MINF 705A Medical Informatics

Medical Student Elective

(4 weeks)

                     



William Hersh, M.D.
Department of Medical Informatics & Clinical Epidemiology
School of Medicine
Oregon Health & Science University
Course Director
Last updated: May 7, 2020

A virtual course in medical informatics is available as an elective for Oregon Health & Science University (OHSU) medical students. The course is a broad survey on the field of informatics and originally derives from the introductory course in our Biomedical Informatics Graduate Program. This course is also used in OHSU's offering as part of the American Medical Informatics Association 10x10 ("ten by ten") program.

We are implementing the course as a 4-week medical student elective, which is awarded 2 credits at OHSU. The course has about 40 hours of lecture, and we anticipate another 40 hours spent on discussion forums, multiple-choice self-assessments for each unit, and optional readings. The course is graded as pass-fail, and passing requires completion of all of 10 units and their self-assessments over the 4 weeks of the course.

We will be offering three 4-week sections of course in the OHSU spring academic quarter. At the end of 4 weeks, each course will end, and those who have completed all of the work, including the self-assessment quizzes for each unit, will receive a passing grade.

Overview of Course

The goal of this course is to provide a detailed overview of biomedical and health informatics for medical students. It is a virtual course with about 40 hours of asynchronous lecture and a comparable amount of time spent on self-assessment quizzes, online forum discussion, and optional readings. The course provides up-to-date details on the informatics field, including electronic health records, data standards and interoperability, clinical decision support, healthcare data analytics, population health, patient engagement, and telemedicine. It also describes and sets the context for new technologies, such as SMART on FHIR, machine learning and artificial intelligence, wearables, and blockchain. The course will also discuss issues specific to the Covid-19 pandemic.

Course Logistics

This course is an adaptation of the on-line Introduction to Biomedical and Health Informatics class currently taught in the OHSU biomedical informatics education program. It is being offered in a 4-week block for medical students. The course is taught in a completely asynchronous manner, but 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 course is accessed via OHSU's Sakai learning management system (LMS). 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. All on-line activities are asynchronous, so there is no specified time that a student must be on-line. Students must complete all of the self-assessment tests and participate in class discussions.

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 and topic, with the full course outline provided below.

Unit
Topic
1
Overview of Field and Problems Motivating It
2
Biomedical Computing
3
Electronic and Personal Health Records (EHR, PHR)
4
Standards and Interoperability
5
Advancing Care With the EHR
6
Data Science and Analytics
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. There is an optional textbook (co-edited by the course instructor) that students may want to consider: Hoyt RE, Hersh WR, Eds. (2018). Health Informatics: Practical Guide, Seventh Edition, 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
Biomedical Computing 3
3
Electronic and Personal Health Records (EHR, PHR)
2, 4
4
Standards and Interoperability 5
5
Advancing Care With the EHR
6, 8, 9
6
Data Science and Analytics 7, 14
7
EHR Implementation, Security and Evaluation 4, 10
8
Information Retrieval (Search)
15
9
Research Informatics
18, 20
10
Other Areas of Informatics
12, 13, 16, 17, 19

Learning Objectives

Unit 1 - Overview of Field and Problems Motivating It

1. Define biomedical and health informatics, the terms related to it, and its role in health, healthcare, public health, and biomedical research
2. Describe the major historical events of biomedical and health informatics
3. Discuss the major problems in healthcare motivating use of biomedical and health informatics
4. Compare and contrast the roles of various individuals in the health information technology workforce
5. Find and access the major sources of information for biomedical and health informatics in the scientific literature and on the World Wide Web

Unit 2 - Biomedical Computing

1. Identify the basic tenets of biomedical computing to be able to inform optimal selection of hardware, software, and network connections for a given health or biomedical setting.
2. Describe the major aspects of software engineering as they relate to biomedical and health informatics.
3. Specify a use case for a biomedical and health informatics task.

Unit 3 - Electronic and Personal Health Records (EHR, PHR)

1. List the major categories of clinical data along with their content and structure.
2. Identify the essential functions of the electronic health record (EHR).
3. Describe the major barriers to EHR use.
4. Define the personal health record (PHR) and describe its usage, content, and value.

Unit 4 - Standards and Interoperability

1. Explain the importance of standards and interoperability for health and biomedical data and information systems
2. Describe the major issues related to identifier standards, including the debate on patient identifiers
3. Discuss the various message exchange standards, their explicit usage, and the type of data they exchange
4. Discuss the different terminology systems used in biomedicine and their origins, content, and limitations
5. Describe the role of platforms for interoperability, including SMART on FHIR

Unit 5 - Advancing Care With the EHR

1. Describe the major threats to patient safety and causes of medical error
2. Explain the basic principles of healthcare quality and how they can be measured in the EHR
3. Distinguish the different types of clinical decision support and describe their use and limitations in clinical practice
4. Discuss the goals of health information exchange and how they are carried out
5. Describe the successes, challenges, and transition of the meaningful use program

Unit 6 - Data Science and Analytics

1. Describe the key applications and limitations of applications of data science and data analytics in healthcare
2. Discuss the different approaches to machine learning and their success in biomedicine and health
3. Describe the techniques and limitations of natural language processing
4. Define the key tenets of evidence-based medicine (EBM)
5. Construct answerable clinical questions and critically appraise evidence answering them
6. Critically appraise studies of intervention and diagnosis as well as systematic reviews of those studies
7. Describe the production and application of clinical practice guidelines

Unit 7 - EHR Implementation and Evaluation

1. Discuss the analysis of workflow for EHR implementation
2. Describe the major steps and challenges in EHR implementation
3. Classify the different types of telemedicine and discuss their uses
4. Discuss the major approaches and challenges for privacy and security of healthcare data
5. Discuss the implications of the major evaluation studies of the EHR

Unit 8 - Information Retrieval (Search)

1. Enumerate the basic biomedical and health knowledge resources in books, journals, electronic databases, and other sources.
2. Describe the major approaches used to indexing knowledge-based content.
3. Apply advanced searching techniques to the major biomedical and health knowledge resources.
4. Discuss the major results of information retrieval evaluation studies.

Unit 9 - Research Informatics

1. Discuss the biomedical research process and enterprise.
2. Describe the ways that informatics can advance clinical and translational research.
3. Define bioinformatics and related areas, and distinguish its work from other areas of biomedical and health informatics.
4. Discuss the role of genetics and genomics in biology and medicine.
5. Describe the precision medicine paradigm and the role of biomedical and health informatics in facilitating it.
6. Understand the challenges for genomic data in the EHR and other information systems.

Unit 10 - Other Areas of Informatics

1. Describe the management of images in clinical settings, including the use of PACS systems
2. Discuss the different modalities of imaging and their capture and use in digital form
4. Describe the ways that biomedical informatics enables nursing practice
5. Describe the ways that biomedical informatics enables public health practice
6. Define consumer health informatics and discuss the methods by which it uses informatics
7. Define population health and discuss the methods by which it uses informatics

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. Biomedical Computing
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 Definitions and Key Attributes of the EHR
3.4 Benefits and Challenges of the EHR
3.5 EHR Examples
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. Advancing Care With the EHR
5.1 Patient Safety and Medical Errors
5.2 Clinical Decision Support (CDS)
5.3 Healthcare Quality Measurement and Improvement
5.4 Health Information Exchange (HIE)
5.5 From Meaningful Use to Promoting Interoperability

6. Data Science and Analytics
6.1 Data Science and Data Analytics
6.2 Machine Learning and Artificial Intelligence
6.3 Natural Language Processing
6.4 Evidence-Based Medicine
6.5 Clinical Practice Guidelines

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 Genomics Data in the EHR and Other Information Systems

10. Other Areas of Informatics
10.1 Imaging Informatics
10.2 Nursing Informatics
10.3 Public Health Informatics
10.4 Consumer Health Informatics
10.5 Population Health