Educating the Future Clinical Workforce for eHealth Competence

1. Educating the Future Clinical Workforce for eHealth Competence Connecting for Healthcare Conference Melbourne, 23 February 2012 Kathleen Gray

2. About this project To initiate and encourage... A Coordinated Interprofessional Approach To Curriculum Renewal For eHealth Capability In Clinical Health Professional Degrees National team Kathleen Gray & Ambica Dattakumar, University of Melbourne Anthony Maeder, University of Western Sydney Helen Chenery, University of Queensland Kerryn Butler-Henderson, Curtin University, WA DEEWR Higher Education Office of Learning & Teaching support 2011-12

3. A coordinated approach Australasian College of Health Informatics www.achi.org.au Australasian Interprofessional Practice & Education Network www.aippen.net Australasian Telehealth Society www.aths.org.au Australian Computer Society www.acs.org.au Australian Council of PVCs and Deans of Health Sciences www.universitiesaustralia.edu.au/page/about-us/committees---contacts/key-contacts/deans-groups/ Australian Health Informatics Education Council www.ahiec.org.au Australian Health Practitioner Regulation Agency www.ahpra.gov.au Australian Qualifications Framework www.aqf.edu.au Canada's Health Informatics Association http://coachorg.com Health Information Management Association of Australia www.himaa.org.au Health Informatics Society of Australia www.hisa.org.au Health Level 7 Australia www.hl7.org.au Health Workforce Australia www.hwa.gov.au International Medical Informatics Association http://imia-medinfo.org National EHealth Transition Authority www.nehta.gov.au UK Embedding Informatics in Clinical Education www.connectingforhealth.nhs.uk/systemsandservices/icd/eice US Office of the National Coordinator for Health Information Technology http://healthit.hhs.gov

4. An interprofessional approach All Australian tertiary degrees for entry into clinical practice: • Medicine • Nursing • Allied Health • Complementary Therapies • + others from the Australian and New Zealand Standard Classification of Occupations in medicine, nursing and other health professions Entry at AQF level 6 through 10, i.e. Bachelor to Doctorate Mostly universities but also TAFE / VET programs at level 6 & 7

5. Focus on future clinicians Out of scope although clearly related: Upskilling & CPD for practicing health professionals Training of specialist clinical informaticians (cf. Smith et al. 2011) “Future clinicians will be expected to be more effective than is now the case in acquiring, managing, and utilising information for clinical decision making.” (UK National Health Service, 2009) Is education in the health professions keeping up in Australia, so as to produce a next generation health workforce with “the right stuff”?

6. Project assumptions and scope (1):eHealth is... “the use of tools such as the internet to support the provision of a healthcare service, process or function” (Oh et al.)“a relatively recent term for healthcare practice supported by electronic processes and communication” (Wikipedia) “the right information for the right person, at the right time and place [in healthcare]” (NEHTA) So what is eHealth capability or eHealth competence? “A clinical health professional who is highly competent in working in an ehealth-enabled healthcare system will display the following key characteristics ...”

7. Project assumptions and scope (2) eHealth is more than IT training. eHealth is not a new discipline. The underlying body of knowledge is health informatics , defined as the application of information science and computer science to healthcare. (AHIEC) Education in health informatics is the best way to develop foundations of eHealth competence in the future clinical workforce. Education in health informatics offers a formal, comprehensive approach to eHealth competence - more so than other curricula such as evidence-based practice, information literacy, computing skills.

8. Curriculum renewal for eHealth capability in the health professions involves (1): Not only plans and intentions, i.e. documenting: the structure and content of tertiary degrees and pathways the structure and content of component units of study But also activities and effects, i.e. engaging with: the business of tertiary education and training the dynamics of learning, teaching & assessment ... (adapted from O’Neill 2010)

9. Curriculum renewal for eHealth capability in the health professions involves (2): Assessment and certification: Are all graduates competent? Do students ever fail eHealth education? Competency can be inferred from: task behaviour task outcomes justification of choices reflection on performance and its effects (Govaerts 2008) How can eHealth competence be convincingly demonstrated ... Pracs / Tests / Projects / OSCEs / External exams?

10. Curriculum renewal for eHealth capability in the health professions involves (3): Evaluation: Is the curriculum doing its job? Does teaching ever fail? The students like it. > Student satisfaction surveys The students learn something. > Review and audit the results of student assessment The students apply what they learn to how they work. > Advisory bodies of alumni, employers, industry reps The way students are educated improves the system they work in. > Health services research (After Kirkpatrick 1993)

11. Obstacles to curriculum renewal (1): Misconceptions Today’s students are born knowing IT: Educating the Net Generation and the Digital Natives Graduates will pick IT up on the job: “Everything I know about informatics, I didn’t learn at nursing school.” (Nagle 2007) Someone else will / should / must look after IT for us: IT has no place in professional practice in our profession.

12. Obstacles to curriculum renewal (2) Overstuffed curricula Curricula in most degrees are already challenged to fit in everything everybody regards as essential (e.g. look at anatomy teaching); adding eHealth seems hard. • The occasional guest speaker? • Elective or compulsory? • Stand-alone subject/s or integrated into others? • 1st, 2nd or 3rd year? • Lecture + tutorial, problem-based learning, work placement? • eLearning for eHealth?

13. Obstacles to curriculum renewal (3): Human resources In many professions, dedicated tertiary teaching staff for clinical degree programs are hard to recruit and retain. Most teaching staff in clinical degree programs trained long ago and have little or no background in eHealth or health informatics. Teaching staff who are responsible for clinical degree programs are really busy - with quality of teaching, industry liaison, (re)accreditation, student selection, placement coordination, student results and appeals, etc., etc. ... not to mention with research and outreach KPIs.

14. Project activities • Reference group • Literature review • Surveys & interviews completed by clinical degree coordinators • Workshops to bring them together with each other and with eHealth experts • Selective further work on networks & resources & re$ource$ to sustain momentum for improvement

15. Reference group Academic champions from partner universities: Philip Davies & Anthony Smith (Queensland), Rhonda Griffiths & Ian Wilson (Western Sydney), Moyez Jiwa & James Semmens (Curtin), Geoff McColl & Elizabeth Ozanne (Melbourne) Links with related ALTC projects in health professions: Alison Lee (interprofessional education) & Maree O’Keefe (threshold concepts) Liaison with national stakeholder organisations: Sallyanne Wissmann(AHIEC), John Zelcer (NEHTA), Jane Austin (HWA) International organisation observers: Paula Otero (IMIA), Di Millen (UK NHS), Maureen Charlebois (Canada Health Infoway) Other international expertise: Ronald Harden, Kendall Ho, Harold Lehmann, Jeannette Murphy, Jim Warren

16. Can we use the peer reviewed literature as a starting point for curriculum renewal for eHealth? Educating future clinicians about clinical informatics: A review of implementation and evaluation cases. European Journal of Biomedical Informatics, Gray et al. 2011. Examples: Preparing tomorrow’s doctors: the impact of a special study module in medical informatics. McGlade 2001 Implementation of an academic medical record for integrating information management competencies into a nursing curriculum. Gassert 2007 Development of an interdisciplinary course in information resources and evidence-based dentistry. Levine 2008 Library-sponsored instruction improves core informatics competencies among allied health students. Van Moorsel 2007 Introduction of a medical informatics course into a medical school curriculum [in osteopathy]. Schwartz 2011 An interdisciplinary online course in health care informatics [in pharmacy, public health, nursing and library science]. Brock 2007 There are very few accounts of learning, teaching or assessment that use externally validated instruments or processes. There is a limited evidence base to draw upon when undertaking curriculum renewal for eHealth competence.

17. Snapshot of present practice (1) ~ 400 invitations to degree coordinators; ~ 100 surveys and ~ 35 interviews completed, August to November 2011 ~40 health professions in all States and Territories What matters about eHealth to degree coordinators of health profession degrees? What are they doing about eHealth in the degrees for which they are responsible?

18. Snapshot of present practice (2) 61.9% agreed or strongly agreed that the major employers of graduates of their degree program expect that at least some aspects of eHealth are included in learning, teaching and assessment. 31 .5% agreed or strongly agreed that the professional / industry body that accredits their degree program requires that at least some aspects of eHealth are included in learning, teaching and assessment. 30.5% agreed or strongly agreed that the assessment strategies in their degree program address at least some aspects of eHealth. 20.9% agreed or strongly agreed that independent expertise about eHealth is used to support decision making about learning, teaching and assessing eHealth in their degree program.

19. Snapshot of present practice (3) The current teaching and assessment of future health professionals does not ensure that Australia will have a clinical workforce that is empowered to work with eHealth. The pre-existing knowledge, experiences and preferences of current students in the health professions are not a strong foundation from which to learn professional eHealth competence. Further efforts to develop eHealth expertise among teaching staff and to develop curriculum resources for teaching and assessing eHealth competence are needed, in order to make any significant improvements to the eHealth education of future health professionals in Australia.

20. 2012 Workshops for health profession degree coordinators • Half-day of interactive sessions and panellists to encourage and gather new ideas • Why do health professionals need to be competent in ehealth? • What does it mean for a health professional to be competent in ehealth? • How can we build ehealth capability in students in the health professions? • How can we assess the ehealth capability of a student in a health professional degree? • Plus half-day NEHTA update session • Brisbane 9 Feb; Sydney 10 Feb; Perth 15 Feb; Melbourne 24 Feb • Workshop resources : Discussion paper; AHIEC Health Informatics Scope, Careers and Competencies 2012.

21. Further work during 2012 Depending on analysis of workshop findings ... • A collection of exemplars and materials that teaching staff can use to support learning and assessment of entry level clinical professionals • A set of guidelines for academic coordinators who are responsible for building up or buying in the necessary staff expertise to teach clinical informatics • A focal event in later 2012 to promote these resources • Development of stronger partnerships to support progress on eHealth education across the clinical health workforce

22. Sustaining momentum How can this project work in with your agenda? Are you interested in forming alliances to take the next steps in educating future clinicians for eHealth competence? Extended opportunities for teaching staff professional development Specification of clinical informatics requirements in accreditation standards Resourcing for tertiary institutions to write new curricula Monitoring and evaluation of the impacts of educational change Please visit http://clinicalinformaticseducation.pbworks.com Please contact kgray@unimelb.edu.au

23. References Brock T., Smith S.: An Interdisciplinary Online Course In Health Care Informatics. American Journal of Pharmaceutical Education 2007; 71(3), Article 43. Retrieved July 4, 2011, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1913289/ Gassert C., Sward K.: Phase I Implementation Of An Academic Medical Record For Integrating Information Management Competencies Into A Nursing Curriculum. In: K. Kuhn (ed.). MEDINFO 2007. Amsterdam: IOS Press, 2007, pp. 1392-1395. Govaerts M.: Educational Competencies Or Education For Professional Competence? Medical Education 2008; 42 (3), pp. 234-236. Kirkpatrick D.: Evaluating Training Programs: The Four Levels. San Francisco: Berrett-Koehler, 1993. Levine A. et al.: Development Of An Interdisciplinary Course In Information Resources And Evidence-based Dentistry. Journal of Dental Education 2008; 72, pp. 1067-1076 McGlade K. et al.: Preparing Tomorrow’s Doctors: The Impact Of A Special Study Module In Medical Informatics. Medical Education 2001; 35, pp. 62-67. Nagle L. Everything I Know About Informatics, I Didn't Learn in Nursing School .Nursing Leadership 2007; 20(7), pp. 22-25. O’Neill G.: Initiating Curriculum Revision: Exploring The Practices Of Educational Developers. International Journal for Academic Development 2010; 15(1), pp. 61-71. Schwartz B.: The Introduction Of A Medical Informatics Course Into A Medical School Curriculum. Medical Reference Services Quarterly 2011; 30(1), pp. 74-82. Smith, S. et al.:Clinical Informatics: A Workforce Priority For 21st Century Healthcare. Australian Health Review 2011; 35(2), pp. 1301-35. UK National Health Service. (2009). Learning to manage health information: A theme for clinical education: Making a difference. Retrieved July 4, 2011, from http://www.connectingforhealth.nhs.uk/systemsandservices/icd/eice/learning/clinedbro.pdf Van Moorsel G.: Library-Sponsored Instruction Improves Core Informatics Competencies Among Allied Health Students: A Research-Based Case Study. Journal of Allied Health 2005; 34(3), pp. 145-152.