Informatics: Opportunities to Improve Healthcare Through Rewarding Careers

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1 References Informatics: Opportunities to Improve Healthcare Through Rewarding Careers William Hersh, MD Professor and Chair Department of Medical Informatics & Clinical Epidemiology Oregon Health & Science University Portland, OR, USA Web: Blog: Anonymous (2012). Demand Persists for Experienced Health IT Staff. Ann Arbor, MI, College of Healthcare Information Management Executives. chime.org/chime/press/surveys/pdf/chime_workforce _survey_report.pdf Anonymous (2013) HIMSS Workforce Survey. Chicago, IL, HIMSS Analytics. Anonymous (2013). Closing the IT Talent Gap in Health Care - The Towers Watson 2013 Health Care IT Survey Report, Towers Watson. Types/Survey- Research- Results/2013/03/Closing- the- IT- Talent- Gap- in- Health- Care Anonymous (2014) HIMSS Workforce Survey. Chicago, IL, HIMSS Analytics. Blumenthal, D (2011). Implementation of the federal health information technology initiative. New England Journal of Medicine. 365: Blumenthal, D (2011). Wiring the health system- - origins and provisions of a new federal program. New England Journal of Medicine. 365: Buntin, MB, Burke, MF, et al. (2011). The benefits of health information technology: a review of the recent literature shows predominantly positive results. Health Affairs. 30: Charles, D, Gabriel, M, et al. (2014). Adoption of Electronic Health Record Systems among U.S. Non- federal Acute Care Hospitals: Washington, DC, Department of Health and Human Services. Chaudhry, B, Wang, J, et al. (2006). Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Annals of Internal Medicine. 144: Detmer, DE and Shortliffe, EH (2014). Clinical informatics: prospects for a new medical subspecialty. Journal of the American Medical Association. 311: Friedman, CP (2009). A 'fundamental theorem' of biomedical informatics. Journal of the American Medical Informatics Association. 16: Furukawa, MF, Vibbert, D, et al. (2012). HITECH and Health IT Jobs: Evidence from Online Job Postings. Washington, DC, Office of the National Coordinator for Health Information Technology. Goldzweig, CL, Towfigh, A, et al. (2009). Costs and benefits of health information technology: new trends from the literature. Health Affairs. 28: w282- w293. Hersh, W (2004). Health care information technology: progress and barriers. Journal of the American Medical Association. 292: Hersh, W (2009). A stimulus to define informatics and health information technology. BMC Medical Informatics & Decision Making. 9: 24.

2 Hersh, W (2010). The health information technology workforce: estimations of demands and a framework for requirements. Applied Clinical Informatics. 1: Hersh, W (2012). Update on the ONC for Health IT Workforce Development Program. HIMSS Clinical Informatics Insights, July, cii Hersh, WR (2007). The full spectrum of biomedical informatics education at Oregon Health & Science University. Methods of Information in Medicine. 46: Hersh, WR (2009). Information Retrieval: A Health and Biomedical Perspective (3rd Edition). New York, NY, Springer. Hersh, WR (2014). Healthcare Data Analytics. Health Informatics: Practical Guide for Healthcare and Information Technology Professionals, Sixth Edition. R. Hoyt and A. Yoshihashi. Pensacola, FL, Lulu.com: Hersh, WR and Wright, A (2008). What workforce is needed to implement the health information technology agenda? An analysis from the HIMSS Analytics Database. AMIA Annual Symposium Proceedings, Washington, DC. American Medical Informatics Association Hoyt, RE and Yoshihashi, A, Eds. (2014). Health Informatics: Practical Guide for Healthcare and Information Technology Professionals, Sixth Edition. Pensacola, FL, Lulu.com. Hsiao, CJ and Hing, E (2014). Use and Characteristics of Electronic Health Record Systems Among Office- based Physician Practices: United States, Hyattsville, MD, National Center for Health Statistics. Jones, SS, Rudin, RS, et al. (2014). Health information technology: an updated systematic review with a focus on meaningful use. Annals of Internal Medicine. 160: Schwartz, A, Magoulas, R, et al. (2013). Tracking labor demand with online job postings: the case of health IT workers and the HITECH Act. Industrial Relations: A Journal of Economy and Society. 52: Shortliffe, EH and Cimino, JJ, Eds. (2014). Biomedical Informatics: Computer Applications in Health Care and Biomedicine (Fourth Edition). London, England, Springer.

3 Informa(cs: Opportuni(es to Improve Healthcare Through Rewarding Careers William Hersh, MD Professor and Chair Department of Medical Informa(cs & Clinical Epidemiology Oregon Health & Science University Portland, OR, USA Web: Blog: hlp://informa(csprofessor.blogspot.com 1 Outline Trends and consequences in healthcare Defini(on and role of informa(cs Health IT employment growth Educa(onal opportuni(es at OHSU and elsewhere 2 1

Trends and consequences in healthcare Trends Healthcare is expensive and poten(ally dangerous Ever- expanding knowledge base of health and medicine Increasing data intensity of clinical and research

4 Trends and consequences in healthcare Trends Healthcare is expensive and poten(ally dangerous Ever- expanding knowledge base of health and medicine Increasing data intensity of clinical and research ac(vi(es Pa(ents want to interact with healthcare the same as they do with other industries Everyone wants to beler manage health Concerns about privacy Dispersed popula(on Health threats natural and human Consequences Electronic health records to facilitate: Communica(on and coordina(on of care Quality measurement and improvement BeLer search and clinical decision- support systems Need for skills in big data and data analy(cs Personal health records and pa(ent portals Personal monitoring and devices Balancing privacy vs. public good of data use Use of telemedicine Surveillance and public health 3 Growing evidence for value of informa(cs interven(ons Systema(c reviews (Chaudhry, 2006; Goldzweig, 2009; Bun(n, 2011; Jones, 2014) have iden(fied benefits in a variety of areas (Bun(n, 2011) 4 2

But it has been difficult to get there (Hersh, 2004) Cost Technical challenges Interoperability Privacy and confiden(ality Workforce 5 All of these are addressed by biomedical and health informa(cs

5 But it has been difficult to get there (Hersh, 2004) Cost Technical challenges Interoperability Privacy and confiden(ality Workforce 5 All of these are addressed by biomedical and health informa(cs Biomedical and health informa0cs (BMHI or informa0cs) is the science of using data and informa(on, ohen aided by technology, to improve individual health, health care, public health, and biomedical research (Hersh, 2009) It is about informa(on, not technology hlp:// Prac((oners of informa(cs are usually called informa0cians (some(mes informa0cists) Overview textbooks: Hoyt, 2014; Shortliffe,

Informa(cs has many sub- areas Imaging Informa(cs {Clinical field} Informa(cs Research Informa(cs Consumer Health Informa(cs Bioinforma(cs (cellular and molecular) Medical or

Technology 7 Addi(onal perspec(ves on informa(cs Fundamental Theorem (Friedman, 2009) based on relentless pursuit of assis(ng people Goal of informa(cs is Goal is not

6 Informa(cs has many sub- areas Imaging Informa(cs {Clinical field} Informa(cs Research Informa(cs Consumer Health Informa(cs Bioinforma(cs (cellular and molecular) Medical or Clinical Informa(cs (person) Public Health Informa(cs (popula(on) Legal Informa(cs Biomedical and Health Informa(cs Chemoinforma(cs Informa(cs = People + Informa(on + Technology 7 Addi(onal perspec(ves on informa(cs Fundamental Theorem (Friedman, 2009) based on relentless pursuit of assis(ng people Goal of informa(cs is Goal is not Informa(cs is different from: IT/IS More focused on informa(on than technology Mostly clinical perspec(ve HIM Less focus on medical records per se HIM is in transi(on toward informa(cs 1.1a 8 4

Informa(cs received a boost from a new US president To lower health care cost, cut medical errors, and improve care, we ll computerize the na2on s health records in five years, saving billions of

7 Informa(cs received a boost from a new US president To lower health care cost, cut medical errors, and improve care, we ll computerize the na2on s health records in five years, saving billions of dollars in health care costs and countless lives. First Weekly Address Saturday, January 24, and entered a new ARRA Health Informa(on Technology for Economic and Clinical Health (HITECH) Act of the American Recovery and Reinvestment Act (ARRA) (Blumenthal, 2011) Incen(ves for electronic health record (EHR) adop(on by physicians and hospitals (up to $27B) Direct grants administered by federal agencies ($2B) Including $118 million for health IT workforce development two of the many grants to OHSU 10 5

8 HITECH has resulted in substan(al EHR adop(on in US (Hsiao, 2014) (Charles, 2014) 11 HITECH has also led to substan(al health HIT employment (Hersh, 2010) Analysis of HIMSS Analy(cs Database es(mated need of 41,000 addi(onal HIT professionals as we moved to more advanced clinical systems (Hersh, 2008) ONC increased es(mate of need to 50,000, leading to Workforce Development Program being part of HITECH Program (Hersh, 2012) Actual numbers hired have been even higher (Furukawa, 2012; Schwartz, 2013) next slide Despite growth of jobs and number trained, shorvalls persist (CHIME, 2012; HIMSS Analy(cs, 2013; Towers- Watson, 2013) 12 6

9 HIT employment growth from Bureau of Labor Sta(s(cs (Furukawa, 2012) >60K! 13 Job growth exceeding healthcare and general economy (Furukawa, 2012) 14 7

Con(nued evidence of job opportuni(es (HIMSS, 2014) Updated workforce survey of health systems and vendors Over 80% of both plan to hire Vendors plan to hire more (though more health systems than

10 Con(nued evidence of job opportuni(es (HIMSS, 2014) Updated workforce survey of health systems and vendors Over 80% of both plan to hire Vendors plan to hire more (though more health systems than vendors) 20% of health systems, 47% of vendors more than 20 FTE Variable plans to outsource Top areas of hires Clinical applica(on support 64% Help Desk 57% IT management 45% Clinical informa(cs 29% Barriers and concerns Lack of qualified talent in area 69%; other talent lured away 50% One- third put projects on hold due to lack of staff 15 Has led to proposal for Standard Occupa(onal Classifica(on (SOC) code Collabora(on of ONC and many professional associa(ons Recommenda(on to classify as a health (as opposed to technology) occupa(on hlp:// sites/amia.org/files/ Recommenda(on- for- Health- Informa(cs- SOC- Proposal pdf 16 8

11 Challenges for EHRs represent opportuni(es going forward Op(mizing the electronic health record (EHR) Analy(cs of EHR and other clinical data for increasing quality, efficiency, and coordina(on of healthcare (Hersh, 2014) Standards, interoperability, and health informa(on exchange (HIE) Will expand to big data when we add in data from genomics, imaging, personal health devices, etc. Pa(ent/consumer engagement Use of personal health record (PHR) for engaging consumers and pa(ents in their health and healthcare Precision/personalized medicine Based in part on bioinforma(cs and computa(onal biology, with poten(al to revolu(onize diagnosis and treatment of disease 17 Career development and study in informa(cs Many educa(onal opportuni(es at a variety of levels, mostly graduate hlp:// academic- training- programs OHSU program one of largest and well- established (Hersh, 2007) hlp:// educa(on Graduate level programs at Cer(ficate, Master s, and PhD levels Building block approach allows courses to be carried forward to higher levels 18 9

2014) Grandfathering now; fellowships later AMIA developing plan for interprofessional cer(fica(on for other

12 Exis(ng and emerging cer(fica(ons Long- standing cer(fica(ons in Nursing informa(cs Health informa(on management RHIA, RHIT, CCS New clinical informa(cs subspecialty for physicians recently launched (Detmer, 2014) Grandfathering now; fellowships later AMIA developing plan for interprofessional cer(fica(on for other disciplines hlp:// interprofessional- informa(cs- cer(fica(on 19 Career development (cont.) 20 10

13 Career pathways have diverse inputs and outputs (Hersh, 2009) Health care professions, e.g., medicine, nursing, etc. Natural and life sciences, e.g., biology, gene(cs, etc. Computer science (CS), IT, and undergrad informa(cs Health informa(on management (HIM) Biomedical and health informa(cs educa(on (graduate level) There is no single career pathway, ladder, etc. Jobs in: Healthcare systems Clinical leadership IT leadership Biomedical research Industry Academia Others, e.g., business, library and info. science 21 What competencies must informa(cians have? (Hersh, 2009) Health and biological sciences: - Medicine, nursing, etc. - Public health - Biology Competencies required in Biomedical and Health Informa7cs People skills: - Communica(on and presenta(on - Organiza(onal behavior and management - Project management Computa7onal and mathema7cal sciences: - Computer science - Informa(on science and technology - Sta(s(cs 22 11

14 OHSU program has three tracks Clinical Informa(cs Original track, focused on informa(cs in health, healthcare, public health, and clinical research se~ngs Bioinforma(cs and Computa(onal Biology (BCB) Focused on informa(cs in genomics. molecular biology, and their transla(onal research aspects Health Informa(on Management (HIM) Overlapping with clinical informa(cs, focused on HIM profession and leading to Registered Health Informa(on Administrator (RHIA) cer(fica(on OHSU offers a variety of degrees and cer(ficates Doctor of Philosophy (PhD) For those who wish to pursue research, academia, or leadership careers Master of Science (MS) Research master s, including for those with doctoral degrees in other fields who wish to pursue research careers Master of Biomedical Informa(cs (MBI) Professional master s degree for prac((oners and leaders Graduate Cer(ficate Subset of master s degree as an introduc(on or career specializa(on 12

15 Tracks, degrees and cer(ficates, and availability Degree/Cer(ficate Track Clinical Informa(cs Bioinforma(cs and Computa(onal Biology Health Informa(on Management PhD MS MBI Grad Cert On- campus On- campus On- campus On- campus On- line On- line On- line On- campus On- campus On- campus On- campus On- campus On- line On- line On- line 25 Overview of OHSU graduate programs Graduate Cer(ficate - Tracks: - Clinical Informa(cs - Health Informa(on Management 10x10 - Or introductory course Masters - Tracks: - Clinical Informa(cs - Bioinforma(cs - Thesis or Capstone PhD - Knowledge Base - Advanced Research Methods - Biosta(s(cs - Cognate - Advanced Topics - Doctoral Symposium - Mentored Teaching - Disserta(on 26 13

16 There are equally many pathways to informa(cs training Ad Hoc Graduate Education Clinical Fellowship Combina(on of: Courses Personal experience Cer(fica(ons Single courses (e.g., 10x10) Graduate Cer(ficate Master s Degree PhD NLM and other training grants For physicians only (for now): ACGME- accredited clinical informa(cs fellowship, leading to board cer(fica(on: Didac(c coursework Project work Clinical prac(ce Another important ac(vity is academia- industry collabora(on Collabora(on beyond usual federal grants hlp://

17 Conclusions BMHI is an important science and profession for improving health, healthcare, public health, and biomedical research with data and informa(on There are many opportuni(es for prac((oners, researchers, and others 29 For more informa(on Bill Hersh hlp:// Informa(cs Professor blog hlp://informa(csprofessor.blogspot.com OHSU Department of Medical Informa(cs & Clinical Epidemiology (DMICE) hlp:// hlp:// 74duDDvwU hlp://oninforma(cs.com What is Biomedical and Health Informa(cs? hlp:// Office of the Na(onal Coordinator for Health IT (ONC) hlp:// American Medical Informa(cs Associa(on (AMIA) hlp:// Na(onal Library of Medicine (NLM) hlp://

Meaningful Use of Health Information Technology Requires a Competent Workforce

Meaningful Use of Health Information Technology Requires a Competent Workforce William Hersh, MD Professor and Chair Department of Medical Informatics & Clinical Epidemiology Oregon Health & Science University