Frontiers of Health Informatics Research: An Innovative Graduate-Level Computer Science Course

Chrysanne DiMarco, Ph.D. and H. Dominic Covvey, B.A., M.Sc., I.S.P.

Department of Computer Science, University of Waterloo, Waterloo, Ontario

We describe here a new graduate course that introduces Computer Science M.Sc. and Ph.D. students to research in Health Informatics. The course examines the nature and content of the work at the forefront of Health Informatics, and identifies what is known as well as the outlines of what must yet be developed, defined, or discovered to bring the work to the desired outcome. It is intended to help students identify and dissect out interesting research problems, and to identify potentially applicable concepts and methods.

The University of Waterloo Department of Computer Science (DCS) launched a program¹ that offers Computer Science graduate students an opportunity to specialize in Health Informatics. This is the first phase of a multi-year plan to offer a graduate program in Health Informatics. During this phase we have identified several action steps that include:

1. Encouraging and fostering collaboration among faculty interested in Health Informatics around several research foci, most particularly intelligent health systems, large-scale health data management, and medical imaging;
2. Identifying graduate students with an interest in health applications and undertaking research projects with partner organizations in the health sector;
3. Seeking funding for specific research projects; and
4. Developing a course that prepares students for research in Health Informatics.

This article describes the last of these steps, the design and development of the course entitled "Frontiers of Health Informatics Research. Future phase of our program define additional graduate, as well as undergraduate courses.

PURPOSE

This course is intended to examine work at the forefront of Health Informatics. It examines the nature and content of the work, and identifies what is known as well as the outlines of what must yet be developed, defined, or discovered to bring the work to the desired outcome. From the perspective of Computer Science it attempts to identify and dissect out interesting research problems, and to identify potentially applicable concepts and methods.

The primary objectives of the course include: using leading edge research projects as exemplars that show the kind of research performed in Health Informatics and illustrate how such research is done, helping students to identify potential research topics for their graduate theses, and introducing students to the breadth and depth of Health Informatics research.

Frontiers of Health Informatics is listed as a graduate (700-level) course in Computer Science. To qualify for the course, students must have satisfied the undergraduate requirements in Computer Science and be admitted to the Masters or Ph.D. programs. It is generally expected that students who take the course will pursue a research thesis in Health Informatics.

The following have been identified as the primary learning objectives. On completing this course, the student will be able to:

1. Identify the major current thrusts of Health Informatics research, articulating the purpose of the tools/capabilities/system being conceptualized and developed, the detailed nature of what is actually being created, the effects the products of the research will have and the values they will deliver when applied in health settings, and the challenges and unsolved problems that lie in the way of completing them.
2. Explain the pathway to the current research, describing predecessor systems/approaches and what they did and did not do, and the needs that spawned their existence.
3. Define next steps in terms of potential research problems that likely lie ahead of current work and that can potentially significantly advance the field. These are areas for possible graduate theses.
4. Identify concepts and methods from Computer Science, Mathematics, and other disciplines that might be productively applied in this research.
5. Launch his or her own research project more independently given the knowledge gained related to how research is performed.

The nature of this course is best illustrated by analogy. Consider the "known" in Computer Science as an island surrounded by the unknown, the ocean. Further envision there being 7 major directions that radiate from the center of the island towards the edges of the island. These seven major directions are the major vectors along which Computer Science knowledge is developed and on which Health Informatics development depends: Health Information Management; Intelligent Health Systems; The Health User Interface and Interactive Systems; Health Communications; Mathematical Computing in Health; Operating Systems, Languages, and the Health Technologic Infrastructure; and Social Aspects of Computing. The edge of the island is at some distance from the center based on the progress in Computer Science research, and the edge of the island represents the limit of the known in each direction.

This course introduces students to the major directions of research and the specific Health Informatics sub-vectors of each major direction. It takes students from the known to the edge of the known island, where the island must be extended if work at the edge is to be successful.

The course is organized along lines familiar to Computer Scientists. It addresses the following topics (note not all sub-topics will be covered in each offering of the course)

1. Health Object Model.
2. VLDBs.
3. Health Data Analysis (OLAP) and Presentation.
4. Health Data Warehousing.
5. Health Data Mining.
6. Advanced Query Systems.
7. Co-operative Health ISs.
8. High-Level Languages.
9. Health-Related Nomenclatures.
10. Computer-Based Patient Records.
11. Standards.
12. Health Process Simulation and Modeling.

1. The Nature of Cognition and Decision-Making.
2. Neural Networks.
3. Natural Language Processing.
4. Natural Language Generation.
5. Knowledge Abstraction and Summarization.
6. Knowledge Representation.
7. Expert Clinical/Administrative Decision-Making/Support Systems.
8. Care Guidance Systems.
9. Image and Signal Processing and Understanding.
10. Patient Monitoring.
11. Prosthetic Systems.

1. Adaptive Interfaces for Providers.
2. Advanced Interactive Technologies.
3. Image Reconstruction Systems.
4. Computer-Assisted Surgery.
5. Voice, Gesture, and Handwriting Recognition.
6. Human Factors in Health Systems.
7. Navigation in Rich Environments.

1. Multimedia Communications Technologies.
2. Telehealth and Telemedicine.
3. Data Compression.
4. Encryption.
5. Data Standards and Mapping.
6. Virtual Conferencing and Collaboration.
7. Internet-Based Systems.
8. Communications System Performance and Adaptability.
9. Health Information Networks.
10. Workflow Management Systems.
11. Standards.
12. Interoperability.
13. Automated Message Analysis and Management.

1. Efficient Algorithms (reconstruction, compression/ decompression, image processing, etc.).
2. Biostatistics.
3. Meta-Analysis of Clinical Trials.
4. Mathematical Modeling of Physiological Systems.
5. Signal Reconstruction (e.g., Cardiac Conduction from the Surface ECG).
6. Techniques for Functional Magnetic Resonance Imaging.
7. Real-time Biological Control Systems.

1. High-Level Languages for Health Systems.
2. Innovative Operating Systems for Health Environments.
3. Security.
4. Tools for Managing Clinical and Basic Research.
5. Enterprise Integration.

1. Privacy.
2. Economics of Computing.
3. Ethics and Computing
4. Psycho-Social Impacts of Computing
5. Evaluation of the Efficacy of Health Systems.

The following is the basic format for the course:

1. The course meets for 1.5 hours twice per week. Two faculty will lead the course.
2. 5-7 seminar hours will be allotted for each of the major topical areas or directions (1-7 above), with 1.5 to 2 hours being given over to an invited "star" speaker.
3. In the first lecture in each topic area one of the course faculty will parse the area, list the major sub-areas or sub-directions of Health Informatics research, and summarize current knowledge. Each of these introductory lectures stands alone as an overview of the given topical area and will be open to interested faculty and students not enrolled in the course.
4. The second lecture will also be delivered by one of the course faculty and will identify key issues in the area, as well as where gaps in knowledge, methods, and tools are known to exist.
5. The third lecture in the area will be performed by one or more students who will have researched a specific Health Informatics sub-topic, and will identify and characterize open problems, i.e., where the edge of the known is, where it must be extended for work to progress, and what some of the potential answers or solutions might come from. This presentation will be one of the primary bases for student evaluation.
6. The final lecture in each topical area will be a keynote talk by an invited speaker (a "star") who is doing original Computer Science research in a selected Health Informatics sub-topic. This lecture will highlight the problems that are "right at the edge" of current research, impart an understanding of the key advances required, possible solutions or at least the direction in which they lie, and known barriers. This final lecture will also be open to all students and faculty. Other meetings and discussions with the invited "stars" will add value to the program.

The methods for evaluating student performance are not fully settled at this time. However, the following are the main approaches under consideration:

1. Each student will choose a topic area and at least one sub-topic which he/she will research in-depth, performing an in-depth literature review on that subtopic, identifying what has been done in the area, the present gaps, and the possible directions for research. Each will present his/her review in a 20-30 minute presentation to the class, which will be videotaped for the course archives. These videos will be used by future students. The student will be graded for both content and presentation quality.
2. The rest of the class will record their questions for each speaker, and will be graded on both their understanding of the topical area and their critical analysis of the presentation.
3. We are reserving the possibility that each student will also undergo a highly structured 20-minute oral examination on the overall course material. Part of the motivation for considering this is to improve student performance at oral exams.

It should be noted that the subtopics that will be covered in each offering of the course will depend on the availability of faculty with the requisite expertise, stars, and students with specific interests.

Both the introductory lecture for each topical area and the "star" sessions will be open to Computer Science faculty and students, and to healthcare professionals in the region who are interested in Health Informatics. External participation will be facilitated using audio and document conferencing techniques. In this way, the course will foster collaboration with professionals in the health system, and provide an educational opportunity for interested health professionals.

This work is supported by the University of Waterloo Department of Computer Science. The authors would like to thank Prof. Nick Cercone for his support of this program.

1. Health Informatics Education Working Paper, Computer Science Department Technical Report CS-99-24, September 1999.

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