteractive.com/vault/HI-Harris-Poll-Cyberchondriacs-2010-08-04.pdf.
4. Hersh, W. (2008). Ubiquitous but unfinished: grand challenges for information retrieval. Health Information and Libraries Journal, 25(Suppl 1): 90-93.
Wednesday, April 20, 2011
What is the Evidence Base for Informatics, Health IT, and Related Areas? Some Recent Analyses
The first part of 2011 has brought a number of publications, and subsequent discussion, about the "evidence base" for the efficacy of biomedical and health informatics interventions, including electronic health records. These publications and conversations come against a backdrop of a very poisoned political environment in the United States, where everything about healthcare, including informatics, has become unfortunately very politicized. In this posting, however, I will stick to the science.
The first high-profile study of the year was the on-line posting of the Archives of Internal Medicine paper by Romano and Stafford [1], which I discussed in an earlier posting. The official publication of the paper, as well as letters about it, will be published in May, 2011.
Probably the next most high-profile study was the publication of an update of a systematic review of studies of outcomes from health information technology interventions by Buntin and colleagues [2]. This was actually the second update of an original systematic review that was published in 2006 by Chaudhry and associates [3], the first update of which was published by Goldzweig and colleagues in 2009 [4].
Systematic reviews are comprehensive reviews of all research evidence on a given area or question [5]. When studies are homogeneous enough (e.g., all studies assessing the treatment of hypertension to reduce cardiovascular disease), a mathematical technique known as meta-analysis can be performed to combine results across studies to achieve larger a sample size and more statistical power. But most areas, certainly so in informatics, have research questions too heterogeneous to enable use of meta-analysis. Nonetheless, studies can be categorized to look at general questions asked, such as efficacy of decision support to reduce medical error or access to data in a more timely manner to reduce cost of care.
The three successive systematic reviews [2-4] using relatively similar methodology have summarized outcomes of studies of health information technology (HIT) over particular time periods:
Chaudhry et al. identified 257 studies, with the most benefit shown for:
In their update, Goldzweig et al. found 179 new studies. They noted comparable results to the study of Chaudhry et al., but also found an increased number of studies of patient-focused applications that ran external to EHR, e.g., Web-based care management. They note a small increase in the number of studies of commercial, off-the-shelf systems, though 20% of studies still came from the four leading institutions. They also found there was still a paucity of cost-benefit analyses.
In the new systematic review, Buntin et al. identified 154 new studies with 278 individual outcome measures. While acknowledging wide divergence of study quality and methodologies, not to mention outcomes studied, they noted that 96 (62%) of studies had positive improvement in one or more aspects of care, with 142 (92%) showing positive or mixed positive-negative outcomes. They found that the studies used quantitative and qualitative approaches, with those using statistical hypothesis testing more likely to have positive outcomes. They slightly redefined “health IT leader” institutions, but noted that a large number (28) still came from these institutions, but did decreased somewhat to 18% of the studies. Somewhat reassuring was that the “leader” studies did not differ in methods or results from the other studies.
Buntin et al. grouped the outcomes into seven categories, noting document improvement in all of them:
It should be noted that another line of thought has been critical of the experimental approach to evaluation of health IT. Two recent commentaries note that these approaches cannot capture the whole picture of a health IT intervention, especially ones that occur in real-world implementations in complex settings, like states or even whole countries [8, 9]. I acknowledge these criticisms, though would argue back that we should not view these approaches as either-or. There is hopefully plenty of room for all types of disciplined evaluation of informatics, with clinical trials and similar experiments
References
1. Romano, M. and Stafford, R. (2011). Electronic health records and clinical decision support systems: impact on national ambulatory care quality. Archives of Internal Medicine, Epub ahead of print.
2. Buntin, M., Burke, M., et al. (2011). The benefits of health information technology: a review of the recent literature shows predominantly positive results. Health Affairs, 30: 464-471.
3. Goldzweig, C., Towfigh, A., et al. (2009). Costs and benefits of health information technology: new trends from the literature. Health Affairs, 28: w282-w293.
4. Chaudhry, B., Wang, J., et al. (2006). Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Annals of Internal Medicine, 144: 742-752.
5. Anonymous (2011). Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC, Institute of Medicine.
6. Black, A., Car, J., et al. (2011). The impact of eHealth on the quality and safety of health care: a systematic overview. PLoS Medicine, 8(1): e1000387.
7. Hersh, W., Hickam, D., et al. (2006). Diagnosis, access, and outcomes: update of a systematic review on telemedicine services. Journal of Telemedicine & Telecare, 12(Supp 2): 3-31.
8. Greenhalgh, T. and Russell, J. (2010). Why do evaluations of eHealth programs fail? An alternative set of guiding principles. PLoS Medicine, 7(11): e1000360.
9. Patrick, J. (2011). The validity of personal experiences in evaluating HIT. Applied Clinical Informatics, 1: 462-465.
The first high-profile study of the year was the on-line posting of the Archives of Internal Medicine paper by Romano and Stafford [1], which I discussed in an earlier posting. The official publication of the paper, as well as letters about it, will be published in May, 2011.
Probably the next most high-profile study was the publication of an update of a systematic review of studies of outcomes from health information technology interventions by Buntin and colleagues [2]. This was actually the second update of an original systematic review that was published in 2006 by Chaudhry and associates [3], the first update of which was published by Goldzweig and colleagues in 2009 [4].
Systematic reviews are comprehensive reviews of all research evidence on a given area or question [5]. When studies are homogeneous enough (e.g., all studies assessing the treatment of hypertension to reduce cardiovascular disease), a mathematical technique known as meta-analysis can be performed to combine results across studies to achieve larger a sample size and more statistical power. But most areas, certainly so in informatics, have research questions too heterogeneous to enable use of meta-analysis. Nonetheless, studies can be categorized to look at general questions asked, such as efficacy of decision support to reduce medical error or access to data in a more timely manner to reduce cost of care.
The three successive systematic reviews [2-4] using relatively similar methodology have summarized outcomes of studies of health information technology (HIT) over particular time periods:
- Chaudhry, 2006 – studies from 1995-2004 [3]
- Goldzweig, 2009 – studies from 2004-2007 [4]
- Buntin, 2011 – studies from 2007-2010 [2]
Chaudhry et al. identified 257 studies, with the most benefit shown for:
- Adherence to guideline-based care
- Enhanced surveillance and monitoring
- Decreased medical errors
In their update, Goldzweig et al. found 179 new studies. They noted comparable results to the study of Chaudhry et al., but also found an increased number of studies of patient-focused applications that ran external to EHR, e.g., Web-based care management. They note a small increase in the number of studies of commercial, off-the-shelf systems, though 20% of studies still came from the four leading institutions. They also found there was still a paucity of cost-benefit analyses.
In the new systematic review, Buntin et al. identified 154 new studies with 278 individual outcome measures. While acknowledging wide divergence of study quality and methodologies, not to mention outcomes studied, they noted that 96 (62%) of studies had positive improvement in one or more aspects of care, with 142 (92%) showing positive or mixed positive-negative outcomes. They found that the studies used quantitative and qualitative approaches, with those using statistical hypothesis testing more likely to have positive outcomes. They slightly redefined “health IT leader” institutions, but noted that a large number (28) still came from these institutions, but did decreased somewhat to 18% of the studies. Somewhat reassuring was that the “leader” studies did not differ in methods or results from the other studies.
Buntin et al. grouped the outcomes into seven categories, noting document improvement in all of them:
- Access to care
- Preventive care
- Care process
- Patient satisfaction
- Provider satisfaction
- Effectiveness of care
- Efficiency of care
It should be noted that another line of thought has been critical of the experimental approach to evaluation of health IT. Two recent commentaries note that these approaches cannot capture the whole picture of a health IT intervention, especially ones that occur in real-world implementations in complex settings, like states or even whole countries [8, 9]. I acknowledge these criticisms, though would argue back that we should not view these approaches as either-or. There is hopefully plenty of room for all types of disciplined evaluation of informatics, with clinical trials and similar experiments
References
1. Romano, M. and Stafford, R. (2011). Electronic health records and clinical decision support systems: impact on national ambulatory care quality. Archives of Internal Medicine, Epub ahead of print.
2. Buntin, M., Burke, M., et al. (2011). The benefits of health information technology: a review of the recent literature shows predominantly positive results. Health Affairs, 30: 464-471.
3. Goldzweig, C., Towfigh, A., et al. (2009). Costs and benefits of health information technology: new trends from the literature. Health Affairs, 28: w282-w293.
4. Chaudhry, B., Wang, J., et al. (2006). Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Annals of Internal Medicine, 144: 742-752.
5. Anonymous (2011). Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC, Institute of Medicine.
6. Black, A., Car, J., et al. (2011). The impact of eHealth on the quality and safety of health care: a systematic overview. PLoS Medicine, 8(1): e1000387.
7. Hersh, W., Hickam, D., et al. (2006). Diagnosis, access, and outcomes: update of a systematic review on telemedicine services. Journal of Telemedicine & Telecare, 12(Supp 2): 3-31.
8. Greenhalgh, T. and Russell, J. (2010). Why do evaluations of eHealth programs fail? An alternative set of guiding principles. PLoS Medicine, 7(11): e1000360.
9. Patrick, J. (2011). The validity of personal experiences in evaluating HIT. Applied Clinical Informatics, 1: 462-465.
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