SNOMED CT and its place in health information management practice.(Reports)(Systematized Nomenclature of Medicine-Clinical Terminology) - Health Information Management Journal

The Systematized Nomenclature of Medicine-Clinical Terminology (SNOMED CT[R]) has been endorsed as an international standard reference terminology to facilitate e-health initiatives. SNOMED CT is developed and supported in an international collaborative effort through the International Health Terminology Standards Development Organization (IHTSDO) and the member countries (approximately15) function as partnered National Release Centres (1). Australia, through our National E-Health Transition Authority (NEHTA) is a charter member, joining this international community early and dedicating resources to development and adoption strategies. (2) There is an eagerness to drive the uptake of SNOMED CT in order to facilitate electronic health records (EHRs) and exchange of health information, to ensure patient safety and quality care delivery, to provide decision support functionality and to achieve health system efficiencies through interoperability.

SNOMED CT and ICD-10-AM/ACHI are very different; they have different purposes, and are intended for different system deployments and for different users:

* SNOMED CT is a clinical terminology. It describes and defines clinical entities such as diseases, procedures, substances, organisms. It is designed to facilitate clinician recording of clinical information in an electronic health record. Essentially, it facilitates input.

* ICD-10-AM and ACHI are statistical classifications. They also describe clinical entities but in a much more aggregated way. They are designed for statistical analysis--the output.

Because SNOMED CT and ICD-10-AM/ACHI are used for different purposes and at different stages of information collection, they are both necessary and are complementary.

Below are two examples showing how SNOMED CT and ICD-10-AM/ACHI represent the same 'thing' differently.

There is a view that building 'maps' between SNOMED CT concepts and ICD-10-AM/ACHI concepts will make the journey from clinical reporting to statistical data collection more accurate and somewhat 'seamless'. It is acknowledged internationally that this 'map' cannot be fully automated due to the complex differences between the two systems. Health Information Managers (HIMs) and clinical coders know that assigning an ICD-10-AM/ACHI code requires a great deal more abstraction, analysis, judgment and compliance with rules and conventions than just 'picking the right word'. The mapping exercise currently underway at the IHTSDO has involved many experts over the past five years or more. Maps are not yet available or endorsed.

When Australia has widely implemented EHR systems, it is expected that these will be structured and deployed with SNOMED CT content as the national standard clinical terminology. Like clinical records now, these EHRs will be completed by clinicians, and with SNOMED CT content supporting the EHR the clinician will be routinely selecting and entering SNOMED CT terms (where appropriate). In this way, we can regard SNOMED CT as the scheme for clinical information input.

This will have an impact upon the health information management and coder workforce because there will be a significant change in the uniformity and predictability of the clinical records they work with and rely upon. Clinical records will contain unambiguous, formal, standard terms describing clinically important information, all will be legible and spelt correctly--drawn directly from SNOMED CT. These features alone should contribute to increased coded data reliability, adding clarity and consistency to documentation and coding practices and reducing miscommunication. Electronic completion, transmission and delivery of clinical records to the health information management and coder workforce could also achieve further efficiencies (through-put and timeliness). At least for the next five years or so, health information management and coding practice using ICD-10-AM/ACHI for data collection and reporting purposes will probably proceed much as it does now, producing coded data outputs (but the process will be easier and the results better, we all hope).

Nationally and internationally we see significant concerns that the health information workforce needs to be fostered and expanded to help with the transition to e-health and interoperability. The USA has taken some proactive steps, attempting an ambitious program to train 10,000 health informatics workers by 2010 (American Medical Informatics Association n.d.). The AHIMA is likewise encouraging its members and workforce to undertake career development and diversification training, particularly focusing on SNOMED CT and EHR topics (American Health Information Management Association n.d. a,b).

[FIGURE 1a OMITTED]

[FIGURE 2a OMITTED]

Recent reviews in both Canada and Australia (Health Informatics Society of Australia 2009) have also identified an alarming shortage of skilled workers in the health information arena. National health information professional associations (HISA, HIMAA) were successful in urging the National Health and Hospital Reform Commission (NHHRC) to highlight workforce capacity building as a key component of the reform agenda.

Figure 1b: Extract from ICD-10-AMAcute appendicitisK35.0 Acute appendicitis with generalized peritonitis        *   appendicitis (acute) with:        *   perforation        *   peritonitis (generalized) (localized) following            rupture or perforation        *   ruptureK35.1 Acute appendicitis with peritoneal abscess        Abscess of appendixK35.9 Acute appendicitis, unspecified        Acute appendicitis with peritonitis, localized or NOS        Acute appendicitis without:        *   generalized peritonitis        *   perforation        *   peritoneal abscess        *   ruptureFigure 2b: Extract from ACHIAppendicectomyAPPENDIXEXCISION926       Appendicectomy30572-00  Laparoscopic appendicectomy30571-00  AppendicectomyIncidental appendectomy

There is recognition that the health information management and clinical coder workforce comprises the indispensable intellectual capital needed to achieve e-health initiatives. The Australian health information management and clinical coder workforce is well trained and supported in traditional roles. We note the HIMAA submission to NHHRC emphasises the opportunities for this workforce to support health information initiatives in primary and non-acute health care settings.

New opportunities are emerging, and new roles and responsibilities will evolve. Recent recruits and new graduates beginning a career in health information are likely to encounter a range of tasks and duties not previously performed in health information management or coding roles. We speculate that the future will demand that this workforce be able to understand and use clinical data captured in SNOMED CT (not just ICD/ACHI statistical data). Data extraction and analysis skills, health outcomes research and service performance monitoring are already becoming prominent demands. Our more experienced HIMs and clinical coders have a wealth of knowledge; their comprehensive understanding of medical terms and clinician use of vocabulary and documentation practice is priceless. We imagine that this workforce sector could make significant contributions to specifying EHR content, selecting and testing relevant SNOMED CT content suited for particular clinical specialties, and for expert assistance and support of adoption and implementation strategies.

References

American Health Information Management Association (n.d.a). Building the workforce for health information transformation Available at: http://www.ahima.org/emerging_issues/ Workforce_web.pdf (accessed 8 Feb 2010).

American Health Information Management Association (n.d.b). Campus Courses. Available at: http://campus.ahima.org/ Campus/course_info/CTS/CTS_info.htm (accessed 8 Feb 2010).

American Medical Informatics Association (n.d.). AMIA 10 x 10 Program. Available at: https://www.amia.org/10x10 (accessed 8 Feb 2010).

Health Informatics Society of Australia (2009). Australian Health Information Workforce Review. [Online] Available at: http:// imianews.wordpress.com/2009/12/10/australian-healthinformatics -workforce-review/ (accessed 8 Feb 2010).

Health Informatics Society of Australia (n.d.). Australian Health Information Workforce Review. http://www.hisa.org.au/ (accessed 8 Feb 2010).

ICTC (2009). Health Informatics and Health Information Management Human Resources Report. Available at: http://www.ictc-ctic.ca/ uploadedFiles/Labour_Market _Intelligence/E-Health/HIHIM_ report_E_web.pdf (accessed 8 Feb 2010).

Donna Truran

Research Fellow (ACCTI Project Manager)

Australian Centre for Clinical Terminology and Information (ACCTI)

University of Wollongong

Wollongong NSW 2522

AUSTRALIA

Patricia Saad

Research Fellow (ACCTI Content Manager)

Australian Centre for Clinical Terminology and Information (ACCTI)

University of Wollongong

Wollongong NSW 2522

AUSTRALIA

Ming Zhang

Research Fellow (ACCTI Systems Manager)

Australian Centre for Clinical Terminology and Information (ACCTI)

University of Wollongong

Wollongong NSW 2522

AUSTRALIA

(1) See International Health Terminology Standards Development Organisation website: http://www.ihtsdo.org/

(2) National E-Health Transition Authority website: http://www.nehta.gov.au/

Corresponding author:

Kerry Innes

Senior Research Fellow (ACCTI Manager)

Australian Centre for Clinical Terminology and Information (ACCTI)

University of Wollongong

Wollongong NSW 2522

AUSTRALIA

ROGUE COMMUNITY COLLEGE PROGRAMS PREPARE STUDENTS FOR NEW HEALTHCARE CAREERS - US Fed News Service, Including US State News

Rogue Community College issued the following news release:

Rogue Community College is working with regional healthcare providers and Oregon Institute of Technology to prepare students for new technologies in healthcare settings.

RCC has joined forces with Asante Health System to establish the nation's first training for a new healthcare informatics assistants (IA) career. The objective is to train 23 current staff member to understand clinical practices and gain advanced computer skills.

In addition to the Asante project, RCC is utilizing SIM Lab, a new computer-based healthcare information system developed by Oregon Institute of Technology.

This groundbreaking system uses virtual patient data and actual healthcare information technology applications and systems to provide simulated educational, training, and research opportunities.

Juliet Long, RCC Computer Science instructor, is working with Asante's Three Rivers Community Hospital employees studying the flow of patient data - from registration to the lab to the doctor's office.

Long said medical informatics, which is the intersection of information science, computer science and health care, is increasingly important nationwide. New computer technology, combined with huge volumes of healthcare-related data, is opening a wide range of highpaying, high-demand job opportunities.

To meet that demand, RCC has developed a one-year Health Care Informatics Assistant certificate and an Associate of Science degree articulated with the Information Technology/Health Informatics option at OIT.

Lori Kainer and Jennifer Monteith work with RCC instructor Juliet Long, who is teaching Three Rivers Hospital employees how to use new healthcare-related computer technology.

'It's part of a national push to streamline the flow of medical information,' Long said. 'The integration of paper and electronic documents will be more efficient, cut costs, and reduce the cumbersome paper trail. Patients would also have access online to some records.'

Asante and RCC received a $433,000 Jobs to Careers grant to jointly develop the new Healthcare IA training and offer college-level instruction. The first group of students began coursework fall term, with an emphasis on workplace-based learning. Included in that group are Three Rivers employees Jennifer Monteith, who works in the hospital lab, and Lori Kainer, who works in patient registration. Taking two classes per term over a two-year period, they each will earn a one-year certificate.

They train using the SIM Lab, which includes the types of applications and systems employed in a variety of health care delivery and support settings, such as hospitals, outpatient clinics, laboratories, and imaging centers. SIM Lab uses real patient profiles but removes any confidential or identifying information.

'This training makes us more well-rounded employees,' said Kainer, an auditor/trainer who is sharing her new skills with other employees. 'There's an exciting sense of being on the ground floor of new technology.'

She has suggested several ideas for her training that would have a patient bypassing registration and entering information from home, the doctor ordering tests, and the patient going straight to the lab.

Monteith, a lab assistant and data analyst, is working with Kainer to evaluate how that process ties in with posting lab results online, making it easier for doctors and patients to access information, and avoid unnecessary office visits.

'There's a need for this and not a lot of people going into a new field that has great potential,' Monteith said.

'The goal is to create an entire patient profile and input it into SIM lab, schedule tests and get results - all without using any paper,' Long added. Because it eliminates paperwork, the new system is likely to save money and improve patient service, she observed.

Contact: Margaret Bradford, 541/956-7304, 541/471-354, mbradford@roguecc.edu.

UNIVERSITY OF SOUTH CAROLINA UPSTATE'S HEALTH INFORMATION MANAGEMENT PROGRAM RECEIVES ACCREDITATION - US Fed News Service, Including US State News

SPARTANBURG, S.C., March 23 -- The University of South Carolina Upstate Campus issued the following news release:

The Health Information Management (HIM) program at the University of South Carolina Upstate recently received accreditation by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM), making it the only accredited four-year program of its kind in the state of South Carolina and one of about 50 such programs in the entire United States.

Fulbright'A four-year degree and certification is necessary for career advancement in this field and South Carolina has been hemorrhaging qualified graduates from the state's accredited two-year programs for a number of years,' said Dr. Ron Fulbright, chair of the Department of Informatics at USC Upstate. 'The state's healthcare industry has been hiring people from other parts of the country over and above our own residents because we have lacked the capability to produce our own certified professionals. This accreditation is a large step forward for South Carolina.'

The HIM program prepares graduates for careers in the records management field, particularly in the areas of insurance coding and health informatics. Graduates of the program receive the Bachelor of Arts in Information Management & Systems and are eligible to take the exam for the Registered Health Information Administrator (RHIA), which is an important professional certification in the field. The HIM program offered at USC Upstate is a 'completion program,' which means that students who enter the program must have graduated from an accredited two-year program and must have achieved the Registered Health Information Technician (RHIT) certification or be able to acquire the RHIT soon after being accepted into the program.

The accredited HIM program is part of the Information Management & Systems (IM&S) program at USC Upstate. IM&S is a four-year undergraduate multidisciplinary information technology program focusing on the production of new knowledge gained from the gathering and analysis of information and the utilization of information processing technology.

'We offer a unique combination of coursework in computer technology, business, communication, and sociology resulting in a Bachelor of Arts in IM&S,' said Fulbright. 'Almost every office job today is dependent on the use of a computer or some other information technology and this program prepares professionals to be 'information workers.' Our graduates find employment in almost every department of a company including, but not limited to: IT support, customer service, sales, marketing, human resources, public relations, logistics, shipping, and manufacturing.'

DEPUTY NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY NAMED - US Fed News Service, Including US State News

The U.S. Department of Health & Human Services issued the following press release:

HHS' Office of the National Coordinator for Health Information Technology (IT) today announced the appointment of Charles P. Friedman, Ph.D., as deputy national coordinator for Health IT in the Office of the National Coordinator for Health IT (ONC). Dr. Friedman had recently been serving as senior advisor to the National Coordinator for Health IT Robert M. Kolodner, M.D.

'Chuck's recent experience in assisting me in matters related to program planning, development, and evaluation has prepared him well to assume the deputy role,' said Dr. Kolodner. 'As he carries out his new role, Dr. Friedman will continue to contribute scientific and managerial expertise and leadership to initiatives under way in the office's four directorates.'

Prior to joining ONC, Dr. Friedman was institute associate director for research informatics and information technology at the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH). Friedman joined NIH in 2003 as a senior scholar at the National Library of Medicine. Previously, Dr. Friedman was professor and associate vice chancellor for biomedical informatics at the University of Pittsburgh, where he established a health sciences-wide Center for Biomedical Informatics.

Over a 26-year academic career, Dr. Friedman's research focused on how to build information technology resources to support health care, research, and education and how to evaluate the impact of these resources. He is the author of several textbooks and has authored or co-authored over 150 articles in scientific journals. He is an elected fellow and past president of the American College of Medical Informatics.

As deputy national coordinator, Dr. Friedman will serve as operations officer for ONC's health IT initiatives to develop, maintain, and direct the implementation of the strategic plan to guide nationwide adoption of interoperable health IT to reduce medical errors, improve quality, and produce greater value in health care.

ICA Promotes Health Information Technology Expert, John Tempesco, to Vice President of Client Services. - Health & Medicine Week

Informatics Corporation of America (ICA; www.icainformatics.com), providing clinicians with a single technology solution for accessing, evaluating, and acting upon patient information across disparate systems, recently appointed John Tempesco to vice president of Client Services, effective December 8, 2008. The move expands TempescoEs responsibilities involving the implementation and support of the ICA solution as former director of client services to include marketing functions u from overall branding and positioning within the market space to Web content and sales support (see also Informatics Corporation of America).

oJohn brings 34 years of healthcare experience, including 18 years of experience in health information technology in both the civilian and government sectors,o says Gary Zegiestowsky, CEO of ICA. oPrior to his impressive civilian career as a pioneer in HIT implementation, he completed a career in the United States Navy as a healthcare administrator, where he was instrumental in the development and implementation of the Department of DefenseEs Tricare program.o

Before joining ICA in February of 2008, Tempesco served as vice president of operations for the Practice Management, Electronic Medical Records, and Revenue Cycle Management product lines of HealthPort. Previously, he was national director of Support Services for Companion Technologies and vice president of Marketing and Sales for Companion Information Management Resource.

oI feel privileged to work with a company like ICA because, as an HIT leader, it offers the kind of cutting-edge technology that brings seamless access to clinical data and allows smoother clinical workflow,o Tempesco says. oAt this crucial time in our nationEs history, the adoption of the ICA solution could bring positive and sustainable change to our ailing health care system.o

In addition to his exceptional marketing expertise, TempescoEs responsibilities will encompass overall implementation of new clients, including the transition from sales to the operational implementation process, expectation setting, goal setting, and project management, as well as scheduling, integration planning, and training of clients for the ogo-liveo process.

Tempesco holds a Bachelor of Science in Business from Lock Haven University and a MasterEs in Health Administration from Baylor University. He is a Fellow in the Life Management Institute, a certified managed care executive, and a diplomat in the American College of Health Care Executives. About Informatics Corporation of America (ICA) Informatics Corporation of America (ICA) was created with nationally renowned Vanderbilt Medical Center to take innovative technology developed by Vanderbilt physicians to the broader healthcare market. ICA builds on existing IT systems to offer a single technology solution for accessing, evaluating and acting upon patient information across all treatment settings. Visit www.icainformatics.com.

Keywords: Informatics Corporation of America.

Recognition given for ground-breaking advancements in digitalizing health data and information. - Biotech Week

'The Signature Award recipients have made significant contributions to informatics, and in the process, have helped streamline the way data and information can be applied to patients,' said AMIA Chairwoman Nancy M. Lorenzi, PhD, Assistant Vice Chancellor for Health Affairs, Vanderbilt University Medical Center. 'This group of Signature Award recipients joins an impressive cohort of pioneers in health who are leading the way to more robust biomedical research, a more responsive public health sector, advancements moving more quickly and efficiently from bench to bedside, and more incisive clinical practice-all of which are made possible through the science of informatics,' she added.

The Signature Awards and recipients are:

Recognizes an individual who has made a significant contribution over the course of a career in health policy, conducted in accordance with the philosophy that all citizens and populations deserve a state-of-the-art health system that provides safe, effective, patient-centered, timely, efficient, and equitable health care services. The recipient exemplifies visionary leadership in the health policy realm, action-oriented advocacy work producing a regional, national or global result, advancement in thought leadership, and generating a sustainable contribution to the health system.

David Bates, MD, MSc, is chief of the Division of General Medicine at the Brigham and Women's Hospital, Boston; medical director of Clinical and Quality Analysis, IS; and a professor at both Harvard's Medical School and its School of Public Health. Dr. Bates has done extensive work evaluating the incidence and prevention of adverse drug events, and in improving efficiency and quality of diagnostic testing using information systems. He is currently evaluating the impact of guidelines on the delivery of quality of care, using electronic medical records. His work focuses on how to help clinicians make better decisions to produce more efficient, higher quality, and safer care, using information technology (see also Public Health).

Donald A.B. Lindberg Award for Innovation in Informatics

Recognizes an individual for a specific technological, research, or educational contribution that advances biomedical informatics. The recipient's work will have been conducted in a nonprofit setting, and the adoption of the particular advance will be on a national or international level.

Carol Friedman, PhD, is a professor of Biomedical Informatics at Columbia University. Her work has demonstrated that a general natural language processing system could be used to improve clinical care and to advance understanding of medicine. Dr. Friedman developed a comprehensive natural language extraction and encoding system for the clinical domain called MedLEE, which has been in use at New York-Presbyterian Hospital, and which has been shown not only to behave similarly to medical experts but also to improve actual patient care. In collaboration, she adapted MedLEE into a natural language processing system called GENIES, which extracts biomolecular relations from journal articles to obtain data on molecular pathways. From there, she went on to co-develop the BioMedLEE system, another adaptation of MedLEE, which extracts a broad range of genotypic-phenotypic relations from the literature, and maps the extracted information to an ontology appropriate for biology. Dr. Friedman is currently working on research in the area of patient safety, using data from clinical narrative notes to detect novel adverse drug events.

Keywords: American Medical Informatics Association, Emerging Technologies, Hospital, Information Technology, Information and Data Systems, Machine Learning, Natural Language Processing, Public Health.

Technology jobs for physician leaders.(Health Care IT) - Physician Executive

The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, is designed to promote the adoption and meaningful use of health information technology. Discussions around HITECH and meaningful use have generated a growing interest in nonclinical careers in the health information technology industry.

Health TT jobs are opening up all over the country for positions ranging from medical director of informatics to chief medical information officer (CMIO). These positions are available within the public and private sectors as hospitals and corporations seek talented physician executives to join their staffs.

Hospitals are recognizing their need to meet meaningful use requirements and they are seeking talented physicians who understand the health IT needs of hospital-based clinicians. Companies like McKesson, Allscripts, Cerner, Siemens, Epic, HP, Dell, Microsoft, and Verizon are hiring physicians to help them develop, improve, and sell health IT solutions that can improve health care delivery.

Language of health IT

Because of the HITECH Act, there is a growing number of career opportunities for physicians who have a strong understanding of health information technology and the evolving world of medical informatics.

You don't need to have a formal degree in medical or health care informatics to find a job in the IT industry. However, you need to understand the language of health IT, because this industry is full of strange acronyms and terminology that may be foreign to you. Here are several examples of common health IT acronyms:

* CDS = Clinical Decision Support

* CPOE = Computerized Physician Order Entry

* HIE = Health Information Exchange

* PHR = Personal Health Record

* PHI = Personal Health Information

* RHIO = Regional Health Information Organization

* CCHIT = Certification Commission for Health Information Technology

* ONCHIT or ONC = Office of the National Coordinator for Health IT

* HITRC = Health Information Technology Research Center

* ONC-ATCB = Office of the National Coordinator for Health IT Authorized Testing and Certification Bodies

Here are some technical acronyms that often come up in the health IT industry:

* API = Application Programming Interface

* ASP = Application Service Provider

* SaaS = Software as a Service

It is also important for physicians to gain familiarity with information technology terms like interoperability, data exchanges, client-based solutions, ASP models, and more. Physicians need to know how to communicate with the IT staff so they can describe their evolving needs and collaborate to build effective systems.

Getting started

If you're interested in pursuing a career in health IT, how should you get started? Here are a few suggestions:

1. Get involved with national health IT organizations.

There are a number of health IT organizations that provide educational resources and networking opportunities for physicians who are interested in health IT. Each of these organizations holds national conferences and several of them also have local and regional chapters. Here are several examples of major health IT organizations:

* AHIMA = American Health Information Management Association

* AMIA = American Medical Informatics Association

* AMDIS = Association of Medical Directors of Information Systems

* HIMSS = Healthcare Information and Management Systems Society

[ILLUSTRATION OMITTED]

This year, the HIMSS annual meeting had over 30,000 attendees and the American College of Physician Executives teamed up for the first time to get more physician executives to attend HIMSS. All ACPE members were offered complimentary registration for the convention so they could participate in HIMSS' first-ever physician executive forum. About 100 ACPE members took advantage of the offer.

The conference was full of energy and attendees were clearly excited about the growing opportunities to improve health care delivery through the use of information technology. There are other national conferences that are more focused around specific issues like mobile health, telemedicine, participatory medicine, and social media. Here are a few examples:

* Health 2.0

* ATA (American Telemedicine Association)

* mHealth Summit

* Connected Health Symposium by the Center for Connected Health

* iHT2 Health IT Summit by the Institute for Health Technology Transformation

By attending major conferences, you will have the opportunity to meet other physicians who are currently working in health IT. You'll also get the chance to walk through the exhibit halls and speak directly with companies and organizations that may be interested in employing you.

2. Volunteer in health IT committees and task forces.

Make time to get involved by volunteering with a health IT committee in your local hospital or medical center. If you spend a significant amount of time in a hospital, get involved in different committees that are looking at ways to leverage health IT resources to improve patient care. Some groups may be focused on finding ways to improve care quality or patient satisfaction. There may be opportunities to identify gaps in care and opportunities for clinical workflow improvement.

Other hospital committees may be trying to identify ways to reduce medical errors by using CPOE and CDS in the ICU. As an experienced physician, you have the opportunity to volunteer in these committees and to interact with nurses, pharmacists, and other members of the care team to develop strategies, protocols, and policies that may improve workflow efficiencies, patient care, and clinical outcomes.

Getting involved with hospital committees may also provide you with greater knowledge about health IT implementation challenges and opportunities within the inpatient setting. Companies that sell EHR solutions are often looking for physicians who have experience and insight around improving EHR clinical workflow and overcoming common implementation challenges.

If you mainly work in an outpatient setting, you can still find opportunities to volunteer in health IT committees by exploring these opportunities at local hospitals. Or, you may create a workgroup within your group practice to identify ways to improve efficiencies or to enhance your existing EHR systems.

Perhaps you can lead a committee involved in identifying the best EHR for your office-based practice as you prepare to transition from paper records to EHRs. By collaborating with surrounding hospitals or group practices, you may identify best practices surrounding health IT selection and adoption.

3. Try writing and publishing.

Another way to transition into the health IT industry is to establish yourself as a subject matter expert by publishing articles related to the use of health IT to improve clinical outcomes or workflow efficiencies. You can submit articles to the Journal of Health Informatics or the Journal of Healthcare Information Management.

Collaborate with nurses and pharmacists so that you can also describe the importance of interdepartmental collaboration as clinicians adopt health IT. You can also create a blog or submit an article to an established blog by writing about health IT security, patient privacy, or clinical workflow challenges.

If you demonstrate your working knowledge of current health IT issues, potential employers may find you and approach you to seek your expertise.

4. Look into mobile health (mHealth), teleHealth and electronic health (eHealth).

Health IT isn't only about hospitals and group practices. Organizations are looking at ways to leverage mobile technology such as smartphones and slate tablets like the iPad in the health care setting. We are in the midst of a mobile health or mHealth revolution, and there are a number of organizations investing resources to grow their mHealth capabilities.

As communication technology advances, the world of telehealth is converging with mHealth. There are still many rural sites that rely on video conferencing and other communication technologies to provide care remotely. However, as mobile devices get equipped with cameras and video capabilities, the future of telehealth may largely reside in the mHealth domain.

Today, mHealth is gaining tremendous momentum in developing countries because the mobile infrastructure provides an affordable way for health care delivery. If you have a strong interest in public health and international medicine, the mHealth industry could be a good fit for you.

The world of eHealth continues to evolve as patients become empowered by finding resources on the Internet. A number of organizations may be looking for medical directors to provide clinical oversight as they develop electronic health solutions through their websites.

Many of these companies focus on providing PHR services, so it is important to become fully knowledgeable about the latest HIPAA guidelines and regulations that relate to personal health information and digital communication technologies.

5. Investigate online learning and social networking

There are a growing number of opportunities to use the Internet to learn and to network with other professionals working in the health IT industry. ACPE offers networking resources on its website and it has an active LinkedIn group where you will find physicians discussing health IT issues. There are other LinkedIn groups such as HIMSS, AMIA, and AMDIS where you can join discussions and contribute your insights surrounding health IT.

By becoming more visible within these online communities, you may get recognized by a potential employer who may eventually approach you about a possible job opportunity.

Other opportunities

Here are some other places where you may find career opportunities related to health IT:

* State medical societies: Your local state medical society may have a group dedicated to providing resources around health IT. Some organizations have developed a separate consulting organization to provide health IT support and guidance for local physicians and hospitals.

* Professional specialty societies or associations: Perhaps you belong to the A AFP, ACP, or other specialty societies like AAP or ASCO. Are you plugged into the health IT workgroups or committees within your specialty societies?

* Consulting organizations: Many management consulting firms are expanding their capabilities to provide health IT services to hospitals and medical group practices. Consulting may require a considerable amount of work-related travel, but you may find it enjoyable to solve complex problems and help medical groups improve organizational efficiencies.

* Startup companies: These days, there are many new startup companies that are trying to ride the huge health IT wave that has been generated by the HITECH Act. You can find these startup companies by engaging local entrepreneur-ship clubs like the MIT Enterprise Forum or Entrepreneurs' Organization. You may also identify startup companies by visiting local business schools that hold startup competitions.

The time to jump into health IT is now. The HITECH Act continues to provide momentum in this field as hospitals and group practices adopt health IT solutions within their organizations. Many health organizations are still operating without clear guidance on the most effective ways to utilize health IT.

There is a lack of formal clinical practice guidelines on health IT implementation, improving clinical workflow processes, transitioning from paper records to EHRs. Make sure to stay current about ongoing health IT issues by reading blogs, journal articles and health IT news websites. Also, participate in health IT webinars so that you can learn what other institutions are doing to effectively leverage health IT solutions.

The health IT industry is rapidly expanding and there is still plenty of room for growth within many organizations. Prove your value as a physician leader so that you become an indispensable member of the care team.

Resource

Do your IT skills need improving?

ACPE is offering a new Health Care IT certificate, aimed at helping physician leaders learn the fundamentals of IT. The 40-hour program is offered entirely on-line and features faculty from Carnegie Mellon, AMIA, CHIME, among others.

Read more at acpe.org/HIT.

Joseph Kim, MD, MPH, is founder of NonClinicaljobs.com.

jkim@nonclinicaljobs.com

DON E. DETMER. MD, FACS, NAMED MEDICAL DIRECTOR OF AMERICAN COLLEGE OF SURGEONS DIVISION OF ADVOCACY AND HEALTH POLICY. - States News Service

CHICAGO, IL -- The following information was released by the American College of Surgeons:

Don E. Detmer, MD, FACS, will become Medical Director of the Division of Advocacy and Health Policy at the American College of Surgeons (ACS) on March 25. A vascular surgeon from Charlottesville, VA, Dr. Detmer most recently served as senior advisor for the American Medical Informatics Association (AMIA). He was president and chief executive officer of AMIA from 2004 to 2009, and in 2010 received the organization's prestigious Morris F. Collen Award as a 'visionary physician for his work in biomedical and health informatics.' He is Professor Emeritus and Professor of Medical Education at the University of Virginia, Charlottesville, and Visiting Professor at the Centre for Health Informatics and Multiprofessional Education (CHIME) at University College London, London, UK.

The ACS Division of Advocacy and Health Policy is responsible for monitoring and analyzing socioeconomic, legislative, and regulatory issues affecting the field of surgery; participating in health policy development; and preparing responses to Congress and federal agencies. Through its Washington, DC office, the division maintains liaison between the ACS and Congress and federal agencies, as well as the offices of other surgical and medical associations, regarding health policy matters of importance to surgeons and their patients. Dr. Detmer becomes the first-ever Medical Director of the Division of Advocacy and Health Policy.

In announcing Dr. Detmer's appointment, David B. Hoyt, MD, FACS, Executive Director of the American College of Surgeons said, 'Dr. Detmer's credentials represent a unique blend of surgical training and practice, health policy leadership, and biomedical informatics expertise. In addition to his significant health policy background, he brings a wealth of visionary experience in medical informatics and participation in the activities of the Institute of Medicine to our organization. We all look forward to working with him in advancing those areas of health policy that affect surgeons and their patients in a rapidly changing health care environment.'

A native of Great Bend, KS, Dr. Detmer earned a MD from the University of Kansas, Kansas City, (1965) and a MA from Cambridge University, UK (2002). He trained as a surgical resident at Johns Hopkins Hospital, Baltimore, MD, and Duke University Medical Center, Durham, NC (1965-67); his military service was as a clinical associate in the surgery branch of the National Heart Institute, National Institutes of Health, Bethesda, MD (1967-69); followed by service as a surgeon in the U.S. Public Health Service. Dr. Detmer displayed a strong interest in health policy issues early in his multifaceted career, and served as the inaugural health policy fellow at the Institute of Medicine (IOM), Washington, DC (1972-73), where he fostered the development of the Robert Wood Johnson Health Policy Fellows Program. He was later elected to IOM membership in 1991.

Following his IOM fellowship, Dr. Detmer embarked upon a multidisciplinary academic career; first at the University of Wisconsin-Madison where he served a joint appointment in preventive medicine and surgery in the capacity of assistant professor (1973-77); associate professor (1977-80); and professor (1980-84) in both disciplines. At the University of Utah, Salt Lake City, he served as vice-president for health sciences and a dual role of professor of surgery and medical informatics (1984-88) before moving on to the University of Virginia (UVA) where he served as vice-president for health sciences, professor of surgery, and professor of business administration (1988-92). He co-founded and served as co-director of the Virginia Health Policy Center (1992-99), while rising through the ranks to become senior vice-president of the University of Virginia, and the Louise Nerancy Professor of Health Sciences Policy and Professor of Surgery and Professor of Health Evaluation Services (1996-98). He left UVA to become the Dennis Gillings Professor of Health Management and director, Cambridge University Health (1999-2003).

Dr. Detmer's academic surgical career includes several notable highlights. At the University of Wisconsin, he developed a master's degree program for clinician-executives, which was the first administrative medicine program in the United States; developed a groundbreaking system for detecting and requiring completion of medical charts that were overdue with regard to documentation; and served as team physician to the Wisconsin Badgers. With a grant from the National Library of Medicine, he collaborated with Homer Warner, MD, to install the University of Utah's Health Evaluation through Logical Processing (HELP) Hospital Information System, which enables clinicians to implement medical decision-making in real time for patient care. The University of Virginia opened a new hospital during his tenure and he administered not only its development and opening, but also introduced a computer-based physician-order entry system at the facility. Clinically, he maintained an energetic 26-year career as a vascular surgeon (1972-88), specializing in the diagnosis and treatment of chronic compartment syndrome (CCS).

Nationally renown for his influential work with the Institute of Medicine, Dr. Detmer chaired the landmark 1991 IOM CPR Report, which analyzed the use of computer-based patient records (CPR) in tandem with emerging technologies, and set forth a long-range vision for their use as a means to improve the quality of patient care. One of the recommendations of the report later led to the development of the Computer-based Patient Record Institute (CPRI) to study the nation's infrastructure and provide recommendations on improving it in order to move toward widespread utilization of computer-based patient records.

In 1991, he began an 11-year term on IOM's Board on Health Care Services, including eight years as its Chair. He chaired the IOM Group to Improve the Medical Record (1989-91); chaired the IOM Board on Health Care Services (1994-2002); and co-chaired the IOM Committee on Physician Supply (1995). He served on the IOM committees that studied and issued the reports 'To Err is Human: Building a Safe Health Care System' (2000) and 'Crossing the Quality Chasm: A New Healthcare System for the Next Century' (2001). In 2009 he received the IOM's Walsh McDermott Award for service to the Institute. Furthermore, from 1989 to 1991, he served as chair of the Board of Regents of the National Library of Medicine and he chaired the National Committee on Vital and Health Statistics for the U.S. Department of Health and Human Services from 1996 to 1999.

Dr. Detmer became a Fellow of the American College of Surgeons in 1982, and served on the ACS Committee on Allied Health Professionals (1988-94) as a member, Vice-Chair, and Chair, in addition to serving as a member of the ACS International Relations Committee (1995-2002) and the ACS Committee on Informatics (2004-10).

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the care of the surgical patient. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 77,000 members and is the largest organization of surgeons in the world. For more information visit: www.facs.org.

Evolving career paths.(Letter to the editor) - Nursing Economics

To the Editor:

I have been a nurse for over 20 years and will be completing my BS-nursing this December. After a number of years in clinical nursing, I recently took a position at a medical software company as a software quality assurance specialist. I work in the development division.

I found the article 'The Nursing Informatics Workforce: Who Are They and What Do They Do?' very informative (Murphy, 2011). I have considered pursuing a nursing informatics career. I am eager to learn about what a nursing informatics nurse does and how to begin a career as an informatics nurse. The article's information on history and development of the informatics nurse is excellent. It is interesting how in a very short period of time, the role of the informatics nurse has evolved. It is also impressive how health care, in general, has become dependent on the information technology industry.

I agree with the author that federal regulation and reimbursement are key reasons why institutions are pursuing electronic health records. However, I think nursing and health care in general see the benefits of health information technology when it is related to patient safety, benchmarking, and health care tracking. This is supported by a previous article in Nursing Economic$. 'A solid partnership can lead to better practice, better care, and better patient outcomes. Correspondingly, this leads to better data, better research, and potentially shortened research cycle' (Francisco, 2011, p. 101).

The article by Murphy shows that nurses who are interested in information technology have an entirely different career path available now and it also shows how nursing informatics has evolved to an important and respected career path.

REFERENCES

Francisco, P. (2011). The quest for quality: Turning data into information. Nursing Economic$, 29(2), 101-103.

OREGON HEALTH & SCIENCE UNIVERSITY AWARDED $5.8 MILLION TO EXPAND HEALTH INFORMATION TECHNOLOGY EDUCATION - US Fed News Service, Including US State News

PORTLAND, Ore., April 7 -- Oregon Health & Science University issued the following news release:

Oregon Health & Science University has been awarded $5.8 million in American Recovery and Reinvestment Act (ARRA) funds to advance the widespread adoption and meaningful use of health information technology (HIT) by educating professionals to work in this rapidly growing field.

The funding is provided in two competitively awarded grants. One will directly support the education of about 150 additional students over three years in OHSU's biomedical informatics graduate program while establishing additional capacity that will meet the ongoing needs of an expanded work force. The other award will establish a national dissemination resource for health IT curricula at OHSU.

The stimulus funds, awarded by the Office of the National Coordinator for Health Information Technology, will enable OHSU to help educate the estimated 50,000 professionals needed to convert the entire country to electronic health records by the year 2014. The recovery act authorizes an estimated $40 billion to achieve this goal.

'We are delighted to be able to contribute to the national initiative to educate the health IT professional work force that will be required to lead the widespread adoption of electronic health records,' says William Hersh, M.D., professor and chairman of OHSU's Department of Medical Informatics and Clinical Epidemiology. 'This work force is a key requirement for achieving 'meaningful use' of health information technology that will help to improve the quality and safety of health care while lowering its costs.'

Through this recovery act funding, OHSU will provide financial aid for nearly 140 new students to enroll in and complete the university's online Graduate Certificate Program in Biomedical Informatics. The funding also will allow at least 12 students to enroll in and complete OHSU's on-campus master's degree program. All financial aid under this grant is for students in graduate-level programs requiring a minimum of a bachelor's degree for admission.

Students receiving financial aid will be required to choose among six career paths:

* Clinician/public health leader

* Health information management and exchange specialist

* Health information privacy and security specialist

* Research and development scientist

* Programmers and software engineer

* Health IT sub-specialist

The eight-course graduate certificate program is entirely online and and can be completed in two to three academic quarters. Students who are funded through this program will receive support for their tuition expenses and must complete its requirements within one year.

The master's degree program requires about 11/2 years of full-time study. The funding will not only provide these students with tuition support, but includes a stipend and student health insurance.

'Biomedical informatics is a growing field with opportunities for people with a variety of backgrounds, especially in health care, computer science and information technology,' added Hersh. 'Although this funding is focused on training professionals to implement electronic health records, there are numerous other career opportunities in such areas as personal health records, telemedicine, clinical and translational research, and bioinformatics.'

The National Training and Dissemination Center will support a total of five Curriculum Development Centers, one of which will be housed at OHSU. Together, the five centers will develop curricula for the five community college consortia being established to train community college students in HIT. These curricula will also be made available to institutions of higher education throughout the nation. The National Training and Dissemination Center will house the curricula on a dedicated Web site, train community college faculty in its use, and collect and disseminate feedback on its content.

The Curriculum Development Center at OHSU is a partnership between OHSU and four local community colleges - Portland Community College, Mt. Hood Community College, Lane Community College and Umpqua Community College.OHSU and community college faculty will collaborate to tailor the curricula for community college students.

OHSU is an established national leader in health information technology education. Its existing educational programs are among the largest in the country, and it has led many innovations, such as the 10x10 ('ten by ten') program in partnership with the American Medical Informatics Association, which aims to train 10,000 health care professionals in biomedical informatics by the year 2010.

IU-Regenstrief programs targeted to alleviate shortage of health IT workforce. - Education Letter

INDIANAPOLIS - Specialized one- and two-year Indiana University graduate certificate and master's programs designed to increase the number of health information technology specialists in Indiana and nationwide will expand enrollment by 50 percent, thanks in part to Recovery Act funding. Two of the programs will be available as distance learning opportunities.

In collaboration with the Regenstrief Institute, an internationally respected biomedical and public health informatics innovator dedicated to improving health by enhancing the quality and delivery of medical care, and the IU School of Medicine, the IU School of Informatics at Indiana University-Purdue University Indianapolis is addressing the growing workforce needs for qualified health IT recruits with an array of specialized one- and two-year graduate programs offering a combination of classroom instruction, distance accessible learning opportunities, and on the job training.

These programs, initiated last year with a class of 15, are supported by a competitively awarded training grant from the U.S. Department of Health and Human Services Office of the National Coordinator for Health Information Technology (ONC). This $1.4 million in Recovery Act funding is part of a $118 million investment by ONC in rapidly and sustainably increasing the availability of skilled health IT professionals needed to support the widespread adoption and meaningful use of health IT.

The first class includes nurses, physicians, computer programmers and individuals from the business world. Most are already launched on an initial career, some in health care and some not. With ONC support, they are being offered a variety of coursework options and are undertaking practicums at leading regional health institutions. Many are employed full or almost full time, but are required to complete six courses and a 180-hour practicum within the calendar year.

'The incoming class, currently being recruited, will have enhanced distance accessible learning options, and we expect to see applicants from within and beyond Central Indiana take advantage of this opportunity to acquire the skills and knowledge needed to manage emerging health IT. Tuition support is available for the most qualified applicants,' said John T. Finnell, M.D., M.Sc., the Regenstrief Institute investigator and IU School of Medicine associate professor of emergency medicine who directs the IU-Regenstrief initiative, the Indiana Health Information Technology Training Collaborative (I-HITTC). He is director and associate professor of health informatics in the School of Informatics.

Six programs are available:

o Certificate in Clinical Informatics (Clinician Leader)

o Certificate in Informatics for Public Health Professionals (Public Health Leader)

o Certificate in Informatics in Health Information Management and Exchange (Health Information Management and Exchange Specialist)

o Certificate in Informatics in Health Information Security (Health Information Privacy and Security Specialist)

o Certificate in Informatics in Health Information Systems Architecture (Programmer and Software Engineer)

o Master of Science in Clinical Research (Research and Development Scientist)

Keywords: Distance Learning, Education, Indiana University School of Medicine, Information Technology, Information and Data Management, Public Health, Software.

INDIANA UNIVERSITY-REGENSTRIEF PROGRAMS TARGETED TO ALLEVIATE SHORTAGE OF HEALTH INFORMATION TECHNOLOGY WORKFORCE - US Fed News Service, Including US State News

INDIANAPOLIS, May 6 -- Indiana University-Purdue University Indianapolis issued the following news release:

Specialized one- and two-year Indiana University graduate certificate and master's programs designed to increase the number of health information technology specialists in Indiana and nationwide will expand enrollment by 50 percent, thanks in part to Recovery Act funding. Two of the programs will be available as distance learning opportunities.

In collaboration with the Regenstrief Institute, an internationally respected biomedical and public health informatics innovator dedicated to improving health by enhancing the quality and delivery of medical care, and the IU School of Medicine, the IU School of Informatics at Indiana University-Purdue University Indianapolis is addressing the growing workforce needs for qualified health IT recruits with an array of specialized one- and two-year graduate programs offering a combination of classroom instruction, distance accessible learning opportunities, and on the job training.

These programs, initiated last year with a class of 15, are supported by a competitively awarded training grant from the U.

S. Department of Health and Human Services Office of the National Coordinator for Health Information Technology (ONC). This $1.4 million in Recovery Act funding is part of a $118 million investment by ONC in rapidly and sustainably increasing the availability of skilled health IT professionals needed to support the widespread adoption and meaningful use of health IT.

The first class includes nurses, physicians, computer programmers and individuals from the business world. Most are already launched on an initial career, some in health care and some not. With ONC support, they are being offered a variety of coursework options and are undertaking practicums at leading regional health institutions. Many are employed full or almost full time, but are required to complete six courses and a 180-hour practicum within the calendar year.

'The incoming class, currently being recruited, will have enhanced distance accessible learning options, and we expect to see applicants from within and beyond Central Indiana take advantage of this opportunity to acquire the skills and knowledge needed to manage emerging health IT. Tuition support is available for the most qualified applicants,' said John T. Finnell, M.

D., M.

Sc., the Regenstrief Institute investigator and IU School of Medicine associate professor of emergency medicine who directs the IU-Regenstrief initiative, the Indiana Health Information Technology Training Collaborative (I-HITTC). He is director and associate professor of health informatics in the School of Informatics.

Six programs are available:

* Certificate in Clinical Informatics (Clinician Leader)

* Certificate in Informatics for Public Health Professionals (Public Health Leader)

* Certificate in Informatics in Health Information Management and Exchange (Health Information Management and Exchange Specialist)

* Certificate in Informatics in Health Information Security (Health Information Privacy and Security Specialist)

* Certificate in Informatics in Health Information Systems Architecture (Programmer and Software Engineer)

* Master of Science in Clinical Research (Research and Development Scientist)

Detailed information on the programs to be offered in the fall of 2011 and links to applications can be found at www.informatics.iupui.edu/HITtraining. Additional information on ONC is located at http://www.healthit.hhs.gov. For any query with respect to this article or any other content requirement, please contact Editor at htsyndication@hindustantimes.com

HEALTH CARE 2.0: PREPARING HEALTH CARE PROFESSIONALS IN DIGITAL AGE - US Fed News Service, Including US State News

INDIANAPOLIS, March 29 -- Indiana University-Purdue University Indianapolis issued the following news release:

Electronic health records, digital imaging and sophisticated diagnostic systems are revolutionizing how we provide patient-centered care.

These increasingly pervasive technologies not only improve the quality, safety and efficiency of our health care system, but also change the skill sets required of qualified health care practitioners. A new online graduate certificate program in clinical informatics from Indiana University Purdue University Indianapolis (IUPUI) instructs local health care professionals on how to effectively apply and interpret emerging information technologies to their practice and career.

The clinical informatics graduate certificate program available at the Indiana University School of Informatics at IUPUI is the first of its kind in the state and one of few in the nation. The program developed from clinical informatics' increasingly high profile on the national stage in the last several years. In 2004, former President Bush set into motion a plan to develop electronic health records (EHRs) for every American by 2014. That plan was reinforced in 2009 when President Obama signed the American Reinvestment and Recovery Act (ARRA) into law, designating $19 billion in incentives to spur the adoption and use of health information technology. EHR adoption is likely to accelerate further due to recent health care reform legislation.

Local health care industry leaders recognize the current and future value of its professionals including doctors, nurses, nurse practitioners and pharmacists gaining knowledge and practice in clinical informatics. 'We know a lot about medicine. We also know how to acquire patient information,' said Dr. John Clark, MD, JD, Medical Director for Clarian Medical Quality and Patient Safety. 'Our industry's challenge is interpreting that information in meaningful and efficient ways. It requires experienced health care practitioners who understand data acquisition, storage and analysis.'

Alan Snell, MD, MMM, Chief Medical Informatics Officer of St. Vincent Health and Chairperson of the Physician Informatics Council through Ascension Health, echoes this sentiment. 'We're becoming more reliant on new information technologies and moving towards the elimination of paper records. In today's environment, health care systems are embracing clinical informatics as a means to improve workflows, information exchange, and, ultimately, patient care.'

The graduate certificate program in clinical informatics consists of six courses available in the evening and accessible through online distance education. Applicants must have clinical backgrounds, be licensed and hold a four-year degree from an accredited institution. For more information, including admission requirements and how to apply, please visit www.informatics.iupui.edu/health/clinical or call (317) 278-4636.For more information please contact: Sarabjit Jagirdar, Email:- htsyndication@hindustantimes.com.

Professional practice: Enterprise Architecture in the Information Services Division, Ministry of Health Holdings, Singapore.(Professional practice)(Interview) - Health Information Management Journal

Health informatics: a journey, not a destination

Looking back at my career as a health informatics professional has made me appreciate how much our industry has evolved over the years. Health Information Managers (HIMs) have needed to be adaptable to changing demands, practices and technologies. More importantly there have been unique opportunities for our industry, and the people in it, to drive and influence change.

The types of roles I have had as a HIM have changed enormously over the years and the entire informatics profession is undergoing, dare I say it, massive change. Factors such as information and digital technology, the Internet and the enormous potential of wireless technologies continue to move us along the path of being a connected society. The demand for instant access to all sorts of data and information, from anywhere, continues to grow and has become an expectation in many industries, including ours.

As a graduate from the Queensland Institute of Technology (as it was known back in 1987), I emerged with a Bachelor of Business, Medical Record Administration. At that time there was a major shortage of people in our field and graduate numbers were very small so we enjoyed choices of different types of roles early in our careers. One of my very early roles was as the Data Manager in the Gynaecological Oncology Unit at the Royal Brisbane Hospital. This is where my passion for health and information started and I discovered 'health information' as an asset that could truly have an impact on people's lives and I could work in an industry that was able to 'make a difference'.

Most HIMs spend at least part of their careers in the medical record department of a hospital or healthcare facility and I am no different. This time provided valuable lessons in managing vast volumes of patient records, clinical information and diverse stakeholders. Over the years I have held various positions with healthcare providers, software vendors, information technology companies, as well as state and commonwealth health departments and consulting groups.

I have had the opportunity to work overseas and spent a number of years, from 1999, as an Information Technology Consultant for a niche consulting group in the United Kingdom. I quickly discovered that the challenges faced by health information managers, particularly in Electronic Health Record (EHR) and e-health programs are global.

I referred to health informatics as a journey, and for me, this has been the case. Some of the most exciting opportunities in my career have come from the challenges that advances in technology bring to information management, including (a) providing access to patient information anywhere, anytime, at the point of care; (b) building foundations that support interoperability and integration across disparate, unconnected information systems; (c) enabling the sharing of patient information across multiple care settings; and (d) bringing business and technology together to drive and enable change. I will focus on just a couple of key roles that touch on these four areas.

As Assistant Director for National Infostructure Development (NID), Department of Health and Ageing (DoHA) I helped develop national strategies for key foundational components that enabled health information exchange at whole-of-enterprise and national levels. The work program included the development of strategies and recommendations to support standard clinical terminologies, information models, information exchange standards and specifications, national patient and provider identifiers and identification services. My time at NID taught me valuable lessons in the conceptualisation of an 'enterprise', be it an organisation, a group of organisations, a state or a country, and then thinking about the problems that needed to be solved at a whole-of-enterprise level. I also started to gain an appreciation of an enterprise architecture based approach to defining, planning, delivering and managing enterprise information assets, both physical and logical.

My next move after NID was to Queensland Health as the Director of Strategy and Architecture for the Clinical Informatics Program. Here I had the opportunity to drive and be involved in the development of clinical informatics architecture to help inform priorities and plan the way forward. The clinical informatics architecture was based on an enterprise architecture (EA) development approach. This involved developing an inventory of the current business, information, application and technology environment, working through options analysis for priorities within the clinical informatics program and then articulating a longer-term vision and goal state architecture. (1)

All of this has led me to where I am today, Principal Enterprise Architect for the Ministry of Health Holdings (MOHH) in Singapore. I relocated to Singapore and joined MOHH in November 2008 and this is where I can truly say that yes, it continues to be a journey and it is also one fantastic ride.

MOHH is the holding company of Singapore's public health care assets. MOHH undertake strategic initiatives for the Ministry of Health and public healthcare institutions and is currently targeting the first phase of delivery of a national EHR by the end of 2010. As the Principal Architect I have two core responsibilities, one being the establishment of an EA practice for MOHH and the second being the development and governance of a national EHR architecture and implementation plan. At the time of writing, Singapore is in the process of procuring an EHR solution and the requirements are being driven by the goal state EHR architecture. This has been a very 'hands-on' role and has included lots of planning, architecting, and numerous healthy, productively tense debates that continue to drive the way forward.

Enterprise Architecture is a great challenge. It is a role that HIMs can well adapt to for a number of different reasons. HIMs often have the opportunity to drive strategic information management, and in the health industry in particular, information matters. Many in the profession have a unique opportunity to develop a set of blended skills that include management across information, clinical, business, and technology disciplines.

As the technological advances continue to move us from the management of silos of information and systems, the need to enable integration and interoperability of across organizations continues to increase. My experience has taught me that through the development of an EA and implementation of an EA based approach to program planning, delivery and management, integration and interoperability become possible across enterprises in a transparent way.

EA is a discipline in its own right and there are many different methodologies and tools that can support the creation of architectures and the component artifacts. Our approach to EA has been a very practical and pragmatic one. EA is being created to inform program development, planning, delivery and investment. EA is not being created for the sake of it, it is a tool that enables the implementation of the business's strategic vision. The EHR continues to be a core focus for me and my team. Our approach is architecture based; however the key to our success is that we are a clinically driven program, not an architecturally or technically driven program. We have had over 100 local clinicians involved in the development of clinical use cases and scenarios that continue to inform clinical priorities and requirements. Our EHR architecture has also been positioned to ensure that the needs of our clinical community and their priorities drive our direction and approach.

To ensure that enterprise requirements continue to be met and that we continue to inform the way forward everything that we develop in the EA practice is driven by core business, information, application and technical principles being:

* Business principles

** deliver 'real' tangible benefits to the healthcare ecosystems

** support the sharing of patient information across health care service providers

** ensure 'fitness for purpose' and alignment to the requirements of the business

** support evolutionary change over time.

* Information principles

** support information sharing through services aligned to business requirements

** support a national approach to data and information standards

** support a quality based approach to information management

** support consistency of data application, usage and interpretation.

* Application principles

** driven by the 'service' needs and business requirements of the organisation

** support loose coupling and flexibility over time

** cater for evolutionary and revolutionary requirements over time.

* Technical principles

** support a 'services' based approach

** provide an agile framework capable adapting and extending to meet the changing needs of the business

** scalable to meet national information exchange requirements

** supportable and maintainable longer term

** acknowledge future operational costs

* ability to support a security infrastructure that aligns to business needs.

As we continue to develop our EA practice, over time my hope is that we will be able to support, inform and govern effective investment and decision making by providing the following:

* decision makers and managers with a transparent view of the whole of enterprise vision for the EHR and health informatics more broadly

* opportunities for collaborative planning and implementation of information technology and solution across the enterprise

* transparency of resources and assets to support project planning

* support for procurement processes and increasing time to market for new technology project as components and services become architectural standards

* simplification of integration problems over time by providing transparency of the application landscape and compliance processes

* clear sets of priorities for solution and infrastructure development

* over time build a repository of architectural products, models and tools that will help all of our stakeholder and partners plan, manage and delivery successful projects.

My role here in Singapore will continue to evolve as the information technology landscape changes and the demands for quality, accessible and timely health information grows. I am definitely going to enjoy this ride!

Sari McKinnon BBus(MRA)

Principal--Enterprise Architecture

Information Services Division

Ministry of Health Holdings

#03--10 UE Square

83 Clemenceau Avenue

SINGAPORE

email: sari.mckinnon@mohh.com.sg

CANTWELL ANNOUNCES $2.7 MILLION FOR HEALTH IT FUNDING TO BELLEVUE COLLEGE WILL PREPARE STUDENTS FOR CUTTING-EDGE HEALTH INFORMATION TECHNOLOGY CAREERS. - States News Service

WASHINGTON -- The following information was released by Washington Senator Maria Cantwell:

Today, U.S. Senator Maria Cantwell (D-WA) announced that Bellevue College will receive the second installment of a two-year grant under the American Recovery and Reinvestment Act (ARRA) to continue a consortium of community colleges in expanding health information technology (health IT) training. Bellevue College was awarded a total $6 million two-year grant to train students in health IT and ensure that Washington state will continue to be a leader in the rapid adoption of health IT and meaningful use. Last year, the college received the first $3,364,798, and today they second installment of $ 2,798,463.

'Washington state has long been a leader in the adoption of health information technology,' said Senator Cantwell. 'Health IT plays an integral role in improving the health care services we deliver, reducing medical errors, and cutting costs, all leading to better patient outcomes. A recent study estimated that our nation will need a health IT workforce of at least 50,000, so it is vital our colleges are training students in the skills necessary to fill future jobs.'

Bellevue College is home to the Center of Excellence for Information and Computing Technology, a statewide resource for community and technical colleges, the educational system, and the information technology industry. The Center is tasked with preparing the state to become a national model in developing partnerships among business, industry, and education for enhancing economic and workforce development initiatives to meet current and future needs critical to the state's economic vitality.

Informatics report: PACS administration--in their own words.(INFORMATICS) - Medical Imaging

At the Thomas Group Ltd (Anaheim, Calif), we conducted a client survey of PACS administrators (PAs) to gather their opinions about the PA hiring process. Here, I will share a summary of the responses and my insight about them.

Q1: When in the PACS process were you hired?

The responses showed no real clear answer. Two answers--'prior to vendor selection' and 'I was not the original PA for our PACS'--generated a response of 25% each. Two other answers--'at committee formation' and 'hired by default'--each generated 17% of responses. The respondents also gave 8% each to the answers of hired 'after financial approval' and 'during implementation.' These results are very reflective of what I have observed and written about in the past--except for the 25% who were not the original PAs. Without interviewing each of these individuals as to why they may have changed jobs, the only thing we can know for certain is that there are many reasons for making a change. Some may have a better opportunity elsewhere with more money; some PAs may move to jobs with PACS vendors; or sometimes, it may just be the wrong position for a person.

Q2: What is your background?

'Radiology' was the answer for 75% of our respondents. (One response was 'biomed,' and I am presuming that he or she supported radiology. I, therefore, included that response in the 75%.) The remaining 25% of the responses were 'IT.' None of the respondents came from a vendor. This, too, reflects what I have observed and would expect to see: This job requires a very strong understanding of radiology workflow and terminology.

Q3: What was your PACS experience prior to hiring?

A dominant 58% responded 'none.' Of the total responses, 17% had either 'worked at another facility that had PACS' or 'was a PA elsewhere.' Another 8% stated that they had completed 'formal PACS training' before being hired. In my experience, it has been very common to hire someone at your current facility with the proper aptitude and a strong, well-known work ethic. Again, talented people with the proper support and skill set are able to understand and comprehend this technology. One question that I am asked all the time is, 'How does someone make themselves attractive as a candidate for one of these positions?' I am fairly certain that the respondents with no experience were all existing employees of the facility with a solid performance track record reflecting the skill set shown in the answer to Q5.

Q4: If a non-health care IT, nonradiology person would like to become a PA, what do you recommend as a precursor?

An overwhelming 75% responded with 'formal training.' This included 58% with 'formal school for radiology or other health care position' and 17% with 'third-party PACS school.' Of the respondents, 17% recommend getting 'vendor experience' (although none of the respondents worked for a vendor), and 8% recommended starting with an 'entry-level health care IT' position to get your foot in the door.

Q5: What do you believe is the most important asset that a PA can bring to the job?

'Radiology knowledge' was selected by 58% as most important. At 17% each were both 'computer, hardware, software, and network knowledge' and 'communication skills.' Of the total respondents, 8% stated 'all of the above' are most important. However, as clearly seen in the responses to Q3, an innate knowledge of radiology is the top criteria to prepare for this position. A PA is going to spend most of his or her days working with technologists and radiologists. Any conversations outside of radiology will focus around radiology image sets, series, views, and the keys to displaying them to best suit users' needs. This would easily be more than 95% of the PA's day-to-day (or night-tonight) activities.

Q6: What are your typical working hours?

As would be expected, the vast majority (83%) responded that they are on-site daily, Monday through Friday. Also, 58% also responded that they provide call support in the evenings and weekend coverage; 50% provide holiday coverage. For those considering PACS administration as a career, these answers are a key insight into the job requirements. PACS is a 24/7 commitment that will always cause problems, issues, or real failures after hours. Therefore, you will be expected to be available and provide support or be a vendor resource to address and manage/fix the inevitable issues. You must have the mentality to deal with these opportunities (issues). In general, when you receive a call, it's because someone has a problem. Your satisfaction will come from helping them; however, sometimes, it will take more effort or longer than the user understands, and you must deal with that situation as well.

Oddly, one respondent selected 'Other' and wrote 'part-time.' I have two thoughts about that: One, there must be two or more people sharing the support responsibility; or, two, if not, I know several hundred PAs who would love to know the secret to a site or system that requires only part-time support.

Q7: Who provides backup coverage, if needed?

Not surprisingly, 75% answered that backup support is provided by IT personnel; several respondents specifically noted RIS support, and one noted clinical analyst, which I added into the IT personnel number. This approach is very common and logical. If any two individuals should know, understand, and live radiology workflow and technology, it should be your PA and the RIS support analyst. In many cases, the PA also provides backup coverage (relief) to the RIS person. On a day-to-day basis, the issues they face are so intertwined that their relationship is very important to a successful support effort. Many times, the after-hours support is directed to the IT help desk as a first line, and many times, the issue is not PACS related; it may be passwords, the network, or other clinical systems creating the problem. Radiology administrators were named in 17% of the responses. My guess is that these are smaller sites that have less of an infrastructure to leverage as backup. Other responses were for biomed or clerical personnel. This is a tough position for these folks to assume, but it might be the only or the most cost-efficient option.

Q8: If you had to choose one thing that would make your job as a PA easier, what would that be and why?

This question really opened a can of worms. First, almost everyone said they would like additional training/support and a second PA to help deal with all the day-to-day issues that need to be managed. The list of things that need to be done each day becomes a juggling act with whatever the next phone call brings. There are concerns about living in a 'reactive' versus a 'proactive' world; in the latter, PAs would be able to perform routine system activities, train referring physicians, and strategically plan. All of these responsibilities quickly can become overwhelming and stressful. Over time, neither of these reactions will be beneficial to the PA or his or her facility.

One respondent mentioned that growing and expanding demands on PAs into other 'ologies,' such as cardiology, pathology, and endoscopy, are going to raise the pressure and time demands on these positions. This question will be answered over time, but PAs must be prepared to expand their horizons, especially in smaller facilities that have the bandwidth.

INDIANA UNIVERSITY LIFE SCIENCES CAREER FAIR OFFERS STUDENTS OPPORTUNITY TO MEET STATE'S HEALTH-CARE BUSINESSES - US Fed News Service, Including US State News

Indiana University issued the following news release:

Seventeen companies will be on campus Thursday (Nov. 2) for the second Indiana University Life Sciences Career Fair.

The fair will be from 10 a.m. to 2 p.m. at the IU Auditorium on the Bloomington campus. The fair is hosted by the IU College of Arts & Sciences Career Development Center, the Kelley School of Business and its Johnson Center for Entrepreneurship and Innovation and the IU School of Informatics.

The cross-campus initiative is in response to requests from students and businesses in the health-care industry to connect life science companies with skilled students. More than half of the companies attending the Career Fair are based in Indiana.

Positions will be available for both internships and full-time employment and are open to both undergraduates and graduates.

IU is dedicated to preparing students for various fields within life sciences through programs such as the College of Arts and Sciences Liberal Arts Management Program, the Kelley School of Business Life Science Scholars MBA Program, the Kelley School of Business Entrepreneurial Management Academy and the School of Informatics Graduate Bioinformatics Program.

'This fair is an exciting collaboration between three great IU schools and the university's outreach to Indiana health-care businesses. This is a win-win situation for both our students and the state's life science business community,' said Donald F. Kuratko, the Jack M. Gill Chair of entrepreneurship and executive director of the Johnson Center.

Perceptive expands imaging services for European trials.(Report from Europe)(Perceptive Informatics ) - Diagnostics & Imaging Week

A Diagnostics & Imaging Week Staff Report

Perceptive Informatics (Waltham, Massachusetts), a provider of clinical trial products and services, reported the expansion of its medical imaging core lab services in Europe, with those services being delivered from Perceptive's office in Berlin, Germany.

The company said its imaging services are focused on helping sponsors to 'rapidiy and objectively assess the safety and efficacy of new drugs, biologics and medical devices in clinical trials.'

As part of the expanded services, Perceptive has added staff in the Berlin office, including diagnostic radiologist Oliver Bohnsack, MD, and Thomas Berger, MD, PhD, a physician and research scientist in telemedicine and e-health.

Mark Coldberg, MD, president of Perceptive, said, 'While we have been supporting global imaging trials for many years, our expansion provides European clients with closer proximity to our innovative imaging solutions. With appropriate planning and execution, medical imaging can be successfully implemented as a trial endpoint, with the potential for significant savings in development time.'

The company said centralized imaging services are valuable in minimizing variability in image acquisition techniques and analysts results, 'so that the power of the clinical trial is not compromised.'

Perceptive has experience with a wide array of imaging modalities including computed tomography (CT), magnetic resonance (MR) Imaging, positron emission tomography (PET), ultrasound, nuclear medicine and conventional radiography. Its capabilities range from the application of novel imaging techniques in early drug development to widely validated methods for registration trials.

The company said its infrastructure enables image collection from investigator sites around the world for multi-center clinical trials. A 24/7 call center with multilingual support in 140 languages provides site support and training.

Perceptive, which has about 270 employees and offices in several North American and European locations, offers technology Including web-based portal solutions and tracking tools, Interactive voice response systems and clinical trial management systems, along with electronic diary and investigator database solution. It is a subsidiary of Parexel International (also Waltham), major contract research organization.

Broadening the healthcare professions

Working with the Higher Education Funding Council for England and the Learning and Skills Council, the UK Department of Health has given [pounds sterling] 3 million to fund a number of plict programs that will look at ways to attract a wider range of people to the healthcare profession.

UK Health Minister John Hutton said, 'The opportunity to develop a career in the healthcare professions should be open to anyone who has the potential and talent, regardless of their background. We can never accept a situation where large sections of our community are effectively held back from joining some of our most important professions,'

Research has shown that 70% of the medical school population comes from the two highest social classes in Britain, although just 37% of the working age population is from that background. Asian ethnic groups are under-represented in applicants to nursing courses, and there is evidence that black and ethnic minority applicants have difficulty in securing course places. Likewise, only 30% of applicants to physiotherapy courses and 10% of applicants to occupational therapy courses are male.

Hutton said the government funding would go toward ensuring that new recruits to the National Health Service accurately reflect the communities they come from and the communities they serve.

'It is not enough just to increase the numbers of people working for the National Health Service,' he said. 'We live in a diverse, multicultural society, and it is vital that the NHS not only improves the health of all sections of the community, but also reflects that community In the people it employs.'

Hutton was speaking at the Widening Participation in the Healthcare Professions conference, which was hosted by Universities UK.

The [pounds sterling] 3 million will come under the umbrella of the 'Aim Higher' project, which will be launched in April 2004.

Medicsight opens another Lifesyne center

Medicsight plc (London) has opened a new Lifesyne Diagnostic Center in the Westminster section of London. The company said the center, whose location is ,just off Parliament Square in the heart of the city, 'has been designed to showcase both the franchise opportunity of Lifesyne and to generate greater public awareness for the unique Medicsight Expert Recognition software.'

The Lifesyne centers provide scanning for high-risk individuals, with a primary focus on coronary heart disease and lung and colorectal cancer. Medlcsight opened its first such center in Hammersmith last spring, while another was opened in Victoria this summer.

The company said the opening of the new Lifesyne Center and the awarding of the CE mark for its software earlier this month have enabled it to begin a series of clinical trials. Those trials are designed to validate subsequent releases of the Medlcsight software, which automatically inteprets data from computed tomography scanners, highlighting abnormalities to radiologists as what the company refers to as 'the earliest and most treatable stages.

A total of 14 studies will commence next month, with Medicsight saying it recruited more than one-quarter of all private family doctors In London to participate in the trials.

Medicsight else said that it has entered into discussions to license the Expert Recognition Software to a number of countries in the Far East, Middle East and Europe, with the licenses being designed to pay revenue to Medicsight on a per-use basis.

Risk test to come from gene discovery

decode Genetics (Reykjavik, iceland) and Roche Diagnostics (Basel, Switzerland) have discovered forms of a gene that confer about twice the average risk of myocardial infarction. The companies plan to use the information to develop a DNA-based test to identify individuals who are at elevated risk for a heart attack.

ANIA-CARING 2009 annual conference raised the stakes.(American Nursing Informatics Association) - CARING Newsletter

Raising the Stakes for Nursing Informatics was the theme of the third ANIA-CARING collaborative conference held in Las Vegas, NV, April 23-25, 2009. The ANIA-CARING Conference Planning team led by Victoria M. Bradley did a stellar job in engaging excellent speakers and attracting exhibitors and attendees. Our thanks go to both Boards and specifically Committee members: James J. Finley, Katherine A. Holzmacher, Susan K. Newbold, Libertad B. 'Liberty' Rovira, Sally S. Russell, Patrick G. Shannon, and Vicki D. Vallejos.

[ILLUSTRATION OMITTED]

There were four pre-conference sessions offering a more in depth look at a variety of topics. The 'Writing for Publication' tutorial was taught yet another year by Kathleen C. Kimmel and Carlene Anteau. Brian Gugerty and Lisa Anne Bove repeated their popular 'Project Management for Nurses.' 'Making Change--The Dollar and Sense Essentials of System Implementation' was presented by Marina Douglas. Victoria M. Bradley and Steve Shaha lead the workshop entitled 'Measuring Clinical Acceptance and Outcomes of Clinical Information Systems.' The main conference kicked off on Thursday evening with an opening reception in the exhibit hall. This gave everyone an opportunity to network, get re-acquainted with colleagues and friends, meet new friends, as well as engage with the exhibitors. A hearty thanks to all of the exhibitors that provided the attendees with the backdrop to enjoy the opening reception and the other exhibit hall hours.

[ILLUSTRATION OMITTED]

Friday morning's opening keynote session set the tone for the other informative educational sessions that were offered during the conference. Marilyn Chow, DNSc, RN, FAAN presented the opening keynote session entitled 'How Nurses Spend Their Time: Effects on Quality and Safety in Hospitals.' A fundamental element from Dr. Chow is that 'A nurse is not an interface.' Since the nurse cannot be the human interaction between all systems, the interfaces between systems need to be 'seamless' and behind the scenes. Therefore, four (4) principles of technology are:

1. Patient-centered design;

2. System-wide integrated technology;

3. Seamless workplace environments; and

4. Vendor partnerships.

It is imperative the vendors work together to create devices and technology that are more efficient and less complex for healthcare and decreases the number of 'one hit wonders' and 'silo systems.' Dr. Chow also presented Kaiser Permanente's past successes as well as their innovative work at the Garfield Center. This center has four zones of innovation for prototypes, the hospital setting, the home setting, and the clinic setting. Technology is designed based on the four principles of design thinking of tools, processes, roles, and spaces. Dr. Chow challenged the attendees to:

1. Understand the work environment;

2. Be alert how to simplify the environment;

3. Be astute observers of how nurses interact with biomedical and clinical IT devices;

4. Be translators of technology 'gobbly gook,' and

5. Think about how to integrate new clinical technology seamlessly into the work environment.

On Saturday morning, Kathleen Shinn, BSN, RN presented the general session entitled 'Alyssa's Story: The Heart of a Medical Error.' This was Kathleen's personal story of a medical error that occurred during the care of her infant daughter which tragically resulted in her death. She presented Alyssa's story and then recommended changes that need to be implemented within technology as well as processes to prevent medical errors. COMMUNICATION, COMMUNICATION, COMMUNICATION is key for people, processes and technology. It is also extremely important to always communicate with patients and their families, especially when there are any potential issues with the care provided. The keynote session motivated the attendees to design, implement, and use technology and processes that will decrease the opportunities for medical errors to occur.

Marion J. Ball, EdD, FHIMSS, FCHIME, presented the closing general session on Saturday afternoon entitled 'Emerging Technologies: Transforming Health Care: Current and Future Impact on Patient Safety, Culture, and Process.' As for any current, emerging, or future technology to be successful and have a positive impact on patient safety, culture and processes, the three key elements of people, processes, and technology must be intertwined and integrate seamlessly. She emphasized elements of IT success, teamwork and the role of the nurse in healthcare informatics. Dr. Ball's presentation reinforced the information presented throughout the conference.

[ILLUSTRATION OMITTED]

Although time and space do not allow for a synopsis of each presentation between the opening keynote session and the closing general session, the other presentations ranged from career development to informatics competencies to clinical adoption, implementation, and outcomes of technology. These sessions provided information that would be beneficial for the novice or the expert and anyone in between, all were well done.

Posters were presented and the attendees were hard-pressed to select the best three (3) posters out of the 16 presented. The People's Choice Award Winner was Beth Kilmoyer who won a free registration to the 2010 ANIA-CARING conference with her work 'Raising the Stakes in Medication Administration Safety: Sustainability of a Barcode Medication Administration System.' Susan K. Newbold, Kathleen C. Kimmel, Randy A. O'Steen, and Gina S. Moran were the First Runner Up awardees with their 'Survey Results: Best Practices in Implementing Automated Nursing/Interdisciplinary Documentation Systems.' Rhonda Struck presented 'Using Workflow Assessment to Understand the Impact of Electronic Clinical Documentation on Nursing Practice' for the Second Runner Up title.

[ILLUSTRATION OMITTED]

The ANIA-CARING Membership Celebration Luncheon on Friday was an opportunity to network as well as hear organization updates. James J. Finley, ANIA President, presented the ANIA annual meeting reports and Jerald T. Chamberlain, CARING President, presented the CARING annual meeting reports to the membership. Mr. Finley also updated the membership on the status of the ANIA-CARING merger. More information will be released to the membership as we progress through and finalize the process.

We had over 300 attendees at this year's event and eighteen exhibitors. Most of the presentations were available to attendees on a flash drive distributed at the conference. Attendees could obtain contact hours for participating. Evaluations indicated that most attendees received value from attending the conference.

Next year's conference is scheduled for Boston, MA, April 22-24, 2010. The theme of the conference is 'Re-Evolution in Nursing Informatics' with Dr. Peter J. Murray as an invited keynote. The call for abstracts for posters and presentations is July 27-August 31, 2009. Please consider submitting an abstract for a poster and/or a presentation. We look forward seeing many of you next year!

[ILLUSTRATION OMITTED]