Communications of the ACM

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The Rise of a Health-IT Academic Focus

By E. Vance Wilson, Bengisu Tulu
Communications of the ACM, May 2010, Vol. 53 No. 5, Pages 147-150
10.1145/1735223.1735259
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The U.S. health care industry is catching up on its lagging information technology (IT) investment, and this trend has important ramifications for IT academics and practitioners. During the 1990s, investing in IT was a relatively low priority for hospitals and health systems, which faced fiscal constraints and pressing need to upgrade aging facilities. Now IT has come to be viewed as a means for improving quality, safety, and productivity in health care. As a consequence, the proportion of hospital revenue that is invested in IT has doubled in recent years² with continuing increases forecast through at least 2011.⁵ And IT investment is beginning to pay off. Analysis of data from 2,000 U.S. hospitals shows that over 60% have now made a sufficient investment in IT to generate a positive return to the organization.⁹

Increasing reliance on IT in health care raises demand for trained workers. It is widely recognized that physicians, nurses, and other medical professionals need training in IT skills related to their work domains.¹ One way this need is being addressed is through the American Medical Informatics Association 10x10™ initiative to provide IT training to 10,000 medical professionals by 2010 (http://www.amia.org/10x10/).

Less recognized is the rising demand within health care for trained IT professionals, especially those who combine health care domain knowledge with skills in business IT. Historically, it was typical to recruit graduates of medical informatics and related programs which provide intensive training in specialized aspects of the health domain, such as HL7 (Health Level 7) standards and ICD (International Classification of Diseases) or SNOMED (Systematized Nomenclature of Medicine) terminology. However, recent health care IT investment has been directed in large part toward generalized business IT, including data warehouses, enterprise systems, and web-based applications, such as e-health websites for use by patients. Of the nine top staffing needs identified in the 18^th Annual Leadership Survey conducted by the Health care Information and Management Systems Society,⁵ six are central to business IT, including application support, systems integration, network support, and systems design. Not surprisingly, it is becoming common for health care positions to be taken by graduates of IT academic programs, including information systems (IS), computer science, and information studies. These new workers arrive on the job with technical skills in business IT, but their experience with specialized aspects of the health care domain is typically limited.

This situation does not fully meet the needs of health care organizations. As Lanzalotto⁷ writes, health care hiring managers "are seeking candidates with strong technical and domain skill sets, as well as extensive industry knowledge." Clearly, academic training in health care topics can benefit IT students who enter health care positions as well as the organizations that hire them. Until recently, however, few IT programs offered a concentration or degree focusing on health care. We refer to this focus as health-IT in recognition that instruction within these programs centers on generalized business IT with supporting curricula in health-related areas.

Since 2006, the authors have conducted an annual survey of health-IT programs for the Special Interest Group on IT in Health Care (SIGhealth) of the Association for Information Systems (AIS). Results are reported at http://www.aissighealth.com. To date, 25 programs have been identified, representing a broad range of degree offerings, including six doctoral degrees, 22 masters degrees, and 9 undergraduate degrees. In the following sections, we profile two recent additions to the SIGhealth listing that exemplify the emerging interest in health-IT academics.

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Case: Undergraduate Health-IT

Idaho State University (ISU) is located in a region that is largely rural. Although local health care organizations attempted to implement electronic medical records, their effort was hampered by a lack of knowledgeable IT professionals who understood the health care environment. In response, ISU recently developed a new undergraduate degree in Health Care Information Systems Management (HISM) that is based upon the existing Bachelor of Arts in Business Administration, including a second major in Computer Information Systems augmented with Health Care Administration courses. During interviews with local health system managers, five dimensions were identified as essential components of the new program.¹⁰ These are summarized in Table 1.

Support by ISU administrators was important to achieving approval of the new HISM program, however, gaining support was simplified by several factors. First, the new program answered a real community need that had been noted by health care managers and documented by researchers. Second, as a result of collaboration between Business and Health Administration faculties the program does not require development of any new courses beyond the 3-credit practicum. Third, it was possible to structure the new program to avoid compromising accreditation within the collaborating departments. Finally, the program was designed without needing new expenditures. Although the practicum course does place demands upon the family medical residency program where students will operate EMR software, this organization considered the availability of students workers as sufficient incentive to absorb the costs of their supervision and training.

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Case: Graduate Health-IT

Northern Kentucky University (NKU) faces a different situation. NKU administrators viewed health-IT as a means to increase community outreach by leveraging university strengths in nursing and IS. Their approach was to develop a Masters in Health Informatics (MHI) degree within the College of Informatics, guided by a three-stage intelligence process.⁸ First, administrators reviewed course offerings of 13 representative graduate health/medical informatics programs to identify key course content areas. They discovered substantial variation in course content across programs. While over half offer coursework in health care administration and policy, decision support, database, and network applications, less than one-third offer courses in project management, quantitative analysis, or application design.

As a second step, administrators conducted a series of interviews with managers and IT personnel working in local health care organizations to identify which of the identified course content areas they considered most important. The resulting curriculum requires all students to complete a set of foundational courses plus a two-semester capstone sequence, while allowing them to choose among electives that cross content areas of health informatics policy, business process management, and knowledge management. Several of these are new courses for which administrators have funded development. The course structure is presented in Table 2.

The third step taken by administrators was to survey two student populations that were considered to be primary consumers for the new degree: Current students in undergraduate business and nursing programs. Both groups perceived the new program to be highly appealing and showed no statistically significant differences in their interest level toward the various course topics.

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What the Example Cases Tell Us

Our first observation is that these two health-IT programs were formed to meet specific local objectives rather than national goals, and the high level of diversity shown by health-IT programs listed on the SIGhealth website suggests this is typical of new programs. Meeting the needs of local employers is an important community benefit. Yet lack of standardized program development presents numerous costs that can include career barriers for participating faculty and limited acceptance of the degree by employers outside the local region.

Second, it is not difficult to develop health-IT programs where champions are in place and faculties are collegial. Champions at ISU emerged among faculty members who drove development from the bottom up, while development at NKU was initiated by university administrators. In both cases champions planned effectively, developing in-depth documentation of a local need for the program and designing their curriculum to satisfy the need. Further, faculty in participating academic units demonstrated a high degree of trust that benefits of the programs, such as increased course enrollments, would outweigh concerns over academic "turf," promotion and tenure, and other potential costs.

Third, health-IT programs do not have to be expensive to implement. At ISU, no new regular courses were developed, and no new funding was required. Where new coursework is envisioned, as at NKU, health-IT can be a route to grow and sustain student enrollments, assuming effective faculty can be recruited and retained.

We find it interesting that each of these observations has important consequences for faculty in health-IT programs. Foremost among these is that much health-IT knowledge is perceived to fall outside the central areas of IT disciplines. Although it is desirable for faculty to research in areas that they teach in order to enhance their academic qualifications, many faculty perceive that a health-IT research focus will diminish their opportunity for tenure and promotion.¹² This presents a dilemma for faculty in health-IT programs. We observe from the ISU and NKU cases that program development succeeds where faculty are open, trusting, and willing to work toward a common goal. Yet, these traits are unlikely to emerge among faculty who fear for their careers.

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Career Support for Health-IT Faculty

For qualified faculty to participate in health-IT programs, they must have the expectation that conducting high-quality health-IT research will lead to promotion and tenure. Theories and methods used by IT researchers are increasingly relevant to many of the areas in which health-IT is expanding most rapidly, including technology-use mediation in medical practices, collaboration in medical workgroups, and patients' use of e-health.⁴ Consequently, new venues have emerged for funding research and for presenting research findings. Both the Agency for Health care Research and Quality (AHRQ) and the National Institutes of Health (NIH) have initiated a multi-year series of calls directed specifically toward research studying the effects of health information technology on health interventions and services. In addition, prominent IT conferences, including the Hawaiian International Conference on System Sciences (HICSS) and the Americas Conference on Information Systems (AMCIS), have created special tracks for health-IT research. Yet it has often proved difficult to publish health-IT papers in mainstream IT journals.

To quantify this situation, Chaisson and Davidson³ analyzed the contents of representative peer-reviewed IT and allied journals between the years of 1985 and mid-2003. Although the health care sector accounted for up to 14% of GDP in developed nations during that period, Chaisson and Davidson found that only 1.2% of articles published in the IT journals addressed any aspect of health care. To assess the current trajectory of health-IT publications in mainstream IT journals, we updated the Chiasson and Davidson³ study to include health-related papers published through 2009. Our analysis attempted to replicate the prior design closely, however, we did make two changes. First, we removed the Journal of Systems Management from our analysis, as it was discontinued in 1996. Second, where Chiasson and Davidson used an estimation methodology to calculate total articles published by each journal, we applied a computer-based count of articles. The combined results are reported in Table 3.

Overall, we find the proportion of health-related articles increased in recent years from 1.2% to 2.3% overall, a gain of 92%. Although this percentage substantially trails the economic impact of the health care sector, the trend is encouraging. We also note several other indicators of increasing editorial interest in health-IT that are not reflected in the Table 3 data. In 2004, Communications of the AIS (CAIS) authorized a special department directed toward research on health care information systems which has published over 30 articles to date. In addition, several IT journals have announced special issues directed toward health-IT topics, including Information Systems Research, European Journal of Information Systems, Decision Support Systems, and Journal of the Association for Information Systems. These outlets offer immediate opportunities for health-IT researchers and also raise visibility of health-IT topics throughout IT academic disciplines. Thus, we are optimistic that the publication rate for health-IT articles in mainstream IT journals is on a strong growth trajectory.

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Challenges to Success

As discussed previously, health care organizations need workers whose training combines health care domain knowledge with business IT skills. IT academic programs are well-positioned to offer this combination of training by developing relationships with other academic units or recruiting health-IT specialists to cover health-related courses.¹¹ In recounting the experiences of ISU and NKU we observe that health-IT programs can gain support of faculties and administrators. In addition, we note that promotion and tenure prospects for faculty in these programs continue to improve as publication opportunities increase in mainstream IT journals. These factors all encourage the rise of a health-IT academic focus, bringing benefits for health care organizations as well as participating IT academic units. Yet certain issues may challenge or obstruct success of health-IT programs.

First, it is essential for faculties and administrators to accept health-IT as a valid IT focus. Informatics programs hosted by schools of medicine or health science have a lengthy academic history, thus many people assume that all health-related IT instruction should be handled by these programs. We argue that effective health-IT training will add new capabilities that are needed by health care organizations rather than duplicate the specialized areas that medical informatics addresses. Much of the new IT being acquired by health care organizations implements generalized business functions, such as system integration, data warehousing, and interaction with consumers via the Internet. IT academic programs are uniquely qualified to instruct students in these areas, and there is no good reason to deny health care organizations the benefit of workers with strong skills in business IT.

Second, although simple acceptance of health-IT is essential, recruitment of faculty members to participate in these programs will be greatly bolstered by valuing research accomplishments outside the traditional IT domain, including conference publications and grant awards. Even though mainstream IT journals are warming to health care, many important audiences for health-IT research, such as health care technology managers, do not read these journals.¹² Health-IT research will have the greatest impact where researchers are rewarded for addressing all interested audiences.

Third, the ability to recruit and place health-IT students depends heavily on acceptance by key stakeholders nationally, as well as in the local health care community. Current health-IT curricula vary widely, and this could harm program acceptance in the long run. Consequently, we conclude by calling upon health-IT program organizers and administrators to begin working toward standards development to refine and improve the emerging health-IT academic focus.

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