A Health Informatics and eHealth Curriculum for Clinical Health - - PowerPoint PPT Presentation

A Health Informatics and eHealth Curriculum for Clinical Health Profession Degrees HIC 2015, Brisbane, 4 August 2015

Kathleen GRAYa, Dawn CHOOa, Kerryn BUTLER-HENDERSONb, Sue WHETTONc, Anthony MAEDERd

aHealth and Biomedical Informatics Centre, The University of Melbourne bCentre for Rural Health, University of Tasmania cTasmanian School of Business and Economics, University of Tasmania dSchool of Computing, Engineering and Mathematics, University of Western Sydney

“Clinical” = dentistry, dietetics, medicine, midwifery, nursing,

• ccupational therapy, optometry, paramedics, pharmacy, physiotherapy,

psychology, radiography, social work and complementary therapies, and so on

~2000 clinical health profession degrees

• ffered in Australia’s ~40 universities

from Bachelor degree to coursework Doctorate

How many of these degrees teach health informatics or ehealth? How well?

Image credit: adctoday .com

Very few can give a clear account. Those who do may teach with reference to recognised curriculum guidelines – or not. Examples…

Australian Health Informatics Education Council, Health Informatics – Scope, Careers and Competencies, 2011. http://www.ahiec.org.au/Documents.htm

• J. Mantas, E. Ammenwerth, G. Demiris, A. Hasman, R. Haux, W. Hersh, et al.,

Recommendations of the International Medical Informatics Association (IMIA) on education in biomedical and health informatics–1st revision. Methods of Information in Medicine 49 (2010), 105-120.

Based on findings from our 2010-2013 study of entry-level degrees, including 100 interviews with university teachers in all States:

• K. Gray, A. Dattakumar, A. Maeder, K. Butler-Henderson, & H. Chenery, Advancing Ehealth

Education for the Clinical Health Professions Final Report, Australia. Department of Education and Training, 2014.

http://olt.gov.au/project-coordinated-interprofessional-curriculum-renewal-ehealth-capability-clinical-health-professi

Image credit: timeshigherducation.co.uk

Yes, we’re teach health informatics and ehealth:

• “The curriculum containing individual subjects on evidence based practice in

addition to discipline specific EBP [evidence-based practice] content dispersed throughout the curriculum”. Physiotherapist, SP13

• “Students have access to remotely located guest lecturers who present using

teleconferencing”. Nurse, SP15

• “Several lectures include content relating to electronic patient records, how they

are accessed and how they relate to the hospital environment and private practice”. Physiotherapist, SP32

• “Evidence-based practice, Communication, Clinical decision support systems,

Professional Experiences in actual health care agencies”. Nurse, SP61

• “The fact that the subject notes must be down loaded by students provides a basis

for this type of learning environment. However, there is no designated aspect of the course in which this sort of information is presented”. Myotherapist, SP69

• “Guest speaker from the State Government […] Data Collection Unit”. Midwife,

SP80

• “Some components of public health essays may touch upon ehealth as a

component of a question or as part of an answer”. Medical Practitioner, SP89

No, we’re not teaching this stuff

• “Some staff are more e-savvy and use technologies such as Skype &

Adobe Connect but there is no requirement. …Our assessment strategies do not address anything related to ehealth”. Psychologist, SP4

• “This is not specifically taught as a topic within the current degree

program but electronic record keeping is used throughout most clinics and students are expected to conform to current practices of reporting”. Audiologist, SP22

• “Only limited specific discussion of evidence based practice

however would not include this as part of ehealth or informatics”. Nurse, SP81

• “The teaching methods to date do not use telehealth or other

methods”. Dietitian, SP90

• “Our students use electronic records in our clinic however they are

not assessed on them”. Chiropractor, SP102

Why should we? Why don’t we?

Image credit: amia.org

Why should they?

Safety and quality of care Efficiency and efficacy Health sector restructuring

Why don’t they?

Few people, thinly spread, with the expertise to teach Not required for degree (re)accreditation Unclear signals from employers

Image credit: amia.org

This project

How could we address scarcity of : quality-assured curriculum? teaching expertise? $$$ to do anything about it?

• Let’s apply for an OLT

extension grant!

• Let’s design a curriculum

aligned with CHIA competencies !

• Let’s target postgraduate

level, for students and staff !

• Let’s make it available
• nline !

Image credit: www.brentholm.com

Three-step curriculum development

Step 1. Peer review Six CHIA competency areas including 52 sub-topics, chunked into 10 roughly equal blocks of study Each of the four academics drafted curriculum related to competencies with best fit to their expertise Task: define key concepts, construct

• verviews, design learning activities,

select or create supporting resource materials Project officer to keep us on track, honest and real

Brief:

• Suit multi-professional and

interprofessional learning

• Be relevant for health professional

practice in local, national and international settings

• Rely on resource based learning,

using a variety of free full-text online resources

• Represent intellectual effort and time

commitment equivalent to 12.5 credit points at AQF level 8/9

Block 10 of 10 Developer TEAM MEMBER NAME Competency area mapped from CHIA CHIA Competency 6 - Human and social context Sub-topics mapped from CHIA 6.1 Technology and social aspects 6.2 The relevance of ethical and legal issues for health informatics 6.3 Policies, principles and guidelines for health informatics management 6.4 Usability and human factors Learning outcomes mapped from CHIA  Discuss the areas of design, evaluation and social sciences taking into account technological limitations  Apply good practice to ethical, legislative political and regulatory obligations related to health information management (e.g. protecting the privacy of consumers)  Apply good practice to the collection, use, disclosure, access, protection and destruction of health information  Apply good practice to human centred design, usability, human factors and ergonomic sciences Overview 150 word transcript, alternative short introduction recording Learning resources For each sub-topic provide at least one well-chosen document with full citation Learning activities For each sub-topic provide clear instructions on one learning activity, reflecting learning outcomes, linked to learning resources, and able to be written up for assessment

Three-step curriculum development

Step 2. External review Twenty-five experts selected from health profession degree and subject coordinators, members of the CHIA Examination Group, and

• ther interested members of national ehealth

and health informatics organisations Email invitation with link to online survey for anonymous review, open December 2014 and January 2015. Options : review curriculum for all 52 sub-topics in all 6 areas of competency; or review curriculum just in your area of interest; or read all curriculum and review none Measures Responses on a 5-point Likert scale to three questions about each sub-topic:

• How relevant are the learning activity and

resources to the clinical professions?

• How well do the learning activity and resources

align with the CHIA competency?

• How interesting are the learning activity and

resources for a clinical health degree student? Respondents were also asked:

• make open-ended comments about curriculum

in each sub-topic

• rate their expertise in each sub-topic as low,

medium or high.

• say whether associated with the CHIA

Examination Group; and /or a degree or subject coordinator in a clinical health degree; and / or experienced in developing curriculum for ehealth and health informatics

12 reviews received, all competency areas reviewed. Useful comments, including:

• ”Purely from a clinical perspective, much of this is (as previously mentioned)

actually not generally visible and could prove both challenging and indeed, awkward for a purely clinically focussed individual to comprehend.” (Q6)

• “... free-text analysis of data is [fraught] with data integrity issues; and in fact

should not even be proposed to students, in that the major drive for decision support is the absolute requirement for strongly codified information values, such that there is a high(er) confidence in the decisions provided by the system ... “(Q9)

• “There is literature on the 'clinical method' that might help, and early writings by

McWhinney, that I think are very relevant here. Need to counter the mechanical view of clinical decision making that pervades HI.” (Q37)

Three-step curriculum development

Step 3. Subject trial Students took a one-semester free subject based

• n the curriculum, March - June 2015

Project leader and project officer implemented the curriculum in University of Melbourne online learning management system Students did self-directed learning, based on a detailed study guide and a choice of weekly activities; and structured group learning, based on lodging their work and reviewing each others’ work in discussion forums each week. Teaching was shared among the project team on a weekly roster. Teachers gave feedback to students individually each week via an online comment and grading facility.

Participants: 41 EOIs from eligible applicants 18 selected and commenced seven completed, from 5 professions and 2 States Measures:

• Pre-trial survey of potential learning

variables

• Hurdle requirement: pre- and post-tests of

HI&eH knowledge

• Graded weekly written assignments x 10

weeks; graded final project presentation

• Post-trial survey of student experience and

satisfaction

Comparative analysis of pre- and post-tests showed that the subject built health informatics and ehealth knowledge

• 7 completing students’ post-tests used a greater number of words than

their pre-tests (2344 words compared to 1852 words, in total).

• The number of different words increased in their post-tests (818 unique

words, compared 612 in the pre-tests) and mean lexical density slightly increased (from 33.05% in pre-tests to 34.9% in the post-tests)

• New salient words emerged in post-tests statements , for example, in

the post-tests five occurrences of ‘interoperability’, a word not seen at all in pre-tests . Indicates acquisition of more specialised terminology and concepts Indicates increased ability to apply content-related concepts

Analysis of post-trial student experience surveys showed that the interprofessional learning experience was valued. Best aspects of the subject:

• learning as a multidisciplinary

cohort

• ability to choose among

learning activities

• provision of relevant links and

resources

• breadth of content coverage
• literature review assignment
• reading the discussion forums
• remote and self-guided learning
• a timed, structured approach

which included weekly tasks The subject could be improved by:

• focus on Australian context and

examples exclusively

• more external video resources
• more flexible weekly due dates
• scheduled lessons and tutorials

Where can I find out more about the project?

• The full paper in the HIC 2015 conference proceedings.
• The current version of the curriculum document is freely

downloadable at: http://clinicalinformaticseducation.pbworks.com

• University of Melbourne Academic Board approval processes are

under way to offer the online subject for postgraduate credit, with teaching by project team members across partner institutions and enrolment available to students across Australian

• universities. For details, contact kgray@unimelb.edu.au

Reflections on CHIA

• How do CHIA competencies fit in Nationally Recognised Training ?

http://training.gov.au/Home/About

• How does passing the CHIA examination compare with completing

a university subject based on the CHIA competencies in the Australian Qualifications Framework ? http://www.aqf.edu.au/

• How do we define concepts such as ‘good practice’ or ‘best

practice’ in CHIA?

• How do we update CHIA competencies to give more attention to

the influence of ehealth - for instance developments in more participatory, social technologies and more natural, ambient user interfaces to information?

• How do we progress still underdeveloped CHIA specialisation

competencies – such as aged care informatics, clinical informatics, clinical research informatics, nursing informatics, public health informatics?

Thank-you to clinical degree students and staff who contributed to this project and to individuals associated with CHIA and its auspicing organisations ACHI, HISA and HIMAA

Support for this project has been provided by the Australian Government Office for Learning and Teaching. The views expressed in this report do not necessarily reflect the views of the Australian Government Office for Learning and Teaching.