Sunday, April 20, 2008

Worforce Shortages Hill Topic

Leaders in the health workforce field speaking at the April 17th Steering Committee on Telehealth and Healthcare Informatics session on Capitol Hill, examined the problems and solutions needed to cope with the huge healthcare workforce shortages facing this country. The experts were in agreement that the solutions involve legislation being passed, federal agencies tackling some of the issues, and for universities, colleges, and associations to lead the way with new innovative ideas and programs.

Representative David Wu (D-OR), Chairman, House Committee on Science, Subcommittee on Technology, and Honorary Steering Committee Co-Chair, stopped by the briefing to say that since the House has passed the “10,000 Trained by 2010 Act”, it is now time for the Senate to act on the legislation.

The legislation would enable the National Science Foundation to award grants to improve healthcare informatics curricula, would create multidisciplinary Health and Medical Informatics Centers, and invest in healthcare informatics research to find hardware or software solutions.

Since the legislation is still in the Senate, Representative Wu would like to talk to Congressional leaders on how to proceed and move the legislation forward. Also, Representative Wu realizes that the HIT community needs to contact the Senate to champion the legislation. It may be that the legislation will have to be incorporated into a larger legislative package in order to get passed. His hopes are to see the legislation passed in the Senate while there is still a window of opportunity in this session of Congress.

Karen Bell, MD, MMS, Technology Coordinator, HHS Office of the National Coordinator for Health Information Technology, told the audience that her office has been working on developing and prioritizing what needs to be accomplished to provide for an effective and efficient workforce. Her office has been following a number of work groups in the HIT field that are discussing issues such as how to make the HIT business case, how to deal with privacy and security, and how to get the right technology in place so that HIT can move forward.

Dr. Bell pointed out that the technology itself is not really the problem as we have many devices that can be used to remotely monitor patients, and we also have the technology and the ability to communicate that is not too expensive. However, if we don’t solve the workforce shortage problem right now, then the adoption and use of technology by providers and consumers will be affected.

William Hersh, MD, Professor and Chair, Department of Medical Informatics, Oregon Health & Science University, feels that there is a bright future for HIT and for the people that work in the field. He sees biomedical informatics, health information management, and health information technology playing an important role. However, as Dr. Hersh noted, we really know surprisingly little about the HIT workforce as most of the research available only looks at specific settings or professional groups.

The study “Characterizing the Health Information Technology Workforce: Analysis from the HIMSS Analytics Database” was released on April 17th. Both the authors Dr. Hersh and Adam Wright, PhD, Senior, Medical Informatician at the Clinical Informatics Research & Development Group at Partners HealthCare concluded that the need for professional IT workers will greatly increase in the future.

The data from the report was extracted from the HIMSS Analytics Database with information mainly limited to IT professionals in 5,000 hospitals. While doing the research for the report, they found that there are about 108,390 full time employees working as IT professionals in healthcare, but to move the entire country to higher levels of adoption will require an additional 40,784 full time IT professionals. The report notes it is very important to pay attention to the future workforce that will develop, implement, and evaluate HIT applications.

Dr. Hersh pointed out that the OHSU educational program is growing. Today, 160 alumni have been awarded 168 degrees with over 500 enrolled in graduate certificate programs, the NLM training grant was recently renewed through 2012, and the university is involved in international collaborations in Egypt, Argentina and elsewhere. The university is making outreach efforts to other academic institutions, industry, and healthcare organizations to develop Oregon into an academia-industry hub in HIT.

Speaking from the Community College vantage point, Brian P. Foley, M.Ed., MHA, Interim Provost, Northern Virginia Community College, said “50% of the nurses in this country and the majority of allied healthcare workers in hospitals are community college graduates with approximately 80% of firefighters, law enforcement officers, and emergency medical technicians credentialed at community colleges.

The 2008 updated PricewaterhouseCoopers study on the Northern Virginia healthcare workforce shortage points out the crucial need to address the problem. The study found that if workforce shortages aren’t addressed by 2020, there will be 17,651 allied health and nursing workforce vacancies with the shortage expected to grow to 36%.

Northern Virginia has established a long term, business-driven sustainable strategy to address the healthcare worker shortage. Because of this strategy, the “NoVaHealthFORCE” was formed with a coalition of private sector, business, government, community, healthcare and educational leaders coming together to develop comprehensive strategies and to develop an action plan.

One of the goals is to increase capacity within the healthcare education and training system by addressing the lack of nursing and allied health faculty, and look for additional clinical training sites and faculty.

To further address the problem, the first CEO roundtable consisting of the region’s healthcare CEOs and college and university presidents was formed. In addition, the first regional meetings of the College and University Deans of Nursing were held to discuss how to meet the shortage of clinical training. In the funding area, the General Assembly provided nursing grants for $1.5 million, and the Department of Labor provided a diagnostic imaging grant for $1.2 million.

Another goal is to develop and sustain an ongoing supply of persons interested in entering healthcare career fields by improving healthcare career preparedness in the school systems, provide upward mobility opportunities, and help foreign trained healthcare personnel get the skills needed to enter the workforce. Fortunately, a MetLife Grant is funding a Bridge Program.

This goal will require developing innovative approaches in healthcare human resource management. This means institutions and organizations will need to nurture the career fields of tomorrow, develop a forum to share best practices, and designate an organization to coordinate the implementation of these actions.

The “NoVAHealth” leadership is working on several innovative collaborations and projects:

· Collaborating with the Commonwealth’s Secretary of Technology on the workforce issue
· Collaborating with GMU for the development of academic pathways in HIM and developing an EHR program
· Collaborating with the Northern Virginia Technology Council to form a Health Technology Committee
· Collaborating with a healthcare informatics solutions company to develop the new career field of Clinical Trials Specialist.
· Helping students find opportunities in the Civil Service HIM workforce
· Providing training to wounded warriors in HIM

Speaking on how to take action to educate and expand the HIM professional workforce, Claire Dixon-Lee, PhD, RHIA, Vice President for Education and Accreditation, American Health Information Management Association (AHIMA), said “in spite of the fact that there are 255 academic programs accredited in the field, in general, there still aren’t enough academic programs available in this country and most of these programs are small.”

Also, in the near future, serious faculty shortages will result as the current faculty begins to retire. In addition, college programs often are not selling the curricula in a competitive education environment. Most importantly, baby boomers are going to retire without providing knowledge transfer to the next generation.

AHIMA has several action priorities for 2008. This includes commissioning employer surveys on marketability and the types of jobs available for individuals with associate baccalaureate degrees, and masters’ degrees, plus information is needed on what jobs are available for HIM professionals. Examining new and existing certification programs is also on the agenda.

In 2005, AHIMA launched an internet based learning lab called “e-HIM Virtual Lab” for HIM students with an array of healthcare technology software, lessons for student practice, along with instructor training support, and a learning management system. The lab supports online and traditional students with self paced, instructor led training. Today 115 colleges have signed on plus there is much company participation. Expansion is planned for other disciplines but funding will be needed to accomplish these expansions.

AHIMA and AMIA have worked on several projects together. The Work Force Summit was held in 2006 to bring together 48 stakeholders to discuss the steps needed to build the work force to support electronic health information transformation. The publication “Building the Work Force for Health Information Transformation” was published as a result of the Summit.

In 2007, the two associations worked on a project together to develop core competencies for the health workforce. A task force was called together to decide on key areas and the competencies needed in four key areas. As a result, the task force developed the 2007 AHIMA/AMIA Core Competencies Workbook.

Meryl Bloomrosen, Associate Vice President of the American Medical Informatics Association (AMIA), emphasized how effectively AMIA is transforming informatics from a serious avocation to a formally recognized health profession.

AMIA has been very actively involved with their signature “10x10 program”. The goal for the program is to train 10,000 healthcare professionals in applied clinical informatics by the year 2010. Right now, there are several university programs now underway at Oregon Health Sciences University, University of Illinois, Chicago, Stanford University, and at the University of Alabama

According to Bloomrosen, AMIA initiated an academic forum with informatics program directors to find ways to integrate and track ways to improve formal education and training in the field. In addition, an academic strategic leadership forum was formed to support informatics at the highest levels within academic health centers.

AMIA has also formed partnerships with professional societies, clinics, foundations, and institutes to promote education outreach. In addition, AMIA is actively involved in public health informatics and working with CDC to advance public health informatics training by developing web based distance learning tutorials.

To address specific workforce issues, AMIA is taking part in several activities with the National Library of Medicine and the Robert Wood Johnson Foundation (RWJF). A grant from RWJF is going to help AMIA develop clinical informatics as a medical specialty. AMIA is also working to integrate the science and practice of clinical informatics into mainstream clinical care. A grant from NLM will provide for an upcoming consensus conference on developing biomedical and health informatics competencies.

Continuing Honorary Steering Committee Co-Chairs are Senators Kent Conrad (D-ND), Mike Crapo (R-ID), Sheldon Whitehouse (D-RI) and Representatives Eric Cantor (R- VA), Rick Boucher (D-VA), Bart Gordon (D-TN), David Wu (D-OR) and Phil English R-PA). The Steering Committee coordinates many activities with the House 21st Century Health Care Caucus, co-chaired by Representatives Patrick Kennedy (D-RI) and Tim Murphy (R-PA).

The next lunch briefing session on Wednesday May 7, 2008, will discuss “Ensuring the Integrity and Reliability of HIE Among Multiple Stakeholders: A Look at Successful Partnerships between Industry, Academia and Government”. For more information, contact Neal Neuberger, President, Health Tech Strategies LLC, at (703) 790-4933 or email