Invited presentation, Fifth Saudi Ehealth Conference, King Saud bin Abdulaziz University for Health Sciences, Riyadh, November 2014.

1. Ehealth education for the clinical health
professions: curriculum change in context
Dr Kathleen Gray
Health and Biomedical Informatics Centre
The University of Melbourne, Australia
www.healthinformatics.unimelb.edu.au

2. Ehealth changes professional practice:
Image sources: edtansrant.blogspot.com.au, histalk2.com ,webicina.com

3. We’re not quite sure how it should, though…
“…there has been little policy or guidance on the best practices to inform standards
for the professional conduct of physicians in the digital environment. Areas of
specific concern include:
• the use of such media for nonclinical purposes,
• implications for confidentiality,
• the use of social media in patient education, and
• how all of this affects the public's trust in physicians as patient–physician
interactions extend into the digital environment.”
(Farnan, 2013).
….. And not only PHYSICIANS, but all sorts of CLINICAL HEALTH PROFESSIONALS….
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4. … giving rise to some educational research questions:
• How does the education of clinical health professionals address ehealth?
• Why should it?
• How could it?
• What’s the baseline?
• What’s the impact?
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5. There are lots of underlying concepts to draw on in this research, e.g.

6. The evolution of a research program
• Gray, Kathleen, and Jenny Sim. "Building ICT capabilities for clinical work in a sustainable healthcare
system: approaches to bridging the higher education learning and teaching gap." Medinfo 2007: Proceedings
of the 12th World Congress on Health (Medical) Informatics; Building Sustainable Health Systems. IOS Press,
2007.
• Kennedy, Gregor, Kathleen Gray, and Justin Tse. “ ‘Net Generation’ medical students: technological
experiences of pre-clinical and clinical students." Medical Teacher 30.1 (2008): 10-16.
• Gray, Kathleen, Lucas Annabell, and Gregor Kennedy. "Medical students' use of Facebook to support
learning: Insights from four case studies." Medical Teacher 32.12 (2010): 971-976.
• Gray, Kathleen, and Jenny Sim. "Factors in the development of clinical informatics competence in early
career health sciences professionals in Australia: a qualitative study." Advances in Health Sciences Education
16.1 (2011): 31-46.
• Gray, Kathleen et al. Advancing ehealth education for the clinical health professions. Final Report.
Sydney, NSW: Department of Education Office for Learning and Teaching. ISBN 9781743613429.
(2014).
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7. Outline –
an ongoing clinical informatics education research project in Australia
1. Context
2. Current practice
3. Challenges for practice
4. Ways forward
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8. 1. Context
• The Australian scene
• Three slides about our project
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9. Australia’s Local & Global Ehealth Concerns
• Australian national strategy www.nehta.gov.au:
Infrastructure, PCEHR, telehealth, e-prescribing, clinical leads
• State & Territory government strategies:
Public hospitals, public health, some primary and community care
• Mixed public and private systems / investments:
Healthcare + biomedical R&D + ehealth IT industry
• Domestic but also international interests:
Health workforce, student population, globalisation of healthcare/IT
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10. Context: An Australian national project (1/3)
To initiate and encourage:
– curriculum renewal for ehealth capability
– in clinical health professional degrees
– through a coordinated interprofessional approach
4-university, 4-State team 2010-2013 :
Kathleen Gray & Ambica Dattakumar, University of Melbourne
Anthony Maeder, University of Western Sydney
Kerryn Butler-Henderson, Curtin University, Western Australia
Helen Chenery, University of Queensland
Supported by Australian Government Office of Learning & Teaching; reference group
from national and international agencies; clinical education champions.
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11. (2/3) Our project focus & assumptions
“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)
How does tertiary education in Australian need to respond,
so that it produces a generation of clinicians
with the knowledge, skills and attributes to use ICTs effectively in healthcare?
– Clinicians can’t all build this competence by informal learning alone.
– The disciplinary foundation is health and biomedical informatics.
– Informatics education for clinicians can be formal & comprehensive; more so than EBP / information
literacy / computing skills curricula.
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12. (3/3) A coordinated interprofessional approach
All Australian tertiary degrees for entry into clinical practice:
• ~20 health professions in all, including medicine, nursing, pharmacy, dentistry, allied
health, complementary therapies
• Bachelor to Doctorate entry level professional degrees
With reference to others doing related work, e.g.
• Australian work: ACPDHS, AIPPEN, ATHS, HWA, NEHTA, AHIEC & its members (ACHI,
ACS, HIMAA, HISA, HL7A)
• International work: UK eICE, US ONCHIT Workforce Development Program, Canada
COACH Clinician Forum, IMIA Health and Medical Informatics Education Working
Group
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13. 2. Our perspective on current practice in clinical informatics education
comes from these project activities:
• Literature review
• Degree coordinator survey & interviews
• Interprofessional workshops
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14. What we wanted from the literature
Evidence from peer-reviewed reports of implementing and evaluating
clinical informatics education for future health professionals.
What is known to be good pedagogical practice in clinical informatics education,
regarding:
– student diversity, learning needs and learning styles?
– teaching methods and modes of delivery?
– techniques for assessment of student learning?
– attainment of intended learning outcomes?
– standardisation and accreditation of curriculum?
– educational quality improvement processes?
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15. What we found in the literature
• A shortlist of around 20 papers in the peer-reviewed journal and conference
literature published in English between the years 2000-2011 covering university
teaching of medical / clinical / health informatics to future clinicians.
• Very few research reports of cases or trials that use externally validated instruments
or processes.
• A limited evidence base to support effective approaches to clinical informatics
teaching, learning, assessment or evaluation.
Details: Gray, K., Dattakumar, A., Maeder, A., & Chenery, H. (2011). Educating future clinicians about clinical
informatics: A review of implementation and evaluation cases. European Journal of Biomedical Informatics, 7(2),
2011.
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16. What we wanted to know from educators
2011 snapshot data from degree program directors / coordinators:
40 universities / 400 invitations
Over 100 completed surveys & 35 extended interviews
Representatives of Faculties, Schools and Departments of health sciences in three-
quarters of Australian universities
What matters about ehealth to you, as the coordinator of an entry level health
profession degree?
What are you doing about ehealth in the degree for which you are responsible?
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17. Educators are unclear about what is known and what is needed.
Clinical informatics education is not systematic nor widespread.
– 25% - 75% were unable to confirm important aspects of educational quality,
e.g. academic knowledge base; explicit curriculum; formal assessment practices;
quality review processes; student-centredness
– Misconceptions e.g. ehealth = elearning.
– Pockets of good practice e.g. contextualised teaching about EHRs.
Details: Dattakumar, A., Gray, K., Butler-Henderson, K., Maeder, A. & Chenery, H. (2012). We are not educating the future
clinical health professional workforce adequately for ehealth competence: Findings of an Australian study. In Maeder,
A.J. and Martin-Sanchez, F.J. Health informatics: Building a healthcare future through trusted information, IOS Press BV,
Amsterdam, Netherlands, pp. 33-39.
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What we found out from educators

18. What else we wanted to know from educators
Can educators responsible for different health profession degrees work together
to improve basic clinical informatics education?
52 academics from 14 different professions took part in a 2012 workshop held in 4
cities.
Resource documents and expert presentations from healthcare, government and
academia were provided.
Individual and small group work was recorded, analysed, reported.
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19. Workshop outcomes
Some core clinical informatics competencies were recognised:
– Efficiency with electronic information and communication
– Accountability for information ethics and security
– Awareness of digital data and tools for decision support
– Evidence-based adoption of ICTs in healthcare
+ examples of learning, teaching and assessment methods.
Some synergies were sparked:
– single profession collaboration across institutions
– interprofessional cooperation within States
AND
Government and healthcare expert panellists,
who had assumed that there was systematic clinical informatics teaching,
were taken aback by low levels of educational activity and educator awareness.
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20. 3. Challenges for educational practice
Our perspective comes from project investigations into:
• Learning resources
• Scenario building
• Accreditation guidelines
• Employer requirements
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21. Can we leverage existing learning resources?
• Broad web search for ‘teachable’ materials from government, industry, education and
research organisations, not-for-profits
• Inventory of 100 relatively open and reputable resources
What’s missing:
• Core clinical informatics materials with an Australasian orientation
• Generic ehealth software and tools for learning and assessment
• AND widely available convenient CPD for educators
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22. Can we leverage scenarios of interprofessional practice?
Development of 13 scenarios of ehealth in clinical practice:
• Chinese Medicine – Drug interaction database
• Chiropractic – Medical image sharing
• Dentistry – Tele-diagnosis
• Dietetics – Online support groups for health
• General Practice – Shared electronic health record
• Midwifery – Patient flow management
• Nursing – Tablet computers for mobile health
• Occupational Therapy – Games for health
• Paramedics – Disaster management system
• Pharmacy – Prescriptions exchange system
• Physiotherapy – Tele-rehabilitation
• Psychology – Virtual environments for therapy
• Social Work – Health data linkage
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23. Can we leverage degree accreditation guidelines ?
• Review of 21 health professions’ degree accreditation guidelines
• Search for terms broadly related to ehealth and clinical informatics
The missing link:
• ‘ehealth’ nowhere; ‘telehealth’ once; ‘electronic health records’ once; ‘informatics’ twice
• Informatics as a knowledge domain is inferred from related concepts ‘data’, ‘databases’,
‘evidence’, ‘information’, ‘technology’ –sometimes.
• BUT just as often the inference is to elearning facilities.
• Informatics related terms often are not clearly defined.
• AND guidelines are revised and referred to over long cycles:
– 8 documents last updated in 2010; the oldest 2001
– degree (re)accreditation happens every 3-5 years
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24. Can we leverage clinicians’ employers’ requirements?
• Monitored Australian clinical job ads weekly for 3 months in 2012
• Analysed 800 ads for any evidence of ehealth and biomedical informatics knowledge,
skills, attributes sought by employers
Missing in action:
• The word ‘ehealth’ never appeared.
• Fewer than 10% of ads (just over 60) included any term that could be construed as
relevant - most commonly ‘computer literate’.
• Such criteria listed as desirable as often as essential.
• Type of competence required often described narrowly or vaguely.
• BUT one ad with an exceptionally detailed job spec; three other ads seeking ability to use
a particular software package.
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25. 4. Ways forward, or where to from here?
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26. Recent Australian developments
• Australian Commission on Safety and Quality in Health Care 2013-14 recommendations for
optimising rollouts of clinical systems, with initial focus on discharge summary and hospital
medications management programs – a new driver for clinical education
• Health Workforce Australia’s National Common Health Capability Resource, provisional edition
March 2013 - associated ehealth tools promised
• National expert consensus on competencies for HI specialists, Certified Health Informatician
Australasia, launched July 2013 - reverse engineering for core clinical informatics competencies?
• A competency-based fully-online ‘Ehealth and Clinical Informatics’ subject open to students in any
Australian health profession degree will be trialled in 2015
• Curriculum standards work is going ahead within separate clinical professions – but what are the
outcomes for connected care if some do and some don’t?
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27. Further leadership and collaboration is needed
• New learning, teaching and assessment resources are needed to explain and explore ehealth and clinical
informatics in current and future healthcare contexts.
• Up-to-date professional development in ehealth and clinical informatics needs to be made accessible to teachers,
tutors and student supervisors in the health professions.
• Revised accreditation and certification frameworks for the clinical health professions need to include clear
specifications of ehealth and clinical informatics competencies.
• Human resources management of professional staff in healthcare organisations needs to recognise and reward
ehealth and clinical informatics competencies.
• Systematic planning and development of professional practice in the health professions needs to integrate long-
term ehealth and clinical informatics goals.
• AND Programs of research are needed to study the design, implementation and outcomes of all of these.
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28. International research is needed
• A recently published national ehealth strategy toolkit makes a start, by suggesting that levels
of educational program participation and completion can be used as ehealth education
outcome measures. (World Health Organization and International Telecommunication Union, 2012)
• Experts in educational impact evaluation know that such measures are only a start. What
matters increases in importance and in complexity of assessment as follows:
– Participants may or may not actively engage in the program that they choose to take up.
– Participants may or may not learn what is intended.
– Participants may or may not apply what they learn to what they do in their practice.
– The way participants practice may or may not improve the way the system works.
(Kirkpatrick & Kirkpatrick, 2006)
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29. Let’s recognise education as a form of ehealth infrastructure
• Education is often invisible in accounts of ehealth infrastructure. It may be implied but is rarely
described within strategic plans. For example, a recent detailed comparison of three nations’ national
electronic health record system implementations is entirely silent about education (Morrison, 2011).
• Ehealth policy issues and solutions extracted from 60 articles in peer-reviewed and grey literature
1998-2008 identified 9 themes: networked care, interjurisdictional practice, diffusion of ehealth /
digital divide, ehealth integration with existing systems, response to new initiatives, goal-setting for
ehealth policy, evaluation and research, investment, and ethics (Khoja, 2012).
• We should not assume that broad and deep ehealth learning and development in the clinical
professions will occur without policies or programming.
Details: Hilberts, S., & Gray, K. (2014). Education as ehealth infrastructure: considerations in advancing a national
agenda for ehealth. Advances in Health Sciences Education, 19(1), 115-127.
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30. Thanks for your attention!
Comments / Questions / Follow-up
Project report
www.olt.gov.au/system/files/resources/PP10_1806_Gray_report_2014.pdf
Project website
http://clinicalinformaticseducation.pbworks.com
Email: kgray@unimelb.edu.au
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