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Thursday, November 12, 2009

Educating the Healthcare Professionals of the Future

One of my favorite activities is engaging with students who are learning about health informatics, and teaching them about what is going on in the healthcare standards space.  Over the past two years I've been fortunate enough to speak at Harvard, the University of Utah, Northeastern University, and undergraduate students at  Stonehill College.  These opportunities also tickle my funny bone, because many of these organizations consider me to be underqualified as a student in their graduate health informatics programs.  I also teach HL7 standards at HL7 Working group meetings, and given seminars in person and online on IHE Profiles and HITSP speciifcations.  I love to teach, and I've been told that I'm pretty good at it by professional educators.

Recently, an educator prompted me to talk about the educational needs of health information professionals.

What do health information professionals need to know?  I recently spoke to a class of undergraduates heading into the health information field at a local college near my home on that very topic.  Healthcare Information professionals need to be able to navigate amongst a complex set of issues including:
  • Technology -- EHR, EMR, HIS, LIS, RIS, PACS and PHR
  • Law and Regulation -- ARRA/HITECH, MMA, CLIA, HIPAA, ICD-10/5010 Regulations
  • Federal, State and Local Agencies
  • Quality and Policy Setting Organizations -- Joint Commission, HIT Federal Advisory Committees, NCQA and NQF
  • Standards, Terminology and Standards Development Organizations
At the very least, in each of these areas, they should be able to identify what/who is important (and not), their purpose and where or who they can go to, to get more information. 

Take a little test, which among these 56 acronyms do you recognize.  Do you know what it stands for, or how it is defined?  Where would you go to get more information about it?  If you get all of them without reference to external resources, I'll be impressed, but I expect you'll be able to figure them all out pretty rapidly through the web.

ANSI
HCPCS
IHE
PHR
ARRA
HIE
ITI
RHIO
ASTM
HHS
ISO
RIS
CDA
HIMSS
JCAHO
SCRIPT
CCD
HIPAA
LIS
SNOMED CT
CDC
HIS
LOINC
TC-215
C32
HITECH
NCPDP
TPO
C83
HITPC
NQF
V2
CMS
HITSC
NCQA
V3
CLIA
HITSP
MLLP
WEDI
CPT
HL7
NEMA
X12N
DICOM
ICD-9-CM
OASIS
XDS
EHR
ICD-10-CM
ONC
4010
EMR
IETF
PACS
5010

The imporance of knowing how to find out was highlighted to me several times today in another classroom setting.  A question came up in the class on how one would roll up codes used to represent race and ethnicity.  I pointed out to the students that there is a) Federal policy in this country for representing (and rolling up) this information, and b) excellent reference terminologies that would enable them to correctly answer the question.  I wouldn't expect these information professionals to know that, but I did point out that they need to ask the question of "has someone else already addressed this issue".

Not too long ago, my home state set policy about tracking race information to help determine racial disparities in the delivery of care.  They wanted more detail than the OMB 6 categories, for which I applaud them.  However, after a little digging I learned that the policy had not been informed by some of the existing work being recommended or already adopted at the national level.  They didn't ask the question. 
Why not?  I'm not sure, but I know that those health information professionals (and policy makers) are already overwhelmed with information, and the important stuff, while all on the web, gets lost in the noise.

So, the first skill that health information professionals need to learn is not about any particular set of standards, agencies, policies, et cetera, but rather critical skills in information retrieval.  How can I find out what is important?  Where are good sources of information?  How do I develop reliable sources of my own?  I was asked 3 questions today about HL7 Version 2 that I didn't know the answer to, but I had the answers within an hour.  They need to be able to demonstrate that skill.

Being able to read critically, and identify salient points quickly is a crucial skill that we simply don't teach people. In addition to finding relevant information, they also need to learn how to plow through it.  In one week I read three different versions of HITECH.  It wasn't fun, but it was necessary.  Many of you have slogged through HITECH, HIPAA, ARRA, MMA or other legislation or regulations that impact our field, or waded through some recent medical research, or read and commented on recenly published specifications.  Ask yourself, did anyone ever teach you how to go through those documents?  There are education programs that teach these skills, but not any I've ever encountered in my educational experience.  Can you spend an hour with a 100 page document and identify the top 10 issues that you need to be aware of?  Health information professionals need to be able to demonstrate that skill as well.

Finally, the last skill is being able to communicate clearly and simply.  So much of what health information professionals need to do involves teams of people with a variety of very different and complex skills.  These teams include doctors dealing with highly specialized medical knowledge, medical researchers dealing with new drug pathways and a complicated array of regulations for clinical trials, to the billing specialist dealing with financial transactions among a half dozen different agencies all responsible for some portion of a patient's bill, to the IT staff dealing with a spaghetti network of technologies that all need to interconnect.  I can dive down into gobbelty-gook with the best of the geeks out there, but when I show real skill is when I've been able to explain some of this gobbelty-gook to a C-level.  Teaching Simple English to healthcare professionals is a pretty good idea.  I think it should be a required course for anyone who has to write specifications, policy, contracts, proposals, requests for proposals, laws or regulation on any topic (and would go a long way towards making all of our lives easier).

There are many other skills that a health information professional needs, and they are important.  But those three skills (information retrieval, critical reading, and simple communications) are fundamental for any information professional.  This is especially true for those working in healthcare.

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