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Designing and Delivering a Public Health Informatics Course

William Olmstadt
Information Services Librarian / Public Health Specialist
Texas A&M University, Medical Sciences Library
College Station, TX 77843-4462
wolmstad@medlib.tamu.edu

Gale G. Hannigan
Director of Informatics for Medical Education
Texas A&M University, Medical Sciences Library
College Station, TX 77843-4462
g-hannigan@tamu.edu

Abstract

Public health is a discipline increasingly reliant on the dissemination, manipulation and synthesis of information from a variety of sources. Public health practitioners now do much of their surveillance, advocacy, reporting, data analysis, and data collection via the web or on a computer. However, students in Master of Public Health programs rarely receive adequate training on the use of information technology. This article reports on the issues involved in designing and delivering an informatics course for public health students, using Public Health Informatics, a class offered since the fall of 1998 at the Texas A&M University System Health Science Center School of Rural Public Health, as an example. Informatics, public health informatics, issues in course design and delivery, and future plans for the course are defined and discussed.

Introduction

Librarians and information professionals have a history of being a part of the instruction programs in our agencies and institutions. We have developed innovative approaches to education, moving beyond print-based bibliographic instruction at preset times, to the delivery of coursework over the web, available virtually any time of day.

Health science librarians play a valuable role in training clients. The sciences as a whole depend and thrive on the creation of new knowledge, now speeded by the electronic transfer of information. Librarians actively teach scientists and their students how to acquire, manipulate, and manage this information. This role has only been enhanced with time and the burdensome amount of information generated every year in the sciences.

For the last 50 years, medical education has been criticized for its information overload (Swanson & Anderson 1996). Today, this education is like aiming a fire hose at a teacup: instructors hope that, at the end, something is retained. This article does not condemn modern health care education. However, there is a serious need for information management education throughout health science curricula.

Particularly evident is the need for information management skills for public health students. Public health is highly interdisciplinary, which implies a great volume of relevant information. Governments are major producers of information about the environment and health of the public, and private agencies create documents increasingly influential in policy making. This so-called "grey literature" of public health is an important source of information. For an excellent bibliography of current grey literature, see the Grey Literature Report (Ascher 2000). Additionally, much of the transfer of information in public health depends on the use of information technology; for instance, almost all the reporting of communicable diseases to the Centers for Disease Control is electronic. Practitioners and students not skilled with such technology are at a disadvantage.

In response to this need, some librarians in schools of public health have developed and taught courses in public health informatics. This article describes the evolution and delivery of such a course at the Texas A&M University System Health Science Center (TAMUS HSC) School of Rural Public Health. First, however, some terms are defined.

Informatics

"Medical informatics" was a term first used in the 1970s, borrowed from the French term "informatique medicale" (Shortliffe & Perrault 1990). By the late 1980s, however, the terms had developed different connotations in Europe and the United States. In Europe, the term was synonymous with "information science," but in the United States, the term was linked to the knowledge base in a discipline, such as law, medicine or dentistry (Ball et al. 1989). This linkage created the titles of courses now familiar to academia, such as dental informatics and nursing informatics (Hinegardner & Lansing 1994). The term "health informatics" is a general term covering the informatics activities in all of the health sciences, not just medicine (Ball et al. 1988).

There is little consensus on exactly what constitutes informatics. Many definitions have been proposed, which are reviewed in a number of publications (Ball et al. 1988; Ball et al. 1989; van Bemmel & Musen 1997). Van Bemmel and Musen (1997) define informatics as "the science that studies the use and processing of data, information, and knowledge." For the purposes of this article, health informatics is the intersection of information technology, information management, and health care, at a variety of levels, ranging from simple data entry, to the creation, design and implementation of new health care information systems, to the development of models for public health policy.

Public Health Informatics (PHI)

In their seminal article, Friede and his colleagues define public health informatics as "the application of information science and technology to public health research and practice" (Friede et al. 1995). They advocate going beyond "computer science" to actually synthesize new systems and processes that will improve health care. Public health practitioners should be trained in both technology and public health so that the two become linked academically, vocationally, and publicly. Friede et al. charge the federal government with creating the appropriate infrastructure to support PHI, and they conclude the paper by calling for academic programs and funding for students and educators interested in PHI as a career. Schools of public health have been slow to respond. Presently, accreditation requirements for schools of public health do not mandate an informatics course (Council on Education for Public Health 2000).

Background

In the fall semester of 1998, the inaugural class entered the newly established TAMUS HSC School of Rural Public Health (SRPH). The school trains practitioners to address the health care needs of rural populations, and has a unique mission among public health programs. It is the first of its kind in the nation.

The Medical Sciences Library (MSL) at Texas A&M University was involved with SRPH from its inception. MSL successfully proposed a 3-credit hour core course, Public Health Informatics. In 1999, the course was made elective, rather than required, due to pressures in the curriculum. Both authors most recently taught the course during the 10-week session in the summer of 2000. Since it was originally offered, 21 students have taken the course. The syllabus for the most recent course is on the web at {http://msl.tamu.edu/MSL/InfoRsrc/Curriculum/SRPH/PHEB640.html}.

Design

The course has been offered with a variety of activities each time it was taught, but some guiding principles have been instrumental in its design.

1. Active Learning

   Informatics is a science reflecting practical applications of technology, not the absorption and regurgitation of facts from a lecture. It is useless to teach an informatics course without a hands-on component. Students complete activities that demonstrate and build skills, as opposed to listening to lectures. They take an active role in delivering some of the content in the course. The instructors design exercises and projects to encourage students to explore a variety of information systems, recognize their limitations, and work with real data sets. Student performance and evaluations support this method of learning.

2. Exposure to new and relevant applications

   The course is not intended to champion the use of Microsoft Office products, or merely show students how to do complex word processing. There are plenty of courses students can take at Texas A&M University to learn specific, commonly used software applications. Instead, relevant and universally available public health software applications are covered. The course has included Epi Info (software to organize epidemiological information), Arc View (geographical information system software), and CDC WONDER (a meta-site for public U.S. government health statistics and information), as well as bibliographic databases highly useful for public health practice. An additional module and exercise on Reference Manager citation management software is included, as students typically were not aware such software existed. The result is a series of relevant exercises and presentations, based on common applications. This meshes with the proposal from Friede et al. (1995) that public health practice be based on unified, common information systems and applications, rather than on learning a number of different applications only relevant to certain cities or towns.

3. Self-Directed Learning

   Teaching informatics works best when students see the relevance of their projects to their future work life. This summer, students had projects outside of the course that they were able to complete using tools they explored in the course. The course gives students opportunity to integrate classroom learning with their graduate assistantship projects and papers. The course project is to describe and evaluate a public health information system. Project topics are not "assigned," but chosen on the basis of student interest. The only stipulation is the inclusion of some aspect of rural health care, since all SRPH courses must weave a rural theme into their content.

   Students acquire skills, develop training materials, and complete a project presentation that gives them something concrete to take away from the course - something they can show potential employers. Self-directed learning encourages students to take ownership of the course and their progress in it.

   A course at this level is not intended to be a rigorous theoretical orientation to the principles of informatics. The instructors aim for student participation, structure the course to meet students' individual needs, avoid lengthy lectures, and provide exercises relevant to the challenges faced in practice.

Delivery

Delivery issues largely center around personnel and timing. The authors are uniquely qualified to team-teach the course. One is the library's liaison to the SRPH (Olmstadt) and the other specializes in health informatics education (Hannigan). Guest speakers are invited, since Texas A&M University has particularly strong faculty in certain public health topics, such as infectious disease and biomedical communication.

The course is designed to require more student participation over time. A significant time commitment from the instructors is required at the beginning of the course. MSL is fortunate to have paraprofessionals staff the reference desk, with librarians on call for complex questions. This allowed both instructors the time to prepare for the first part of the course. Constructing exercises that work with existing software, finding relevant printed and electronic readings, and grading weekly exercises, took time, especially at the beginning of the course.

Grades are assigned according to the percentages on the syllabus. Participation is weighted 30% of the grade, and this is clearly explained at the beginning of the course. Students who attend class, turn in assignments reflecting effort and thought, and participate regularly in class discussion may expect an A in the course. Lack of participation has lowered students' grades. Library systems personnel are frequently called upon to install software and troubleshoot equipment in the classroom. If such personnel are not available to support an informatics class, instructors will need to consider the level of technical support available and provide backup exercises in case of technological problems.

The summer course lost a class day for the Independence Day holiday. While the course could not legally meet that day, the students and instructors arranged to hold a class meeting later in the week via the AOL Instant Messenger service. This is free, and it eases the burden of physically coming together for a meeting when participants are in remote locations.

Conclusions

Developing and teaching a public health informatics class is part of the larger role that librarians have taken in teaching information management and processing skills to health professionals. The idea of informatics in the curriculum is not new, and its successes are well documented (Association of American Medical Colleges 1999; Ball et al. 1988; Brahmi et al. 1999; Hinegardner & Lansing 1994; Owen 1995; Woods & Coggan 1994; Zimmerman et al. 1988). Instruction should be accompanied by evaluation, both from the students and the instructors (Hannigan 1998). This feedback provides input for future course development. For the two years this course has been regularly taught, written student evaluations have been overwhelmingly positive. All quantitative evaluation indicators have been greater than 4.5 on a scale of 1-5. Students have reported that the course fills a need not addressed in the SRPH curriculum. Several students indicated they would have benefited from taking the course earlier in the curriculum, when it would have been useful for other coursework. This only reinforces that, as with any instruction, proper timing is key. Students expressed a strong interest in training in information ethics, particularly on intellectual property issues. There have been selected complaints. For instance, the first time the course was offered, students were required to abstract and report on a legislative issue in public health and track its progress throughout the course. This was one of the least popular assignments and was removed from the course.

Due to the number of required courses, it is unlikely that Public Health Informatics will be reinstituted into the core curriculum. The instructors are investigating the possibility of delivering the course through the web in a self-directed environment, as an adjunct to the core curriculum. So much high-quality public health information is available on the web that designing a web-based PHI course may be easier than designing a traditional distance education course, which involves textbooks, course packs, and copyright clearance. For PHI, one can often simply link to valuable resources, without infringing copyright. Not only could students proceed through an informatics course at their pace, but the web-based course could be delivered to distance learners, as well as other interested students. In Texas, that is particularly useful, as distance learners and local students are legally required to have comparable access to resources (Texas Higher Education Coordinating Board 2000).

The authors predict that public health informatics courses will become required in the next 3 - 5 years at schools of public health. The amount of information and the technology to manage it are increasing in complexity, not decreasing. Educators in public health cannot ignore the information-intensive environment into which they are sending their graduates. Evidence of this already exists. The Centers for Disease Control has established a fellowship in public health informatics (see {http://www.cdc.gov/epo/phifp/}), and the Rollins School of Public Health at Emory University created a new degree, an MSPH in public health informatics (see {http://sph.emory.edu/departments/bios/degree-programs/msph-phi/index.html}). Librarians have a unique opportunity to be at the forefront of education for public health students. By providing students with the skills that informatics teaches about managing and organizing needed information, they improve both the access to public health information and the quality of public health practice.

References

Ascher, M.T. 2000. Grey Literature Report. [Online]. Available: {http://www.nyam.org/library/greylit/glrindex.shtml}. [October 4, 2000].

Association of American Medical Colleges. 1999. Medical School Objectives Project: Medical Informatics Objectives. [Online]. Available: {http://www.aamc.org/meded/msop/informat.htm}. [October 4, 2000].

Ball, M.J., et al. 1988. Informatics and education in the health professions. Journal of the American Society for Information Science 39(5): 344-347.

Ball, M.J., et al. 1989. Informatics education and the professions. Journal of the American Society for Information Science 40(5): 368-377.

Brahmi, F.A., et al. 1999. Teaching lifelong learning skills in a fourth-year medical curriculum. Medical Reference Services Quarterly 18(2): 1-11.

Council on Education for Public Health. 2000. Accreditation Procedures. [Online]. Available: {http://www.ceph.org/pg_accreditation_procedures.htm}. [October 4, 2000].

Friede, A., et al. 1995. Public health informatics: how information-age technology can strengthen public health. Annual Review of Public Health 16: 239-252.

Hannigan, G.G. 1998. Editorial: informatics in the curriculum. Medical Reference Services Quarterly 17(4): 71-75.

Hinegardner, P.G. & Lansing, P.S. 1994. Nursing informatics programs at the University of Maryland at Baltimore. Bulletin of the Medical Library Association 82(4): 441-443.

Owen, D.J. 1995. Library instruction in genome informatics: an introductory library class for retrieving information from molecular genetics databases. Science and Technology Libraries 15(3): 3-15.

Shortliffe, E.H. & Perrault, L.E. 1990. Medical Informatics: Computer Applications in Health Care. Reading, MA: Addison-Wesley.

Swanson, A.G. & Anderson, M.B. 1993. Educating medical students. Assessing change in medical education - the road to implementation. Academic Medicine 68(6 suppl): S1-S46.

Texas Higher Education Coordinating Board. 2000. Chapter 5, Subchapter H: Approval of distance learning for public colleges and universities. THECB Rules and Regulations. [Online]. Available: {http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=143231&p_tloc=&p_ploc=&pg=1&p_tac=143231&ti=19&pt=1&ch=5&rl=130&dt=&z_chk=&z_contains=}. [October 4, 2000].

Van Bemmel, J.H. & Musen, M.A. 1997. Handbook of Medical Informatics. Bohn: Springer-Verlag.

Woods, S.E. & Coggan, J.M. 1994. Developing a medical informatics education program to support a statewide health information network. Bulletin of the Medical Library Association 82(2): 147-152.

Zimmerman, J.L., et al. 1988. Medical informatics education. Journal of the American Society for Information Science 39(2): 138-141.

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