Back to School

MDNG Hospital Medicine, May 2008, Volume 2, Issue 2

There is an increasing number of options available these days for physicians who are interested in becoming more technology savvy.

Continuing Medical Education is nothing new for physicians. Keeping abreast of the latest trends and techniques is essential for providing high-quality care. What’s changing, however, is the content of some CME courses. There is an increasing number of options available these days for physicians who are interested in becoming more technology savvy.

The University of Virginia Health System defines health informatics as the science that underlies the academic investigation and practical application of computing and communications technology to healthcare, health education, and biomedical research. Put simply, it’s the point where IT and healthcare meet. And of late, it’s becoming a very popular meeting place. “Interest in [health informatics] is exploding along with the increasing deployment of electronic medical records, e-prescribing, and pay for performance,” explains Stanley Hochberg, MD, assistant clinical professor and program director for Northeastern University’s graduate health informatics program. “Th ere are lots of people with clinical expertise and lots of people with technical expertise. What is missing are people who can work the middle and bridge the gap.” There are now a wide range of programs available to help build that bridge.

Program, enrollee diversity

Whatever a clinician’s inclination might be, health and medical informatics programs are available to suit their need, budget, and schedule. Everything from two-day seminars to two-year masters and doctorate programs are on the menu, and many of the programs are off ered in distance learning formats that are more compatible with physicians’ busy schedules. Northeastern University’srecently inaugurated graduate health informatics program requires a two-year commitment to attend on-campus courses in the evening. The curriculum combines resources from the Bouve College of Health Sciences and the College of Computer and Information Sciences. One of the pioneers of health informatics programs is Oregon Health (OHSU). The school’s Department of Medical Informatics and Clinical Epidemiology (DMICE) offers a standard master’s degree program—52 non-thesis and 60 thesis credit hours—but also features certifi cate (24 credits) and PhD programs. The programs are available online, and they’re structured in such a way that all courses taken at the certifi cate level can be carried forward to the next level. Th e key challenge faced by all health informatics programs is teaching eff ectively to a diverse student population. “About half of my students are from clinical backgrounds, and half are from technical backgrounds,” Hochberg explains. “That’s the ongoing challenge of the program: fi nding that middle ground.”

William Hersh, MD, DMICE Chair, acknowledges the challenge, but also sees the virtues. “One of the nice things is to be able to foster an appreciation among the students of the diversity of their peers,” he explains. “One student with an IT background may know little about healthcare, but their knowledge and experience can be very complementary.”

Fruits of knowledge

Dina Strachan, MD, was an academic dermatologist at Columbia University when she attended a one-week fellowship program in biomedical informatics sponsored by the National Library of Medicine. Today, Strachan is a board-certifi ed dermatologist practicing in New York City, and she credits the program with giving her the confi dence to evaluate how technology impacts her practice.

The fellowship “gave me a respect for what technology could do,” Strachan explains. “You have to look at how technology aff ects things. Bringing in technology doesn’t make something better and easier instantly; it changes people’s jobs. You have to understand a process without the technology, and then think about how technology will change that.”

Larry Dean, MD, an interventional cardiologist and professor of medicine and surgery at the University of Washington Medical Center in Seattle, is currently enrolled in OHSU’s distance learning health informatics program. Why enroll? He points to the move to electronic medical records, already underway and likely to accelerate in the coming years, and he sees a problem. “Th ere are people making multi-million dollar investments without a lot of background knowledge,” says Dean. “It stands to reason that if you combine an understanding of the clinical aspects of the practice of medicine with the knowledge of IT, that’s going to be a very powerful combination when it comes to rolling out these electronic medical records. It certainly isn’t as easy as turning on a switch.”

Two years ago, Angel Brana, MD, retired from his post as an offi cer of the US Public Health Service stationed along the Mexico border. He started doing consulting work, providing technical assistance and training in primary healthcare and disaster medicine. He recognized the role that information management played in the successful implementation of healthcare systems and turned to the online Master of Science in Health Informatics program at the University of Illinois at Chicago(UIC) to supplement his knowledge. “I saw an opportunity to develop a second career,” Brana explains. “I’m getting training in information technology and learning best practices in terms of designing the systems. Most people just think about the applications, but [the UIC program] focuses on the people side of the equation. It has been a real eye-opening experience.”

The curriculum

In most cases, the curriculum and course load for health informatics programs vary from school to school. Drexel University in Philadelphia off ers an Online Certifi cate in Healthcare Informatics program. The nine-credit curriculum includes an introductory course, as well as work in organization and sociological issues in healthcare informatics and clinical information technology. Prudence Dalrymple, PhD, auxiliary professor in the Drexel health informatics program, says enrollees are a mixed group of nurses and other clinicians, as well as individuals with an information science background.

The scene is similar at Northeastern University, where Hochberg says the 42 students currently enrolled in the program include one physician, eight registered nurses, four pharmacists, and a variety of students from the technical side of the house. Courses focus on organizational behavior, workfl ow design, and change management, as well as the business of healthcare informatics.

Standardization is not far off

In addition to off ering programs online—which entice more physicians to participate due to the fl exibility of scheduling—the common thread that joins UIC and OHSU is a partnership with the American Medical Informatics Association, an organization dedicated to the development and application of medical informatics in support of patient care, teaching, research, and healthcare administration. In March 2007, AMIA was awarded a $300,000 grant from the Robert Wood Johnson Foundation to lay the groundwork for a system that will certify competency of physicians as a subspecialty of applied clinical informatics. AMIA’s goal, through its 10x10 Program, is to train 10,000 healthcare professionals in applied health and medical informatics by 2010. Both UIC and OHSU off er AMIA’s 10x10 intensive introduction course to medical and health informatics as part of their curricula.

“There’s no standardization of what it means to be an informatics professional, or to have training in informatics,” OHSU’s Hersh explains. “Fifty years ago when computers were starting to come to the fore, there were no computer science degrees. Eventually, there emerged a discipline called computer science. I think the same thing is happening in health informatics.”

The road ahead

It would be easy to view health informatics as a tech-heavy discipline, but that would be wrong. According to Hersh, health informatics is not about technology; it’s about the application of technology in healthcare, biomedicine, and research. “It’s important to know and understand the technology,” he says, “but it’s not just the technology.” UIC’s Annette Valenta, professor and associate dean for Health Informatics Technology, says among the biggest issues facing health informatics are the socio-technical dynamics that occur in the workplace. “We’re not struggling with technology, we’re struggling with the technology in use in the healthcare arena, wherever that might be,” says Valenta. “Systems change the workflow in a physician’s

practice, and they need to therefore accommodate how that technology works within their office. That’s a very significant challenge in today’s healthcare arena.”

That challenge is also opening the door to opportunity. Health informatics specialists will soon be needed to develop expert systems to help doctors and nurses make evidence-based diagnoses and treatments. Hersh believes that many of these positions could be filled by today’s practicing physicians.

“Even smaller hospitals are now designating a physician as chief medical information offi cer to serve as the liaison between the IT people and the clinical people,” Hersh explains. “And it needs to be a physician; it needs to be someone who has the clinical credibility.” Dalrymple echoes that idea, emphasizing the importance of clinicians playing an active role in addressing technology’s growing presence within the healthcare arena. “If we in the medical community don’t step up to that opportunity, and instead wait for some system to come along that is thrust on us, then we’ll get something that we don’t want,” says Dalrymple. “We have to take the opportunity to engage with each other.”

Ed Rabinowitz is a veteran healthcare journalist based in Bangor, PA.