From the Beginning:An Introduction to Medical Informatics

William Hersh, MDProfessor and Chair

Department of Medical Informatics & Clinical EpidemiologyOregon Health & Science University

Portland, OR, USAEmail: hersh@ohsu.eduWeb: www.billhersh.info

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

What is (bio)medical informatics? http://www.ohsu.edu/dmice/whatis/ 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

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!

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

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

Categories of medical informatics practice

Category

Jobs

Research

Informatics researcher or teacher

Applied CIO, Chief Medical/Nursing Information Officer, Developer, Trainer

Practical Health care professional, research assistant/associateAdapted from Covvey et al., Pointing the Way, 2001

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

But medical informatics is a discipline (Friedman)

+ >( )Person

such that an intelligent person (practitioner)

working in combination with information resources/technology

TechnologyWith

is “better” than the person without such support.

Person withoutSupport

Better Than

Creating an environment of “supported practice”

Environment

Environment

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 (www.amia.org)

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

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 timehttp://www.nlm.nih.gov/ep/AwardsTrainInstitute.html

Categories of informatics education

Category Typical Programs

Research - PhD- Postdoc ± master’s degree

Applied - Postdoc ± master’s degree- Master’s Degree- Certificate

Practical - Continuing Education

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

OHSU numbers

Program (Year started) Matriculants per year

Graduates per year

PhD (2003) 2-3 None yet

Master’s (1996) 15-20 10-15

Certificate (2000) 40-50 10-15

Postdoc Fellowship (1992)

2-4 2-4

Library Fellowship (1998)

2 2

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

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.

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

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)

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

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

More information: Web sites What is medical informatics?

http://www.ohsu.edu/dmice/whatis American Medical Informatics Association

http://www.amia.org Health Information Management Systems

http://www.himss.org Association of Medical Directors of

Information Systems http://www.himss.org

Web sites (cont.) National Library of Medicine

http://www.nlm.nih.gov Informatics Review

http://www.informatics-review.com Guide to Health Informatics (Coiera)

glossary http://www.coiera.com/glossary.htm

British Association of Clinical Terminology Specialists Health Informatics Glossary (acronyms) http://www.bacts.org.uk/glossary.html

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

Terminology, jargon, and buzzwords Adjective problem Politically correct terms

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

A larger view of “health and biomedical informatics”

(Adapted from Shortliffe in Kukafka et al., JPHPM, 2001)

Informatics

Health andBiomedicalInformatics

Bioinformatics MedicalInformatics

Public HealthInformatics

ImagingInformatics

X Informatics Y Informatics

Cells and biomolecules Organs People Populations

X and Y might be Legal,Chemical, Social, etc.

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

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!)

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!