Rapid advancement in computer technology and the increasing availability of electronic health information are revolutionizing health care systems worldwide. Innovations in technology have made portable electronic devices, network database applications, electronic medical records, and computer software programs increasingly integrated into many health care settings. These changes create the educational need for health care providers to become proficient at appropriately using technology to deliver high quality health care services. This need is highlighted in an Institute of Medicine (IOM) report which recommends all programs that educate and train health professionals should adopt 5 core competencies; specifically, the abilities to (1) deliver patient-centered care, (2) work as a member of an interdisciplinary team, (3) engage in evidence-based practice, (4) apply quality improvement approaches, and (5) use information technology.1 Interestingly, these competencies can all be connected to the emerging area of medical (or health care) informatics, which is defined as the scientific field that deals with biomedical information, data, and knowledge, and their storage, retrieval, and optimal use for problem-solving and decision-making. 2
Despite growing research in this area, however, relatively few pharmacy schools offer dedicated training programs in informatics and or the opportunity for interdisciplinary learning in the area. Indeed, a recent comprehensive review of pharmacy informatics education in professional programs at US colleges of pharmacy suggests that only a third of pharmacy programs offer any courses in pharmacy informatics and even fewer (16%) require this coursework.3 Through a similar review process conducted within their institution, the authors identified a need for informatics training in several of the health professions programs, suggesting that an interdisciplinary course would not only be consistent with the IOM recommendations, but also be an efficient method of introducing these concepts. To accommodate the difference in academic schedules among students in the different health programs as well as to illustrate the concept of “using technology to teach about technology,” it was determined that an online course would be the most appropriate format. This manuscript describes the development, implementation and evaluation of Health Care Informatics, an interdisciplinary, online course at the University of North Carolina (UNC) at Chapel Hill.
DESIGNThe University of North Carolina at Chapel Hill health sciences group consists of the Schools of Pharmacy, Medicine, Nursing, Public Health, and Allied Health, and the Health Sciences Library. As the authors (both pharmacists who have completed national training programs in health informatics) collected information about the availability of informatics instruction on their campus, they identified some discipline-specific informatics topics within the curricula of several programs. Through networking, an advisory council of interested faculty and staff members from these constituent schools and programs was recruited to serve as reviewers and lecturers in the new interdisciplinary course. In addition to the course development objectives, the council met quarterly to discuss contemporary informatics topics as well as to explore mechanisms for funding new program initiatives.
Creating new courses is a resource-intensive process and using new (eg, technology-enhanced) methods and recruiting from multiple audiences (eg, a variety of professional programs) can lead to challenges in the development process. Because of the interdisciplinary recruitment and online course format, the Health Care Informatics course qualified for development funding from the UNC Health Affairs Interdisciplinary Education Committee. In addition, course implementation was funded by an educational grant received from a private philanthropic organization. This funding provided support for dedicated computer hardware, digital camera, microphone, software purchases/site licenses, modest honoraria for external lecturers, and salary for a graduate student assistant.
Specific course content was identified through a variety of mechanisms. Practicing pharmacists (N = 51) attending a statewide workshop on pharmacy technology were surveyed about their current informatics priorities. This information was combined with data collected through literature review and attendance at scientific meetings, then reviewed by members of the advisory council for further prioritization. Because of the variability of the interdisciplinary target audience, it was decided that the course would provide an overview of the field with an opportunity to develop depth in a particular area of interest via the required project assignment. The final weekly topic list is shown in Table 1.
Curricula in health science programs are generally governed by individual schools, and because of this, the University's mechanism for course approval for an interdisciplinary offering was not easily navigated. Essentially, the proposed course first needed approval by the School of Pharmacy Curriculum Committee using the school-specific process. Following this approval, the curriculum committee of at least one other health sciences school needed to approve the course in order for it to receive an interdisciplinary designation. Once approval at a second school was granted, the University reassigns the course an interdisciplinary number that could be publicized for enrollment purposes. Ultimately, the authors received approval from the School of Pharmacy and then requested approval in the School of Public Health because of a longstanding collaborative relationship with the graduate program there. With the interdisciplinary number and course title, enrollment was positioned as a 2-credit hour elective course for third-professional year pharmacy students and students from other health programs who had completed similar prerequisites.
The course coordinators created a web site to describe the course and to provide a preview of the courseware and delivery system. To request permission for enrollment, interested students were required to submit some demographic information (eg, discipline, previous computer experience) and to complete a validated assessment of their readiness to participate in online learning.4 After students were screened and registered for the course, one face-to-face meeting on campus was scheduled to orient the students to the course coordinators, the course format, and the software.
Health Care Informatics was the first online offering of the UNC School of Pharmacy, so technical support and resources were limited. Unlike some courses described in the literature for which content tested in the classroom was transformed for online application,5 Health Care Informatics was developed as an online course from the onset. With this in mind, the authors spent considerable time reviewing the literature about effective learning in the online environment.6-10 This literature suggests that successful technology-based learners are confident, motivated, persistent, and able to assume responsibility for their own learning. These students are also typically busy people who manage their time well. The course format was developed with this target audience in mind.
To deliver the course, the authors reviewed the many standalone software packages available but ultimately selected technology that was compatible with Blackboard, the University's existing course management software because that system was supported around-the-clock and was familiar to students who would enroll in the course. Lesson “lectures” were deployed via Blackboard using Macromedia Breeze software (now Adobe Connect Professional). This software allowed the individual lecturers to create their media using a standardized Microsoft PowerPoint template designed by the authors to optimize online visibility. Next, lecturers recorded voice narration for the slides. These files were combined and converted to Macromedia Flash format by the Breeze software to minimize file size and maximize accessibility. To optimize the attention span of the learner, online lectures were divided into thematic segments no longer than 20 minutes in length with some type of feedback exercise prior to accessing the next segment.
After the live orientation meeting, the remainder of the course was delivered online in a quasi-synchronous format; with new lessons posted each Wednesday by 8:00 AM EST and students completing weekly activities subsequently by the following Tuesday at 11:00 PM EST. All lessons utilized a uniform user interface with standard links to instructor information, objectives, readings, the Breeze lectures, an interactive exercise (eg, a discussion board), summary points, supporting links, a 5- to 10-item online quiz to self-evaluate learning, and a brief, anonymous online survey to provide feedback on the lesson.
ASSESSMENTThe demographics of the students who completed the course are presented in Table 2. To introduce themselves virtually to the instructors and cohort, students created Blackboard-based personal web pages describing their health care interests. After establishing this baseline, they regularly provided comments on their classmates' work using the discussion board function of the course web site. Both the quantity and quality of student postings increased as the course progressed, suggesting that students' comfort with using the media and software improved over time. Frequently, the online discussions highlighted that different professions have different views on the incorporation of technology into health care. Students even requested their own “open” discussion board for informing one another about information technology resources they identified from other extracurricular sources. Weekly reviews of the modular lesson were positive and participation in course activities was high. At the end of the course, more than half the students (54%) indicated they felt more comfortable participating in online course discussions than classroom-based (live) discussions. Several students (38%) joined the American Medical Informatics Association (AMIA) as a result of learning about the organization in the course, suggesting a continued interest in learning about health care technologies.
Overall performance in the course was very good and students consistently met or exceeded the course expectations (mean final score = 92%, range 78%-98%). In addition to the self-assessment quizzes and the weekly activities, each student completed an informatics project of their choosing and presented this using voice-annotated PowerPoint slides accessible via the Blackboard page. Projects were peer reviewed by 1 student from his/her discipline and 1 from outside his/her discipline, prior to the instructor's evaluation. Students reported that the process of having their project reviewed by a student enrolled in another discipline, as well as having to review the project of a student enrolled in another discipline was meaningful and interesting. Table 3 lists these projects.
A majority of students (54%) indicated that the concepts covered in the course had not been covered elsewhere in their required curricula (ie, the topics were not duplicative); although nursing students were more likely to report some exposure to these areas as compared to students from other disciplines. Several students (46%) commented that they appreciated that online faculty lecturers represented a variety of disciplines, reflecting both the interdisciplinary nature of the course and the field of informatics. At the end of the course a comprehensive online survey in which all students provided anonymous feedback showed that 100% of the students would recommend the course to other students, thought the course would be useful in their profession, and felt it encouraged them to take responsibility for their own learning. These opinions were validated by a substantial increase in enrollment requests for the following year.
Because a substantial amount of time was spent creating multimedia lectures that could be both listened to and read, we were interested in whether students consistently used both the audio and visual components of the lessons. More than half (54%) of the students said that in most cases they did not listen to the lectures but relied instead upon the handouts and the accompanying scripts. In addition, although identity was not authenticated before completing the online quizzes, students reported that because credit was given for completion (rather than for providing the correct answers), the temptation to “cheat” on the quizzes was low. By utilizing the course statistics function of Blackboard, the authors were able to track the times and dates that students accessed the web site. Consistent with reports from other online pharmacy courses,11,12 students frequently accessed the site at times outside those reserved for traditional classroom instruction.
DISCUSSIONThe availability of new computer applications and information resources holds the potential to change the role of health professionals and positively influence the patient-provider relationship. Consumers and third-party payers are increasingly demanding services that require health professionals to rapidly retrieve, critically evaluate, and quickly implement new knowledge, as well as continue to provide traditional health care services. Pharmacists, physicians, nurses and other health professionals are not being adequately prepared to incorporate health information technology into practice to provide the highest quality and safest medical care possible. Providing interdisciplinary instruction in health informatics prepares health care providers with skills to utilize new technologies to prevent medication errors and improve health outcomes.13
Developing new courses, specifically those that are technology-enhanced and targeted for interdisciplinary audiences can be expensive. This course was supported via grants and similar funding that may not be available at all colleges and schools. For instructors at colleges and schools where online coursework is already prevalent, many of the supplies (eg, hardware and software) would likely be available. Partnerships between health sciences programs, however, can increase the likelihood for funding, share the expense burden, and optimize the use of faculty time. The formation of the Interschool Advisory Council was a tremendous advantage in the course development process and was consistent with published recommendations3 for identifying curricular content in informatics.
Although the IOM report suggests that interdisciplinary instruction should be prioritized,1 university and college and school policies may lag in their support of these recommendations. Such policies must be updated to decrease the barriers associated with colleges and schools pursuing innovative and nontraditional learning methods. For example, Lust 12 presents a model for developing an online course in veterinary pharmacy, suggesting that for some curricular content, expert centers could serve pharmacy education needs regardless of geography. This model may also be applicable in a field like informatics, where the appropriate use of technology is both a method and an outcome. In addition, as suggested in the literature, 11,12 once the content is available in an online format, it may be convenient for delivery to other audiences (eg, as continuing education programs for practitioners).
Elective courses such as Health Care Informatics can also offer the opportunity to test content and format that may be appropriate for larger groups (and/or required courses). For example, after successful use in this course, the Breeze software was adopted by the School of Pharmacy for use in its required curriculum for the new distance education program. The lessons learned using the software in the elective course led to valuable experience and insights for implementing it in courses for a larger, distance-based community.
One of the contributing reasons for the success of this course was that enrollment was limited to a small group of motivated students who had demonstrated their readiness for learning in the online environment. Because of this, it is not known how successful similar methods would be in a required course offered to all professional students. Similarly, although the creators of this course were already high-end users of technology, the individual lecturers varied in their degree of savvy with the courseware. Because of this, the a priori creation of templates and clear guidelines for the lesson lectures was critical. Still, a variety of methods were employed (eg, recording of lectures to live audiences, conversion of preexisting slides to the course template) to ensure that lecturers felt comfortable producing their materials. With this in mind, advanced preparation is probably more important for interdisciplinary online courses than for live courses to more narrowly defined audiences.
CONCLUSIONSDespite the tremendous amount of work required for creating and managing an interdisciplinary online course, the learning outcomes for the course were achieved, student feedback was outstanding, and the instructors built positive relationships with faculty members in other health sciences programs across the campus. As technology becomes more integrated into health care, health training curricula (content and methods) should reflect this and shared expertise in the classroom (live and online) may encourage interdisciplinary team-building in practice. For the immediate future, forums such as AMIA's web-based seminar, which looks specifically at applied informatics curricula in the health professions, may be a good mechanism for opening this dialog.13
ACKNOWLEDGEMENTSThis project was funded by UNC's Health Affairs Interdisciplinary Education Committee and an unrestricted educational grant from the Merck Foundation. Preliminary results were presented as a poster at the 2004 AACP Annual Meeting in Salt Lake City, Utah. This paper does not represent the policy of either the Agency for Healthcare Research and Quality (AHRQ) or the US Department of Health and Human Services (DHHS). The views expressed herein are those of the authors, and no official endorsement by AHRQ or DHHS is intended or should be inferred.