August 2013

Staffing Shortages Plague HIT
By Julie Knudson
For The Record
Vol. 25 No. 11 P. 14

While technology implementations continue at a record pace, harried IT departments go wanting for qualified workers.

The technology revolution in health care is driving unprecedented demand for IT talent. Hospitals are implementing new systems, managing growing data sets, and training employees to use these platforms, all while aiming to comply with omnipresent meaningful use deadlines.

“It certainly is a perfect storm,” says Heidi J. Töppel, consulting director of compensation in health care and nonprofit organizations at Towers Watson, a professional services company. “With all the health care reform mandates going on, the health care industry needs to become more technology savvy. It needs to become more connected with its different parts, and to do that it needs an IT system that’s better than anything we already know today.”

It’s a tall order, and the overwhelming demand to meet those objectives is leading to a shortage of experienced IT professionals. A recent study conducted by Towers Watson found that 67% of health care employers reported difficulties attracting and retaining experienced IT employees.

The lack of skilled IT workers is creating alarm throughout the industry. For example, research from the College of Healthcare Information Management Executives (CHIME) revealed that 59% of chief information officers (CIOs) thought staffing shortages may negatively impact their chances to receive meaningful use incentives.

In a series of focus groups, Susan H. Fenton, PhD, RHIA, FAHIMA, a former assistant professor of HIM at Texas State University in San Marcos, gained a firsthand view of the task facing hospitals and the long-term outlook. “We talked to lots of employers who not only said they had a need, but that they anticipated more need in the future,” she says.

Different regions may be seeing varying levels of demand and worker availability. “For example, Houston, being a large metro area, probably has more supply than some of the smaller communities, and certainly more than some of the remote communities,” says Fenton, who believes the pressure of obtaining meaningful use incentives is driving the need for adequate staffing levels.

According to Spencer Hamons, CHCIO, vice president and CIO of Taos Health Systems in New Mexico, the industry is “absolutely seeing problems” with attracting skilled IT workers. The biggest issue may be that health care is atypical from most other industries. “We do things so much differently than the rest of the world,” he says.

Professionals entering the industry often are unaware of its unique expectations. For example, a candidate may agree to work nights and weekends but not realize that off-hours work isn’t the exception; in an environment that’s truly 24/7, it’s the rule. “People come in with a complete misunderstanding of what it’s going to take to do things in health care,” Hamons says, adding that finding professionals who are not only qualified but who are also willing to accommodate the often-demanding schedules of a busy hospital is a difficult chore.

Show Me the Money
It’s nearly impossible to talk about IT staffing issues without mentioning pay rates. According to data gathered by Towers Watson in February and November 2012, programmer salaries increased by 10% while project managers received a 23% pay boost over that time period. “I think the problem that hospitals are not acknowledging is that they aren’t following the market,” says Töppel, who believes hospitals should pull IT jobs out of the standard salary structure and instead apply a framework that more closely matches market activity. “They need to do something special with these folks. Otherwise, they might find a person and offer them pay that was set a year ago, which is already 10% to 12% behind the market.”

There are a handful of niche skills seeing the greatest demand. Professionals who understand pharmacy systems, regardless of whether they’re pharmacists, and those who can support nursing systems are among the most sought after, according to Joseph Hobbs, CHCIO, MBA, CIO at Community Hospital Anderson in Indiana. “We’ve always believed that, at least for the clinical system analyst roles, we really should try to have people with the background of an RN or LPN,” he says. “I just think you end up with a better product.”

Technology-inclined people with the skills to translate how systems and people interact also appear on hospitals’ most desired lists. “Anybody who does application software, who can talk to people about how to get what it is that they do into a system, is in demand,” Töppel says, adding that this select group includes application programmers, engineers, and project managers—any position that has anything to do with real-world systems applications. Unfortunately, those typically are the IT professionals who are also the scarcest, she says.

The Consultant Equation
Consultants may be both contributing to and alleviating the worker crunch. Hospitals pressed for time to meet various deadlines may look outside their doors to help get systems and processes built and implemented. “Sometimes there just aren’t enough hours in the day to complete everything without bringing in extra help,” Hamons explains. “We have the hard stops of the various meaningful use requirements. Also you have contracts you’ve signed with Epic or Cerner or whomever your EMR vendor is, and people are under pressure.”

However, Hamons believes consultants aren’t always the best place to spend limited budget dollars, pointing out that CIOs generally are conservative when it comes to enlisting their services.

Nevertheless, tight deadlines and a general lack of available talent have made the health care arena fairly lucrative for IT consultants. “They’re in such demand, and the highest quality consultants have a very strong niche,” says Jeff Urban, an area vice president for MedSys Group, a Texas-based HIT consulting firm. As a result, consultant pay has increased significantly. “It’s sustainable up to a point,” Urban says of the typical consulting fee, “but hospitals will have to create less demand, frankly, to lower those costs.”

The situation has contributed to a revolving-door scenario in which people are brought on board and trained only to be lured away by the siren song of earning big bucks as a consultant. “That scenario costs the hospital so much more than just bringing in consultants,” Urban says, noting that getting outsiders acclimated and trained can be expensive.

An overreliance on consultants may come back to haunt hospitals in other ways, too. Hobbs says one looming pitfall is a skills shortage that’s potentially greater than the one being experienced right now. “I think the big downside we’re going to see will be in a few years when organizations that have relied on consultants to do this need to make some budget cuts,” he says. “If they let some of that staff go, all the expertise they had is no longer with them.”

Maintaining technology platforms without the right internal knowledgebase—and no money to find one externally—is a difficult prospect at best, Hobbs adds.

How to Attract and Retain Talent
Finding the right IT people and enticing them to stay are top priorities at many hospitals. However, figuring out a formula to make it happen can be tricky. Community Hospital Anderson sports a fairly long tenure in general—not just within IT—and while staff members are aware of the potential to make more money elsewhere, the hospital has made employee retention a priority.

If IT personnel need to work from home on occasion, the hospital does its best to be accommodating. When possible, work hours are flexible to counterbalance the long days, evenings, and weekends required for always-on system reliability. “We have a lot of things on our plate, but you also don’t want to burn people out,” Hobbs says. “You sometimes have to be creative in how you work for that balance.”

Hamons says pay parity has long been a sticking point when it comes to attracting and keeping IT professionals. A perceived emphasis on the value of clinicians over administrative staff may have hampered salary equality before, but that’s beginning to change. “I think people are starting to see now—especially with meaningful use—that IT does have value here,” he says.

The move toward higher compensation also may encourage other staff to more seriously consider transferring to IT. “I’ve had great opportunities in the past to bring in nurses who really wanted to do the job, but they said there was no way they were going to IT because they would be taking a one-third pay cut,” Hamons says, adding that these were excellent internal candidates who had the skills and expertise necessary to make a real difference in care delivery.

Providing attractive prospects for career advancement also can influence IT staff members who are considering leaving the organization, particularly if their other option is a consulting position featuring a significant pay boost. In the current landscape, Töppel says that so much emphasis is being placed on compliance deadlines that technology folks may opt for more money now because their long-term options appear limited. “I think [hospitals] need to put a lot of effort into career advancement and explaining to people that this is not a short-term position,” she says.

As databases continue to expand in health care, some organizations are sure to pursue initiatives that hinge on the ability of IT professionals to manage and interpret the information. By emphasizing this trend as an opportunity for future growth, Töppel says hospitals may be more successful in hanging on to their current staff.

To help fill staffing gaps in the meantime, Fenton encourages hospitals to broaden their scope when reviewing potential employees. “They need to look at the background of the person and not necessarily rule them out because they don’t meet one particular requirement,” she says, adding that probationary or trial periods may allow candidates enough time to get up to speed with their new job responsibilities.

In addition, Fenton says more needs to be done to ensure prospective candidates aren’t slipping through the cracks. “We all know that résumés aren’t read by humans; they’re read by software,” she explains while suggesting that hiring managers may want to review all résumés for key positions. “Yes, it’s more work, but there may be a hidden gem in there.”

Hamons agrees that hospitals have a tendency to overlook internal candidates who have the potential to grow into a valuable IT team member. “There is this expectation they’re going to be able to bring in somebody who can hit the ground running,” he says. “But from my experience, very rarely—and only in very specific situations—can a technology person, even one with dozens of years of experience, come into an organization and truly hit the ground running.”

Because every organizational culture is unique, getting new employees acclimated can take longer than expected. Learning how a company functions—how processes work, who to talk to when something needs to get done, what’s the best way to interact with various departments—takes time.

Even if a hospital comes across a candidate with suitable baseline skills and excellent growth potential, Urban says it often takes too long before making a hiring decision. In a talent pool with nearly nonexistent unemployment, that’s usually a bad strategy. “As they’re hesitating, they’re losing individuals,” he says. “Then the entire process has to start over again.”

It’s a cycle that actually creates more demand—and more work for providers. “Once you’ve found the right person, pull the trigger and bring that person in because that’s by far the most beneficial scenario,” Urban says. Whether delays happen because filling the position isn’t the organization’s highest priority or because someone on the hiring team wants to continue interviewing other individuals, many times the result will be that the candidate takes a job elsewhere, he adds.

Urban says educational institutions should be looking ahead to begin addressing the staffing gap because the time to fix today’s problem already has passed. “Right now, it’s just weathering the storm,” he says. To produce more work-ready students, Urban recommends schools recruit clinicians to share their experiences in a classroom setting.

In-house learning opportunities also should be explored. Suggest that clinicians participate in HIT training, which will help build teamwork and add another perspective. “Bring in a clinician who understands the workflows and how it will affect the physicians, and have them work side by side with the HIT people,” Urban says.

Developing strategic partnerships with local organizations can allow hospitals to look beyond their doors for help. “Especially for the organizations in smaller communities or out in rural areas, I would really be working with my community colleges to see if I could train people who are from the area, who have family ties, and who are more likely to stay,” Fenton says, noting that it’s an approach that addresses not only the challenge of graduating enough qualified IT professionals but also speaks to the issue of those who abandon in-house positions in favor of the sometimes-nomadic life of a consultant.

Fenton is concerned the shortage eventually may contribute to failed implementations—if it hasn’t already. However, she points out health care isn’t the only industry feeling a worker pinch. “If you look at large IT implementations across all industries, a huge number of them fail,” she says.

However, a failed HIT project can lead to serious consequences. “When people ask, ‘Why is health IT different than IT?’ I tell them, ‘Because if we mess up, people can die,’” Fenton says.

— Julie Knudson is a freelance business writer based in Seattle.