From the Beginning: An Introduction to Medical Informatics

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  • 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. Overview
    • Work and education for physicians in medical informatics
    • Web sites with information and glossaries about medical informatics
    • Terminology, jargon, and buzzwords of the field
  • 3. What is (bio)medical informatics?
    • Hersh WR, Medical informatics: improving health care through information, Journal of the American Medical Assoc. , 2002, 288: 1955-1958
      • The field concerned with the management and use of information in health care
      • It is not only about computers and technology
    • Biomedical informatics reflects larger scope
  • 4. Characteristics of medical informatics
    • It is a heterogeneous field, with physicians, other clinicians, non-clinicians, etc.
    • It is not a “cookie cutter” field where all practitioners have a defined set of skills and competencies
      • In contrast to accounting, surgery, etc.
    • There are few, if any, jobs that require formal training in informatics
      • Though many health care IT leaders would benefit from more knowledge of informatics!
  • 5. Medical informatics is one part of larger health care IT
    • Other professionals in health care IT include
      • IT professionals, often with computer science (CS) or management information systems (MIS) backgrounds
      • Health information management (HIM) professionals, historically associated with managing medical records departments
      • Health science librarians
      • Clinicians who gravitate into IT roles with or without formal training
  • 6. So what distinguishes medical informatics?
    • My view (probably not everyone agrees): Informatics is focused on the information more than the technology
      • Another way to look at it: the subject domain matters, may be preeminent
    • Is probably the best professional pathway for clinicians (especially physicians) to move into IT jobs of all sorts from academic to operational
  • 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. Is medical informatics a profession?
    • According to SWEBOK, a profession is characterized by
      • An initial professional education in a curriculum validated through accreditation
      • Registration of fitness to practice via voluntary certification or mandatory licensing
      • Specialized skill development and continuing professional education
      • Communal support via a professional society
      • A commitment to norms of conduct often prescribed in a code of ethics
    • By this definition, medical informatics is not a profession
  • 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. Education in medical informatics
    • Since a highly multi-disciplinary field, no standard curriculum or certification
      • Listing of programs on Web site of American Medical Informatics Association (
      • Description of OHSU program to follow as an example; consult other programs’ Web sites for details on their programs
    • Education has historically focused on academics but is evolving to meet the needs of practitioners and users
  • 11. Programs funded by National Library of Medicine
    • Tend to be research-oriented
    • Require full-time commitment
    • Degrees are usually optional, at least at the present time
  • 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. Medical informatics education at OHSU
    • Research
      • Predoc/Postdoc Fellowship funded by NLM and VA
      • PhD in Biomedical Informatics degree
      • Master of Science in Biomedical Informatics degree for postdocs from other fields
    • Applied
      • Master of Science and Master of Biomedical Informatics degrees
      • Graduate Certificate Program (distance learning)
    • Practical
      • Continuing education courses
  • 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. OHSU biomedical informatics core curriculum
    • Master’s and PhD program have core courses in six areas
      • Biomedical informatics – Core courses in informatics science and applications
      • Organizational and management sciences
      • Computer science – Practical introduction to core concepts
      • Health and biomedicine – for non-clinicians
      • Research methods – quantitative, qualitative
      • Thesis/capstone
    • Certificate program focuses mainly on first two areas
    • PhD program adds specialized research training, cognate area of interest, doctoral seminar, and dissertation
  • 16. Additional aspects of curriculum
    • Provide opportunities for students in “real world” internships and practicums with local vendors and companies
    • Take advantage of local external (aka, “clinical”) faculty for lectures, projects, etc.
    • A big challenge, reflecting immaturity of field, is career counseling, professional development, etc.
  • 17. Distance learning
    • Teaching modalities include
      • Voice-over-Powerpoint lectures
      • Threaded discussions
      • Readings, virtual projects, etc.
    • Courses are not correspondence courses; interaction is a core component
    • Have created a virtual community
      • Receptions at AMIA, HIMSS, OHSU
  • 18. Graduate Certificate program
    • Designed for established professionals to move into informatics practice
      • Over 250 matriculated students, 36 graduates
    • Completely Web-based
      • Designed for busy adult learners
    • Courses are subset of master’s program
      • Can be carried forward toward master’s degree
    • HIMSS, AMDIS, and AMIA members receive 5% tuition discount (full individual members only)
  • 19. Graduate Certificate program curriculum
    • Required courses
      • Introduction to Biomedical Informatics
      • Clinical Systems
      • Information Retrieval & Digital Libraries
      • Organizational Behavior & Management
    • Some select other courses (of ~12)
      • Project Management
      • Business of Healthcare Informatics
      • Computer programming/databases/networks
      • Practicum or Research
      • “ Local” relevant course
  • 20. How have our students done?
    • General observation: What people do when they graduate often depends on what they did when they entered, e.g.,
      • Physicians, nurses, and other clinicians draw on their clinical background
    • Graduates have obtained jobs in a variety of settings, e.g., clinical, academic, and industry
    • Some have obtained jobs before finishing the program; a few before starting
  • 21. More information: Web sites
    • What is medical informatics?
    • American Medical Informatics Association
    • Health Information Management Systems
    • Association of Medical Directors of Information Systems
  • 22. Web sites (cont.)
    • National Library of Medicine
    • Informatics Review
    • Guide to Health Informatics (Coiera) glossary
    • British Association of Clinical Terminology Specialists Health Informatics Glossary (acronyms)
  • 23. Leading (only!) general textbook in field
    • Shortliffe et al. (eds.), Springer-Verlag
    • Current (second) edition getting out of date
    • Third edition due at end of 2004
  • 24. Terminology, jargon, and buzzwords
    • Adjective problem
    • Politically correct terms
  • 25. Informatics has an “adjective” problem
    • What should the word(s) in front of informatics be?
      • Medical? – Implies only the work of doctors
      • Biomedical? – Implies the biomedical model
      • Health? – Too broad, leaves out bio-
      • Bio-? – Implies basic science
      • Nursing? Pathology? Public Health? – Too focused
  • 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. Other language issues to demonstrate “in the know”
    • EHR (electronic health record) is politically correct, not EMR (electronic medical record)
    • National Health Information Infrastructure refers to all infrastructure (political, legal, regulatory, etc., and not just technical)
    • Another emerging item of jargon is healthcare information technology, or HIT
  • 28. Thoughts about the future
    • These are exciting times for medical informatics
      • Bush 2004 State of Union stating benefit of HIT
      • National Health Information Infrastructure initiative leading to adoption
      • Harris Interactive survey (1/04) of industry leaders shows adoption of HIT is “most significant opportunity” for health care
      • Institute of Medicine reports continue to come out and exert influence
      • Growth and maturation of HIT industry insures progress (and employment opportunities!)
  • 29. More thoughts
    • These require that we educate more informaticians as well as others about informatics
    • A degree or formal training is not essential now in a young field like ours but will likely become so in the future
    • We need to get this right!