Health Informa.on Technology and Its Impact on the Health Workforce Charles Safran, MD
Associate Professor of Medicine, Harvard Medical School Chief, Division of Clinical Informa.cs, Beth Israel Deaconess Medical Center 1 Overview of talk •  Why we need more health informa.on technology (HIT) •  How is HIT affec.ng healthcare •  What we know about the HIT workforce •  Implica.ons for the heath workforce Thanks to Bill Hersh (OSHU) and Chuck Friedman (ONC) for
their assistance in the preparation of this talk.
2 Advocate-­‐in-­‐Chief •  “To improve the quality of our health care while lowering its cost, we will make the immediate investments necessary to ensure that within five years, all of America’s medical records are computerized … It just won’t save billions of dollars and thousands of jobs – it will save lives.” (January 5, 2009) 3 Why do we need more informa.on technology (IT) in healthcare? Magical thinking or
•  Quality •  Safety •  Efficiency •  Access •  Transforma.on 4 Some Effects of HIT Intended
Unintended
 Quality & Safety
 Mortality in ICU
Rind DM et al. Arch Int Med 1994; 154:1511-17
Han, YY et al. PEDIATRICS 2005; 116:1506-12
 Adherence & Timeliness
 Tests & Time in ED
Safran et al. Lancet 1995; 346:341-6
Roukema J et al. JAMIA 2008; 15:107-13
 Medication Errors
 Time with Patients
Bates et al. JAMA 1998; 280:1311-16
Hollingworth W et al. JAMIA 2007;14:722-30
Transparency
 Clerical Tasks shifted to
Clinicians
 Connection to community
- home, work, school
 Administrative Demands
 Tools for Patients & Families
± Confidentiality
American Recovery and Reinvestment Act (ARRA) $40+ Billion for –
•  Adop.on of electronic health records (EHRs) •  Health informa.on exchange (HIE) •  Infrastructure •
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Regional extension centers – 60 across country Research centers – four centers in specific areas Beacon communi.es – 15 “beacon” demonstra.on projects Workforce development – four programs “Meaningful Use”
6 State of Clinical Computing in United States 2010
Stage 0
No Clinical Computing Systems
Stage 1
Results Reporting from Laboratory, Radiology, and
Pharmacy Information Systems
Stage 2
Central Data Repository
16.5%
Stage 3
Nursing Documentation, some Clinical Decision
Support, Images outside of Radiology
50.0%
Stage 4
Computerized Practitioner Order Entry, clinical
pathways, error checking
7.7%
Stage 5
Maximized point of care patient safety processes for
medication administration
5.0%
Stage 6
Physician online documentation, images, advanced
decision support
1.8%
Stage7
No longer need paper charts to deliver and manage
patient care, clinical information can be readily shared
0.7%
Adapted from HIMSS EMR Adoption Model
7 11.4%
6.9%
Can’t we just buy an EHR? (what could possibly go wrong) •  Are all practice setting the same?
•  Are all certified vendor systems
adequate?
•  Is there only one way to implement a
particular vendor’s EHR?
•  Why have 50% of implementations been
considered failures?
•  Can the introduction of an EHR have
unintended consequences?
8 Disrup.ve Technology •  IT Systems are designed to be:
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Objective
Rationalize
Linear
Solitary
Single minded
•  Clinical Work is fundamentally:
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Interpretative
Multitasking
Collaborative
Distributed
Opportunistic
Reactive
–  Interuppted frequently
Document & Bill
What do we know about the HIT workforce? •  Informa.on technology (IT) – usually with computer science or informa.on systems background •  Health informa.on management (HIM) – historical focus on medical records; cer.fied as •  Registered Health Informa.on Administrator (RHIA) •  Registered Health Informa.on Technologist (RHIT) •  Clinical Coding Specialist (CCS) •  Clinical informa.cs (CI) – ofen from healthcare backgrounds; focus on use of clinical informa.on – will guide meaningful use 10 Clinical Informa.cs •  Individuals who bring skills at intersec.on of health care and IT (Hersh, 2008 -­‐ 2009) –  Focus more on informa.on than technology –  Likely to lead “meaningful use” of HIT •  Integra.ve discipline requiring a unique combina.on of educa.on, Clinical Processes skills, and experience •  Growing Scien.fic Literature Business Informa.on •  Wealth of Experience Processes Technology ONC es.mates 51,000 needed for HITECH agenda in 12 job roles •  Mobile Adop.on Support Roles –
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Implementa.on support specialist* Prac.ce workflow and informa.on management redesign specialist* Clinician consultant* Implementa.on manager* •  Permanent Staff of Health Care Delivery and Public Health Sites –
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Technical/sofware support staff* Trainer* Clinician/public health leader† Health informa.on management and exchange specialist† Health informa.on privacy and security specialist† •  Health Care and Public Health Informa.cians –  Research and development scien.st† –  Programmers and sofware engineer† –  Health IT sub-­‐specialist† 12 Experience of the OHSU program •  Graduate level programs at Cer.ficate, Master’s, and PhD levels –  “Building block” approach allows courses to be carried forward to higher levels •  Two “popula.ons” of students –  “First-­‐career” students more likely to be full-­‐.me, on-­‐campus, and from variety of backgrounds –  “Career-­‐changing” students likely to be part-­‐.me, distance, mostly (though not exclusively) from healthcare professions •  Many of laper group prefer “a la carte” learning –  This has led to the successful 10x10 (“ten by ten”) program that began as OHSU-­‐AMIA partnership (Hersh, 2007; Feldman, 2008) 13 ONC workforce development program •  Community College Consor.a to Educate Health Informa.on Technology Professionals Program ($70M) •  Curriculum Development Centers Program ($10M) •  Program of Assistance for University-­‐Based Training ($32M) •  Competency Examina.on for Community College Programs ($6M) 14 Community College Consor.a to Educate HIT Professionals Program •  Five regional consor.a of 70 community colleges to develop short-­‐term programs to train 10,000 individuals per year in the six community college job roles •  An.cipated enrollment of people with healthcare and/or IT backgrounds – probably baccalaureate or higher degrees 15 Curriculum Development Centers Program •  Five universi.es to collabora.vely develop (with community college partners) HIT curricula for 20 components (topics) –
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Oregon Health & Science University (OHSU) Columbia University Johns Hopkins University Duke University University of Alabama Birmingham •  One of the five centers (OHSU) addi.onally funded as Na.onal Training and Dissemina.on Center –  Training – event for 300-­‐400 community college faculty in August, 2010 –  Dissemina.on – Web site and feedback collec.on for curricula 16 Program of Assistance for University-­‐Based Training •  Funding for educa.on of individuals in job roles requiring university-­‐level training at nine universi.es with exis.ng programs –
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Oregon Health & Science University (OHSU) Columbia University University of Colorado Denver College of Nursing Duke University George Washington University Indiana University Johns Hopkins University University of Minnesota (consor.um) Texas State University (consor.um) •  Emphasis on short-­‐term cer.ficate programs delivered via distance learning •  OHSU program to be run as “scholarship” program for exis.ng programs –  www.ohsuscholarships.info 17 “Run to where the ball is going to be”
– with apologies to Wayne Gretzky
18 Conclusions •  Informa.cs is maturing as a discipline and profession –  Field has emerging iden.ty as one with exper.se in using informa.on to solve biomedical and health problems •  There are tremendous opportuni.es now and in the future –  A competent and well-­‐trained workforce is an essen.al requirement •  Invest in people 19 Charles_Safran@Harvard.Edu
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