Where Will the 'Mini-Army' of Health IT Workers Come From?

by George Lauer, iHealthBeat Features Editor

TOPIC ALERT:

The American Recovery and Reinvestment Act contains a set of provisions known as the Health Information Technology for Economic and Clinical Health Act, or HITECH Act, that advances the use of technology in health care.

Among other things, the HITECH Act provides funding for the integration of health IT education in the training of health care professionals.

Industry experts predict that not only must current health care providers be trained in health IT, but a whole new tier of health IT specialists will be needed to convert the country's health system to digital records. 

Many predict it will take a small army to achieve the goal of computerizing the nation's medical records within five years. Don Detmer, president of the American Medical Informatics Association, estimates it will take as many as 130,000 information technicians and 70,000 informatics specialists.

Where will this "mini-army" of new workers come from?  Does the stimulus package include enough money to train enough people? How long will this new learning curve take?

Training Programs Already Under Way

Bill Hersh, chair of the Department of Medical Informatics and Clinical Epidemiology at Oregon Health and Science University's School of Medicine, predicts many members of the new mini-army will be health professionals looking to move into the growing IT field. He says there also will be IT professionals from other industries looking for work in the newly expanding health IT arena.

Training already is under way online and in brick-and-mortar classrooms.

"The acuteness of the stimulus package requires that we build this new 'mini-army' quickly," Hersh said, adding, "They will come from short-term training and re-training programs."

One example is the 10x10 program offered by AMIA. With a goal of training 10,000 health care professionals in applied health and biomedical and health informatics by the year 2010, the program is national in scope and includes several educational partners.

Oregon Health and Science University was AMIA's original partner and so far more than 600 people have completed the four-month course through the Portland campus. Coursework is an adaptation of the online introductory course in the school's graduate program.

"This program is very scalable and could easily train hundreds or even thousands over the next year or two," Hersh said. "While many of these people will come from the ranks of those experienced in health care who wish to move their careers in this direction, it may well be that veteran IT professionals willing to learn the intricacies of the health care setting are also likely to be able to succeed. Many of them, of course, have been laid off from IT jobs that are unlikely to reappear, especially in the financial industry."

JoAnn Klinedinst, vice president of education for the Healthcare Information and Management Systems Society, said HIMSS is forming a workforce development group dedicated to providing a forum bringing stakeholders together to address the opportunities and challenges of meeting new health IT work force demands. The group will be formally announced at the HIMSS conference next month.

"HIMSS believes that sources of [health IT] workers, both implementers and end users of health care information technology, will include the displaced worker; our veterans; those currently working in health care who desire a role centered on health care information technology; sources from other industries that provide similar core competencies on topics like quality assurance, management engineering, process improvement, project management; and our high schools and vocational schools," Klinedinst said.

Enough Money To Train Enough People?

The stimulus package, with an overall expenditure on health IT at $19 billion, designates $2 billion to be used by the Office of the National Coordinator for Health IT for a variety of purposes -- including training. Dollar amounts are not specified for any programs so spending priorities appear to be in the hands of the HHS secretary and the national coordinator for health IT.

Whether the stimulus money will be enough or not, Klinedinst points out the situation is unprecedented.

"This allocation amounts to more than has ever been allocated to health care information technology and will provide the foundation to meet the needs of the work force," she said.

Some industry leaders, including Hersh, urge policymakers to keep the focus on improving quality of care, not on technology for technology's sake.

"Many people, myself included, are worried that this massive infusion of incentive money could be wasted if systems are not implemented efficiently and using known best practices," Hersh said.

"A growing body of research studies as well as reported experience shows that the best results in electronic health record adoption are achieved when the focus is on how systems can improve the delivery, quality and safety of care and is not on the technology for its own sake," Hersh said.

A recent report from the National Research Council documenting shortcomings in some health IT systems "drives this point home," Hersh said, adding, "Health IT should focus on its clinical value and not the technology itself."

Hersh said it is essential that EHR implementation teams include expertise in the field of medical informatics -- "also called biomedical informatics or health informatics … they're all the same to me," Hersh said. "These individuals bring expertise at the synergistic intersection of health care and IT," he added.

In addition to medical informatics specialists, there still will be a significant need "for pure IT skills, such as maintaining servers, installing and troubleshooting applications, and training users," Hersh said.

Hersh authored a study last year predicting it will take at least 40,000 IT workers to help the nation's hospitals alone shift from paper to computerized record-keeping. Because the research dealt only with hospitals -- not vendors, public health organizations or doctors' offices -- the number is likely to be significantly higher for the industry as a whole.

How Long Will Learning Curve Take?

Although it slows some portions of the effort to reform health care, the nation's financial crisis in other ways could help speed up the transition from paper to digital records in health care.

While IT opportunities in other industries are stagnating, health IT offers many new opportunities and probably will attract skilled IT workers from other walks of life, such as from the financial, auto and engineering industries.

For people already skilled in either health care or IT, putting the two together does not take long, experts say.

"We have found that experienced health care professionals can attain basic informatics leadership skills relatively quickly, although it is in their best interest to have a formal education that covers the field more broadly," Hersh said.

"I believe that a three- to six-month immersion for health care or experienced IT workers in informatics could give them the grounding necessary to meet the health IT goals of the stimulus package," Hersh said.

For those not versed in health care or IT, the learning curve can take longer.

"This process is gradual for those new to" health IT, Klinedinst said.

"Foundation courses must be created that provide an introduction while experience is gained. HIMSS is actively involved in creating courses and facilitating collaborative agreements with institutions of higher learning and other societies and associations that will positively impact the HIT work force challenge," Klinedinst said.

Robert Patton
National HMOs (e.g. Wellpoint, UnitedHealth, Aetna, Cigna, etc.), the big regional health plans, & a myriad of health care consulting firms have legions that could be redeployed if the country were to jettison the distribution of health care through employers.
Adam Bosworth
Some thoughts. First, at an average total compensation of $200K $20 Billion would pay for 100,000 workers. That's a lot of workers. Secondly, PCIP under Farzad Mostashari in NYC has been able to enroll and train over 1,000 physicians in EMR using 50 employees who I'm sure cost a lot less than $200K / year. For the 130K primary care physicians (the front lines) that's about 6,000 people required then, not 100,000.

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