What did we hear (explicitly or between the sentences)?

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1 The following article was published in Healthcare Information Management & Communications Canada in the 4 th Quarter October 1999 Issue (Vol. XIII No. 5) Health Informatics Education: More Work Required H. Dominic Covvey, Adjunct Assistant Professor, Department of Computer Science Health Informatics Group, University of Waterloo, Waterloo, Ontario. The American Medical Informatics Association (AMIA) dedicated its 1999 Spring Congress to the topic of Health Informatics education. The Congress was attended by over 200 individuals representing academic organizations, corporations, and healthcare organizations from around the world. Canada was well-represented, with participants from the Universities of Alberta, Toronto, Victoria, Waterloo, and McMaster University, and several hospitals. The two day agenda included plenary educational sessions on various topics, such as Issues in Health Informatics (HI) Education, Needs Assessment, Defining Goals for HI Education, Toward Enhancing HI Education, and Solutions. These plenary sessions were followed by workshops to allow group participation related to the plenary topic. What did we hear (explicitly or between the sentences)? There were many messages that came through loud and clear, while others emerged from interpreting the differing stances of the presenters, the questions from participants, or what was not said but implied: 1. Despite decades of effort there is still a lot of work required to achieve a consensus on what a Health Informatics professional is, what roles he or she should be able and expected to play, and what the content of the Health Informatics curriculum that produces such professionals should be. 2. The HI educational world is still balkanized : each health profession (medicine, nursing, healthcare administration, etc.) sees itself as unique, and believes that it must define its own curriculum, and operate its own programs. 3. There is little or no agreement on a core curriculum, or, for that matter the meaning of those words, which one would think should refer to those knowledge, skills, and experience (KS+E) elements that are common to all health disciplines. The resistance to the definition of the core curriculum may be based on the fact that it would defeat the balkanization and threaten certain interests. 4. There still does not seem to be any commonly accepted or objective basis from which one could derive the set of knowledge elements, the set of skills, and the types of experience that must be accumulated to realize competency as an HI professional. IMIA and our own group have used the roles of professionals as a basis, but this work does not seem to have yet diffused into the existing programs. Consequently, different programs differ substantially and not necessarily in positive ways. 5. Most educational organizations have emphasized the production of academic Health Informaticians (and these in the narrow disciplines of medicine, nursing, etc.), many of whom have pursued careers as teachers and researchers. In so doing, the Science of Discovery has been emphasized versus the Science of Application 6. The numbers of graduates produced in the programs is very small, an average of a little over 3 a year in the programs funded by the U.S. National Library of Medicine (NLM), and at the

2 most about per year from the largest programs, although some may produce more. It appears that production is substantially inferior to demand. 7. Only recently (with a few exceptions, including Canada s premier program at the University of Victoria, and several programs in the U.S., most notably Walter Panko s program at the University of Illinois at Chicago) have significant programs begun to emerge that focus on the production of Applied Health Informaticians, doers like CIOs, Directors, analysts, and other health IT staff. Suddenly, these programs (or at least hopeful announcements of intent) are popping up everywhere and in many faculties, including Computer Science, Business, and Allied Health. What are the lessons for us? Those of us who attended no doubt walked away with many different lessons based on our interests and biases. I left with many conclusions, including: 1. We still need to fully characterize the nature and roles of the Health Informatician in different settings (e.g. in organizations that wish to develop new solutions or approaches, in those that focus on deploying proven technologies, and in those that might do both), addressing issues such as what the HI should optimally be and be able to deliver, not just what he or she has been in the past. These roles must be sourced in the actual needs of health organizations and companies, be accepted by informed senior managers, and be validated by respected and successful HI professionals in such settings. 2. We must determine the true level of need for competent staff of each type where positions are unfilled and for positions that we project to be required in the future. In our counting we should tabulate both new staff required, as well as existing staff that require retraining because they are not fully qualified for the role they must play. This is a kind of market study to justify the investment in the development of HI education programs, and to ensure that the educational response is properly scaled. 3. We must recognize that there are several kinds of HI professionals. Examples are theoreticians who will discover new knowledge or innovative methods and solutions; and doers (we call the Applied Health Informaticians) who deploy solutions, apply methods, and use what the theoreticians produce. These are people who dedicate their careers to HI, but we need to remember that there are also non-hi professionals, such as physicians, nurses, and administrators, who need HI KS+E to be effective in their chosen domains as well. 4. There are also many possible specializations of HIs, such as Nursing Informatics, Medical Informatics, Dental Informatics, etc. 5. These different kinds of professionals require differing kinds and levels of knowledge, skill, and experience to achieve and maintain competency. There may be sets of KS+E elements that are common to all HI professionals, but there will be those that are specific to certain roles, and particularly to the kind or specialization of HI professional (the theoreticians will definitely require far greater depth in certain areas as well as specialized SK+E elements). 6. We must evolve a model HI curriculum that addresses these commonalties and differences, and that serves as a content standard for all HI programs. This will undoubtedly be based on or affected by the work of organizations like IMIA, but there is much work that yet needs to be done.

3 7. There is a large pent-up need for competent HI professionals, as indicated by many empty positions and delayed projects. The education system must respond quickly, effectively, and flexibly to this need. 8. The education of Applied Health Informaticians, especially those already employed, will require the use of distance education techniques, as few will be willing to disrupt their careers to qualify themselves in this field. What s Happening in Canada Related to HI Education? There are several initiatives that will be of great interest to educators, to managers who need competent staff, and to individuals who wish to become qualified in HI: 1. Dr. David Buckeridge, a resident in Community Medicine, is completing a study of Health Informatics research and education in Canada. This work is being sponsored by HEALNet, and his report should be available this Fall. David s address is 2. HEALNet is planning an invitational Health Informatics Curriculum Development Workshop that should be launched before the end of the year. The objective of this workshop is the development of a model HI curriculum. Information on HEALNet education initiatives can be obtained from Jennifer Briand, Educational Opportunities Coordinator: 3. A workshop is being sponsored in Calgary on November 25 by Healthcare Computing and Communications Canada and HEALNet, to examine the skills required by Applied Health Informaticians. For further information on this workshop, contact What s it got to do with me? Health is a virtual vacuum for competent health informatics professionals, especially the applied variety. Programs must emerge that produce adequate numbers of qualified entry-level professionals that are accessible by health organizations of al types from coast to coast. But there is also the need for programs that allow those of us already in the field to upgrade our skills and knowledge and to maintain competence in this dynamic area. So, regardless of where each of us is in his or her career, health informatics education should be a must know topic. Knowing is one thing, but getting involved is another. Who should get involved and how? Consider the following: Health system and health industry company administrators (really the whole executive team, but especially those responsible for IT) should ensure that their organizations have identified the specific knowledge, skills and experience that they require their IT staff to have, and should become aware of where their existing teams are weak. Learning about the skills and knowledge content of HI curricula gives a basis for this assessment. Noticing any missing elements relative to perceived needs motivates providing input to curriculum developers thereby influencing what future students will know. IT professionals in the Health Informatics field should also investigate the content of various curricula, using them to develop a personal SK+E template or checklist to guide their own continuous learning process. Those that find that what is being taught does not conform to what they have found to be necessary for their own effectiveness, can bring their concerns to the curriculum developers and make sure students are more adequately prepared.

4 Those thinking of becoming HI professionals can use the curricula as a detailed description of what being a Health Informatician entails, and can compare one vision of HI to another, perhaps enabling a better selection of a training program. Those who have specific requirements or who believe that something is missing from the curricula can interact with the curriculum developers and potentially influence curriculum content. Market-wise educators will listen to you, because you are their consumers. Those involved in or interested in curriculum development itself can get together and bring their individual efforts and wisdom to a forum where a consensus or model curriculum is developed that can serve as a guide for what they do and a content standard against which their local efforts can be compared (See the HEALNet Workshop mentioned herein). So, there is a role for all of us. The only trick is to become knowledgeable enough to get involved, and to get this item on our to-do lists. Well then, visit the websites listed in the sidebar, or contact for further information. And, oh yes, get an action item on your list now! Sidebar: Where Can I Learn More? For those seeking more information, the following web sites were provided during the Congress: 1. AMIA has promised to make some of the presentations available on its web site. See: 2. The University of California at San Francisco has defined 17 informatics competencies for healthcare professionals (nurses, administrators, etc.) See: In addition, the Association of American Medical Colleges (AAMC) has developed curriculum guidelines for the education of medical students related to HI. See: And also see: 3. Those desiring information on asynchronous learning (any-time, any-place learning) techniques, see: 4. For information on the Applied Health Informatics distance education program at the University of Illinois at Chicago, see: The Health Information Management Certificate Program is described at: 5. The Recommendations of the International Medical Informatics Association (IMIA) on Education in Health and Medical Informatics can be found via: 6. Those interested in HI in Public Health, should contact Bill Yasnoff at the U.S. Center for Disease Control via: In addition, Marilynne Hebert has recently completed a Learning Needs Assessment survey related to HI. For additional information on the results of this survey, contact Jennifer Briand via: CREDIT: This work was supported by the Department of Computer Science at the University of Waterloo and Health/IT Advisors Inc.

5 H. Dominic Covvey Dominic is a consultant, educator and writer who finds himself in the fortunate position of being able to dedicate half his time to academic interests, among which are Health Informatics curriculum development, HI education, and HI research. The other half of his time is spent in the far less hallowed practice of Health IT consulting. He can be reached via or by phone at

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