Saturday, December 5, 2009

Two new international workforce studies

Things are really heating up in the health information technology (HIT) workforce arena! Not only have two new workforce analyses from abroad been published, but in the US, the long-anticipated Funding Opportunity Announcements (FOAs) for HIT workforce development, as specified in Section 3016 of the American Recovery and Reinvestment Act (ARRA), have been released by the Office of the National Coordinator for Health IT (ONC).

The first workforce study comes from Australia (Legg, M. and Lovelock, B., 2009. A Review of the Australian Health Informatics Workforce. Melbourne, Australia: Health Informatics Society of Australia). Commissioned by the Health Informatics Society of Australia (HISA), this analysis looked at the "health informatics" workforce in that country. The authors defined health informatics for the purposes of its analysis, although also noted that this definition was likely incomplete. The study was carried out in two steps consisting of two focused workshops with a small number of people and then a larger survey that was distributed to all members and anyone who ever participated in any HISA activity. A total of 1,279 (out of 6,434 possible) people completed the latter.

The study classified jobs into two broad categories:
  1. Those who work "in the system," e.g., to use their words: records, analysis, direct, decision, communications, and training
  2. Those who work "on the system," e.g., to use their words: systems, infostructure, improvement, education, resource, and administration
The study characterized the work of these individuals by categories (many performed more than one) and also captured data on perceived needs for education, training, and expansion of the workforce. The authors concluded with a number of recommendations for expansion and improvement of the workforce.

On the issue of workforce size, the authors made several estimates, all of which came out with a relatively consistent range. This included the use of government employment statistics for health information management and IT professionals in health care. The authors also made a quick calculation based on my own previous research (of other research studies) finding a ratio of 1 IT worker per 50 non-IT workers in healthcare settings. The bottom line is an estimate of around 12,000 health informatics professionals (range 9,000-15,000) in a country with a population of approximately 21 million. (This number is not that far off the proportionate number of people identified for the United States in my HIMSS Analytics Database study, i.e., 108,390 IT personnel, perhaps along with 10,000 informaticians and 50,000 need for the ARRA EHR agenda, in a country of over 300 million.)

The study also reported that participants consistently expressed concern about a pending shortage of personnel, for which the authors proposed a number of solutions. These included efforts to increase the supply of workers through training and re-training, improving their productivity, and reducing demand through better design of systems and processes.

The second workforce study comes from Canada (O'Grady, J., 2009. Health Informatics and Health Information Management: Human Resources Report. Toronto, Ontario, Prism Economics and Analysis). It focused on professionals defined as working in the fields of health informatics and health information management . This study attempted to characterize job roles and activities, quantify the workforce, and anticipate future needs based on low, medium, and high growth scenarios. (They also noted that Canada was similar to the US and different from most Western European countries in being a laggard in the adoption of HIT.) Similar to other studies, they used a variety of techniques, including government employment statistics. They calculated needs based not only on growth in use of HIT but also replacement of those retiring or otherwise leaving the workforce.

The study looked at seven categories of workers, assessing job roles and specific challenges for each. In aggregate, the authors estimated current HIT employment in Canada at 32,450, broken down among the job categories as follows (approximately):
  1. Information Technology - public sector 11,000-13,000, private sector 5,000-6,000
  2. Health Information Management - 4,300-5,800
  3. Canadian Health System Management and Administration (counted in Analysis and Evaluation)
  4. Project Management - public sector 760-900, private sector 1,100-1,300
  5. Organizational and Behavioral Management - public sector 1,100-1,300, private sector 1,900-2,300
  6. Analysis and Evaluation - 3,300-3,900
  7. Clinical Informatics - public sector 600-710, private sector 380-450
The growth scenarios were based on the following (interesting) assumptions:
  • Low growth - across the board expenditure cuts by the Canadian health system
  • Medium growth - deferring of some capital investments
  • High growth - HIT investment unaffected by changes in health care spending
The cumulative employment growth for all categories combined to 2014 would then be:
  • Low growth - 7.6% growth to 35,020
  • Medium growth - 14.3% growth to 37,200
  • High growth - 26.1% growth to 41,030
For a country with a population of 33 million, these numbers are similarly proportionate to the Australian and US data!

The study also noted that Canada, like most countries, will face a substantial training need for many current and future personnel. Not only does 27% of the current 2009 workforce require additional formal training and experience, but 39%, 59%, or 78% of the 2014 workforce will require additional training under the low, medium, and high growth scenarios respectively.

So clearly Australia and Canada have major HIT training needs. Of course, so does the United States, as noted by my HIMSS Analytics Database study as well as recent estimates by ONC. To that end, two FOAs were recently released by the ONC to address workforce needs, as specified by Section 3016. These will be addressed in another posting soon.

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