Course Syllabus

Overview & Course Rationale

Information technology lies at the heart of revolutions in many industries, from finance to travel to communications. Health care especially has been touched by technologies which facilitate patient care, management and research. Edward H. Shortliffe and Leslie E. Perreault point out, however, that "society's overriding concern for patient well-being, and the resulting need for optimal decision making . . . sets medicine apart from many other information-intensive fields. That concern gives a special significance to the effective organization and management of the huge bodies of data with which health professionals must deal" (Shortliffe and Perreault, ix). For this reason, the Association of American Medical Colleges has recognized and defined the special field of medical informatics as: "a developing body of knowledge and a set of techniques concerning the organizational management of information in support of medical research, education, and patient care. . . . Medical informatics combines medical science with several technologies and disciplines in the information and computer sciences and provides methodologies by which these can contribute to better use of the medical knowledge base and ultimately to better medical care" (1986).

Information technology holds the potential to revolutionize health care practice if developed and applied appropriately to change physician and patient behavior rather than merely to refine existing practices. Even if practitioners choose to eschew these technologies themselves, they will be faced with patients who do not. Access to health care resources on the Internet, for example, is seldom limited only to health care providers. Patients may thus arrive at the doctor’s office either very well informed about their condition or grossly misguided by inaccurate yet easily attained online information. For these reasons a course which teaches students and practitioners how to capitalize effectively on these information resources and how to evaluate both their implications and ramifications is warranted.

Prerequisite Skills

Successful performance in this online course requires the following prerequisite skills of the learner:

1. The ability to connect to the Internet
2. The ability to create, modify and save a document using a commonly available word processor such as Microsoft Word or Corel WordPerfect.
3. The ability to browse the World Wide Web using a commonly available browser such as Microsoft Internet Explorer or Netscape Navigator 
4. The ability to send and receive Internet electronic mail, including the ability to send and receive file attachments.

Objectives

Students on rotation will learn about current technologies and their impacts on health care practice and research. Specifically, students will:

1. Use and evaluate Internet-based electronic communication resources:
   a. Find, subscribe to and participate in an electronic mail discussion list in a health care related area of interest;
   b. Browse and search the World Wide Web for resources in a desired topic area and narrow or broaden the search if needed;
   c. Evaluate the quality of health-care related Internet resources;
   d. Articulate implications of Internet design and function, including bandwidth, content regulation and privacy/encryption/digitial signatures.
   
   
2. Use and evaluate clinical decision support systems:
   a. Understand the role and function of the components of personal computer systems, along with issues associated with their use;
   b. Search bibliographies of biomedical literature (e.g., MEDLINE) for articles in a desired topic area and narrow or broaden the search if needed;
   c. Use WebEDD to order articles for electronic document delivery;
   d. Use electronic drug information resources (e.g., Electronic Drug Reference, Physician’s Desk Reference, Clinical Pharmacology, PharmInfoNet or WV CONSULT) to locate pharmacological information such as drug interactions, dosage recommendations, adverse reactions and patient medication advisories;
   e. Use expert decision support systems (e.g., Quick Medical Reference, DXPlain or Illiad) to generate and refine differential diagnoses based upon physical symptoms and laboratory findings;
   f. Use electronic repositories of clinical protocols (e.g., CancerNet or US Task Force on Clinical Preventive Services Report) to develop a treatment plan based upon a particular diagnosis;
   g. Compare the advantages and disadvantages of printed versus electronic clinical resources;
   h. Articulate the advantages and disadvantages of various clinical study designs;
   i. Understand and employ data analysis techniques such as absolute risk reduction (ARR), relative risk (RR), number needed to treat (NNT) and odds ratio (OR);
   j. Comprehend and employ tools and techniques such as sensitivity (SN) and specificity (SP) of tests, Bayes' Theorem, positive predictive value (PPV), negative predictive value (NPV), expected-value decision analysis and sensitivity analysis to aid in clinical decision making.
   
   
3. Understand broad issues surrounding technological advances in health care:
   a. Recognize the importance of the discipline of medical informatics, including its mission, scope and current issues;
   b. Recognize the potential of information technology to change health care practice;
   c. Appraise potential and limitations of telemedicine in the treatment of patients;
   d. Assess the promise and hurdles of implementing electronic medical record systems;
   e. Critically evaluate a recent technological advance in a health care area of interest;
   f. Envision the clinical information "system-after-next" and identify trends which will spur or impede its development.
   

If you would like more detail, you can see a preview of the current learning modules.

Assignments and Course Requirements

You are required to complete the short, multiple choice quizzes and short-answer discussion questions which follow most learning modules (not all modules have these quizzes or discussion questions).

If you are a health professions student or resident (such as an MS-IV or PG-2 at MUSOM) seeking two to four weeks of clerkship credit, you must in addition complete the following assignments (note that licensed practitioners seeking continuing education credit need not complete these assignments): 

For TWO (2) weeks of credit:

1. Web Site Review
   You are required to select between 3 and 5 web sites within a health care related topic area of interest to you and write a critique of the sites. You may select your own criteria, but you may wish to consider characteristics such as:
   
   • Target audience (patients, providers, students)
   • Ease of navigation
   • Accuracy of information
   • Timeliness of updates

   For more suggestions on appropriate criteria, see guidelines on evaluating Internet resources (adapted from Florida Atlantic University). Your web site review should be approximately 2 - 3 double-spaced pages in length and will need to be submitted to your course director via electronic mail.
   
   

2. Literature Review
   You are required to write a literature review within the theme of "The impact of some technology on health care." You may define technology broadly to include any device, innovation, technique, procedure, etc. The topic need not be a recent one; an historical examination of the invention of the stethoscope, for example, would be acceptable. You should describe the technology or innovation and discuss both the positive and negative implications of its use. Your paper should be approximately 3 - 5 double-spaced pages in length with proper citations and will need to be submitted to your course director via electronic mail.

For THREE (3) weeks of credit:

1. Complete required assignments for two weeks of credit, above (web site reviews and literature review).
   
2. Informatics Article Critique
   Read the article provided (Murray, et. al., "Effects of Computer-based Prescribing on Pharmacist Work Patterns"), write a critique of 2 - 3 double-spaced pages in length and submit it to the course director via electronic mail. You can evaluate the article based on whatever criteria you deem appropriate, but you may wish to consider attention to the following questions:
   
   • What is the research question which the authors intend to address? Is this a question worth exploring? Are there, perhaps, other aspects of the question which you find more compelling and worthy of evaluation?
   • What methods did the authors employ to address their research question? Is the methodology adequate to address the research question? How (if at all) did the authors validate their instrument to ensure it measured what they hoped it would? Were their validation methods adequate? Are there any flaws in the methodology itself? Would the methodology work to answer any other research questions that you identified above?
   • What conclusions did the authors reach? Do their data support their conclusions? What lingering questions did the study raise that might merit further exploration?

For FOUR (4) weeks of credit:

1. Complete required assignments for three weeks of credit, above (web site reviews, literature review and article critique).
   
2. Informatics Evaluation Model and Plan
   You should develop a detailed evaluation model and plan to evaluate an existing informatics resource (or the actual need for one) based on the guidelines and methods suggested in the "Evaluation Methods for Health Care Informatics" learning module. This plan should be detailed enough to be understood and implemented by another person, should range between 1000 and 2000 words (5 to 10 double spaced pages) and should be submitted to the course director via electronic mail.

Technical Requirements

The following minimal requirements are necessary for successful performance in this online course:

1. Internet access (at least a 28,800 bps -- 28.8Kbps -- dialup connection).
2. A commonly available World Wide Web broswer such as Microsoft Internet Explorer version 3.0 (or higher) or Netscape Communicator version 4.0 (or higher).  Your browser must be set to allow cookies (the default setting of both listed versions will work).
3. A minimum display resolution of 640 x 480 (but 800 x 600 or higher is recommended).
4. A valid Internet electronic mail address.
5. A commonly available word processor, such as Microsoft Word or Corel WordPerfect.
6. The Adobe Acrobat reader plug-in.

Some learning modules provide enhanced versions which include embedded video, animations and other demanding technologies.  For these enhanced versions, your system must meet the following requirements:

1. Internet access (at least a 56,600 bps -- 56Kbps -- dialup connection).
2. Microsoft Internet Explorer version 5.0 or higher.  Your browser must be set to allow cookies (the default setting will work).
3. A minimum display resolution of 640 x 480 (but 800 x 600 or higher is recommended).
4. Windows Media Player plug-in version 6.4 or higher.
5. Macromedia Flash plug-in version 4.0 or higher.
6. A valid Internet electronic mail address.
7. A commonly available word processor, such as Microsoft Word or Corel WordPerfect.
8. The Adobe Acrobat reader plug-in.

If your system lacks any of the required software, please contact Michael J. McCarthy, Asst. Dean for Information Technology & Medical Informatics at the Marshall University School of Medicine, at mccarthy@marshall.edu or (304) 691-1765 for information on obtaining required licenses and installation sets.

Works Cited

• Shortliffe, Edward H. Leslie E. Perreault, eds. Medical Informatics: Computer Applications in Health Care. Reading, MA: Addison-Wesley, 1990.

Revised:  7 February 2001