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Distributed health informatics graduate education forworking professionals

Francis Lau ∗

School of Health Information Science, University of Victoria, P.O. Box 3050 STN CSC, Victoria, British Columbia, Canada V8W 3P5

a r t i c l e i n f o

Keywords:

Health informatics education

Capacity building

Core competency

a b s t r a c t

This paper describes a new distributed Master of Science degree program stream in health

informatics (HI) at the University of Victoria, Canada, aimed at healthcare and information

technology professionals working in the health setting. This is a part-time graduate pro-

gram where students are required to complete 10 courses and a research project for the

degree over 2 years. The course delivery is through a mixture of real-time virtual classes,

asynchronous online forums/resources, two capstone courses each summer as a 2-week

intensive on-campus workshop, and a major workplace related field research project. Exam-

ples of innovation include the use of Web-based conferencing for real-time virtual classes,

simulated tele-debriefing for policy/decision makers, roundtable sessions with chief infor-

mation officers, modularized professional development courses, and joint field research

project oversight with employers. The paper then discusses the need to refine the pro-

gram/course offering to ensure its consistency to current HI curriculum and competency

standards, pleas for a coordinated approach to HI capacity building in Canada, and outlines

planned next steps for the School in the coming year.

While such large-scale ICT deployment efforts to improve

1. Introduction

Over the past few years we have witnessed a great dealof activities related to the deployment of information andcommunication technology (ICT) in different countries withthe aim to improve their healthcare service delivery sys-tems and the health outcomes of their citizens. For example,the eEurope 2005 e-Health Action Plan has outlined a num-ber of policies and targets for the implementation of theElectronic Health Cards, Online Services with information pro-vision, tele-consultation and e-reimbursement, and HealthInformation Networks to speed the flow of health infor-mation through their healthcare systems [1]. Similarly, the

National Health Service (NHS) in England has recently consol-idated their information technology departments to becomethe ‘NHS Connecting for Health’ responsible for the imple-

∗ Tel.: +1 250 472 5131; fax: +1 250 472 4751.E-mail address: fylau@uvic.ca.

1386-5056/$ – see front matter © 2007 Elsevier Ireland Ltd. All rights resdoi:10.1016/j.ijmedinf.2007.01.008

© 2007 Elsevier Ireland Ltd. All rights reserved.

mentation of the Electronic Care Record, eBooking andePrescribing services for the entire country [2]. In NorthAmerica, the Canada Health Infoway (Infoway) has beenworking with the federal/provincial/territorial jurisdictionsto implement diagnostic imaging, laboratory, pharmacy andtelehealth applications as the foundational systems for thepan-Canadian electronic health record [3]. Meanwhile in theUnited States, the National Office for the Coordinator of HealthInformation Technology has recently been created to lead thedevelopment and implementation of a nationwide interop-erable Health Information Technology infrastructure in thatcountry [4].

the organization and delivery of healthcare services are greatlyneeded, one area that has received less attention is the needfor and availability of qualified personnel to plan, design,

erved.

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passes all levels of educational needs from novice to expertthat integrates research, practice and lifelong learning in HI,as seen in Fig. 1. This model was created using results fromour 2000 survey of alumni and health/ICT professionals across

i n t e r n a t i o n a l j o u r n a l o f m e d i c

mplement and use these systems. For instance, the Americanedical Informatics Association recently mentioned the need

or 10,000 healthcare professionals to be trained in appliedealth and medical informatics by 2010 in order to cope withhe proliferation of ICT across different healthcare settingsn United States [5]. In its 2003–2004 business plan, Infowaystimated that “. . . there will be a need for an additional 1,500-,000 technology, health informatics and change managementersonnel over the next six years as Infoway’s investments areealized” [6, p. 22]. When compared with the number of strate-ies and plans already published on the deployment of ICT inealth, there is much less detail on how to effectively buildhe human capacity needed to work with these systems. Someocumented efforts have recently emerged, such as the cre-tion of NHS Faculty of health informatics [7] and the proposedstablishment of Foundation for Learning and Socialization asart of the end user acceptance strategy at Infoway [8]. How-ver, what still seems lacking is a coordinated approach toI capacity building that involves the academic community,

unding agencies, government ministries, professional asso-iations and the “learners” themselves.

This paper describes a new distributed Master of Sci-nce (MSc) program stream in health informatics (HI) at theniversity of Victoria, Canada, aimed at healthcare and ICTrofessionals working in the health setting. Our intention iso advocate the need for flexible HI education at the grad-ate level for working professionals, who are the best localhampions to lead/facilitate the deployment and use of ICTnd to maximize its positive impacts in workplace settings.o be successful, such advanced HI education offering shoulde coordinated with other education and training initiativest varying knowledge and skill levels to accommodate theifferent learning needs of healthcare and ICT professionalsver time. In this paper, we describe the background, peda-ogy and design of this distributed MSc program, includingxamples of innovative learning approaches used. We theniscuss the need to refine our program/course offering tonsure its consistency with current HI curriculum and com-etency standards, plea for a coordinated HI capacity buildingpproach in Canada, and outline our planned next steps forhe School.

. Building capacity in HI

.1. Background

he School of Health Information Science (School) at the Uni-ersity of Victoria (UVic), currently with 8 full time faculty, 15djunct and 5 staff members, has been offering a comprehen-ive undergraduate program leading to a Bachelor of ScienceBSc) degree in HI for 25 years (see [9] for further details on thechool). In spring of 2001, the School conducted a strategiclanning exercise to revisit its mandate, vision and strategicirection, and developed a 3-year action plan to strengthen

ts role in HI education within Canada. Amongst the planned

ctions was a commitment to focus on graduate HI educationt the master, doctoral and postdoctoral levels as part of aarger coordinated pan-Canadian effort to build capacity in HI.t the same time the School would maintain its current under-

f o r m a t i c s 7 6 ( 2 0 0 7 ) 344–350 345

graduate program offerings which continued to have strongenrollment of 60 students each year.

In 2002, the Office of Learning Technologies (OLT) at thefederal Ministry of Human Resources Development Canadaco-funded a 2-year pilot initiative with the School to buildHI capacity for professionals in the health setting throughalternative delivery approaches. The consortium consistedof the School as the lead, the Health Telematics Unit atthe University of Calgary (UC), the Centre for Health Evi-dence at the University of Alberta (UA), the Division ofContinuing Professional Development and Knowledge Trans-lation (CPD-KT) at the University of British Columbia (UBC),COACH—Canada’s Health Informatics Association, and a pri-vate sector e-learning company called Shirwin Knowledge andLearning Systems. Through this initiative, 10 learning mod-ules covering various HI topics were developed by the fouruniversities using different delivery modalities that includedsynchronous virtual classes, online asynchronous interac-tions, intensive face-to-face workshops and mixed interactionformats. The modules were piloted with small groups of learn-ers in 2003–2004 to determine their feasibility and logistics.In fall of 2004, the School obtained approval from UVic Boardof Governors to introduce a distributed MSc degree programstream in January 2005 drawing on the modules, collaborationand experiences from this initiative.

2.2. Pedagogy

As part of the School’s strategic plan 2001 to build HI capacity,a conceptual holistic learning model was created that encom-

Fig. 1 – A holistic HI learning model that integrates practice,research and lifelong learning at all levels.

346 i n t e r n a t i o n a l j o u r n a l o f m e d i c a l i n f o r m a t i c s 7 6 ( 2 0 0 7 ) 344–350

men

Fig. 2 – A collaborative HI learning environ

Canada, which confirmed a great demand for HI educationand training at all levels, ranging from novice to expert. Tobe successful, we also recognized the importance of engagingeducational institutions, healthcare organizations, fundingagencies and most importantly the learners as key stakehold-ers to define the learning needs and contexts. Based on thesepremises, we proposed a collaborative HI learning environ-ment where our conceptual holistic learning model can beimplemented across a continuum of learning contexts andstakeholders, shown in Fig. 2. We believed a holistic HI learn-ing model embedded within a highly collaborative learningenvironment can provide the necessary vision and roadmapto guide the realization of a pan-Canadian HI educationstrategy.

The pedagogy that underlies our approach to HI capacitybuilding at the graduate level for the School stems from threeguiding principles established during the OLT pilot initiative.These principles cover the incorporation of adult learning thatis experiential and context-dependent when designing theprogram, the use of e-learning methods/technologies whereappropriate to enrich the learning experiences and outcomes,and the need to establish long-term partnerships that canbuild and sustain a collaborative HI learning community overtime. Our proposed pedagogy was strongly influenced by the2002 Task Force Report on Virtual Universities and OnlineLearning from the Tri-Council Research Funding Agencies1

in Canada that advocated the need to expand the nationalresearch base through experimentation with “virtual gradu-ate programs” [10]. The School also received encouragement

from the university administration to pursue the distributedmodel as a response to the Provincial Ministry of AdvancedEducation’s post-secondary strategy that encourages non-

1 The Tri-Council funding agencies are of the Natural Sciencesand Engineering Research Council of Canada, Social Sciences andHumanities Research Council of Canada, and Canadian Institutesfor Health Research.

t with different contexts and stakeholders.

traditional learning [11], and the Federal Government’s call forinnovations in education through e-learning [12], to increaseaccess of post-secondary education across the country.

3. Distributed HI graduate education

3.1. Program design

The School’s distributed graduate stream is a 2-year part-timecost-recovery2 program that leads to the degree of Master ofScience (MSc) in health informatics. The program is offered asa collaborative partnership among the Universities of Victo-ria, British Columbia, Alberta and Calgary spanning the twowestern Canadian provinces of British Columbia and Alberta,respectively. Health and ICT professionals with two or moreyears of relevant work experience who wish to become HIspecialists are eligible to apply for admission into this pro-gram stream. Candidates are required to have a Bachelor’sdegree and may include such health professionals as physi-cians, nurses, therapists and laboratory technologists, as wellas ICT professionals working in the health sector. Those witha Bachelor’s degree in a non-health or non-ICT/health relatedfield wishing to enter the program are assessed on an indi-vidual basis and may be required to take additional courses aspart of the program or elsewhere depending on prior educationand experience.

Students enrolled in this program stream are required tocomplete 10 courses and a research project over 2 years. Theseare graduate level courses from the School and online elec-

tive courses from our partner institutions at UA, UC and UBC.The course delivery is through a mixture of real-time vir-tual classes, asynchronous online forums/resources, and twocapstone courses offered each summer as a 2-week inten-

2 The distributed MSc is financially self-sustaining through a dif-ferential tuition fee to cover all operating costs.

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3.3.1. Real-time virtual classesSince 2004, the School has been using a Web-basedconferencing software called Elluminate3 to conduct real-time weekly departmental seminars4 and ongoing virtual

Fig. 3 – A sample schedule f

ive on-campus workshop held at UVic. An example of theistributed MSc program schedule and course offering ishown in Fig. 3. There are three required courses each stu-ent must complete—HI graduate seminar, research methods

n HI, and research project. Beyond the three core courses,here are 17 electives listed in the calendar, including sixourses contributed by the three partners. The initial programegan somewhat opportunistically as it was built mostly onhe respective strengths of the partners involved rather thandhering to a well-defined graduate level HI curriculum. Fornstance, such courses as HI research methods, information

anagement and technology, electronic health record, andealthcare quality improvement are historically the flagshipourses for the School. Similarly, the e-health sustainabil-ty and e-health evaluation courses represent key researchreas of the Health Telematics Unit at UC, the courses onelemedicine and PDA for clinicians are part of the continuingrofessional development offering by the Division of CPD-KTt UBC, and the critical appraisal and clinical decision sup-ort systems courses being the core strengths in the Centreor Health Evidence at UA.

.2. Implementation logistics

he initial implementation was to begin the program in Jan-ary 2005 with a cohort of 25 students, and to allow it to runhrough the entire 2-year program cycle before taking on moretudents. At the time this seemed to be a reasonable approachs it allowed us to monitor the progress closely, but it meanthe courses would only be offered once every 2 years until weere ready to admit a new cohort each year. This approachuickly proved to be financially infeasible since there werenumber of student withdrawals from the program at vari-

us times of the year for different reasons. To overcome thisroblem, the School quickly obtained permission from the uni-ersity to switch to three intakes a year in order to maintainhe enrollment cap of ∼25 seats at all times. One implications a result of this change was the need to review the sequenc-ng of all courses to ensure they were not dependent on eachther, as students would be entering the program at differentimes in January, May and September of each year.

The initial program schedule began year-1 with a 5-day

ace-to-face workshop in the second week of the Januaryerm, followed by an online elective from February to May,hen the 2-week on-campus workshop in June with another

weeks to complete the assignments, before proceeding to

e distributed MSc program.

the fall elective. The research project would then begin inyear-2 and run for the entire year, together with another twoonline electives and the second on-campus workshop to com-plete the program. This sequencing proved to be impracticalas it deviated from the regular university semester/term sys-tem which typically runs during January–April, May–August,and September–December of each calendar year. The first 5-day workshop in January also had to be held in a downtownhotel as there was no classroom or accommodation avail-able on campus at that time of the year. This arrangementadded further cost to running the program since the Schoolcovered all accommodation and meal costs for the work-shops. The change to three-intakes per year also required thecourse/workshop offerings to be consistent each year and tofollow the regular university semester/term system to avoidadministrative difficulties. The schedule shown in Fig. 3 rep-resents the current configuration of the program after 1 yearof ongoing experimentation and adjustments.

3.3. Examples of innovation

Through this distributed program, we experimented witha number of technologies and learning approaches, includ-ing the use of Web-based conferencing for real-time virtualclasses, simulated tele-briefing for policy/decision makers,roundtable sessions with chief information officers (CIO’s)across the country, modularized professional developmentcourses, and joint field research project oversights withemployers as the client representatives. Other efforts under-way include the creation of: multimedia learning objects onsuch special topics as health literature search techniques,health systems data analysis with solitaire card games on PDA,and a Web repository of HI research methods for such areasas usability engineering and systematic review for HI studies.Examples of these innovations are described below.

3 Elluminate is a Web-based conferencing system from Ellumi-nate Inc. at http://www.elluminate.com.

4 The School archive of its departmental seminars can be foundat http://web.his.uvic.ca/hinf580/.

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348 i n t e r n a t i o n a l j o u r n a l o f m e d

classes/seminars5 as part of a pan-Canadian PhD/Postdocresearch training initiative. For the distributed program weincorporated the use of Elluminate to hold virtual classesin several online courses – health systems data analysis, HIresearch methods and e-health evaluation – supplementedwith online discussion forums and resources through webCT®

and Blackboard®. Thus far, the technology has worked well toprovide a high level of interactivity with and interconnected-ness among students not achievable through asynchronousmeans alone.

3.3.2. Simulated tele-briefing for policy/decision makersIn the health systems data analysis course, tele-briefing wasused as part of a living case study called Evidence Qual-ity Investment Program (EQIP) on pharmacosurveillance inchronic disease management to improve prescribing quality inprimary care within the province. While learning how to turnadministrative data (e.g. drug and medical service claims, hos-pital discharges and vital statistics) into usable evidence forpolicy/decision makers, students had to prepare 15 min highimpact ‘tele-briefing’ oral presentations for the instructor inthe role of the EQIP Working Group and Advisory Commit-tee. The tele-briefing proved to be an excellent learning toolfor students to experience the need for quality evidence andtradeoffs in time-constrained policy-relevant decision makingsituations.

3.3.3. Roundtable sessions with CIO’sAs part of the information management and technology(IM&T) course offered during the 2-week on-campus work-shop, eight CIO’s from the banking, petroleum, insuranceand healthcare sectors participated in roundtable discussionseither in-person or by videoconference with the students todiscuss IM&T strategies and issues. In particular, the CIO’sfrom the health sector shared their insights on IM&T at theorganizational, regional and provincial levels; comparisonswere also made with the private sector in terms of contexts,strategies and challenges. Student feedback thus far revealedthey were most impressed with the caliber of the executiveswho took part in the sessions.

3.3.4. Modularized professional development coursesOne of the partners, the Division of Continuing ProfessionalDevelopment and Knowledge Translation at UBC (CPD-KT, for-merly the Division of Continuing Medical Education or CME),worked closely with the School to create two online elec-tives called telemedicine in action and PDA use for clinicians,drawing on their years of CME expertise and experience. Eachof these electives is made up of a number of self-containedmodules that can be taken individually by physicians forCME credits or together as a graduate level course for creditby students enrolled in the distributed program. The initial

offering of these electives was well received by both stu-dents in the program and physicians seeking CME credits asthey brought different perspectives that enriched the learningprocess.

5 See under Session Presentations/Meetings for recorded ses-sions http://web.his.uvic.ca/chpstp/pubarchive.html.

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3.3.5. Field research project oversight with employers asclientsA key component of this distributed program is the needfor students to complete a field research project that is rel-evant to their workplace settings. To ensure that the projectis closely aligned with the interest of the employer organiza-tion, we would invite the workplace manager of each studentto sit on the supervisory committee as the client representa-tive to jointly oversee the work being done. Diverse examplesof such students projects include usability testing of an e-triage system in the emergency department, requirementsfor a regional palliative care reporting system, and design oftelehealth store-and-forward applications to enhance clinicalcare.

4. Discussion

The distributed MSc program has now been in existence for18 months, with the initial cohorts of students still workingdiligently toward completing their course work and researchprojects. Some of the early experiences and lessons learnedfrom this program within the Canadian context have beenpublished elsewhere and will not be repeated here [9]. Instead,we discuss the need to refine our program/course offering to beconsistent with current HI curriculum and competency stan-dards, plea for a coordinated approach to HI capacity buildingin Canada, and outline next steps for the School to furtherenrich our graduate education initiatives.

4.1. HI curriculum refinement

In May 2006 we held a 1-day retreat with faculty membersinvolved with the program and delivery from all four part-ner institutions. Recognizing that the initial program wasdesigned opportunistically based on the respective strengthsand availability of faculty from the four institutions, an imme-diate task ahead was to refine our program/course offering toensure it is consistent with current HI curriculum and com-petency standards. To do so, we reviewed the InternationalMedical Informatics Association (IMIA) HI core competenciespublished in 2000 [13], the U.S. Health Information Manage-ment Systems Society (HIMSS) requirements for the CertifiedProfessional in Health Information Management Systems(CPHIMS) designation [14], and the U.K. National Health Ser-vice (NHS) 2001 HI Competency Annual Survey results [15].We noted key differences between the three sets of HI compe-tencies in terms of their intended purpose, area of coverage,and depth of knowledge/skills involved. While the IMIA HIcore competencies seem more focused on the theory andmethods of HI as an academic discipline, the NHS HI compe-tencies and HIMSS CPHIMS requirements both emphasize thepractical aspects of planning, implementing and managinginformation systems in healthcare organizations. The IMIAcompetencies also require a good understanding of medicineand the healthcare system, while those for HIMSS and NHS

seem more focused on technology and management aspects.

We then compared these competency standards with ourMSc curriculum, and with our undergraduate HI curriculum atthe School as the benchmark [9]. We believe the comparison is

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ppropriate since our undergraduate HI curriculum has under-one several revisions over the past 24 years based mostly onndustry feedback, and is considered highly successful judgedrom the consistent 100% employment rates for our co-oplacements and graduates. The comparison revealed that ourSc curriculum is lacking particularly in IT implementation

nd management components. Since the program is aimedrimarily at working professionals in the health sector, it madeense to include courses in these areas in order to have a widerppeal. Therefore, our current plan is to broaden our offeringo include elective courses in IT procurement, project man-gement, organizational change and IT security and privacyspects.

.2. A coordinated approach to capacity buildingn HI

ur recent HI education effort at the School has been focusedt the graduate level with an emphasis on distance delivery,hile staying on track with our flagship undergraduate HI pro-

ram that has been in place for 24 years with continued strongnrollment and employment prospects. With the distributedSc program aimed at working professionals in the health

etting, our goal is to create a seamless virtual learning envi-onment with different delivery modalities to maximize theange and depth of learning experiences by the students inays that can also benefit their organization. To ensure therogram can stay relevant with current and emerging healthystems priorities and issues, our faculty are actively involvedith major ICT policy and implementation initiatives across

he country and elsewhere in order to bring our research andxperience into the “virtual classroom” to share with the stu-ents.

Just in the last few years, we have seen an increasing num-er and type of HI related educational offerings across theountry (see recent article by Covvey et al. [16] for an inventoryf HI education programs in Canada). Although this trend is aeassuring sign of the growing recognition and importance ofI as a discipline, it requires careful coordination among theseI education/training programs to ensure harmony across thearious HI curricula, avoid duplication of efforts, and provide aoadmap to those wishing to advance their career through HI.or the working professionals, we need to guide them throughhe myriad of HI education/training programs available basedn their existing HI competencies, learning needs and careeroals.

While there is consensus on the urgent need for qualifiedealth informaticians to deal with the challenges of ICT imple-entation in health, to date there is no coordinated strategy in

lace on how to build HI capacity in Canada. National agenciesuch as Infoway, Canadian Institute for Health Informationnd Health Canada have acknowledged such shortage butave thus far not offered any specific plans to address thiseed. At the same time, the bureaucratic structures inherentithin existing academic institutions have made it difficult

o share faculty/support resources and offer joint degree pro-

rams. There is also little funding available for existing andew HI education programs to adapt/convert to flexible deliv-ry modalities for those in the workforce. For Canada to beuccessful at ICT in health, we need to take a strategic, collab-

f o r m a t i c s 7 6 ( 2 0 0 7 ) 344–350 349

orative and coordinated approach to train existing and newhealth professionals to become HI savvy, and to nurture thenext generation of HI specialists, educators and researchers tofurther advance the science and practice of health informaticsin the country.

4.3. Next steps ahead

The achievements to date with the distributed MSc programat the School represent at least 4 years of relentless effortfrom the faculty, staff and partners involved. In order to sus-tain the momentum of what has been accomplished thus far,the School and its partners must continue to innovate, refineand improve the program on an ongoing basis. The curricu-lum review meeting held in May 2006 among the faculty fromall four university partners has identified specific areas withinthe curriculum and delivery that require attention and refine-ment. As such, our immediate next steps are to broaden ourcourse offering to increase the appeal of this MSc program, cre-ate a virtual lifelong learning HI community among studentsand alumni of the School, and conduct a formal evaluation todemonstrate the value of distributed HI education to healthorganizations, funding agencies, and most importantly, theworking professionals.

Acknowledgments

The author wishes to thank Robert Hayward from UofA, Mar-ilynne Hebert from UofC, Kendall Ho from UBC, Debra Greigof ShirWin and Gil Sampson of COACH as the original OLTproject collaborators that led to the creation of the distributedMSc program. Acknowledgment is also due to the faculty andstaff who have worked hard to make this program a reality.In particular, the help of Daphne Rintoul and Heidi Bell hasbeen invaluable. The students currently enrolled in this pro-gram have shown a great deal of patience and enthusiasm, andhave provided very useful input to improve program delivery.The foresight of the university administration to push forwardwith distance education and e-learning at UVic is also to becommended. Last, funding for the OLT pilot project has beenprovided by the Office of Learning Technologies in the Ministryof Human Resource and Skills Development Canada.

e f e r e n c e s

[1] Europe’s Information Society Thematic Portal, eEurope 2005:e-Health, http://europa.eu.int/information society/eeurope/2005/all about/ehealth/index en.htm, last accessed April 15,2006.

[2] NHS Connecting for Health, Better Information BetterHealth, NHS National Programme for IT Annual Report2004–2005.

[3] Canada Health Infoway, Corporate Business Plan 2005–2006

Building on Our Successes, 2006.

[4] Office of the National Coordinator for Health InformationTechnology, Mission, United States Department of Healthand Human Services, http://www.hhs.gov/healthit/mission.html, last accessed April 15, 2006.

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[15] NHS Information Authority, National Health InformaticsCompetency Annual Survey, UK, July 2001.

350 i n t e r n a t i o n a l j o u r n a l o f m e d

[5] C. Egan, Interviews: Work Force Training Vital to ITOutcomes, Experts Say, iHealthBeat California HealthcareFoundation, August 11, 2005.

[6] Canada Health Infoway, Building Momentum 2003/04Business Plan, 2004.

[7] NHS Connect for Health, Education, Training andDevelopment, http://www.connectingforhealth.nhs.uk/delivery/serviceimplementation/modernisation/etd, lastaccessed April 15, 2006.

[8] Canada Health Infoway, End User Acceptance Strategy, April2006.

[9] A. Kushniruk, F. Lau, E. Borycki, D. Protti, The School ofHealth Information Science at the University of Victoria:towards an integrative model for health informatics

education and research, IMIA Yearbook Med. Inform. (2006)1–7.

[10] Task Force on Virtual Universities and Online Learning,Expanding the National Research Base, Discussion Paper,November 18, 2002.

i n f o r m a t i c s 7 6 ( 2 0 0 7 ) 344–350

[11] British Columbia Ministry of Advanced Education,Post-Secondary Strategy, Charting a New Course, ExecutiveSummary, March 2003.

[12] Human Resources Development Canada, KnowledgeMatters—Skills and Learning for Canadians, 2002.

[13] IMIA WG1, Recommendations of the International MedicalInformatics Association (IMIA) on Education in Health andMedical Informatics, Methods Inform. Med. 29 (2000)267–277.

[14] HIMSS, Certified Professional in Healthcare Information andManagement Systems, Candidate Handbook andApplication, 2005.

[16] H.D. Covvey, A. Kushniruk, S. Fenton, The state of healthinformatics education in Canada, Healthcare Inform.Manage. Commun. Can. 20 (2) (2006) 44–47.