Australian Skill Needs Analysis of Health Informatics Professionals. Volume 1: Rationale & Methods, Key Findings & Conclusions

Transcription

1 Australian Skill Needs Analysis of Health Informatics Professionals Volume 1: Rationale & Methods, Key Findings & Conclusions Sebastian Garde, David Harrison, Evelyn Hovenga Research Report 1/2005 of the Health Informatics Research Group Central Queensland University June 2005

2 2

3 1. EXECUTIVE SUMMARY INTRODUCTION MATERIAL AND METHOD Demographics Development of the Survey Form and Distribution of the Survey...8 Paper-based questionnaire...8 Web-based questionnaire RESULTS Demographics Reliability and validity Overview of Results Key Findings...20 Top 13 Knowledge/Skills (overall respondents)...20 Bottom 16 Knowledge/Skills (overall respondents)...20 Further findings Demographical Differences Comments from Participants...27 Web-based survey...27 Paper-based survey DISCUSSION CONCLUSION ACKNOWLEDGEMENTS REFERENCES

4 1. Executive Summary In the process of developing global health informatics education, a common understanding of educational outcomes is required. Therefore, an educational framework for Health Informatics professionals is desirable to support student mobility, trans-national and borderless education. Health Professionals with various roles in Health Informatics need to be properly educated for their respective roles in Health Informatics. To ascertain their perceptions of needs and priorities, we developed a webbased questionnaire and surveyed Australian Health Professionals on the preferred knowledge/skills set for Health Informatics Professionals. Among others, the questionnaire is based on the IMIA set of recommendations on education and IMIA s scientific map. Benner s 5 levels of competencies were applied to measure the degree of competency required for each skill/knowledge. Altogether, 629 Australian Health Professionals completed the questionnaire. The Health Professionals perceived degree of competency required for a total of 69 specific skills and knowledge items in five skill categories is presented in this report as well as the overall results for each of the 5 categories and interesting key findings and demographical differences. The development of a comprehensive health informatics education framework needs to take into account various health professions and the various roles in Health Informatics. Repeating the survey in other countries and for other professions is essential. 4

5 2. Introduction In the process of developing global health informatics education ([1], [2]), a common understanding of educational outcomes is required. This reflects the need to be able to characterize Health Informatics (HI) Professionals by their graduate attributes. An Educational Framework for Health Informatics Professionals as proposed in [3] can provide clarity about the relative position of different qualifications. This then supports decision-making regarding the progression between various educational sectors, including countries and providers. Such a framework would assist with program accreditation, positioning the results of any recognition of prior learning exercise, and the administration of credit-transfers. As a consequence, such frameworks provide a desirable infrastructure for supporting student mobility, transnational and borderless education. It is highly desirable to establish such a framework for Health Informatics education as this would assist with the identified need to be able to characterise Health Informatics Professionals by their graduate attributes. Health Professionals like physicians, nurses and allied Health Professionals, increasingly use Information Technology (IT), and some also deploy, research or develop health care IT. Consequently, they need to be adequately educated for their roles in Health Informatics. For these reasons, we developed a questionnaire to survey health professionals on the preferred knowledge/skills set for Health Informatics Professionals to ascertain their individual perceptions of needs and priorities. Thus, we can ensure we remain relevant and current in the content and delivery of such education and training and simultaneously provide the foundation for the development of comprehensive health informatics education while acknowledging the diversity of roles in Health Informatics. In doing so, however, we cannot exclusively rely on Internet/Web-based survey techniques as we anticipated big differences when only people with Internet access and the appropriate information technology literacy (and interest!) respond to our questionnaire. The aim of the report is to: outline methods used for the development of the survey; and present and discuss results from a paper-based survey and a web-based survey in the context of global health informatics education. Present and discuss significant differences between various demographic groups between the results of the paper-based and the web-based survey The overall report consists of 4 Volumes: Volume 1: This overview report detailing the rationale, methods, key findings and conclusions 5

6 Volume 2: Paper-based Survey Results Volume 3: Web-based Survey Results Volume 4: Integrated Web-based and Paper-based Survey Results 3. Material and Method 3.1. Demographics The approximately 450,000 Australian Health Professionals work in the following fields ([4]): Medical workers (51,800) Medical Imaging workers (8,100) Dental workers (25,900) Nursing workers (232,000) Pharmacy workers (12,300) Allied Health workers (31,200) Complementary Therapy workers (6,600) Other Health workers (46,200) While 92% of Australian nursing workers are female, 64% of the medical workers are male. Altogether, 74% of Health Professionals are female, mainly caused by the large number of female nursing workers. 38.6% of these Health Professionals were aged 45 years or more Development of the Survey IMIA endorsed a set of recommendations on education in Health and Medical Informatics [5] in 1999 and a scientific map was developed in 2002 ( These provide a sound foundation for a more comprehensive and detailed health informatics education framework and were used as a basis for the development of our survey. The recommendations include topic areas to be covered within each of three knowledge/skill domains and indicate the level of knowledge required in terms of introductory, intermediate or advanced. Some of these are applicable only to certain specialty areas which are also indicated. The recommendations have recognised that students undertaking health informatics education are either undertaking an undergraduate degree in one of the health professions or in informatics (e.g. computer science, information and communication technology, information management, information science, bioinformatics) or they have previously graduated with a degree in a wide variety of knowledge domains. This diversity makes it difficult to model a health informatics education framework that clearly indicates the many different pathways one can follow towards a professional health informatics qualification. Recent research to analyse the various roles and functions of health informaticians and to develop associated competencies [6-9] was taken into 6

7 account during the development of the questionnaire as well as a major workforce research study that was undertaken in 2002 [10] regarding skill sets for health information management. In these studies, usually a roles-based approach was employed to develop the frameworks and identify required competencies for each role. The British NHS multidisciplinary framework is based on the most widely recognised national standards of competency in Information Management as outlined in the Management Charter Initiative (MCI) Management Standards and applies to all staff working at strategic and operational levels of management [11]. Canada [5] identified three macro roles for which competencies were identified: 1) applied HI, 2) Research and Development HI and 3) Clinician HI. We employed this to define primary roles in Health Informatics for health professionals: Health professionals primarily using IT in health care; Health professionals deploying IT in health care; and Health professionals researching and/or developing IT in health care. Further, a survey of academic and industry professionals regarding the preferred skill set of graduates of medical informatics programs was conducted in the USA several years ago [12]. While HI terminology changed considerably over these years we took their experiences into account when developing our questionnaire. Collectively, these works provided a sound foundation for the development of our survey that intends to advance a comprehensive health informatics education framework. Our questionnaire is divided into two parts: demographic questions and knowledge/skills questions. The knowledge/skills questions are further divided into five categories to reflect the highly interdisciplinary field of health informatics: specific health informatics knowledge/skills; information technology knowledge/skills; people and organisational knowledge/skills; clinical, medical and related knowledge/skills; and various knowledge/skills. In contrast to others, we decided to employ the internationally recognized degrees of competencies as introduced by Benner [13]: Novice, Advanced Beginner, Competent, Proficient, and Expert in our questionnaire. The degrees were given values from 1 (Novice) to 5 (Expert). As we expected that not all Health Professionals are sufficiently confident with Health Informatics terminology we gave in addition to Benner s 5 levels of competencies the possibility to answer don t know. Further, to indicate that a knowledge/skill is not applicable, we gave the option of not applicable. 7

8 3.3. Form and Distribution of the Survey We distributed the survey in two forms: a paper-based questionnaire a web-based questionnaire Paper-based questionnaire The paper-based questionnaire was developed to be able to address a representative sample of Australia s health workforce. The Australasian Medical Publishing Company (AMPCo) holds the most comprehensive and up-to-date database of all health professionals in Australia. AMPCo was asked to send the questionnaire together with a covering letter and return envelope to a stratified random sample of 3000 Australian Health Professionals consisting of the following 9 strata: Practicing Doctors (various Classifications), Radiologists, Dentists, Nurses, Pharmacists, Physiotherapists, Podiatrists, Dieticians, Complementary Medicine Professionals To increase the response-rate, an additional letter and a copy of the questionnaire was sent after four weeks to remind the non-responders. Returns were electronically processed by Central Queensland University s Population Research Laboratory using Cardiff Software Teleform automated document and data capture applications. The paper-based questionnaire is presented in Figure 1 and Figure 2. 8

9 Figure 1: Page 1 of the paper-based questionnaire. 9

10 Figure 2: Page 2 of the paper-based questionnaire. 10

11 Web-based questionnaire The web-based survey was developed to be able to address the more IT literate part of Australia s health workforce. We set up an Internet survey using QuestionPro.com-technology and widely circulated the web-based questionnaire across the membership of Australia s professional health associations and colleges in November/December 2004 to complete the questionnaire and also reminded them after 3 weeks. The organisations mailing lists and member mail-outs were used to distribute the URL of the web-based questionnaire. The questions asked were completely identical to be able to compare the results, no advanced features of web-based surveys were used. An extract of the web-based survey is given in Figure 3. Figure 3: Screenshot of a part of the web-based questionnaire. 11

12 4. Results The detailed results are presented in Volume 2 to 4 of this report. Volume 2 presents the results of the paper-based questionnaire. Volume 3 presents the results of the web-based questionnaire. Volume 4 integrates both results and searches for significant differences between the paperbased and the web-based survey Demographics Altogether, 629 Health Professionals completed the questionnaire, 167 via the Internet, 462 using the paper-based questionnaire. 51.4% of the responding Health Professionals were female, compared to 74% of the Australian Health Professionals. 3.4% of the responding Health Professionals were younger than 30 years, 18% between 30 and 39 years, 37.6% between 40 and 49 years, 30.1% between 50 and 59 years, and 11% over 60 years old, resulting in an approximate average age of 47 for our respondents compared to the average Australian Health Professional who is roughly 43 years old (estimated from [4]). 86.1% (of the valid results as always) described their primary role in Health Informatics as I use information technology in health care. 8.5% described their primary role as I deploy information technology in health care while the remaining 5.4% described their primary Health Informatics role as I research & develop information technology in health care. Asked for their degree of competency in their primary Health Informatics role, 17% answered Novice, 25.4% Advanced Beginner, 33.7% Competent and 17% Proficient. 6.9% considered themselves an expert in their primary Health Informatics role. Asked for the statement that best describes their primary interest in Health Informatics 36.5% answered I want to use information effectively. 49.1% answered I want to use information technology effectively while the remaining 14.5% answered I want to manage information technology projects effectively Reliability and validity The analysis of reliability of the questionnaire showed good results. The reliability index Cronbach-Alpha was.982 for the 69 knowledge/skills questions. That is, answers in the survey are most likely to differ because respondents have real differences of opinions, not because the survey is confusing or has multiple potential interpretations. For the analysis of validity, we chose to empirically check the correlation between the mean values for each of the 5 skills categories and an external criterion related to the construct. As the external criterion, in the absence of a gold standard, we chose the one question on the overall degree of competency required for the respective skills category. In this, we assumed that health professionals who perceive that a high overall degree of competency is required for a skill category should be consistent with the mean value of their answers to the individual questions of this category. 12

13 Each of the 5 means was positively correlated with the overall degree of competency for the respective category (correlation coefficient r between.482 and.586, p <.001 for each correlation). The mean values of the individual skills questions are thus well correlated to the overall skills questions, pointing to an acceptable validity of the questions. While the actual values of the means and the result for the respective category differ considerably, the ranking order of the 5 categories is not affected by this (Table 1, Table 2). Looking at each individual skill question and correlating them with their respective overall category score, all 69 are correlated with p <.001. Table 1: Means of the means for the various categories. For example the mean for specific Health Informatics skills equals the mean of the means of questions 8 to 27. Specific Health Informatics - means of categories Information Technology - means of categories People & Organisational - means of categories Clinical, Medical & Related - means of categories N Minimumum Maxi- Std. Rank N Mean Deviation Specific Health Informatics means of means Information Technology means People & Organisational means Clinical, Medical & Related means Various means Valid N (listwise) 517 Minimum Maximum Mean Std. Deviation Rank Various Knowledge/Skills - means of categories Valid N (listwise) 462 Table 2: Means of the various overall category questions. For example the mean for specific Health Informatics skills equals the mean of Question

14 4.3. Overview of Results The following five figures provide an overview of the results for each knowledge/skills category of our surveys. These are the combined results for the paper-based and web-based survey and designed to provide a quick overview. However there are significant differences between the paperbased and web-based surveys, therefore please refer to Volumes 2-4 of this report for more detailed results of the survey. Figure 4 provides an overview of the mean values for specific health informatics knowledge/skills. Figure 5 provides an overview of the mean values for information technology knowledge/skills. Figure 6 provides an overview of the mean values for people & organisational knowledge/skills. Figure 7 provides an overview of the mean values for answers for clinical, medical & related knowledge/skills. Figure 8 provides an overview of the mean values for various other knowledge/skills. The overall mean score of is As a summary question, we asked the Health Professionals to assess the overall degree of competency required for each of the 5 categories: Figure 9 provides an overview of the mean values for the overall degree of competency required to create the ideal HI skills package as perceived by the health professionals. Medical Robotics Mathematical Models in Medicine/ Biomedical... Technology of Measurement & Electrical Engineering Medical Signal Processing Organ Imaging Informatics Artificial Intelligence in Medicine Electronic Patient Records/ Electronic Health Records Health Care Organisation & Administration Outcome Measurement/ Practice Evaluation Biometry Epidemiology Bioinformatics Decision Support Systems/ Knowledge Based... Health Informatics Standards (HL7 etc) Coding & Classification (ICD, DRG etc.) E-Health/ Telehealth/Telemedicine Health Concept Representation Health Data, Information & Knowledge Management Management of Health Information Systems Health Information Systems (General Characteristics % CI Figure 4: Means and 95% Confidence Interval for specific Health Informatics Knowledge/Skills (combined results of Paper and Web-based Survey Results) 14

15 User Interface Design Distributed Systems Speech Recognition Network & other Protocols System Programming Real Time Data Processing Graphical Data Processing Database Protection & Security Database Querying Database Design Database Management Modelling (Objects, Processes; UML) Systems Test Systems Design/ Technical Requirements... Systems Analysis/ User Requirements Identification Business Analysis/ Workload Analysis Technical Informatics Theoretical Informatics Operating Systems & Administration Algorithms & Data Structures Software Development Methodologies & Processes Programming Languages Programming Principles % CI Figure 5: Means and 95% Confidence Interval for Information Technology Knowledge/Skills (combined results of Paper and Web-based Survey Results). 15

16 Expressing complex clinical Knowledge in plain English Effective Communication between Health & IT Professionals Social Competency Risk Management Quality & Safety Management Change Management Project Management % CI Figure 6: Means and 95% Confidence Interval for People & Organisational Knowledge/Skills (combined results of Paper and Web-based Survey Results) 16

17 Diagnostic & Therapeutic Strategies Clinical Guidelines Clinical Trials Evidence-based Practice Clinical Disciplines (Internal Medicine, Surgery,...) Genomics Biochemistry Pathology Physiology Anatomy % CI Figure 7: Means and 95% Confidence Interval for Clinical, Medical & Related Knowledge/Skills (combined results of Paper and Web-based Survey Results) 17

18 Cryptology/ Cryptography Statistics Mathematics Medical Physics Ethics Social Science Legal Understanding Economics Business Management % CI Figure 8: Means and 95% Confidence Intervals for Various Knowledge/Skills (combined results of Paper and Web-based Survey Results) 18

19 Various Knowledge/Skills Clinical, Medical & Related People & Organisational Knowledge/ Skills Information Technology Knowledge/ Skills Specific Health Informatics % CI Figure 9: Means and 95% Confidence Interval for required Degrees of Competency as perceived by Health Professionals for the 5 overall Categories. 19

20 4.4. Key Findings Top 13 Knowledge/Skills (overall respondents) 1. Expressing complex clinical Knowledge in plain English (mean value: 3.47) 2. Anatomy (3.38) 3. Physiology (3.34) 4. Clinical Guidelines (3.29) 5. Evidence-based Practice (3.26) 6. Diagnostic & Therapeutic Strategies (3.21) 7. Pathology (3.21) 8. Social Competency (3.22) 9. Effective Communication between Health & IT Professionals Ethics (3.13) 11. Clinical Disciplines (Internal Medicine, Surgery,...) (3.08) 12. Electronic Patient Records/Electronic Health Records (3.04) 13. Health Data, Information & Knowledge Management (3.01) Bottom 16 Knowledge/Skills (overall respondents) 1. Medical Robotics (mean value: 1.47) 2. Technology of Measurement & Electrical Engineering (1.59) 3. Cryptology/ Cryptography (1.59) 4. Mathematical Models in Medicine/ Biomedical Modelling (1.62) 5. Distributed Systems (1.73) 6. System Programming (1.75) 7. Medical Signal Processing (1.75) 8. Artificial Intelligence in Medicine (1.81) 9. Speech Recognition (1.81) 10. Algorithms & Data Structures Theoretical Informatics Programming Languages Technical Informatics Modelling (Objects, Processes; UML) Biometry Software Development Methodologies & Processes 1.97 Further findings Throughout the survey it appears that conventional IT skills are not regarded as very important. However, this is mainly true for Health Informatics Professionals with primary role to use information technology in health care as opposed to Health Informatics Professionals with primary role to deploy, research or develop information technology in health care. A high percentage of our respondents are IT users only, therefore the low interest in actual IT knowledge/skills, and high interest in clinical, medical and related knowledge/ skills could be expected. This clearly shows the need to strictly differentiate between 20

21 the various Health Informatics roles to provide adequate education for Health Informaticians that use information technology in health care deploy information technology in health care research & develop information technology in health care Although it appears that clinicians and especially doctors tend to overestimate the required clinical/medical skills required for their Health Informatics role (in comparison to their Health role), it appears throughout the survey that at least a solid foundation if not more of medical and clinical knowledge/skills is required to be successful in common Health Informatics roles. Very few respondents actually define themselves to research or develop information technology in Health Care. Throughout the surveys and independent of the various strata it appears that Expressing complex clinical Knowledge in plain English Social Competency Effective Communication between Health & IT Professionals Ethics are regarded as extremely valuable general skills/knowledge. Throughout the surveys and independent of the various strata it appears that skills/knowledge re Electronic Patient Records/Electronic Health Records Health Data, Information & Knowledge Management are regarded as extremely valuable specific Health Informatics skills/knowledge. It appears that skills for Medical Robotics, as well as Technology of Measurement & Electrical Engineering skills are not often required for the typical Health Informatician, maybe because especially the former is to specific, even for specific Health Informatics skills. It is somehow surprising that Cryptology/ Cryptography has scored so low as it is the undeniable basis for secure systems in health care. Only low level knowledge/skills in Biometry (sometimes referred to as Biostatistics or Biometrics - the application of statistics to biology and, most commonly, to medicine) seems to be required. Given that good design and analysis of clinical trials is undeniably a very important task also in relation to ethical requirements (which were rated very high in this survey), the authors suspect that some confusion with a recent different meaning of biometrics might have occurred: technologies for measuring and analysing human physiological characteristics such as fingerprints, eye retinas and irises, voice patterns, especially for authentication purposes. Medical Signal Processing and Artificial Intelligence in Medicine score a low mean value probably because their current examples in clinical practice might still be limited. 21

22 4.5. Demographical Differences The following figures provide an overview of the mean values for all questions in one of the 5 skill categories detailed according to the demographical questions for gender, age, highest level of education, primary profession, primary role in Health Informatics, experience in this role, and primary interest in Health Informatics. Mean Specific Health Informatics Knowledge/ Skills Information Technology People & Organisational Clinical, Medical & Related Knowledge/ Skills Various Knowledge/Skills male Gender female 22

23 Mean Specific Health Informatics Knowledge/ Skills Information Technology People & Organisational Clinical, Medical & Related Knowledge/ Skills Various Knowledge/Skills < >60 Age of Participant Mean Specific Health Informatics Information Technology People & Organisational Clinical, Medical & Related Knowledge/ Skills Various Knowledge/Skills Secondary School Bachelor's Degree Master's Degree MD Highest Level of Education PhD 23

24 Mean Specific Health Informatics Knowledge/ Skills Information Technology People & Organisational Clinical, Medical & Related Knowledge/ Skills Various Knowledge/Skills Medical Doctor Nurse Computer Professional Health Administrator Allied Health Other Primary Profession Mean Specific Health Informatics Information Technology People & Organisational Clinical, Medical & Related Knowledge/ Skills Various Knowledge/Skills 2.00 I use information technology in health care i deploy information technology in health care I research & develop information technology in health care Best describes your Primary Role in Health Informatics 24

25 Mean Specific Health Informatics Information Technology People & Organisational Clinical, Medical & Related Knowledge/ Skills Various Knowledge/Skills Novice Advanced Beginner Competent Proficient Expert Rate your Experience in your Primary Role in Health informatics Mean Specific Health Informatics Information Technology People & Organisational Clinical, Medical & Related Knowledge/ Skills Various Knowledge/Skills I want to use information effectively I want to use information technology effective Best describes your Primary Interest in Health Informatics I want to manage information technologyprojects effectively 25

26 Significant differences could be detected for 20 of 23 IT skills supporting the theory that Health Professionals perceive these skills of varying importance for each of their HI roles. Significant differences were also detected for 22/2 IT skills (all except speech recognition) with regard to the respondent s primary interest in Health Informatics. There are also significant differences between the Internet and Paper-based survey: the results of 12/20 specific Health Informatics skills, 22/23 Information Technology skills, 7/7 People and Organisational Skills, 4/10 Clinical/Medical & related skills, 5/9 various skills delivered significant differences. Overall it seems that the Internet respondents were more inclined to rate specific Health Informatics skills and Information Technology skills higher than paper respondents whereas paper respondents value the Clinical/Medical & related skills higher than the Internet respondents do. Mean Specific Health Informatics Information Technology People & Organisational Clinical, Medical & Related Knowledge/ Skills Various Knowledge/Skills Internet-based Internet or Paper-based Paper-based 26

27 4.6. Comments from Participants In the following we present typical comments made by participants of the web-based and the paper-based survey. Web-based survey Some of the terms are over my head, I'm a clinician and managing information is relevant mainly as it impacts on practice and practice quality. IT service personnel in health have little ability to express themselves in plain English and not much interest in understanding healthcare processes. The aims of Healthcare IT providers are not related to the provision of quality healthcare. The systems are so corrupted that it is doubtful if any degree of education will result in improved care. I believe Clinical Knowledge and understanding is essential to my role. It is difficult particularly in health to design systems if you do not understand the Business of healthcare at a clinical level. Communication and effective interpersonal skills are also essential to the success of any IT project. I believe the businesss of Health (patient care) should drive IT not IT drive Health. Understanding how people learn when training staff is an important skill. I work in nurse regulation and have managed the development and implementation of an integrated business system for regulation and moved that system to ebusiness. The system has been sold to other regulation bodies. I find the survey difficult to relate to the issue of health informatics skills required for healthcare management in the future. There is an urgent requirement for bright practicing doctors to get intense training in high level medical informatics and other areas so that they can lead the revolution that needs to occur in establishing clinical information systems. I work in a team and have access to experts. My need is to have access to trends and have enough information to work smart, lead and manage a team. Related to question 7: Which of the following best describes your primary interest in Health Informatics?: I want others to use the information effectively! Skills in communication and change management are particularly important. It is difficult for health professionals to verbalise and articulate their business processes and requirements, so designing what they need can be problematic. They are very resistant to changing business processes, especially if this involves altering demarcation lines. 27

28 I like to learn more on IT Health and how I could use it for teaching. Midwives need to be competent in the day to day use of the computer. They need to be able to access information similar to that which Dr's need, especially in places where the midwife is the primary care provider. They also need to be able to use databases and have the ability to compile statistics for quality improvement activities. My experience in Qld Health is that very few have the above opportunities and many don't have the skills. Surprised that integration/interfacing between systems didn t have a stronger focus. This is a critical and major component to all of our clinical IT developments. The questionnaire underestimates the skill set required to translate business requirements into a functioning technical architecture and the generic integration skills required to draw that together and meaningfully represent that to the end user Missing skills: Contract negotiation (commercial management) Systems integration User acceptance testing Marketing knowledge of major health IT players and their product suite (market analysis) Mobile Technologies Paper-based survey I am not representative of IT in Medicine. My younger colleagues are both more informed users of IT - and have more faith in it than I do. Technology is simply a tool in the management of a patient. We must not lose sight of the basic principle of medicine, i.e. the raw material is a person and the technology comes second. I think the person needs to understand the terminology + relative importance of aspects of medical information in clinical context before they can understand the information requirements of medical practitioners because the environment is so unique. The art of making health informatics benefits user friendly to clinicians. The theories often fail at implementation because clinicians have very different skill levels with IT. We rely on our software support for many of these disciplines. The internet is too time-consuming to be an every day tool in our environment. The most important ability, insight, etc. is time to learn skills. At present I learn on the job with no expert teaching. It is very slow! 28

29 In a retail pharmacy setting, skills need generally to be broad so as to put into layman s terms the answers to 100s of questions received weekly. The broad base though requires specific training in medical chemistry/ pharmacology/ business/ IT & people skills as more demands are made on us to specialize, e.g. home medication. This is total computer-jargon technobabble I don t understand half of what you are actually asking. Medical Imaging needs a detailed knowledge of data transfer. ADSL, cable, fibre optic, Satellite interfaces. DICOM3/4. Computer-aided Diagnosis CAD (covered in Artificial Intelligence). International law international reporting. Clinicians learn by personal experience over many years no short cuts. This survey should include research skills. This is mostly irrelevant to my practice all I want is to get X-rays online & via cable & we have people doing that for us. I have felt quite intimidated in completing this survey. I believe any candidate taking part needs to have a fairly general knowledge of IT and its terminology and I believe I fall short of that requirement. My answers probably reflect my lack of competence in this area. So long as patient files & results are available and readily accessed, then that s all that is required. I found the questionnaire difficult to relate answers to. I work in a country nursing home attached to a hospital (clinical manager). The area most required is in the accessory of evidence-based information. One of the major difficulties with computer information is time and dexterity. Many people don t have typing skills. 29

30 5. Discussion A comprehensive health informatics education framework is needed to enable Australian and international collaborative health informatics education to function optimally. Developing a comprehensive educational framework for health informatics professionals is a tedious task, this is a first, yet crucial step. As we have seen, the differences between the webbased and the paper-based survey are that significant that we could not exclusively rely on Internet/Web-based survey techniques. These differences will have to be carefully interpreted, we provide help for this by asking for the individual s primary role and primary interest in Health Informatics. Eventually, we propose that other researchers in other countries use our questionnaire to carry out similar surveys: In-depth analysis of the many emerging roles and functions of health informatics professionals around the world is needed to further inform this process. The primary role of HI professionals requires high levels of versatility ranging from the health professionals simply using information technology in their daily routine, up to especially educated health informatics researchers and developers. Obviously, depending on one s role, the education needed to succeed in HI is considerably different. We controlled for this by asking for the health professionals self-assessment of their primary role in Health Informatics, their assessment of the skills for their own primary role and their primary interest in Health Informatics. Some interesting statistically significant differences could be found. Some significant differences could be observed, for example regarding the degree of competency required for various Information Technology skills required for the various roles in Health Informatics. This is in harmony with the IMIA recommendations [5] on education in Health and Medical Informatics. The IMIA recommendations differentiate between education for IT users and Health/Medical Informatics (HMI) specialists and e.g. they stated that education in practical informatics (programming languages, etc.) should provide excellent knowledge/skills for Master/Bachelor programs in HI, but on the other hand IT users don t generally need any of these skills. Change management and project management are important to both types of Health Informaticians (albeit HMI specialists need even more advanced knowledge/skills). This is not different in our survey: Both project management and change management are perceived as requiring a high degree of competency by Australian Health Professionals and significant differences could be found pointing to the conclusion that Health Informaticians with a primary role in HI research and development or primary interests in managing IT projects in health care need to be even more competent in these areas. However, other people and organizational skills like Quality & Safety Management, Risk Management, Social Competency, Effective Communication between Health & IT Professionals, Expressing complex clinical Knowledge in plain English are regarded as requiring an even higher degree of competency. Although not a classical skill, Expressing complex clinical knowledge in plain English was the skill 30

31 with the highest score. These skills are not mentioned by the IMIA recommendations. We believe that this clearly indicates the need for further research on the content and delivery of Health Informatics education. If for example, we compare Management of information systems in health care (IMIA) and Management of Health Information Systems (our questionnaire), the IMIA recommendations conclude that while advanced knowledge/skills are needed for HMI specialists, no knowledge/skills are needed for IT users. Likewise, we can detect significant differences between the various groups. Still, even Health Informaticians primarily using IT feel that basic knowledge is still important by awarding an above-average mean score of 2.73 (compared to research and development Health Professionals awarding a mean score of 3.72 and compared to the overall mean score for all 69 questions of 2.495). Finally, it is emphasised that the focus of this research has been the perceptions of individual Health Professionals as they relate to their own roles in Health Informatics. It is possible and at least partly shown in this report that the expectations in terms of knowledge and competencies by administrators, project managers and technical specialists working with Health Professionals are significantly different from the Health Professionals themselves. It is also possible that individuals with limited knowledge or exposure to IT have naïve or unrealistic perceptions of skill and competency needs. 31

32 6. Conclusion Firstly, we believe that our results will enable universities to remain relevant and current in the content and delivery of health informatics education. Secondly, we hope that they will facilitate student mobility, trans-national and borderless education by establishing the foundation for a nationally and internationally recognized educational framework for health informatics professionals. This will help internationally collaborative Health Informatics education to function optimally. The framework needs to take into account the needs of the various health professions and the various roles in Health Informatics. Repeating the survey in other countries and for other professions is essential. 32

33 7. Acknowledgements This research was funded by an Internal Research Grant of the Faculty of Informatics and Communication of Central Queensland University. The authors thank Mitchell Duncan from Central Queensland University s Population Research Laboratory, Centre for Social Science Research for the implementation of the paper-based questionnaire in the Teleform software and processing of the returned questionnaires. The authors thank all Health Professionals who participated in either the paper-based or the web-based survey. 33

34 8. References [1] Hovenga EJS and Mantas J, Eds. Global Health Informatics Education. Stud Health Technol Inform. Amsterdam: IOS Press, [2] Hovenga EJS. Globalisation of Health and Medical Informatics Education what are the issues? IMIA Working Group on Education Conference, Portland, Oregon, USA, April 2003, [3] Hovenga EJS. A Health Informatics Educational Framework. In: Hovenga EJS and Mantas J: Global Health Informatics Education. Amsterdam: IOS Press [4] Australian Institute of Health and Welfare. Australia's Health [5] Haux R, Grant A, Hasman A, Hovenga E, and Knaup P. Recommendations of the International Medical Informatics Association (IMIA) on education in health and medical informatics. Methods Inf Med 2000; 39: [6] Saba V, Skiba DJ, and Bickford C. Competencies and Credentialing: Nursing Informatics. In: Hovenga E and Mantas J: Global Health Informatics Education. Amsterdam: IOS [7] NHS Information Authority. Health Informatics Skills and Competencies: A framework to support NSF implementation. 2002; [8] Canadian Nursing Informatics Association. Educating Tomorrow's Nurses: Where's Nursing Informatics? OHIH Research Project: Final Report. 2003; [9] Covvey HD, Zitner D, and Bernstein RM, Eds. Pointing the Way: Competencies and Curricula in Health Informatics, [10] Wing P, Langelier M, Continelli T, and Armstrong D (2003). Data for decisions: The HIM Workforce and Workplace 2002 Member Survey. [11] Institute of Health and Care Development (IHCD). IM&T Competency Framework for NHS Managers [12] Hoffmann S and Ash J. A survey of academic and industry professionals regarding the preferred skillset of graduates of medical informatics programs. Medinfo 2001; 10(Pt 2): [13] Benner P. From novice to expert: Excellence and power in clinical nursing practice. Menlo Park: Addison-Wesley,