Wednesday, October 9, 2013

Further Evidence That Health IT Job Growth Has Been Underestimated, and Some Ramifications

New data from an analysis of online job postings confirms that employment growth in health information technology (HIT) has even further exceeded projections, driven by funding from the Health Information Technology for Economic and Clinical Health (HITECH) Act. In addition, two other reports show that the job market for those working with electronic health record (EHR) and related systems continues to be strong for employees and challenging for employers.

In the new analysis, Schwartz and colleagues used a comprehensive database of 84 million online job postings,  extracted out those related to HIT, and built a model aiming to determine the influence of HITECH [1]. The authors limited their focus to jobs that would be defined in the realm of clinical informatics. Although this was important for their goal of assessing the influence of HITECH, from the perspective of a biomedical informatics graduate program director like myself, this excluded other important informatics jobs, such as those in imaging informatics, bioinformatics, clinical research informatics, and other areas where a graduates of our program are employed.

The analysis classified jobs into two broad categories, HIT core jobs and HIT clinical user jobs. The former category included those developing, implementing, supporting, and selling EHRs, while the latter included clinicians, receptionists, technicians, and other personnel making heavy use of EHRs in their jobs. Wearing my informatics educational program director's hat, I was most interested in the authors' results for the HIT core job listings, as these individuals would be most likely to be employed in (and to seek education preparing them for) informatics careers.

Schwartz et al. counted a total of HIT-related 434,282 job postings between 2007-2011, with 226,356 HIT core jobs and 207,926 HIT-related clinical user jobs. Yes, not 41,000 [2], not even 51,000 [3], but over 226,000!

For both categories of HIT jobs combined, the authors categorized employer type and provided a percentage of all HIT jobs for each. The largest employer category was IT vendor, which included IT service providers, consulting firms, sales firms, and IT staffing firms hiring developers and posted 42% of all HIT-related listings. Another 39% were posted by healthcare provider organizations. The remaining 19% were either ambiguous as to the employer type (15%) or another type of employer (4%).

For all HIT jobs, they also categorized and tallied job responsibilities, which could be assigned to more than one category for a given posting. The most frequent job responsibility was implementation support, with 43% of jobs including responsibilities such as system installation, customization, building, debugging, purchasing, or workflow redesign. The next highest category was user training (27%), followed by system development (22%). This was followed by technical support, with 21% of jobs including the maintaining of continued technical functionality or providing customer support. Other responsibilities included IT strategy (long-term IT planning and system optimization in the clinical setting - 13%), sales (11%), and research (quantitative hypothesis testing using health IT systems - 6%).

Their model estimated that about 48% of the job growth was due to HITECH, with the remainder due to growth that would have continued at historical trends prior to HITECH. Some other interesting findings for the time period between 2007-2011 included HIT jobs growing from 0.75% to nearly 2.5% of all healthcare job postings (consistent with prior findings of healthcare organizations hiring one IT employee per 48-60 non-IT employees [2]) and an approximately four-fold increase in the number of jobs posted.

It will remain to be seen how strong the job market remains as the HITECH incentives wind down, although HIT will continue to be a cost of doing business in healthcare, especially as the system moves to payment models that require better management and use of data, such as accountable care organizations and primary care/patient-centered medical homes [4].

Two other reports show that healthcare organizations are responding to the need for hiring and maintaining more HIT talent. A report by Towers Watson that surveyed 100 healthcare organizations [5] found that 67% of reported problems in attracting experienced IT employees, with an even higher proportion (73%) finding problems hiring Epic-certified employees. These organizations also reported problems in retaining experienced IT employees (38%) and Epic-certified employees (52%) as well. Many fewer organizations reported problems in attracting (14%) or retaining (9%) new graduates with IT skills, indicating a strong incentive for those early in their careers to get up to speed quickly.

The Towers Watson report also discerned differences between employees and employers in the drivers of attracting and retaining IT personnel. For attracting personnel, employees listed job security and salary as their primary concerns, whereas employers believed that challenging work and organizational reputation were key drivers. There was more concordance on drivers of IT employee retention, with both employees and employers ranking salary and opportunities for career advancement highest.

The second report was the first of what will be an annual survey of the HIT workforce by HIMSS Analytics [6]. The survey was completed by 224 individuals who were HIMSS corporate members as well as hospital and health system IT executives. About three-quarters of respondents were employed by healthcare provider organizations, including standalone hospitals (45%), hospitals as part of an integrated delivery system (17%), and corporate offices of a delivery system (13%). The remaining respondents worked vendor organizations, including companies (20%) and consulting firms (4%).

Over 80% of healthcare provider organizations reported adding IT FTE in the past year, with half hiring 1-5 FTE and the rest hiring more. Only 8% reporting laying off staff. The most common areas for hiring were clinical application support (51% of all healthcare provider organizations hiring), help desk (51%), IT management (29%), financial application support (28%), system design and implementation (24%), IT security (22%), project management (21%), clinical informatics/clinical champion (19%), system integration (19%), user training (15%). About three-quarters of provider organizations outsourced rather than hired some of the above types of personnel. Essentially similar percentages were seen in hiring plans for the coming year.

A similar picture was seen for vendors and consultants for the past year, with over 90% adding FTE, and nearly 60% hiring more than 20 FTE. Most common areas for hiring included sale and marketing (88%), field support staff (84%), support staff (68%), and executive team (58%). Nearly a third reported laying off some staff. Similar to provider organizations, comparable percentages were noted in hiring plans for the coming year.

Various types of certification were deemed important, more so vendors than healthcare provider organizations. The most highly rated certifications were security professional, network/architecture support, database administrator, project manager, and informatics professional.

Strategies for retaining qualified staff were also important for providers and vendors, including offering professional development activities (60% for providers, 64% for vendors), paid tuition (48%, 41%), membership payment in professional associations (35%, 41%), and telecommuting (29%, 52%).

About 80% of providers and 57% of vendors reported lack of fully qualified staff as a barrier to achieving organizational IT goals. The most common reason for lack of staff was lack of qualified staff in their local region (43%, 56%). Both types of organizations reported hires being attracted to other organizations by more lucrative offers (25%, 19%). About 31% of provider organizations reported putting an IT initiative on hold due to inadequate staffing, with another 19% contemplating doing so.

Overall, these new data show that the HIT job market is robust, and provides great opportunities for a career. Of course, like essentially all professional areas these days, the job market will change. This will be driven in HIT by the tapering of the incentive funding from HITECH and the shift from implementing to optimizing (i.e,, making use of the data) systems. This will require that the skill sets of professionals, and the curricular content of educational programs, adapt to (or ideally anticipate) the likely changes.


1. Schwartz, A, Magoulas, R, et al. (2013). Tracking labor demand with online job postings: the case of health IT workers and the HITECH Act. Industrial Relations: A Journal of Economy and Society. 52: 941–968.
2. Hersh, W (2010). The health information technology workforce: estimations of demands and a framework for requirements. Applied Clinical Informatics. 1: 197-212.
3. Conn, J (2010). 50,000 new health IT workers might be needed. Modern Healthcare, May 25, 2010.
4. Anonymous (2011). Support for Accountable Care: Recommended Health IT Infrastructure. Washington, DC, eHealth Initiative.
5. Anonymous (2013). Closing the IT Talent Gap in Health Care - The Towers Watson 2013 Health Care IT Survey Report, Towers Watson.
6. Anonymous (2013). 2013 HIMSS Workforce Survey. Chicago, IL, HIMSS Analytics.

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