A Health Informatics and ehealth Curriculum for Clinical Health Profession Degrees. HIC 2015, Brisbane, 4 August 2015

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1 A Health Informatics and ehealth Curriculum for Clinical Health Profession Degrees HIC 2015, Brisbane, 4 August 2015 Kathleen GRAY a, Dawn CHOO a, Kerryn BUTLER-HENDERSON b, Sue WHETTON c, Anthony MAEDER d a Health and Biomedical Informatics Centre, The University of Melbourne b Centre for Rural Health, University of Tasmania c Tasmanian School of Business and Economics, University of Tasmania d School of Computing, Engineering and Mathematics, University of Western Sydney

2 Clinical = dentistry, dietetics, medicine, midwifery, nursing, occupational therapy, optometry, paramedics, pharmacy, physiotherapy, psychology, radiography, social work and complementary therapies, and so on ~2000 clinical health profession degrees offered in Australia s ~40 universities from Bachelor degree to coursework Doctorate How many of these degrees teach health informatics or ehealth? How well? Image credit: adctoday.com

3 Very few can give a clear account. Those who do may teach with reference to recognised curriculum guidelines or not. Examples Australian Health Informatics Education Council, Health Informatics Scope, Careers and Competencies, J. Mantas, E. Ammenwerth, G. Demiris, A. Hasman, R. Haux, W. Hersh, et al., Recommendations of the International Medical Informatics Association (IMIA) on education in biomedical and health informatics 1st revision. Methods of Information in Medicine 49 (2010), Based on findings from our study of entry-level degrees, including 100 interviews with university teachers in all States: K. Gray, A. Dattakumar, A. Maeder, K. Butler-Henderson, & H. Chenery, Advancing Ehealth Education for the Clinical Health Professions Final Report, Australia. Department of Education and Training, Image credit: timeshigherducation.co.uk

4 Yes, we re teach health informatics and ehealth: The curriculum containing individual subjects on evidence based practice in addition to discipline specific EBP [evidence-based practice] content dispersed throughout the curriculum. Physiotherapist, SP13 Students have access to remotely located guest lecturers who present using teleconferencing. Nurse, SP15 Several lectures include content relating to electronic patient records, how they are accessed and how they relate to the hospital environment and private practice. Physiotherapist, SP32 Evidence-based practice, Communication, Clinical decision support systems, Professional Experiences in actual health care agencies. Nurse, SP61 The fact that the subject notes must be down loaded by students provides a basis for this type of learning environment. However, there is no designated aspect of the course in which this sort of information is presented. Myotherapist, SP69 Guest speaker from the State Government [ ] Data Collection Unit. Midwife, SP80 Some components of public health essays may touch upon ehealth as a component of a question or as part of an answer. Medical Practitioner, SP89

5 No, we re not teaching this stuff Some staff are more e-savvy and use technologies such as Skype & Adobe Connect but there is no requirement. Our assessment strategies do not address anything related to ehealth. Psychologist, SP4 This is not specifically taught as a topic within the current degree program but electronic record keeping is used throughout most clinics and students are expected to conform to current practices of reporting. Audiologist, SP22 Only limited specific discussion of evidence based practice however would not include this as part of ehealth or informatics. Nurse, SP81 The teaching methods to date do not use telehealth or other methods. Dietitian, SP90 Our students use electronic records in our clinic however they are not assessed on them. Chiropractor, SP102

6 Why should we? Why don t we? Image credit: amia.org

7 Why should they? Safety and quality of care Efficiency and efficacy Health sector restructuring Why don t they? Few people, thinly spread, with the expertise to teach Not required for degree (re)accreditation Unclear signals from employers Image credit: amia.org

8 This project How could we address scarcity of : quality-assured curriculum? teaching expertise? $$$ to do anything about it? Let s apply for an OLT extension grant! Let s design a curriculum aligned with CHIA competencies! Let s target postgraduate level, for students and staff! Let s make it available online! Image credit:

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12 Three-step curriculum development Step 1. Peer review Six CHIA competency areas including 52 sub-topics, chunked into 10 roughly equal blocks of study Each of the four academics drafted curriculum related to competencies with best fit to their expertise Task: define key concepts, construct overviews, design learning activities, select or create supporting resource materials Project officer to keep us on track, honest and real Brief: Suit multi-professional and interprofessional learning Be relevant for health professional practice in local, national and international settings Rely on resource based learning, using a variety of free full-text online resources Represent intellectual effort and time commitment equivalent to 12.5 credit points at AQF level 8/9

13 Block 10 of 10 Developer TEAM MEMBER NAME Competency area CHIA Competency 6 - Human and social context mapped from CHIA Sub-topics 6.1 Technology and social aspects mapped from CHIA 6.2 The relevance of ethical and legal issues for health informatics 6.3 Policies, principles and guidelines for health informatics management 6.4 Usability and human factors Learning outcomes mapped from CHIA Overview Discuss the areas of design, evaluation and social sciences taking into account technological limitations Apply good practice to ethical, legislative political and regulatory obligations related to health information management (e.g. protecting the privacy of consumers) Apply good practice to the collection, use, disclosure, access, protection and destruction of health information Apply good practice to human centred design, usability, human factors and ergonomic sciences 150 word transcript, alternative short introduction recording Learning resources Learning activities For each sub-topic provide at least one well-chosen document with full citation For each sub-topic provide clear instructions on one learning activity, reflecting learning outcomes, linked to learning resources, and able to be written up for assessment

14 Three-step curriculum development Step 2. External review Twenty-five experts selected from health profession degree and subject coordinators, members of the CHIA Examination Group, and other interested members of national ehealth and health informatics organisations invitation with link to online survey for anonymous review, open December 2014 and January Options : review curriculum for all 52 sub-topics in all 6 areas of competency; or review curriculum just in your area of interest; or read all curriculum and review none Measures Responses on a 5-point Likert scale to three questions about each sub-topic: How relevant are the learning activity and resources to the clinical professions? How well do the learning activity and resources align with the CHIA competency? How interesting are the learning activity and resources for a clinical health degree student? Respondents were also asked: make open-ended comments about curriculum in each sub-topic rate their expertise in each sub-topic as low, medium or high. say whether associated with the CHIA Examination Group; and /or a degree or subject coordinator in a clinical health degree; and / or experienced in developing curriculum for ehealth and health informatics

15 12 reviews received, all competency areas reviewed. Useful comments, including: Purely from a clinical perspective, much of this is (as previously mentioned) actually not generally visible and could prove both challenging and indeed, awkward for a purely clinically focussed individual to comprehend. (Q6)... free-text analysis of data is [fraught] with data integrity issues; and in fact should not even be proposed to students, in that the major drive for decision support is the absolute requirement for strongly codified information values, such that there is a high(er) confidence in the decisions provided by the system... (Q9) There is literature on the 'clinical method' that might help, and early writings by McWhinney, that I think are very relevant here. Need to counter the mechanical view of clinical decision making that pervades HI. (Q37)

16 Three-step curriculum development Step 3. Subject trial Students took a one-semester free subject based on the curriculum, March - June 2015 Project leader and project officer implemented the curriculum in University of Melbourne online learning management system Participants: 41 EOIs from eligible applicants 18 selected and commenced seven completed, from 5 professions and 2 States Students did self-directed learning, based on a detailed study guide and a choice of weekly activities; and structured group learning, based on lodging their work and reviewing each others work in discussion forums each week. Teaching was shared among the project team on a weekly roster. Teachers gave feedback to students individually each week via an online comment and grading facility. Measures: Pre-trial survey of potential learning variables Hurdle requirement: pre- and post-tests of HI&eH knowledge Graded weekly written assignments x 10 weeks; graded final project presentation Post-trial survey of student experience and satisfaction

17 Comparative analysis of pre- and post-tests showed that the subject built health informatics and ehealth knowledge 7 completing students post-tests used a greater number of words than their pre-tests (2344 words compared to 1852 words, in total). The number of different words increased in their post-tests (818 unique words, compared 612 in the pre-tests) and mean lexical density slightly increased (from 33.05% in pre-tests to 34.9% in the post-tests) New salient words emerged in post-tests statements, for example, in the post-tests five occurrences of interoperability, a word not seen at all in pre-tests. Indicates acquisition of more specialised terminology and concepts Indicates increased ability to apply content-related concepts

18 Analysis of post-trial student experience surveys showed that the interprofessional learning experience was valued. Best aspects of the subject: learning as a multidisciplinary cohort ability to choose among learning activities provision of relevant links and resources breadth of content coverage literature review assignment reading the discussion forums remote and self-guided learning a timed, structured approach which included weekly tasks The subject could be improved by: focus on Australian context and examples exclusively more external video resources more flexible weekly due dates scheduled lessons and tutorials

19 Where can I find out more about the project? The full paper in the HIC 2015 conference proceedings. The current version of the curriculum document is freely downloadable at: University of Melbourne Academic Board approval processes are under way to offer the online subject for postgraduate credit, with teaching by project team members across partner institutions and enrolment available to students across Australian universities. For details, contact kgray@unimelb.edu.au

20 Reflections on CHIA How do CHIA competencies fit in Nationally Recognised Training? How does passing the CHIA examination compare with completing a university subject based on the CHIA competencies in the Australian Qualifications Framework? How do we define concepts such as good practice or best practice in CHIA? How do we update CHIA competencies to give more attention to the influence of ehealth - for instance developments in more participatory, social technologies and more natural, ambient user interfaces to information? How do we progress still underdeveloped CHIA specialisation competencies such as aged care informatics, clinical informatics, clinical research informatics, nursing informatics, public health informatics?

21 Thank-you to clinical degree students and staff who contributed to this project and to individuals associated with CHIA and its auspicing organisations ACHI, HISA and HIMAA Support for this project has been provided by the Australian Government Office for Learning and Teaching. The views expressed in this report do not necessarily reflect the views of the Australian Government Office for Learning and Teaching.