10x10 with OHSU: Course Description

Course Logistics

The course is offered in two parts:

1.  A 10-unit Web-based component starting July 25, 2012. The Web-based portion is provided through readings, on-line lectures, interactive discussion, and self-assessment tests.

2.  An intensive one-day in-person session held in conjunction with the 2012 AMIA Annual Symposium in Chicago, IL on Sunday, November 4, 2012.  The in-person session will bring participants together to integrate the material, allow presentation of course projects, and meet the instructor as well as other students in person.

(NOTE: Participants wishing to take part in an in-person session at a different AMIA meeting are able to do so for up to one year after the end of the course.  Those unable to attend an in-person session for hardship reasons will also be allowed to opt out of attendance.  All work in the Web-based component must be completed, however, by October 31, 2012).

The registration deadline for the course is July 25, 2012.  We will accept enrollees after that date on a space-available basis.  Registration is now open!

The course is an adaptation of the on-line Introduction to Biomedical and Health Informatics class currently taught in the OHSU biomedical and health 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 threaded discussion forums. An on-line faculty moderator helps keep the discussion on track.
• Reading assignments - The course uses a variety of readings made available to students.
• 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 OHSU's Sakai learning management system. 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.  The course has no required textbook; with all assigned readings 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 unit on the course. All on-line activities are asynchronous, so there is no specified time that a student must be on-line.

Students must complete all homework/quizzes, the course project (see below), and participate in class discussions to receive the AMIA 10x10 Certificate of Completion.  Physicians are eligible for up to 56 hours of AMA PRA Category I CME Credit(s).

Policy for OHSU 10x10 In-Person Session

OHSU 10x10 participants have the option of attending the in-person session associated with any AMIA meeting within one year of their taking the class and not just the session that occurs at the end of the offering in which they are enrolled. 

(We are also allowing participants to forego the in-person session if hardship or other reasons prevent them from attending an in-person session, although we strongly encourage attendance to complete their learning experience.)

In 2012, there is one remaining AMIA meeting where in-person sessions will be held on the dates listed:  AMIA 2012 Annual Symposium, November 4, 2012, Chicago, IL.  In 2013, there will be 2 meetings where in-person sessions will be held:  AMIA Joint Summits on Translational Science, March 17-22, 2013 in San Francisco, CA and the AMIA Annual Symposium, Nov. 16-20, 2013 in Washington, DC.

Course Interaction

Even though the 10x10 course is on-line, it provides a great deal of interaction among the faculty, teaching assistants, and students.  A discussion forum is set up for each unit of the course, where students can pose questions, comments, and opinions related to the course materials.  The instructor poses 1-2 questions to kick off the discussion but students are encouraged to post their own questions and engage in discussion with their classmates.

Students are also encouraged to post questions or comments about any topic in the course or the field in the general discussion forum at any time.

Course Project

Students must complete a course project to obtain the AMIA 10x10 Certificate of Completion. The goal of the project is to identify an informatics problem in their local setting (e.g., where you practice or work, or otherwise have access) and propose a solution based on what is known from informatics research and best practice.  The project write-up is due by October 31, 2012.  (If you do not have access to a health care setting, you can do the project in another setting, such as a company or organization. The instructor can help if you have a challenge with this.) The problem and solution should be written into a succinct 2-3 page (please no longer!) document that should include references that justify the framing of the problem and the proposed solutions. This is submitted in a Word document and uploaded to Sakai.

Students will present their project to their colleagues at the in-person session that they attend. The room at the in-person session has round tables, and students will break into small groups around the tables. Each group selects one individual to present an overview of the group's discussion. The remaining people in the group serve as discussants in a short (10-15 minute) panel presentation at the session.

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 by the specified due date at the end of the course.
• 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 where they will present their assessment to their fellow students and faculty, gaining new insights into the required elements for such an undertaking.

Optional Final Exam

The 10x10 course has no final exam, and those who complete all of the online coursework will receive the AMIA 10x10 Certificate of Completion.  At the end of the course, an optional final exam is given for those who are eligible and desire graduate-level academic credit for the course from OHSU.  The exam is an open-book, take-home final exam that is completed over a one-week period.  Credit is typically sought by those desiring further study in biomedical and health informatics or for those requiring an academic transcript for tuition reimbursement.  More information about the final exam and how to enroll at OHSU to receive academic credit is provided once the course has started.

Readings

The course has no textbook.  Students are provided  assigned readings from 2-4 key articles or reports for each unit.  Students are also provided comprehensive lists of references for topics covered in the lectures.

Curriculum and Dates

The following table outlines the curriculum with unit number, topic, 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 is difficult to catch up once one is too far behind.

Detailed Course Outline

1. Overview of Field and Problems Motivating It
1.1 What is Biomedical and Health Informatics? 
1.2 A Discipline Whose Time has Come
1.3 Problems in Healthcare Motivating Biomedical and Health Informatics
1.4 Who Does Biomedical and Health Informatics?
1.5 Seminal Documents and Reports
1.6 Resources for the 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 and Personal Health Records (EHR, PHR)
3.1 Clinical Data
3.2 History and Perspective of the Health (Medical) Record
3.3 Definitions and Key Attributes of the Electronic Health Record (EHR)
3.4 EHR Examples
3.5 Benefits and Challenges of the EHR
3.6 Personal Health Records
3.7 Nursing Informatics

4. Standards and Interoperability: Privacy, Confidentiality, and Security
4.1 Standards: Basic Concepts
4.2 Identifier and Transaction Standards
4.3 Message Exchange Standards
4.4 Terminology Standards
4.5 Natural Language Processing of Clinical Text
4.6 Privacy, Confidentiality, and Security: Basic Concepts
4.7 HIPAA Privacy and Security Regulations

5. Meaningful Use of the EHR
5.1 Patient Safety and Medical Errors
5.2 Healthcare Quality
5.3 Clinical Decision Support (CDS)
5.4 Computerized Provider Order Entry (CPOE)
5.5 Health Information Exchange (HIE)
5.6 HITECH, ARRA, and Achieving Meaningful Use

6. EHR Implementation and Evaluation
6.1 Clinical Workflow Analysis and Redesign
6.2 System Selection and Implementation
6.3 Evaluation of Usage, Outcomes and Cost
6.4 Clinical Research Informatics
6.5 Public Health Informatics
6.6 Analytics and Business Intelligence

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

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

9. Imaging Informatics and Telemedicine
9.1 Imaging in Health Care
9.2 Modalities of Imaging
9.3 Digital Imaging
9.4 Telemedicine: Definitions, Uses, and Barriers
9.5 Efficacy of Telemedicine
9.6 Patient-Clinician Communications

10. Translational Bioinformatics and Personalized Medicine
10.1 Bioinformatics - The Big Picture
10.2 Overview of Basic Molecular Biology
10.3 Important Biotechnologies Driving Bioinformatics
10.4 From Clinical Genetics and Genomics to Personalized Medicine
10.5 Bioinformatics Information Resources
10.6 Translational Bioinformatics Challenges and Opportunities

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 and health informatics educational program, those who complete the 10x10 course will be able to obtain credit for the course in the OHSU program.  This credit is taken by passing the optional final examination at the end of the 10x10 course.  Upon enrolling in the OHSU Graduate Certificate or Master's Degree program, students passing the final examination will 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.  Recently, financial support for study has become available through the University-based Training Program of the HITECH Act.

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

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.