The federal government hopes that $19 billion of economic stimulus incentives will be the spoonful of sugar that entices large numbers of doctors and hospitals to finally embrace electronic health records. Threatening the ambitious incentive program, however, is a poison pill of sorts: a shortage of health IT professionals who will be needed to see practitioners through the transition.
The administration has responded with a crash program of grants aimed at getting colleges to train more than 11,000 new health IT professionals per year. The grants, totaling $120 million, were announced in November and December. Applications were due in January, and award winners must begin the new study programs this fall.
The Department of Health & Human Services is pushing the program apace in hopes of expeditiously closing the shortfall of health IT experts, estimated by the administration at around 51,000 skilled workers over the next five years.
"We know what works," says Charles Friedman, the deputy national coordinator for health IT, who will supervise the grants. "The challenge is to ramp this up quickly enough with high enough quality."
The new training programs encompass four competitive "Health IT Workforce Development" grants that are available for higher education institutions. The largest will provide $70 million to some 70 community colleges, organized in five regional consortia, to establish a new type of training.
Awardees will open intensive, sixmonth certification programs for people who already have some relevant work experience or education, typically in either healthcare or IT. Programs will include such topics as healthcare workflow, change strategies and quality improvement techniques.
The three other grants will fund curriculum development centers at about five universities to support the community college programs; establishment of mostly 12-month graduate programs at a dozen four-year colleges and universities; and development of competency exams for graduates of non-degree programs and for people who have relevant work experience.
Is it enough?
Yet as fast as the grant program is being rolled out, some wonder if it is fast enough.
"My question is, is it already too late" to start training the needed health IT specialists, asks Dr. Blackford Middleton, a professor of medicine at Harvard Medical School and director of clinical informatics at Partners Healthcare System, in Massachusetts.
That's not Middleton's only concern. While the incentives are a good start, he says, he worries they may not be enough to push more reluctant doctors to switch to EHR. More measures may be needed to make sure there is "a sustainable business case" for the change, he says.
Exacerbating the shortage of health IT workers is the urgency with which the administration hopes to establish a robust health IT infrastructure.
Many policymakers believe such a move is an essential part of efforts to improve the delivery and efficiency of healthcare. According to the Office of the National Coordinator for Health IT (ONC), only 20 percent of doctors' offices and 10 percent of hospitals currently have even a "minimally functional" EHR system.
Yet making the transition from paper records is often difficult, hence the need for qualified experts who understand the unique challenges of healthcare environments. Asking an IT whiz who doesn't have a health background to shepherd such a transition is asking for trouble, experts say.
"There are many electronic health record implementations that have failed because [the IT specialists] didn't understand healthcare," said Dr. William Hersh, a professor and chair of the Department of Medical Informatics & Clinical Epidemiology at Oregon Health & Science University, which was applying for two of the grants.
The Obama administration is convinced that electronic health records hold the potential to advance evidence-based care and transform health delivery. What is required, experts say, are systems that integrate with healthcare's distinct workflow, terminology and reimbursement methods"while managing the interaction of highly trained specialists in different fields.
"In many respects, healthcare is a unique industry," says Lawrence M. Pawola, interim head of the department of Biomedical and Health Information Sciences at the University of Illinois at Chicago, which is applying for three of the grant programs. "It's over-regulated, lacks standards, is very inefficient and has incredible documentation needs. You add to that that a person's life is on the line."
The university is a leader in health-informatics graduate programs that primarily enroll doctors, nurses and pharmacists. "In our training we try to increase students' understanding of these issues, present new case studies and provide tools they can use to deal with these issues," he says.
Blending faculties
The grants will accelerate programs that have already been underway for a few years in higher education, especially for widespread associate degrees in health information management (HIM), formerly known as medical record keeping.
Brandy Ziesemer, an associate professor and manager of health information programs at Lake-Sumter Community College, in central Florida, which has joined a regional consortium seeking a grant, says the four hospitals in their area recently adopted an EHR.Consequently, the focus of Lake-Sumter's programs has shifted from paper to EHR, "and now we teach students how to help doctors change to electronic health records," she says.
As a similar trend spreads among colleges, they are increasingly "blending faculty from health information management and IT," says Claire Dixon-Lee, executive director of the Commission on Accreditation for Health Informatics and Information Management Education, which certifies 280-degree programs of all levels at 225 colleges.
"Health information management knows about data," she says, "and IT knows about technology." Such integration, she adds, will be a key feature of the community college consortia.
Patricia Dombrowski, director of the Life Science Informatics Center at Bellevue College, WashingtonState's largest community college and the lead institution of a consortium applying for a grant, noted that collaboration between HIM and IT departments is "one of the biggest benefits" of the grant program.
Demand for teachers
A major challenge will be finding qualified teachers to staff the new training courses. The grants will increase the number of programs and enrollments sharply, experts say, further straining a supply of teachers that has already been stretched by enrollments in health IT programs that have grown substantially in recent few years.
The number of certified programs has risen from 230 in 2005, to an estimated 310, including the new ones waiting to be accepted this year, says Dixon-Lee of the accreditation commission.
Some colleges, especially those that use a significant number of CIOs and other health IT professionals as adjuncts, report no shortage, but Dixon-Lee expects many institutions to have trouble "finding and cultivating" teachers with a modern understanding of both the HIM side and the IT side of health IT.
Retired faculty members and teachers from related fields may have to be recruited, according to W. Ed Hammond, a professor and director of Duke University's new, interdisciplinary Center for Health Informatics. If Duke wins the grant it is applying for to become a curriculum development center, the university anticipates that it will need to provide close support to community college teachers using the new syllabuses."We'll hopefully man a desk 24 hours a day, seven days a week to provide help," says Hammond.
