---

Objectives
The 10x10 program was started when former American Medical Informatics Association (AMIA) President Dr. Charles Safran asserted that the United States needs one physician and one nurse trained in medical informatics in each of the 6,000 hospitals in the United States. Dr. William Hersh of Oregon Health & Science University (OHSU) operationalized this definition by working with AMIA to launch the 10x10 program that aims to train 10,000 health care and related professionals in medical informatics by the year 2010. The 10x10 program aims to provide introductory training to build the workforce that will enable information technology to improve the quality, safety, and cost-effectiveness of health care. Since the program was launched in 2005, nearly 500 people have completed in the course, some going on to advanced study in the field.

The goal of the AMIA-OHSU 10x10 course is to provide a detailed overview of informatics to those who will work at the interface of health care and information technology. It also aims to provide an entry point for those wishing further study (and career development) in the field.

Course Logistics

The course is offered in two parts: an 11-unit Web-based component followed by an intensive one-day in-person session held in conjunction with the AMIA 2008 Annual Symposium(Nov 8-12, 2008, Washington, DC). The in-person session will take place on, Novermber 9, 2008, from 8 am - noon. The Web-based portion is provided through readings, lectures, interactive discussion, and self-assessment tests. The in-person session will bring attendees together to integrate the material, allow presentation of course projects, and meet leaders in the field as well as other students.

The registration deadline for the course is Monday July 21, 2008. We will accept enrollees after that date on a space-available basis.

The course is an adaptation of the on-line Introduction to Biomedical Informatics class currently taught in the OHSU biomedical informatics education program. This survey course provides a broad overview of the field, highlighting the key issues and challenges for the field. The course is taught in a completely asynchronous manner, i.e., there are no "scheduled" classes. However, students must keep up with the course materials so they can benefit from the interactive discussion with faculty and other students. The course uses the following teaching modalities:

• Voice-over-Powerpoint lectures - The key material is delivered using the Flash plug-in, which is freely available and already installed in almost all Web browsers. The content is easily accessed by connections to the Internet using a telephone modem.
• Interactive threaded discussion - Students engage in discussion on important issues using the on-line bulletin board. An on-line faculty moderator helps keep the discussion on track.
• Reading assignments - The course uses the best-known general textbook in the field, Biomedical Informatics - Computer Applications in Health Care and Biomedicine, by Shortliffe and Cimino (eds.), with supplemental readings as necessary. In addition, students are pointed to key other documents, reports, and papers from the field.
• Homework/quizzes - Each of the 11 units is accompanied by a 10-question multiple-choice self-assessment that aims to have the student apply the knowledge from the unit.

The on-line part of the course is accessed via the Blackboard course delivery tool. At the onset of the course, each student is provided a login and password by the OHSU distance learning staff, who also provide technical support for the course. Students are required to purchase the textbook; all other assigned readings are either freely available on-line or provided by OHSU. Students are expected to keep up with the materials each week and participate in ongoing discussion. They should anticipate spending 4-8 hours per week on the course. All on-line activities are asynchronous, so there is no specified time that a student must be on-line

The goal of the course project is for students to identify an informatics problem in their local setting (e.g., where they practice or work) and propose a solution based on what is known from informatics research and best practice. It is due before the in-person session at the end of the course. If a student does not have access to a health care setting, they can do the project in another setting, such as a company or organization.

Here are the details of the assignment:

• You should assess some local setting (work environment, practice, hospital,etc.) to identify an informatics-related problem or a problem that could be improved by an informatics solution.


• Based on your knowledge of research and best practices in informatics, you should propose a solution to the problem.


• The problem and solution should be written into a 2-3 page (please no longer!) document that should include references that justify the framing of the problem and the proposed solutions.


• The room at the in-person session will have round tables, and you will break into small groups around the tables. Each group will select one individual to present an overview of the group’s discussion. The remaining people in the group will serve as discussants in a short (10-15 minute) panel presentation at the session.

The in-person component aims to bring students, faculty experts, and the materials together for an intensive in-person session. For the in-person session, students must complete a short course project consisting of an enrivonment scan of an organization (which could be their own practice or a department in their hospital) to assess readiness for an orgnization-wide IT implementation, such as electronic health record. At the in-person session, they will present their assessment to their fellow students and faculty, gaining new insights into the required elements for such an undertaking.

Curriculum and Dates

The following table outlines the curriculum with unit number, topic, reading assignment, date posted, and date due. The course in general runs with two weeks in a row of posted materials and then a third week to finish the work. The due date for each unit is when the next cycle of material is posted. We are lenient about giving extensions but participants are strongly encouraged not to fall behind, since it can be difficult to catch up.

Unit	Topic	Reading	Date Posted	Date Due
1	Overview of Field and Problems Motivating It	1, 2, 23, and Hersh papers	7/23	8/13
2	Biomedical Computing	5, 6,  and Malan paper	7/30	8/13
3	Electronic Health Records	12, 13,16	8/13	9/3
4	Clinical Decision Support and EHR Implementation	20	8/20	9/3
5	Standards and Interoperability, Privacy and Security	7	9/3	9/24
6	Secondary Use of Clinical Data: Clinical Research, Health Care Quality, Public Health, and Personal Health Records	14, 15, 16	9/10	9/24
7	Evidence-Based Medicine and Medical Decision Making		9/24	10/15
8	Information Retrieval and Digital Libraries	19	10/1	10/15
9	Imaging Informatics and Telemedicine	9, 14, 18, Hersh paper	10/15	11/5
10	Translational Bioinformatics	22	10/22	11/5
11	Organizational and Management Issues in Informatics	6	10/29	11/5

The on-line portion of the course will run from late July to early-November. The in-person session will take place at the 2008 AMIA Annual Symposium (November 8-12, 2008, Washington, DC).


Readings

Reading assignments consist of chapters from the required textbook as well as additional articles and other readings. Students are responsible for learning all content in the readings, whether discussed in the lectures or not.

The textbook for the class is: Edward H. Shortliffe, James J. Cimino, (Eds.), Biomedical Informatics: Computer Applications in Health Care and Biomedicine (3rd edition), Springer-Verlag, 2006. Please note that the third edition of this textbook is required and that the book is not included in the price of tuition.

Instructor

The instructor for the course is William Hersh, MD. The best way to reach him is via email hersh@ohsu.edu.

Beyond 10x10

The goal of the AMIA 10x10 program is to train clinicians and other health care professionals in informatics so they can be knowledgeable participants in IT implementations in their local settings. The 10x10 program alone will not make one a full-time professional in informatics (any more than a semester of medicine or nursing will make one a doctor or nurse!). The program is being structured, however, to allow those who complete the course to carry the credits forward into other graduate programs in informatics. The details need to be arranged with each individual program.

Since the course is an adaptation of the introductory course in the OHSU biomedical informatics, those who complete the 10x10 course will be able to obtain credit for the course in the OHSU program. Upon enrolling in the OHSU Graduate Certificate or Master's Degree program, students will need to complete the final examination for the OHSU course and will then be awarded three credits in the OHSU graduate program. (OHSU is on an academic quarter system, with each quarter consisting of 11 weeks of instruction. A three-credit course is comparable to a course with three contact hours per week plus additional work for reading assignments, homework, and projects.) Most of OHSU's informatics courses are taught on-campus and on-line, and each course is considered equivalent whether it is taught live or via distance.

More details about the individual degree programs are available on the OHSU informatics education Web site, but the following table provides an overview of the programs.

Program Name	Description	Admission Requirements	Graduation Requirements
Graduate Certificate in Biomedical Informatics	Core courses in informatics	Bachelor's degree in any field	24 credits (generally 8 3-credit courses)
Master of Biomedical Informatics	"Professional" master's degree with capstone project	Bachelor's degree in any field plus introductory courses in Computer Science and Anatomy & Physiology	52 credits (48 hours of instruction plus 4 hours of capstone project)
Master of Science in Biomedical Informatics	"Research" master's degree with master's thesis	Bachelor's degree in any field plus introductory courses in Computer Science and Anatomy & Physiology	60 credits (48 hours of instruction plus 12 hours of master's thesis)
Doctor of Philosophy (PhD) in Biomedical Informatics	PhD program for advanced leaders and research in the field	Bachelor's degree in any field plus introductory courses in Computer Science and Anatomy & Physiology	135 credits, including dissertation

Competencies

The OHSU offering of 10x10 has the following learning objectives:

• Explain biomedical informatics and its role in health, health care, public health, and biomedical research.
• Compare and contrast the roles of various individuals in the health information technology workforce.
• Identify the basic tenets of biomedical computing to enable optimal selection of hardware, software, and network connections for a given setting.
• Identity the essential functions of the electronic health record (EHR) and the barriers to its use.
• Distinguish the different types of clinical decision support and their limitations in clinical practice.
• Explain the process of computerized provider order entry and challenges to its use.
• Differentiate the difference among privacy, confidentiality, and security and their role in the HIPAA regulations.
• The role of health information exchange and Regional Health Information Organizations (RHIOs).
• The personal health record (PHR), its interface with the EHR, and its value in promoting personal health.
• Explain the importance of standards and interoperability of clinical data and the major initiatives underway to enable them.
• Explain the basic principles of health care quality assessment, including pay for performance programs, and how the EHR enables them.
• Identify components of health information exchange and its implementation via Regional Health Information Organizations (RHIOs).
• Identify the components of the personal health record (PHR) and describe its value.
• Demonstrate the ability to apply evidence-based medicine and critical appraisal to clinical questions.
• Understand the basic medical knowledge resources and be able to perform searching of them.
• Describe the management of images in clinical settings, including the use of PACS systems.
• Classify the different types of telemedicine and their efficacy as shown in clinical studies.
• Explain how people and organizational issues impact the use of health information technology.