9 Recommendations for Hospital Health IT Staffing and Training

While unemployment continues to saturate the nation's working classes, there has been one field within healthcare where the demand has been higher than the supply: health information technology. According to a survey by IT management firm Computer Economics, 61 percent of healthcare organizations are increasing IT staff this year, the highest rate of any sector among the organizations surveyed. Additionally, healthcare providers have grown their IT operational budgets by 3.1 percent since last year, according to Computer Economics, something several other sectors cannot say they are doing.

Martin Memorial Health Systems in Stuart, Fla., is one provider that has ramped up its health IT staffing and training efforts. Ed Collins, vice president and chief information officer of MMHS, says last year, the health system began updating its IT infrastructure in its transition to electronic health records with Epic, a health IT vendor. Situated in a market where 75 percent of its patients rely on Medicare, Mr. Collins knew MMHS had to put strong tools in place to receive the meaningful use stimulus money on time. Now, nearly one year later, he says they are ready to go live in December.

In the long term, hospitals and health systems will look to health IT to extract data to prove they are providing quality care, but in the short term, they need the personnel — both internal and external — to implement it all. Here are nine recommendations for hospital health IT staffing and training during EHR implementations.

1. Create a sense of urgency. Mr. Collins says showing the importance of these projects, specifically the EHR projects, should be displayed to vendors, hospital leadership and potential health IT staff members. After deciding last August to implement EHRs, MMHS needed a team of approximately 60 people to be staffed and trained by October to start the project. They completed the task with tight deadlines, and Mr. Collins says they actually have more than 70 positions dedicated to the project now.

Kimberly Bowden, president and CEO of 1st Solution USA, has seen the urgency firsthand. The federal government incentives were not a primary concern for all providers in 2009, but much has changed since last year. "In 2010, everyone started waking up and said, 'This deadline is coming up fast, and we might be far behind,'" she says. "The last time there was this type of urgency was Y2K. But this deadline is worse because it's affecting pocket books and [the hospitals'] reimbursements."

2. Look at internal, clinical people to own the projects. Because so much of EHR implementation involves clinical processes, clinicians should be involved in EHR system development. When MMHS began its EHR development journey, Mr. Collins approached department leaders to offer up some of their best clinical and operations employees to help guide the system. He informed them that his team would need these staff members for upwards of a year and a half, maybe longer, and there would be no guarantee they would go back to their original positions. For MMHS' project, Mr. Collins says hiring internally and working collaboratively with other departments was the best way to lay the foundation for the project's staff because they have the mindset of the people who will work with the systems the most. Teaching them the basics of IT was the smaller cliff to jump than looking for outside IT staff familiar with clinical issues. Overall, Mr. Collins says roughly 90 percent of his EHR implementation staff was hired internally.

Clinical input from multiple areas can increase the likelihood implementation will be well received by the hospital's entire workforce. "A lot of hospitals underestimate gathering requirements on the front end of the implementation," Ms. Bowden says. "If you're shoving a new solution down [physicians' and nurses'] throats and saying, 'We're going to go live next week,' that's not going to go well."

However, most health IT projects are not exclusive to internal staffing. Recruitment must take place, and for Mr. Collins, it began within the community. The 10 percent of his EHR implementation staff that was hired externally were all local candidates. Emphasizing the appeal of working locally without the rigors of traveling associated with vendor positions is one way hospitals can look for their external help. Successful hospitals could also engage with a recruiting firm to view candidates from a specialized database, Ms. Bowden adds.

3. Have an engaged team of executive and clinical leaders. A hospital's CIO, chief medical officer and other executive and clinical leaders must be open-minded and diligent when it comes to these types of health IT initiatives and staffing issues, Ms. Bowden says.

Mr. Collins reiterates this point, saying the dedication of his team's work ethic has powered the successful implementation. It's been especially evident as MMHS gets closer to its "go-live" date. "It can be extremely stressful," he says. "This is where the stress and pressure really builds, and it requires a different work ethic when you work in the IT space."

4. Use federally funded health IT training programs as a resource.
The Office of the National Coordinator for Health Information Technology graduates students from various community colleges throughout the country in several different health IT backgrounds. These include information management redesign specialists and implementation support specialists. Similarly, Ms. Bowden has worked with the University of Texas at Austin, which offers a nine-week extensive training course on EHRs. These resources can offer a multitude of candidates in a field of different health IT positions if hospitals are struggling to find internal candidates.

5. Temper expectations for external candidates. While there are many students going through health IT training programs, Ms. Bowden says the younger workforce is getting scooped up by the vendors because the vendors offer a more appealing work environment. She says most successful hospitals will temper expectations, realizing they won't always find external people with five years of EHR experience.

6. Inform candidates of challenges. Mass-scale health IT projects like EHR implementations are big commitments in terms of dollars spent and hours worked. Mr. Collins says the hospital held two town hall meetings to inform internal candidates they would be working hard with long hours and no overtime. Additionally, working on weekends and holidays would be commonplace, and after the project is over, there would be no guarantee they will have a job. However, he says hospitals must motivate them to take the leap of faith because it will be "the most rewarding project" they've ever worked on. "We wanted to alleviate some of their fears but also inform them to say it's serious, and you can't change your mind halfway through," Mr. Collins says.

7. Consider hiring a transformation specialist. Transformation specialists are people that specialize in these types of massive organizational changes, such as a hospital taking on new health IT projects. These specialists can also spot out areas where extra training is needed. For example, there may be nurses on the floor that have never used a computer before and need basic computer training before moving on to EHR training. "Hospitals need to realize how important it is to mentally prepare for this change," Ms. Bowden says.

8. Motivate the team during training and beyond. Training to learn new EHR systems can create a data overload of sorts. While it may be easier for younger hires to grasp, Mr. Collins says there are many people who have been out of school for several years who are not used to the rigors of high-pressure studying and training. "There is a ton of pressure on these folks to learn this stuff in a short period of time," he says. "You have to be able to help those last few people cross the finish line."

9. After staff is set, make sure there is full confidence in those chosen.
After Mr. Collins appointed a chief clinical information officer to manage the EHR project, the accelerated hiring process began. Within weeks, the team of applications analysts, report writers, trainers and other health IT staff members was cemented through internal and external searches. In a way, Mr. Collins says he would equate the final layout to a fantasy football draft. With the board filled out and team members placed in specific grids to do particular tasks, all of the directors must be happy with their teams to roll into the implementation.

Related Articles on Health IT Staffing:

Survey: 61% of Healthcare Providers Increasing IT Staff
ONC Opens Competency Examination Program for Health IT Workers
8 Key Roles to Incorporate Into an Excellent Health IT Team

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