CONNECTING WITH EHR IT TALENT IN THE FACE OF AN IMMINENT SHORTAGE

Transcription

1 CONNECTING WITH EHR IT TALENT IN THE FACE OF AN IMMINENT SHORTAGE

2 ARRA SPELLS THE NEED FOR EHR IT TALENT ASAP The IT talent explosion of the late 90s and early 2000s is now a faint memory. But the technology demands of the American Recovery and Reinvestment Act (ARRA) are putting IT workers back in the limelight again, with an exception that they also be skilled in electronic health record (EHR) technology. ARRA has transformed integrated technology and EHRs into a national priority and an urgent one at that by providing approximately $20 billion for health information technology, Medicare and Medicaid incentives to drive healthcare providers to adopt EHRs and other integrated IT solutions. The act offers incentives for adopting EHRs by 2011 and imposes penalties on those who do not by This carrot-and-stick strategy, with its tight deadlines throughout the five-year period, has produced IT talent challenges in critical workforce sectors that provide expertise in both pre- and post-implementation stages such as IT strategy, vendor selection, programming, data security, networking, data warehousing, reporting and analytics, systems analysis and continuing administration. Ultimately, ARRA will foster staffing efficiency, reduce service duplication and medical errors, enhance the patient experience and outcome, and provide better overall patient care. But getting there will likely require the hiring or contracting of highly specialized IT staff trained in EHR to meet the demand. Healthcare providers will need this talent, along with time, to plan and implement the systems needed to comply with ARRA, especially those dealing with the complexities of security inherent in working with medical data. Federal government incentives to stimulate EHR adoption are working. Most hospitals are allocating significant budget dollars to prioritize EHR spending to meet the meaningful use criteria. Because the deadline for all providers is the same, everyone is fishing from the same talent pool at the same time, and overfishing will result in a very real talent crisis. The federal government has suggested the shortfall over the next five years will be 50,000 qualified healthcare IT workers. With penalties commencing in 2015, most experts anticipate intense activity to accelerate through 2012, dipping marginally thereafter but still with plenty of growth opportunity. There will be a significant uptick around , as the clock approaches midnight in terms of financial penalties. 2

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4 WHAT IS THE GOVERNMENT DOING TO SUPPORT HEALTHCARE ORANIZATIONS? There are several federally funded training programs in place that strive to fulfill the expected IT healthcare worker shortage as it relates to EHR ramp-up and implementation. As part of the government s stimulus package, about $640 million has been allocated to establish EHR regional extension centers to help small practices across the nation (that mainly serve uninsured, underinsured or medically underserved patients) adopt and become meaningful users of health information technology (HIT). Help ranges from guidance on vendor selection and workflow redesign to privacy best practices and local workforce support. The Office of the National Coordinator for Health Information Technology (ONC) has awarded $84 million in stimulus-funded grants to create intensive IT curricula (lasting six months or less in community colleges and 12 months or less at four-year universities) to train a new workforce of health IT professionals who will be ready to help providers implement EHRs. These include: Community College Consortia to educate HIT professionals Program of Assistance for university-based training Curriculum Development Centers Competency Examination Program By ONC estimates, these federally funded programs are expected to reduce the shortfall of skilled health IT professionals by 85 percent. In addition, many associations such as the American Health Information Management Association, American Academy of Professional Coders and National Cancer Registrars Association offer certification programs. YET, THE NATION DOES NOT SIMPLY NEED HEALTHCARE IT WORKERS It needs qualified, experienced healthcare IT workers familiar with EHR. It also demands workers with a wide variety of skills programmer, developer, systems analyst, database specialist, senior data architect, coder, among others. Many of these IT workers will be fresh out of college, quickly trained by federally funded programs, or transferred in from another industry. They may be, for example, a displaced telecom worker or clinician looking to transition into EHR. This, however, does not translate into experienced IT skills in EHR. 4

5 A DISCONNECT BETWEEN IT AND HEALTHCARE? From a clinician s standpoint, I find it frustrating that there aren t enough of us represented in the IT industry who can speak the [medical] language to the IT developers and vendors to get products that work for us. I don t see how to lend my 20+ years of expertise in primary and specialty care to the development of usable EHR products. In my experience the majority of the newly trained professionals are very IT savvy, but not healthcare savvy. The end users (physicians and nurses, primarily) still stand the very real risk of having software developed by very smart IT people who don t address the many needs and nuances in our work settings (not the least of which is medical-speak; i.e., anatomical descriptors, symptomatology) and work flow. The industry doesn t seem to be seeking out and hiring experienced healthcare providers to act as liaisons between IT and providers. To me this is an obvious and cost effective way to help the IT side and reduce the time investment on the end user side. JEANNE FINDLAY, DNP RESEARCH PROGRAM MANAGER AND PEDIATRIC NURSE PRACTITIONER JOHNS HOPKINS SCHOOL OF MEDICINE 5

6 TRAINING AND TIMING ARE NOT IN SYNC Today, the time required to adequately train an EHR-ready staff is far from optimal. On the provider side, it can take 3-6 months to evaluate and select a system and months to implement an enterprise EHR system. Then it can take another 6-12 months to resolve issues and become truly productive. The system is not equipped to train professionals quickly enough so they are truly EHR-qualified in time to meet aggressive meaningful use deadlines, especially when significant incentives and even more substantial penalties are at stake. While IT professionals may use these training programs and certifications to get their foot in the door, it s questionable whether the meaningful use timelines will allow hospitals to utilize these folks because the ramp-up time needed is just too long. 6

7 KEEPING UP-TO-DATE Technology is changing the qualifications required to perform both clinical and administrative allied health duties. Students entering the job market today must be familiar with ways in which technology is used to perform on-the-job tasks. In particular, understanding electronic health records is essential. Compounding these exhaustive technical requirements is the depth of a programmer s communication skills, which are rooted in the personality of the prospective employee. Technical and logical skills needed to write reports can transfer very well. However, when designing reports, communication between the report writer and the report requester is paramount. This sets the scope of the report and requires extensive communication, clarification and, at times, negotiation. In most cases, the requester will not be an IT professional, meaning the communication must be conducted in terms that can be interpreted by all parties. Explicitly understanding the workflow, purpose and what the information is being used for is critical. One of the limitations of the programs working under federal HITECH grants is that they cannot favor one software vendor over another, and they do not have the resources to train students in all existing EHR systems. In addition, while ONC Health IT programs can draw from a national curriculum, they differ greatly from school to school because faculty background significantly influences the nature of the training. As a result, the graduating talent has a varied depth and breadth of training. In reality, federal training programs in place are often inadequate in building all the necessary skills. Some programs include an internship phase that walks students through a real world case of EHR implementation from start to finish. Even then, most employers prefer to see more experience on the resume before hiring an IT professional for an implementation. 7

8 CAN HOSPITALS FIND QUALIFIED STAFF RIGHT OUT OF TRAINING PROGRAMS? THERE IS NO QUESTION THAT THE NEED FOR TALENT IS DIRE, AND WILL ONLY INCREASE FROM HERE As Matthew Sappern, a senior vice president at EHR solutions provider Allscripts noted, The HITECH Act has created a universal need for domain expertise such as the HIT industry has never seen. In addition to the right software, for the next five years every healthcare provider in the country needs access to the human resources that can bring that software to life across the entire continuum of care. These professionals need technical savvy but also an understanding of workflows that only comes with experience. Software firms and third party consultants are scrambling to ramp up staff and innovate new training techniques to meet this bolus of demand. Hospital C-level staff often say they need experience, not kids right out of school. While there may be a glut of health IT applicants, the subset of those who are qualified to do the job is much smaller, making the search even more challenging for many healthcare organizations. In addition, IT training outside of healthcare does not immediately translate into marketable skills in an EHR environment. For displaced IT workers, moving into health - care is not a slam dunk, said Thomas P. Flannery, a partner at global consulting firm Mercer. While they may be trained in IT, they certainly are not trained in healthcare IT. They are going to have to learn the language of medicine to be able to operate appropriately. They will have to deal with issues unique to the healthcare industry, including privacy, protocols and technologies. Getting over that hump will be hard. A recent survey of 182 CIOs found that more than 70 percent of organizations lack IT staff to implement clinical applications. And 51 percent reported that an IT staffing shortage might affect their ability to implement an EHR system and qualify for meaningful use incentive payments. Ten percent said the deficiency definitely will have an adverse effect. 2 Another study by market research firm Brown Wilson Group revealed that about 90 percent of a subset of nearly 4,000 healthcare leaders are not on track to reach their meaningful use implementation goals, even though they purchased electronic medical records technology. One of the top five reasons for this is due to lack of available and/or trained staff to properly implement an EHR system, according to 77 percent of the respondents. Questions abound about whether the federal training programs will really help. Addressing the government s stated need for 50,000 more healthcare IT workers to achieve meaningful use equates to almost a 50 percent increase in the current size of the workforce of 108, College of Healthcare Information Management Executives (CHIME) 3 Computer Sciences Corp. Falls Church, Virginia.

9 A VALID OPTION: CONTRACTING HEALTHCARE IT STAFF Today s healthcare organizations are faced with obviously growing pressure. To successfully administer new EHR technology, both in implementation and ongoing maintenance, organizations need to access the best healthcare IT talent pool. Finding, attracting and retaining qualified professionals to meet the growing healthcare IT demand is a real challenge. Healthcare providers faced with this talent shark s tank are increasingly leveraging qualified healthcare IT experts on a temporary basis. IT staffing experts who live and breathe the EMR talent landscape can identify and cherry pick the top talent, relieving hospitals from the daunting task of combing through the entire talent pool. Healthcare IT staffing today for providers is about heterogeneity, said Gregory A. Stoskopf, director of Human Capital and Talent Management Consulting for Health Care Providers at Deloitte Consulting, LLP. There is an immediate need to bring on board workers qualified in healthcare IT for EHR implementations, and a longer term need to ensure clinically oriented staff exist within organizations to handle the myriad challenges ahead, including Healthcare Information Exchanges (HIE), Accountable Care Organizations (ACOs) and many other constructs needing technological support. To meet these challenges and get the right resources applied to technical modules and clinical infrastructure likely requires both contracting from outside IT firms and training onsite staff. By utilizing highly skilled temporary staff with EHR experience, healthcare organizations are able to build up their teams as needs dictate, and allow existing IT teams to concentrate on their core competencies delivering optimum patient care. As a result, hospitals can improve morale, increase efficiency and lower total operating costs related to EHRs. 9

10 DECODING THE HITECH ACT & MEANINGFUL USE A PART OF THE ARRA, THE HITECH ACT (HEALTH INFORMATION TECHNOLOGY FOR ECONOMIC AND CLINICAL HEALTH) is driving the adoption of interlinked EHRs and other health information technology and encouraging health information exchanges (HIE). The HITECH Act seeks to improve health outcomes through the widespread use of technology in the healthcare setting. MEANINGFUL USE comes from this concept. The Act s goal is to have meaningful users who do not simply purchase a certified EHR system but who use it in a meaningful way to improve clinical outcomes. The Centers for Medicare & Medicaid Services (CMS) generally expect that under Medicare, meaningful EHR users will demonstrate each of the following: meaningful use of a certified EHR, the electronic exchange of health information to improve the quality of healthcare, and reporting on clinical quality and other measures using certified EHR technology, integrated clinical decision support (CDS) and computerized provider order entry (CPOE). The HITECH Act has a graduated approach. Current meaningful use Stage 1 requirements serve as a launch point for improved outcomes and will evolve to align with changing national priorities. Then meaningful use requirements will ramp up in later stages because the government anticipates that new processes coming out of Stage 1 will deliver better patient outcomes, increased efficiency and enhanced patient experience in later stages. To date, only Stage 1 has been defined in the initial rules. Stage 2 will be identified by the end of 2011 and Stage 3 by the end of CMS, if it so chooses, can make further changes to what constitutes meaningful use beyond Stage 3. Several measures need to be submitted to CMS to show meaningful use, including health IT functionality and clinical quality metrics. Eligible Professionals (EPs) and Eligible Hospitals (EHs) need to prove that their EHR technology is used to capture data elements and calculate results for clinical quality measures. Hospitals and professionals need to show meaningful use for a continuous 90-day reporting period for the first payment year of incentives. Subsequent payment years require demonstrating meaningful use throughout the entire payment year. EHs must have EHR in place before they can receive any incentive payment. Medicaid EPs and EHs do not need to achieve meaningful use in the first payment year but they do need to show that they are adopting, implementing or upgrading certified EHR technology. The timing of meaningful use stages varies based upon the first payment year of the EP or EH. EPs and EHs eligible for the Medicaid incentive program can begin incentive payments as late as 2016 and there are no payment decreases for pushing back the start date. This is opposed to the Medicare Incentive Program, in which there is an aggregate decrease in payments. Incentive Program for Electronic Health Records: Issued by CMS, this final rule defines the minimum requirements that providers must meet through use of certified EHR technology to qualify for payments. Standards and Certification Criteria for Electronic Health Records: Issued by the Office of the National Coordinator for Health Information Technology, this rule identifies the standards and certification criteria for the certification of EHR technology so EPs and EHs can be assured that the systems they adopt are capable of performing the required function. See healthit.hhs.gov for more information on HITECH stages and payment incentive rules. 10

11 FORECAST: THE IMPORTANCE OF TALENT RETENTION Healthcare IT staff trained and experienced in EHR will hold the golden ticket. Those thoroughly acquainted with technologies like Epic will have the opportunity to jump ship as demands escalate, requiring hospitals and other healthcare providers to prepare for turnover churn. Today s healthcare organizations must recognize the need for robust retention and recruitment plans like flexible work hours, telecommuting recognition programs and professional development initiatives. Some of these tactics include: Biannually reviewing EHR employee and contractor pay and benefits to assure that the organization is in line with the current market. In accordance with supply and demand, they must acknowledge that wages will increase and make market adjustments to retain top talent. Giving IT professionals extra opportunity and training to make sure they stay with the organization. True all-inclusive replacement costs are simply too high. Identifying and developing internal talent through mentoring, shadowing programs and formal training. Companies should take opportunities to invest in certification whenever possible. Being flexible in hiring. HR managers should develop an Ideal Candidate Profile and a Secondary Candidate Profile and create recruiting plans for both, given the stiff competition for top talent. For example, some CIOs have leveraged SQL programmers from the financial industry, trained them to be Cerner CCL report writers given the similarity in languages, and minimized ramp-up time. As Timathie Leslie, vice president of Booz Allen Hamilton deftly described, The accelerated adoption of EHRs underscores the need to look beyond technology. Workforce, process integration, operations, and other elements are critical to EHR success and sustainability. Ushering in workforce training programs is one great way government is helping to meet the immediate and future market need for healthcare IT workers. Contracting healthcare workers who understand EHR is another viable option for the short term. The real value for EHR adopters lies at the intersection where all of these things work in harmony with each other. It is essential that the focus of EHR adoption does not end with technology installation. Success is about finding the right fit across people, solutions, environment and objectives. While finding the holy grail of those who possess the mix of EHR knowledge, skill sets and experience may be a tall order, healthcare organizations who embrace flexibility and creativity in their search will find they indeed can be nimble, efficient and strikingly effective in today s mission of becoming EHR proficient. To learn more about connecting with the right EHR IT talent, please contact your local Modis representative today. The most capable candidates will possess the aptitude to gain new skills and learn new software. Rewarding, developing, nurturing and valuing top performers should be a top priority for all healthcare providers in the coming years. 11

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