OHSU’s twelve-week online certificate program helps prepare the health workforce for the EHR transition.

By Laura Trude, HWIC Information Specialist

Oregon Health & Science University (OHSU) is doing its part to educate some of the estimated 50,000 health information technology (HIT) professionals needed to implement electronic health records (EHR) nationwide. In 2005, the American Medical Informatics Association (AMIA) and Oregon Health & Science University (OHSU) partnered to create the AMIA-OHSU 10×10 Certificate Program, with the objective of training “10,000 health care and related professionals in medical informatics by the year 2010.” Specifically, they want to train one nurse and one physician for every hospital in the nation. Since its inception, the AMIA-OHSU 10×10 Certificate Program has expanded to other schools and realized part of that goal.

The 10×10 program introduces health care providers and information technology (IT) professionals to the integration of information and technology in a health care environment. Dr. William Hersh, director of the OHSU Department of Medical Informatics and Clinical Epidemiology, defines informatics as “the discipline focused on the acquisition, storage, and use of information in a specific setting or domain” in his paper A Stimulus to Define Informatics and Health Information Technology. The 10×10 program applies informatics to a health care setting.

In an interview, Hersh explains that “Informatics is not really about the technology, it’s about the information and what you do with it. With all of the historically-based paper health care, we don’t really have any way to know how well we are doing other than when someone does a deliberate research study. Now that we’re going to have more electronic data, we can see if what we are doing is helping people. If not, we should change our practices.”

Informatics is one of three major components of the growing HIT workforce, the other two branches being information technology (IT) and health information management (HIM). HIM has been around for many years, but has evolved significantly since the implementation of electronic health records. The IT component of the HIT workforce generally develops and maintains health information systems, “caring and feeding for the server, keeping it secure, and things like that,” states Hersh.

“Informatics comprises a whole spectrum of jobs,” Hersh elaborates. “There are people in informatics who are physicians, there are people in informatics who are from allied health fields and IT fields. They do different things. It’s not a field like, for example, medicine, where you go to medical school, you have a certain level of skills and your career options are relatively constrained if you want to stay in medicine. Informatics is all over the map in terms of what the opportunities are.” Informaticians focus on “working with different clinicians, whether it’s physicians or nurses, implementing systems, making sure that good information goes into them, analyzing the information that comes out for quality improvement, and other kinds of measurement.”

Participants in the 10×10 program include those working in health care who want to learn more about informatics, IT professionals who want to learn more about the health care system and data with which they are working, and those who suddenly find themselves in a job for which they have no formal training. “I sometimes chuckle about it when someone says ‘I am now the chief medical information officer in my hospital and I realize that there’s a lot about this I don’t know. I’d like to learn something quickly,’” reflects Hersh. “Sometimes it’s organizations who want to have people in their health care delivery organization know more about this and work in this area that will send them for something like this.”

The 10×10 course itself consists of a twelve-week online program followed by a two-day session conducted in person, which allows participants to present their course projects and meet other leaders in the field. For the course’s final project, students “identify an informatics problem in their local setting (e.g., where they practice or work) and propose a solution based on what is known from informatics research and best practice.”

As the 10×10 program was originally adapted from the introductory course for OHSU’s graduate program in informatics, participants may count the course towards a graduate degree in that field. About 15% of those who complete the 10×10 program enroll in further courses.

Hersh articulates that “The goal of our programs is to train the future professionals, researchers, and leaders in the field of informatics. Their focus is to use information to improve health, health care, public health, etc. They learn about a lot of the technical details of doing that. They also learn about people and organizational issues. Hospitals and health care organizations develop cultures; sometimes they are difficult to change for the better, including things like IT, so you need to also understand some of those things as well.”

OHSU also helps connect graduates with jobs, through internships and practicum experiences. “We have some experience doing this even with our distance-learning students,” states Hersh. “They can set up a practicum learning experience in their local community and get mentored by someone on our faculty and someone in the health care setting when they do the internship. There are job boards, and growing numbers of professional organizations, like the American Medical Informatics Association, that allow people to network. Even in our online graduate program we have this kind of virtual community that students get to know each other and network. Those kinds of things are important.”

The next few years will likely bring a number of new informatics programs. Besides the incentive payments from the Centers for Medicare & Medicaid Services (CMS) for meaningful use, the American Recovery and Reinvestment Act (ARRA) earmarked funding for the creation of short-term training programs in community colleges and universities.

Hersh highlights some of the challenges these programs will face and offers advice: “I think that the community colleges are going to have to work hard to get these programs up and running, because informatics has historically been at the graduate level. ARRA is also funding these curriculum development centers that are basically going to take curricula from programs like ours at OHSU and work with community college people to adapt them. The Office of the National Coordinator for Health Information Technology (ONC) anticipates that a lot of people going into these community college programs won’t be people fresh out of high school, but health care professionals or IT professionals, which is a growing audience for community colleges. So it’s an interesting experiment that’s about to take place. I think it should succeed, but it will be challenging for a lot of community colleges. I think they should probably work with their consortia and seek out the expertise of some of the existing graduate level programs that have been doing this for quite some time.”

“Another challenge in this field,” according to Hersh, “is getting people to understand what informatics is and what the opportunities are for careers, especially younger students. If you’ve worked in health care, you know a lot of the problems and challenges of health care delivery and how lack of access to information impedes good quality care. But it’s hard to really explain that to a 19 or 20-year-old in college. So there are probably other ways we need to give them information on why this might be a career path they might want to pursue.”

“The field is constantly changing. Sometimes for fun, I go back in my archive and look at my slides in my introductory course, the thing that is now 10×10, from ten years ago. The language was so much different, just the whole perspective was different. It’s not the kind of field where your education stops when you graduate. It requires continuous learning. That’s not unique to informatics, but it’s certainly a challenge in informatics, because things are changing quickly.”