Building the Next Generation's Regional Health IT Workforce: Past Journeys and Future Directions (May 25, 2018)

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Building the Next Generation’s
Regional Health IT Workforce:
Past Journeys & Future Directions
Nawanan Theera-Ampornpunt, M.D., Ph.D.
Assistant Dean for Informatics
Faculty of Medicine Ramathibodi Hospital
Mahidol University
May 25, 2018
www.SlideShare.net/Nawanan

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Introduction
2003 Doctor of Medicine (1st-Class Honors) Ramathibodi
2009 M.S. (Health Informatics) University of Minnesota
2011 Ph.D. (Health Informatics) University of Minnesota
Current Position
Lecturer, Department of Community Medicine
Assistant Dean for Informatics
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Contacts
nawanan.the@mahidol.ac.th
SlideShare.net/Nawanan

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Outline
• A Personal Journey
• The “Informatics Spectrum”
• Literature on Informatics Workforce
• Informatics Workforce Development Abroad
• Informatics Workforce in Thailand

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A “Lost” Medical Student

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“Who” To Train
• So who are we supposed to train
anyway?

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The “Informatics
Spectrum”

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What Is “Informatics”: A Review
Theera-Ampornpunt. JTMI. 2015;1(1)

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What is “Informatics”
• French: informatique = “information processing,
data processing”
Harrap’s New Standard French & English Dictionary (1979), in Collen (1986)
• Russian: informatika
• English: informatics = “the discipline of science
which investigates the structure and properties
(not specific context) of scientific information, as
well as the regularities of scientific information
activity, its theory, history, methodology and
organization.”
Oxford English Dictionary Supplement (1976), in Collen (1986)

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What is “Informatics”
• “The discipline focused on the
acquisition, storage, and use of
information in a specific setting or
domain” (Hersh, 2009)

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Medical Informatics
• “Ancient” term
• Being retired
• Future use discouraged by experts
• Only retained in titles of professional
organizations
Main Problems
• Medical = Doctor? (e.g. not nursing?)
• Medical informatics vs. Clinical informatics

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Better Terms
• Biomedical informatics
• Health informatics
• Biomedical and Health informatics

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But What Is M/B/H Informatics Anyway?
• Medical computing/computers in
medicine?
• ‘Referring to biomedical informatics as
“computers in medicine” is like defining
cardiology as “stethoscopes in
medicine”.’ (Bernstam et al, 2010)

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More Definitions of M/B/H Informatics
• “The field that is concerned with the optimal use
of information, often aided by the use of
technology, to improve individual health, health
care, public health, and biomedical research” (Hersh,
2009)
• “The application of the science of information as
data plus meaning to problems of biomedical
interest” (Bernstam et al, 2010)

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Summary of the Field
• Context: Health & Healthcare
• Focuses more on information, not technology
• Task-oriented view:
Collection Processing
Storage
Utilization
Communication
/Dissemination/
Presentation

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Focus on “Information”
Wisdom
Knowledge
Information
Data
Data-Information-Knowledge-Wisdom (DIKW) Pyramid

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3 Sciences for Education of
21st Century Clinicians
• Basic Science
• Clinical Science
• Information Science
Shortliffe EH. JAMA. 2010;304(11):1227-8.

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Health
Systems
Science
Clinical
Science
Basic
Science
Skochelak, SE, Hawkins, RE, et
al., Eds. (2017). Health Systems
Science. New York, NY,
Elsevier.

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Health
Systems
Science
Clinical
Science
Basic
Science
Skochelak, SE, Hawkins, RE, et
al., Eds. (2017). Health Systems
Science. New York, NY,
Elsevier.
• Health Care Delivery System
• Value in Health Care
• Patient Safety
• Quality Improvement
• Teamwork & Team Science
• Leadership in Health Care
• Clinical Informatics

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The “Informatics Spectrum”
Shortliffe EH. J Biomed Inform. 2002;35(5-6):279-80.

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The “Informatics Spectrum”
Kulikowski CA, Shortliffe EH, Currie LM, et al. J Am Med Inform Assoc. 2012;19(6):931-8.

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Informatics Contribution
de Savigny D, Adam T, editors. Systems thinking for health systems strengthening.
Geneva: World Health Organization; 2009.

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Workforce Implications
• Biomedical & health informatics is a large
interdisciplinary field covering a broad
spectrum of work in health & biomedicine
• Informatics focuses more on information
than technology
• Workforce should reflect the field’s
landscape & contribution to health
systems

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Literature on
Informatics Workforce

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Informatics Workforce Paper
Hersh W. BMC Med Inform Decis Mak. 2009;9:24.

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Categories of Informatics Workforce
Workforce development by HITECH Act
• IT professionals: install, maintain & optimize
hardware & software
• Health Information Management (HIM)
professionals: medical records documentation,
coding, and legal & compliance issues
• Clinical informaticians: bring expertise at the
intersection of health care & IT to assure successful
adoption & use of HIT & information. Also serve as a
bridge between IT & clinical personnel.

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Career Path & Job Opportunities

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Diversity in Informatics Workforce
• No distinct professional identity, due to
heterogeneous nature of the field and people
in the field
• “What you do when you complete informatics
education is related in part to what you did
when you entered.”
• Roles sometimes divided into academic vs.
professional/applied/operational

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Informatics Workforce Paper
Hersh W. Yearb Med Inform. 2008;157–64.
Hersh W. Stud Health Technol Inform. 2010;151:492–503.
Hersh W. J Am Med Inform Assoc. 2006 Apr;13(2):166–70.

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Informatics Workforce Problems
• Incomplete data of HIT workforce
• Low quantity & lack of training of skilled
workers to implement HIT
• IT professionals & HIM professionals often
viewed as separate: Technologists vs.
Medical Records. Artificial distinctions &
ignoring roles of others e.g. clinicians

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• No clear definition of the informatics field and its
terminologies
– The “adjective problem”
– Unresolved preferred terms: “Informaticist” vs. “informatician”
• Unclear boundary between pure IT &
informatics
– A person who installs applications on hospital PCs probably
doesn’t need informatics training
– CIO & project leads certainly need informatics training
• Lack of knowledge of the profession by career
advisers Hersh W. Yearb Med Inform. 2008;157–64.

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Importance of Informatics Mindset

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• Informatics not represented in standard occupational
classifications, thus the field is not represented in
some workforce analyses
• In U.S., Standard Occupational Classification (SOC)
– Health Diagnosing & Treating Practitioners
– Medical Records & Health Information Technicians
– Computer Specialists
– Nothing that combines these elements of what
informaticians do into a single code
• Same issue for International Standard Classification of
Occupations (ISCO) Hersh W. Yearb Med Inform. 2008;157–64.

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Forces that Shape Informatics Workforce
• Importance of “informaticians” being
recognized
• Informatics as a professional discipline, with
attributes of a profession
– Well-defined set of competencies
– Certification of fitness to practice
– Shared professional identity, life-long commitment
& code of ethics

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Informatics Workforce Assessments
• England estimated employment of 25,000 FTEs out of
1.3 million workers in NHS (1 IT staff : 52 non-IT
workers)
– ICT staff (37%)
– Health records staff (26%)
– Information management staff (18%)
– Knowledge management staff (9%)
– Senior managers (7%)
– Clinical informatics staff (3%)
• Retention issues (mostly due to non-competitive pay)
• Expected skills shortages
• Strong support for establishing formal informatics
profession Hersh W. Yearb Med Inform. 2008;157–64.

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• Gartner Research assessed IT staff in 85 integrated
delivery systems in U.S. (1 IT Staff : 56 non-IT employees)
– Programmer/analyst (51%)
– Support (28%)
– Telecommunications (16%)
• HIMSS AnalyticsTM Database (1 IT Staff : 68 hospital staff)
Hersh W. Yearb Med Inform.
2008;157–64.

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IT & informatics
workforce needed to
implement U.S.
Nationwide Health
Information Network
(NHIN)
Hersh W. Yearb Med Inform.
2008;157–64.

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Categories of Informatics Workforce

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Informatics Workforce: Future Directions
• Optimal education of HIT workforce is another gap in
knowledge
• Need for more research to better characterize workforce
of those who develop, implement, & evaluate HIT
• Workforce research must go beyond narrow focus of single
groups (e.g. IT staff, HIM, clinicians) or applications (EHRs,
HIE), but focus on larger picture
• More effort on occupational coding classifications &
promoting profession
• Focus on other areas of informatics (e.g. clinical research,
public health informatics) & other parts of the world outside
U.S. & Europe

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Informatics Workforce in
Developing Countries
Hersh W, Margolis A, Quiros F, Otero P. Health Aff. 2010;29(2):274–7.

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• Growing evidence for value of well-trained informatics
workforce
• Educational programs emerging around the world to meet
the need, from graduate education to short courses
• Various Initiatives
– Informatics Training for Global Health Program (Fogarty International
Center, U.S. National Institutes of Health)
– AMIA’s Global Partnership Program (Funded by Bill & Melinda Gates
Foundation)

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• Paucity of research
– All national-level data come from English-speaking
developed countries
– Some U.S. studies focused on specific segments of
workforce (e.g. IT professionals, health information
managers)
– No research on long-term needs, specific roles,
competencies & optimal education of health
informatics professionals in U.S. and elsewhere

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• Recommended Data Collection
– Characteristics of health care organizations & HIT
applications used, in the context of a country’s
larger health care system
– Data on health care organizations’ ICT structure,
organization & infrastructure, roles &
responsibilities, and needs

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Development Abroad

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U.S.: HITECH Act & Informatics Workforce
Blumenthal D. Launching HITECH. N Engl J Med. 2010 Feb 4;362(5):382-5.

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U.S.: HITECH Act & Informatics Workforce
Hersh WR. Informatics for the health information technology workforce. In: Berner ES, editor.
Informatics education in healthcare: lessons learned. London: Springer; 2014. p. 93-107.
More information: https://www.healthit.gov/sites/default/files/health_it_workforce_6_month_roles_as_of_06_03_10.pdf

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U.S.: 10x10
More Information: https://www.amia.org/education/10x10-courses
Image Source: http://www.kumc.edu/health-informatics/ku-amia-10x10.html
• AMIA 10x10 Program

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U.S.: Clinical Informatics Subspecialty
Safran C. Yearb Med Inform. 2009;164–5.

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Detmer DE, Munger BS, Lehmann CU. Applied Clinical Informatics. 2010;1(1):11–8.

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Detmer DE, Munger BS, Lehmann CU. Applied Clinical Informatics. 2010;1(1):11–8.

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U.S.: Advanced Interprofessional
Informatics Certification
https://www.amia.org/advanced-interprofessional-informatics-certification

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in Thailand
Problems, Progress & Plan

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Problems: Professional Identity
http://www.uis.unesco.org/Education/Documents/isced-fields-of-education-training-2013.pdf
• What ISCED category
should health
informatics program
fall into?

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Where Is Health Informatics in
the Fields of Education Classification?

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Where Is Health Informatics?
My Answer: 0988 Inter-disciplinary programmes and
qualifications involving health and welfare
Nawanan Theera-Ampornpunt

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Problems Voiced by
Practitioners in Thai Hospitals
Theera-Ampornpunt N. Thai hospitals' adoption of information technology: a theory development
and nationwide survey [dissertation]. Minneapolis (MN): University of Minnesota; 2011 Dec. 376 p.
http://conservancy.umn.edu/handle/11299/162267
• Nationwide survey on
health IT adoption of
Thai hospitals
• 70% response rate
(908/1298)
• Content analysis from
open-ended comments

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Problems Voiced by
THAIS Study

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Problems Voiced by
THAIS Study

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Progress: Informatics Programs
in Thailand
Otero PD, Perrin C, Geissbuhler A, Cheung NT, Theera-Ampornpunt N, Lun KC.
Informatics education in low resource settings. In: Berner ES, editor. Informatics
education in healthcare: lessons learned. London: Springer; 2014. p. 197-222.

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Progress: Informatics Programs
in Thailand
Otero PD, Perrin C, Geissbuhler A, Cheung NT, Theera-Ampornpunt N, Lun KC. Informatics education in low resource
settings. In: Berner ES, editor. Informatics education in healthcare: lessons learned. London: Springer; 2014. p. 197-222.

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Progress: Informatics Training
in Thailand
Images courtesy of TMI

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in Thailand
Image courtesy of Ramathibodi Hospital Administration School
Ramathibodi Healthcare CIO Certificate Program, 6th Class (2015)

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in Thailand
Images courtesy of Faculty of Tropical Medicine, Mahidol University
MU Faculty of Tropical Medicine Biomedical & Health Informatics Master
• Graduated first batch of students in early 2014
• Now in third batch of students

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in Thailand
Image courtesy of Faculty of Social Sciences & Humanities, Mahidol University
MU Faculty of Social Sciences & Humanities:
Health Information Management Masters Program

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Progress: TMI Informatics Education SIG
• In January 2013, TMI approved establishment of the “Biomedical
and Health Informatics Education Special Interest Group” within TMI
(BHI-ED-SIG)
• Executive Committee
• 1. นพ.ดาวฤกษ์ สินธุวณิชย์ ที่ปรึกษา
• 2. ดร.นพ.บุญชัย กิจสนาโยธิน ประธาน (Chair)
• 3. ดร.นพ.นวนรรน ธีระอัมพรพันธุ์ รองประธาน (Vice Chair)
• 4. รศ.ทญ.ดร.ศิริวรรณ สืบนุการณ์ กรรมการ
• 5. ผศ.ภก.ดร.อนุชัย ธีระเรืองไชยศรี กรรมการ
• 6. ดร.นพ.บดินทร์ ทรัพย์สมบูรณ์ กรรมการ

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Progress: “GEEKS”
Image Source: https://pg.usembassy.gov/two-successfully-complete-u-s-sponsored-e-health-training-thailand/

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Plan: Workforce as Part of eHealth Roadmap

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Problems in Thailand’s eHealth Workforce from
eHealth Roadmap Brainstorming (August 2015)
• No national eHealth authority, thus no leadership
• No standard competencies of eHealth workers
• No standard IT/eHealth competencies of health
professionals
• No eHealth/IT competencies in the private sector
• Lack of eHealth KM & Community of Practice
• No collaboration among CIOs of various health
departments

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Plan: Proposed Strategies for Thailand’s eHealth
Workforce from eHealth Roadmap Brainstorming
(August 2015)
• eHealth HRM
– Workforce analysis
– Standard competencies
– Retention efforts & talent management
• eHealth Development
– Capacity building
– Continuing education
– Expert Profiles & Community of Practice
– Certification

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Plan: Workforce as Part of eHealth Roadmap
• The Informatics Knowledge Spectrum
Degree of Informatics Knowledge
Patient/Public Supporting
Hospital Workers
Clinicians/Health
Professionas
Executives IT Workers, HIM
eHealth/Health IT
Workers

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Plan: Proposed Strategies for Thailand’s eHealth
Workforce from eHealth Roadmap Brainstorming
(August 2015)
• Networking & Collaboration
– Better collaboration between ICT & health agencies
– Cross-departmental ICT communities in health sector
– User training & support
– Public-private partnership & resource sharing
• Public Awareness
– Consumer health knowledge portal
– Improving health literacy & IT literacy
– Engaging local governments on eHealth

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Summary of Health Informatics
Workforce
Situation Abroad
• Unique value of informatics workforce in healthcare
increasingly recognized
• Informatics workforce is a challenge in many developed
& developing countries
• Breadth of informatics part of the challenge
• Some, but limited, data/research on current situation,
needs, competencies & training
• Various initiatives to build stronger informatics workforce
• The new wave of “Data Science”

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Summary of Health Informatics
Workforce
Situation in Thailand
• Unique value of informatics workforce in healthcare
increasingly recognized
• Informatics workforce is a serious challenge: a
bottleneck for Thailand’s 21st Century health system
• Virtually no systematic research on current situation,
needs, competencies & training
• Several initiatives to build stronger informatics workforce
ongoing, but with limited capacity

Building the Next Generation's Regional Health IT Workforce: Past Journeys and Future Directions (May 25, 2018)

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