Preparing the Health IT Workforce of Tomorrow
Today’s announcement of $80 million in Recovery Act funds for workforce training marks the first in a series of HITECH grant programs to address our nation’s growing need for highly skilled and trained health IT professionals. The development of this workforce will have a significant impact through job creation in two fields – technology and health care – that comprise a significant portion of our economy.
As we move toward broad adoption and use of electronic health records in medical practices, we will need more than 50,000 qualified and trained health IT professionals to support our modernized health system. We need to “grow” a corps of talent to support rising demand sparked by the upcoming HITECH incentives.
How do we get 50,000 workers ready to usher in the digital information age in health care? We intend to leverage the nation’s community colleges as the training ground for health IT professionals. These institutions are present in many of our communities and offer the reach, flexibility, and diversity we need to help assure that the proper educational resources are available for both experienced and new IT professionals looking to play a role in this important evolution in health care.
As a physician who has had to incorporate EHRs into my daily practice, I understand how important it is to have well-trained IT support on hand that understand not only the technology, but its unique applications in patient care. I’ve often characterized information as the “lifeblood” of modern medicine, and health IT as the “circulatory system.” Well, these are the people who will make sure the ‘lifeblood’ keeps flowing through the system. This is why workforce initiatives are among the first programs to be formally unveiled.
Over the next few days, you will be hearing more about the community college training programs and curriculum development to help strengthen the health IT workforce. And in the coming weeks, additional programs to fund workforce training and development will be announced.
As the workforce training grants are published you can find application information and deadlines at http://HealthIT.HHS.gov/HITECHgrants.
– David Blumenthal, M.D., M.P.P. – National Coordinator for Health Information Technology
While we certainly need these folks, we also need to remember that most physicians are in very small practices. They cannot afford (in many cases) the cost of continuing ongoing IT support especially in rural areas. We need to find a support model that is affordable for these physicians. Perhaps they will receive help from their community hospital or perhaps they can get help from a physician organization like an IPA or medical association. They certainly are unable to hire these people on their own. I assume most of these folks would work for some sort of IT support firm or an extension center.
In theory, it should be easy and efficient for an area hospital to provide the IT services for the practitioners in the rural area. But one major obstacle is the way that the current software vendors charge for their software. IT is sypically by the provider–doctor, dentist, etc. I can buy an communications or e-mail systek for an entire area for a single price and use it for as many individuals as I want.
The hosital, which always has its own fiscal problems, cannot be expected to commit to licences for all the physicians in the area and pay for them without some assurance of getting their money back. And the vendors will not sell this without getting an annual fee per sear as well.
What is needed is an open source development system for rural areas funded so that hospitals can act as medical electonic service centers for any providers who wish to cooperate. It’s a conceptual cross between a rural cooperative and an oen source development concept.
One additional wringkle is to allow the physicians who are entitled to the incentive of the over $40,000 to tranfer thir subsidey to a local hospital which in turn agrees to support and provide the physician with IT service and access.
While we certainly need these folks, we also need to remember that most physicians are in very small practices. They cannot afford (in many cases) the cost of continuing ongoing IT support especially in rural areas. We need to find a support model that is affordable for these physicians. Perhaps they will receive help from their community hospital or perhaps they can get help from a physician organization like an IPA or medical association. They certainly are unable to hire these people on their own. I assume most of these folks would work for some sort of IT support firm or an extension center.
As a IT professional, I tried so many times to find a job so I can contribute my new ideas to the changes of health IT but I found it is so hard to find the open door….. It seems to me that we did not create enough opportunity here in America as it used to be.
I hope the situation will be improve in the year ahead….
Good luck with that in the former constitutional republic.
Those of us in the business of providing document imaging services can see how we can help assist users with the task of becoming digital through the effecient conversion of existing paper files. What a typical service bureau will lack is clinical knowledge that may be required to properly satisfy the EHR. A hybrid approach might work well where a service bureau performs the mass conversion and elementary data entry then the file can be completed by appropriate knowledge workers. Here the data is verified by the care giver, and the conversion is also professionally handled with maximum value.
Dr. Blumenthal asks: “How do we get 50,000 workers ready to usher in the digital information age in health care? We intend to leverage the nation’s community colleges….”
YES, get those 50,000 nine-dollar-per-hour jobs while the millions, upon millions of manufacturing jobs have been outsourced in order to de-industrialize and sovietize the U.S. All that is left is a government job IN “healthcare” (after all, government and healthcare ARE one and the same) or maybe you can hope for crumbs leftover from the nationalization of the auto industry. WOW!! Am I glad we have such great opportunities now.
For those who are HARD OF THINKING: if you believe Electronic Health Records are going to be used for the benefit of the common man/woman, you will be sorely and utterly disappointed —-if you’re still alive.
Best regards to all my former, fellow Americans and greetings to all the Commissars and bureaucrats out there.
As a mental health care quality compliance manager in Illinois, I was laid off due to state budget issues. My job over 17 years has entailed implementing three separate electronic records systems and providing training and support to end-users. I am so happy to see these grants and hope that it will allow me an opportunity to transition into medical health care. Currently, health IT positions that I am finding require experience in computer technology or more likely, an RN degree. If I am able to obtain a job after 6 months or less training, this is excellent news!
This is a key element in developing a successful plan, but there appears to be a dichotomy in the number of HIT professionals to be trained.
In Massachusetts, the Mass Health Information Technology Council are talking about a shortfall of 120,000 workers in this sector in Massachusetts alone. I suspect the variance is in definition, but it would be good to see what the 50,000 mentioned by Dr. Blumenthal includes, and what others might be included in other programs currently planned or in the future.
It might also be worth insisting that training programs funded in this program include change management training, because that has been a consistent problem in implementations, (in the US and internationally).
Foster Kerrison
a shortfall of 120,000 workers in this sector in Massachusetts ? If this is true then why are there no job postings to fill these positions?
Initially, as a part of ARRA Sections 3016 – 3018, funding would be made available for colleges and universities for undergraduate and graduate level programs. Does today’s announcement of $80 million for community college training programs mean that funding will not be made available for the establishment of undergraduate and graduate level programs? From today’s phone call, I was under the impression that some of the $80 million would be for such programs; not only for community colleges.
Could someone please clarify? I’d like to know if there is another bucket of funding that exists or will be available soon for these schools and programs.
Also, will CCHIT-approved EMR vendors have any involvement with the training that will be provided by these community colleges? It is my experience, and I feel it is that of others as well, that many health IT organizations, hospital systems, and outpatient systems looking to hire Health IT professionals first look for those individuals that have direct training / certification in the EMR product that organization is using. Without any such direct EMR training, how will these programs be beneficial?
Implementing EHRs in small physician practices requires a very clear understanding of the workflow issues and challenges of clinicians and staff. The challenge will be not only training the 50,000+ individuals who require technical skills and knowledge about EHRs, but also ensuring that they have strong communications skills and are not intimidated going into the medical practice setting. My experience in Canada has been that the ability to manage people is equally as important as the knowledge of the EHR tools and processes that need to be adapted.
As a national, non-profit, professional member association for working level IT professionals who specialize in Health IT, the American Society of Health Informatics Managers (ASHIM) believes in the importance of a skilled Health IT workforce to best serve the needs of physicians who are using and adopting Health IT.
In response to what we believe is a national need for a capable Health IT workforce, ASHIM developed a certification exam, the Certified Health Informatics Systems Professional (CHISP) credential. The exam certifies the skills necessary to support the adoption of various Health IT tools and resources. The CHISP credential provides the hiring public with a means to differentiate the skills of IT professionals by validating their current healthcare industry knowledge. The credential also provides a means for job applicants to inform prospective employers of their qualifications with respect to the healthcare industry. It serves to validate the superior knowledge and skill of IT professionals already serving the healthcare community.
We believe that IT professionals who are knowledgeable in healthcare are what make it easier for physicians to use HIT in a manner that improves patient outcomes and overall efficiencies. It is this enhanced ability to communicate that makes an IT professional the best supporter of HIT.
I like the comment from Stephanie
I’m with Dr. Heyman. If we can develop EHR technologies that are simpler and easier to implement and use, and which outsource much of the maintenance to cloud sourcing vendors, we will need much less IT support in the office. And the support can quickly move into the areas associated with meaningful use of the information and data to improve care; on ways to enhance workflows; and on networking users to create a learning community engaged with the outcomes of the use of the IT — and NOT its complexities. The doctors graduating from medical school today all know how to utilize computers, they download apps to their cell phones, and they communicate with their patients using online care modalities from email to videoconferencing. Let’s not build in system requirements that mean health IT consulting and support will be needed forever.
Kind regards, DCK
Outsourcing. You are failing to learn the lesson from every other industry. Outsourcing requires high QA and QC from in house human and infrastructure resources. Meaning, you’re not going to get out from under it that easily. From reviewing the ‘experienced’ writers on this comment thread with extensive vertical market knowledge of healthcare ya’ll still are at a loss for implementing quality assurance on what you do have. Want innovation? It usually requires fresh blood, against whom the industry has barred and locked the doors. Seems like a few vendors long ago learned to stroke healthcare organizations’ ego that they are oh, so unique and created lower quality products requiring complex and inefficient implementation, with a level of end-user difficulty needing time consuming training, which they are happy to provide for a fee. No, Healthcare isn’t the only industry to paint itself into a corner. To get out, others have employed creativity and open-mindedness. I see a couple of those on this thread, so there is hope. And it can come quickly, if you let it. There are thousands of people out of work right now whose specialty is delivering in areas where there is no historical solution, where they are not the industry expert, who work with teams of subject matter experts, across multiple cultures, where the success or failure is high stakes (lives, $billions, devastation). In the lingo these are called transferable skills. But you keep on making sure your boders are locked. Hmmm, maybe you can build a fence. For me, I’ll get my medical and dental out of country. Wish there was something I could do for the poor who don’t have that option. Anything I could provide (and I am silled) the industry would try to kill because it really does like to maintain its power structure. A big shout out and thank you to those who keep trying to do the right thing anyway.
One of the first areas that we might want some standardization is in the area of certifications as there isn’t currently any standardization and nearly anyone can become competent in the systems on the job (or they are too complex for end users to use).
1) HIMSS with its 23,000 members has the CPHIMS http://www.himss.org/ASP/certification_cphims.asp but over 46% of the people who take the test are CIO’s or VP or director level and only 4% are nurses
2) AHIMA has Commission on Certification for Health Informatics and Information Management (CCHIIM) http://www.ahima.org/certification/about-cchiim.aspx
3)AHIM -in the thread below was just formed and their Certified Health Informatics Systems Professional (CHISP) http://ashim.org/ test is still in beta although they have a great advisory board and web site. .
IMPLEMENTATIONS
None of the large vendors require or use any of these certifications however and as people in the thread have discussed nearly all of the large hospital system implementations require certification in their vendors application. The largest vendor will not allow anyone to receive training who isn’t already employed on a project and blocks their own employees from working for a client for a year after they leave.
Epic “our training is reserved for our customers and those third parties that are actively supporting our customers” but lots of people do get hired without certification if they have a couple of years experience.
If we focus on large hospital implementations and the larger vendors will probably need to pro-actively ramp up their training for hospital implementations.
Tthe bulk of the need however is in small or solo provider practices where implementations typically happen over a few days with outside consultants who are brought in and then remote phone support. For example, one of the largest ambulatory EMR’s – E-clinical works also requires a BS at a minimum and a Masters Degree in Engineering with computer background is preferred and there is no need nor requirement for certification on top of this at the current time.
LONGER TERM NEED
One of the biggest needs is actually for up-training of existing clinical and administrative staff – often referred to as super users in large hospital systems but also often referred to as the front desk in a small physician practice and ongoing training once it is up and running since the largest benefit often comes from workflow redesign vs the IT itself from people with front line experience.
Nurses leave the profession at an alarming rate 22% plan to leave the profession in the next year and over 500,000 are not working with. This untapped talent pool would be a perfect population to target and at the same time bring highly educated health care professionals back into the health care system at the same time we upgrade the skills of health IT workers.
This certainly sounds encouraging having been on both sides of that fence, programming and then training physicians and staff. There are a number of individuals who are out of work that might slip into those roles immediately too. I consult with EHR systems and it is a job keeping up with several of them to know and recommend which one fits the practice too. For my part keeping up with ever evolving software is a chore for the consultant too as everything changes so frequently with technology throwing you that left curve every day.
I had one MD tell me he had to learn 5 different EHR systems to get through his internship. Practicing medicine and learning a myriad of software systems is a credit to him as well. One item that I always thought made sense was the Common User Interface, which is open source from Microsoft. Any vendor could keep their entire system as it but just modify the user input screens for clinicians so again there’s at least a similarity and going to the same place to reference or add patient data. Other ends of the administration are not affected as much as the clinical input which has to be quick and accurate and have somewhat dynamic screens that respond quickly too. There are many developers working on the program and I have written about it many times on the blog.
I am just thinking out loud here if you will, but if an MD could walk into any facility and know where to find and enter data quickly without a long learning curve it seems like it might help out. I did a post a while back on a hospital in Long Beach about their transition to medical records and they had MDs at every level, and provided basic “Windows” classes for those who needed it too. Devices reporting data are emerging here too with adding patient data and those too will be incorporated into the work flows. There are some interesting new devices that have and are coming out, i.e. Cambridge Consultants has a blue tooth inhaler that reports data as an example, and we could stand to get more exotic as technology moves along there too, and they will be part of the system with MDs monitoring.
I know all of this has to mesh together somehow and it’s a tough project as we have a big moving target here. Even for a force right out of college, training the trainers will be challenging too. Again, I think if we can develop some similar standards for data input with vendors getting together on this to make the job easier for clinicians it would really help tremendously. I think standards maybe taking priority over “screen” branding for EHRs could help everyone, the IT professionals doing the training would probably give a yes vote on that too.
I’m happy to see Community Colleges playing such a key role in training the new health IT workforce. Dr. William Hersh makes many good points in his commentary in Healthcare IT News (http://www.healthcareitnews.com/news/substantial-need-trained-workforce-hit) particularly the difficulty that community colleges do not have many on their faculty with expertise in clinical informatics.
The first step will be getting qualified instructors to train the trainers – and this will take time and resources. I will be very interested in seeing how this program is rolled out and hope also that the critical area of rural community colleges is not overlooked.
I agree with Dr. Heyman. I have worked in a private, non profit community mental health center for many years, and my wife is a pediatrician in a single, private practice. I am also our agency’s Privacy Officer.
As a large, private, non profit agency, we have used several electronic client databases/EMR’s over the past 2 decades. These have been very expensive yet inefficient. Our current system is not user friendly, and has added time needed for staff to document services. There are also other types of technical problems. Even though we are a large agency, we do not have discretionary funds to change systems. We seem to be “stucK’ with what we have. Some managers think a paper system is easier.
My wife is in a single doctor, private practice. It was very expensive for her to purchase the base/core progam module for an EMR, and it will cost more to add modules. The annual fees for software support are very high. Add into the cost expenses for hardware purchases and support. It definitely hurts the bottom line.
Finally, as Privacy Officer, the currently movement towards EMR seems to be based on the traditional medical standars of practice, and the HIPAA regulations. In the Behavioral Health practices, we must comply to more stringent State and Federal regulations governing the privacy/confidentiality of records of Mental Health clients and Substance Abuse treatment clients. Access to this information by regulations need to be restricted on an a need to know basis. I have not seen the types on internal controls in software that provide the level of security needed to protect this information.
Williakm Maslak is right on regarding the difference in Behavioral Health with regard to privacy issues.
One dramatic example is that some states, like Pennsylvania, have regulations that prohibit release of certaintypes of mental health data EVEN IF THE PATIENT CONSENTS.
I have been participating in the CCHIT (Certification Commission for Health Information Technology) Behavioral Medicine Workgroup and we have tried to set stadnards for IT Software and systems to accomodate these differences. These are now availalbe for public comment. http://www.cchit.org/participate/public-comment/register is the url to register for the public comment process. My colleagues and I would apprecaiate as many prople as possible reviewing our work and adding to it or criticizing it were we may have missed something.
[...] for Health Information Technology (NCHIT) David Blumenthal has launched his own blog, where he announced this week $80 million in grants for health IT training, mainly to community [...]
I also agree with Dr. Heyman. Hospitals and large medical groups are always able to locate and pay for resources to implement HIT. The problem in small practices is twofold.
They can hardly afford the cost, and please remember that vendor provided training for one physician takes almost as much time and resources as training for three or four, but the cost is not shared, so perversely the costs are higher for the those that can afford them the least.
The second issue is that vendors tend to spend less resources on small practices for obvious reasons. Pre-implementation workflow analysis is rarely performed, project managers are rarely assigned and as Sherry wrote, the entire thing takes a few days after which the doctor is on his own with remote support only. This may explain why small offices are having unsavory experiences when implementing EHRs and why the adoption rates are so meager in this sector.
The solution would most likely be regional extension centers that will support these physicians at no charge. However, as usual, there is a caveat.
From my experience, a person fresh out of school, or coming from a different discipline, takes about 1 year of supervised work in the field before he/she becomes effective and another year before excellence is observed in some. This is for one particular software product. Transitioning to another EHR takes about 6 months for a seasoned trainer. I have not found the independent certifications to be a predictor of quality work. Vendor certifications (or experience) are, on the other hand, very good predictors of successful implementations, not just for that one vendor product.
I am not sure how curricula will be built, but I am a bit skeptical of the ability to train trainers and implementers without reference to a particular product. Best case scenario, IMHO, would be to expose folks to several most common products that are used in small ambulatory offices in their geographical region (guest lectures come to mind). Vendors will probably be happy to oblige.
So a mixture of general medical office workflows, computer and networking skills, combined with basic EHR theory and exposure to those mostly used in the region, ought to do it.
If we start offering associate programs in the fall of 2010, we may have graduates by 2012 and effective resources by 2013. We should probably also come up with a plan for the interim.
Margalit Gur-Arie has articulated the classic IT training dilemma ever since Radio Shack and Apple were trying to outdo each other with the new PC concept.
Specifically, should professionals be trained to use specific products (programs) or should they be taught general principles that could apply to theoretically any software that might be used or come along in the future?
The community colleges currentloy have this dilemma, and they go both ways. Many courses are proviced for particualr sofware packages–ie Photoshop, Microsoft Word, AutoCad. Others are more general and non-specific. Software publishers have a an obvious vested interest in having courses taught specific to their products. One of the major variables that determine success of a software product is the availability of traned personel to install, configure, operate and manage their product. Nowhere is this illustrated moreso than with data base software. There are literally millions of people trained to support Microsoft SQL Server, but relativly few who can support Oracle, When I had to make decisions in government and private agencies as to which system we would utilize, this was a major factor–the ease of continuoous supply of qualified technical personel. Ironically, there is an Open Source data base–My SQL–that also has many technical personnel who are competent to support it, the result of great use and avaialblity as the “price is right”: FREE. But that is not always the case.
Publishers of software also know that personell trained in their software tend to also be evangelists for the product. They are more chary of generally trained support personnel, who do not have as much comittment or loyality (intelelctual and familiar, not financially motivated) to their individual products. Generally trained personnel are much more willing to change systems as technology develops–the do not have the same level of de facto “brand loyalty”.
This is particularly important at this early stage of medial IT conversion. The software that is in use today can be likened to the early versions of Microsoft Word and PowerPoint for example. Much value and achievement, but a minimal result compared to those products of today. As a matter of fact, and this is a critical lesson for us in medical IT, Word Perfect was the dominant word processor and was initially so superior to Word that they did not take the competition seriouswly and before long Word was as good as Word Perfect and then became far superior. The dominant software for medical records today, will not likely be (and probably should not be) the best product availalbe in the coming years.
Unlike software in other fields where the PC pricing models tend to predominate, the medical software insutry thus far has used the old minicomputer and mainframe software pricing. Typically, today’s software might cost $25,000 a head for each provider. Even a full suite of Adobe creative desigh software–considered expensive by Microsoft and other PC norms, is one tenth the price. So far, the pricing models of medical equipment and supplies are dominating and not those of IT software. All the more reason why change of vendors in the medium term will be so important. There is a risk that meidal IT will be so expensive compared to other IT that the cost will offset what might be saved by the technology. Hopefully, with easier use programming and development techniques and a lot of competition, the cost of medical IT will come down to that of accounting, legal, engineering, scientific, and general office IT. But if the trained personell are mentally locked ito specific vendor packages, then change will be much more difficult with a cost of not more expense for health IT but the inability to use what should be rapidly improving medical technology.
Therefore, it is very important for Dr. Blumenthal and his team to see to it that the Federal Funds to train the criticfally needed 50,000 IT personnel (and I personally think that the government has been very conservative with only 50,000 needed) are used to provide GENERAL training. If General Electric or other vendors want–as they will certainly do–personnel specifically trained to operate their software, let them pay for it. At today’s prices, there is huge profit margin that can be used for this process.
At the moment there are no “open software” systems for medical practice IT, free software the equivalant of Drupal, Word Press, and Joomla in the website development world. But there will be if the government gives any encouragement to this process and does not close them out a few years from now be training all the personel to just use existing commercial packages. It is the open software the keeps most of the commercial software companies within reasoanble pricing bounds. Otherwise the two or three leaders all increase prices with no inhibition.
One difficulty in requireing general training in the community colleges is that it is a little harder for the educators to create a generalized curriculum. Vendors often will provide free software to the schools to teach with. But they are not so anxous to provide free tools to illustrate their software along with their competitors. The professors have to have a wider scope of the market and know the various products so illustrations can be produced from the different extant software packages and not from just a single one. The implication for the government here is to provide some grant funds to create some generalized curricula and instructional materials that community colleges could use. Most of us are not familiar with a major difference between a professor at a community college and his/her counterpart at a 4 year college and university. The former has a MUCH heavier teaching load. The univerisity professor is provided with time to write curricular and textboos and other instructional materials. When I was a professor, the administrators all preferred that I develop curricula and materials than teach another class section or two. Not so in the community college. Ideally, to implement the community college, health IT, educational inititive, there will be some public support for 2 of 3 curricular development projects. Othereise there will be overdependency on the existing software vendors who will steer the training to their particualr advantage rather than the advantage of the health care system as a whole. Let’s use the public investment for public results and benefit and not de facto subsidies for private companies.
Lewis Eigen has the junior college and university situation down. He’s being straight with ya’ll. The industry is trying to become free of an oligarchy of established vendors thus improving services and lowering costs. However, it will be the software vendors who will come in and take over the junior college instruction. That will make your educated and ‘certified’ pool useless. Again, check how they’ve manipulated other industries who tried the junior college and certificate routes.
The problem is a little knowledge is dangerous. HIT needs to be led by real expert leadership and the folks who get trained can then be further developed. This training is like a jumpstart, but with the low success rate and low user satisfaction of many HIT implementations, it may be the blind leading the blind.
Sorry for being so blunt, but this isn’t PR is it?
Agree with Dr. Heyman. Like him I am also in solo practice, and have successfully implemented a fully electronic office for more than 7 years (without any financial recognition from govt or private payers). My personal involvement in implementing and upgrading HIT in a private practice setting has given me the breadth and depth of understanding that no technical professional can ever understand. The govt. could start with people like myself – by first involving us directly, recognizing our achievements and using us as “physician-champions” of some sort.
I just hung up from a call talking to another doctor of the same specialty about how to start up an EMR implementation process and potential pitfalls to look for. I have done this dozens of times out of pure altruism. It would be great to go this on a larger scale with govt support.
Thanks Doc, we need more citizens like you who say “Yes I can help” It’s the only way we’ll be able to drag the naysayers into the 21st century. Keep up the good work on our behalf.
Dr. A Cavale,
In what part of the country are you currently practicing? You are correct, your input in this process is vital….
Something in the equation doesn’t balance: 50,000 technically trained people with an employment cost, conservatively estimated, of $40,000 per year = adding about $2 billion to the cost of health care, while reimbursement for the services of the licensed professionals responsible for providing that health care, as well as the IT employee pay, is projected to decrease.
Health care information technology has not proved to be cost effective for most medical practice. It’s much better for insurance companies, and the government, to review, especially if the health care professionals are required to input the data as well as care for the patients.
IT has a long way to go before it will really contribute to improved health care at reduced cost, for many reasons, some of which are noted above.
I just don’t see how government help to the industry is a good idea. The health Care Industry is already running @ a profit. the money should be used to help those who cannot afford insurance or to create clinics. I vote less it more medicine.
yes I agree with you
While I appreciate training being set aside for healthcare IT (presumably informatics) support, I’m a little fearful that this approach is a little bit akin to the difference between a person learning a second language and a professional intepreter. Informatics fits a linguistic model very well – and for optimally effective translation, a person needs to be fluent not only in both languages but in both *cultures*. (This is why professional interpreters will tell you it’s important to live at least a few months a year in both countries that you interpret for… The UN generally requires this for UN-level interpretation.)
In any case, as a multilingual CMIO, I look forward to hearing more details about this plan.
First, I have to apologize for posting a few days ago before reading the actual grant documentation. Now that I read it, I understand that we are proposing 6 months programs that can be done on site or on line or during evening hours, and not, as I assumed, formal associate degrees that usually take two years. At this point I have no understanding of why anybody would assume that a quality EHR implementation resource can be created through such program. As a previous poster wrote, this may turn out to be outright dangerous.
We know today that one of the main reasons EHR adoption is painful and very likely to fail is to be found in the implementation process, or lack thereof. Yes, Dr. Kibbe is correct, software should become simpler and more intuitive, but a hospital is a very complex enterprise and the technology required to manage such enterprise will never be as simple as an iPhone app. Successful implementers are highly educated, highly experienced people with a thorough understanding of the entire process, from selection of products all the way to ongoing support. I don’t quite see how, as the grant documentation implies, one can be expert at choosing a particular software without being an expert at clinical workflows and requirements, or how one can train users without being an expert at all of the above.
Although the grant document describes 6 distinct roles for implementation and support, I assume in an effort to shorten the training required, in my experience, there are only three disciplines at work: pure IT (hardware, OS, connectivity), software (EHR and clinical workflow expertise) and project management. In a hospital or large clinic you may very well find multiple specialized resources during and after implementation, both vendor supplied and hospital employed. In a typical small practice implementation, there will be one resource that is vendor supplied and very rarely a temporary consultant that most of the time has very little knowledge of anything other than running interference between the doctor and the vendor.
If we are serious about developing useful resources for both small practices and hospitals, that will actually contribute to successful HIT adoption, than we shouldn’t indulge in short cuts that look good on paper, but have very little to do with the grim realities. Just because we want this baby by Christmas doesn’t imply that we can employ nine women to deliver it on time.
One possible solution hinted by Dr.Cavale below, would be to establish and fund excellence centers that draw on the experience of folks that have been at this for many years, and there are more of them than you would think. These are people that understand the benefits a good EHR, correctly selected and implemented, can deliver, and these are people that would love to share their hands on, in the trenches, expertise and promote the HITECH goals. I don’t see any indication that we are even contemplating this strategy. I thought that maybe the regional extention centers could fulfill this role, but I am starting to doubt that.
There are many grants out there. There seems to be no shortage of money. There are also very lofty and admirable goals. It really pains me to have to say this, but my concern is that the execution seems to be disjointed and not too terribly anchored in reality.
Not much of a blog with two posts in a week!
and no replies to any comments!!!!
There are some replies but perhaps they are hidden—just as the “disliked” comments are hidden. What a terrible joke this entire “reform” is going to be on the American public. Keep on sleeping.
What is a “disliked comment” that is supposedly hidden? I see various levels of “Reply” comments.
The green/red icons only increment a number, but don’t lead to a comment box. So what is missing?
I would hope that some of these funds are put aside to guarantee that recently discharged veterans and soon to be discharged veterans have the opportunity to be trained or retrained for employment opportunities in these HIT jobs. These hospitals or physician practrices that are going to be collecting these funds and the vendors that are installing the HIT products should be encouraged in the strongest manner possible to hire veterans. Many veterans have been trained in IT, they are computer literate, they work well in teams and they are drug free. They make great employees.
It’s not only the smart thing to do, it’s the right thing to do!
$80 million? That’s a big number in recovery Act Funds. I agree with Lori Keller’s comment
I somewhat agree that the community colleges will have the resources to provide training, I don’t agree that basic training is going to produce the quality of employee that Blumenthal is envisioning. Anyone can be trained to enter data or sit at a computer and enter code. What the U.S. is going to require in this dynamic and fast-moving arena of advanced electronic health information is a professional with the competencies to integrate electronic health information across modalities and products for improved quality, efficiencies and patient outcomes.
What’s missing in the discussions is a description of what a high-functioning eHealth professional looks like, what competencies he/she will need, and a discussion of the strategic direction that eHealth is heading toward. One think is for sure. The eHealth professional of tomorrow is not going to look anything like yesterday. Health organizations need to partner with higher-level academic institutions to outline what a top-notch eHealth professional will look like. That’s the person I want working in my organization!
As with any profession, there are varying levels of IT personnel. I fear that the federal government does not fully grasp the problem: what we are lacking in seasoned, gifted, IT personnel — I am talking about extremely bright people who have been working in medical support IT for at least 5 years. This sort of individual makes $100K plus a year and is at least 5 years out. Thus, there is no instant fix. I just hope the people in charge understand that there is going to be a serious lag between their grants and the effects that wish to see from their investment.
yes I agree with you
I would prefer to see the federal government expand the concept of HIT beyond the clinical focus it now has. As the CEO of a FQHC in a high poverty area in West Virginia I implemented EMR in June 2007 as a part of a total IT infrastructure. I was disqualified from participating in any EMR Grant program from HRSA because I was not part of a CHC controlled network even though I produced a better and more effective program at less costs. Our CHC uses our IT infrastructure for many important tasks and has an integrated practice managment program with real time reporting. We are just now learning how to data mine for clinic quality since the program was generally not written with QA in mind.
Our costs have not decreased nor will they decrease in the near future. We have improved our billing and collection structure and the management information system allows for quality management in real time. I would hope that instruction in the HIT program would include instruction for CEO’s, CFO’s and other administrative people beyond the clinical uses. Larry W. Dent. JD, CEO Roane County Family Health Care. Spencer, WV
obstacle is the way that the current software vendors charge for their software. IT is sypically by the provider–doctor, dentist, etc. I can buy an communications or e-mail systek for an entire area for a single price and use it for as many individuals as I want.
The hosital, which always has its own fiscal problems, cannot be expected to commit to licences for all the physicians in the area and pay for them without some assurance of getting their money back. And the vendors will not sell this without getting an annual fee per sear as well.
What is needed is an open source development system for rural areas funded so that hospitals can act as medical electonic service centers for any providers who wish to cooperate. It’s a conceptual cross between a rural cooperative and an oen source development concept.
One additional wringkle is to allow the physicians who are entitled to the incentive of the over $40,000 to tranfer thir subsidey to a local hospital which in turn agrees to support and provide the physician with IT service and access.
I am not yet that impressed with the workforce initiatives that I have seen coming from many Federal grants (not the HIT ones) thus far. In my perusing a number of Federal, state, local and community college sites, I found numerous programs that simply listed local training opportunities and many were quite costly, promoting existing expensive certification programs or full college degrees versus the more timely solutions that are needed to ramp up a workforce but at a reasonable cost to those seeking to transition into a new career. I also found major neglect of sites (e.g., look at the State of Virginia’s web site), documents, and programs indicating they may be languishing and no longer available to those who may partake of the services. I strongly hope ONC will ride herd on the those organization’s whom it awards these (and other) grants so that the programs are meaningful, affordable, timely, and remain viable over time. The American workforce needs retooling and these are wonderful opportunities to do just that if done well.
Moving forward should always be seen as a good thing, especially if it will benefit the society in the long run. Training the new breed of professionals in IT would be a great way to ensure that the health sector will be able to tend to the needs of a lot of people. Medical and dental care, for instance, will be a lot better for the majority of the population.
great article, i like this blog
Progress is a good thing when it comes to healthcare. Cost is often a very scary thing for those paying insurance for dental work, health care, preventive care or even long-term treatment.
Software pricing is easily a barrier here and I think many entrepreneurs creating the technology for healthcare realize it’s a great market to be in because of the profit potential.
Thanks for highlighting this issue. It’s easy for people to think that with the recession giving many people job problems that technical skills are no longer as useful as in the past, but in reality issues like this are everywhere and require up-to-date IT skills and application to keep healthcare systems moving forward and growing.
Thanks for the post, nice read.
As an IT professional, I can tell you that Medical and Dental offices make great customers! They have high-tech needs, but their training and energy is spent in ‘better’ areas. They can fix people, not machines, which makes it perfect for someone like me who fixes machines.
But even from my perspective, I wish that they would more readily embrace new technology, and embrace it faster. They love new diagnostic equipment, but what about something as simple as an electronic document that allows patients to fill out their patient info online, ahead of time (saving time in the office)?
Good luck – I wish you all the best!
It is like being punished 3to5 times anyway we have the right to vote for what we think think would help this country and or state let us make a decision it well help us respect the fact that we can feel worth something as far as what happens with our country i mean a lot of people just get off track
y wife is in a single doctor, private practice. It was very expensive for her to purchase the base/core progam module for an EMR, and it will cost more to add modules. The annual fees for software support are very high. Add into the cost expenses for hardware purchases and support. It definitely hurts the bottom line.
Thank you very much for this information. Good post thanks for sharing.
The challenge will be not only training the 50,000+ individuals who require technical skills and knowledge about EHRs, but also ensuring that they have strong communications skills and are not intimidated going into the medical practice setting.
“In theory, it should be easy and efficient for an area hospital to provide the IT services for the practitioners in the rural area. ”
as you pointed out this will never work, and that leaves a gap in the solution. A high cost gap
what we need is an open source protocol solution that can be deployed using intranet / extranet / vpn or even https. if the solution were say to be open source
project then you could utilize programmers from high school colleges or even go into elance and have an offsite person complete the project.
Instead the gov will scare us into thinking we need a saas model and farm out the project to the largest competitor say oracle, who then will charge as much
as the gov will permit them per seat. and the kickback go back to the politicians who empowered them
you think health care is bad now ?
all the gov is and a middle man then manifest itself in an organism and feeds off it, in this case extraction of revenue from every angle they dream of.
As a IT professional, I tried so many times to find a job so I can contribute my new ideas to the changes of health IT but I found it is so hard to find the open door….. It seems to me that we did not create enough opportunity here in America as it used to be.
Some great points were made here..
This is a key element in developing a successful plan, but there appears to be a dichotomy in the number of HIT professionals to be trained.
In Massachusetts, the Mass Health Information Technology Council are talking about a shortfall of 120,000 workers in this sector in Massachusetts alone!!
I suspect the variance is in definition, but it would be good to see what the 50,000 mentioned by Dr. Blumenthal includes, and what others might be included in other programs currently planned or in the future.
Mercen
One of the best things a community college can do in training practitioners to be ready for health care in the digital age is to create programs that allow the student to work and have a family while going to school.
This would mean more distance learning options and more blocking of classes (i.e. all evening classes for a day worker or all morning classes for a swing shift worker).
I’ve worked with so many people struggling to find work while attending school because their classes are scheduled throughout the day and evening.
It will be interesting to see how long all this will take to get into action. Will this only add to the overall cost of healthcare or will it just increase it more?
It is fascinating to me how the success of one’s IT department and the success of one’s business go hand in hand these days. What was once a luxury, and some said frivolous at the time, is now a staple and considered indispensable, especially in Health “and” Care. And this after only 10 or so years! One thing that many practitioners do not take into consideration is how their IT meshes with the process of building a meaningful relationship with clients. This goes beyond mere strategic planning or marketing, it must be considered as a touch point and component of the overall narrative that the Organization (Hospital, Care Facility, etc…) is telling to the client. That narrative is what the client takes with them, and remembers, and many times that begins with a website or an online solicitation for services…
What about using an iPhone or better an iPad for some of this tasks like training?
E-Learning has develop since their early days and so everybody could train and learn when he wants and where he wants?
Targeting community colleges for IT training is a great start. Engaging corporations to develop pipelines for graduates of the community is an altogether different challenge. More efforts and energy can be placed on setting the bar for hires.
It is vitally important that we become prepared for the next level of technology in the medical field and having the proper number of adequately trained IT professionals is heading in the right direction. Whether its training at the looking community colllege or some kind off campus or online educational training, all will be important in getting the next level of IT professionals ready.
I do believe that this crucial change will bring vast benefits for the population who consume health care in the future. This is because digital technology will give us greater efficiency. Also, with the infusion of technology, health care can be made more affordable as more investment and capital will pour in to fuel the industry. Given an aging population, the implementation of this will definitely help many.
However, I believe that there will be some short-term pain involved as the use of technology will make many past practices obsolete. Since technology can replace them, people once employed for these practices could be laid off. Also, it is a difficult task for community colleges to manage the educational resources to be taught as there are few examples of such to emulate. To add on, sufficient funds ought to be allocated annually to sustain this. Thus, prudence ought to be practiced to ensure a smooth transition.
Although the transition will be painful, I believe that the long-term benefits can guide us to a better future, given that we have close supervision over it and practice efficient management of resources allocated.
I work with several health care clinics and it seem the largest barrier is changing the physicians workflow. They are used to dealing with paper and are more comfortable writing notes as they talk to the patient.
But, the next generation of physicians will be more comfortable with technology than traditional paper processes. I look at my kids and they can be watching TV, studying and texting their friends all at once. This multitasking mindset will aid them in embracing technology like EMR.
Paper-Mess to Paper-Less>
Health professionals with broad knowledge on information technology will surely gain more edge than those who are not yet that skilled in using computers and techie equipments. This is where medical schools and colleges appear into the picture. They should improve their facilities and professors should be knowledgeable so that they can share their wisdom to their students.
On the other hand, those who are already working in hospitals and are somewhat old already to take up courses, they can try to ask help from those skilled health IT professionals in their workplace so they won’t be behind and can still give ultimate care to their patients through the information they learn from their colleagues.
We should be ready for the next wave of technological advances in the field of medicine. Getting trained IT experts is a good step. It does not matter if the training happens in community colleges or through off-campus and online training. What matters is that we get the next generation of IT professionals ready to tackle the new challenges.
Baker College in the Detroit area recently had their healthcare IT program approved by the Department of Education. Cisco is also heavily involvedby helping with the curriculum, providing resources, and creating internship and job placement opportunities in the healthcare IT industry. Sounds like a great program and opportunity for anyone in the area interested in a healthcare IT career.
IT or ICT as they now say is important and we need well educated ICT specialists. Any initiative that leads to this goal is great!
We have seen an explosion of data in just every place. The health industry needs IT Pros that have quantifiable skills. Programs specially designed to respond to the growing needs of Health IT are pretty much on demand. Database technologies are on the same pool also. Take for example SQL Server. The latest SQL Server 2012 has a new features that will greatly impact the productivity of the Health IT.
An important component of this medical revolution is Health Information Technology (Health IT), the use of information and communication technology in health care to record, store, protect, retrieve and transfer medical information within healthcare settings. The field of Health IT bridges several professional disciplines including medicine and allied health professions, law, informatics, computer science, business, project management and research.
President Barack Obama has made the investment in “e-health” a priority for the U.S. Towards that end, the president is investing $56 billion dollars in the next five years to move the U.S. health care system to “paperless medicine” by encouraging physicians to adopt standards-based electronic health record (EHRs). It is estimated that between 50,000 and 200,000 new jobs will be created in Health IT in the near future.
They should improve their facilities and professors should be knowledgeable so that they can share their wisdom to their students.
Our country needs more than ever well qualified IT professionals. The importance of this sector cannot be underestimated and we have to make sure that we don’t fall behind other countries. Any initiative like this Recovery Act is essential – and well needed.
What is needed is an open source development system for rural areas funded so that hospitals can act as medical electonic service centers for any providers who wish to cooperate. It’s a conceptual cross between a rural cooperative and an oen source development concept.