10x10 ("Ten by Ten") Course

Syllabus from current offering of course

Objectives

The goal of this course is to provide a detailed overview of biomedical informatics and artificial intelligence (AI) to those who will work at the interface of healthcare and information technology (IT). The course also aims to provide an entry point for those wishing further study (and/or career development) in the field. It provides a broad understanding of the field from the vantage point of those who implement, lead, and develop IT solutions for improving health, healthcare, public health, and biomedical research. It provides up-to-date details on current events in the field, including electronic health records, data standards and interoperability, clinical decision support, machine learning, population health, patient engagement, and telehealth. It also describes and sets the context for newer technologies, such as SMART on FHIR, large language models (LLMs), generative AI, and wearables. Although the course has a clinical orientation, many non-clinicians working in health IT environments have found the course accessible and the knowledge gained invaluable to their professional development.

Among the individuals who can benefit from this in-depth introductory course are:

Clinicians who wish to gravitate their careers into informatics professionally
IT personnel in healthcare settings who desire a more detailed knowledge of the clinical and healthcare aspects of their work
Informatics professionals seeking a broad and detailed update of the field
Professionals, students, and others seeking an introduction or refresher on the field

The 10x10 course gets its name from its original goal when launched in 2005 of educating 10,000 healthcare and related professionals in biomedical and health informatics by 2010. The goal of 10,000 individuals came from an assertion in 2005 by former AMIA President Dr. Charles Safran that the US needed at least one physician and one nurse trained in medical informatics in each of the country's 6000 hospitals. The needs are equally strong beyond the US in the rest of the world and for professionals beyond physicians and nurses. Dr. Safran's goal was operationalized by Dr. William Hersh of Oregon Health & Science University (OHSU). The OHSU offering of 10x10 was the original offering in the program and still has the largest enrollment. The success and continued interest in the course has led us to continue it beyond the original 2010 goal. Since the program was launched in 2005, over 3400 people, mostly from the US but also from a variety of international locations, have completed the course. About 10-15% of those graduating have gone on to further graduate study in the field, mostly in the OHSU Biomedical Informatics Graduate Program.

Course Logistics

The 10x10 course is offered three times per year through AMIA, usually starting in March, July, and December. There are also a number of custom offerings for various professional associations, companies, and other organizations. (If interested in such an offering, please contact Dr. Hersh.) The course is also offered as a one-quarter graduate-level course in the OHSU Biomedical Informatics Graduate Program every term as well as a medical student elective in the OHSU School of Medicine.

The course is offered in two parts:

A 10-unit Web-based component that is provided through readings, voice-over-Powerpoint lectures, interactive discussion, and self-assessment tests.
An optional half-day in-person session that brings attendees together to integrate the material, allow presentation of course projects, and meet leaders in the field as well as other students.

The course is an adaptation of the on-line Introduction to Biomedical Informatics and Artificial Intelligence class currently taught in the OHSU Biomedical Informatics Graduate Program. This survey course provides a broad overview of the field, highlighting the key issues and challenges for the field. The course is taught in an asynchronous manner, i.e., there are no "scheduled" classes. However, students must keep up with the course materials so they can benefit from the interactive discussion with faculty and other students. The course uses the following teaching modalities:

Voice-over-Powerpoint lectures - These are available on any device connected to the Internet.
Interactive threaded discussion - Students engage in interactive discussion on important issues using on-line discussion forums.
Reading assignments - The course uses supplemental readings as necessary. In addition, students are pointed to key documents, reports, and papers from the field.
Homework/quizzes - Each of the units is accompanied by a 10-question multiple-choice self-assessment that aims to have the student apply the knowledge from the unit.

The on-line part of the course is accessed via the Sakai learning management system. At the onset of the course, each student is provided a login and password by the OHSU distance learning staff, who also provide technical support for the course. Students are expected to keep up with the materials each week and participate in ongoing discussion. They should anticipate spending 4-8 hours per unit on the course. All on-line activities are asynchronous, so there is no specified time that a student must be on-line.

OHSU 10x10 participants have the option of attending the in-person session associated with any AMIA meeting within one year of their taking the class and not just the session that occurs at the end of the offering in which they are enrolled.

The goal of the course project is for students to identify an informatics problem in their local setting (e.g., where they practice or work) and propose a solution based on what is known from informatics research and best practice. It is due before the in-person session at the end of the course and presented there if the student is attending. If a student does not have access to a health care setting, they can do the project in another setting, such as a company or organization. Here are the details of the assignment:

You should assess some local setting (work environment, practice, hospital, etc.) to identify an informatics-related problem or a problem that could be improved by an informatics solution.
Based on your knowledge of research and best practices in informatics, you should propose a solution to the problem.
The problem and solution should be written into a 2-3 page document that should include references that justify the framing of the problem and the proposed solutions.

Instructor

The instructor for the course is William Hersh, MD.

Content Outline

The following table outlines the curriculum with unit number, topic, and reading assignment. The course in general runs with two weeks in a row of posted materials and then a third week to finish the work. The due date for each unit is when the next cycle of material is posted. We are lenient about giving extensions but participants are strongly encouraged not to fall behind, since it can be difficult to catch up.

Overview of Fields and Motivating Problems
Computing Concepts for Biomedical Informatics
Electronic and Personal Health Records (EHR, PHR)
Standards and Interoperability
Artificial Intelligence
Advanced Use of the EHR
EHR Implementation, Security, and Evaluation
Information Retrieval (Search)
Research Informatics
Other Areas of Informatics

Readings

The course has no required textbook. Students are provided comprehensive lists of references for topics covered in the lectures. There is an optional textbook (co-edited by the course instructor) that students may want to consider: Hersh WR, Ed. (2022). Health Informatics: Practical Guide, Eighth Edition. The reading assignments from the book are optional, and no material will appear on the homework assignments that is not also covered in the class. But some students prefer to also read a textbook when learning.

Detailed Course Outline

1. Overview of Fields and Motivating Problems

1.1 Definitions and Historical Perspectives of Biomedical and Health Informatics (BMHI)

1.2 Definitions and Historical Perspectives of Artificial Intelligence (AI)

1.3 Problems in Healthcare Motivating BMHI and AI

1.4 Who Does BMHI and AI?

1.5 Resources for BMHI and AI: Organizations, Information, Education

2. Computing Concepts for Biomedical Informatics

2.1 Types of Computers

2.2 Data Storage in Computers

2.3 Computer Hardware and Software

2.4 Computer Networks

2.5 Software Engineering

3. Electronic and Personal Health Records (EHR, PHR)

3.1 Clinical Data

3.2 History and Perspective of the Health (Medical) Record

3.3 Examples of the EHR

3.4 EHR Data Entry

3.5 Clinical Decision Support

3.6 Personal Health Records

4. Standards and Interoperability

4.1 Standards and Interoperability: Basic Concepts

4.2 Identifier and Transaction Standards

4.3 Message Exchange Standards

4.4 Terminology Standards

4.5 SMART on FHIR

5. Artificial Intelligence

5.1 Data Science and Machine Learning

5.2 Predictive AI

5.3 Generative AI

5.4 Natural Language Processing

5.5 Trustworthy AI

6. Advanced Use of the EHR

6.1 Patient Safety and Medical Errors

6.2 Healthcare Quality Measurement and Improvement

6.3 Health Information Exchange (HIE)

6.4 Population Health

6.5 From Meaningful Use to Promoting Interoperability

7. EHR Implementation, Security, and Evaluation

7.1 Clinical Workflow Analysis and Redesign

7.2 EHR System Selection and Implementation

7.3 Telemedicine and Telehealth

7.4 Privacy and Security

7.5 Evaluation of the EHR

8. Information Retrieval (Search)

8.1 Information Retrieval

8.2 Knowledge-based Information

8.3 Content

8.4 Indexing

8.5 Retrieval

8.6 Research: Evaluation and Future Directions

9. Research Informatics

9.1 Clinical Research Informatics

9.2 Overview of Basic Molecular Biology

9.3 Translational Bioinformatics

9.4 From Clinical Genetics and Genomics to Precision Medicine

9.5 Omics Data in the EHR and Other Information Systems

10. Other Areas of Informatics

10.1 Nursing Informatics

10.2 Consumer Health Informatics

10.3 Public Health Informatics

10.4 Imaging Informatics

10.5 Evidence-Based Medicine