Pointing the Way:
Competencies and Curricula in Health Informatics
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Edited By:
H. Dominic Covvey
University of Waterloo
David Zitner
Dalhousie University
Robert M. Bernstein
University of Ottawa
INTRODUCTION
Health Informaticians (HIs) are professionals that develop and/or deploy
systems and methods based on information and communications technologies
in support of health care, research, health system administration, and teaching.
HIs require a well-developed knowledge base that encompasses the health system,
computer science, and health information systems-related topics, as well
as a set of intellectual and procedural skills, and preparatory experiences.
The availability of skilled and knowledgeable HIs has become a critical issue
in today’s health system.
THE NEED FOR HEALTH INFORMATICIANS
Because Health Informaticians require knowledge and skills from such diverse
disciplines, fully capable professionals are few and far between. Few
people have the broad education and training necessary to fully understand,
design, develop, deploy, and use the many techniques and technologies. Serious
consequences include that health organizations often make unproductive investments
in IT, and find it difficult to identify and recruit professionals to deploy
and maintain systems. In addition, systems developers often lack for professionals
that are capable of mastering the complexities of healthcare systems development,
and health professionals lack access to the most suitable decision support
tools for clinical care, health services administration, research, and teaching.
Additionally, systems are implemented which don’t meet the needs of diverse
constituencies.
But the need for Health Informatics education goes beyond IT professionals.
Today’s clinicians need to effectively use computer-based records and decision
support tools, administrators need to be able to link health care activities
with the results they produce, and researchers need data which they can manipulate
to develop new concepts and practices of health care.
THE TYPES OF HEALTH INFORMATICIAN
We have proceeded with three distinct groups of professionals in mind. There
are the Applied Health Informatics (AHI) professionals who are the solution
deployers; the Research and Development Health Informatics (RDHI) professionals
who are the researchers and teachers who create new capabilities and produce
new professionals; and the Clinicians with Health Informatics (CHI) competence
who are the users of the systems in patient care, research, and teaching.
This document addresses the competencies required by these three categories
of professionals, and the contents of educational programs that are required
to prepare them for their roles.
OUR FRAMEWORK FOR CURRICULUM DEVELOPMENT
Each health Information Technology/Information Management (IT/IM) professional
is conceived as fulfilling a role (for clarity we term these macro-roles
and examples include CIO, Researcher, and Consultant). A professional in
a macro-role faces challenges (challenges equate to major job functions,
and examples include strategic planning and technology procurement). In order
to address these challenges, the IT/IM professional performs micro-roles
(micro-roles are job sub-functions; micro-roles related to the challenge
“technology procurement” include requirements definition and options analysis).
Each of these micro-roles requires that the professional have specific skills,
knowledge, and experience (these are the required professional competencies).
We have defined a curriculum to be the content and sequencing of educational
modules that impart these skills, knowledge elements, and experiences.
PROGRESS ON THE CURRICULUM DEVELOPMENT PROCESS
The model curriculum development process, co-directed by D. Covvey and D.
Zitner, began in December 1999 with a kick-off videoconference at 11 sites
(with approximately 100 participants selected based on a stakeholder analysis).
Two focus groups in the Spring and Fall of 1999 related to AHI skills preceded
the process. The participants were introduced to the framework and brought
up to speed regarding HI curriculum development issues and methods.
Starting in March 2000, Working Group sessions were convened every three
weeks. In addition, a plenary progress review session involving all groups
was held on June 26, 2000. These sessions have been supported using document
(Sprint’s “On-Line Presenter”, using the “Live Demo” feature that allows
real-time, on-line editing) and audio conferencing tools. The final Working
Group meeting occurred in mid-September 2000.
DETAILED WORKING GROUP METHODOLOGY
Workshop participants (see the list of AHI Working Group participants below)
were selected based on a stakeholder analysis, and include HI curriculum
developers, HI teachers, potential and current HI students, employers (health
and health-related industries), representatives of professional organizations,
and potential certifiers of HI professionals. Each Working Group has been
facilitated by a member of the core team of curriculum developers (AHI: D.
Covvey, RDHI: D. Zitner, CHI: R. Bernstein).
After an initial preparatory session, each Working Group worked with a template
containing straw versions of the macro-roles, challenges, micro-roles, and
skills, knowledge, and experience elements (the latter, collectively: competencies).
These Working Groups (approximately 30 participants per group) comprised
both on-line participants supported by document and audio conferencing technologies,
and off-line participants interacting via e-mail. Working Group participants
added to, modified, or deleted items in the templates. A plenary session
to review progress to date was held on June 26, 2000 during the InFocus meeting
in Vancouver. Overall, approximately ten on-line sessions as well as e-mail
interaction provided the basis for the refinement of the templates. The basic
work of the Working Groups was completed in sessions on September 12-14,
2000.
Each working Group has produced detailed lists of the macro-roles, of the
micro-roles (functions) associated with each macro-role, of the detailed
skills and knowledge (competencies) required to address each micro-role,
of the experience components associated with each challenge, and of the mapping
of challenges to macro-roles. Each Working Group has also prepared a document
that combines skills and knowledge into course-like categories (approximately
20 for each curriculum). The RDHI Working Group has developed, in addition,
a set of Guidelines for Graduate RDHI Program Content that is being prepared
for circulation. All material is available on the project website: http://healnet.mcmaster.ca/nce/workshops.htm.
As produced, it has also been circulated to all participants via e-mail.
SUMMARY
The health system needs effective IT/IM solutions to the challenges it faces.
However, realizing these solutions depends on the availability of capable
IT/IM professionals. The products we have developed provide curriculum developers
and teachers with models on which they can base the design of their health
informatics education programs. But they also directly support the health
system by helping employers, prospective health informaticians, and clinicians
to understand the competencies they require to create, deploy, manage, and
improve health IT/IM techniques and systems.
NOTES TO THE READER
This document should be seen as a living document - a work in progress. Strong
interest in Health Informatics program development motivated us to release
this document at the earliest possible date, but while doing so we wish to
recognize the following:
We have not yet standardized the terminology across the three sections, so
the reader will see several variants of the name of a knowledge item or a
skill.
The tables that show the relationship between different macro-roles and the
importance of the challenges to each macro-role, and the relationship between
challenges and the experience required to address them, are the subject of
on-going revision and validation.
No meaning should be associated with the order in which skills and knowledge
items appear.
We have at times been inconsistent with regard to repeating a skill or knowledge
item under each micro-role associated with a challenge. Generally we elected
to not repeat these, but sometimes they are repeated. This means that each
micro-role cannot yet be looked at independently, but rather that skills
and knowledge elements are associated with addressing the challenge. The
micro-roles, although we believe that they are complete, are at this time
merely a tool we used to ensure we determined as complete a set of competencies
as possible.
Personal skills and knowledge elements are repeated only very selectively.
In early work, we found that many of these applied to virtually all challenges
and their micro-roles, and repeating them wasted space and distracted attention
from the other items.
We have constructed the main sections of the document (the AHI, RDHI, and
CHI sections) so that they can be read and used independently. We did this
because we believe that, in general, users will work with one section and
not the others. This has introduced a measure of redundancy into the section
introductions. We hope this will not prove to be too annoying.
Having such a wealth of participation also confronted us with the challenge
of maintaining up-to-date information on all participants. Some personal
items are obsolete. We encourage participants to update their personal information
via either dcovvey@sprynet.com or david.zitner@dal.ca. We will attempt to
re-version the document regularly to address this, or at least to provide
forwarding information.
As we review the document, we continually discover skill and knowledge elements
that we either missed or would now prefer to see repeated. Future versions
of the document will undoubtedly contain additional items that others and
we recommend for inclusion.
Finally, we emphasize that producing this material was akin to multiple artists
collaborating on a painting. Each of us contributed strokes that gradually
filled in a scene that only took its final shape as the work progressed.
Each of us had his or her own perspectives, objectives, and styles. So, what
is here is a compromise, but one developed with real thought behind each
choice. It is no one person’s work, a reality that protected it from the
bias that any one of us might have wanted to put on it. It is a true collaboration,
and one many of us put our hearts into and thoroughly enjoyed even as we
slogged through the grueling process.
What it is finally is a product that is incomplete, that will remain incomplete,
and that needs the skills of others. We turn it over to you now, asking you
to join the collaboration with the hope that you will take it the next steps
and bring out its full value to the field. If we give you a better starting
point than you had before this work, then we succeeded. Now it is your turn.