• 10x10 with New York State Academy of Family Physicians

    NYSAFP-AMIA 10x10 Informatics Education Program

10x10 with NYSAFP

10x10 with NYSAFP: Course Description


The goal of the AMIA-OHSU 10x10 (“ten by ten”) program 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 the “meaningful use” of electronic health records specified by the Health Information Technology for Economic and Clinical Health (HITECH) Act of the American Recovery and Reinvestment Act (ARRA, also known as the US economic stimulus package) of 2009.  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 program aims to provide introductory training to build the workforce that will enable clinically motivated use of IT to improve the quality, safety, and cost-effectiveness of healthcare and public health.  Since the program was launched in 2005, over 2,200 people, mostly from the US but also from a variety of international locations, have completed the course.  About 20% of those graduating have gone on to advanced study in the field.  

Target Audience

The target audience for this Internet enduring material activity is members of the NYSAFP.

Course Logistics

The course is offered in two parts:

  • A 10-unit Web-based component starting March 1, 2017.  The Web-based portion is provided through on-line lectures, readings, interactive discussion, and self-assessment tests. (Quizzes are required to be completed but grades do not count towards a final grade.) 
  • An intensive one-day in-person session held in conjunction with the NYSAFP meeting on June 23, 2017 in Troy, NY.  The in-person session on June 23 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 who are unable to attend the in-person session for hardship reasons are allowed to opt out of attendance; there are also other opportunities to attend a different in-person session on a different date.)

The registration deadline for the course is March 1, 2017. 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 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, 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 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 46.5 hours of AMA PRA Category 1 CME credits.  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. 

The on-line portion of the course will run from early-March through mid-June 2017.  The in-person session will take place at the NYSAFP meeting in Troy, NY on June 23, 2017.

When Problems Arise

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 sakai@ohsu.edu. The Sakai Help Desk hours are 8 am - 10 pm Pacific Mon-Fri and 12-5 pm Pacific on weekends. The Sakai Help Desk is closed on all OHSU-observed holidays.
  • 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. 

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.


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. 
In addition, there are two optional textbooks that students may want to consider, for which a table below lists chapters appropriate for each unit in the course:

  • Shortliffe, EH and Cimino, JJ, Eds. (2014). Biomedical Informatics: Computer Applications in Health Care and Biomedicine (Fourth Edition). New York, NY, Springer.
  • Hoyt, RE, Yoshihashi, A, et al., Eds. (2014). Health Informatics: Practical Guide for Healthcare and Information Technology Professionals, Sixth Edition. Pensacola, FL, Lulu.com.

The reading assignments from these books are optional and no material will appear on the homework quizzes or final exam that is also not 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:

Unit Topic Shortliffe Hoyt
1 Overview of Field & problems Motivating It 1 1
2 Biomedical Computing 5, 6 7, 11
3 Electronic & Personal Health Records (EHR, PHR) 2, 12, 17 2, 4
4 Standards and Interoperability 7, 8 6
5 Meaningful Use of the EHR 13, 22 5, 15, 16, 17
6 EHR Implementation and Evaluation 11, 15, 16 10, 21
7 Protection and Analytical Use of Data 3, 10 3, 8, 14
8 Information Retrieval (Search) 21 12, 13
9 Imaging Informatics and Telemedicine 9, 18, 20 18, 19
10 Research Informatics 24, 25, 26 20, 22

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 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 June 14, 2017.  (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 and 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 instructor for the course is William Hersh, MD. The best way to reach him is via email (hersh@ohsu.edu).  Dr. Hersh does not keep regular office hours but phone calls or meetings can be arranged with him.  He also maintains the Informatics Professor Blog (http://informaticsprofessor.blogspot.com/). 

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.  



Date Posted

Date Due


Overview of Field and Problems Motivating It




Biomedical Computing




Electronic and Personal Health Records (EHR, PHR)




Standards and Interoperability




Meaningful Use of the EHR




EHR Implementation and Evaluation




Protection and Analytical Use of Data




Information Retrieval & Digital Libraries




Imaging Informatics and Telemedicine




Research Informatics



Detailed Course Outline

1.0 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
2.0 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
3.0 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
4.0 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 Natural Language Processing of Clinical Text
5.0 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 and Achieving Meaningful Use
6.0 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 Nursing Informatics
   6.5 Public Health Informatics
   6.6 Patient Engagement
7.0 Protection and Analytical Use of Data
   7.1 Privacy, Confidentiality, and Security
   7.2 HIPAA Privacy and Security Regulations
   7.3 Evidence-based Medicine
   7.4 Clinical Practice Guidelines
   7.5 Healthcare Data Analytics
  7.6 Analytics and Business Intelligence
8.0 Information Retrieval (Search)
  8.1 Information Retrieval
  8.2 Knowledge-based Information
  8.3 Content
  8.4 Indexing
  8.5 Retrieval
  8.6 Research: Evaluation and Future Directions
9.0 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
10.0 Research Informatics
  10.1 Clinical Research Informatics
  10.2 Bioinformatics - The Big Picture
  10.3 Overview of Basic Molecular Biology
  10.4 From Clinical Genetics and Genomics to Precision Medicine
  10.5 Genomics Data in the EHR and Other Information Systems

Learning Objectives

After participating in this activity, the learner should be better able to:

1.) Overview of Field and Problems Motivating It

1. Define biomedical and health informatics, the terms related to it, and its role in health, healthcare, public health, and biomedical research.
2. Discuss the major problems in healthcare motivating use of biomedical and health informatics.
3. Compare and contrast the roles of various individuals in the health information technology workforce.
4. Describe and find the major sources of electronic and print information for biomedical informatics in the scientific literature and on the World Wide Web.

2.) Biomedical Computing

1. Identify the basic tenets of biomedical computing to be able to inform optimal selection of hardware, software, and network connections for a given health or biomedical setting.
2. Describe the major aspects of software engineering as they relate to biomedical and health informatics.
3. Be able to specify a use case for a biomedical and health informatics functionality.

3.) Electronic and Personal Health Records (EHR, PHR)

1. List the major categories of clinical data along with their content and structure.
2. Identify the essential functions of the electronic health record (EHR).
3. Describe the major barriers to EHR use.
4. Define the personal health record (PHR) and describe its usage, content, and value.
5. Understand the major issues and systems in nursing informatics.

4.) Standards and Interoperability

1. Explain the importance of standards and interoperability for health and biomedical data.
2. Understand the major issues related to identifier standards, including the debate on patient identifiers.
3. Describe the various message exchange standards, their explicit roles, and the type of data they exchange.
4. Discuss the different terminology systems used in biomedicine and their origins, content, and limitations.
5. Understand the techniques and limitations of natural language processing.

5.) Meaningful Use of the EHR

1. Understand the major threats to patient safety and causes of medical error.
2. Explain the basic principles of healthcare quality and how the EHR enables them.
3. Distinguish the different types of clinical decision support and describe their use and limitations in clinical practice.
4. Explain the process of computerized provider order entry and challenges to its use.
5. Understand the goals of health information exchange and how they are carried out.
6. Apply the meaningful use criteria under the HITECH/ARRA legislation.

6.) EHR Implementation and Evaluation

1. Understand the analysis of workflow for EHR implementation.
2. Describe the major steps and challenges in EHR implementation.
3. Discuss the results of the major studies on use, outcomes, and cost-benefit of the EHR.
4. Discuss the role of EHR and other clinical data in clinical and translational research.
5. Describe the ways that biomedical informatics enables public health practice.

7.) Protection and Analytical Use of Data

1. Differentiate the definitions of privacy, confidentiality, and security.
2. Describe the elements of HIPAA and other privacy and security issues in health care.
3. Define the key tenets of evidence-based medicine (EBM) and comparative effectiveness research (CER).
4. Construct answerable clinical questions and critically appraise evidence answering them.
5. Apply the key statistics of EBM for intervention studies, including discerning relative and absolute risk.
6. Describe the use of analytics and business intelligence in healthcare.

8.) Information Retrieval (Search)

1. Enumerate the basic biomedical and health knowledge resources in books, journals, electronic databases, and other sources.
2. Describe the major approaches used to indexing knowledge-based content.
3. Apply advanced searching techniques to the major biomedical and health knowledge resources.
4. Discuss the major results of information retrieval evaluation studies.
5. Define the structure and content of digital libraries and the major issues challenging them.

9.) Imaging Informatics and Telemedicine
1. Describe the management of images in clinical settings, including the use of PACS systems.
2. Understand the different modalities of imaging and their capture and use in digital form.
3. Classify the different types of telemedicine and discuss their uses.
4. Describe the efficacy of telemedicine as shown in clinical studies.
5. Discuss the different approaches to patient-clinician communications.

10.) Translational Bioinformatics and Personalized Medicine

1. Define all aspects of bioinformatics and distinguish its work from other areas of biomedical and health informatics.
2. Understand the role of genetics and genomics in biology and medicine.
3. Discuss the major techniques of bioinformatics, including emerging approaches in gene expression, gene variation, and their association with the phenotype.
4. Describe the concept of personalized medicine and how it is enabled by biomedical and health informatics.
5. Access the major bioinformatics data resources and demonstrate their use.

Accreditation Statement

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. 

Commercial Support

No commercial support was received for this activity.

Disclosure Policy

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.

Instructions for Claiming CME Credit

CME site (MyAMIA) works best with IE 8 or above version, Chrome, and Firefox.

  • Login to the AMIA site
  • Go to “My Events" under Membership/Activities
  • Click “Apply for Credits" link for meeting or event you attended.
  • Follow the instructions on the Credit Registration page.
  • Physicians: To print out your certificate, go to "My CME/CE Credits" under
  • Membership/Activities.
  • Other attendees: if you require a certificate of participation, please contact pesha@amia.org

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

Contact Information

For questions about the 10x10 course please contact Susanne Arnold, Education Program Manager at susanne@amia.org or (301) 657-1291.

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 Department of Medical Informatics & Clinical Epidemiology Web site, but the following table provides an overview of the programs. The Web site also has information about OHSU's various fellowship programs, funded by the US National Library of Medicine and others, and its program track in Health Information Management (HIM).

Program Name


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 OHSU offering of 10x10 aims to impart the following competencies to students:

  •  The value proposition of health information technology and how medical informatics and other fields contribute to it.
  •  The role of various individuals in the health information technology workforce.
  •  The basic tenets of biomedical computing to enable optimal selection of hardware, software, and network connections for a given setting.
  •  The essential functions of the electronic health record (EHR) and the barriers to its use.
  •  The principles of implementing EHRs in ambulatory, hospital, and other settings.
  •  The role of clinical decision support in health care settings and within the EHR.
  •  Computerized provider order entry and how it enhances clinical decision support.
  •  The role of IT in nursing.
  •  The importance of standards and interoperability of clinical data and the major initiatives underway.
  •  Maintaining privacy, confidentiality, and security, including the role of HIPAA.
  •  The convergence of motivations for the secondary use of clinical data.
  •  The basic principles of health care quality assessment, including pay for performance programs, and how the EHR enables them.
  •  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.
  •  The core principles of evidence-based medicine and their application in clinical practice.
  •  Accessing medical knowledge resources and linking them to clinical practice.
  •  People and organizational issues in the use of health information technology.
  •  The unique aspects of nursing information and practice in relation to clinical information systems.
  •  The growing impact of genomics on medicine and its implications for health information systems.
  •  The management of images in clinical settings, including the use of PACS systems.
  •  The role of telemedicine and barriers to its use.
  •  The key issues in organizational, project, and business management in informatics projects and the notion that informatics projects require more than an understanding of technology.
  •  The function of public health information systems and their interaction with clinical systems.

Academic Honesty

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.... for information on code of conduct for OHSU and http://www.ohsu.edu/xd/education/teaching-and-learning-center/for-studen... 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.