Health IT Workforce Curriculum – initial impression

I've spent a number of hours today reviewing the ONC HIT Workforce Curriculum materials, and since I've seen many tweets referencing them .. I've seen little substantive narrative on their value – so I'll offer a bit here – with the caveat that this is the product of ~ 4 hours of review of only one component.  There is a mountain of material here – and while I had previously flipped through a handful of PowerPoints – today was the first time I sat down and listened to the presenters talk through each module from start to finish.  

It's an impressive set of work.  I was assigned component #12 (Quality Improvement) to review.  I can say with certainty that this isn't how I would have approached educating a group of HIT students on this topic.  Why not?

  • There is way too much detail.  Far too many trees – with only occasional views of the forest.  If I was a community college student – I wouldn't be able to digest or retain all of this detail – nor would I be able to distinguish between what's really important and what isn't.
  • Too acute-care focused.  There is far more emphasis on the challenges / opportunities / processes of acute care – with only occasional reference to outpatient care.   This is the opposite of what I would do.  Implementing HIT in mature settings (acute care facilities) is very different from outpatient settings – and small practices in particular.  Does an educated HIT worker really need to understand the Donabedian model or the SEIPS model?  No.  Never.  Call me anti-academic if you like (recall that I was an Associate Dean of Biomedical Informatics) but this material is just too deep for this audience.  
  • Disconnected from the roles that the learners are training for.  In many cases – speakers make reference to the "leadership roles" that the learners will play in health care organizations.  In the vast majority of cases – I can't imagine that the graduates of these training programs will become change agents or leaders in the organizations that hire them initially. This isn't to say that these folks aren't important (they are very important) or that they won't evolve into leaders in the years to come.  But this program isn't about training leaders – it's about training a group of  students to become familiar with this important field in order to fill a resource gap that exists in the "engine room" of the industry.  

    Again – I want to be very clear:  this is IMPORTANT work – but we shouldn't suggest that these folks will be "leading" HIT initiatives in the near term.  That's just not realistic.   The educational needs of this group are therefore quite different from the needs of undergraduate computer science students (HIT developers-to-be?) , MPH students (strategic guides to-be?), AMIA 10×10 students (CMIOs-to-be?), or Medical/Nursing informatics students (CMIO/CNIO/etc to-be?).  Alas, in many instances – I got the sense that I was listening to the re-purposed lectures of educators who had been teaching to these other groups, but failed to separate the most salient nuggets for this new type of trainee.

Way back in the "dark ages" (10 years ago) when I was a full-time educator, I worked hard to make sure that I deeply understood the needs of my learners before I launched into "covering" material for them.    I think that's a core problem here:  the faculty who developed these materials were developing them for an audience with whom they have had little interaction – and the reviewers of the materials (generally informatics experts) are looking at this from a perspective of completeness with respect to informatics education curricula that exist today.  At one point – one of the faculty mentions a book that he has written on the topic of patient safety: "as you may have read in my book on this topic .. "  Oh please.  Really?  Do you expect that these folks have read your book?  Unlikely.  Have I?  Well .. yes I have – and it's a good book.  But this isn't a forum for pitching a book.  I would suggest that this sort of narrative offers little value – and may actually detract from the curriculum.  It's easy to remove – and probably should be.

While I am certainly  looking for gaps (as I've been asked to do) - my overall sense so far is that the flaws are the opposite:  too much detail – and too much expertise – with too much of a focus on what the educator KNOWS – and too little focus in the foundational material that the learner must UNDERSTAND.  

Having said all of this – I need to be clear that I think these materials are a great resources – and a great foundation for a strong training program. 

 

“compliance”

This post on the-blog-that-used-to-be-kevin's-blog (alas, Kevin Pho writes rather few posts these days) … is accurate, but I wish that the medical community was saying the same thing.  In general – we are not.  Patients who have guts will say this – but on the other side of the stethoscope – we continue to use such terms as "noncompliant" and "adherence" on a daily basis – and nobody recognizes how offensive it is.   I blogged about this in 2002.  Same story today.    This is a nomenclature is symptom of a problem – not the problem itself.  Care providers who have been taught to expect patients to "comply" are not learning the skills they will need to really help patients meet their treatment goals.