Frequent Questions

Estimating the Workforce Needs for Building the NHIN

William A. Yasnoff, MD, PhD, FACMI Managing Partner,NHII Advisors AHIC EHR Workgroup Washington, DC September 25, 2007
N H I I ADVISORS

       Outline

1. Background
2. Goal of Study
3. Description of Research
4. Activities/Architectures
5. Personnel Types
6. Results
7. Conclusions

1. Background
   • NHIN=Nationwide Health Information Network
   • "Anywhere,anytime health care information and decision support"
   • Current issue: how can we build it?
   • Next issue: Who will build it?
     • Not enough trained professionals to build NHIN
     • Need better understanding of workforce problem
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2. Goal of Study
   • Quantative estimation of needed workforce to install NHIN
     • Additional workers--not extrat burden on current workers
     • Workforce-- NOT cost
   • Flexible estimation tool
   • Variety of assumtions & scenarios
   • Expert input and guidance
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3. Description of Research
   • Assumptions
     • Three independent NHIN activities
       • EHR's in provider offices
       • EHR's in institutions (e.g. hospitals)
       • Infrastructure to create complete records
     • Multiple architectures for each activity
     • Specific architecture will impact workforce needs
     • Estimate of workforce for each activity-->useful model
   • Research Plan
     • Development of detailed approach and framework (2 expert panels)
     • Independent expert review and validation of approach and framework(2 expert panels)
     • Site visits (5) to further validate model and gather additional workforce estimates
     • Synthesis review and valdation of final model
   • Methodology
     • Create spreadsheet model including
       • Timeframe for building NHIN
       • Number pf installations fo each type needed
     • Determine number of personnel needed for each activity
       • Average of multiple estimates
   • Limitations
   • Workforce to install (not maintain)
   • Focus on workforce, Not cost
   • Not including:
     • Burden on existing workforce
     • Differences between specialties
     • Economies of scale
     • Potential impact of more/improved standards
     • Potential new approaches to NHIN
   • Data on Community HII's very limited
   • First study of this type
     • Results heavily dependent on assumptions and expert input
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4. Activities & Architectures
   • EHR's for providers (small, medium, large, very large)
     • Architecture 1: independent systems
     • Architecture 2: asp model
   • EHR's for institutions (small/rural hospitals, community hospitals, large hospitals, academic/chain hospitals, long-term care)
     • Architecture 1: independent systems
     • Architecture 2: asp model
   • Health Information Infrustructure(HII)in Communities
     • Architecture 1: scattered model
     • Architecture 2: repository model
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5. Types of Personnel (expert panel 2)
   • Project Manager
   • Implementation Coordinator
   • IT Interface Builder
   • Change Management Specialist
   • Desktop Specialist
   • Database administrator
   • Network Enginee
   • Records Management Specialist
   • Q.A. Specialist
   • Privacy Officer
   • Security Officer
   • Technical Analyst
   • Trainer
   • Help Desk Specialist
   • CMIO
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6. Results
   • Available Data
     • 8 estimates for physician office EHR's (normalized per physician
     • 4 estimates for hospital EHR's
     • 2 estimates for community health information infrastructures
   • Insufficient data for subcategories of activites, architecures, or personnel types
   • Five year implementation timeframe
   • Physician office EHR's (400,000)
   • Need 7,600+/-3700 personnel
   • Hospital EHR's (4,000)
   • Need 28,600 personnel
   • Community HII's (300)
   • Need 416 personnel
   • Tool to estimate workforce under different assumptions of number of systems and timeframe
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7. Conclusions
   • First ever quantitative estimates of NHIN workforce
   • Tool to estimate workforce under different assumptions
   • Since no data available on number of existing personnel, cannot determine if shortage exists
   • More research is needed to
     • refine estimates with additional data
     • provide details re: subcategories of activities, architectures, personnel types

Questions?

This research was sponsored by the Office of the Assistant Secretary for Planning and Evauation (ASPE), U.S. Department of Health and Human Services
Contractors: Health Systems Research/Altarum, NHII AdvisorsWilliam A. Yasnoff, MD, PhD, FACMI
william.yasnoff@nhiiadvisors.com 703/527-5678

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