Tuesday, October 23, 2012

Health IT Workforce Policy: Roundtable with Rep. Susanne Bonamici

The First Congressional District of Oregon has a history of leadership in health information technology (HIT) workforce policy. As one who lives in the district, I am delighted that its Congressional representative, Susanne Bonamici, is holding a roundtable discussion on HIT workforce policy this week. I am honored to participate, especially in light of my role on the Workforce Group of the Office of the National Coordinator for HIT (ONC) HIT Policy Committee. Of course I also lead the informatics education program at Oregon Health & Science University (OHSU), an institution of which many employees are constituents of Rep. Bonamici and which is a well-known leader in HIT workforce development.

According to Rep. Bonamici, "As Oregon leads the nation in developing coordinated health delivery systems, the role of technology in managing information flow between patients, providers, and insurance companies will become increasingly important. The results of this roundtable discussion will inform legislative and oversight actions in the health IT field for the 113th Congress." She has further elaborated three topics for the roundtable:
  • What can be done to better prepare practitioners to effectively use health IT and electronic health records?
  • How can technology developers better design their products to fit with workflow in a medical setting?
  • Does current curriculum adequately prepare technology developers and future medical service providers to meet industry and patient needs?
I heartily concur with her statement about Oregon's leadership in coordinated delivery systems and the importance of information in such systems. Regardless of one's political views, or the fate of "Obamacare" after next month's Presidential election, our healthcare system needs to become more coordinated, patient-centered, and focused on rewarding value over quantity of care. This vision is exemplified by the recent report from the Institute of Medicine, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, which makes a compelling case for a learning health care system infused with all aspects of HIT and informatics.

I also agree with the importance of the topics she raises. Namely, how do we prepare healthcare professionals to work in a data-driven healthcare system that strives for value and coordination of care? Likewise, what sort of professional workforce do we need to optimize information systems and their use? How do we best train that workforce and do so in a cost-effective manner? How do we nurture the industry in which they work? How do we advance the science, practice, and innovation?

What advice do I have for Rep. Bonamici concerning HIT workforce development? Since her first topic mentions the training of clinicians, I will begin there. In this realm, we need to insure that 21st century healthcare professionals are knowledgeable and savvy in their use of HIT to deliver optimal care, not only to individual patients, but entire populations. Current practitioners will need to be brought up to date through continuing education, while students will require their curricula to be updated to reflect what it takes to provide care in a data-driven learning healthcare system. Probably the best way to deliver this care is through the growing push for "interprofessional" education that brings all future healthcare professionals in the same classroom, preparing them to work in the future care system that is increasingly coordinated and team-based.

Delving further, all current and future healthcare professionals need to learn about tools that capture data and transform it into information and knowledge that can be used for both individual and population-based care. As such, these clinicians need to have competency in the following:
  • Understanding the importance of the efficient and accurate collection of data not only for the electronic health record (EHR) of their delivery organization, but also how that data will populate other sources, such as personal health records (PHRs), health information exchange (HIE), and the public health system
  • While not needing the detailed knowledge of informaticians, healthcare practitioners must learn the informatics basics of data standards, interoperability of clinical data systems, and clinical decision support
  • Understanding the critical need to protect patient privacy and confidentiality
  • Have skills in finding pertinent and reputable sources of knowledge to be applied to patient care, i.e., being expert in searching knowledge sources, from scientific literature (e.g., Pubmed) to summary textbooks and related sources
  • Being able to deliver care in teams, using data and information to plan and guide care
  • Mastering the concepts of healthcare quality measurement and improvement, i.e., understanding the rationale but also the limitations of quality measures, and how electronic data systems will facilitate them
  • Being able to look forward and see other changes coming to healthcare in the future, such as personalized medicine, based on genomics and bioinformatics, and the role that it will play in the delivery of healthcare
  • Understanding the ways that care is delivered over telecommunications networks, i.e., telemedicine and telehealth
  • Be competent in the use of a wide variety of information devices, from computers to tablets to smartphones and the networks to which they connect
Implementing this vision and putting the technology and skills to use it will not come without the help of HIT and informatics professionals. The future HIT workforce must be ready to develop, implement, and evaluate HIT systems. These professionals will certainly need to be savvy with technology, but they will also need to be highly knowledgeable in the science and best practice of informatics to make sure these tools serve clinicians, patients, and the healthcare system. They must also be cognizant of the concerns of how HIT impacts workflow and patient safety. We must also adapt the curricula of our educational programs for future HIT professional workforce needs by increasing our experiential learning and preparing for "big data," predictive analytics, and advanced forms of clinical decision support.

Also, in settings like the First Congressional District, with its Silicon Forest, we will need to train additional individuals who will innovate and lead in industry. Our informatics program at OHSU has been working for some time to increase its collaboration with the HIT industry. It must be remembered that not only does HIT have the potential to improve health and healthcare, but in places like the First Congressional District, it can also contribute to economic development.

There must also be a cadre of academic informaticians who perform research and develop the future. In addition to education, a wide variety of innovative informatics research takes place at OHSU. Examples of the areas addressed include:
  • Care coordination - the Integrated Care Coordination Information System (ICCIS) project led by Dr. David Dorr collects data and it makes available for analysis to enhance coordination of care.
  • Secondary use of clinical data - my own research involves the development of data sets to augment the development of systems and algorithms to allow re-use of data in clinical systems.
  • EHR simulation for patient safety - working with intensive care physician Dr. Jeffery Gold, we are developing realistic simulations to improve both users of EHRs and the systems themselves.
As in most scientific fields, government has funded the basic research that industry does not. Exemplary government agencies that support this research include the National Library of Medicine (NLM) and the Agency for Healthcare Research and Quality (AHRQ). I encourage Rep. Bonamici to continue her support for NLM and AHRQ, and encourage her to be in the lead in making sure to maintain and consider increasing their funding.

Another policy challenge going forward will be to maintain the investment made through the HITECH Act. Educational institutions associated with the First District were highly successful in competing for funding provided through the HITECH workforce development programs. OHSU has delivered on the work it was funded to do under the two programs for which grants were awarded to it:
  • Development of national HIT curriculum, which focused initially on community colleges but then generalized to all institutions of higher education. OHSU served as one of five curriculum development centers as well as served as the National Training and Dissemination Center (NTDC) that distributed and supported the curriculum.
  • Educating its share of students in the University-Based Training (UBT) Program. Most of our graduates have been highly successful in fulfilling the roles envisioned for them in the expanding HIT workforce.
Now, of course, the HITECH funding is winding down, ending in early 2013 for the curriculum project and mid-2013 for the UBT program. While student tuition and other sources of funding will fill in some of the declining federal investment, there is still a case for investing in the common good of educating not only the HIT workforce, but also clinicians who use HIT in a more coordinated and learning healthcare system.

I hope that Rep. Bonamici can spur the entire community, from academia to industry to healthcare organizations, to work together to improve healthcare delivery as well as advance the HIT industry. Both are vital to the future health and economic well-being of Oregonians.

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