HIT and Medical Education: The Innovators

The purpose of this series is to make the case for implementing a widespread, systematic approach to HIT education in medical schools and CME programs for physicians. Previous posts covered The HIT Deluge, Impact of EHRs on Medical Education, Tweaking Medical Education to Leverage the Benefits of EHRs, and Social Media, Disruptive Force in Medicine.
----------------------------------------

Earlier posts in this series suggested that EHRs and social media have had a large impact on medicine. It does not necessarily follow however, that medical education processes should be modified to account for them. After all, thousands of technologies have disseminated into the medical mainstream, and the system seems to have accommodated them organically.

To some extent, this is already happening with social media, the most disruptive of the new health information technologies. In the previously discussed Florida study of Facebook utilization by young physicians for example, 64% of medical students were found to have fully public Facebook accounts, whereas only 12% of resident physicians did.

And Russ Cucina, an associate medical director of IT at UCSF points out that, "we had these same conversations 10 or 15 years ago about the Internet. As the Internet became ubiquitous, people wrote articles about whether medical groups should have Web sites, and whether doctors should have e-mail. Now, it's taken for granted they should."

Over time, Cucina added, providers came to learn “when to use encryption and greater security to manage privacy, and that diagnoses and difficult conversations shouldn't be communicated through e-mail. The same understandings will develop for social media (and presumably other forms of HIT).”

It’s also true that finding space to teach HIT in a densely packed medical school curriculum means subtracting time from something else.

Still, it is argued here that the HIT Deluge presents unprecedented challenges to time-honored communication channels involving patients and physicians, and that it blurs boundaries between all stakeholders in the care process in ways that generate new ethical challenges and legal risks of a magnitude that simply cannot be ignored.

Many medical schools including Harvard, Stanford, Vanderbilt, UCSF and Ohio State have chosen to approach the conundrum by offering elective courses in HIT, often in conjunction with other graduate programs at the university.

HST.921, also known as “Information Technology in the Health Care System of the Future” is an example. The course is open to all graduate students at Harvard and MIT, including those at Harvard Medical School.

The course objective is to demonstrate how HIT shapes and redefines the health care marketplace. Students learn how HIT (1)improves the quality and efficiency with which health care is delivered, (2)provides new options for patient education and self-care, and (3)enables e-health delivery via the Internet.

As is typical in these elective courses, many faculty members pitch-in to teach HST.921. Their collective expertise includes patient care, medical and bioinformatics, consumer health, innovation and managed care.

The Florida State University College of Medicine has taken a more aggressive approach. It is one of the newest medical schools in the US, so its curriculum developers were not constrained by prior commitments and teaching methods. They chose to leapfrog ad hoc approaches to HIT education and design an Internet-age curriculum that has medical informatics woven into its fabric.

Nancy Clark, who directs the Medical Informatics program there, told me recently that FSU students receive laptops upon arrival at the school. Their textbooks are on line. During orientation and first semester, they learn to access library resources on line and gain early exposure to decision support tools.

In the second semester, she said, FSU medical students receive PDAs and learn how to use them. They also learn how to carry out literature reviews and manage bibliographies on line.

In their fourth semester, the students meet in specially designed classrooms where they learn how to use SOAPware, a laptop-supportable EHR. During their third year, students use SOAPware during supervised patient encounters and receive feedback from attending physicians regarding their work.

Alas, the hide-bound curriculums of most medical schools are unlikely to undergo full-scale renovations of this sort in order to accomodate the HIT Deluge. Even if they did, medical schools are not properly positioned to meet the immediate learning needs created by it.

After all, most practicing physicians graduated long before even the innovators had HIT courses, and health care professionals other than physicians need HIT education as well.

This has prompted the American Medical Informatics Association to initiate its so-called 10x10 program, whose goal is to train 10,000 health care professionals in applied health and medical informatics by the year 2010.

Former AMIA President Don Detmer stated the 10x10 vision thusly: "There must be a cadre of health care professionals who have knowledge and skills beyond their clinical training. Virtually every hospital, clinic, physician office, or other health care provider organization will in some way utilize IT solutions in the coming years and will need health care professionals versed in informatics to assist with the implementation, use, and success of these systems."

AMIA 10x10 utilizes curricular content from existing informatics programs to provide hands-on experience with EHRs, personal health records, standards and terminology, and health care quality.

And it turns out there is plenty of superb HIT content out there.

At University of West Florida’s School of Allied Health and Life Sciences for example, Bob Hoyt and Melanie Sutton oversee a Certificate in Medical Informatics Program that focuses on topics like EHRs and eprescribing. Recently, Hoyt’s group turned its curriculum into a book which is available here (proceeds from sales of the book are donated to the Medical Informatics Program at the University).

In Hoyt’s classes, students get hands-on experience with the Practice Fusion EHR, which is donated free of charge as part of the company's Academic Program.

Meanwhile, what about all the physicians out there who graduated medical school years ago and have had no HIT education whatsoever?

That’s where Cucina plays a vital role. Cucina, you see, teaches a class called, "Blogs, Tweets, and Facebook: What the Hospital and Medical Administrator Needs to Know" as part of UCSF’s tour de force CME course, Management of the Hospitalized Patient.

The next offering is October in San Francisco. We hear it’s filling up fast.

Glenn Laffel MD, PhD
Sr. VP Clinical Affairs