Special Report: The rush to train healthcare IT workers
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
T he American Recovery and Reinvestment Act of 2009, commonly known as the stimulus law, has a host of tight deadlines for its myriad health information technology subsidy and IT network development initiatives.
Nearly all of them are timed to help fulfill the ambitious goal set by former President George W. Bush in 2004 and adopted by President Barack Obama last year to make electronic health records available to most Americans by 2014.
Not surprisingly, a federally funded health IT workforce training effort is both part of the overall program and caught up in its mad rush.
“We are moving fast,” says Patricia Dombrowski, director of the Life Science Informatics Center at Bellevue (Wash.) College, which is leading a consortium of community colleges that applied for and won $3.4 million in workforce training grants funded by the stimulus law—covering career paths from information management to IT hardware installation.
Preparations at the college are moving so fast, “We were talking about using roller skates this morning, but we raised our hands,” Dombrowski says. “We knew the time line, so I really feel confident moving forward.”
Last month, HHS’ Office of the National Coordinator for Health Information Technology awarded $112 million of stimulus funds to dozens of universities and community colleges such as Bellevue for various IT workforce training and advanced-education programs ranging from six-month certificates through post-graduate degrees.
The faculties and administrators at those schools will be preparing feverishly for the fall semester and the first influx of what they hope will be thousands of new health IT students and job seekers.
Feeling the need
Boosting employment nationwide was a major goal of the stimulus law, and there is little doubt, according to the government and industry leaders, that tens of thousands of new jobs will be needed if the federal effort to push provider adoption of EHRs is to be successful.
Under the stimulus law, both physicians and hospitals seeking subsidy payments for their IT purchases must use certified EHRs in a meaningful manner. Last December, the ONC and CMS issued rules for certification and meaningful use. In response to thousands of subsequent public comments, both rules are likely to be modified sometime this spring.
The National Center for Health Statistics, part of the Centers for Disease Control and Prevention, estimates there are 308,900 officebased physicians who are not federal employees, Dombrowski: “We are moving fast” to get programs ready. who are not working for a hospital’s ambulatory-care program, and who are not radiologists, anesthesiologists or pathologists.
Almost half of these doctors are either in solo practice or work in partnership with just one other physician. According to the latest NCHS data available—the 2009 estimates from its National Ambulatory Medical Care Survey— only 21% of these office-based physicians have a “basic” EHR.
By NCHS definition, a basic system has rudimentary capabilities, including the ability to create patient problem lists and clinical notes and do electronic prescribing. Although it’s not part of the definition, a basic system most likely lacks sufficient functionality to be certified under ONC rules and thus be considered to be an EHR system worthy of reimbursement under the multibillion-dollar stimulus technology subsidy program that is dominating the health IT landscape.
Just 6% of all office-based physicians use what the NCHS defines as a “fully functional” EHR. Such a system might have enough bells and whistles—such as automatic warnings of drug interactions and out-of-range test levels— that a physician using one might reasonably expect to qualify for federal EHR subsidy payments under the stimulus law, based on current drafts of ONC and CMS rules.
But even these advanced EHR systems are likely to require vendor upgrades to meet proposed ONC certification criteria, while many clinicians will still be expected to change their workflows and reporting requirements to fully qualify for EHR subsidy payments under proposed CMS meaningful-use standards.
On average, hospitals are a bit higher up the IT adoption curve than physician offices, but most hospitals are still a long way from where they’ll need to be to achieve meaningful use under the proposed CMS criteria.
Computerized physician order entry is an advanced EHR function in hospitals. According to the CMS proposed rule, to qualify for federal EHR subsidy payments under the Medicare portion of the stimulus law, hospitals must run 10% of their orders through a CPOE system for a 90-day period sometime during the first year of the program, which starts this fall.
Jason Hess, general manager of clinical research at KLAS Enterprises, Orem, Utah, a