Monday, May 11, 2009

Crossing the Health IT People Chasm

I was recently at a dinner with Dr. Mark Leavitt, Chairman of the Certification Commission for Health Information Technology (CCHIT), who noted that the gap between the American Recovery and Reinvestment Act (ARRA) vision for health information technology (HIT) and our current status comes down to people. We have the technology already, and the money now with ARRA, but we still need the people, from the clinicians who will use the systems to the administrators who will fund them and the HIT professionals who will develop and implement them.

To borrow from the parlance of one of the early Institute of Medicine (IOM) reports that spurred health care's interest in HIT, we have a "chasm" between where we currently are and where we need to be.

A partial bit of good news is that some people are starting to do things to cross this chasm. Clearly one place we need to start is with the ultimate users of HIT, the clinicians and others in the health care trenches. We need to make it easy for them to use systems, not only to get data in and out, but also to use them to improve their practices by measuring quality and improving it by acting on the deficiencies they uncover. We also need to make it easier for administrators and others who run health care systems to make the investments in them, knowing they will benefit the care delivered and the bottom line.

And of course, another area where we need people is my passion, which is the HIT workforce. Unfortunately, most people still don't know exactly what biomedical and health informatics is all about. Some people who work in the field don't even agree with each other on its definition. Nonetheless, I believe that most people who do know about the field will agree that its work is absolutely essential to pull off the goals for HIT in the ARRA legislation. This is part of the reason for Section 3016 in the stimulus bill, which calls explicitly for a well-trained informatics workforce to carry out the health IT adoption elsewhere in the bill.

One challenge for the field of biomedical and health informatics is the heterogeneous nature of careers and education in the field. People who are called informaticians perform a variety of jobs from the highly technical development and implementation of hardware and software to the more people-oriented tasks of project management and institutional leadership. As such, there is no single career or educational pathway in this field.

But there is one attribute that defines people who call themselves informaticians, which is that they understand health care, IT, and the uniqueness that occurs at their intersection. This was pointed out in an article in the New York Times recently, which featured a quote from myself about how informatics was different from IT in being more focused on information and how it is used to improve health care than technology.

While most education in this field has historically been at the graduate level, combining careers in health professions, IT professions, and others, it is key to pay attention to the pipeline of the community colleges, undergraduate institutions, and others. We need to get the word out about the great opportunities and the career satisfaction that comes from working in this field. I would be interested in hearing from others on how to do that.

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