eHealth Initiative Report on Hiring in Health Information Exchanges

The eHealth Initiative (eHI), a health information exchange (HIE) advocacy group, recently released a report stating that while HIEs are likely to generate jobs in health information technology (HIT), few of those jobs have gone to those trained by the workforce development programs of the Office of the National Coordinator for Health Information Technology (ONC). As one who is associated with the ONC workforce development programs, I was naturally alerted to the report as well as an article in the trade publication, Health Data Management.

My overall reaction to the eHI report is that while I do not disagree what its findings and conclusions, I do believe those findings and conclusions need to be viewed as part of a larger perspective about HIE and HIT employment. I also believe that the reporting of the methodology used for the report is incomplete, leading to some uncertainty about the meaning of its findings and conclusions. In particular, I wonder whether the report authors or those surveyed fully understand the ONC workforce program or even the HIT workforce itself. There may be more information about this report in one of eHI's proprietary publications, but I cannot find anything on their Web site. (Although I support the work of eHI, I am not a member.)

I do acknowledge up front that I have a vested interest in the ONC workforce development program. I am funded on two grants, one devoted to curriculum development for the six-month community college programs and another for university-based training in the Oregon Health & Science University (OHSU) graduate program in biomedical informatics. I also believe it is fair for anyone to question the value of these programs and whether the investment being made is productive.

My main problem with the report is that its methodology is incompletely described. To begin with, the report itself has no listed author(s) or contact information. Who carried out this report and how can they be contacted?

A related concern is whether those who developed the report's survey or those who answered it are sufficiently knowledgeable about the ONC workforce program itself.  The report does not describe how the question(s) about the ONC programs was/were asked or how knowledgeable the respondents were about the different programs. Many people, for example, are unaware that the program is larger than just the six-month community college certificate programs. Are they knowledgeable, for example, of the university-based training (UBT) programs, which have a workforce role called "Health Informatics Management & Exchange Specialist" that is likely to be most amenable to work in HIEs? This workforce role has been the most subscribed workforce role among the six covered by the UBT programs.

By the same token, the report does not put employment within HIEs in perspective. While I certainly believe that HIEs are a critical element to the larger success of HIT adoption, it is important to remember that the number of people employed in HIEs will be a relatively small part of the overall HIT workforce. For any given state or region, there are many healthcare organizations whose HIT systems will feed into one or a small numbers of HIEs. Although there will be many important jobs for those who implement, lead, and utilize HIEs, their numbers will be modest relative to the large number of HIT professionals in hospitals, physician offices, and other health-related organizations. It is just simple math.

Also important to remember is that many HIEs are still early in development, where the critical skills are more around planning and development than implementation. It is not surprising to see consultants being heavily used, as opposed to professionals just out of their education programs without a great deal of workforce experience. Related to this, the report seems to look only at direct hiring of ONC workforce program graduates by HIEs. We do not know how many graduates of ONC programs work for consultants, vendors, or others as opposed to being hired directly by HIEs, on which the report seems to focus

We also need to remember that HIE jobs vary in the same way that HIT and clinical informatics jobs do. As such, those trained in the ONC programs might not be a fit for the jobs available in HIE. In fact, it is likely that HIE jobs require a great deal of HIT workforce experience, which ONC workforce program graduates by definition do not have.

The Health Data Management article also goes off on a tangent and raises some issues about the ONC HIT curriculum. Some of these are valid criticisms, but it is also important to remember that these curricular materials are designed for HIT teachers, who are encouraged to use them creatively to offer a meaningful learning experience and not just a rote curriculum out of the box. Some of the community colleges have done this better than others in this regard.

While I applaud eHI for brining the workforce issue in the context of HIE to light, I also believe that their report raises more questions than it answers. I do hope that someone will come forth and explain the details of the report's methodology and its findings. I will certainly make a postscript to this entry in my blog if anyone does so. I also encourage dialogue about the value of the ONC workforce programs and how we can improve them not only for content, but also the employability of their graduates.