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January 22, 2008

The Honorable Michael O. Leavitt

Chairman

American Health Information Community

200 Independence Avenue, S.W.

Washington, D.C. 20201

Dear Mr. Chairman:

The Electronic Health Records (EHR) Workgroup was formed on January 17, 2006 to address both the broad and specific charges formulated by the AHIC:

Broad Charge for the EHR Workgroup: Make recommendations to the Community on ways to achieve widespread adoption of certified EHRs, minimizing gaps in adoption among providers.

Specific Charge for the EHR Workgroup: Make recommendations to the Community so that within one year, standardized, widely available, and secure solutions for accessing current and historical laboratory results and interpretations are deployed for clinical care by authorized parties.

The EHR Workgroup has spent more than a year and a half focused on the specific charge and the primary enablers and barriers to ambulatory EHR adoption. For the last several months the Workgroup has widened its focus to also explore the issues with regards to widespread adoption of certified EHRs in the inpatient setting. Throughout, the Workgroup continued to structure its work in the key enabling areas of:

  • Privacy and Security

  • Business case alignment

  • Organizational

  • Technology

  • Medical/ legal issues

This cross-cutting recommendation letter addresses the specific workforce needs for adoption of health information technology (HIT) and is intended to be broad enough to encompass all areas of health care.

BACKGROUND AND DISCUSSION

As the EHR Workgroup broadened its focus to incorporate the inpatient environment, several changes in Workgroup membership were made to reflect this additional scope. To initiate this work, in May 2007, the Workgroup heard testimony from the American Hospital Association on their recent survey of hospitals’ use of health information technology, “Continued Progress: Hospital Use of Information Technology,” available at: http://www.aha.org/aha/content/2007/pdf/070227-continuedprogress.pdf. The survey covered topics such as information technologies used by hospitals, the functions of hospitals’ EHRs, information exchange, and barriers to greater adoption of information technology. Additionally, in July 2007, the EHR Workgroup was very privileged to have presentations on HIT adoption and implementation experiences from three hospital systems, Vanderbilt Health System, Geisinger Health System and Midland Memorial Hospital, and built on prior input on this topic provided by AHRQ funded research. (c.f. Blumenthal et al). These presentations were very informative, giving the Workgroup both the broad, national perspective of the state of HIT adoption in the hospital setting, but also some very focused and detailed case study experiences. The Workgroup heard and determined that a critical and potentially rate-limiting issue requiring further exploration was the necessity for an HIT trained and competent workforce throughout the health care enterprise, particularly during adoption and implementation.

As the Workgroup focused on the specific workforce needs to achieve the broad goal of widespread HIT adoption, this September the Workgroup heard testimony from industry leaders as they participated in an HIT Workforce panel discussion. Distinguished panel participants included:

Ms. Kloss and Dr. Detmer discussed the findings of their collaborative workforce research and recommendations emanating from their 2005 AHIMA/AMIA work force summit, “Building the Work Force for Health Information Transformation” available at http://www.ahima.org/emerging_issues/Workforce_web.pdf. Dr. Yasnoff, presented the results of his research project that was borne out of the AHIMA/AMIA workforce summit and sponsored by HHS/ Assistant Secretary for Planning and Evaluation (ASPE), entitled “Nationwide Health Information Network (NHIN) Workforce Study” http://aspe.hhs.gov/sp/reports/2007/NHIN/NHINReport.pdf. Dr. Gassert, provided data and information about the T.I.G.E.R initiative, and efforts within nursing education regarding adoption and use of HIT. She provided the Workgroup with a letter of several recommendations http://www.hhs.gov/healthit/ahic/materials/10_07/ehr/followup.html. The Workgroup found the efforts and testimony of these leaders in the area of HIT workforce extremely valuable and is reflected in the following recommendations.

RECOMMENDATIONS

As stated by the workforce panel participants, and discussed extensively during the Workgroup’s deliberations, more research and evaluation of the HIT workforce needs is still required. The AHIMA/AMIA report call for this was the impetus for the ASPE workforce study, but as they and the EHR Workgroup agreed, this is just the beginning and there is considerable work ahead to determine the needs, develop an action plan and monitor the progress of workforce development in the areas of clinical, research, public health and research informatics, and translational bioinformatics.

RECOMMENDATION 1.0: HHS should support funding for a collaborative group to research and better quantify discipline-specific workforce deficits (calibrated to different rates of HIT implementation) and to develop an approach for supporting informatics workforce needs.

As Recommendation 1 notes, there is a great need to continue to research and monitor HIT workforce needs. A current barrier to this necessary work, identified in testimony, was the lack of adequate occupational classifications needed to enable this research.

RECOMMENDATION 2.0: HHS should work with the Department of Labor to develop occupational classifications for HIT professionals.

RECOMMENDATION 2.1: HHS should encourage OPM to recognize health informatics professionals in the federal professional series.

Several health professions, namely Nursing and Medicine, have or are in the process of developing HIT competencies and standards of practice for their respective disciplines. Yet, many health professions and specialty areas of practice are still not engaged fully in these efforts. The identification of health informatics competencies and the development of curricula across all health care disciplines to support such education and training will be essential for the widespread adoption and effective use of HIT to improve patient outcomes. The following several recommendations reflect the Workgroup’s desire to further develop, support and grow these professions.

RECOMMENDATION 3.0: HHS should support funding for additional research within specific Federal agencies to create HIT career pathways (including occupational series & job classifications), with particular attention to clinical informatics, research informatics, translational bioinformatics, and public health and population informatics, in support of HIT implementation; improved quality, and clinical effectiveness; systems development; and executive leadership.

RECOMMENDATION 4.0: HHS should support Federal funding for research in health informatics (including clinical informatics, health information management and IT) which would increase attractiveness of academic careers in HIT and the pool of faculty for HIT curricula in health care disciplines.

RECOMMENDATION 5.0: HHS should work with the DOE to institute loan forgiveness programs or other incentives to attract necessary health professions trainees to HIT careers in underserved and safety net areas.

RECOMMENDATION 6.0: Appropriate Federal agencies engaged in HIT should identify and develop informatics competencies for health profession disciplines, and incorporate these in academic programs and mentorship/fellowship programs.

Although there is great need to “grow” the HIT workforce through additional recruitment into the professions and subsequent formal academic education, there is a considerable cultural change and training/re-training needed within the current workforce and across all health care disciplines. Those current health care workers/ professionals will need training and a transition strategy as they become the current adopters and implementers of HIT.

RECOMMENDATION 7.0: For the current health care worker, public or private, participation in educational and certification programs such as AMIA 10x10 program, HIM progression and certificate programs, European Computer Driver’s License equivalent, and other programs for basic/core HIT competency training and evaluation should be encouraged through bonus criteria, training programs, or other means.

The EHR Workgroup recognizes that the states have significant influence and a stake in having an adequate and competent HIT workforce as they embark on local and regional HIT adoption and implementation efforts. We wish to engage the states and encourage them to determine their HIT workforce needs and develop collaborative plans to address these.

RECOMMENDATION 8.0: ONC should work with the states to encourage governors to increase recognition of health IT workforce needs and suggest ways to address them. This could include health professional licensing activities.

Sincerely yours,

Jonathan B. Perlin, M.D., Ph.D., FACMI

Co-chair, Electronic Health Records Workgroup

Sincerely yours,

Lillee Smith Gelinas, R.N., M.S.N., FAAN

Co-chair, Electronic Health Records Workgroup