Course Description

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 600 people have completed 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:

1. An 11-unit Web-based component starting July 30, 2009. The Web-based portion is provided through readings, lectures, interactive discussion, and self-assessment tests.

2. An intensive one-day in-person session held in conjunction with the AMIA 2009 Annual Symposium (San Francisco, CA; November 14-18, 2009). This session will take place on Sunday, November 15, 2009 from 8 am to noon. 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 Thursday July 30, 2009. 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 any type of connection to the Internet.
• 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 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 Sakai 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 document that should include references that justify the framing of the problem and the proposed solutions. This should be submitted in a Word document by email no later than November 12, 2009.
• 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 face-to-face session on November 15, 2009.  At the in-person session, the students 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.

Detailed Course Outline

1. Welcome and Overview of Field
1.1 A discipline whose time has come
1.2 The discipline of biomedical informatics
1.3 Problems in health care motivating biomedical informatics
1.4 Seminal documents and reports
1.5 Resources of field - organizations, information, education

2. Biomedical Computing
2.1 Types of Computers
2.2 Data Storage in Computers
2.3 Computer Hardware and Software
2.4 Computer Networks
2.5 Software Engineering

3. Electronic Health Records
3.1 Clinical Data
3.2 History and Perspective of the Health (Medical) Record
3.3 Potential Benefits of the Electronic Health Record
3.4 Definitions and Key Attributes of the EHR
3.5 EHR Examples
3.6 Nursing Informatics

4. Clinical Decision Support; EHR Implementation
4.1 Historical Perspectives and Approaches
4.2 Medical Errors and Patient Safety
4.3 Reminders and Alerts
4.4 Computerized Provider Order Entry (CPOE)
4.5 Implementing the EHR
4.6 Use and Outcomes of the EHR
4.7 Cost-Benefit of the EHR

5. Standards and Interoperability; Privacy, Confidentiality, and Security
5.1 Standards: Basic Concepts
5.2 Identifier and Transaction Standards
5.3 Message Exchange Standards
5.4 Terminology Standards
5.5 Privacy, Confidentiality, and Security: Basic Concepts
5.6 HIPAA Privacy and Security Regulations

6. Secondary Use of Clinical Data: Personal Health Records, Health Information Exchange, Public Health, Health Care Quality, Clinical Research
6.1 Personal Health Records
6.2 Health Information Exchange
6.3 Public Health Informatics
6.4 Health Care Quality
6.5 Clinical Research Informatics

7. Evidence-Based Medicine and Medical Decision Making
7.1 Definitions and Application of EBM
7.2 Interventions
7.3 Diagnosis
7.4 Harm and Prognosis
7.5 Summarizing Evidence
7.6 Putting Evidence into Practice
7.7 Limitations of EBM

8. Information Retrieval and Digital Libraries
8.1 Information Retrieval
8.2 Knowledge-based Information
8.3 Content
8.4 Indexing
8.5 Retrieval
8.6 Evaluation
8.7 Digital Libraries

9. Imaging Informatics and Telemedicine
9.1 Imaging in Health Care
9.2 Modalities of Imaging
9.3 Digital Imaging
9.4 Telemedicine: Definitions and Barriers
9.5 Efficacy of Telemedicine

10. Translational Bioinformatics
10.1 Translational Bioinformatics - The Big Picture
10.2 Overview of Basic Molecular Biology
10.3 Important Biotechnologies Driving Bioinformatics
10.4 Genetics-Related Diseases
10.5 Bioinformatics Information Resources
10.6 Translational Bioinformatics Challenges and Opportunities

11. Organizational and Management Issues in Informatics
11.1 Organizational Behavior
11.2 Organizational Issues in Failure and Success of Informatics Projects
11.3 Change Management

The on-line portion of the course will run from late July to early November. The in-person session will take place at the 2009 AMIA Annual Symposium (November 14-18, 2009, San Francisco, CA).

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.

The Web site also has information about OHSU's National Library of Medicine-funded fellowship program, Graduate Certificate Track in Health Information Management (HIM), and master's degree programs in bioinformatics.

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.