AMIA-OHSU 10x10 Program

Logistics, Accessing Demo, Detailed Curriculum, Learning Objectives, and Additional Information

William Hersh, M.D.
Department of Medical Informatics & Clinical Epidemiology
Oregon Health & Science University
Course Director
Last updated: July 20, 2011

Next offering of the course

Objectives

The goal of the AMIA-OHSU 10x10 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. The course also aims to provide an entry point for those wishing further study (and 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).

The 10x10 (“ten by ten”) 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 the year 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. The goal of 10x10 was operationalized by Dr. William Hersh of Oregon Health & Science University (OHSU), which already had an online course in biomedical and health informatics when the program was launched. The OHSU offering of 10x10 was the original offering in the program and has had the largest enrollment.

The 10x10 program aims to provide introductory training to build the workforce that will enable information technology to improve the quality, safety, and cost-effectiveness of healthcare and public health. Since the program was launched in 2005, over 1,000 people, mostly from the US but also from a variety of international locations, have completed the course. About 15% of those completing the course have gone on to advanced study in the field.

Course Logistics

The course is offered in two parts:

An 11-unit Web-based component that is provided through readings, voice-over-Powerpoint lectures, interactive discussion, and self-assessment tests.
An intensive one-day in-person session that brings attendees together to integrate the material, allow presentation of course projects, and meet leaders in the field as well as other students.

The course is an adaptation of the on-line Introduction to Biomedical Informatics class currently taught in the OHSU biomedical informatics education program. This survey course provides a broad overview of the field, highlighting the key issues and challenges for the field. The course is taught in a completely asynchronous manner, i.e., there are no "scheduled" classes. However, students must keep up with the course materials so they can benefit from the interactive discussion with faculty and other students. The course uses the following teaching modalities:

Voice-over-Powerpoint lectures - These are 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 interactive discussion on important issues using on-line discussion forums.
Reading assignments - The course uses the best-known general textbook in the field, Biomedical Informatics - Computer Applications in Health Care and Biomedicine, by Shortliffe and Cimino (eds.), with supplemental readings as necessary. In addition, students are pointed to key other documents, reports, and papers from the field.
Homework/quizzes - Each of the units is accompanied by a 10-question multiple-choice self-assessment that aims to have the student apply the knowledge from the unit.

The on-line part of the course is accessed via the Sakai course delivery tool. At the onset of the course, each student is provided a login and password by the OHSU distance learning staff, who also provide technical support for the course. Students are required to purchase the textbook; all other assigned readings are either freely available on-line or provided by OHSU. Students are expected to keep up with the materials each week and participate in ongoing discussion. They should anticipate spending 4-8 hours per unit on the course. All on-line activities are asynchronous, so there is no specified time that a student must be on-line.

The goal of the course project is for students to identify an informatics problem in their local setting (e.g., where they practice or work) and propose a solution based on what is known from informatics research and best practice. It is due before the in-person session at the end of the course. If a student does not have access to a health care setting, they can do the project in another setting, such as a company or organization. Here are the details of the assignment:

You should assess some local setting (work environment, practice, hospital, etc.) to identify an informatics-related problem or a problem that could be improved by an informatics solution.
Based on your knowledge of research and best practices in informatics, you should propose a solution to the problem.
The problem and solution should be written into a 2-3 page document that should include references that justify the framing of the problem and the proposed solutions.
The room at the in-person session will have round tables, and students 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.

Accessing a Demo Version of the Course

A demo version of the introductory graduate course from which 10x10 is derived can be accessed at the URL:
http://sakai.ohsu.edu/xsl-portal/site/b6042e92-ea91-442a-af63-d3f882d2e88c
From this page, log in with the following:
Username: bmi_demo
Password: format

Readings

The course has no textbook. Students are provided assigned readings from 1-3 key articles or reports for each unit. A comprehensive lists of references for topics covered in the lectures is also provided.

Instructor

The instructor for the course is William Hersh, MD. The best way to reach him is via email (hersh@ohsu.edu). You may also find interesting reading in his blog.

Syllabus

The following table outlines the curriculum with unit number, topic, and reading assignment. The course in general runs with two weeks in a row of posted materials and then a third week to finish the work. The due date for each unit is when the next cycle of material is posted. We are lenient about giving extensions but participants are strongly encouraged not to fall behind, since it can be difficult to catch up.

Unit	Topic
1	Overview of Field and Problems Motivating It
2	Biomedical Computing
3	Electronic and Personal Health Records (EHR, PHR)
4	Standards and Interoperability; Privacy, Confidentiality, and Security
5	Meaningful Use of the EHR
6	EHR Implementation and Evaluation
7	Evidence-Based Medicine
8	Information Retrieval and Digital Libraries
9	Imaging Informatics; Telemedicine
10	Translational Bioinformatics and Personalized Medicine
11	Organizational and Management Issues in Informatics

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
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
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: Approaches and Historical Perspectives
5.4 Reminders and Alerts
5.5 Computerized Provider Order Entry (CPOE)
5.6 Health Information Exchange
5.7 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 Usage of the EHR
6.4 Outcomes of the EHR
6.5 Cost-Benefit of the EHR
6.6 Clinical Research Informatics
6.7 Public Health Informatics

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 Healthcare
9.2 Modalities of Imaging
9.3 Digital Imaging
9.4 Telemedicine: Definitions, Uses, and Barriers
9.5 Efficacy of Telemedicine
9.6 Patient-Provider 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

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

Learning Objectives

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 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; Privacy, Confidentiality, and Security

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. Differentiate the definitions of privacy, confidentiality, and security
6. Describe the elements of HIPAA and other privacy and security issues in healthcare

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. Evidence-Based Medicine

1. Define the key tenets of evidence-based medicine (EBM) and comparative effectiveness research (CER).
2. Construct answerable clinical questions and critically appraise evidence answering them.
3. Apply the key statistics of EBM for intervention studies, including discerning relative and absolute risk.
4. Understand the critical appraisal of other key clinical questions of diagnosis, harm, and prognosis.
5. Discuss the benefits and limitations to summarizing evidence.
6. Describe how to implement EBM in clinical settings and its limitations.

8. Information Retrieval and Digital Libraries

1. Enumerate the basic health and biomedical 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 health and biomedical 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 facing 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-provider communications.

10. Translational Bioinformatics

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.

11. Organizational and Management Issues in Informatics

1. Understand the role of organizational behavior and other issues in implementing health IT systems.
2. Be able to apply the principles of change management in leading implementation of health IT interventions.

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 structured, however, to allow those who complete the course to carry the credits forward into graduate programs in informatics. While moving into the OHSU program is straightforward, doing so with other programs requires getting the agreement of that particular program.

Since the course is an adaptation of the introductory course in the OHSU biomedical informatics, those who complete the 10x10 course are able to obtain credit for the course in the OHSU program. Before enrolling in the OHSU Graduate Certificate or Master's Degree program, students need to pass the (optional) final examination for the OHSU 10x10 course that is offered at the end of each course. Upon passing the final exam and enrolling in the program, they are 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.

The OHSU Biomedical Informatics Graduate Program is designed in a "building block" fashion, so work done at a lower level can be carried forward to higher levels. This is depicted in the figure below. Students who have completed 10x10 have gone on to graduate from the Graduate Certificate as well as the Master's Degree. One 10x10 student is currently in the OHSU PhD program!

Building blocks

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.

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 National Library of Medicine-funded fellowship program, Graduate Certificate Track in Health Information Management (HIM), and master's degree programs in bioinformatics.

More Detailed History of the Course

The 10x10 program was launched in 2005 by the American Medical Informatics Association (AMIA) and Oregon Health & Science University (OHSU). The genesis for the program came when then-President of AMIA, Dr. Charles Safran, called for at least one physician and one nurse in each of the 6000 hospitals in the US to have some training in medical informatics.

At that time, the biomedical informatics distance learning program at OHSU was mature and included an introductory course that I had been teaching on-line for nearly a decade. I proposed to AMIA that we re-package this course into a standalone course that included an in-person session at the end (not present in the OHSU course) that brought participants together for interaction and additional learning. Based on Dr. Safran's numbers and my knowledge of the scalable capacity of the distance learning course, I proposed that we name the program 10x10, embodying the aim of training 10,000 individuals in medical informatics by the year 2010.

The course is not limited to physicians and nurses, nor is it limited to US citizens. Those who complete the course (and are eligible for graduate study, i.e., have a baccalaureate degree) can subsequently obtain credit for the introductory course in the OHSU and enroll to take further courses in the OHSU Biomedical Informatics Graduate Program.

The first cohort of 44 students completed the 10x10 course in 2005. In addition to the "standard" offering of the course being offered to coincide with the in-person session at the end coinciding with an AMIA spring or fall meeting, a number of special offerings have been developed, tailored to specific audiences. These include:

California Health Care Foundation (2006) - California physicians
American College of Physicians (2007) - internal medicine physicians
Scottsdale Institute (2007) - an organization of innovative health care systems
Mayo Clinic (2007 and 2008) - senior nursing executives, embedded in a larger program centered around health care quality
Society for Technology in Anesthesiology (2008) - anesthesiologists
American College of Emergency Physicians (2008-2011) - emergency medicine physicians
Gateway Consulting (2009-2011) - offering of course in Singapore
American Dietetic Association (2011) - dieticians

In addition, AMIA received a grant from the Centers for Disease Control and Prevention (CDC) in 2008 to organize education for public health professionals in public health informatics in 2008. Part of the grant went to providing the tuition for some of those professionals to enroll in several 10x10 offerings, including OHSU's.

Students in 10x10 have come not only from the US, but also from many other countries, including Canada, Argentina, Hong Kong, Singapore, Kuwait, Pakistan, Israel, and Thailand. One of the original students from Argentina, Dr. Paula Otero, translated the course into Spanish and has delivered it to 380 individuals across Latin America.

The course has also inspired federal legislation in the US, leading to the 10,000 Trained by 2010 Act, introduced by Rep. David Wu (D-OR). The bill was passed by the US House in the 111th Congress (2009-2010), and elements of it were incorporated into the HITECH Act. The HITECH program includes funding for Health IT Workforce Development, including grants awarded to the OHSU program.

For more information

More information about 10x10 can be found on the AMIA web site at:
http://www.amia.org/10x10/
Information about the most current OHSU offering is at:
http://www.amia.org/10x10/partners/ohsu/

A number of papers have been written about the 10x10 program:
Hersh, W. and Williamson, J. (2007). Educating 10,000 informaticians by 2010: the AMIA 10×10 program. International Journal of Medical Informatics, 76: 377-382.
Hersh, W. (2007). The full spectrum of biomedical informatics education at Oregon Health & Science University. Methods of Information in Medicine, 46: 80-83.
Feldman, S. and Hersh, W. (2008). Evaluating the AMIA-OHSU 10x10 program to train healthcare professionals in medical informatics. AMIA Annual Symposium Proceedings, Washington, DC. American Medical Informatics Association. 182-186.
Otero, P., Hersh, W., et al. (2010). A medical informatics distance-learning course for Latin America - translation, implementation and evaluation. Methods of Information in Medicine, 49: 310-315).