Postgraduate Training in Healthcare Informatics - a personal

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					Postgraduate Training in
Healthcare Informatics -
 a personal experience

         Dr. John E. Coia
 Consultant Clinical Microbiologist
        What is Health
“Health informatics or medical informatics
is the intersection of information science,
medicine and health care. It deals with the
resources, devices and methods required
to optimize the acquisition, storage,
retrieval and use of information in health
and biomedicine. Health informatics tools
include not only computers but also clinical
guidelines, formal medical terminologies,
and information and communication
        Why do we need
     healthcare informatics?
                   Biomedical Knowledge Base
                    Basic & Applied Research
Clinical Governance
                                        Islands of Information
                                            Clinical Records
                                            Feeder Systems

                                     “Distributed” Health Care
                      Telemedicine          Primary Care
                    Other applications
     Core elements of
   Healthcare Informatics
• Electronic Medical Records
• Decision support
• Standards
  – Interoperability
  – Definitions
  – Technology and Non-technology e.g. (Controlled
    Medical Vocabularies)
• Networking/portable devices/remote
• Integration
• Systems design & implementation
   Health care informatics
• Similar themes
• Differences in pace of progress
• Differences in emphasis and
    Training in healthcare
• Courses to generate health-care
  informatics staff of the future
  – “Ground up” training
  – Specialisation from other backgrounds
• Courses to meet training
  requirements of staff already in post
  – Specific skills & competencies
  – Generic training
        Types of training
• Specific skills
  – Use of specific software packages etc.
  – Often task-oriented
• Generic
  – Wider issues & broader concepts e.g.
    Theory of Systems design,
    Confidentiality etc.
  – Non task-orientated
        Type of structure
• Full-time
  – Undergraduate level
  – Entering the discipline
• Part-time
• Modular
  – Increase flexibility and tailoring
        Type of delivery
• Traditional
  – Proximity
  – Numbers
  – Scheduling
• Distance-learning
       Distance Learning
• Increasingly popular for CPD/training
  – Web-based
  – Accessible any time
  – All you need is internet connection
     • Facilitating technology
  – Virtual Learning Environment (VLE)
     • Web CT
     • Course genie
    Time to get personal!
• Enthusiastic amateur!
• Involvement in various
  procurements and implementations
  of laboratory systems
• Interested in innovative uses of IT in
• Increasingly frustrated by “gaps” in
            FHI RCSEd
• Faculty of Healthcare Informatics of
  the Royal College of Surgeons of
• Courses
  – CPD modules
  – MSc
       Modular Structure
• Compulsory residential weekend
• Series of 12 modules
  – Standalone (Module 1 compulsory)
  – 6 Modules (including module 12) for PG
    Certificate in Medical Informatics (CMI)
  – 12 Modules for PG Diploma in Medical
    Informatics (DMI)
•   Web-based via Internet
•   Synchronised 10 week module runs
•   Virtually all material available on-line
•   Up to 5 years to complete
•   First ran in October 2000
•   Last graduations this month
•   Constant logging of progress
•   Assessed discussion forum posts
•   “In-line” tasks
•   End of module assessments
•   Module 12 project proposal
    Module 1: An Introduction to
       Medical Informatics
•   Definitions
•   History of development
•   Concepts of data and information
•   Trends & directions
       Module 2: Internet &
• Overview of the Internet and intranets
  from a general perspective as well as
  covering aspects related to health
• Main objective was to understand
  principles which underpin how the Internet
  functions, including areas which are
  technical (e.g. communication protocols),
  organisational (e.g. DNS), cultural (e.g.
  "netiquette") or developmental (e.g.
  implementing an Intranet)
     Module 3: Websites
• Basic principles of web site design
  and authoring
• Introduction to HTML programming
• Had to design and produce your own
         Module 4: Protecting
    Information: Theory & Practice
•   Personal Data
•   Confidentiality
•   Privacy
•   Ownership
•   Electronic Mail
•   Email In Use
•   Security
       Module 5: Clinical Data
        Storage & Retrieval
• Database theory and structures
• Introduction to Microsoft Access and Structured Query
  Language (SQL)
• Strategies for storing data and techniques for optimising
• Maintaining portability and cross-platform compatibility of
• Maintaining quality of data and reducing errors within a
• Specific requirements for storage and retrieval of various
  types of data within a hospital setting
• The importance, implementation and problems associated
  with the Electronic Health Record (EHR)
   Module 6: Information in
• Significance and process of evidence
  based healthcare and strategies for
• Principles of clinical and non-clinical
  audit and their role in practice
• Concept of the “informed patient”
  and potential benefits and pitfalls for
  healthcare practitioners and patients
   Module 7: Digital Imaging,
  Media Acquisition & Processing
• Basics of digital images
• Image capture for individuals and
  organisations in Healthcare
• Use of presentation graphics
• Methods of image manipulation relevant to
  clinical images
• Image output and storage options
• Digital video
• Diagnostic imaging and clinical applications
    Module 9: Computers in Clinical
•   Human-computer interaction
•   Decision support systems
•   Remote access and wireless systems
•   Virtual reality and simulations
        Other modules
• Module 8 Communication of
• Module 10 Systems & Standards
• Module 11 Telemedicine
 Module 12: The Future of
   Health Informatics
“an opportunity to apply the health
informatics skills you have learnt on this
course. There is little formal content for
this module. Instead the main focus is self
directed learning (with assistance from a
tutor) to develop a proposal plan for a
health informatics project that would be
useful in your own local environment. The
project should investigate a problem and a
possible solution or innovation that leads
to measurable improvement in your
•   Flexible study programme
•   Access anywhere
•   Access anytime
•   No need to take time off of work
•   Generic
•   International perspective
• Any course of study is hard to
  combine with work!
  – Don’t underestimate the time
• Isolation
  – How am I doing?
  – Lack of camaraderie
• Generic
• International perspective
        How did they do?
• 207 Students joined the course

                             CMI (32)
                             DMI (66)
                             Other (11)
                             Out of time (6)
                             Withdrew (92)
         3% 5%
        Specific Benefits
• SPE Project
  – Handhelds used for audit in North
• Tutor on DMI course for Module 7
• Module leader for UHI infection
• Generic Investigations Data
  Standards Clinical Working Group
   What the DMI was not
• Doesn’t make you an “IT expert”
• Doesn’t give you in-depth specific
         What the DMI was
• Wide range of disciplines represented
• Only a small number wanted to be “career”
  HI people
• A way to create the “interface” people
• Understand both sides of the problem
  –   Systems development and implementation
  –   Process redesign
  –   Knowing the potential & seeing the opportunities
  –   Expert systems development
           Is it for me?
• Two key questions
  – Do you really require or need to?
  – What is it you really want?
MSc course
     How are they doing?
• 217 Have joined the course since 2002
                5%            MSc (11)

                     75%      (44)
          Would I do it again?
• Yes
  –   I can see the joins now
  –   Understand more of the pitfalls
  –   See why big IT projects often fail!
  –   Chance to look at things in more depth
  –   Increased my comfort zone
  –   Consolidated and organised my knowledge
• Links
  – MSc
  – UK Council for Health Informatics Professions