Meaningful Use of Health Information Technology Requires a Competent Informatics Workforce

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1 Meaningful Use of Health Information Technology Requires a Competent Informatics Workforce William Hersh, MD Professor and Chair Department of Medical Informatics & Clinical Epidemiology Oregon Health & Science University Portland, OR, USA Web: Blog: informaticsprofessor.blogspot.com References Altman, RB (2012). Translational bioinformatics: linking the molecular world to the clinical world. Clinical Pharmacology and Therapeutics. 91: Anonymous (2012). Demand Persists for Experienced Health IT Staff. Ann Arbor, MI, College of Healthcare Information Management Executives. chime.org/chime/press/surveys/pdf/chime_workforce _survey_report.pdf Anonymous (2012). Needles in a haystack: Seeking knowledge with clinical informatics, PriceWaterhouseCoopers. industries/publications/needles- in- a- haystack.jhtml Anonymous (2013). Solving the talent equation for health IT, PriceWaterhouseCoopers. Araujo, J, Pepper, C, et al. (2009). The profession of public health informatics: still emerging? International Journal of Medical Informatics. 78: Blumenthal, D (2010). Launching HITECH. New England Journal of Medicine. 362: Bui, AAT and Taira, RK, Eds. (2010). Medical Imaging Informatics. New York, NY, Springer. Buntin, MB, Burke, MF, et al. (2011). The benefits of health information technology: a review of the recent literature shows predominantly positive results. Health Affairs. 30: Chaudhry, B, Wang, J, et al. (2006). Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Annals of Internal Medicine. 144: Detmer, D, Bloomrosen, M, et al. (2008). Integrated personal health records: transformative tools for consumer- centric care. BMC Medical Informatics & Decision Making. 8: 45. Furukawa, MF, Vibbert, D, et al. (2012). HITECH and Health IT Jobs: Evidence from Online Job Postings. Washington, DC, Office of the National Coordinator for Health Information Technology. Gardner, RM, Overhage, JM, et al. (2009). Core content for the subspecialty of clinical informatics. Journal of the American Medical Informatics Association. 16: Goldzweig, CL, Towfigh, A, et al. (2009). Costs and benefits of health information technology: new trends from the literature. Health Affairs. 28: w282- w293. Hersh, W (2004). Health care information technology: progress and barriers. Journal of the American Medical Association. 292:

2 Hersh, W (2010). The health information technology workforce: estimations of demands and a framework for requirements. Applied Clinical Informatics. 1: Hersh, W (2012). Update on the ONC for Health IT Workforce Development Program. HIMSS Clinical Informatics Insights, July, Hersh, WR and Wright, A (2008). What workforce is needed to implement the health information technology agenda? An analysis from the HIMSS Analytics Database. AMIA Annual Symposium Proceedings, Washington, DC. American Medical Informatics Association Kulikowski, CA, Shortliffe, EH, et al. (2012). AMIA Board white paper: definition of biomedical informatics and specification of core competencies for graduate education in the discipline. Journal of the American Medical Informatics Association. 19: Miller, HD, Yasnoff, WA, et al. (2009). Personal Health Records: The Essential Missing Element in 21st Century Healthcare. Chicago, IL, Healthcare Information and Management Systems Society. Richesson, RL and Andrews, JE, Eds. (2012). Clinical Research Informatics. New York, NY, Springer. Safran, C, Shabot, MM, et al. (2009). ACGME program requirements for fellowship education in the subspecialty of clinical informatics. Journal of the American Medical Informatics Association. 16: Smith, M, Saunders, R, et al. (2012). Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Washington, DC, National Academies Press.

3 Meaningful Use of Health Informa4on Technology Requires a Competent Informa4cs Workforce William Hersh, MD Professor and Chair Department of Medical Informa4cs & Clinical Epidemiology Oregon Health & Science University Portland, OR, USA Web: Blog: informa4csprofessor.blogspot.com 1 Overview Role of meaningful use of health informa4on technology (HIT) and informa4cs in a learning healthcare system Needs and opportuni4es for a competent professional workforce Larger picture and future direc4ons 2 1

4 Regardless of your poli4cal views, the US healthcare system needs fixin Recent IOM report (Smith, 2012) analyzes data to find annual $750B in waste (out of $2.5T system) 75,000 premature deaths Sources of waste Unnecessary services provided Services inefficiently delivered Prices too high rela4ve to costs Excess administra4ve costs Missed opportuni4es for preven4on Fraud 3 Health informa4on technology (HIT) is part of solu4on Systema4c reviews (Chaudhry, 2006; Goldzweig, 2009; Bun4n, 2011) have iden4fied benefits in a variety of areas Although 18-25% of studies come from a small number of health IT leader ins4tu4ons (Bun4n, 2011) 4 2

5 The learning healthcare system provides the context for informa4cs (Smith, 2012) Records immediately updated and available for use by pa4ents Care delivered the has been proven reliable at the core and tailored at the margins Pa4ent and family needs and preferences are a central part of the decision process All healthcare team members are fully informed about each other s ac4vi4es in real 4me Prices and total costs are fully transparent to all par4cipants in the care process Incen4ves for payment are structured to reward outcomes and value, not volume Errors are promptly iden4fied and corrected Outcomes are rou4nely captured and used for con4nuous improvement 5 Why has it been so difficult to get there? (Hersh, 2004) Cost Technical challenges Interoperability Privacy and confiden4ality Workforce 6 3

6 Help was provided by a (then) new US president To improve the quality of our health care while lowering its cost, we will make the immediate investments necessary to ensure that within five years, all of America s medical records are computerized It just won t save billions of dollars and thousands of jobs it will save lives by reducing the deadly but preventable medical errors that pervade our health care system. January 5, 2009 Health Informa4on Technology for Economic and Clinical Health (HITECH) Act of the American Recovery and Reinvestment Act (ARRA) (Blumenthal, 2010) Incen4ves for electronic health record (EHR) adop4on by physicians and hospitals (up to $27B) Direct grants administered by federal agencies ($2B, including $118M for workforce development) 7 One of the challenges has been lack of a professional workforce Analysis of HIMSS Analy4cs Database es4mated need of 41,000 addi4onal HIT professionals as we moved to more advanced clinical systems (Hersh, 2008) ONC increased es4mate of need to 50,000, leading to Workforce Development Program being part of HITECH Program (Hersh, 2012) Actual numbers hired have been even higher (Furukawa, 2012) see next slide Despite growth of jobs and number trained, shorpalls persist (CHIME, 2012) 8 4

7 HIT employment growth from Bureau of Labor Sta4s4cs (Furukawa, 2012) >60K! Percent change in online health IT job pos4ngs per month (Furukawa, 2012) 5

8 Demand s4ll persists for experienced health IT staff (CHIME, 2012) Skills most ouen in demand Clinical souware implementa4on and support staff (e.g., EHR, CPOE) 74% Infrastructure staff 47% Business souware implementa4on and support staff 45% 71% said IT staff shortages could jeopardize an enterprise IT project, while 58% said they would definitely or possibly affect mee4ng meaningful use criteria for incen4ve funding 85% also expressed concerns about being able to retain current staff 67% were aware of the ONC workforce programs, with 12% of those respondents repor4ng that they had hired graduates from them What do we know about the health IT/ informa4cs workforce? Not much! (Hersh, 2010) Three historical groupings Informa4on technology (IT) typically have background in computer science, IT, MIS, etc. Health informa4on management (HIM) historical managers of medical records and their coding Clinical informa4cs growing number of individuals who work at intersec4on of clinical fields and IT 12 6

9 Important informa4cs workforce developments Office of the Na4onal Coordinator for Health IT (ONC) Workforce Development Program Aiming to create the workforce needed to implement the HITECH Act Cer4fica4on in health IT and informa4cs New cer4fica4ons being added to historical ones from nursing and HIM Emerging needs in the coming data- rich, informa4on- driven healthcare system 13 ONC Workforce Development Program Investment of $118M based on es4mated need for 51,000 health IT professionals in 12 workforce roles $32M Nine universi4es funded, with emphasis on short- term training using distance learning OHSU funded to enroll trainees in exis4ng programs $70M $10M $6M Five universi4es funded to develop curricula for community college programs OHSU funded to develop curricula and to serve as Na4onal Training & Dissemina4on Center (NTDC) Curriculum available at ntdc.info 14 7

10 Community College Consor4a to Educate HIT Professionals Program Five regional consor4a of 82 community colleges to develop short- term programs to train individuals in the six community college workforce roles Enrollment of people with healthcare and/or IT backgrounds most with baccalaureate or higher degrees 15 Community College Consor4a graduates Students Enrolled or Completed: 21,321 8

11 Curriculum Development Centers Program Five universi4es to collabora4vely develop (with community college partners) HIT curricula for 20 components (courses) Oregon Health & Science University (OHSU) Columbia University Duke University Johns Hopkins University University of Alabama Birmingham One of the five centers (OHSU) addi4onally funded as Na4onal Training and Dissemina4on Center Downloadable from ntdc.info Version 3 (final ONC- funded version) delivered in Components of the ONC HIT curriculum 1. Introduc4on to Health Care and Public Health in the U.S. 2. The Culture of Health Care 3. Terminology in Health Care and Public Health Sexngs 4. Introduc4on to Informa4on and Computer Science 5. History of Health Informa4on Technology in the U.S. 6. Health Management Informa4on Systems 7. Working with Health IT Systems 8. Installa4on and Maintenance of Health IT Systems 9. Networking and Health Informa4on Exchange 10. Fundamentals of Health Workflow Process Analysis & Redesign 11. Configuring EHRs 12. Quality Improvement 13. Public Health IT 14. Special Topics Course on Vendor- Specific Systems 15. Usability and Human Factors 16. Professionalism/Customer Service in the Health Environment 17. Working in Teams 18. Planning, Management and Leadership for Health IT 19. Introduc4on to Project Management 20. Training and Instruc4onal Design (Lab components using VA VistA EHR) 18 9

12 Another outcome of project: VistA for Educa4on 19 Program of Assistance for University- Based Training (UBT) Funding for educa4on of individuals in workforce roles requiring university- level training at nine universi4es with exis4ng programs Oregon Health & Science University (OHSU) Columbia University Duke University George Washington University Indiana University Johns Hopkins University Texas State University (consor4um) University of Colorado Denver College of Nursing University of Minnesota (consor4um) Emphasis on short- term cer4ficate programs delivered via distance learning ONC funding winding down, with likely transi4on to tui4on- paying programs 20 10

13 Workforce Training - University- Based Program Enrollment & Gradua4on Students Enrolled or Graduated: 1,627 (Target: 1,685) As of September 14, 2012 Historical cer4fica4ons in nursing and HIM Nursing bachelor s degree with prac4ce experience h{p://www.nursecreden4aling.org/nursespecial4es/ Informa4cs.aspx HIM has many; first three require formal educa4on Registered Health Informa4on Administrator (RHIA) Registered Health Informa4on Technician (RHIT) Cer4fied Coding Specialist/Associa4on (CCS, CCA, CCS- P) Cer4fied Health Data Analyst (CHDA) Cer4fied in Healthcare Privacy and Security (CHPS) Clinical Documenta4on Improvement Professional (CDIP) h{p://www.ahima.org/cer4fica4on/default.aspx 22 11

14 Other cer4fica4ons do not require specific formal training HIMSS CPHIMS/CAHIMS Cer4fied Professional/Associate in Healthcare Informa4on & Management Systems h{p://www.himss.org/getcer4fied/ HITPro developed out of ONC Workforce Development Program but available to anyone h{p://www.hitproexams.org Health IT Cer4fica4on h{p://www.healthitcer4fica4on.com CompTIA h{p://cer4fica4on.comp4a.org/getcer4fied/cer4fica4ons/ hi{ech.aspx 23 Clinical informa4cs subspecialty for physicians History 2009 AMIA develops and publishes plans for curriculum (Gardner, 2009) and training requirements (Safran, 2009) 2011 American Board of Medical Special4es (ABMS) approves; American Board of Preven4ve Medicine (ABPM) becomes administra4ve home 2013 first cer4fica4on exam in October; AMIA board review course launched Subspecialty open to physicians of all primary special4es But not those without a specialty or whose specialty cer4fica4on has lapsed 12

15 Clinical informa4cs subspecialty (cont.) Will follow usual path of five years of grandfathering training requirements to take cer4fica4on exam before formal fellowships required Two paths to eligibility for exam in first five years Prac4ce pathway prac4cing 25% 4me for at least three years within last five years (educa4on counts at half 4me of prac4ce) Non- tradi4onal fellowships qualifying educa4onal or training experience, e.g., NLM fellowship, or educa4onal program (master s degree, cer4ficate?) ABPM rules h{p://www.theabpm.org/abpm_clinical_informa4cs.pdf My interpreta4on h{p://informa4csprofessor.blogspot.com/2013/01/ eligibility- for- clinical- informa4cs.html 25 Some concerns regarding capacity- building for the subspeciality Age at which many physicians enter informa4cs OHSU experience shows many physicians (and others) enter field mid- career Ability of programs to provide both educa4on and training Will ACGME be flexible regarding educa4onal por4ons? Paying for cost of training 2012/09/challenges-for-building-capacityof.html 26 13

16 Informa4cs is transi4oning from implementa4on to analy4cs Health sector demands for informatics (PwC, 2012) 27 Most important skills needed to achieve HIT priori4es (PwC, 2013) 28 14

17 More workforce roles than just those designated by ONC (PwC, 2013) 29 Opportuni4es in informa4cs are not limited to healthcare Bioinforma4cs genomics and personalized medicine (Altman, 2012) Clinical and transla4onal research building the learning healthcare system (Richesson, 2012) Public health protec4ng the public and promo4ng health (Araujo, 2009) Consumer health for all ages, especially aging Internet- savvy baby boomers (Detmer, 2008; Miller, 2009) Imaging informa4cs use of images for biomedical research, clinical care, etc. (Bui, 2010) 30 15

18 Conclusions Achieving the learning healthcare system will require informa4cs tools and professionals The grand experiment of HITECH is going on in the US results not yet in There is con4nued need and career opportunity for informa4cs professionals, researchers, and others Now that adop4on is widespread, work of informa4cs must change to make beneficial use of data and informa4on 31 For more informa4on Bill Hersh h{p://www.billhersh.info Informa4cs Professor blog h{p://informa4csprofessor.blogspot.com OHSU Department of Medical Informa4cs & Clinical Epidemiology (DMICE) h{p://www.ohsu.edu/informa4cs h{p://www.youtube.com/watch?v=t- 74duDDvwU h{p://oninforma4cs.com What is Biomedical and Health Informa4cs? h{p://www.billhersh.info/wha4s Office of the Na4onal Coordinator for Health IT (ONC) h{p://healthit.hhs.gov American Medical Informa4cs Associa4on (AMIA) h{p://www.amia.org Na4onal Library of Medicine (NLM) h{p://www.nlm.nih.gov 32 16

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