From the Beginning: An Introduction to Medical Informatics


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From the Beginning: An Introduction to Medical Informatics

  1. 1. From the Beginning: An Introduction to Medical Informatics William Hersh, MD Professor and Chair Department of Medical Informatics & Clinical Epidemiology Oregon Health & Science University Portland, OR, USA Email: [email_address] Web:
  2. 2. Overview <ul><li>Work and education for physicians in medical informatics </li></ul><ul><li>Web sites with information and glossaries about medical informatics </li></ul><ul><li>Terminology, jargon, and buzzwords of the field </li></ul>
  3. 3. What is (bio)medical informatics? <ul><li> </li></ul><ul><li>Hersh WR, Medical informatics: improving health care through information, Journal of the American Medical Assoc. , 2002, 288: 1955-1958 </li></ul><ul><ul><li>The field concerned with the management and use of information in health care </li></ul></ul><ul><ul><li>It is not only about computers and technology </li></ul></ul><ul><li>Biomedical informatics reflects larger scope </li></ul>
  4. 4. Characteristics of medical informatics <ul><li>It is a heterogeneous field, with physicians, other clinicians, non-clinicians, etc. </li></ul><ul><li>It is not a “cookie cutter” field where all practitioners have a defined set of skills and competencies </li></ul><ul><ul><li>In contrast to accounting, surgery, etc. </li></ul></ul><ul><li>There are few, if any, jobs that require formal training in informatics </li></ul><ul><ul><li>Though many health care IT leaders would benefit from more knowledge of informatics! </li></ul></ul>
  5. 5. Medical informatics is one part of larger health care IT <ul><li>Other professionals in health care IT include </li></ul><ul><ul><li>IT professionals, often with computer science (CS) or management information systems (MIS) backgrounds </li></ul></ul><ul><ul><li>Health information management (HIM) professionals, historically associated with managing medical records departments </li></ul></ul><ul><ul><li>Health science librarians </li></ul></ul><ul><ul><li>Clinicians who gravitate into IT roles with or without formal training </li></ul></ul>
  6. 6. So what distinguishes medical informatics? <ul><li>My view (probably not everyone agrees): Informatics is focused on the information more than the technology </li></ul><ul><ul><li>Another way to look at it: the subject domain matters, may be preeminent </li></ul></ul><ul><li>Is probably the best professional pathway for clinicians (especially physicians) to move into IT jobs of all sorts from academic to operational </li></ul>
  7. 7. Categories of medical informatics practice Adapted from Covvey et al., Pointing the Way, 2001 Health care professional, research assistant/associate Practical CIO, Chief Medical/Nursing Information Officer, Developer, Trainer Applied Informatics researcher or teacher Research Jobs Category
  8. 8. Is medical informatics a profession? <ul><li>According to SWEBOK, a profession is characterized by </li></ul><ul><ul><li>An initial professional education in a curriculum validated through accreditation </li></ul></ul><ul><ul><li>Registration of fitness to practice via voluntary certification or mandatory licensing </li></ul></ul><ul><ul><li>Specialized skill development and continuing professional education </li></ul></ul><ul><ul><li>Communal support via a professional society </li></ul></ul><ul><ul><li>A commitment to norms of conduct often prescribed in a code of ethics </li></ul></ul><ul><li>By this definition, medical informatics is not a profession </li></ul>
  9. 9. But medical informatics is a discipline (Friedman) + > ( ) Person such that an intelligent person (practitioner) working in combination with information resources/technology Technology With is “better” than the person without such support . Person without Support Better Than Creating an environment of “supported practice” Environment Environment
  10. 10. Education in medical informatics <ul><li>Since a highly multi-disciplinary field, no standard curriculum or certification </li></ul><ul><ul><li>Listing of programs on Web site of American Medical Informatics Association ( </li></ul></ul><ul><ul><li>Description of OHSU program to follow as an example; consult other programs’ Web sites for details on their programs </li></ul></ul><ul><li>Education has historically focused on academics but is evolving to meet the needs of practitioners and users </li></ul>
  11. 11. Programs funded by National Library of Medicine <ul><li>Tend to be research-oriented </li></ul><ul><li>Require full-time commitment </li></ul><ul><li>Degrees are usually optional, at least at the present time </li></ul>
  12. 12. Categories of informatics education - Continuing Education Practical - Postdoc ± master’s degree - Master’s Degree - Certificate Applied - PhD - Postdoc ± master’s degree Research Typical Programs Category
  13. 13. Medical informatics education at OHSU <ul><li>Research </li></ul><ul><ul><li>Predoc/Postdoc Fellowship funded by NLM and VA </li></ul></ul><ul><ul><li>PhD in Biomedical Informatics degree </li></ul></ul><ul><ul><li>Master of Science in Biomedical Informatics degree for postdocs from other fields </li></ul></ul><ul><li>Applied </li></ul><ul><ul><li>Master of Science and Master of Biomedical Informatics degrees </li></ul></ul><ul><ul><li>Graduate Certificate Program (distance learning) </li></ul></ul><ul><li>Practical </li></ul><ul><ul><li>Continuing education courses </li></ul></ul>
  14. 14. OHSU numbers Graduates per year Matriculants per year Program (Year started) 2 2 Library Fellowship (1998) 2-4 2-4 Postdoc Fellowship (1992) 10-15 40-50 Certificate (2000) 10-15 15-20 Master’s (1996) None yet 2-3 PhD (2003)
  15. 15. OHSU biomedical informatics core curriculum <ul><li>Master’s and PhD program have core courses in six areas </li></ul><ul><ul><li>Biomedical informatics – Core courses in informatics science and applications </li></ul></ul><ul><ul><li>Organizational and management sciences </li></ul></ul><ul><ul><li>Computer science – Practical introduction to core concepts </li></ul></ul><ul><ul><li>Health and biomedicine – for non-clinicians </li></ul></ul><ul><ul><li>Research methods – quantitative, qualitative </li></ul></ul><ul><ul><li>Thesis/capstone </li></ul></ul><ul><li>Certificate program focuses mainly on first two areas </li></ul><ul><li>PhD program adds specialized research training, cognate area of interest, doctoral seminar, and dissertation </li></ul>
  16. 16. Additional aspects of curriculum <ul><li>Provide opportunities for students in “real world” internships and practicums with local vendors and companies </li></ul><ul><li>Take advantage of local external (aka, “clinical”) faculty for lectures, projects, etc. </li></ul><ul><li>A big challenge, reflecting immaturity of field, is career counseling, professional development, etc. </li></ul>
  17. 17. Distance learning <ul><li>Teaching modalities include </li></ul><ul><ul><li>Voice-over-Powerpoint lectures </li></ul></ul><ul><ul><li>Threaded discussions </li></ul></ul><ul><ul><li>Readings, virtual projects, etc. </li></ul></ul><ul><li>Courses are not correspondence courses; interaction is a core component </li></ul><ul><li>Have created a virtual community </li></ul><ul><ul><li>Receptions at AMIA, HIMSS, OHSU </li></ul></ul>
  18. 18. Graduate Certificate program <ul><li>Designed for established professionals to move into informatics practice </li></ul><ul><ul><li>Over 250 matriculated students, 36 graduates </li></ul></ul><ul><li>Completely Web-based </li></ul><ul><ul><li>Designed for busy adult learners </li></ul></ul><ul><li>Courses are subset of master’s program </li></ul><ul><ul><li>Can be carried forward toward master’s degree </li></ul></ul><ul><li>HIMSS, AMDIS, and AMIA members receive 5% tuition discount (full individual members only) </li></ul>
  19. 19. Graduate Certificate program curriculum <ul><li>Required courses </li></ul><ul><ul><li>Introduction to Biomedical Informatics </li></ul></ul><ul><ul><li>Clinical Systems </li></ul></ul><ul><ul><li>Information Retrieval & Digital Libraries </li></ul></ul><ul><ul><li>Organizational Behavior & Management </li></ul></ul><ul><li>Some select other courses (of ~12) </li></ul><ul><ul><li>Project Management </li></ul></ul><ul><ul><li>Business of Healthcare Informatics </li></ul></ul><ul><ul><li>Computer programming/databases/networks </li></ul></ul><ul><ul><li>Practicum or Research </li></ul></ul><ul><ul><li>“ Local” relevant course </li></ul></ul>
  20. 20. How have our students done? <ul><li>General observation: What people do when they graduate often depends on what they did when they entered, e.g., </li></ul><ul><ul><li>Physicians, nurses, and other clinicians draw on their clinical background </li></ul></ul><ul><li>Graduates have obtained jobs in a variety of settings, e.g., clinical, academic, and industry </li></ul><ul><li>Some have obtained jobs before finishing the program; a few before starting </li></ul>
  21. 21. More information: Web sites <ul><li>What is medical informatics? </li></ul><ul><ul><li> </li></ul></ul><ul><li>American Medical Informatics Association </li></ul><ul><ul><li> </li></ul></ul><ul><li>Health Information Management Systems </li></ul><ul><ul><li> </li></ul></ul><ul><li>Association of Medical Directors of Information Systems </li></ul><ul><ul><li> </li></ul></ul>
  22. 22. Web sites (cont.) <ul><li>National Library of Medicine </li></ul><ul><ul><li> </li></ul></ul><ul><li>Informatics Review </li></ul><ul><ul><li> </li></ul></ul><ul><li>Guide to Health Informatics (Coiera) glossary </li></ul><ul><ul><li> </li></ul></ul><ul><li>British Association of Clinical Terminology Specialists Health Informatics Glossary (acronyms) </li></ul><ul><ul><li> </li></ul></ul>
  23. 23. Leading (only!) general textbook in field <ul><li>Shortliffe et al. (eds.), Springer-Verlag </li></ul><ul><li>Current (second) edition getting out of date </li></ul><ul><li>Third edition due at end of 2004 </li></ul>
  24. 24. Terminology, jargon, and buzzwords <ul><li>Adjective problem </li></ul><ul><li>Politically correct terms </li></ul>
  25. 25. Informatics has an “adjective” problem <ul><li>What should the word(s) in front of informatics be? </li></ul><ul><ul><li>Medical? – Implies only the work of doctors </li></ul></ul><ul><ul><li>Biomedical? – Implies the biomedical model </li></ul></ul><ul><ul><li>Health? – Too broad, leaves out bio- </li></ul></ul><ul><ul><li>Bio-? – Implies basic science </li></ul></ul><ul><ul><li>Nursing? Pathology? Public Health? – Too focused </li></ul></ul>
  26. 26. A larger view of “health and biomedical informatics” (Adapted from Shortliffe in Kukafka et al., JPHPM, 2001) Informatics Health and Biomedical Informatics Bioinformatics Medical Informatics Public Health Informatics Imaging Informatics X Informatics Y Informatics Cells and biomolecules Organs People Populations X and Y might be Legal, Chemical, Social, etc.
  27. 27. Other language issues to demonstrate “in the know” <ul><li>EHR (electronic health record) is politically correct, not EMR (electronic medical record) </li></ul><ul><li>National Health Information Infrastructure refers to all infrastructure (political, legal, regulatory, etc., and not just technical) </li></ul><ul><li>Another emerging item of jargon is healthcare information technology, or HIT </li></ul>
  28. 28. Thoughts about the future <ul><li>These are exciting times for medical informatics </li></ul><ul><ul><li>Bush 2004 State of Union stating benefit of HIT </li></ul></ul><ul><ul><li>National Health Information Infrastructure initiative leading to adoption </li></ul></ul><ul><ul><li>Harris Interactive survey (1/04) of industry leaders shows adoption of HIT is “most significant opportunity” for health care </li></ul></ul><ul><ul><li>Institute of Medicine reports continue to come out and exert influence </li></ul></ul><ul><ul><li>Growth and maturation of HIT industry insures progress (and employment opportunities!) </li></ul></ul>
  29. 29. More thoughts <ul><li>These require that we educate more informaticians as well as others about informatics </li></ul><ul><li>A degree or formal training is not essential now in a young field like ours but will likely become so in the future </li></ul><ul><li>We need to get this right! </li></ul>