MODELS FOR TEACHING HEALTHCARE INFORMATICS: A SURVEY OF HEALTHCARE INFORMATICS PROGRAMS *

MODELS FOR TEACHING HEALTHCARE INFORMATICS: A SURVEY OF HEALTHCARE INFORMATICS PROGRAMS * Bonnie K. MacKellar Division of Computer Science, Mathematics and Science St. John's University Queens, NY 11439 718-990-7452 mackellb@stjohns.edu ABSTRACT Healthcare informatics programs are becoming increasingly popular in higher education due to the demand in healthcare settings for employees skilled in the use of information technology. When designing healthcare informatics programs, it is important to understand existing programs but this can be difficult due to the plethora of related terms for the field. In order to better understand similarities and differences among existing educational programs related to healthcare informatics, we analyzed 51 existing undergraduate programs. Questions to be answered were: Which departments house the programs? What is the computer science content of the programs? What is the healthcare-specific content of the programs? Our results indicate that undergraduate programs fall into one of two types: accredited health information management programs rooted in management of medical records, and health/medical informatics programs related more closely to computer science. The two types of programs are discussed in terms of curriculum and accreditations as well as implications for CS/IT departments that wish to develop offerings in this area. INTRODUCTION Healthcare informatics (HCI), also sometimes referred to as healthcare IT, is a field attracting a great deal of interest within the computer science and information technology community. There is currently a push to expand HCI education in the United States, in * Copyright 2011 by the Consortium for Computing Sciences in Colleges. Permission to copy without fee all or part of this material is granted provided that the copies are not made or distributed for direct commercial advantage, the CCSC copyright notice and the title of the publication and its date appear, and notice is given that copying is by permission of the Consortium for Computing Sciences in Colleges. To copy otherwise, or to republish, requires a fee and/or specific permission. 146

CCSC: Eastern Conference part due to the American Recovery and Reinvestment Act (ARRA) of 2009, which mandates that healthcare providers adopt certified electronic medical record systems by 2015 or face reduced Medicare reimbursement. As a result, hospitals need to hire many additional HCI specialists. A report by the Computing Community Consortium on Information Technology Challenges for Healthcare, mentions the need to train "fledgling" computer scientists in the biomedical domain as a critical need [1]. For this reason, educational institutions are ramping up their offerings in this area. In the past decade, computer science enrollments have dropped significantly [2]. One of the potential ways of attracting more students to major in computer science is to offer interdisciplinary courses and programs within computer science [3,4]. The field of healthcare and medical informatics is a service-oriented field which may be more attractive to women and underrepresented minorities [5]. Many CS and IT programs are adding courses, minors, certificates, and even entire bachelor's degrees in healthcare and medical informatics. For example, the University of Minnesota Crookston offers a certificate in Health Informatics for Software Engineers within its software engineering program, Oregon Institute of Technology offers a major in healthcare informatics within its School of Information Technology, and Simmons College offers a major in healthcare informatics within its Department of Computer Science and Informatics. The author's university has developed a new bachelor's program and a minor in HCI, housed in the computer science division and developed in cooperation with the healthcare administration division. Since our program is very new, it is still in flux. In order to determine the best direction for this program, and to better understand the educational landscape surrounding health and medical informatics, the author decided to conduct a study of existing programs. The purpose of this study was to answer the following questions: What is the range of existing undergraduate programs in healthcare informatics or related fields? Which departments house existing programs? What is the computer science content of existing programs? What is the healthcare-specific content of existing programs One of the difficulties for CS and IT departments planning offerings related to healthcare informatics is in understanding the landscape of existing programs. This was mentioned as an issue at a recent Birds of a Feather session on healthcare informatics in the computer science curriculum, held at SIGCSE2011 [6]. Participants also mentioned related concerns such as the role of accreditation, identification of career paths within health informatics, nuances of meaning among the various names for the field, and difficulties in finding appropriate textbooks and software. The purpose of this paper is to help answer these questions, which might be asked by CS and IT departments wishing to develop offerings in the HCI area. WHAT IS HEALTHCARE INFORMATICS? A significant challenge is that there is no agreed-upon definition of the fields of health and medical informatics. In fact, it isn't even clear which term belongs in front of the word "informatics". Programs variously describe themselves as health informatics, medical informatics, biomedical informatics, and nursing informatics. In addition, the 147

JCSC 27, 3 (January 2012) terms healthcare information technology and healthcare information management are also commonly used. William Hersh, who writes extensively on healthcare informatics education, describes health information management (HIM) as a field which historically focused on medical records but is now increasingly overlapping with healthcare informatics, while health information technology (HIT) is the field in which computers and information systems are applied to the healthcare setting [7]. He defines health informatics (HCI) as the field which is concerned with "the optimal use of information, often aided by the use of technology, to improve individual health, health care, public health, and biomedical research." [8]. Since it turns out that these distinctions have implications for educational programs, we will use these definitions, as well as the alternate term medical informatics(mi) which is favored by the American Medical Informatics Association instead of healthcare informatics. Career paths are also quite varied. The Office of National Coordinator (ONC), which was established to provide a direction for the development of an integrated information infrastructure in healthcare, defines 6 professional roles in healthcare informatics that require training at the university level: a) Clinician/public health leader; b) Health information management and exchange specialists; c) health information privacy and security specialists; d) research and development specialists; e) programmers and software engineers; and f) health information technology sub-specialists [9]. In general, software engineers and IT professionals do the same types of work in the healthcare setting as they do in most sectors: design, implement, and maintain computer-based systems. Currently, IT professionals in the healthcare setting need a CS or IT background, depending on their role, and also need some knowledge of the healthcare setting. Students aiming at this type of career may benefit from a HIT minor within their CS or IT major. Health information management professionals are more likely to work in an administrative capacity, and are often found in the billing or records management departments rather than the IT department of a hospital. These professionals typically graduate with an accredited degree in HIM. Professionals who work in the research and development capacity or as clinical leaders often have a graduate degree in medical informatics. PROGRAMS IN HEALTHCARE INFORMATICS Existing educational programs tend to fall into either the HIM subfield or the HCI/MI subfield. The two professional organizations also follow this division: the American Health Information Management Association (AHIMA) which represents the interests of the field of healthcare information management, and the American Medical Informatics Association (AMIA), which uses the term medical informatics(mi) instead of healthcare informatics when referring to educational programs. The Commission on Accreditation for Health Informatics and Information Management Education (CAHIM) accredits associates, bachelors, and master's degree programs in HIM, and masters degree programs in Health Informatics. The HIM accreditation standard uses knowledge standards developed by AHIMA, and requires that a HIM program have a director who is a Registered Health Information Administrator. A student who completes a bachelor's level accredited HIM program is eligible to take the RHIA exam to become a Registered Health Information Administrator. This is the primary focus of HIM programs. As a result, accredited HIM bachelors programs are all 148

CCSC: Eastern Conference fairly similar in their course offerings. These programs will be analyzed in the next section. The graduate level HCI accreditation standards use knowledge standards developed by several organizations including AMIA, and the International Medical Informatics Association (IMIA) on Education in Biomedical and Health Informatics. The majority of programs at the undergraduate level are HIM programs, and are accredited through CAHIM. HCI and MI programs, on the other hand, exist at the bachelors, masters, PhD, and certificate levels, but the overwhelming majority of them are at the graduate level. On AMIA's website, there are 108 schools listed that have programs in health or biomedical informatics. Of these, 9 schools are listed with undergraduate degrees, one with an associate's degree, 71 have master's degrees, and 43 have certificate programs. The curricula in these programs tends to vary widely, and to be more based on computing than the HIM programs, which typically have very little computer science content. STUDY METHODOLOGY AND RESULTS For comparison purposes, 51 bachelors' level programs were identified, using lists on the CAHIM website, the AMIA website, and by doing Google searches. These programs were analyzed on the following criteria: Accreditation, if any Computer Science content, determined by number of required courses in programming, databases, networking, and other computer science courses Healthcare information management content, determined by the number of required courses in medical terminologies and coding Type of department in which the program is housed. The programs were analyzed using information publically available on their websites. All of the programs posted curriculum information on their websites. The analysis was done in June and July 2010. The following table contains results. In cases where the number of programs does not add up to 51, the reason is because the information could not be determined from the source. Table 1: Characteristics of surveyed programs (HIM and non-him) Question CAHIM accreditation Number of required computer programming courses Results 40 programs were accredited as HIM programs, one had pending accreditation, and 10 did not have accreditation. 1 course: 4 programs More than 1 course: 8 programs No courses: 36 programs Of interest is the breakdown by type of program: of the 40 HIM programs, only 2 required a programming course, whereas all of the non-him programs required at least, and often more, programming courses. 149

JCSC 27, 3 (January 2012) Number of required database courses Number of required medical coding courses required Requires a course in medical terminology Requires a course in networking Whether a course in statistics is required 1 course: 9 programs 2 courses: 4 programs Component in another course: 2 programs No courses: 25 programs 1 course: 5 programs 2 courses: 23 programs 3 courses: 7 programs No courses: 8 programs As with programming courses, the breakdown by type of program is striking. All of the HIM programs required at least one coding course, and none of the non-him programs required any coding courses. Clearly, coding courses are a defining feature of HIM programs. In fact, only two programs had both programming and medical coding in their major. Not required: 5 programs Required: 46 programs Of the programs that did not require medical terminology, all were non-him programs. 5 programs required either a course in networking, or networking as a significant part of another course. Of the programs that required networking, only one was a HIM program. Required: 43 programs Not required: 4 programs This is clearly a standard requirement. Type of department DISCUSSION Computer science, informatics or IT: 7 programs Business: 2 Engineering technology: 1 Other: 8 The majority of HIM programs were in health-related departments. On the other hand, 10 of the 11 health/medical informatics programs were in non-health-related departments The most important conclusion that was reached by this analysis is that HIM programs are quite standardized because of the need for CAHIM accreditation. These programs mainly do not include any computer programming or networking components, although many do require a course in databases. All of them require multiple courses in medical coding, anatomy and physiology, medical terminology, and a supervised professional practicum. On the other hand, programs in health or medical informatics tend to be more strongly based on computer science, most requiring multiple programming 150

CCSC: Eastern Conference courses as well as database courses and networking courses. These programs were not as standardized; some, like New Jersey Institute of Technology's program, are very engineering-oriented and focus on imaging and wireless devices in medicine. Others focused on genomics or bioinformatics. Since health/medical informatics programs seem to have a stronger foundation in computer science core areas than HIM programs, CS and IT departments considering adding a major or minor in a healthcare related field will probably consider going in that direction. However, there are still a number of issues to be addressed. Textbooks are a big issue. Since the majority of undergraduate programs are in HIM, most textbooks are aimed at that audience and contain a great deal of content about medical records management. Examples include Abdelhak, Grostick, Hanken, and Jacobs [10], Gartee [11], and LaTour [12]. There are a number of textbooks in medical informatics, most notably Shortliffe and Cimino [13], but these are mainly aimed at graduate students since most programs in medical informatics are graduate level. In addition, and this is particularly a concern for programs such as minors where most of the enrollment would be computer science majors, the books tend to not contain the level of technical detail and hands-on problems that we typically expect of CS textbooks. Another issue is the potential for confusion with HIM programs in the eyes of students and employers. In particular, we must be alert to the possibility that students might enroll in a program thinking that it is an accredited HIM program, discovering only later that they are not eligible to sit for the RHIA exams. Area hospitals who might wish to hire students may also be confused by a program that is nonstandard from their perspective. It is very important to communicate clearly the focus of the program. An example of this may be found on Oregon Institute of Technology's website (http://www.oit.edu/portland/programs/information-technology/health-informatics), which contains a document outlining the differences between HIM and healthcare informatics, in order to explain to potential students the focus of their health informatics degree. CONCLUSION In order to understand better the breadth and content of existing education programs related to healthcare IT, we surveyed the content of 51 undergraduate programs. Programs fell strongly into one of two types: health information management (HIM) programs accredited by CAHIM, and health/medical informatics programs. HIM programs are highly standardized, are usually housed in healthcare related departments, and have a great deal of content related to medical records. HCI and MI programs are much less standardized, have more computing content, and may be easier for CS/IT departments to implement. However, there are still issues, especially related to resources such as textbooks, and potential for confusion with accredited HIM programs. REFERENCES [1] S. Graham and D. Estrin, "Information Technology Research Challenges for Healthcare," SIGHIT Record, vol. 1, pp. 4-9, 2010. [2] J. Vegso, "Drop in CS Bachelor's Degree Production," Computing Research News, vol. 18(2), p. 5, 2006. 151

JCSC 27, 3 (January 2012) [3] J. Beck, B. Buckner, and O. Nikolova, "Using interdisciplinary bioinformatics undergraduate research to recruit and retain computer science students," Proceedings of the 38th SIGCSE Technical Symposium on Computer Science Education, p. 358, 2007. [4] A.E. Tew, C. Fowler, and M. Guzdial, "Tracking an innovation in introductory CS education from a research university to a two-year college," Proceedings of the 36th SIGCSE Technical Symposium on Computer Science Education, 2005, p. 416. [5] A. Fisher and J. Margolis, "Unlocking the clubhouse: the Carnegie Mellon experience," ACM SIGCSE Bulletin, vol. 34, p. 79-83, 2002. [6] B. MacKellar, "Connecting Biomedical and Health Informatics with Computer Science," SIGCSE Technical Symposium on Computer Science Education (Birds of a Feather session), 2011. [7] W. Hersh, "Who are the informaticians? What we know and should know," Journal of the American Medical Informatics Association, vol. 13(2), p. 166-170, 2006. [8] W. Hersh, "A stimulus to define informatics and health information technology," BMC Medical Informatics and Decision Making, vol. 9(1), p. 24, 2009. [9] J.A. Jacko, T. Adam, B. Westra, M. Witrak, R. Berkeland, A.F. Nelson, A.L. Ali, L. Johnson, R. Kuang, and K. LaTour, "Launching: university partnership for health informatics," Proceedings of the 1st ACM International Health Informatics Symposium, p. 521-525, 2010. [10] M.A. Abdelhak, S. Grostik, M.A. Hanken, and E. Jacob, Health Information: Management of a Strategic Resource, Saunders, 2011. [11] R. Gartee, Health Information Technology and Management, Prentice Hall, 2010. [12] K.M. LaTour and S.E. Maki, Health Information Management: Concepts, Principles, and Practice, Third Edition, Ahima, 2009. [13] E.H. Shortliffe and J.J. Cimino, Biomedical Informatics: Computer Applications in Health Care and Biomedicine, Springer, 2006. 152