Research Articles An Informatics Curriculum for Psychiatry

Milton P. Huang, M.D. Norman E. Alessi, M.D.

Information technology is growing at a tremendous rate, becoming a part of all aspects of the practice of psychiatry. Medical informatics is the study of the use of information in medicine. As information management becomes a greater part of the denition of psychiatric practice, it becomes critical that an understanding of medical informatics principles as applied to psychiatric practice should be incorporated into psychiatric residency training. The authors outline the components and objectives of such a curriculum, focusing on basic tasks of patient care, communication, education, and practice management. The authors conclude with a discussion of issues affecting implementation, including assessment of resources and program planning. (Academic Psychiatry 1998; 22:7791)

ll around us, we see a rapidly growing explosion of computers and related technologies appearing in our lives. Electronic pagers, educational CD-ROMs, and databases on the Internets World Wide Web are only a small selection of examples. Many of these technologies are information technologies: they alter how we gather, create, organize, and disseminate information. They inuence how we practice psychiatry as well as how others expect us to practice it. Their impact will only continue to grow with time, becoming an essential part of psychiatric work (1). Many forces are contributing to making knowledge of these technologies an essential part of practicing psychiatry. The everincreasing volume of medical knowledge is too vast to be taught in a time-limited medical curriculum (2,3), requiring access to tools that can assist in obtaining and organizing that expanse of information. A related increase in the amount of specialization and in the distribution of care demands effective communications and database tools for psychiatrists who must contact consultants and manage the various comACADEMIC PSYCHIATRY

ponents of a dispersed treatment team. Most signicantly, the enormous pressure to manage care has created large enterprises that demand information about the services that psychiatrists and other physicians provide (4). These groups have instituted the use of computers for most medical tasks in an attempt to obtain risk-adjusted data for comparing the outcomes of treatment in different hospitals and managed care plans (57). In this environment, we need to train psychiatrists to use the technologies they will face in their daily practice. Even more than this, we need to help them to learn to introduce information technology into their understanding of how they practice so that
Dr. Huang is assistant director of the Psychiatric Informatics Program and course director of the informatics core of the residency training program; Dr. Alessi is the chief information ofcer, director of the Psychiatric Informatics Program, and director of the Division of Child and Adolescent Psychiatry; both at the University of Michigan, Department of Psychiatry. Address reprint requests to Dr. Huang, 1500 E. Medical Center Drive, Box 0390, Ann Arbor, MI, 481090390. E-mail: [email protected]. Copyright 1998 Academic Psychiatry.

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information technology can serve as a useful tool, rather than an outside demand. It will not be enough for psychiatrists simply to learn to operate computer equipment or particular idiosyncratic software. We will need to be familiar with the concepts and potential that guide the operation and implementation of these devices. The study of the application of information technologies to medical tasks is part of the science of medical informatics. Medical informatics has been dened as the scientic eld that deals with the storage, retrieval, and optimal use of biomedical information, data, and knowledge for problem solving and decision making (8). This paper will briey review the development of medical informatics before presenting some guidelines about the necessary content of informatics training in a psychiatric context. Finally, the article ends with a detailed exploration of possible strategies and barriers to the implementation of an informatics component into a training program. MEDICAL INFORMATICS Historically, information has always been a large part of work in medicine. Whether approaching the four humours or the 16 types of serotonin receptors, physicians have always had to contend with learning extensive nomenclatures, as well as medical theory, diagnosis, and treatment. Computers began to play a larger role in organizing this information in the 1960s (9). Medical informatics started as the study of such computer applications, formally recognized as an academic eld in the 1970s. At that time, organizations like the IMIA (International Medical Informatics Association) or meetings like the SCAMC (Symposium for Computer Applications in Medical Care) gathered together physicians of similar interest and encouraged research into making information tools that would accomplish common medical tasks. Today, after astronomical growth in the power of computers, this
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research has produced easily available systems, shifting the emphasis from creating computer tools for physicians to the problem of implementing their use in physician ofces, hospitals, and other health care organizations (10,11). Time has seen an especially successful application of medical informatics to solving the information challenges of particular elds of medicine, such as radiology and pathology. Such work is only beginning in the eld of psychiatry (12). LEARNING OBJECTIVES FOR INFORMATICS IN PSYCHIATRY We believe that an informatics curriculum needs to be developed in psychiatry. Although programs exist for specic training in medical informatics (13,14), they generally focus more on producing technically skilled information professionals rather than informed clinicians (15). Informatics training in medical schools is limited, though it should improve in the near future (16). It continues to have a bias toward teaching computer literacy rather than clinical use of the computer (17). Residency training programs have begun to implement and study the effects of specic training curricula (18,19), although this is more prominent in nonpsychiatric training programs than psychiatric ones (20). These curricula also tend to emphasize mastery of technology instead of the information process of clinical practice. This section describes what we feel are the four essential areas of knowledge where psychiatrists must be able to apply an informatics approach to their clinical work. These are patient care, communications, education, and practice management (see Table 1). The focus of the rst section will be on the learning objectives of training in these areas. The subsequent section will describe in greater detail how instruction in these areas might be accomplished and how
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such a curriculum might be implemented in an academic setting. Patient Care The primary learning task of this area is to dene and learn to execute the information tasks of clinical patient care. Instruction on these processes should include analysis of how we interact with the patient and others to collect history and mental status information, deciding how that data should be organized and prioritized, and theorizing or implementing ways to efciently effect such processes. Information technology has been applied to these tasks in the form of computer software that automates standardized interviews, computer applications for electronically maintaining patient records, and software that aids in the formulation of diagnoses. Gathering ancillary lab data has also become computer based due to the development of electronic clinical support systems for communicating pathology or radiology results. With these changes, an informatics curriculum should encourage discussion and exploration of issues of interface. Important questions to raise include the following: What are the limiting and promoting factors that make a patient cooperate in providing information? Where do miscommunications occur? How do these change if a clinician is typing into a database during the interview or if the interview is completely conducted by a computer? What is the impact of collecting other types of information or media, such as audio or video recordings? How does the gathering and storage of audio or video information differ from more traditional types? How do different types of information systems (paper or electronic) to provide condentiality and security of information?
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Communication and Networking The learning tasks of this area cover communication with others, whether patient or physician. Instruction on these tasks should include study of how we communicate with patients; how the timing and the space in which we meet affect the message; what we relate using nonverbal cues; and what types of information we provide and how we provide it. We should examine how in consultation we communicate the basic information describing a patients difculties as well as the ineffable qualities of interpersonal interaction. Such aspects of communications will be affected as the Internet and other computer networks are used more and more in forms ranging from plain text e-mail to large-screen videoconferencing for telemedicine-type evaluations and consultation (21). Psychiatric informatics curricula should explore several issues in this area: What are the benets and limitations of different modes of network communications such as the World Wide Web, e-mail, fax, and telephone? What are the different assumptions persons make about timing or distance when using e-mail, the fax, or the telephone? How does text compare with video in its ability to communicate mental status information or opinions regarding assessment? How does the use of these technologies affect security and condentiality? Such issues will become signicant as new communications options create new expectations of how psychiatry should be practiced, introducing changes into the doctorpatient relationship (22). Education The learning task of this category is to discover how we obtain and disseminate
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TABLE 1. Category

Competency areas in informatics Information Tasks Collecting demographic and patient history information. Technologies Used Paper-based structured interviews. Automated computer interviews. Examples of ProblemBased Learning Tasks Use of computerized Symptom Checklist-90 interview. Issues for Discussion Reaction of patient to computer interfaces. Misinterpretation of questions on selfassessment forms. Maintaining condentiality and security. Limitations of recording information on paper or in structured electronic databases. Comparison of text to audio or video recording. Qualities of interpersonal space that change between physical and electronic presence. Security and condentiality. Effectiveness and biases in communications with different types of media.

Patient Care: the study of obtaining, organizing, and storing patient information.

Collecting ancillary laboratory data. Recording information and impressions.

Computerized clinical support systems. Traditional paper or electronic medical records. Voice or video recording.

Access pathology data for a particular patient. Entering information into a computerized record. Searching through records for needed information.

Communication and Networking: communication with patients and physicians

Communicating with patients in follow-up.

Telephone, e-mail, videophone, telemedicine links.

Using e-mail to provide contact with patients.

Teaching patients about their illness.

Consulting with colleagues.

Paper and electronic pamphlets. Paper and electronic charts and diagrams. Multimedia programs. Telephone, e-mail, videophone, telemedicine links

Use of a multimedia teaching package.

Consulting an electronic newsgroup oriented toward psychiatric care.

Education: learning and teaching the practice of psychiatry

Finding information on diagnosis or treatment.

Books. CD-ROMs. Paper and electronic bibliographic reference lists.

Execute literature search on MEDLINE.

Areas for miscommunication. Quality and biases of information. Maintaining condentiality and security. Relevance and validity of information. Potential of information sources.

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Perform a presentation using presentation software. Tracking an entire encounter from scheduling to registration and identication of payor, to generating accounts receivable and a bill. Completion of a quality improvement study on a set of generated patient visits

the information needed to practice the art and science of psychiatry. As new kinds of teaching occur through the use of multimedia programs on videodisc, CD-ROM, or the World Wide Web and as the research base and list of publications and new sources of information continue to swell, residents must master the ability to critically look at the information they acquire and the process by which they obtain and organize it. New information sources such as the Internet pose a challenge to learning because of the quantity and diversity of opinions expressed (21). Relevant questions for study include the following: How do we know if a theory or treatment claim is valid? What information do we need to make that judgment? How reliable are our sources of information? What methods do we use to nd new sources of information? How do we coordinate and prioritize our search for new learning? Do different types of media (text, video) introduce different biases into our learning? Practice Management This nal area covers the study of managing information related to maintaining a clinical practice. Typical management tasks include scheduling patients, tracking their treatment and bills, monitoring outcomes of treatment, and handling quality assurance. Informatics instruction should include discussion and evaluation of what these tasks are and how they are best organized. What different types of patients do we treat? How often do we need to see each of these particular groups? How do frequent telephone or e-mail
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Effectiveness of multimedia techniques. Costs involved. Costs and benets of ongoing systems use, of system implementation. Ease or difculty of modifying the systems.

Overheads, slides, electronic presentation software.

Paper and electronic scheduling systems, registration systems, billing systems.

Paper and electronic auditing systems.

How one documents and measures quality of care.

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Practice Management: managing information used to maintain a clinical practice

Patient scheduling. Appointment reminder generation. Patient registration. Insurance verication. Bill generation.

Auditing quality. Treatment planning. Measuring and monitoring outcomes.

Presenting and teaching information.

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contacts compare with less frequent direct contact? What types of reminder systems and tracking are important to have to provide optimal psychiatric care? New information systems are beginning to automate some of these tasks, but we need to rst dene and ponder the goals that such systems should strive to accomplish. Such an emphasis can help trainees prepare themselves and maintain an appropriate focus as they attempt to forge a practice in the future information age. CURRICULUM IMPLEMENTATION To achieve the learning objectives described earlier, direct experience with technology is important to help instill an understanding of the challenges it brings. Just as the breadth of a psychiatry curriculum ranges from basic science in molecular genetics and neuroscience to clinical studies of many forms of psychopathology, the breadth of a complete informatics curriculum ranges from basic studies of computer operations to theoretical consideration of the application of computers in different tasks. Problem-based learning (PBL) has been suggested as an appropriate means to bridge the breadth of behavioral science training (23) and has been applied to learning informatics (24). We suggest that specic tasks be devised to ensure experience and thought about the information skills useful for psychiatric work. Although the ability to operate a computer is important, an informatics curricula for residents should focus on using computers to accomplish psychiatric information tasks instead of specic didactics on computer functioning. Such a focus has been described as learning with computers instead of learning about them (3). As in the PBL model, learning is accomplished through solving a problem related to the learning objectives, then
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supplemented with relevant discussion of underlying theory and related issues. Implementation of any part of this curriculum is challenging, and complete implementation is likely to be beyond the resources of any training institution. Much of this training can be accomplished, however, if available resources and support are appropriately acquired and organized. We have divided the types of assets that require assessment and organization into three broad categories: physical assets, personnel assets, and cultural/political assets. Physical assets include available computers, networking equipment, and software. Personnel assets are the different people who can serve as instructors or provide support in using the physical resources. Cultural/ political assets are the positive and negative environmental factors that will affect an informatics effort driven by particular political or personal motivations. We will cover the assessment of each category in turn and follow with a discussion of how this assessment can guide program design and the expansion of further resources and instruction. Assessing Physical Assets Assessment of physical assets can be simply divided into assessment of available hardware and software (see Table 2). Assessment of hardware starts with determining what types of computers are available for resident use. Many hospitals, especially older ones, rely on terminals connected to a mainframe computer. For such systems, one needs to discover what types of software and information delivery the mainframe or system administrator supports. Other clinical facilities use desktop computers, in which case one needs to nd out the available disk space, RAM, operating system, and processor type of these machines. This list of parameters dene the computer capacity and, consequently, the types of software that can be used. Assessment of assoVOLUME 22 NUMBER 2 SUMMER 1998

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ciated hardware such as type of networking card, availability of CD-ROM or scanner, etc., allows one to determine the ability to use more specialized software such as Internet browsers or optical character-recognition software. Assessment of software starts with discovering what is currently available for both desktop computers and hospital-wide mainframe systems. Personal computers will usually have word-processing, spreadsheet, and perhaps some type of communications software. Specialized programs for database, education, or practice management may be present. Determine if licensing agreements are present for these individualized packages, remaining alert for site licenses that may have been obtained for the entire organization. Larger mainframe or other hospital-wide servers will provide lab information and testing data to an entire institution. Determine how access to this information is made available (through terminals, terminal emulators, or database systems). Other hospital-wide services may be made through subscription, such as to bibliographic services like MEDLINE or Grateful MED, in conjunction with the use of particular software. Assessing Personnel Assets The assessment of physical assets goes hand-in-hand with the assessment of personnel assets. There are many groups of individuals who can contribute to establishing an informatics curriculum (see Table 3). Discovering who among these groups is capable and interested in providing help will not only identify potential instructors, but will also identify people who own or are aware of other physical information assets that might be accessible. Looking within ones own department is the rst step in identifying potential personnel resources. Find out who has interest or experience in dealing with informatics or computer systems. The scope of informatics
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is broad, ranging from high-level understanding of knowledge synthesis and generation to the nuts and bolts of making a computer perform seemingly banal tasks. No single person can maintain expertise in such a large range of topics, making it essential to build a team of informatics leaders and instructors within the department. Looking outside ones department can yield a variety of talented individuals who may be willing to contribute to an informatics effort. Depending on how computer support, librarian services, and informatics studies are organized, different groups will have different skills and different computer resources available. Most academic institutions, for example, have a dedicated Information Service (or Information Technology) group. Such a group is responsible for installing and maintaining all computer hardware and software necessary for supporting clinical work. Often, these groups also provide instruction in how to use the hardware and software they install. Thus, Information Service people may be able to teach technical information to residents or provide some of their teaching materials. Librarian services can be an excellent source of personnel as well. Medical libraries are usually responsible for providing bibliographic tools (like MEDLINE or Grateful MED) and access to medical teaching resources such as CD-ROM. In a given medical institution, librarians often spearhead the effort of discovering potential Internet resources and may offer classes or instruction on using the Web or other information resources. Finally, other medical departments and even nonmedical departments may have informatics expertise they are willing to share. Departments of radiology and pathology have a tradition of informatics involvement, as much of the information they gather and disseminate is processed using computers. Nonmedical departments, such as biomedical engineering, computer science, library science, or even art, should also be exam83

TABLE 2.

Assessing physical assets

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Area of Assessment Hardware Computers

Questions What is currently available? What is supplied by the institution? What are the computer capabilities? RAM (Random Access Memory)? disk space? operating system? processor? What peripherals are available? mass storage? printers? CD-ROM drives? How are computers locally networked? physical communications protocol network operating system (NOS) What Internet access is available? What devices for capturing images? scanners? digital cameras? Devices for producing images? color printers? slide makers? projection devices? Sound equipment? sound cards hardware Video equipment? computer cards hardware

Examples VT100 terminals, PC workstations

8 MB, 16 MB, 32 MB 160 MB, 500 MB, 1.2 GB, 2.1 GB, 4 GB MacOS, Windows 95, Windows NT DX486, PowerPC 603, Intel Pentium II, PowerPC G3 DAT tape drive, Magneto-Optical drive, ZIP drive, SyQuest drive laser printer, inkjet printer, 600 dpi (dots per inch) 4X speed, 8X speed, 24X speed Ethernet, Localtalk, Token Ring NetWare, LAN Server, AppleTalk T1 network, T3 network, modem dial-up connection (28.8k baud, 14.4k baud) atbed, hand-held, 1200 dpi 24 bit color inkjet printer, laser printer LCD (liquid crystal display) panel, large screen monitors, video projection system Sound Blaster, MIDI compatible, 16 bit samples, 22 kHz sampling rate, 44 kHz sampling rate microphones, speakers, ampliers graphics acceleration, video capture, MPEG (Motion Picture Experts Group) board video camera, microphone, VCR, VCR controller, lights, studio

Networking

Multimedia

Software Patient Care

What is supplied by the institution? computerized lab results?

terminal access to mainframe, telnet access to mainframe, programs for retrieving lab results

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programs for entering orders into chart, for retrieving orders from chart programs for charting, for calling up charts Flat le, relational, object oriented, networked programs for charting, for calling up charts e-mail, groupware, WWW browsers (World Wide Web) telnet, e-mail, FTP (le transfer protocol), WWW browsers

MEDLINE, Grateful MED, Silver Platter Telnet, WWW browser

American Psychiatric Electronic Library, Cochrane Database of Systematic Reviews, Electronic Physicians Desk Reference networked resources physician scheduling, patient scheduling, resource scheduling bill generation, accounting, accounts receivable claims generation, electronic claims ling treatment plan generation, treatment plan review, monitoring

ined as potential sources of help and information. If a formal Medical Informatics program exists at a given institution, it will often be tied to such a department. Such programs provide a reservoir of expertise about the subject of informatics as well as experience in the practical difculties of implementing technology in the local environment. Assessing Political Assets Evaluation of the cultural and political environment proceeds with the assessment of personnel (see Table 4). Looking at ones own department, it is important to have a sense of the degree of support from fellow faculty as well as administrators who control resources. An informatics program requires both nancial and personnel resources, which inevitably makes it the target of political struggles. Ideally, an informatics effort would be something supported by all faculty. Residents would be encouraged to understand and use information technology in all of their clinical and learning settings, moving instruction beyond the limits of a didactic series. It is also important to assess the degree of support that can be provided by extradepartmental groups. Information Systems/Information Technology groups bear a responsibility to institutional technology as a whole and may have other agendas for encouraging psychiatry to use the same technologies as other departments. Their recommendations and instructions will be biased toward institutional solutions instead of the broader range of information tools that are available, possibly missing effective and simple areas that are still useful for the clinician. Medical library groups, on the other hand, can be less biased, since their goal as librarians is simply to make information more available to the physician. Other medical departments and nonmedical departments are generally subject
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electronic medical record? Do we have database software? PC-based electronic medical charts? What institutional software is used for communications? Do we have software for different Internet communications protocols? Do we have a subscription to a bibliographic service? Do we have communications software to access bibliographic services? Do we have educational software or CD-ROMs? Communications

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Practice Mngment

Educational

What is supplied by the institution? Do we have software for scheduling? Billing? Claims processing? Treatment planning?

electronic order entry?

TABLE 3.

Assessing personnel assets Questions Who is interested or experienced in informatics or computers? Who has organizational skills? Who is interested or experienced in informatics or computers? What services do they provide? Who teaches? What does their instruction cover? Have time or skills for lectures? Can they help in planning or setup of equipment? Examples Previous lab or research work using computers, work with computer-based statistics, formal training in informatics or computer science Management training, organizational systems experience Previous training in engineering or computer science

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Area of Assessment Departmental Faculty

Fellows and Residents Extradepartmental Medical Information Service (MIS) Instructional staff

Support staff

Medical Library

What courses are offered? Who offers them? What facilities are available? Who provides training for medical students?

Medical School Other Departments Pathology

Instructional services, hardware support, software support, network support Formal instructional staff, support staff, self-guided software packages, booklets Computer basics, using hospital systems, using email Discuss networking or local area network, discuss hardware basics Help install hardware or software, help obtain Internet connectivity Courses on using MEDLINE, e-mail, World Wide Web, decision support systems Librarians, specialized instructional staff Computer lab, multimedia CD-ROM, instructional programs Training by medical library, courses in computer system use, formal courses in curriculum Electronically available lab results, electronically based handbooks Technical service within pathology, informaticians working in pathology Electronic radiology reports Technical service within radiology, informaticians working in radiology EEG-monitoring studies, biofeedback projects, research in virtual reality Courses in multimedia, multimedia lab

What type of electronic services do they provide? Who provides them?

Radiology

What type of electronic services do they provide? Who provides them?

Other University Biomedical Engineering Art

Any work done on topics related to psychiatry? What computer courses and resources?

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Research in cognitive science, models of decision making, articial intelligence, models of cognition Use of bibliographic search tools, use of the World Wide Web Instructional services, hardware support, software support, network support Formal instructional staff, support staff, self-guided software packages, booklets Computer basics, using university systems, using e-mail, using the World Wide Web, creating homepages Discuss networking or local area network, discuss hardware basics Help install hardware or software, help obtain Internet connectivity Access to specic research projects, psychiatric information systems under development

to the more obvious bias of self-interest. Whether associated with a formal medical informatics program, or not, such groups will be looking for help and resources themselves. It is important to try to understand what their specic needs and goals may be, so that synergistic relationships might be encouraged. Our experience is that many of these groups are interested in working with others, but that psychiatry has rarely pursued involvement. Program Design Once resources are assessed, one can proceed to program design. This should start by targeting areas of competency to be covered by particular learning tasks that use present hardware, software, and instructor expertise. Some tasks might be delegated to medical librarians and the computer systems they possess. Others might require the acquisition of new hardware, software, or training that allows someone to become an instructor on a particular task and subject. Looking at the example of our own program, we nd it under constant revision. There are still areas in which we have little expertise available. As we discover new resources or as we learn more about the subject of informatics ourselves, we devise new learning tasks that can be assigned or demonstrated for residents. It is always possible to nd alternatives for teaching particular competency areas where resources are scarce. If we lacked the benet of our local computer network, for example, we could still demonstrate Internet principles by using a computer hooked up to a modem and a subscription to a local Internet service provider. As our time in the overall curriculum is limited, we emphasize issues of how to continue learning and how we learned this information ourselves. Our goal is not to teach every detail of how to use e-mail or database software or MEDLINE, but to give
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Can they help in planning or setup of equipment?

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Formal Informatics Group

Library Science University Information Services (IS) Instructional staff

Computer Science

Support staff

Are any psychiatrists part of their group? Are any members working on topics related to psychiatry?

Any work done on cognitive or psychological or psychiatric topics? What computer courses and resources? What services do they provide?

What does their instruction cover?

Have time or skills for lectures?

Who teaches?

TABLE 4.

Assessing cultural/political assets Questions Is the faculty supportive? Examples Chair supports instruction, residency education director supports, other instructors or clinical sites willing to give up time Able to teach and demonstrate use in their daily activities. Able to feel they can contribute to informatics teaching Control by chair, by committee, by appointed CIO (chief information ofcer), outside of department Hospital-wide integration of a single computer network, communications software package, practice management software package Hardware, software, application development for new or modied software Board decisions, decision of hospital CIO, building of network and infrastructure, uniform software packages Increase availability and use of medical information resources Medical information resources, instructional materials Preparing students for future managed environment, encourage research and effective gathering of information Classes training students in use of computers and hospitalbased information systems Producing and maintaining current systems for providing departmental information (pathology results, radiology results, etc.) Systems equipment, database software, networking

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Area of Assessment Departmental Faculty

Are they willing to learn and use informatics skills? How is funding controlled? Extradepartmental Medical Information Service (MIS)

What are their goals?

What are they expected to provide? How do they allocate their funds? What inuences that process? What are their goals? How do they allocate their funds? What inuences that process? Which of their goals include informatics themes? How do they allocate their funds? What inuences that process? Which of their goals include informatics themes?

Medical Library

Medical School

Other medical departments

How do they allocate their funds? What inuences that process? Other university Biomedical Engineering What are their goals? How do they allocate their funds? What inuences that process? What are their goals?

Create and research tools that assist medical (and psychiatric) diagnosis and treatment Research projects, training grants, courses Encourage creativity

Art

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residents an overall framework for organizing their computer knowledge and what questions they should be asking. The examples we use are the ones that we nd easily available in our own environment. These are used to promote discussion and the critical evaluation of the limits and potential of technology and modern information management. We want to encourage not only familiarity with the tools but also understanding of the types of resources available, the social structure of information generation, and the factors to consider in judging the value and impact of technology. These are the factors that make a person truly well rounded in their understanding of information technology (25). As a corollary to this principle of emphasizing a broader process of learning, we also emphasize the use of systems that are already in place in the department and hospital. All computer hardware and software is continuously outdated, and it makes little sense to try to keep everyone constantly updated with a limited education budget. When we do obtain hardware or software, it is generally made available through a shared workstation. Most of our communications software is free or discounted because we are an educational institution. We attempt to teach the use of information technology while remaining within the limitations of our resources. The basic components of the curriculum will shift as well. Our suggested curriculum outlines what we consider minimum standards based on how psychiatry is currently practiced and the technologies we feel will become so ubiquitous that they cannot be avoided and must be learned. With time, even more aspects of information technology will likely become unavoidable parts of psychiatric practice and thus essential components of the curriculum. As an example, one could imagine a future where psychiatric practice involves frequent, short, intensive outpatient visits by videophone. The information demands and
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Institution or campus-wide integration of a single computer network, communications software instructional software Hardware standards, software standards, network standards Instruction, courses, equipment

How do they allocate their funds? What inuences that process? What are their goals?

How do they allocate their funds? What inuences that process? What are their goals? How do they allocate their funds? What inuences that process? What are their goals?

What are they expected to provide? How do they allocate their funds? What inuences that process? What are their goals? Formal Informatics Group

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University Information Services (IS)

Computer Science

Library Science

How do they allocate their funds? What inuences that process?

Disseminate the science of medical informatics, train future medical informaticians Research projects, training grants, courses, equipment, software

Multimedia classes, multimedia equipment, shows and demonstrations Understanding how people think or make decisions, simulating or modeling such processes Research projects, training grants, courses, equipment, software Increase availability and use of information resources Information resources, instructional materials, courses

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the application of technology would shift, requiring informatics instruction to explore if trainees should simply talk into the screen, or if it would be more effective in some cases to combine speech with instructional slides. CONCLUSION Information technology is playing an increasingly important role in psychiatric work. Psychiatric training needs to include not only experiences teaching psychiatric treatment and diagnosis but also experiences that teach how information technology is employed in the daily tasks of the psychiatrist. Basic familiarity with a computer or a computer program will not be

enough. Increased information demands from patients, managed care, and other physicians will require us to be able to understand how to apply these technologies to our usual habits of work (26). Other authors have found that psychiatric residency training directors have hesitated in implementing computer training because of a lack of funds, lack of resident time, lack of knowledgeable instructors, and lack of a nationally accepted curriculum (20). We hope that this description of a curriculum and discussion of implementation will help generate ideas and a discourse as to important aspects of informatics in psychiatry and how we can increase our efforts to incorporate these aspects into our training.

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