Postscripts: Noteworthy Mentions and Links

This posting is devoted to some postscripts on items covered in prior postings.

First, the public rollout of the Health IT Curriculum, funded by Office of the National Coordinator for Health IT (ONC), has received many mentions in the press. Among the more notable include:

• "In a rather amazing example of the taxpayers actually getting something for their money…"
• "A trove of free health information technology teaching materials for higher education has been opened…"
• "The Office of the National Coordinator for Health IT has publicly released teaching materials to help develop the nation's health IT work force..."

Second, a well-produced version of a recent talk of mine has been posted on YouTube by my colleagues in the Department of Biomedical Informatics at Ohio State University.

Follow-up from HIMSS

This year's Healthcare Information Management and Systems Society (HIMSS) Annual Conference in Orlando, Florida was interesting and enjoyable as always. Clearly the focus was on healthcare organizations and vendors achieving meaningful use of electronic health records (EHRs) . However, there was also plenty of other buzz on topics such as health information exchange, the impact of the departure of Dr. Blumenthal, and changes going on in Washington, DC.

There was also, of course, much talk about health IT workforce issues and the ONC Workforce Development Program. I was video-interviewed on aspects of the topic by:

• Joseph Conn of Modern Healthcare, who produced a six and a half minute video on workforce issues and educational programs
• Mary Stevens of CMIO Magazine, who produced a three and a half minute video on education and career opportunities for physicians, especially those aspire to be CMIOs.

New Data Reiterates Coming Need for Health IT Workforce

A recent survey from the College of Healthcare Information Management Executives (CHIME) provides additional data on the growing need for a skilled health IT workforce, with a particular need in "clinical software implementation and support staff." The survey was administered to healthcare CIOs in September, 2010 and had 182 respondents, representing 13% of CHIME's membership. A summary and full report of the survey are available.

The respondents came from a variety of hospital types and sizes, from large academic centers to small community hospitals. Interesting enough, the biggest needs, more than 20% staff shortages, were found at the big and small institution ends of the spectrum.

The highest proportion of open positions, as noted above, were in clinical software implementation and support staff, with 71% of CIOs reporting openings. The types of positions open included project managers, analysts, application coordinators, report writers, trainers, informatics staff, and technical staff. I really consider all of these positions to be in the realm of "informatics," or at least are positions for which informatics training would prepare one well.

One disappointing finding of the survey was half of the respondents reporting that they did not foresee additional spending on bolstering IT staff. On the other hand, most of the those organizations will be seeking their "meaningful use" incentive dollars, so hopefully their leadership can be convinced to invest in staff.

Healthcare organizations are not the only ones with needs and who are hiring. The EHR vendor Meditech reported that it will be hiring over 800 people in a new facility in Massachusetts. (Note to Oregon economic development leaders: There is opportunity for job creation in this field!)

These data are very consistent with a survey reported by HIMSS last spring, which had a total of 149 respondents. The survey found that 86% of organizations planned to hire additional IT staff in 2010. The areas respondents would most likely hire included implementation support specialists (55%), implementation managers (51%), and technical support (48%). The highest ranked area that organizations felt they lacked qualified candidates was clinical informatics (30%), followed by implementation expert (26%) and software maintenance expert (17%).

Finally, the consulting firm CSC, whose web site of reports on various aspects of meaningful use is one of my favorites, has produced a report on HIT workforce shortages. They summarize the research (including my study that used HIMSS Analytics data), describe the ONC workforce development programs, and discuss the implications to healthcare organizations. The latter include competition for qualified staff, inexperience among those newly trained, leading to lack of those with enough experience to assume leadership roles, attrition, and competition from other HIT tasks, such as ICD-10 implementation, HIPAA issues, and insurance exchanges.

The report's recommendations for overcoming these challenges is "expand, retain, and exploit," i.e., training and developing from within as well as exploring alternatives from outside the organization.

Of course, my advice is to hang tight, and hopefully the graduates from the newly funded ONC workforce development programs, including ours at OHSU, will start to fill the need soon.

The Dust Settles on HITECH Funding for Development of the Health Information Technology Workforce

One of the elements deemed essential for "meaningful use" of health information technology (HIT) as legislated in the Health Information Technology for Economic and Clinical Health (HITECH) Act of the American Recovery and Reinvestment Act (ARRA) was an adequately trained professional workforce. Section 3016 tasked the Office of the National Coordinator for Health IT (ONC) will developing programs to meet the needs for this workforce. Of the $2 billion allocated for HIT infrastructure in HITECH (to support the awarding of $36-40 billion in incentives for electronic health record adoption), a total of $118 million was allocated to four programs for workforce development.

The focus of this funding was on short-term training to develop professionals in 12 job roles (described in the Funding Opportunity Announcements and reproduced in an earlier posting in this blog). An analysis by ONC estimated a need for an additional 51,000 personnel above and beyond the existing HIT workforce. The bulk of these individuals fall into six of the job roles that will be trained in community colleges, while the remainder in the other six job roles will be trained in universities.

Three of the programs are focused on the community college training:

Community College Consortia to Educate Health Information Technology Professionals Program - This $70 million program establishes five regional consortia of 70 community colleges that will develop short-term certificate programs to train 10,000 individuals per year in the six community college job roles. Programs are expected to enroll their first students, most of whom will bring backgrounds in healthcare or information technology, by September 30, 2010.

Curriculum Development Centers Program - Because many of the community colleges in the new consortia do not have existing HIT educational programs, $10 million has been allocated to five universities with graduate-level educational programs to collaboratively develop (with community college partners) HIT curriculum for 20 components (topics). Members of the community college consortia will be able to use the components in whole (as courses) or in part. One of the five centers (Oregon Health & Science University) is additionally funded to serve as the National Training and Dissemination Center that will archive and distribute the curricula, train community college faculty in its use, and collect feedback to facilitate its improvement.

Competency Examination for Individuals Completing Non-Degree Training Program - Northern Virginia Community College has been provided a $6 million grant to develop and provide initial administration of a set of HIT competency examinations focused on the six community college job roles.

The fourth program is focused on university-based training:

Program of Assistance for University-Based Training - This $32 million training grant funds education of individuals in the six job roles requiring university-level training at nine universities (or consortia of universities). The funded programs will be able to use the funding as financial aid for students in their existing, mostly graduate-level, programs. The emphasis of the funding will be on short-term certificate programs delivered via distance learning, training about 500 individuals per year. While the focus of the program is on training individuals who will work in health care settings, some of the programs will also be training personnel to work in public health settings.

Taken together, these programs represent an unprecedented investment in HIT education and professional development. My hope is that not only will the individuals trained in these programs find rewarding careers in healthcare and public health organizations, regional extension centers, governments, and companies, but that biomedical/health informatics and related HIT disciplines will achieve more visibility as career options when the funding ends. Similar to information professionals in other industries, the need for these individuals will not go away when the HITECH funding ends.

OHSU Awarded $5.8 Million to Expand Health Information Technology Education

The "holding pattern" (see last post) has ended, and most of the ARRA/HITECH funding has now been awarded. Last week, OHSU received word that two grants for curriculum development and student financial aid from ARRA Section 3016 Health IT Workforce Development will be funded. In the near future, I will share more information and thoughts about the workforce funding programs, their implications for informatics education and the profession, and some of the other ARRA/HITECH-funded programs. In the meantime, however, I share below the text of the press release from OHSU.

04/07/10 Portland, Ore.

Oregon Health & Science University has been awarded $5.8 million in American Recovery and Reinvestment Act (ARRA) funds to advance the widespread adoption and meaningful use of health information technology (HIT) by educating professionals to work in this rapidly growing field.

The funding is provided in two competitively awarded grants. One will directly support the education of about 150 additional students over three years in OHSU’s biomedical informatics graduate program while establishing additional capacity that will meet the ongoing needs of an expanded work force. The other award will establish a national dissemination resource for health IT curricula at OHSU.

The stimulus funds, awarded by the Office of the National Coordinator for Health Information Technology, will enable OHSU to help educate the estimated 50,000 professionals needed to convert the entire country to electronic health records by the year 2014. The recovery act authorizes an estimated $40 billion to achieve this goal.

“We are delighted to be able to contribute to the national initiative to educate the health IT professional work force that will be required to lead the widespread adoption of electronic health records,” says William Hersh, M.D., professor and chairman of OHSU’s Department of Medical Informatics and Clinical Epidemiology. “This work force is a key requirement for achieving ‘meaningful use’ of health information technology that will help to improve the quality and safety of health care while lowering its costs.”

Through this recovery act funding, OHSU will provide financial aid for nearly 140 new students to enroll in and complete the university’s online Graduate Certificate Program in Biomedical Informatics. The funding also will allow at least 12 students to enroll in and complete OHSU’s on-campus master's degree program. All financial aid under this grant is for students in graduate-level programs requiring a minimum of a bachelor’s degree for admission.

Students receiving financial aid will be required to choose among six career paths:
• Clinician/public health leader
• Health information management and exchange specialist
• Health information privacy and security specialist
• Research and development scientist
• Programmers and software engineer
• Health IT sub-specialist

The eight-course graduate certificate program is entirely online and and can be completed in two to three academic quarters. Students who are funded through this program will receive support for their tuition expenses and must complete its requirements within one year.

The master’s degree program requires about 1½ years of full-time study. The funding will not only provide these students with tuition support, but includes a stipend and student health insurance.

“Biomedical informatics is a growing field with opportunities for people with a variety of backgrounds, especially in health care, computer science and information technology,” added Hersh. “Although this funding is focused on training professionals to implement electronic health records, there are numerous other career opportunities in such areas as personal health records, telemedicine, clinical and translational research, and bioinformatics.”

The National Training and Dissemination Center will support a total of five Curriculum Development Centers, one of which will be housed at OHSU. Together, the five centers will develop curricula for the five community college consortia being established to train community college students in HIT. These curricula will also be made available to institutions of higher education throughout the nation. The National Training and Dissemination Center will house the curricula on a dedicated Web site, train community college faculty in its use, and collect and disseminate feedback on its content.

The Curriculum Development Center at OHSU is a partnership between OHSU and four local community colleges — Portland Community College, Mt. Hood Community College, Lane Community College and Umpqua Community College.OHSU and community college faculty will collaborate to tailor the curricula for community college students.

OHSU is an established national leader in health information technology education. Its existing educational programs are among the largest in the country, and it has led many innovations, such as the 10x10 (“ten by ten”) program in partnership with the American Medical Informatics Association, which aims to train 10,000 health care professionals in biomedical informatics by the year 2010.

Students will be able to enroll in the new programs this fall. More information about student financial aid opportunities will be available on the OHSU Department of Medical Informatics and Clinical Epidemiology Web site in early May. In the meantime, for descriptions of the Graduate Certificate and Master’s degree programs or to sign up to receive further information when it becomes available visit: http://www.ohsu.edu/dmice.

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.

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.

The workforce for meaningful use

The discussion about health IT workforce continues to heat up as health care organizations realize that achieving meaningful use of electronic health records will require not only hardware and software, but people who have the expertise to make it happen. That expertise requires as much an understanding of information use and analysis, clinical organization and workflow, and business and management as it does IT, i.e., the substance of informatics.

One recent article describes a developing "war on talent" for health IT workers. The same publication features another article about how health care organizations are "racing" to fill CIO positions.

Finally, an IT publication describes why "your next job may be in health care."

By the way, many people ask me where they can read a succinct overview about "meaningful use," and I have found a nice 6-pager by David Classen of CSC. Of course, the "ground truth" comes from the matrix recommended by the Office of the National Coordinator to CMS, who will set the final rules in the near future.