Workforce Development Essential to Obama's Health Care IT Initiative

The American Recovery and Reinvestment Act includes more than $19 billion over the next two years to move the U.S. health care system toward widespread adoption of information technology systems. The assumption is that broad implementation of a modern health care information technology system could save the U.S. $80 billion annually.

This is only true, however, if technological investment is accompanied by strategic investment in human capital.

We are just beginning to understand what it takes to build an effective national (or even local) integrated health IT system and most health care technology leaders agree that we do not have sufficient or appropriately skilled workers for the current projects underway. A recent analysis of the U.S. workforce estimates that almost 40% more health care IT staff and professionals are needed at U.S. hospitals for broad adoption of health care IT. This estimate does not include the staff at technology vendors or consulting firms, which provides critical support for most hospital-based IT initiatives.

Hospitals are not banks, or insurance agencies, or hotels. Health care's unique workflows -- including many physicians and nurses sharing computers in a busy emergency room, the challenges of maintaining working hardware in an intensive care unit, and the vast realm of data accessed to care for a sick human being -- require novel technologies and processes that cannot be easily translated from other industries.

The uniqueness of healthcare's IT needs are re-validated every time an IT worker, vendor, or consultant tries to enter health care after demonstrating success in another industry -- and then fails. Examples of promising solutions that stalled in health care include: voice recognition for dictation (hospitals can be very noisy); mobile computers (nurses move constantly and can't carry heavy items or push bulky stands); 8 am to 5pm help desk support (health care runs 24/7); or implementation plans that do not recognize the organizational culture of hospitals (physicians usually are not employees).

Physicians, nurses, and other health care providers routinely learn new skills and adopt new technologies, so there exists an infrastructure of programs to train providers on how to use new technologies. What is missing, however, is a parallel training track for a sufficient workforce to develop, implement, manage, and support advanced information technologies in hospitals, doctors' offices, and other health care venues.

As the new Administration calls on the Department of Health and Human Services to put in place interoperability guidelines for health care IT, it must also call on the Office of the National Coordinator for Health Information Technology (ONC) to find the best way to train a workforce to develop and manage this new technology.

The American Recovery and Reinvestment Act includes provisions to assist educational institutions "to establish or expand medical health informatics education programs, including certification, undergraduate, and master's degree programs for both health care and information technology students..." It also calls for "resources needed to establish a health information technology workforce ...including education programs in medical informatics and health information management." What remains unclear, however, are the exact skills and expertise necessary for this health information technology workforce, a subject regularly debated by experts at all major health information technology conferences.

To ensure the investments in a national health care technology infrastructure create the needed workforce, the ONC should undertake a nationwide analysis -- one that looks at the skills and knowledge health care IT employers should seek in their workforce, how workers should develop these skills or gain this knowledge, and how rapidly this workforce could be expanded to support initiatives that will constantly evolve with new technologies. The ONC should collaborate with the American Medical Informatics Association, American Health Information Management Association, Healthcare Information Management and Systems Society, and other professional organizations whose members have led and supported technology efforts across the US and the world.

The stimulus package's $19 billion in IT and $250 million to prepare workers for careers in the health care sector are laudable first steps, but both become high risk investments if we do not take care to identify workforce training and educational needs and ensure that technological investments are accompanied by appropriate workforce training investments every step of the way.

Julian L. Alssid is the executive director of Workforce Strategy Center, a nonprofit organization that seeks to strengthen the nation's economy by producing a prosperous and globally competitive workforce.

Jonathan A. Leviss, MD, is the Chief Medical Officer at Sentillion, Inc., and practices internal medicine at the Thundermist Health Center in Rhode Island.

Comments

[Sustane]

The real challenge is that most vendors require you to be certified but they won't allow anyone to become certified (trained) unless they are already working at a client that is doing an implementation. Once someone is certified they become so valuable as a consultant they often leave when the project is over. .

There is very little need for pure IT or project managers to move over into health IT. The choke point is going to be large outdated bulky vendors (Cerner, Epic, mysis) who aren't going to be able to scale up fast enough or don't meet the small or individual provider offices with their current product lines. The large consulting firms are lining up to the trough but it is the second tier specialty firms that have the best reputation. Both GHC and Kaiser who have the largest most successful implementations did most of their EMR work in-house vs Stanford which farmed it out and missed deadlines. )

So even though it was supposed to be a job bill they simply pulled existing bills off the shelf (hitech act) and plastered it onto the stimulus bill.. We need to implement EMR's but most large hospital projects take 2 years of planning and some vendors (like Epic) limit how many clients they will work with at a time. There will be tremendous opportunity for people with a few years of experience already under the belt, not for new hires.

[Sustane]

Some of the job creation data came from an IBM report that very very few people actually took the time to read. It http://www.itif.org/files/roadtorecovery.pdf actually assumes that you will only need about 40,000 people to implement and support EMR's (about 1 per 10 docs?) So they take credit for jobs at the local grocery stores, school teachers etc even though any job creates the same effect.

It actually takes very little training to get someone up to speed for an implementation You can teach anyone the technology side in less then a couple of days although we usually train them for 3 weeks. School teachers and former nurses and people already working at the facility are first choice over outside consultants (cheaper too) and many projects have failed when the IT guys try to run the implementation.

[wendillpb]

Do you have a link or more information to the study you reference ("A recent analysis of the U.S. workforce estimates that almost 40% more health care IT staff and professionals are needed at U.S. hospitals for broad adoption of health care IT.")

[Jonathan Leviss MD]

here's a link to the authors' poster presentation from the AMIA 2008 Congress:
http://www2.amia.org/meetings/s08/slides/Hirsh_William.pdf

[livinCalDemtbubble]

Excellent points. I know people are curious as to what trainings will be helpful to them in their often desparate search for work. The current economy is so lacking in job opportunities and many unemployed workers need training for 21st Centruy jobs, etc. Do you know, or anyone reading this blog, know of trianing programs that would be helpful for those wanting to work in the transition to a digital, universal medical records system? Any helpful information will be passed on to those in need. Thank you.

[Julian L. Alssid - Huffpost Blogger]

One good place to learn about training for careers in medical records is at the American Health Information Management Association (http://www.ahima.org). Good luck.