October 2014

The Search for HIT Talent
By Susan Chapman
For The Record
Vol. 26 No. 10 P. 12

There’s never been a better time to be in the market for an HIT position.

To borrow from a well-known slogan: HIT departments want you. Who’s you? Anyone with the capability to bolster undermanned hospitals looking to stay on top of their technology to-do list.

The Office of the National Coordinator for Health Information Technology (ONC) reports HIT job postings have increased 199% per month since the passage of the HITECH Act. In February 2009, the ONC tallied 4,850 postings, a figure that grew to 14,512 three years later.

According to the College of Healthcare Information Management Executives (CHIME), providers are becoming increasingly concerned about their ability to retain IT staff and the capability of federal training programs to produce qualified HIT professionals. As the demand continues to rise, facilities are searching for creative solutions to find educated and talented individuals to fill vacant posts.

HIT’s Changing Dynamics
William Hersh, MD, FACP, FACMI, a professor and chair of the department of medical informatics & clinical epidemiology at Oregon Health & Science University (OHSU), believes that while federal incentives for the health care market are beginning to wane, most health care organizations are continuing to invest in HIT. “As we move toward new models of care delivery that require new, more complex information systems, organizations are going to continue to fund them,” he says.

In the past, as facilities transitioned from paper records to an EMR, the market required employees with skills such as system configuration and change management. Now, as these same organizations seek to analyze and better utilize the data they are gathering, a completely new skill set is required to meet their needs. “The main discipline that feeds this is informatics,” Hersh says.

Paul Ceverha, a director in the HIT practice at PricewaterhouseCoopers, points out that because the HIT workforce has become more mobile, the industry is more reliant on temporary workers. Most HIT resources are project-based and consultants usually spend less than two years working with a hospital system.
“We’ve seen clients respond by taking advantage of their existing staff—training clinicians (nurses, pharmacists, physicians) to be the in-house experts for an application. These resources typically have greater affinity to the enterprise, stay in place longer, and are often more cost-effective than contractors and consultants,” he says.

Organizations also have to deal with the retirement of long-time employees with decades of experience. “In my experience, this type of attrition is twofold,” says Judy Kirby, CPC, president of Kirby Partners, a health care executive search firm. “At the C-level, there are individuals who have been with their organizations for a long time and move on to other executive positions in other fields that are not as demanding.

At the entry level, mergers and acquisitions can also facilitate the exit of talented workers with experience in the health care industry. As facilities try to rebuild their workforces, the question then becomes ‘Are we willing to take people with book learning, or do we want experience?’ It’s a catch-22.”

Kirby also cites the general lack of students interested in studying technology as a reason for the dearth of qualified HIT candidates. “We lag in STEM (science, technology, engineering, and mathematics) areas, especially among females,” she says. “This lack of STEM education cuts across all verticals, not just health care. Because of this, we’re going to continue to see a shortage of the real ‘A’ players, and there will be high prices for the best and the brightest.”

As health care systems become more sophisticated, educators are witnessing a shift in the workforce’s composition. “We’re definitely seeing a shift go more toward technology and informatics,” says Kaila Givens, MPH, RHIA, an adjunct instructor at Kaplan University’s School of Health Sciences, adding that it’s not just workers who are evolving. “If you look at the HIT industry over time, moving from paper to electronics, that changes the types of positions people have. Not only does the industry need people who can analyze data, but it also needs physicians to play a role. The HIT industry must train physicians how to enter, use, and interpret data. Clinical documentation improvement programs are in place in facilities, and HIT people are training physicians and other providers to ensure we’re getting something meaningful out of these programs.”

Kathleen Healy-Collier, MD, DHA, MHA, CSSBB, vice president of business line operations for Regional One Health and a teacher at the University of Phoenix, sees three distinct areas emerging in the new marketplace. “There is a strong demand for programmers who can consider the needs of end users. Physicians, nurses, and patients need an interface that is functional,” she notes. “The programming skills must match the needs of the end users. So it’s important for them to experience a clinical setting and see firsthand how the flow works.”

Security is equally important. “The beauty of the EMR is that all clinicians can see information,” Healy-Collier says. “The challenge is making sure the right people are seeing the information, not the wrong people.” Like Givens and Hersh, she believes informatics is increasingly critical to a facility’s overall success.

The Shifting Marketplace
Educators must follow the lead of human resource professionals who have adjusted their idea of the ideal HIT recruit from someone who primarily implements systems to someone well versed in data analysis. “We have to change how we educate and look more closely at the students coming in,” Givens says. “From the very beginning, we need to offer them a solid understanding of what they will be doing in the workplace.”

Suzanne Paone, MBA, DHA, a professor at Kaplan University’s School of Health Sciences, says a broader group of candidates is being recruited into health care organizations. “Some are traditional HIM and some are IT people from other industries,” she says. “My former facility [the University of Pittsburgh Medical Center] has hired a lot of people from other industries with IT backgrounds due to the lack of education for HIM people. A lot of these people are working side by side with consultants to meet deadlines or sales demands. What emerges is a combination of traditional HIM, IT, and project managers from other industries, consultants, and physicians—a very eclectic team.”

In terms of salary, hospitals, vendors, and payers are all increasing the compensation of qualified candidates. “Because it is a demand economy, you do have to fill a lot of positions with consultants who have years of experience but come at a much higher cost,” Paone says.

In-Demand Skills
Besides seeking subject matter experts, health care organizations also should be on the lookout for key intangibles. “What’s probably most important,” says Kirby, “are individuals who can work independently and think for themselves. The industry is changing so quickly that organizations must have staff and leadership who are self-motivated, innately intelligent, and proactive.”

For medical transcriptionists, Givens believes data analysis skills are most in demand. “We’re seeing more of a shift in transcription on the back end because of speech recognition software,” she explains. “Technical skills are going to play an important role in that area. We also need strong editors and those who can interpret the record.”

Because the wide range of skills involved makes it difficult to find the ideal HIT candidate, the position attracts professionals from outside the health care ranks, Givens says. Paone concurs: “In 15 years, I’ve not been able to find the perfect HIT person. Different people have different experience, understandings, skill sets, and strengths.”

Educators are working toward ensuring students have ample knowledge of anatomy, physiology, technology, and interpreting the EMR. “They have to know what they need in an EMR and what happens when a system goes down,” Givens says. “It’s hard to find that good mesh of qualities. Some people have been in the industry for a long time but lack IT experience. Newer people have the technology background but not necessarily in health care. Our goal in HIT education is to fill in the gaps.”

Paone cites the importance of a project management background. “If you’re an analyst, you have to have strong people and project management skills,” she says. “You’re dealing a lot with physicians but also with other health care staff. It’s really a multidimensional situation.”

Lawrence J. Donovan, MD, vice dean at the Texas A&M Health Science Center College of Medicine, believes future physicians must become somewhat tech savvy to work effectively in their caregiving roles. “The use of HIT in hospitals is so commonplace that you can’t be a doctor without knowing some technology,” he notes. “By the time they get to their clinical rotations, their third and fourth year, medical students are using the EMR and other point-of-care clinical decision tools. They have to know business practices and read reports on quality and patient safety.”

Donovan says the explosion in HIT jobs presents physicians with new career opportunities. “There are many courses for practicing physicians who are interested in pursuing a career as a CMIO [chief medical information officer], for example,” he says. “Those folks tend to be practicing physicians with an interest in IT, whether they also have a master’s degree or informal education. In hospitals, there is a strong need for them to have a background in management, patient safety, and IT, both formally and informally.”

Hersh points out the emerging physician subspecialty of clinical informatics, in which informatics and IT converge to deliver health care services.

Education Levels
Kaplan University offers three levels of degrees: an associate’s in HIT, and bachelor’s and master’s in HIM. As students embark on their educational paths, Givens says they have to shift their way of thinking rather quickly. “HIT is widely known for its coding aspect,” she explains. “When a lot of students come in, they think, ‘I’ll code, work from home, and make all this money.’ We have to help them understand that this industry is limitless. There are so many things you can do aside from coding. Many students already have their sights on a BS, with the ultimate goal of pursuing the RHIA from AHIMA. Those students already start with that expectation whether they come from the industry or a two-year program.”

The University of Phoenix offers bachelor’s and master’s degrees in health administration with a focus on IT. “There is also a certificate program in electronic health records,” Healy-Collier says. “If they take these preparatory classes, they will also be ready to sit for the exam. Because it’s a simulated environment, they have a good idea of what the real world will look like.”

Many universities, including OHSU, offer graduate-level programs in biomedical or health informatics. “Students typically bring backgrounds in health care or IT, and emerge with training that enables them to fill jobs that require combinations of both. Some jobs are specific to one’s original discipline,” notes Hersh, who says physicians typically fill the role of CMIO. “However, there are many opportunities for others with diverse backgrounds, even some without health care or IT.”

Paone says many students do not initially connect technology with the health care industry. “I’ve had many people come to me and say, ‘We have all those tech companies—Google, Microsoft, Apple. Why would a hospital hire IT people?’” she notes. “People don’t yet understand. There is a big PR problem. Young people don’t ponder a choice between nursing and HIT. In fact, if you quizzed a hundred young people, you’d be hard-pressed to find a handful of individuals who think health care means HIT. That disconnect is a big challenge for all of us.”

It can be difficult for institutions to stay ahead of the technology and develop the appropriate curricula, but Healy-Collier believes educators can do so by frequently reviewing the latest information. Dasantila Sherifi, MBA, RHIA, chair of the HIT program at DeVry University, takes that concept one step further. “I would like HIT programs to shift from being reactive to being proactive and contribute to and shape health information technology,” she says. “This requires a higher academic/education level from HIM professionals, more research, better leadership, and better partnerships between academia and industry.”

To bolster HIT education, the federal government has provided millions of dollars in grant funding to universities and colleges across the country. The recipients range from large institutions, such as Johns Hopkins, OHSU, and Duke, to small community colleges.

Where It Hurts
Ceverha believes from a cost, time, and quality standpoint, the difficulty in procuring scarce external resources has adversely impacted EMR implementations. As a result, many clients are spending significant capital optimizing their existing EMR installation.

Kirby is less convinced of the situation’s urgency. “Organizations are definitely doing more with less,” she says. “Consultants, who are generally highly qualified and experienced, fill the gaps. We’ve slowed down a little bit because of meaningful use stage 1 and meaningful use stage 2, plus ICD-10, but most of the organizations have met deadlines, so that’s not a real negative.”

Even with input from experienced consultants, EMR implementations have suffered, according to Paone. “Without qualified HIT workers, vendors are unable to put out RFPs [requests for proposals],” she says. “And even though the UCLAs, Dukes, and Stanfords of the health care world have been able to pay consulting firms, the midsize to small organizations are absolutely flailing. They don’t have enough person-power to complete the tasks, and technical things are holding them back.”

Research underscores Paone’s point. When CHIME asked its members to identify the largest obstacles for health care CIOs to meeting meaningful use requirements, respondents cited implementing or upgrading the EMR as their foremost concern. In fact, 28% viewed it as the largest hurdle, with 41% placing it among the top three concerns.

The Battle for Top Talent
Opinions differ as to whether facilities are actively vying for top candidates and luring talent away from competitors. For example, Ceverha says organizations in certain geographical areas typically are not in the same place on their EMR roadmap and thus need different types of resources at any given time. Yet, he also notes that at the executive level, there definitely is local competition for the best talent.

Paone believes there is some “poaching,” but most organizations have agreements in place to refrain from such practices. “There are many agreements, but it really depends on an organization’s philosophy,” she says. “There are battles all over the country to steal people from organizations that are considered training grounds where people work a few years and then go somewhere for more money. And all of it drives up cost.”

The EMR platform plays a role in whether hospitals vie for the same people, says Healy-Collier. “If hospitals in a particular region have different platforms, then competition is not as extreme,” she says. “I’ve seen it more with vendors. A facility will launch a new system, so when a vendor wants to launch the same new system in a different health care facility, they will reach out to talented employees to see if they can help in that process. Even when the skills are transferable, most organizations and vendors prefer to hire someone who has already worked on a particular system.”

The talent battling for these positions figures to remain strong for the foreseeable future. “More clinicians are going to get into technology,” Kirby says. “Doctors and nurses will want to go right into technology, along with those individuals specifically training for HIT. And all of those factors will be very important as we search for talent to fill vacant posts.”

— Susan Chapman is a Los Angeles-based writer.