Health care providers in the U.S. are encountering a lack of qualified candidates as they race to meet federal government deadlines for EHR (electronic health record) and health IT use.
The challenge, medical CIOs say, is to find enough IT staff who can help hospitals and medical practices migrate from paper records to EHRs and manage the large amount of patient data generated from practicing medicine. At stake is US$25 billion in funding allocated in 2009 by the American Recovery and Reinvestment Act, for spending on EHRs and health IT. Medical providers will be compensated for the cost of the systems if they meet criteria by certain dates, with four key deadlines coming in the next six months.
With the government spending almost as much as the health care industry's total value of $27 billion, "you can imagine there's going to be a fair amount of hiring," said John Halamka, a doctor at and CIO of Beth Israel Deaconess Medical Center in Boston.
To manage his hospital's EHR rollout, Halamka opted to outsource the task to a firm that specialized in EHR implementation and practice transformation.
"You will see a combination of approaches," he said. "Some may seek services from vendors, others outsource to groups. We'll figure out a logical way to leverage staff. Having every hospital hire their own is probably not going to happen."
Halamka determined that cloud computing best met the hospital's health IT needs and developed a private cloud. This required staff to support the cloud's infrastructure, and he hired workers with backgrounds in database development, wireless networking, security and server administration.
Equally critical are employees who grasp how introducing technology into medicine changes how care is administered.
"I need an analyst who really understands how it is you can take a paper-based office environment and then move it to this new world of using electronic records because it isn't just digitizing paper," said Halamka. "So they really have to understand how do you leverage the technology and change processes in order to move doctors from what they may have been doing for 30 years to a new world. You understand what the EHR does. You understand how tablets, printers and iPads are part of the equation."
Beyond IT skills, Halamka looks for candidates who "have a working vocabulary of health care" and are familiar with the industry's privacy, security, compliance and regulatory aspects.
Halamka also finds his organization competing with EHR vendors for staff. Candidates may find vendors' fast growth and lucrative salaries more appealing compared to a nonprofit hospital's offerings, he said. However, Beth Israel Deaconess' status as a Harvard University medical school hospital gives him an edge over private companies.
"There is some reputation at Harvard hospitals of being innovative," he said. "And to be part of that innovation is maybe appealing to people. People have different motivating factors. Generally when you are talking about a nonprofit you enjoy the atmosphere, you enjoy the mission. You feel the health care itself is something you are passionate about."
With the government financially penalizing health care providers that fail to use EHRs by 2015, there is a need to hire staff with the right blend of health care knowledge and technology skills, said Josh Lee, a doctor at and chief medical information officer for the University of California San Diego Medical Center.
"There's a lot of dedicated health care professionals out there in the universe," he said. "There's a lot of dedicated IT professionals. But it's a much narrower band where you have people that can live in both of those worlds."
The growing number of clinical workers "who were raised in a computer-savvy environment" means Lee turns to them to help fill his ranks.
"The short-term solution is to take people who are clinically smart and interested in systems work and have them receive the IT training they need to configure these systems," he said.
This track has emerged as the preferred IT staffing route for hospitals, said Eric Marx, vice president of health care IT services at IT staffing firm Modis.
"If they come up through clinical, people are seen as more valuable than a displaced IT worker trying to pick up the clinical side of the equation," he said.
Marx's clients have also turned to consultants and adopted creative approaches to hiring.
"One CIO got them from finance. Within six months they can get them up and running," Marx said, noting that some employers see SQL database programming skills as helpful when using products from health IT vendor Cerner.
Even with health care providers looking to increase IT headcounts, hospitals are looking for candidates with training on EHR products from certain companies.
"At least for now organizations are sticking with people with specific vendor package experience. They're not looking at people as interchangeable," Marx said.
Lee concurs and, during implementation periods, will turn to consultants if he can't find candidates who are familiar with software from health IT vendor Epic Systems.
"There's not an endless supply of Epic-certified analysts out there in the universe," he said. "We have higher needs during implementation. We won't have all those analysts on staff. We will use consultants to keep a stable of trained Epic consultants."
To meet the worker demand, the federal government allocated approximately $120 million in grants to community colleges for health IT training. Experts anticipate that these programs will pay off in a few years since hospitals need skilled workers now in order to meet immediate deadlines and some organizations want more seasoned graduates.
"Health care systems don't have time to get someone up to speed in six months" with how the incentive program is structured, Marx said.
"CIOs feel like people coming out of the programs are not perfectly aligned with their needs," he continued. "They needed someone with a clinical background."
Expect benefits from the community college programs between 2013 and 2020, said Lee, after more people have received health IT training and hospital work experience and know how to use EHRs for patient data management.
"You don't walk out of school able to be the world's best analysts," he said. "We'll see the benefit in the coming years as they get on the job and interact with real problems in real hospitals and clinics."
The 7,000 graduates produced by the community college training program will not meet the 50,000 heath IT employees the industry needs by their deadlines, Halamka said. This shortage is "a short-term problem" with "the peak of demand coming right now" since the stimulus ends in a few months, he said.
Despite the hiring challenges, doctors praised the stimulus package for making technology more affordable to health care providers and promoting the adoption of EHRs.
"What the stimulus has done is take those folks who are reluctant to go to the EHR, go through the process and really motivated them because not only is there a carrot now, but there is a stick and in 2016 you're going to start seeing a reduction in reimbursement if you don't have any EHR," Halamka said. "The stimulus is good because it made everyone move faster and also gives criteria of what makes an EHR that is good enough."
"The biggest beneficiary to electronic health records is the patients," Lee said. "It gives them much broader access to what's going on with them and what their plan is."