CC BY-NC-ND 4.0 · Methods Inf Med 2017; 56(S 01): e129-e133
DOI: 10.3414/ME16-01-0152
Original Articles
Schattauer GmbH

The Informatics Stack: A Heuristic Tool for Informatics Teaching[*]

Harold Lehmann
1   Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore, MD, USA
› Author Affiliations
Funding: This work was supported in part by the US Office of the National Coordinator for Health Information Technology through their University-based training (grant number T15OC000048).
Further Information

Publication History

received: 26 December 2016

accepted: 19 April 2017

Publication Date:
31 January 2018 (online)


Objective: To develop a heuristic framework for students to organize and apply the many concepts of informatics for rapid use.

Method: Organization of curriculum material and recurrent refinement by student feedback. An Informatics Stack was developed based on several existing informatics and software-development frameworks comprising several levels of abstraction, from what a system is supposed to accomplish (4 levels) to how it accomplishes it (5 levels). At each level, there are specific concerns, types of interoperability, ethical and legal issues, testing and evaluation approaches and methods, and relevant scientific disciplines, and privacy (upper 5 levels), confidentiality (middle 3 levels), and security (lower 4 levels ) concerns whose levels overlap. An 8-week Introduction to Informatics course was taught for 6 years to masters students of informatics and of public health, based on the Stack, with a Final Project continually filled in during the course, where students applied the Stack to existing reports describing health information systems and their deployments.

Results: Student feedback from 538 students working in 116 groups over 6 years shows near-universal appreciation that the Stack helped to organize their review of the report. Each student, from a wide variety of backgrounds, identified some level of the Stack as something they might have otherwise missed, and all levels were invoked by some student. Attributes identified by the students as missing from the Stack concerned the practicalities of system development.

Conclusion: The Stack is a broadly-encompassing heuristic whose application can be learned and applied by students from a wide variety of backgrounds in an 8-week course.

* Supplementary material published on our website

  • References

  • 1 Carraccio C, Wolfsthal SD, Englander R, Ferentz K, Martin C. Shifting paradigms: from Flexner to competencies. Acad Med 2002; 77 (05) 361-367.
  • 2 US Office of Management & Budget. Federal Enterprise Architecture Framework Version 2. 2013: 1-434. Available from:
  • 3 Pearl J. Heuristics: Intelligent Search Strategies for Computer Problem Solving. New York: Addison-Wesley; 1984
  • 4 Glaser JP. The role of the chief information officer in the health care organization in the 1990s. Top Health Inf Manage 1993; 13 (03) 62-68.
  • 5 Mantas J, Ammenwerth E, Demiris G, Hasman A, Haux R, Hersh W, Hovenga E, Lun KC, Marin H, Martin-Sanchez F, Wright G. Recommendations of the international medical informatics association (IMIA) on education in biomedical and health informatics. Methods Inf Med 2010; 49 (02) 105-120.
  • 6 Friedman CP, Wyatt JC. Evaluation methods in biomedical informatics. 2nd ed.. New York: Springer; 2006
  • 7 ISO/IEC 7498 Information processing systems - Open Systems Interconnection - Basic Reference Model. Geneva: 1989
  • 8 Medical School Objectives Project. Report II: Contemporary issues in medicine: Medical informatics and population health. Washington, DC: Association of American Medical Colleges; 1998
  • 9 The Logical Framework. Practical Concepts Incorporated. 1979 Available from:
  • 10 Friedman C, Rubin J, Brown J, Buntin M, Corn M, Etheredge L, Gunter C, Musen M, Platt R, Stead W, Sullivan K, Van Houweling D. Toward a science of learning systems: a research agenda for the highfunctioning Learning Health System. J Am Med Inform Assoc 2015; 22 (01) 43-50.
  • 11 Aho AV, Hopcroft JE, Ullman JD. Data Structures and Algorithms. Pearson; 1983
  • 12 Goodrich MT. Roberto Tamassia. Data Structures and Algorithms in Java. Hoboken, NJ: Wiley; 2014
  • 13 Stead WW, Sittig DF. Building a data foundation for tomorrow’s healthcare information management systems. Int J Biomed Comput 1995; 39: 127-131.
  • 14 Shortliffe EH, Cimino JJ. Biomedical Informatics: Computer Applications in Health Care and Biomedicine. New York: Springer; 2014
  • 15 HIMSS Davies Awards. 2015 [cited 2015 Sep 27]. Available from:
  • 16 The MAPS Toolkit: mHealth Assessment and Planning for Scale. Geneva: 2015
  • 17 Wysocki R, Beck R, Crane D. Effective Project Management. New York: Wiley; 1995
  • 18 Hoyt RE, Yoshihashi A. Health Informatics: Practical Guide for Healthcare and Information Technology Professionals. Pensacola, FL: Information Education; 2014
  • 19 Westbrook JI, Braithwaite J, Georgiou A, Ampt A, Creswick N, Coiera E, Iedema R. Multimethod evaluation of information and communication technologies in health in the context of wicked problems and sociotechnical theory. J Am Med Inform Assoc 2007; 14 (06) 746-755.
  • 20 Coiera E, Hovenga EJS. Building a sustainable health system. Yearb Med Inform. 2007: 11-18.
  • 21 Coiera E. Guide to Health Informatics. 3rd ed. Boca Raton, FL: CRC; 2014
  • 22 Brown GD, Patrick TB, Kalyan P. Health Informatics: A Systems Perspective. Arlington, VA: Health Administration Press; 2012
  • 23 Whetton S. Health informatics: a socio-technical perspective. Oxford; New York: Oxford University Press; 2005
  • 24 Magnuson JA, Fu PC. Public health informatics and information systems. 2nd ed. London: Springer; 2014
  • 25 Gardner RM, Overhage JM, Steen EB, Munger BS, Holmes JH, Williamson JJ, Detmer DE. Core Content for the Subspecialty of Clinical Informatics. J Am Med Informatics Assoc 2009; 16 (02) 153-157.
  • 26 AMIA Accreditation Committee. Foundational domains: Draft for public comment. 2016 [cited 2016 Dec 26]. Available from: