50,000 new health IT workers might be needed

Part two of a two-part series (Access part one):

Along with the push to ramp up the use of health information technology in hospitals and doctors' offices comes the need for a highly skilled labor force to get the job done.

Claire Dixon-Lee is executive director of the Commission on Accreditation for Health Informatics and Information Management Education; the CAHIIM is a division of the American Health Information Management Association that accredits 281 health information management certificate and baccalaureate degree programs at schools across the country. In the past, health information management workers dealt with managing paper records, but their jobs have changed with the times.

Dixon-Lee said that today many AHIMA members are doing the work of IT specialists at their hospitals and physician offices while others can be retrained for these new positions. CAHIIM-accredited programs graduate between 3,000 and 3,500 students a year, of which 600 receive bachelor's degrees and the rest associate's degrees, she said.

“Our data show a 95% placement rate, but we aren't producing them fast enough,” said Dixon-Lee, who cited a 2009 private workforce study commissioned by AHIMA last year projecting the need for anywhere between 12,000 and 50,000 new health information professionals over the next eight years.

Many Modern Healthcare readers who participated in our most recent annual IT survey reported having a tough time recruiting and retaining IT staff. A majority of survey respondents (58%) indicated they'll need to hire more IT staff in the next 12 months. Meanwhile, 49% of responding executives said they have a hard time hiring or retaining IT workers, most commonly, because of a scarcity of trained personnel, but also because of low wages for IT workers in healthcare compared with other industries.

Officials at the Office of the National Coordinator for Health Information Technology think the demand for workers skilled in health IT will be even greater than the Bureau of Labor Statistics suggests, but perhaps near the upper end of the numbers that Dixon-Lee cited.

“In the aggregate, we have estimated to get to meaningful use by almost all care venues in the country we're going to need something like 50,000 more trained healthcare workers in these roles than the educational system as it currently exists can produce,” said Charles Friedman, chief scientific officer for the ONC and its point man on ONC-funded educational and workforce development programs. The goal is to have 10,500 new healthcare IT workers trained each year over five years.

“We believe most of the people who can benefit from this program will come into it already possessing part of what they will need to know,” Friedman said. “They will be either IT people who will need to know more about health, or health people who will need to know more about IT. I can't say what the balance between those two is.”

Friedman said the ONC picked the six “career paths” that the community colleges will train students to take. Those jobs are: clinician/practitioner consultants; implementation managers; implementation support specialists; practice workflow and information management redesign specialists; technical/software support staffers; and trainers.

“We looked at the field as it was evolving, not as it is today, but as we expect it to evolve,” Friedman said. ONC staffers looked at all the activities under the stimulus law and the low EHR adoption rate “and said, OK, what's going to be necessary to get these practices from paper to electronic, and what roles are needed,” and what is needed to do it properly?

Under the ONC-supported, six-month certificate programs, U.S. community colleges are expected to train 10,500 students a year over five years. For those programs, there will be no certification organization required to look over the shoulder of the 70 community colleges expected to churn out those graduates.

“It's a bit early to be contemplating that,” Friedman said.

Instead, Friedman said, the ONC has awarded a $6 million grant to Northern Virginia Community College, Annandale, to create and administer a competency examination for graduates of the community college training programs. AHIMA is “very much involved” in the grant, Friedman said.

The individual competency testing program was chosen as an alternative to certification, Friedman said, “to make it very clear this grant award is to assess objectively a certain set of competencies in each examinee who sits for the exam.

“This could evolve in the future into some kind of certification program,” he said.

Community college graduates of the six-month certificate programs won't be required to sit for the competency exam, “but we hope they will,” Friedman said. Part of the money for the competency testing grant is to underwrite the cost of 20,000 students to sit for the exam for free, he said. “We're considering this as a pump-priming mechanism to ensure enough sit for the exam to demonstrate its value.”

For the new student certificate holders, “We think it will improve their job prospects. Think of how colleges use the SAT exam to complement a student's grades to enhance admission. I think in the same way, this exam will be a comparable assessment of a certain set of competencies,” Friedman said.

“For a prospective employer, it will be information above and beyond” the educational program, Friedman said. Data on pass-fail rates from the competency exams could be aggregated and reported back to the community colleges to help them assess their programs, he added.

Bill Hersh is a physician and chairman of the medical informatics and clinical epidemiology department at Oregon Health & Science University and a man on the hustle.

The university was a triple winner in the federal workforce grant competition, receiving a total of $5.8 million in funding for three programs—nearly $3.1 million for advanced training to medical professionals in healthcare informatics; more than $1.8 million to develop curricula to be used by community colleges to train healthcare IT workers; and $900,000 to serve as the National Training and Dissemination Center for the curriculum-development program.

Oregon Health & Science has an established, nationally recognized medical informatics program. At any given time, Hersh said, the university may have as many as 200 people enrolled in its postgraduate, 24-credit-hour certificate program and its 52-credit-hour, master's degree in biomedical informatics program.

About two-thirds of the current enrollment in those programs consists of clinical professionals—with half of that group being physicians—and the remaining third being computer people, Hersh said.

The federal, advanced-education grants will be for scholarships to those programs, Hersh said, with the caveat being that enrollees in the federally funded graduate certificate programs must complete their work in 12 months, whereas in the past, a typical enrollee, who works and goes to school at the same time, often takes longer to complete the same course.

“If they do our graduate certificate program, they have to do it all in a year,” Hersh said, but the trade-off for the rush is, “in essence, people can get a free education.” Tuition for the certificate program is about $12,000. “We have 45 slots per year,” Hersh says. “The people who don't get funded can still do the program.” It just won't be subsidized, he added.

Aid recipients under this one-year, advanced educational grant program also must choose from six career paths: clinician/public health leader; health information management and exchange specialist; health information privacy and security specialist; research and development scientist; programmers and software engineers; and health IT subspecialist.

In addition to Oregon Health & Science, eight other universities will share in a total of $32 million in stimulus law funding for university-based, advanced IT education programs. They are: Columbia University; the University of Colorado at Denver's College of Nursing; Duke University; George Washington University; Indiana University; Johns Hopkins University; the University of Minnesota; and Texas State University, San Marcos.

Along with its graduate-level programs, Oregon Health & Science, as part of its triple-win, will join Columbia, Duke and Johns Hopkins as well as the University of Alabama at Birmingham in sharing ONC grants totaling $10 million to develop curricula to support the six-month, community college IT certificate programs.

The new curricula will cover 20 different content categories, including history of health IT, installation and maintenance of health IT systems, project management, and the use of IT in quality improvement.

“The people who got funded were all experts in informatics who have been doing this kind of instruction,” Hersh said, although none of them has ever developed curricula for community colleges.

To make up for lack of community college experience, each of the contracting universities was obliged to enlist “a suitable number of community college partners,” Hersh said. “In my center, there are four community colleges partners. There are faculty that will work with us as subject-matter experts that will come up with curricula suitable for the community college setting.”

Work on curriculum development by the five universities and their community college partners began almost immediately after the grants were awarded in early April, Hersh said.

The schools have less than four months to complete their curriculum development work before Oregon Health & Science welcomes 400 community college educators to Portland in August for a crash course in the new IT training program outlines.

“It will be a pretty intensive week late that month,” Hersh said. After that, the newly trained faculty will return home and get ready for a hoped-for influx of new IT students. By the end of September, the entire first wave of new IT students is expected to be enrolled.

The participating 70 community colleges will form five consortia, each geographically dispersed, although not every state will have a participating community college. The five consortia will each be led by one community college—Bellevue (Wash.) College; Los Rios Community College, Sacramento, Calif.; Cuyahoga Community College, Cleveland; Pitt Community College, Greenville, N.C., and Tidewater Community College, Norfolk, Va. Grants awarded to these schools could total $70 million over the next two years—$36 million this year and up to $34 million the next.

At Bellevue College, administrators years ago foresaw the looming demand for health IT workers and began developing training programs to meet the industry's needs. Patricia Dombrowski, director of the school's life-science informatics center, said the college has graduated about 17 health IT workers a year over the past six years from its 12-month, 30-credit-hour health IT training program.

In 2008, as doldrums beset the Puget Sound IT job market, the college responded by creating a six-month program aimed at providing experienced IT workers from other industries with a background in healthcare IT. The 18-credit-hour program for these IT veterans opened this January with students to spare.

“We could have probably seated 50 or more, but we limited it to 25,” Dombrowski said.

In addition, Bellevue this summer will offer a three-month program for incumbent physician-office practice managers on IT project management and EHR support, she said. “Now we're ready to scale up” for the HHS-funded training program, Dombrowski said.

Community colleges are not obligated to use the curricula developed by Oregon Health & Science and the other four universities, but all must focus their training programs on the six federally designated career paths. Although no single school is required to offer courses on all six job targets, each consortium must see that all six are covered within their group.

“I doubt we'll do all six,” Dombrowski said. “We have to see a little more about the curriculum before we make a decision about that.”

Bellevue could get by with just some tweaks to its existing courses and curricula to adapt them to the federal program, Dombrowski said.

“We think we're spot on and at the very worst, very close, but we have not seen the standard, and we've made some suggestions about the ONC accepting the existing curriculum,” she said. If required, “We stand ready to implement the national curricula.”

Bellevue will receive $1 million from the ONC grant to oversee its consortium, which includes seven other community colleges. Each community college, including Bellevue, will receive the same $625,000 in federal grant money to run its training programs and other services. Bellevue's additional $375,000 will go to administer the consortium.

Beyond providing teachers and course materials, Dombrowski said, Bellevue will offer tutoring and counseling and employment services. The amount of money the ONC is providing “seems adequate to the task,” she added.

Will there be enough time to develop and disseminate the curricula, train educators and be ready for the first day of school by September?

Dombrowski thinks so.

“It's wonderful in these tough times for people to be able to draw a direct line from training to be put to work,” she said. “The beauty of this is it's so directly related to people who need work.”

A version of this story initially appeared in this week's edition of Modern Healthcare magazine.