Among the major issues related to wide-scale implementation of health information technologies in community health centers, the shortage of skilled HIT workers and managers at every level looms as one of the most challenging.
We know that CHCs are experiencing critical shortages of healthcare professionals. “Health centers across the country are significantly understaffed compared to other providers. According to a recent report, health centers currently need 1,843 primary care providers, inclusive of physicians, nurse practitioners, physician assistants, and certified nurse midwives. On top of this need, health centers are 1,384 nurses short.”
With the transition to an “e-enabled” delivery environment, health center administrators also need to start planning aggressively for a significantly enhanced HIT work force, and for training other professionals to use important HIT applications.
Health Information Technology Workforce Demands
According to the Bureau of Labor Statistics’ (BLS) Occupational Outlook Handbook 2006-07, eighteen of the top twenty 20 fastest-growing occupations between 2004 and 2014 will be in healthcare- and computer science-related professions. The demand for medical records and health information technicians and computer support specialists is expected to grow faster than for all other professions. The BLS projects a 49 percent growth in the number of health information management (HIM) workers by 2010, making this occupation one of the fastest-growing health occupations.
William Hersh, M.D. of Oregon Health & Science University estimates that there is a current need of at least 100,000 trained IT professionals in healthcare settings throughout the United States. And the overall need is thought to increase by at least 50,000 during the next few years. Much of this needed support is in rural and underserved communities. Yet there has been precipitous decline in computer science undergraduate enrollments nationally in recent years. The resulting gap between demand and supply will likely overwhelm the rapidly emerging HIT field.
The Western Interstate Commission for Higher Education (WICHE) has found that: “With significant, industry- wide advancements in health information technology (IT), institutions of higher education in the West will be called upon to provide a new generation of health IT graduates. New academic programs must be developed, existing programs will need to be retooled, and student recruitment strategies will be required to meet the health IT workforce demands of the future.”
Several organizations have considered the issue and proposed approaches to workforce training and development. The American Medical Informatics Association (AMIA) held a major summit in 2005 to address issues of building an HIT workforce. “The resultant AMIA’s 10×10 program aims to realize the goal of training 10,000 health care professionals in applied health and medical informatics by the year 2010. This training will be conducted in a wide range of settings across the United States by AMIA in collaboration with key academic partners in the biomedical and health informatics education community”. Currently AMIA’s 10×10 courses cover the following topics in the field of informatics:
• Clinical or health informatics
• Clinical research informatics
• Translational bioinformatics
• Nursing informatics
• Public Health informatics
In September of 2009, a National Rural Health Information Technology Workforce Summit was convened to help identify rural HIT workforce shortage issues, understand the gaps in rural HIT workforce and what needs to be done, and to develop rural HIT workforce recommendations. The Summit made a number of recommendations focused on data development needs; public and private sector policy strategies; and the need to develop a range of workforce resources including sustainable business plans, workforce “retraining” programs, and job marketing efforts.
A “Needs Assessment Document” prepared last year on behalf of the National Health IT Collaborative for the Underserved (NHIT Collaborative) based on key informant interviews, helps further identify the types of positions among existing safety net providers; the types of vendors who offer training programs; workforce trends including educational background, hiring success, hiring gaps, priorities, challenges, and recruitment efforts; and more than a dozen respondent recommendations going forward.
Then, just last December the NHIT Collaborative facilitated a “Workforce Roundtable Discussion” in Washington among key policy makers to help determine:
• Effective strategies to promote health IT and health information management careers in underserved communities and communities of color;
• Effectives strategies to improve the “findability” of information on health IT workforce careers and curriculums, as well as Federal and State health IT workforce programs;
• Approaches to better align Federal and State workforce and training programs with private industry.
The roundtable, chaired by Neal Neuberger, CISSP, included representatives of the DHHS Office of the National Coordination, DHHS Office of Minority Health, Health Resources and Services Administration (HRSA), Department of Education, Department of Labor Employment and Training Administration (ETA), and several trade associations and community college training programs.
From the perspective of Health Center Controlled Networks, the pooling of resources may help in overcoming the HIT workforce barriers. Late last year NACHC sponsored HCCN Bulletin #15“Using Health Information Technology to Improve Quality”suggesting that: “By utilizing the resources of a HCCN, health centers can meet the challenges faced by the lack of an HIT workforce.” Looking within a CHC or HCCN to reposition available resources is an important first step. But more needs to be done to facilitate these efforts.
HITECH Provides Substantial Funding for HIT Workforce Training
ARRA HITECH contains many workforce-related training provisions, including well over $200 million for curricula development, competency examinations, and direct assistance to both community colleges and university-based efforts. In a major Blog post in October 2010, National Coordinator Dr. David Blumenthal summarizes the ONC HIT workforce development effort, which includes:
Office of the National Coordinator for Health Information Technology
Program Assistance for University-based Training
One of four workforce development programs ONC has developed under HITECH, the Program of Assistance for University Based Training is designed to rapidly and sustainably increase the availability of individuals qualified to serve in specific health IT professional roles requiring university-level training.
The six roles targeted by this program are:
1. Clinician/Public Health Leader
2. Health Information Management and Exchange Specialist
3. Health Information Privacy and Security Specialist
4. Research and Development Scientist
5. Programmers and Software Engineer
6. Health IT Sub-specialist
In April 2010, nine colleges and universities were granted awards under this program.
Regional Community College Consortia Awards
The Community College Consortia to Educate Health Information Technology Professionals in Health Care Program comprises five regional groups of more than 70 member community colleges in all 50 states. These community colleges received $36 million in grants to develop or improve non-degree health IT training programs that students can complete in six months or less. In addition, $32 million was recently made available in second-year funding for community colleges that have developed programs to train health IT specialists to provide support for RECs and physician offices.
Curriculum Development Centers Program
In April 2010, ONC awarded $10 million in grants to five domestic institutions of higher education under the Curriculum Development Centers program to develop curriculum and instructional materials to enhance workforce training programs primarily at the community college level. One of the awardees under this program, Oregon Health & Science University, will receive additional funding to serve as the National Training and Dissemination Center (NTDC) that will host an in-person training event for community college faculty, establish a secure electronic site from which all materials may be downloaded, collect feedback from instructors and students, and coordinate subsequent revisions of the curriculum materials.
Competency Examination Program
The Competency Examination Program for individuals completing non-degree training programs, one component of the Workforce Program, is intended to provide funding for institutions of higher education (or consortia thereof) to support the development and initial administration of a set of health IT competency examinations. In April 2010, ONC awarded $6 million in a single two-year cooperative agreement to Northern Virginia Community College. Development of the competency examinations will benefit institutions of higher education by providing them with a set of health IT competency examinations that they may use to evaluate, develop, and improve health IT educational programs.
State Health Information Exchange Cooperative Agreements
Every state and territory now has awards designed to build capacity for health information exchange across the health care system. Awardees are responsible for increasing connectivity and enabling patient-centric information flow to improve the quality and efficiency of care.
Beacon Community Programs
The Beacon Community Cooperative Agreement Program provides funding to 17 selected communities throughout the United States that have already made inroads in the development of secure, private, and accurate systems of electronic health record (EHR) adoption and health information exchange. The Beacon Program will support these communities to build and strengthen their health information technology (HIT) infrastructure and exchange capabilities to improve care coordination, increase the quality of care, and slow the growth of health care spending. Community Health Centers should look to the Beacon Communities as models for how to best integrate HIT workers into complex operations.
Regional Extension Centers
The Regional Extension Centers authorized under HITECH is in the process of establish approximately 70 regional centers, each serving a defined geographic area. The regional centers will support at least 100,000 primary care providers, through participating non-profit organizations, in achieving meaningful use of EHRs and enabling nationwide health information exchange. RECs offer every part of the country access to technical resources and training assistance.
Department of Education
The Department of Education Career Clusters program (under the Carl D. Perkins Career and Training Act of 2006) requires states to offer “career and technical programs of study” that comprise academic, career, and technical content that prepares students to make successful transitions to postsecondary education and the workplace. Among sixteen “career clusters” or career pathways, a track on Health Sciences specifically includes programming on Health Informatics. More about vocational training programs is available on the U.S. Department of Education office of Vocational and Adult Education page.
Department of Labor, Employment and Training Administration
The U.S. Department of Labor, through its Employment and Training Administration (ETA) is responsible for approximately $4 billion to help Americans get back to work through the national network of One-Stop Career Centers. The ETA manages a number of training and placement efforts for dislocated and other workers with special emphasis on Native Americans, farm workers and seniors. Community Health Centers may find it instructive to work through some of these DoL sponsored efforts as they ramp up an HIT workforce, more is information available on DoL’s Service Locator.