Health informatics education: a global challenge

Jeannette Murphy, Senior Research Fellow in Health Informatics, Centre of Health Informatics and Multiprofessional Education, Faculty of Biomedical Sciences, University College London, UK Having just returned from an International Medical Informatics Association (IMIA) working group meeting on health and medical informatics education, I would like to reflect on what I learned and to share this with readers. The theme of the conference was Building Worldwide Capacity for the Health Informatics Workforce. The IMIA education working group seeks to advance knowledge of how health and medical informatics is taught: to health care professionals around the world; to students of computer science/informatics; within dedicated curricula in health and medical informatics. Since 1974, the IMIA working group has sponsored nine conferences aimed at disseminating and exchanging information on Health and Medical Informatics programmes and courses.1 The October 2008 conference, in Buenos Aires, Argentina, was truly international, with representatives from 17 countries and six continents. Although there were no librarians in attendance, many of the papers and debates would be of interest to health science librarians. The workshops and keynote papers covered six topics: Case Studies of Programmes and Projects. Curriculum; History of Health Informatics Education. Occupational Standards, Competencies, Benchmarking; Career Opportunities. Educational Methods/Resources/Approaches. International Initiatives. Information Retrieval. All the papers and PowerPoints from this event are online at http://www.hospitalitaliano.org.ar/imiawged/. I have singled out a few papers whose content is likely to interest readers of this journal. Steven Bedrick and Bill Hersh's paper2 (Non-Native-English-Speaking Researchers and English-Language Information Systems) is interesting because it bridges the domains of health informatics and information science. The starting point of this research is a concern with language barriers to information retrieval, both for authors and for those seeking biomedical information. The authors make three observations: approximately 90% of articles indexed by medline in 2000 were in English; language problems are routinely cited as one of the most important explanations for the disproportionately small number of articles from authors in the developing world that are published in international journals; language issues may pose a significant barrier to non-native-English speakers attempting to access current research in their fields of study. Is there a solution to these problems? The presenter suggested that machine translation and other cross-language information retrieval techniques may make it easier for non-native-English-speaking researchers and clinicians to access English-language information sources. However, the development of information retrieval systems with in-built language support features requires a sound understanding of the information behaviour of non-native English-speaking researchers and clinicians. As part of his PhD research, Bedrick plans to undertake a formal qualitative study of the experiences of non-native-English speakers using English language electronic information resources. This will take the form of a series of interviews and electronic questionnaires, involving individuals from three groups: researchers, clinicians and students. (The initial focus will be Latin America, but the study could later be expanded to other parts of the non-Anglophone world.) His first and most important question is whether non-native English-speaking clinicians or researchers actually perceive a need to access English-language information sources. The findings from this phase of the study will inform the design goals for a cross-language information retrieval system. A further two papers which caught my attention because of their relevance to health librarians were by two Canadians, Yuri Kagolovsky and Kathryn Brillinger, who have developed an innovative health informatics programme at Conestoga College Institute of Technology and Advanced Learning (Ontario). Their undergraduate programme, leading to a Bachelor of Applied Health Sciences (BAHSc) Degree in Health Informatics, makes extensive use of case studies and includes a course on intercultural communication. In one paper (A Systematic Approach to Using Case Studies in Health Informatics Education),3 they explain what makes for a good case study and describe a checklist they developed for choosing and adapting case studies. Their checklist could readily be adapted to meet the needs of a variety of courses (Table 1). Case studies are widely used in business schools and in clinical education. However, apart from articles on the Sheffield programme,4,5 there has been little written about their role in training health informatics professionals. In the discussion relating to the Canadian paper, there was general agreement on the benefits of using case studies and the need to develop a database of good case studies to support health informatics teaching. Health librarians could play a very pivotal role in helping to create and maintain such a resource. Richard Heeks’ website,6 Cases of Public Sector Health Information Systems from Developing/Transitional Countries, could provide a starting point for developing such a resource. Heeks’ site includes a form for submitting a case study. Another thought-provoking paper (Intercultural Communication: A ‘Foundation’ Competency in Health Informatics) by the same two authors, Brillinger and Kagolovsky,7 dealt with intercultural communication. Their thesis is that, as health informatics projects are very diverse endeavours, involving a complex mosaic of ‘cultures’, intercultural communication skills should be seen as a core competency. They identified five reasons why diversity is a defining feature of any health informatics project. (i) Health informatics is itself a ‘new frontier’ or ‘culture’ for the health care sector; (ii) health informatics runs across academic programmes requiring professors and students to make cultural connections across academic ‘silos’; (iii) health informatics teams are always multidisciplinary, therefore, mixing different professional cultures; (iv) given the incredible rates of globalization and immigration, health informatics projects usually cross ethnic, national and religious divides as well; (v) health informatics education itself is becoming increasingly internationalized, requiring professors with cross-cultural teaching skills. Despite the need for a health informatics workforce able to cope with these challenges, health informatics education rarely addresses the issue of intercultural communication. The authors outlined their model and the principles health informatics educators can apply in their teaching. They described two courses currently taught in their programme, Intercultural Communication Skills and Cultural Diversity in the Workplace. Here again, there would be scope for health librarians to contribute their expertise. Bioinformatics originated in genetics and molecular biology but nowadays its scope is much broader, interacting with medicine and other health-related domains. Consequently, there is a need to devise educational programmes for populations without a background in biological research. As librarians are often the ‘gatekeepers’ or providers of information for other health professionals, they need training on the available bioinformatics data resources and some of the available tools. Since the end of the last century, there has been discussion on the training needs of librarians in bioinformatics.8,9 Norman,10,11 for example, recommended that medical librarians should have a basic understanding of the type of information contained in key genetic information resources and know how to search them. At the IMIA conference, a group of Spanish researchers based in Madrid12 discussed their experience of providing training in bioinformatics methods, tools and databases to non-biologists. For 10 years the group has explored ways of meeting the needs of physicians, nurses and librarians. In their two papers, they made the case for diversified training to meet the needs of different target audiences and described several initiatives in their own research group. One initiative, the ‘BIB-GEN’ project, is an online course aimed at librarians and organized in collaboration with several international institutions (NCBI, BVS-PAHO). The experience of Lopez-Campos et al.13 in developing a range of bioinformatics educational programmes highlights the need for customization—in terms of content, length and delivery mode. The demand of training activities will undoubtedly increase as new technologies, genomics and molecular medicine approaches leave the research laboratories and become a reality in health practice environments. To adapt to these changes, health professionals will require training activities to keep them up to date. Librarians in turn will need training to access and manage these information resources and to support end-users. Some science faculty members may think librarians are not capable of teaching non-bibliographic databases. Parlaying previous experience teaching other statistical or databank resources may be one way to change this perception. By offering and advertising library-based courses in bioinformatics databases, librarians can promote their ability to provide support and training on these resources.14 The Spanish team also reported on an online educational resource (NBIOTIC) they have developed on convergent technologies for biomedical informaticians.14 NBIOTIC is aimed at an extensive audience from students to librarians and may also be useful to educators. The reason for developing this resource is that converging technologies are producing tools to facilitate the acquisition and integration of biomedical information at all levels. To exploit this development, biomedical informaticians need education and training resources in convergent technologies. The group maintains that the scientific community not only needs to learn about the convergence of technologies but also to explore the potential social, political and ethical implications. Under the leadership of Bill Hersh, the IMIA working group has mapped out a programme of work for the next year. There are three main projects planned. The first is to develop a methodology for an international survey of graduates from health informatics programmes. The aim of the survey will be to find out how graduates have applied their knowledge and skills in the workplace. The study will explore what aspects of the curriculum enabled alumni to make a contribution to their health care system and how, in hindsight, their course of study could be improved. The person leading on this project is Harold Lehmann at Johns Hopkins University (Baltimore, MD, USA). Once a method of sampling and data collection has been agreed, educational providers will be invited to participate. The findings from the study will be useful to curriculum developers; a common data collection form will enable educational providers to see how their students compare with graduates from other programmes. The second piece of work, led by John Mantas15 from Greece, is the revision of IMIA Educational Recommendations. The International Medical Informatics Association (IMIA) endorsed a set of recommendations on education in health and medical informatics in 1999. These are currently out for consultation and the final version will be disseminated in 2009. A related piece of work is the IMIA Scientific Content Map16 which builds on the earlier work of Nancy Lorenzi. The map organizes the domain of Health Informatics into six themes: applied technology; information technology infrastructure; applications and products; data–infrastructure related; human–organizational; education and knowledge. Inspection of the items under each theme reveals many concepts which are common to information science and health informatics, for example: information management–dissemination, knowledge management, linguistics, terminology–vocabulary, syntax, concept representation–preservation (medical, nursing, etc.), indexing, language representation, lexicons, thesaurus tools, nomenclatures, knowledge-based systems and evidence-based guidelines. The third area of work is an American Medical Informatics Association (AMIA)/IMIA collaboration on both the Rockefeller eHealth initiative and the 2020 initiative. In the summer of 2008, the Rockefeller Foundation convened a 1-month-long conference series entitled ‘Making the e-Health Connection: Global Partnerships’. AMIA was awarded a grant to help convene a conference in collaboration with the IMIA on ‘capacity building in health informatics’. Don Detmer, president of AMIA, reported on this development.17 The grant will also be used to support AMIA's efforts to address the growing global workforce shortage and implement global health and bioinformatics education programmes. AMIA's 20/20 programme, launched in late 2007, seeks to further refine and develop the concept of an international distance learning continuing education programme in biomedical and health informatics. The goal of the education programme is to apply distance learning approaches and communication and educational technologies to create globally appropriate, sound educational offerings delivered through a network of professional health informaticians. Training will include activities and offerings for various disciplines, community health workers and lay persons.18 ‘This grant sets the stage for planning a set of collaborations with some developing economies in the Global South that will support global education in the knowledge and skills relating to practical applications of biomedical and health informatics.’ (Don E. Detmer, AMIA President and CEO)18 How might this project impinge on health libraries? And what opportunities will there be for health science librarians to get involved? There are a variety of ways in which librarians will be able to participate. Firstly, by helping to develop online educational resources; secondly, by inputting their expertise about digital libraries; and, thirdly, by assisting in the development of toolkits, starting with a National eHealth Assessment Methodology, which will enable countries to work through their needs and profiles to formulate a viable National eHealth Roadmap. It was a great privilege to participate in this meeting. Our Argentina hosts organized a tour of the hospital and provided a superb conference dinner, with a spectacular tango show. On the whole, there was consensus on the challenges facing health informatics educators and agreement on the need to expand educational provision, nationally, regionally and globally. Most participants were committed to flexible delivery methods, including online learning, and some were starting to experiment with social software tools (blogs, wikis, Second Life, etc.). There were some concerns raised in the meeting about cultural variables and the need to ensure that educational initiatives are sensitive to cultural diversity. Sedick Isaacs19 from South Africa made a case for research in cross-cultural transfer of education in health or medical informatics.

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