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HIT: A Sea Change in Health Workforce?

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Educating the Health Information Technology Workforce: The AMIA-OHSU
10x10 Certificate Program

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Educating the Health Information Technology Workforce: The AMIA-OHSU
10x10 Certificate Program
OHSU's twelve-week online certificate program helps prepare the health
workforce for the EHR transition.

By Laura Trude, HWIC Information Specialist

Dr. William HershOregon 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 10x10 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 10x10 Certificate Program has
expanded to other schools and realized part of that goal.

The 10x10 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 10x10 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, Informatics comprises a whole spectrum of jobs.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 10x10 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 10x10 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 10x10 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 10x10 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.”

photo of women looking at computerOHSU 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.”

It's not the kind of field where your education stops when you graduate. It requires continuous learning.“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 10x10, 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.”

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