Overview

The goal of the AMIA-IUPUI 10x10 course is to explore the electronic exchange of data, information and knowledge between clinical and public health organizations in support of population health. Students will examine the strategic, organizational, legal, technical, and socio-political aspects of clinical and public health information exchange in the United States and abroad.

The IUPUI 10x10 course aligns with two of AMIA’s core domains: Clinical and Public Health Informatics. Exchange of data and information is critical to supporting and improving not only individual but also population health. Increasingly health systems and public health agencies struggle to design, implement, and use information systems effectively; and rarely do those systems talk to one another. This course will prepare clinical and public health professionals to work on addressing interoperability issues within health systems as well as their communities; which contributes to the transformation of health care through informatics practice.

Course Topics

• • Electronic Health Records and Systems for Population Health


• • Information Exchange for Population Health: Background, Drivers, and Barriers


• • Population Health Information Infrastructure and Architecture


• • Messaging, Interoperability & Standards


• • The Critical Role of Registries: Identifying and Linking Patients, Facilities, and Health Workers across Disparate Systems


• • Future Directions shaping HIE: Challenges and Trends


• • Illustrating Information Exchange between Clinical and Public Health


• • Ethics, Governance, and Security of Information Exchange


• • Managing the Business of HIE: Towards Sustainability


• • Evaluation and Research on Health Information Exchange


• • Putting the pieces together: The Shared Health Record and Health Management Information System


• • Implementation and Adoption of HIE in the Context of Global Health

Target Audience

The target audience for this Internet enduring material activity is health care professionals, public health professionals, information technology professionals and health care administrators who seek to understand HIE.

Class Schedule

Please note that this is the preliminary course schedule. Updates will be posted on Canvas. Holidays are not included in the following schedule. If a deadline falls on a holiday, the deadline will be postponed to the next working day.

May 7, 2019
Title	Course Introduction
Overview	This lecture will introduce students to the course, including how we will organize the lectures and assignments. The instructor will also introduce himself and ask students to provide their information so we can familiarize ourselves with each other.
May 14, 2019
Title	Electronic Health Records and Systems for Population Health
Overview	In this first lecture, we explore the definition of an electronic health record (EHR) and EHR systems. Other health information systems used in clinical and public health will also be described in comparison to EHR systems. The goal is to provide students with limited exposure previously to HIT systems to understand the general nature and purpose of health information systems as these foundational aspects will be important to understanding HIE and how it "fits" into the broader picture of clinical and population health.  Objectives At the end of the module, the student should be able to: • Define an electronic health record (EHR) and EHR system • Define a health information system • Outline the types of data found in operational health IT systems • Compare and contrast various types of health IT systems • Discuss how health information systems support patient care and the process of health care delivery.
May 21, 2019
Title	Information Exchange for Population Health: Background, Drivers, and Barriers
Overview	This lecture will introduce students to HIE in the context of population health. Basic definitions for HIE (both a verb and a noun) and its relationship to population health will be outlined. The lecture will further review the intended benefits of HIE and socio-political drivers of HIE in the United States and abroad. Barriers to HIE will also be explored. This lecture builds upon the foundations in informatics/info systems and layers in the concept of "clinical population health." HIE and its role in clinical pop health will be explored.  Objectives At the end of the lecture, the student should be able to: • Define and list various forms of health information exchange (HIE) in clinical and public health contexts. • Discuss the general move in clinical and public health towards automation and use of electronic health information • Define and discuss the concept of population health • Compare and contrast notions of clinical versus "public health" population health • Discuss how HIE supports public health functions as well as population health management • Identify the drivers to HIE • Outline the intended benefits of HIE • List and describe barriers to the adoption and usage of HIE
May 28, 2019
Title	Population Health Information Infrastructure and Architecture
Overview	This lecture will initiate a focus on the technological components of the population health enterprise and how HIEs fit into health systems. Students will be introduced to the various technical architectures used by HIEs and their relative strengths and weaknesses. The lecture will also describe the core technical functionalities/services that need to be present to act upon data and information as it is exchanged between clinical and public health organizations.  Objectives At the end of the lecture, the student should be able to: • Define the concepts of a) a health information infrastructure and b) a technical architecture  • Identify and describe three types of HIE architectures • Discuss how HIE architectures complement clinical and public health information infrastructures • List and describe the various technical components of an HIE, such as a concept dictionary and master person index (MPI)
June 4, 2019
Title	Messaging, Interoperability & Standards
Overview	Foundational to HIE is the notion of messaging - electronically routing a packet/document from one provider (or IT system) to another. This module will explain the concept of messaging and explore messaging systems in HIE networks. In addition, this lecture will describe the concepts of interoperability, which enables two IT systems to exchange messages, and standards, which are technical guidelines that facilitate interoperability between IT systems. Examples drawn from the exchange of date with the Veterans Health Administration, Social Security Administration, and statewide HIE initiative from the Office of the National Coordinator will be used to enable in-depth exploration of how data standards can form a basis for scaling exchange across jurisdictions, states, and regions.  Objectives  At the end of the lecture, the student should be able to: • Define and compare the concepts of messages, interoperability, standards, controlled vocabulary, and value set • Discuss the role of standards to the development and operations of an HIE initiative • Describe the challenges associated with utilizing available standards for HIE services • Explain the role of technical validation and the use of reference implementations • Discuss the challenges associated with mapping local terms to international standards • List and describe various available value sets
June 11, 2019
Title	The Critical Role of Registries: Identifying and Linking Patients, Facilities, and Health Workers Across Disparate Systems
Overview	Foundational to exchanging data between clinical and public health organizations or even within a large, complex state health department is the ability to link disparate records. Techniques for record linkage will be presented in this lecture. Methods for matching records when patient identities are known will be discussed along with methods when identities are not known. These methods rely heavily on statistical models, so students should be prepared to brush up on their stats prior to class discussions and exercises.  In addition to matching patient identities, the ability to identify health facilities and workers is important, especially in the developing world. The concepts of Client (Patient), Facility, and Health Worker registries will be covered in the module. Objectives At the end of the lecture, the student should be able to: • Define the concepts of a registry, master person index (MPI), and facility identifier • Distinguish between deterministic and probabilistic matching algorithms used to link individual identities in an HIE • Identify and describe techniques for matching records even when individual patient identities are not known • Discuss the role of a record locator service (RLS) in a distributed network • Distinguish between client (patient), facility, and health worker registries  • Discuss the importance and challenges associated with identifying facilities within an HIE network.
June 18, 2019
Title	Putting the Pieces Together: The Shared Health Record and Health Management Information System
Overview	In the prior modules, we discussed components of an HIE architecture and how, in theory, they "fit" together to support HIE among a network of providers. In this module, we focus on demonstrating the "fit" or how the network's component parts work together through case studies as well as an in-depth look at the Shared Health Record (SHR) component. It is the SHR that creates a longitudinal accounting of health events, problem lists, medications, etc. On top of the SHR, one can implement a Health Management Information System (HMIS) that enables population-level analysis of health and well-being. In this module, we will explore the SHR and HMIS as well as consider examples of population-level HIE efforts in Indiana, New York and Maryland.  Objectives At the end of the lecture, the student should be able to: • Identify and describe the differences between an electronic medical record, electronic health record, and a shared health record • Explain the role of a shared health record in HIE • Discuss the role and benefits of a health management information system within a health information exchange • Define a population health indicator • Identify and describe application domains for a health management information system • Define a database management system • Discuss emerging trends likely to shape the evolution of shared health records and health management information systems.
June 25, 2019
Title	Ethics, Governance, and Security of Information Exchange
Overview	This lecture will describe and discuss the importance of governance, which is the means by which an HIE network ensures that its policies, processes, and procedures are appropriate, implemented correctly, and effective. The lecture will discuss the attributes of good governance for HIE and review the core policies and processes necessary for HIE. Much of the policies affecting HIE stem from privacy and security laws and regulations as well as general medical ethics. Applicable laws and regulations governing the exchange of health information between clinical and public health organizations will be reviewed. The role and current discussions regarding patient consent and the right to opt-out versus opt-in to HIE will also be presented. The concept of a data use agreement will be introduced, and the lecture will provide an in-depth look at the data use agreement used in the Indiana Network for Patient Care (INPC) and the one used by the eHealth Exchange network. Objectives At the end of the lecture, the student should be able to: • Describe the attributes and criteria for good governance of HIE • Identify the core policies and procedures necessary to govern HIE operations and activities • List key stakeholders that would make good Board members Define privacy, security, confidentiality, and transparency in the context of HIE • Identify the major U.S. laws and administrative rules governing exchange of sensitive health data • Discuss the ethical foundations for private, secure exchange of health data to improve population health • Review data use agreements and other HIE legal documents
July 2, 2019
Title	Managing the Business of HIE: Towards Sustainability
Overview	HIEs are businesses that must focus on sustainability. This module will explore the concept of sustainability and why it is important to HIE. This module will further describe common services provided by existing HIEs. It will describe each service in-depth, outlining the data senders, data receivers, the workflows associated with the service, and a sense for the number of HIEs offering this service. Objectives At the end of the lecture, the student should be able to: • Define sustainability and explain how it is applied to HIE • Explain how sustainability differs for the three forms of HIE: Private, Government-facilitated, and Community-based • Describe, in financial terms, the ways in which an unsustainable HIE business can move to a sustainable financial position • Describe the importance of the alignment of mission, organizational structure, and business model and examples of how misalignment can undermine an HIEs sustainability • Identify and understand challenges to HIE sustainability resulting from factors outside the HIE itself.
July 9,     2019	Title: Evaluation and Research on Health Information Exchange
Overview	This lecture will describe and discuss HIE research and evaluation. A framework for the evaluation of HIE will be introduced, and students will be shown how to design evaluations for measuring the impact of HIE on process as well as population outcomes. Examples of prior HIE studies will be used to examine study design, measurement selection, analysis fit, and dissemination issues. Objectives At the end of the lecture, the student should be able to: • Design an evaluation study of HIE • Choose appropriate measures for an HIE evaluation study • Critique an evaluation study on HIE
July 16, 2019	Title: Illustrating Information Exchange between Clinical and Public Health
Overview	There are multiple public health use cases in which HIE is being used to monitor the health of a population. This module will focus on a several examples: electronic laboratory reporting (ELR), syndromic surveillance, cancer registries, case reporting, chart review, and decision support. Together we will examine each use case from multiple perspectives including the provider, public health and the HIE. We will also examine emerging trends in leveraging HIE to support public health activities under the meaningful use program.  Objectives At the end of the lecture, the student should be able to:  • Define electronic laboratory reporting (ELR) and identify the technical systems involved in reporting lab data to public health • Discuss the policies and requirements for reporting information to public health agencies • Describe available methods that facilitate ELR and other forms of HIE with public health agencies • Discuss the impact of meaningful use on HIE between clinical and public health organizations • List common scenarios where HIE between clinical and public health organizations would be beneficial • Discuss the benefits to public health agencies in leveraging HIE to perform common tasks in PH practice
July 23, 2019	Title: Implementation and Adoption of HIE in the Context of Global Health  Lecturer: Shaun Grannis, MD, MS, FACMI
Overview	During the course, we primarily examined HIE within the context of the U.S. with some readings influenced by HIE activities abroad. In this module, we explore how HIE can be an important element of a nation's eHealth strategy as defined by the World Health Organization. We further examine the unique drivers and barriers to HIE in resource-constrained environments.  Objectives At the end of the lecture, the student should be able to: • Define global health informatics • List and describe some examples of international HIE efforts Describe international laws and/or regulations that influence the need or implementation of HIE in other countries • Compare implementation challenges globally to those of us in the U.S.

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July 30,  2019
Title: Future Directions Shaping HIE: Challenges and Trends

Overview - During the course, we primarily considered examples of HIE to support either population health management by providers or population health analysis by governmental public health agencies.  At the end of the course, we consider a broader array of emerging HIE-based technologies that have the potential to transform both population health and direct-to-consumer care management. As always, we examine system design and challenges to implementation as identified from cutting-edge research. This module also provides a recap of the semester and thoughts on challenges that HIE must address to improve adoption and use in the next decade and beyond. 

Objectives - At the end of the lecture, the student should be able to: 

• • Describe outstanding challenges that HIE must address in order to improve adoption and use


• • Discuss the potential role of HIE in transforming population health in the future


• • Discuss the potential role of HIE in engaging patients in self-management


• • Identify emerging technologies to support both pop health as well as patient engagement.

Logistics

This course will be principally structured as a series of didactic, weekly lectures on the fundamentals of HIE with readings, activities, and discussion to supplement formal instruction. Students will be asked to complete weekly assignments to measure learning and engage in class discussions using the online platform. Students will further complete a synthesis paper, integrating evidence from three recent systematic reviews and discussing the existing evidence base for HIE. Students will further design their own HIE evaluation, submitting a structured abstract in lieu of a final exam.

The course uses the following teaching modalities:

• • Online Discussions – Students will be asked to virtually introduce themselves to their peers at the beginning of the course. Students will also be asked to periodically post information online about current events, news items of interest, or other information they feel is relevant to the course to advance learning outside the classroom. In addition, students will be asked to participate in online discussions based on the reading materials and class lectures. The instructor will post questions for the students to address, and students will be expected to respond to the instructor and each other. All students are expected to participate in online learning activities.


• • Homework – Students will be periodically assigned tasks to complete that will require work beyond the timeframe of a single week. Students will usually have 2-3 weeks to complete the homework assignment. Homework may include tasks such as the analysis of HIE data extracted from real-world technical systems; design of an HIE architecture; execution of scripts for processing health care data; locating information on clinical guidelines; or generating reports on HIE system activity. Students will complete the assigned tasks then submit their results and/or a report detailing their results/experiences.


• • Synthesis Paper – Students will be asked to complete a 5-7 page double-spaced paper on a topic assigned by the instructor or TA. The paper should address specific question(s) in a topic of relevance to information exchange. For example, the instructor may ask students to perform a thorough literature review on privacy laws relevant to public health data exchange; analysis of data captured by or transmitted between disparate information systems; an algorithm designed to enhance patient matching; a module to interpret data or information received from a sending application using HL7 standards; or an implementation guide for exchanging data between clinical and public health systems. Students will have approximately 3-5 weeks to work on the assignment, allowing time to incorporate concepts and examples from the course.


• • Abstract – Students will submit a one (1) page abstract, summarizing their design for a project to evaluate HIE. The style will be that of a typical professional abstract submitted for presentation at a conference such as AMIA, APHA, or the CDC’s Public Health Informatics Conference. A prototype format is as follows: BACKGROUND/INTRODUCTION, OBJECTIVE, STUDY DESIGN, METHODS, OUTCOME VARIABLES, DATA SOURCES, DATA ANALYSIS, and RELEVANCE TO POPULATION HEALTH. These sections are suggestions; not all evaluations will lend themselves to this outline. More detail about the format and style of the abstract will be provided by the instructor.


• • Presentation – In addition to submitting the abstract to the instructor for grading, students will present their abstract to their peers in the final class session. Students should present a 10-15 minute professional presentation that follows the outline of the abstract. Students should expect questions from the instructors and peers.


• • Peer Evaluations - Students will be asked to peer-review others' homework assignments. This is because peer review is a natural occurring role as a professional in the health sciences. Colleagues peer review conference abstracts, papers, memos, reports, etc. It is expected that students will read the submissions assigned to them within a 1-2 week timeframe. Furthermore, comments should be constructive and refrain from using profanity or other unprofessional language. Peer review comments can influence the instructor's grading of an assignment. Furthermore, failure to peer review others' work will negatively impact the grade of the assigned reviewer.

Learning Objectives

At the completion of this course, the learner will be better able to:

1. 1. Define and distinguish public health from population health.


2. 2. Define and discuss electronic information exchange of individual as well as population data in support of clinical, public, and population health.


3. 3. List and describe key technical systems and components necessary to achieve electronic information exchange between clinical and/or public health organizations (or departments within the same organization).


4. 4. Identify key policy drivers that facilitate the move towards broader information exchange and interoperability of health information systems.


5. 5. Identify key barriers that inhibit broader adoption of electronic information exchange policies, governance, and technologies that would enable sharing of data among the disparate parts of the broader health system.


6. 6. Identify and describe techniques for matching records, even when individual patient identities are not known.


7. 7. Discuss the important role that technical standards play in facilitating interoperability among disparate health information systems.


8. 8. Discuss the needs of a ministry of health with respect to integration of data and information among multiple disparate systems deployed within its jurisdiction.


9. 9. Review and critique an evaluation of a system designed to integrate disparate health information for the purposes of population health.


10. 10. Describe and discuss the ethical and legal foundations for private, secure exchange of health data among clinical and public health organizations.

Required Textbook

Health Information Exchange: Navigating and Managing a Network of Health Information Systems
Brian E. Dixon
Academic Press, 2016
ISBN 9780128031353
http://store.elsevier.com/Health-Information-Exchange/isbn-9780128031353/

Also available at the IUPUI Bookstore, Amazon, and in eBook (9780128031506) at various price points.

Hardware/Software Requirements

• • A computer with an Internet connection.


• • Internet Explorer 8 or higher, Firefox 4.x or higher, Safari 2.x or higher, or any other W3C standards compliant browser


• • HTML5-capable browser for video or audio play or download


• • Additional software such as PowerPoint® or Adobe Acrobat Reader software

Evaluation and Grading Scale

The final grade will be a weighed composite of many smaller grades. This should create a fair result.

The conversion table from numerical format to letter grades is as follows:

Grade	Percentage
A+	97-100
A	93-96
A-	90-92
B+	87-89
B	83-86
B-	80-82
C+	77-79
C	73-76
C-	70-72
D	60-69
F	0-59

Grades will be based on a weighted scale distributed as follows:

#	Assessment Method	Percent
1	Online Discussions	10
2	Homework	50
3	Synthesis Paper	15
4	Evaluation Abstract & Presentation	15
5	Peer Evaluations	10
	Total	100

Guidelines

Late work
Assignments are due by the date and time posted in Canvas; generally assignments will be due at 11:59 pm on Mondays. Severe weather rarely results in cancellation of classes or changes in due dates/times of assignments. As such, previously assigned work will still be due as posted in Canvas. Please clarify with the instructor regarding due dates of assignments.

Extensions
Extensions may be granted in the case of exceptional circumstances. You must discuss these circumstances with your instructor at least 24 hours before the assignment is due. (Note: discussing the situation is not the same as merely informing your instructor). In order for a late assignment to receive full marks, it must include a note from the instructor confirming the extension date. An instructor note, attached to your assignment, can include a printed copy of an e-mail exchange between instructor and student indicating that an extension has been granted. Medical reasons for a late assignment must be documented by a doctor’s note. Under normal circumstances (according to university regulations) medical excuses must be presented promptly (within two weeks from the date of the illness).

Attendance

Students are responsible for all lecture materials and assignments. Students will participate in class using Canvas (https://canvas.iu.edu/lms-prd/app). Each week the instructor will create a module that will consist of assigned readings, one or more recorded lectures, assignments, and class discussion questions. Students will use the online learning management system Canvas to download all materials for the module and complete all assignments. Assignment due dates will be posted in Canvas. Grades will be recorded in Canvas, and feedback on assignments will be provided using Canvas.

Beyond 10x10

The goal of the AMIA 10x10 program is to train future leaders in the development, dissemination, and evaluation of information technology as it relates to the healthcare environment. 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. More details about further training opportunities are available on The Indiana University-Purdue University Indianapolis website at www.pbhealth.iupui.edu