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Education Competency Recommendations for Global Health Informatics

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What does it take to maintain relevant, up-to-date educational curricula for health informatics students? Especially when entering an industry where best practices are constantly changing to keep up with technological advancements.

Though health informatics recommendations on competencies support the overall design of curricula, they can’t inform educators on how to customize content for local needs and requirements.

With these challenges in mind, the Technology Informatics Guiding Education Reform (TIGER) initiative’s International Competency Synthesis Project and the EU*US eHealth Work Project, funded by the European Commission's Horizon 2020, came together to describe and validate the TIGER framework of global health informatics Core Competencies for health professionals.

Using evidence-based competencies from international literature and recommendations from professional associations worldwide, a survey was designed to gather information to build the framework. The goal was to solve the challenge of providing future nursing informatics professionals an education that is specific in addressing local and global relevancies while also enriching the educational experience.

Two of the masterminds behind these endeavors, Beth Elias, PhD, MS, FHIMSS, University of Scranton Health Informatics faculty, and Ursula Hübner, PhD, professor of medical and health informatics from the University of Applied Sciences Osnabrueck Germany, shared how they worked collaboratively to describe and validate a health informatics framework.

Watch Dr. Hübner and Dr. Elias, talk with HIMSSTV about strategic approaches to seamlessly deliver health informatics education.

How did you determine the need for customization of competencies?
Hübner: The project was motivated by the very practical need to break down international and national medical and health informatics competencies when designing academic curricula and courses. When you are a teacher, you want to be sure you are telling your students things that are relevant, leading edge and guiding them on their way into the future. Not all competencies are relevant to all roles nor to all health professions, so you have to decide which competencies to focus on.

As medical and health informatics is such a broad field incorporating and tapping into technology, human factors engineering, clinical workflow, change management, governance, leadership, finance and more, you really have to select carefully and have a solid ground to do so. When talking to colleagues all around the globe, they told me that they were confronted with pretty similar issues.

Elias: These issues are also complicated by the move towards a more interprofessional model of care in many countries. We have a need to identify competencies that are applicable to different members of the healthcare team and that can support effective team communication using health IT. In the past, competencies have been very siloed and specific to roles – such as nursing, medicine or pharmacy. We need to have a method of looking at and developing competencies that take into account not only the needs of a particular role, but the needs of the team as an entity. As interprofessional education is becoming more common, this need will become more pressing. Competencies that can be integrated with the design of interprofessional educational experiences are a must.

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What were some challenges that were identified leading up to this?
Hübner: Regarding competencies, there were no big challenges – because the current literature including well-known recommendations from the International Medical Informatics Association, American Medical Informatics Association, and other associations revolved around very similar requirements and recommendations. This reinforced our assumption that these were globally relevant competencies.

Challenges emerged when discussing the level of the competencies. For example, what level needs to be addressed in a bachelor’s course or a master’s course. This led to very controversial discussions pointing at the differences even in one country, let alone across the globe.

The competency level very much depends on the previous knowledge of your students and on the focus of their previous studies in combination with their professional role. That is getting exponentially complicated and controversial. We, therefore, refrained from aiming at distinguishing between levels. Thus, we are speaking about competency areas, not dedicated single competencies.

Elias: We also experienced challenges when soliciting exemplar case studies internationally. Some came from the level of national efforts and some from a single educational program, which made them difficult to compare. We received many case studies and had to ensure that they were framed as competency areas, rather than dedicated single competencies, to fit within our framework.

Since this framework is a new way of viewing competencies, communicating the requirements of the case studies to the experts developing them was also a challenge. We developed a template for contributors to use that helped them develop this understanding. We also supported them with editing both for language and to ensure the case study was based on competency areas.

What surprised you most about the survey results?
Hübner: Well, for all of us it was surprising and reassuring that the response was so well accepted. We were obviously asking the right questions in the right manner. Also, the willingness to take part was overwhelming and we got answers from very different countries. The variance of the answers was not that pronounced as you might suspect. We were thus in a position to summarize and average the relevance ratings.

Elias: What I found fascinating, if not surprising, was the level of passion in what we heard from the survey participants and case study contributors. Sometimes it can be discouraging when you think of how far we still have to go to fully realize the benefits of health IT. But in reading the survey responses and case studies, it was clear that so much great work is already in process in so many countries. We don’t often hear this since we are usually focused on our own situations. By bringing these frameworks forward and sharing the case studies, we can create synergy between those working on similar efforts or with similar needs.

How did the global experts validate core competency areas, other than through relevance of survey results?
Hübner: The validation process is a very importance part in any scientific work. You always want to be sure that your findings are generalizable and valid external to your study. In addition, you want to be sure that you did not miss anything.

We thus presented our list of competencies, the professional roles we had compiled and the relevance ratings to experts in dedicated group discussions: first within Germany and Austria at two national medical and health informatics conferences, and finally at an international conference in Geneva, Switzerland with participants from all over the world. In all three cases, we chose open discussions as validation format. This gave us the certainty that we covered all relevant topics and helped us formulate how these topics could be clustered. Finally, we should not forget that the core competency areas were extracted from literature and thus, already possess a high level of validity.

Elias: By using this method, we had the benefit of not only soliciting individual expert opinions, but also the benefit of having a conversation around the competency areas among experts. This gives us a high level of confidence in the validation since it was the result of multiple experts discussing the competency areas in real time. The synergy resulted in a higher quality result than if we had talked to experts one-on-one.

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Did variances in global healthcare policies and practices present any challenges when developing a universal roadmap? If so, how did you navigate?

Hübner: We had to make sure the roles we were selecting were universal enough. For example, in nursing, we distinguished between clinical nursing with direct patient contact, nursing management, IT management in nursing, quality management in nursing and coordination of interprofessional care.

Apart from the idiosyncrasies in the countries, you must be aware that the technology, human-computer interaction and the patients with their diseases are similar around the globe. This is why medical guidelines from one country are valid and also accepted in other countries, such as the Scottish Intercollegiate Guidelines Network guidelines and the National Institute for Health and Care Excellence guidelines from the U.K. So yes – we have to be careful not be too specific to touch different understandings, such as privacy rights and data protection. But we can be sure that there is a core common ground in medical and healthcare shared by many experts globally – as we witness internationally.

Elias: The study also benefited from support from the Horizon2020 EU-US consortium in this area. With an international group to call for help, we were able to be more effective in understanding and navigating the complexities.

Can you share some findings from the global case studies leveraged in this project and how they connect with the survey’s findings?

Hübner: Core competency areas in the domains of data, information and knowledge enjoy rather high relevance ratings and thus are covered by all of the case studies. For example, the core competency area Information and Knowledge Management in Patient Care. This is not surprising; we expected the high relevance given to these topics by the experts. The recommendation framework also includes emerging topics of high relevance such as ethics and IT, which is also covered by case studies. Other emerging topics such as ‘biostatistics/statistics’ were rated less relevant in the context of medical and health informatics for nurses, but when it comes to data analytics, health information management professionals, scientists and educators appreciate the relevance.

Elias: One of the main findings from the case studies is how applicable many of them are to other countries and professional roles. We found more commonality – and, frankly, optimism – than we expected in the exemplars. At first, we thought that it would be a challenge to match the case studies to the survey results – even with the use of a template to help contributors understand that we were asking for case studies around competency areas rather than specific competencies.

After the first case studies started coming in, it was clear that they illustrated the survey findings very well and that contributors were able to share many experiences that were very similar. In the case studies, we have observed so far, it was clear they were aligned with the core competency areas which we feel further validates the survey findings.

We are excited to continue to solicit case studies to explore this further and to help us all break out of our silos to share best practices.

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Originally published March 18, 2019