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Providence-OHSU Informatics Course

Logistics, Detailed Curriculum, Learning Objectives, and Other Information

    

William Hersh, M.D.
Department of Medical Informatics & Clinical Epidemiology
Oregon Health & Science University
Course Director
Last updated: January 8, 2013

Objectives

The goal of the Providence-OHSU Informatics Course is to provide a detailed overview of biomedical and health informatics to Providence employees and others who work (or desire to 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
Providence-OHSU Informatics Course is an adaptation of the well-known 10x10 (“ten by ten”) course offered by OHSU and the American Medical Informatics Association. The course also allows those who successfully complete it (and are eligible for graduate education, i.e., have a bachelor's degree) to enroll in the OHSU biomedical informatics graduate program to pursue further courses and/or a graduate degree.

Course Logistics

The course is offered in two parts:
  1. A 10-unit Web-based component that is provided through readings, voice-over-Powerpoint lectures, interactive discussion, and self-assessment tests. This portion of the course will start on February 6, 2013 and run through May 15, 2013.
  2. Two in-person sessions locally at a Providence location (with capability for others to participate remotely) that brings attendees together to integrate the material, allow presentation of course projects, and meet other students. The first session will be mid-way through the course while the final session will be prior to the optional final exam. (Exact dates to be determined, likely to be in late March and again in early May.)
Registration information will be available in early January, 2013. The cost of the course will be $1800 per person. Participants will be able to use the Providence employee tuition benefit for the course.

This course and the 10x10 course itself are adaptations 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:
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 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., Providence work setting) 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, with permission of the instructor. Here are the details of the assignment:

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
Date Posted
1
Overview of Field and Problems Motivating It
2/6/13
2
Biomedical Computing 2/13/13
3
Electronic and Personal Health Records (EHR, PHR)
2/27/13
4
Standards and Interoperability; Privacy, Confidentiality, and Security 3/6/13
5
Meaningful Use of the EHR
3/20/13
6
EHR Implementation and Evaluation
3/27/13
7
Evidence-Based Medicine
4/10/13
8
Information Retrieval and Digital Libraries 4/17/13
9
Imaging Informatics; Telemedicine
5/1/13
10
Translational Bioinformatics and Personalized Medicine
5/8/13

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 (CDS)
5.4 Computerized Provider Order Entry (CPOE)
5.5 Health Information Exchange (HIE)
5.6 HITECH, ARRA, and Achieving Meaningful Use

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


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

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

9. Imaging Informatics and Telemedicine
9.1 Imaging in 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

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.

Beyond the Course

The goal of the Providence-OHSU Informatics Course 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 program is structured to allow those who complete the course to carry the credits forward into OHSU's informatics graduate programs.

Since the course is an adaptation of the introductory course in the OHSU biomedical informatics, those who complete the 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 course that is offered at its conclusion. 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 the Providence-OHSU Informatics Course have gone on to graduate from the Graduate Certificate as well as the Master's Degree.

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.