The goal of this course is to provide a detailed overview of biomedical and health informatics to those who will work at the interface of healthcare and information technology (IT). The course also aims to provide an entry point for those wishing further study (and/or career development) in the field. It provides a broad understanding of the field from the vantage point of those who implement, lead, and develop IT solutions for improving health, healthcare, public health, and biomedical research. It provides up-to-date details on current events in the field, including electronic health records, data standards and interoperability, clinical decision support, healthcare data analytics, population health, patient engagement, and telemedicine. It also describes and sets the context for new technologies, such as SMART on FHIR, machine learning, wearables, and blockchain. Although the course has a clinical orientation, many non-clinicians working in health IT environments have found the course accessible and the knowledge gained invaluable to their professional development.
The 10x10 course gets its name from its original goal when launched in 2005 of educating 10,000 healthcare and related professionals in biomedical and health informatics by 2010. The goal of 10,000 individuals came from an assertion by former AMIA President Dr. Charles Safran that the US needed at least one physician and one nurse trained in medical informatics in each of the country’s 6,000 hospitals. The needs are equally strong beyond the US in the rest of the world and for professionals beyond physicians and nurses. The goal of 10x10 was operationalized by Dr. William Hersh of Oregon Health & Science University (OHSU). The OHSU offering of 10x10 was the original offering in the program and has had the largest enrollment. The success and continued interest in the course has led us to continue it beyond the original 2010 goal. Since the program was launched in 2005, over 2,500 people, mostly from the US but also from a variety of international locations, have completed the course. About 10-15% of those graduating have gone on to further graduate study in the field, mostly at OHSU.
The target audience for this Internet enduring material activity is physicians, other healthcare professionals, and non-healthcare professionals with an interest in biomedical and health informatics.
The course is offered in two parts:
1. A 10-unit Web-based component starting April 3, 2019. The Web-based portion is provided through readings, on-line lectures, interactive discussion, and self-assessment tests. (Quizzes are required to be completed but grades do not count towards a final grade.)
2. An intensive one-day in-person session held in conjunction with an AMIA meeting (see below). 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.
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 also allow participants to forego the in-person session if hardship or other reasons prevent them from attending a session, although we strongly encourage attendance to complete their learning experience.) The next available AMIA meetings include:
- 2019 AMIA Annual Symposium, November 16-20, 2019; Washington, DC
- 2020 AMIA Informatics Summit, March 2020, Houston, TX
The registration deadline for the course is April 3, 2019. We will accept enrollees after that date on a space-available basis.
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 Flash, HTML 5, or a special iPad player. As such, 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 (LMS). 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 and 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 of the self assessment tests, the course project, and participate in class discussions to receive the AMIA 10x10 Certificate of Completion. Physicians are eligible for up to 46.5 hours of AMA PRA Category I CME Credit(s).™ Because the course is continuing education, it does not use academic letter grades (e.g., A, B, etc.). However, those wanting academic credit by taking the optional final exam (see below) will be assigned a letter grade based on their score on the exam.
It is critical to contact the appropriate person when problems arise:
- For basic Sakai problems (cannot log in, something not apparently working) and course issues (e.g., unit or discussion forum not posted when it should be), contact the Sakai Help Desk at 877-972-5249 or firstname.lastname@example.org. The Sakai Help Desk hours are 8 a.m. - 10 p.m. Pacific, Mon-Fri and 12-5 p.m. Pacific on weekends.
- For questions about course content (e.g., do not understand a topic or disagree with homework quiz answer), contact the Teaching Assistant (TA), who will be announced at the beginning of the course.
When appropriate, all issues will be elevated to Dr. Hersh. While Dr. Hersh does not maintain scheduled office hours, he is readily accessible via email and will respond within 24-48 hours. Appointments to discuss course matters by phone or in person can be arranged via email.
The instructor for the course is William Hersh, MD. The best way to reach him is via email (email@example.com). Dr. Hersh does not keep regular office hours but phone calls or meetings can be arranged with him. He also maintains a blog, Informatics Professor.
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 also allow participants to forego the in-person session if hardship or other reasons prevent them from attending a session, although we strongly encourage attendance to complete their learning experience.)
The course aims to provide a great deal of interaction among the faculty, students, and teaching assistants. On-line discussion begins for each unit with the instructor posing 2-3 questions per unit. 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. The instructor aims to guide and fill in details of the discussion but not dominate it.
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 your 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 July 3, 2019. (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 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.
Optional Final Exam & Earning OHSU Credit
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.
Those seeking tuition reimbursement from employers or others should check regarding conditions and timelines for reimbursement. Some employers require an official transcript from OHSU showing the final grade before reimbursing class fees. The transcript and course credit are not available until the end of the academic term that follows completion of the 10x10 course.
The course has no required textbook. Students are provided assigned readings from 1-3 key articles or reports for each unit. Students are also provided comprehensive lists of references for topics covered in the lectures.
There is an optional textbook (co-edited by the course instructor) that students may want to consider: Hoyt RE, Hersh WR, Eds. (2018). Health Informatics: Practical Guide, Seventh Edition, which is available from Lulu.com in eBook and paper versions. The reading assignments from the book are optional, and no material will appear on the homework quizzes or final exam that is not also covered in the class. But some students prefer to also read a textbook when learning. The appropriate chapter readings for each unit in the course are as follows:
|1||Overview of Field and Problems Motivating It||1|
|3||Electronic and Personal Health Records (EHR, PHR)||2, 4|
|4||Standards and Interoperability||5|
|5||Advancing Care with the EHR||6, 8, 9|
|6||Healthcare Data Analytics||7, 14|
|7||EHR Implementation and Evaluation||10, 12, 19|
|8||Information Retrieval (Search)||15|
|9||Imaging Informatics and Telemedicine||16, 17|
|10||Research Informatics||18, 20|
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.
|Unit||Topic||Date Posted||Date Due|
|1||Overview of Field and Problems Motivating It||4/3/19||4/24/19|
|3||Electronic and Personal Health Records (EHR, PHR)||4/24/19||5/15/19|
|4||Standards and Interoperability||5/1/19||5/15/19|
|5||Advancing Care with the EHR||5/15/19||6/5/19|
Healthcare Data Analytics
|7||EHR Implementation and Evaluation||6/5/19||6/26/19|
|8||Information Retrieval (Search)||6/12/19||6/26/19|
|9||Imaging Informatics and Telemedicine||6/26/19||7/17/19|
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 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 EHR
3.4 Benefits and Challenges of the EHR
3.5 EHR Examples
3.6 Personal Health Records
4. Standards and Interoperability
4.1 Standards and Interoperability: Basic Concepts
4.2 Identifier and Transaction Standards
4.3 Message Exchange Standards
4.4 Terminology Standards
4.5 SMART on FHIR
5. Advancing Care with the EHR
5.1 Patient Safety and Medical Errors
5.2 Clinical Decision Support (CDS)
5.3 Healthcare Quality Measurement and Improvement
5.4 Computerized Provider Order Entry (CPOE)
5.5 Health Information Exchange (HIE)
5.6 HITECH and Meaningful Use
6. Healthcare Data Analytics
6.1 Data Science and Data Analytics
6.2 Machine Learning
6.3 Natural Language Processing
6.4 Evidence-based Medicine
6.5 Clinical Practice Guidelines
6.6 Population Health
7. EHR Implementation and Evaluation
7.1 Clinical Workflow Analysis and Redesign
7.2 EHR System Selection and Implementation
7.3 Privacy and Security
7.4 Nursing Informatics
7.5 Public Health Informatics
7.6 Consumer Health Informatics
7.7 Evaluation of the EHR
8. Information Retrieval (Search)
8.1 Information Retrieval
8.2 Knowledge-based Information
8.6 Research: Evaluation and Future Directions
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
10. Research Informatics
10.1 Clinical Research Informatics
10.2 Overview of Basic Molecular Biology
10.3 Translational Bioinformatics
10.4 From Clinical Genetics and Genomics to Precision Medicine
10.5 Genomics Data in the EHR and Other Information Systems
Course participants are expected to maintain academic honesty in their course work. Participants should refrain from seeking past published solutions to any assignments. Literature and resources (including internet resources) employed in fulfilling assignments must be cited. See
http://www.ohsu.edu/xd/education/library/research-assistance/plagiarism.cfm?WT_rank=1# for information on code of conduct for OHSU and http://www.ohsu.edu/xd/education/teaching-and-learning-center/for-students/index.cfm for more information on citing sources and recognizing plagiarism.
In an effort to uphold the principles and practice of academic honesty, faculty members at OHSU may use originality checking systems such as Turnitin to compare a student's submitted work against multiple sources. To protect student privacy in this process, it will be necessary for students to remove all personal information, i.e. student name, email address, student u-number, or any other personal information, from their documents BEFORE submission.
The goal of the AMIA 10x10 program is to train clinicians and others 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 physician 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 Department of Medical Informatics & Clinical Epidemiology 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 (46 hours of instruction plus 6 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|
The Web site also has information about OHSU's various fellowship programs, funded by the US National Library of Medicine and others.
OHSU is committed to providing equal access to qualified students who experience a disability in compliance with Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act (ADA) of 1990, and the ADA Amendments Act (ADA-AA) of 2008. If you have a disability or think you may have a disability (physical, sensory, chronic health, psychological, or learning) please contact the Office for Student Access at (503) 494-0082 or firstname.lastname@example.org to discuss eligibility for academic accommodations. Information is also available at www.ohsu.edu/student-access. Because accommodations may take time to implement and cannot be applied retroactively, it is important to have this discussion as soon as possible. All information regarding a student's disability is kept in accordance with relevant state and and federal laws.
Learn more about Student Access:
After participating in this activity the learner should be better able to:
- Describe 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 personal health record (PHR), along with barriers to their use.
- Explain the importance of standards and interoperability of clinical data and the major initiatives underway to enable them.
- Describe the principles of patient safety and how health information technology facilitates and exacerbates it.
- Explain the basic principles of health care quality assessment, including pay for performance programs, and how the EHR enables them.
- 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.
- Discuss health information exchange and its facilitators and barriers.
- Describe the US meaningful use program of EHR incentives.
- Discuss the implementation of the EHR, including workflow analysis and re-design.
- Describe the results of evaluation studies assessing implementation and outcomes from the EHR.
- Discuss informatics applied to nursing, public health, and other specific aspects of the healthcare system.
- Differentiate the difference among privacy, confidentiality, and security and their role in the HIPAA regulations.
- Demonstrate the ability to apply evidence-based medicine and critical appraisal to clinical questions.
- Discuss the basic application of healthcare data analytics.
- Understand the basic medical knowledge resources and be able to search them effectively.
- Describe the management of images in clinical settings, including the use of PACS systems.
- Classify the different types of telemedicine and telehealth, and their efficacy as shown in clinical studies.
- Discuss the role of biomedical and health informatics in clinical and translational research.
- Describe the key issues and findings of translational bioinformatics.
The American Medical Informatics Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit Designation Statement
The American Medical Informatics Association designates this enduring material for a maximum of 46.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Estimated Time Expected to Complete Activity
Estimated time to complete this activity: 46.5 hours
Criteria for Successful Completion
Completion of this enduring material is demonstrated by participation in all online sessions, completion of a Capstone project, completion of participant survey, attendance at an in-person session for class participants with the faculty is optional.
No commercial support was received for this activity.
As a provider accredited by the ACCME, AMIA requires that everyone who is in a position to control the content of an educational activity disclose all relevant financial relationships with any commercial interest for 12 months prior to the educational activity.
The ACCME considers relationships of the person involved in the CME activity to include financial relationships of a spouse or partner.
Faculty and planners who refuse to disclose relevant financial relationships will be disqualified from participating in the CME activity. For an individual with no relevant financial relationship(s), the participants must be informed that no conflicts of interest or financial relationship(s) exist.
AMIA uses a number of methods to resolve potential conflicts of interest, including: limiting content of the presentation to that which has been reviewed by one or more peer reviewers; ensuring that all scientific research referred to conforms to generally accepted standards of experimental design, data collection, and analysis; undertaking review of the educational activity by a content reviewer to evaluate for potential bias, balance in presentation, evidence-based content or other indicators of integrity, and absence of bias; monitoring the educational activity to evaluate for commercial bias in the presentation; and/or reviewing participant feedback to evaluate for commercial bias in the activity .
Disclosures for this Activity
William Hersh, MD, FACMI, FACP, discloses that neither he nor his spouse have relevant financial relationships with commercial interests.
For questions about the 10x10 course please contact Susanne Arnold, Education Program Manager at email@example.com or (301) 657-1291.