Empowering Healthcare through Comprehensive Informatics Education: The Status and Future of Biomedical and Health Informatics Education

1. Importance of Biomedical Health Informatics Education

Health informatics, fundamentally driven by data, has emerged as a cornerstone of the contemporary digital era. A worldwide consensus exists regarding the urgent need to accelerate digital advancements in healthcare. Biomedical and health informatics (BMHI) uniquely integrates health and medical practice with elements of information science, technology, and socio-behavioral sciences, facilitating the management and dissemination of data within healthcare settings [1]. The widespread impact of information technology, heightened by challenges such as the coronavirus disease 2019 pandemic and demographic changes like aging populations, highlights the necessity for healthcare professionals to go beyond basic computing skills to develop proficiency in data management, expertise in advanced digital healthcare strategies, and a dedication to personalized care solutions [2,3].

The World Health Organization projects a daunting deficit of 18 million healthcare professionals by the year 2030 [4]. This scenario is especially acute in countries experiencing rapid aging, such as South Korea. The horizon of healthcare is poised to be reshaped by breakthroughs in artificial intelligence and robotics. The industry is on the cusp of transitioning from the rudimentary use of electronic health records to a more enriched engagement with health data to refine patient experiences. This amplifies the urgency for comprehensive BMHI educational frameworks, an aspect often neglected in traditional pedagogies. Recognizing that living entities are fundamentally information processors and that healthcare is innately data-centric, technological progress will drive the evolution of health informatics [5,6]. As healthcare transforms into a more digitized and integrated domain, professionals must have a deep understanding of informatics to ensure superior care delivery. A thorough grounding in BMHI is imperative for stimulating interdisciplinary collaboration, deciphering the nuances of modern healthcare systems, and catering to the expanding digital prerequisites of the field. This report aims to shed light on the definition and development process of biomedical and health informatics education and its global trends. Based on this understanding, the report proposes future strategies for developing BMHI education in South Korea.

2. Development of BMHI Education

The development of BMHI began with hospital information systems. As BMHI is a newly defined and evolving field, its terminology has evolved. Similar to the challenges of translating terms like “genome” into Korean, defining informatics can be complex. Initially, the term “medical informatics” was popular in the United States until 2000. The emergence of bioinformatics led to a shift towards a broader term that encompasses various healthcare and life science disciplines, transitioning from “medical informatics” to “biomedical informatics.” Currently, “biomedical informatics” is more commonly used in the United States, encompassing all areas, including healthcare, clinical practice, and biomedical research. Clinical informatics focuses on areas such as medicine, nursing, and dentistry, while other subfields include public health, imaging, and biomedical informatics [7].

Global efforts have been directed toward defining the BMHI curriculum. These initiatives began in 1973 when German organizations took the lead. By 1992, Europe had established guidelines through EDUCTRA. The International Medical Informatics Association (IMIA) developed competencies for nursing in 1998 [8]. In 2000, IMIA provided recommendations for health informatics programs [9], and the American Medical Informatics Association (AMIA) launched the 10×10 program in 2005. By 2012, AMIA had outlined the core competencies for BMHI [10]. Additional efforts included TIGER’s contributions to the clinical field curriculum [11] and AMIA’s collaborative efforts in 2015 and 2019. The Baccalaureate Education Community emphasized basic competencies in 2019 and shared insights from a master’s-level analysis in 2023 [12]. In 2021, the American Association of Colleges of Nursing introduced core competencies for nursing education [13].

1. IMIA Recommendations

The IMIA, established in 1967, is a leading global organization in the field of medical informatics. It is dedicated to developing international standards for education in medical informatics and regularly issues relevant recommendations. The goals of the IMIA include improving education in medical informatics, strengthening resources, courses, and certifications to enhance expertise within the field. Since its 2000 recommendations, IMIA has released two updated versions aimed at supporting curriculum development, identifying core competencies, and promoting roles in healthcare. The 2022 version introduces eight domains and outlines a framework of six core competencies in BMHI [1]. Depending on one’s primary area of study, the emphasis may vary, such as recommending an increased focus on computer science for healthcare professionals (Table 1).

Table 1

Major areas and core competency framework related to biomedical and health informatics (BMHI) defined by the International Medical Informatics Association

The IMIA defines three roles in the BMHI field. First, BMHI users possess a basic education that enables them to efficiently utilize information technology (IT) in their professional tasks. This foundational knowledge can be integrated into undergraduate courses. Second, BMHI generalists, who often have backgrounds in healthcare or BMHI, bridge the gap between BMHI technology and medicine. They define user requirements, guide software development, and implement medical information systems. A year of full-time study in computer science or BMHI-related subjects is essential for this role. Lastly, BMHI specialists are graduate-level learners focused on specific fields such as nursing or dental informatics. They develop innovative medical information processing techniques, teach, and conduct research. Achieving this level of expertise requires a master’s or doctoral degree in BMHI, or a specialized program in another area. Specialist education should cover domains such as biomedical imaging, clinical research informatics, global health informatics, and translational bioinformatics.

2. AMIA Recommendations

Founded in 1989, AMIA has played a crucial role in shaping US medical informatics through its educational programs and policy initiatives. In the 2000s, AMIA expanded its focus to include the training of informatics professionals, launching fellowship and certification programs. Between 2009 and 2012, it focused on standardizing graduate-level biomedical informatics (BMI) education. In 2012, a white paper recommended replacing the term “medical informatics” with “biomedical informatics” to reflect its broader scope, which now includes the increasingly important field of genomics [10]. This white paper also defined core competencies for BMI graduate students, covering a range from foundational to advanced skills and outlining the comprehensive knowledge required to become an expert in BMI. The graduate program in BMI welcomes students from diverse academic backgrounds, including but not limited to medicine, biology, mathematics, computer science, physics, information or engineering, and cognitive or social sciences. The program aims to equip students from these varied fields with common foundational and procedural competencies [10] (Table 2).

Table 2

Summary of the core competencies recommended for graduate students specializing in biomedical informatics in the 2012 the American Medical Informatics Association White Paper [10]

AMIA has diligently worked to develop professionals who are well-versed in healthcare clinical practices. A notable achievement was the introduction of the clinical informatics subspecialty in 2009, which integrates medical expertise with information science [14,15]. Specialists in this area assess the needs of healthcare professionals, improve clinical processes, and collaborate with clinical information systems. To obtain certification in clinical informatics, candidates must understand medical knowledge, information science, the healthcare environment, the influence of information systems on medical decisions, the lifecycle of information systems, and how clinical systems affect users. The clinical informatics fellowship, overseen by the Accreditation Council for Graduate Medical Education (ACGME), requires a program director and three faculty members for training purposes. From 2013 to 2019, 1,983 individuals achieved certification, with the majority coming from internal medicine (37%). AMIA serves as a central hub for healthcare informatics training, offering a variety of programs, including fellowships and the 10×10 program, an online course that has attracted over 5,000 participants since its inception in 2005 [16]. As of September 2023, 84 US institutions were providing education in healthcare informatics. Among these, 65 were universities, predominantly offering master’s programs. Additionally, 18 hospitals and 36 schools offered clinical informatics fellowships. Doctoral programs were also available, with 28 currently active. Notably, the fellowships primarily featured face-to-face learning, whereas master’s programs frequently employed online or hybrid formats (Figures 1, 2).

Figure 1

Degree levels according to organizations operating medical information curricula that are registered with the American Medical Informatics Association.

Figure 2

Education provision methods of the medical information degree programs registered with the American Medical Informatics Association.

3. Other Cases in Europe

European health informatics education varies, complementing approaches from IMIA and AMIA. While these organizations primarily address postgraduate students, some countries have focused on integrating informatics training during or after medical school. Tudor Car et al. [17] evaluated health informatics courses for medical students through a literature review. Out of 34 documents, 59% incorporated health informatics as elective courses, primarily centered on medical informatics. These courses typically spanned the first 3 years of medical school, lasting 1–3 hours weekly. 18% of these courses were online, and a significant 88% reported competency improvement after course completion. The approach to training healthcare professionals seems consistent internationally but varies in structure and certification. In the UK, similar to Korea, postgraduate medical training incorporates health informatics for both interns and specialists. Jidkov et al. [18], in a 2019 study, explored health informatics implementation across 71 specialties. The study found that out of 50 core competencies, 29 were covered in various specialties. Pathology included the most, at 16 (32%), but many specialties, such as surgery, barely touched upon health informatics. The authors proposed a general health informatics education curriculum applicable to training subjects, as shown in Table 3 [15,17–29].

Table 3

International cases of nursing informatics education

Furthermore, European initiatives such as the ERASMUS+program support educational projects in the field of health informatics. Alliances like CIVIS, a European Civic University, offer programs related to biomedical and health informatics, including special summer programs. Approximately 1,900 educational institutions offer 180,000 programs, with about 1,000 specialized programs designed for BMHI experts [30]. The Healthcare Informatics and Management Systems Society provides resources and programs in health informatics education, including a Certification for Professionals in Healthcare Information and Management Systems (CPHIMS).

4. Cases of Nursing Informatics Education

In the global healthcare environment, with the widespread adoption of information and communication technology, nurses are encouraged to utilize IT to uphold core values such as health equity and patient safety [31,32]. In 2013, AMIA projected that as many as 70,000 health informatics professionals would be required in the United States [33]. According to the job information website Zippia, approximately 12,534 informatics nurses are currently active in the United States as of 2023 [34]. Additionally, about half of these informatics nurses hold master’s degrees, and 27% possess degrees in nursing informatics [35]. The United States has established the most systematic education in nursing informatics, whereas countries like Canada, Australia, Europe, and Japan have relatively limited educational opportunities in this field (Table 4).

Table 4

Areas and contents of medical informatics competencies required for doctors proposed in the UK

1. Medical Education

Medical informatics education in Korea began in 1987 with the establishment of the Korean Society of Medical Informatics (KOSMI). Since then, in collaboration with KOSMI, several medical schools have created departments of medical informatics and have developed graduate programs that train professionals, following a model similar to that of the United States, which requires significant coursework or fulltime study in BMHI. In response to the growing need for enhanced informatics skills among current healthcare practitioners, KOSMI launched the Certification for Physicians in Biomedical Informatics program in 2012 [36]. Designed specifically for physicians, this 18-month program includes formal coursework covering a range of topics from basic programming and biostatistics to artificial intelligence and genomics. The curriculum also emphasizes practical skills in Python, SQL, and R programming. Additionally, it incorporates clinical system rotations, research projects, conference participation, and journal presentations. Candidates who successfully pass the final exam receive an official certification. From 2018 to 2022, the Ministry of Health and Welfare supported the precision medical workforce development program. This initiative, which is centered around real clinical settings, addresses six key data topics, including electronic health records and genomics. The Certified Medical Informatics Expert program, another significant effort, has been effective in developing skilled informatics professionals across various disciplines. Due to the increasing demand for information science in medical academia, numerous medical schools have expanded their informatics courses within undergraduate curricula. In 2022, KOSMI established a consortium comprising major medical school departments to enhance collaboration and advance medical informatics education. This consortium aims to create a foundational, mandatory curriculum designed to cultivate IT-proficient physicians. Initial actions included surveys to assess the distribution of informatics-related courses across medical schools. Data analysis and medical statistics were identified as the most prominent subjects, followed by medical informatics and artificial intelligence. Courses such as medical statistics and electronic medical records have become standard offerings in many schools.

2. Nursing Education

The history of nursing informatics education in Korea dates back to the 1990s, when it was first introduced at several universities in Seoul. However, a low demand for nursing informatics majors and a shortage of qualified faculty in this field limited its expansion. In 2021, the Korean Accreditation Board of Nursing Education incorporated the “utilization of information and communication technology and new healthcare technology” into the program outcomes of nursing education during its fourth accreditation evaluation.

Research on nursing informatics education programs includes studies such as the analysis of the status of nursing informatics education in 2000 by Park et al. [37], and the development of a standard curriculum for nursing informatics in 2007 by Yom et al. [38]. More recent studies include research on nursing education programs in 2016 by Jeon et al. [39], and an analysis of the current status and curriculum of nursing informatics education conducted by the Nursing Informatics Special Working Group of KOSMI in 2020 [40].

An analysis of educational trends indicates an increase in undergraduate programs focused on nursing informatics [41]. Initially, the courses offered to first-year students have now expanded into specialized courses aimed at third and fourth-year students. However, the proportion of elective courses, as opposed to mandatory ones, remains high (Table 5). Challenges in nursing informatics education include a shortage of educational materials, insufficient university recognition of the subject’s importance, and difficulties in conducting practicums. A survey of educators’ needs highlighted a demand for training in information system utilization and the latest information and communication technologies. There was also a strong call for the standardization of educational programs and the sharing of educational practices.

Table 5

Trends in undergraduate nursing informatics programs (unit: %)

To meet the demands of both practice and educational settings, the Nursing Informatics Special Working Group of KOSMI has been developing learning objectives for undergraduate programs since 2019 and recommended these guidelines nationwide in 2022 [41] (Table 6).

Table 6

Standardized curriculum recommended by the Nursing Informatics Special Working Group [41]

1. Challenges and Strategy for Medical Education

The digitization of the healthcare field is an irreversible trend, and advances in artificial intelligence are accelerating this transformation [42]. Consequently, there is an urgent need for medical informatics education across the entire healthcare and welfare workforce [43]. This underscores the importance of not only enhancing digital literacy but also strengthening the skills needed to utilize digital technology beyond mere data handling capabilities [44]. Additionally, even in a digitized healthcare environment, deep empathy and compassion for patients remain crucial values, and education in these areas should be emphasized [45]. Furthermore, addressing ethical and legal issues arising from the use of digital healthcare technologies requires the development of effective strategies and policies. Future developments and strategies will make it possible to nurture healthcare professionals who are well-adapted to the digitized healthcare environment [46]. The development of both technical competencies and the cultivation of human values and ethical considerations are essential for the training of healthcare professionals. Amidst these changes, healthcare professionals must possess both technical skills and human values, along with the ability to make ethical judgments.

Traditional medical education has long focused on patient care, disease diagnosis, and treatment methods, a system that has been in place for centuries [47]. This approach is deeply rooted in the historical philosophy of medicine. However, the healthcare landscape in the 21st century is increasingly defined by digitization and the extensive use of data. In particular, the rise of artificial intelligence underscores the need for healthcare professionals to move beyond mere knowledge acquisition. It encourages a deep understanding of underlying principles, the ability to apply knowledge effectively, and the recognition of the importance of lifelong learning [48]. Despite these shifts, many educational institutions have yet to fully adapt to these changes. Future medical education must prioritize a variety of curriculum innovations and the development of integrated education programs. These should focus not only on students but also extend to all healthcare personnel in the field. Additionally, while it is important to develop technical skills among healthcare professionals, there should also be a strong emphasis on improving communication and empathy skills with patients. Education should not overly depend on artificial intelligence and digital technology; instead, it is vital to uphold an educational philosophy that prioritizes person-centered healthcare services and remains adaptable to change.

2. Challenges and Strategy for Nursing Education

The history of nursing informatics education in Korea, introduced in 1987 and initiated at some universities in Seoul in the late 1990s, has experienced limited expansion. The primary barriers have been the low demand for nursing informatics courses at universities and a limited number of scholars in the field. These factors have contributed to a shortage of qualified faculty and inadequate educational environments. Significant improvements at the level of individual universities would require considerable time. Consequently, nursing informatics professionals are collaborating to pool their expertise to support future educators in the field. The Nursing Informatics Special Working Group within KOSMI serves as an exemplary collaboration among experts from academia, industry, and various healthcare stakeholders. However, reliance on individual enthusiasm or short-term academic support is insufficient. A systematic policy development for future healthcare informatics education is essential and should be implemented at the governmental level.

The nursing informatics competencies outlined by Staggers et al. [49] in 2002 include computer skills, informatics knowledge and skills, human information processing skills, and information management competencies. These competencies are divided into four levels: beginning nurses, experienced nurses, informatics specialists, and informatics innovators. An informatics specialist at the master’s level is expected to possess advanced knowledge and skills in information management and computer skills, and should be capable of understanding information needs, managing data, and utilizing knowledge and tools. At the Ph.D. level, an informatics innovator should be equipped to conduct informatics research, generate theories, and creatively present a vision for the development of informatics utilization. These competency levels are crucial for the development of educational programs at the undergraduate, master’s, and Ph.D. levels. The recent inclusion of informatics competency in nursing program outcomes by the Korean Accreditation Board of Nursing Education has heightened interest in nursing informatics across universities [50]. However, it lacks clear criteria regarding the specific content to be included in the outcomes, the interconnection of courses, instructors’ qualifications, and how the content should vary by academic year.

The Nursing Informatics Special Working Group of KOSMI has developed standardized curriculum guidelines. Further efforts are required to classify the content within the curriculum and to develop measurable learning outcomes. In terms of program outcomes, there should be a focus on skill development within the domains of knowledge, attitudes, and skills. Students should have opportunities to acquire and internalize the latest technology through practicum experiences. For instance, education on nursing records can be facilitated using electronic medical record systems. Additionally, simulation training environments should be made available, enabling students to search and explore clinical data, understand patient conditions, and apply the nursing process.

In conclusion, to advance BMHI education, a roadmap for the following challenges is needed. First, there should be a shared understanding of how the information competencies of healthcare professionals can reduce medical errors, improve patient safety, and increase job satisfaction. Second, given the rapid advancement of information technology and evolving demands in the field, educational programs must be updated regularly and in a timely manner. Third, the development of leadership, particularly at the doctoral level, is vital. Leadership skills that foster change and innovation are just as critical as technical competencies. Fourth, as healthcare information technology finds applications across various domains, it is important to improve the basic competencies of existing professors in healthcare information. Additionally, there is an urgent need to train educators who specialize in health informatics. Addressing these challenges will require collaborative efforts among educational institutions, academic societies, government agencies, and international organizations.