HIT Workforce: The ONC View

For those of us who are students of health information technology (HIT) workforce issues, the new funding opportunity announcements (FOAs) from the Office of the National Coordinator for Health Information Technology (ONC) provide an interesting glimpse into their view of the HIT workforce needed to meet the electronic health record (EHR) adoption goals of the American Recovery and Reinvestment Act (ARRA) of 2009. ONC Coordinator Dr. David Blumenthal gives a high-level vision of their approach in his blog.

In the FOAs, ONC lays out the job roles and competencies for the workforce that they believe is necessary to achieve meaningful use of EHRs. The information is spread out over the different FOAs, but I have attempted to bring it into a single narrative, which follows in this posting. The content for this posting was largely created by copy and paste from the ONC documents but I assume full responsibility for any errors introduced in my process. This is the workforce that ONC hopes to see trained with its $118 million investment in the four FOAs.

The roles are grouped into three general categories. Those with an asterisk (*) are slated to have training take place in community colleges, while those with a dagger (†) will have training occur in university-based settings. I will first list the categories and roles, and then provide more details on the roles and their competencies. (Again, to be clear, I am cutting and pasting from ONC documents, so this is not my work, but I do assume responsibility for any errors that I introduce.)

Category 1: Mobile Adoption Support Roles
These members of the workforce will support implementation at specific locations, for a period of time, and when their work is done, will move on to new locations. They might be employed by regional extension centers, vendors, or state/city public health agencies.

• Implementation support specialist*
• Practice workflow and information management redesign specialist*
• Clinician consultant*
• Implementation manager*

Category 2: Permanent Staff of Health Care Delivery and Public Health Sites

These roles are needed for ongoing support of health IT at office practices, hospitals, health centers, Long Term Care (LTC) facilities, health information exchange organizations and state and local public health agencies.

• Technical/software support staff*
• Trainer*
• Clinician/public health leader†
• Health information management and exchange specialist†
• Health information privacy and security specialist†

Category 3: Health Care and Public Health Informaticians

These individuals will be based in universities, research centers, government agencies, and research and development divisions of software companies.

• Research and development scientist†
• Programmers and software engineer†
• Health IT sub-specialist†

Now, here are the roles and their competencies in more detail.

Mobile Adoption Support Positions

These members of the workforce will support implementation at specific locations for a period of time, and when their work is done, will move on to new locations. Workers in these roles might be employed by regional extension centers, providers, vendors, or state/city public health agencies, and would work together in teams. Preparation for this set of roles will typically require six months of intense training for individuals with appropriate backgrounds

1. Practice workflow and information management redesign specialists
Workers in this role assist in reorganizing the work of a provider to take full advantage of the features of health IT in pursuit of meaningful use of health IT to improve health and care. Individuals in this role may have backgrounds in health care (for example, as a practice administrator) or in information technology, but are not licensed clinical professionals. Workers in this role will:

• Conduct user requirements analysis to facilitate workflow design
• Integrate information technology functions into workflow
• Document health information exchange needs
• Design processes and information flows that accommodate quality improvement and reporting
• Work with provider personnel to implement revised workflows
• Evaluate process workflows to validate or improve practice’s systems

2. Clinician/practitioner consultants
This role is similar to the “redesign specialist” role listed above but brings to bear the background and experience of a licensed clinical and professional or public health professional. In addition to the activities noted above, workers in this role will:

• Suggest solutions for health IT implementation problems in clinical and public health settings
• Address workflow and data collection issues from a clinical perspective, including quality measurement and improvement
• Assist in selection of vendors and software
• Advocate for users’ needs, acting as a liaison between users, IT staff, and vendors

3. Implementation support specialists
Workers in this role provide on-site user support for the period of time before and during implementation of health IT systems in clinical and public health settings. The previous background of workers in this role includes information technology or information management. Workers in this role will:

• Execute implementation project plans, by installing hardware (as needed) and configuring software to meet practice needs
• Incorporate usability principles into design and implementation
• Test the software against performance specifications
• Interact with the vendors as needed to rectify problems that occur during the deployment process

4. Implementation managers
Workers in this role provide on-site management of mobile adoption support teams for the period of time before and during implementation of health IT systems in clinical and public health settings. Workers in this role will, prior to training, have experience in health and/or IT environments as well as administrative and managerial experience. Workers in this role will:

• Apply project management and change management principles to create implementation project plans to achieve the project goals
• Interact with office/hospital personnel to ensure open communication with the support team
• Lead implementation teams consisting of workers in the roles described above
• Manage vendor relations, providing feedback to health IT vendors for product improvement

Permanent Staff of Health Care Delivery and Public Health Sites

These roles are needed for ongoing support of health IT that has been deployed in office practices, hospitals, health centers, long-term care facilities, health information exchange organizations and state and local public health agencies. Preparation for this set of roles will typically require six months of intense training for individuals with appropriate backgrounds.

5. Technical/software support staff
Workers in this role maintain systems in clinical and public health settings, including patching and upgrading of software. The previous background of workers in this role includes information technology or information management. Workers in this role will:

• Interact with end users to diagnose IT problems and implement solutions
• Document IT problems and evaluate the effectiveness of problem resolution
• Support systems security and standards

6. Trainers
Workers in this role design and deliver training programs, using adult learning principles, to employees in clinical and public health settings. The previous background of workers in this role includes experience as a health professional or health information management specialist. Experience as a trainer in from the classroom is also desired. Workers in this role will:

• Be able to use a range of health IT applications, preferably at an expert level
• Communicate both health and IT concepts as appropriate
• Assess training needs and competencies of learners
• Design lesson plans, structuring active learning experiences for users
• Track training records of the users and develop learning plans for further instruction

7. Clinician/Public Health Leader
By combining formal clinical or public health training with training in health IT, individuals in this role will be able to lead the successful deployment and use of health IT to achieve transformational improvement in the quality, safety, outcomes, and thus in the value, of health services in the United States. In the health care provider settings, this role may be currently expressed through job titles such as Chief Medical Information Officer (CMIO), Chief Nursing Informatics Officer (CNIO). In public health agencies, this role may be currently expressed through job titles such as Chief Information or Chief Informatics Officer. Training appropriate to this role will require at least one year of study leading to a university-issued certificate or master’s degree in health informatics or health IT, as a complement to the individual’s prior clinical or public health academic training.

8. Health Information Management and Exchange Specialist
Individuals in these roles support the collection, management, retrieval, exchange, and/or analysis of information in electronic form, in health care and public health organizations. We anticipate that graduates of this training would typically not enter directly into leadership or management roles.

9. Health Information Privacy and Security Specialist
Maintaining trust by ensuring the privacy and security of health information is an essential component of any successful health IT deployment. Individuals in this role would be qualified to serve as institutional/organizational information privacy or security officers.

Health Care and Public Health Informaticians

These individuals will be based in universities, research centers, government agencies, and research and development divisions of software companies.

10. Research and Development Scientist
These individuals will support efforts to create innovative models and solutions that advance the capabilities of health IT, and conduct studies on the effectiveness of health IT and its effect on health care quality. Individuals trained for these positions would also be expected to take positions as teachers in institutions of higher education including community colleges, building health IT training capacity across the nation.

11. Programmers and Software Engineer
We anticipate that these individuals will be the architects and developers of advanced health IT solutions. These individuals will be cross-trained in IT and health domains, thereby possessing a high level of familiarity with health domains to complement their technical skills in computer and information science. As such, the solutions they develop would be expected to reflect a sophisticated understanding of the problems being addressed and the special problems created by the culture, organizational context, and workflow of health care.

12. Health IT Sub-specialist
The ultimate success of health IT will require, as part of the workforce, a relatively small number of individuals whose training combines health care or public health generalist knowledge, knowledge of IT, and deep knowledge drawn from disciplines that inform health IT policy or technology. Such disciplines include ethics, economics, business, policy and planning, cognitive psychology, and industrial/systems engineering. The deep understanding of an external discipline, as it applies to health IT, will enable these individuals to complement the work of the research and development scientists described above. These individuals would be expected to find employment in research and development settings, and could serve important roles as teachers.