Training Faculty (and Others) in Biomedical Informatics William Hersh, MD Professor and Chair Department of Medical Informatics & Clinical Epidemiology Oregon Health & Science University Portland, OR, USA Web: Blog: informaticsprofessor.blogspot.com 1

Overview of talk Biomedical and health informatics Why we need more faculty What we know about the HIT workforce How we can/should build the HIT workforce The HITECH workforce development program 2

Biomedical and health informatics (BMHI) “The field that is concerned with the optimal use of information, often aided by the use of technology, to improve individual health, healthcare, public health, and biomedical research” (Hersh, 2009) – It is more about information than technology We pay inadequate attention to – The growing deluge of data and information (Stead, 2010) – The role of information in medical education and subsequent practice (Shortliffe, 2010) – The critical role and importance of people, including academics, practitioners, and users (Hersh, 2010) 3

Why do we need more BMHI? In healthcare – Quality – not as good as it could be (McGlynn, 2003; Schoen, 2009; NCQA, 2010) – Safety – IOM “errors report” found up to 98,000 deaths per year (Kohn, 2000); problem persists (Classen, 2011) – Cost – rising costs not sustainable; US spends more but gets less (Angrisano, 2007) – Inaccessible information – missing information frequent in primary care (Smith, 2005) In other areas – Clinical and translational research (Bernstam, 2009) enabling the learning healthcare system (Friedman, 2010) – Enabling patients, consumers, etc. (Gibbons, 2009) 4

Why do we need more faculty (and others)? Growing use of BMHI as users – Improving healthcare quality, safety, cost- effectiveness, etc. – Meeting meaningful use and other incentives – Communicating with and empower patients – Enabling research, public health, etc. Increasing career opportunities as – Academics/researchers – research, teaching, and leadership – Professionals/practitioners – new subspecialty and other opportunities 5

How do we train more faculty (and others)? Historically most BMHI education at graduate level – Informatics is inherently interdisciplinary and there is no single job description or career pathway More information on programs on AMIA web site – programs Commentary at – Let’s look at – Competencies – Funding opportunities – OHSU experience 6

What competencies should informaticians have? (Hersh, 2009) 7 Health and biological sciences: - Medicine, nursing, etc. - Public health - Biology Computational and mathematical sciences: - Computer science - Information technology - Statistics Management and social sciences: - Business administration - Human resources - Organizational behavior Competencies required in Biomedical and Health Informatics

Inventory of competencies for various groups (Hersh, 2010) Competencies differ by group – Informaticians Developing, implementing, and evaluating systems Making optimal use of information – Clinicians Applying informatics in delivery of care – Patients Health information literacy 8 …

Funding for BMHI training Mostly self-funded, sometimes at institutional level – e.g., University of Connecticut HSC “grow your own” Research training historically available through NLM (NIH) training grant program – New opportunities in ONC Workforce Development Program funded under HITECH Act – healthit_hhs_gov__workforce_development_program /3659 9

ONC Workforce Development Program 10 Nine universities funded, with emphasis on short-term training using distance learning OHSU funded to enroll trainees in existing programs Based on need for 51,000 professionals in 12 workforce roles Five universities funded to develop curricula for community college programs OHSU funded to develop curricula and to serve as National Training & Dissemination Center (NTDC)

Experience of the OHSU program Graduate-level programs at Certificate, Master’s, and PhD levels – “Building block” approach allows courses to be carried forward to higher levels – Train practitioners and researchers from a wide variety of backgrounds – Mostly self-funded but some funded by NLM, ONC, and others Two “populations” of students – “First-career” students more likely to be full-time, on-campus, and from variety of backgrounds – “Career-changing” students likely to be part-time, distance, more likely (though not exclusively) from healthcare professions Many of latter group prefer “a la carte” learning – This has led to the successful 10x10 (“ten by ten”) program that started as OHSU-AMIA partnership (Hersh, 2007; Feldman, 2008) 11

PhD - Knowledge Base - Advanced Research Methods - Biostatistics - Cognate - Advanced Topics - Doctoral Symposium - Mentored Teaching - Dissertation Overview of OHSU graduate programs Graduate Certificate - Tracks: - Clinical Informatics - Health Information Management Masters - Tracks: - Clinical Informatics - Bioinformatics - Thesis or Capstone 10x10 - Or introductory course 12

Challenges Institutions do not understand informatics – Do not fully appreciate potential synergy with research, clinical enterprise, and/or education Growing departmental “self-sufficiency” models that discourage collaboration and encourage silos and short-term thinking – Exacerbated by tightening of NIH, state, and other budgets Informatics departments do not fit in classical basic-clinical divide 13

For more information Bill Hersh – Informatics Professor blog – OHSU Department of Medical Informatics & Clinical Epidemiology (DMICE) – – – – What is Biomedical and Health Informatics? – Office of the National Coordinator for Health IT (ONC) – American Medical Informatics Association (AMIA) – National Library of Medicine (NLM) – 14