AMIA-OHSU 10x10 Program

Logistics, Curriculum, Learning Objectives, and Additional Information

     


10x10
William Hersh, M.D.
Department of Medical Informatics & Clinical Epidemiology
Oregon Health & Science University
Course Director
Last updated: January 31, 2024

Next AMIA offering of the course

Objectives

The goal of the 10x10 ("ten by ten") course is to provide a detailed overview of biomedical and health informatics to those who will work at the interface of healthcare and information technology (IT). The course also aims to provide an entry point for those wishing further study (and/or career development) in the field. It provides a broad understanding of the field from the vantage point of those who implement, lead, and develop IT solutions for improving health, healthcare, public health, and biomedical research. It provides up-to-date details on current events in the field, including electronic health records, data standards and interoperability, clinical decision support, artificial intelligence (AI), population health, patient engagement, and telehealth. It also describes and sets the context for new technologies, such as SMART on FHIR, large language models (LLMs), generative AI, and wearables. Although the course has a clinical orientation, many non-clinicians working in health IT environments have found the course accessible and the knowledge gained invaluable to their professional development.

Among the individuals who can benefit from this in-depth introductory course are:
 The 10x10 course gets its name from its original goal when launched in 2005 of educating 10,000 healthcare and related professionals in biomedical and health informatics by 2010. The goal of 10,000 individuals came from an assertion by former AMIA President Dr. Charles Safran that the US needed at least one physician and one nurse trained in medical informatics in each of the country's 6000 hospitals. The needs are equally strong beyond the US in the rest of the world and for professionals beyond physicians and nurses. The goal of 10x10 was operationalized by Dr. William Hersh of Oregon Health & Science University (OHSU). The OHSU offering of 10x10 was the original offering in the program and has had the largest enrollment. The success and continued interest in the course has led us to continue it beyond the original 2010 goal. Since the program was launched in 2005, over 3000 people, mostly from the US but also from a variety of international locations, have completed the course. About 10-15% of those graduating have gone on to further graduate study in the field, mostly in the OHSU Biomedical Informatics Graduate Program.

Course Logistics

The 10x10 course is offered three times per year through AMIA, usually starting in March, July, and December. There are also a number of custom offerings for various professional associations, companies, and other organizations. (If interested in such an offering, please contact Dr. Hersh.) The course is also offered as a one-quarter graduate-level course in the OHSU Biomedical Informatics Graduate Program every term.

The course is offered in two parts:
  1. A 10-unit Web-based component that is provided through readings, voice-over-Powerpoint lectures, interactive discussion, and self-assessment tests.
  2. An optional one-day in-person session that brings attendees together to integrate the material, allow presentation of course projects, and meet leaders in the field as well as other students.
The course is an adaptation of the on-line Introduction to Biomedical and Health Informatics class currently taught in the OHSU biomedical informatics education program. This survey course provides a broad overview of the field, highlighting the key issues and challenges for the field. The course is taught in a completely asynchronous manner, i.e., there are no "scheduled" classes. However, students must keep up with the course materials so they can benefit from the interactive discussion with faculty and other students. The course uses the following teaching modalities:
The on-line part of the course is accessed via the Sakai course delivery tool. At the onset of the course, each student is provided a login and password by the OHSU distance learning staff, who also provide technical support for the course. Students are expected to keep up with the materials each week and participate in ongoing discussion. They should anticipate spending 4-8 hours per unit on the course. All on-line activities are asynchronous, so there is no specified time that a student must be on-line.

OHSU 10x10 participants have the option of attending the in-person session associated with any AMIA meeting within one year of their taking the class and not just the session that occurs at the end of the offering in which they are enrolled.

The goal of the course project is for students to 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. It is due before the in-person session at the end of the course and presented there if the student is attending. If a student does not have access to a health care setting, they can do the project in another setting, such as a company or organization. Here are the details of the assignment:

Instructor

The instructor for the course is William Hersh, MD. The best way to reach him is via email (hersh@ohsu.edu). You may also find interesting reading in his blog.

Syllabus

The following table outlines the curriculum with unit number, topic, and reading assignment. The course in general runs with two weeks in a row of posted materials and then a third week to finish the work. The due date for each unit is when the next cycle of material is posted. We are lenient about giving extensions but participants are strongly encouraged not to fall behind, since it can be difficult to catch up.
Unit
 Topic
1
 Overview of Field and Problems Motivating It
2
 Computing Concepts for Biomedical and Health Informatics
3
 Electronic and Personal Health Records (EHR, PHR)
4
 Standards and Interoperability
5
 Artificial Intelligence
6
 Advanced Use of the EHR
7
 EHR Implementation, Security, and Evaluation
8
 Information Retrieval (Search)
9
 Research Informatics
10
 Other Areas of Informatics

Readings

The course has no required textbook. Students are also provided comprehensive lists of references for topics covered in the lectures. There is an optional textbook (co-edited by the course instructor) that students may want to consider: Hersh WR, Ed. (2022). Health Informatics: Practical Guide, Eighth Edition, which has a Web site and is available from Lulu.com in paper and eBook format. The reading assignments from the book are optional, and no material will appear on the homework quizzes or final exam that is not also covered in the class. But some students prefer to also read a textbook when learning. The appropriate chapter readings for each unit in the course are as follows:

Unit
 		Topic
 		Textbook Chapter(s)
1
 Overview of Field and Problems Motivating It
 1, 2
2
 Computing Concepts for Biomedical and Health Informatics 3, 23
3
 Electronic and Personal Health Records (EHR, PHR)
 4, 7
4
 Standards and Interoperability 5
5
 Artificial Intelligence 6, 8, 21
6
 Advanced Use of the EHR 9, 10
7
 EHR Implementation, Security and Evaluation 11, 12, 13, 22
8
 Information Retrieval (Search)
 14
9
 Research Informatics
 15, 16
10
 Other Areas of Informatics
 17, 18, 19, 20

Detailed Course Outline

1. Overview of Field and Problems Motivating It
1.1 What is Biomedical and Health Informatics?
1.2 A Short History of Biomedical and Health Informatics
1.3 Problems in Healthcare Motivating Biomedical and Health Informatics
1.4 Who Does Biomedical and Health Informatics?
1.5 Resources for Field - Organizations, Information, Education

2. Computing Concepts for Biomedical and Health Informatics
2.1 Types of Computers
2.2 Data Storage in Computers
2.3 Computer Hardware and Software
2.4 Computer Networks
2.5 Software Engineering

3. Electronic and Personal Health Records (EHR, PHR)
3.1 Clinical Data
3.2 History and Perspective of the Health (Medical) Record
3.3 Examples of the EHR
3.4 EHR Data Entry
3.5 Clinical Decision Support
3.6 Personal Health Records

4. Standards and Interoperability
4.1 Standards and Interoperability: Basic Concepts
4.2 Identifier and Transaction Standards
4.3 Message Exchange Standards
4.4 Terminology Standards
4.5 SMART on FHIR

5. Artificial Intelligence
5.1 Definitions and Resources
5.2 Data Science and Machine Learning
5.3 Predictive AI
5.4 Generative AI
5.5 Trustworthy AI

6. Advanced Use of the EHR
6.1 Patient Safety and Medical Errors
6.2 Healthcare Quality Measurement and Improvement
6.3 Health Information Exchange (HIE)
6.4 Population Health
6.5 From Meaningful Use to Promoting Interoperability
6.6 Natural Language Processing

7. EHR Implementation, Security, and Evaluation
7.1 Clinical Workflow Analysis and Redesign
7.2 EHR System Selection and Implementation
7.3 Telemedicine and Telehealth
7.4 Privacy and Security
7.5 Evaluation of the EHR

8. Information Retrieval (Search)
8.1 Information Retrieval
8.2 Knowledge-based Information
8.3 Content
8.4 Indexing
8.5 Retrieval
8.6 Research: Evaluation and Future Directions

9. Research Informatics
9.1 Clinical Research Informatics
9.2 Overview of Basic Molecular Biology
9.3 Translational Bioinformatics
9.4 From Clinical Genetics and Genomics to Precision Medicine
9.5 Omics Data in the EHR and Other Information Systems

10. Other Areas of Informatics
10.1 Nursing Informatics
10.2 Consumer Health Informatics
10.3 Public Health Informatics
10.4 Imaging Informatics
10.5 Evidence-Based Medicine

Beyond 10x10

The goal of the AMIA 10x10 program is to train clinicians and other health care professionals in informatics so they can be knowledgeable participants in IT implementations in their local settings. The 10x10 program alone will not make one a full-time professional in informatics (any more than a semester of medicine or nursing will make one a doctor or nurse!). The program is structured, however, to allow those who complete the course to carry the credits forward into graduate programs in informatics. While moving into the OHSU program is straightforward, doing so with other programs requires getting the agreement of that particular program.

Since the course is an adaptation of the introductory course in the Health & Clinical Informatics (HCIN) major of the OHSU Biomedical Informatics Graduate Program, those who complete the 10x10 course are able to obtain credit for the course in the OHSU program. Before enrolling in the OHSU Graduate Certificate or Master's Degree program, students need to pass the (optional) final examination for the OHSU 10x10 course that is offered at the end of each course. Upon passing the final exam and enrolling in the program, they are awarded three credits in the OHSU graduate program. (OHSU is on an academic quarter system, with each quarter consisting of 11 weeks of instruction. A three-credit course is comparable to a course with three contact hours per week plus additional work for reading assignments, homework, and projects.) Most of OHSU's informatics courses are taught on-campus and on-line, and each course is considered equivalent whether it is taught live or via distance.

The OHSU Biomedical Informatics Graduate Program is designed in a "building block" fashion, so work done at a lower level can be carried forward to higher levels. This is depicted in the figure below. Students who have completed 10x10 have gone on to graduate from the Graduate Certificate as well as the Master's Degree. Two 10x10 students have completed the OHSU PhD program!

Building blocks

More details about the individual degree programs are available on the OHSU informatics education Web site, but the following table provides an overview of the programs.

Program Name
 Description
 Graduation Requirements
Graduate Certificate
 Core courses in informatics
 21 credits (7 3-credit courses)
Master of Science Non-Thesis
 "Professional" master's degree with capstone or internship project
 49 credits (43 hours of instruction plus 6 hours of capstone/internship project)
Master of Science
 "Research" master's degree with master's thesis
 55 credits (43 hours of instruction plus 12 hours of master's thesis)
Doctor of Philosophy (PhD)
 PhD program for advanced leaders and researchers in field
 135 credits, including dissertation

The Web site also has information about OHSU's National Library of Medicine-funded Fellowship Program and ACGME-accredited Clinical Informatics Subspecialty Fellowship for Physicians.

More Detailed History of the Course

The 10x10 program was launched in 2005 by the American Medical Informatics Association (AMIA) and Oregon Health & Science University (OHSU). The genesis for the program came when then-President of AMIA, Dr. Charles Safran, called for at least one physician and one nurse in each of the 6000 hospitals in the US to have some training in medical informatics.

At that time, the biomedical informatics distance learning program at OHSU was mature and included an introductory course that I had been teaching on-line for nearly a decade. I proposed to AMIA that we re-package this course into a standalone course that included an in-person session at the end (not present in the OHSU course) that brought participants together for interaction and additional learning. Based on Dr. Safran's numbers and my knowledge of the scalable capacity of the distance learning course, I proposed that we name the program 10x10, embodying the aim of training 10,000 individuals in medical informatics by the year 2010.

The course is not limited to physicians and nurses, nor is it limited to US citizens. Those who complete the course (and are eligible for graduate study, i.e., have a baccalaureate degree) can subsequently obtain credit for the introductory course in the OHSU and enroll to take further courses in the OHSU Biomedical Informatics Graduate Program.

The first cohort of 44 students completed the 10x10 course in 2005. In addition to the "standard" offering of the course being offered to coincide with the in-person session at the end coinciding with an AMIA spring or fall meeting, a number of special offerings have been developed, tailored to specific audiences. These include:
Students in 10x10 have come not only from the US, but also from many other countries, including Canada, England, Argentina, Hong Kong, Singapore, Saudi Arabia, Kuwait, Pakistan, Israel, and Thailand. One of the original students from Argentina, Dr. Paula Otero, translated the course into Spanish and has delivered it to over 1000 individuals across Latin America.

The course  also inspired federal legislation in the US, leading to the 10,000 Trained by 2010 Act, introduced by Rep. David Wu (D-OR). The bill was passed by the US House in the 111th Congress (2009-2010), and elements of it were incorporated into the HITECH Act. The HITECH program included funding for Health IT Workforce Development, including grants awarded to the OHSU program.

For more information

More information about 10x10 can be found on the AMIA web site.
Information about the most current OHSU offering is available.

A number of papers and a book chapter have been written about the 10x10 program: