b. Don Detmer, MD, President and CEO, American Medical Informatics Association (AMIA)

Dr. Detmer said that AMIA’s s agenda is twofold: (1) to transform health and health care with informatics and (2) to make informatics an identified health profession rather than an avocation. He emphasized that estimating the number of biomedical and health informaticians needed by the United States is challenging in part because there are several domains and levels of knowledge in informatics. The field includes four major domains: (a) clinical informatics (implementing and using EHRs), (b) research informatics, (c) translational bioinformatics, and (d) public health and population informatics. All health professionals need basic knowledge and skills, chief information officers need applied clinical informatics, and public health and research informaticians need master’s- or doctoral-level training.

There are 37 or more formal informatics programs with 50 to 80 physicians in the pipeline a year and separate nursing informatics programs with 30 to 60 people in the pipeline a year. Dr. Detmer believes we have the capacity, given some support, to triple output of informaticians. In 2005, AMIA announced its 10x10 Program to develop the capacity to train 10,000 health care professionals in informatics by 2010. About 500 people have been trained in this program to date. AMIA is also undertaking several other educational initiatives related to informatics.

c. William A. Yasnoff, MD, PhD, representing HHS/ Office of the Assistant Secretary for Planning and Evaluation (ASPE)

Dr. Yasnoff described and presented results of a recent study ASPE sponsored to develop a quantitative estimate of the additional human resources needed to install the NHIN for “anywhere, anytime health care information and decision support.” The ASPE NHIN workforce study was the first-ever study of this type. One limitation of the study is that the results were heavily dependent on assumptions and expert input.

Two separate expert panels were convened to develop a detailed approach and framework for the study. A key assumption was that the size of the workforce needed to install the NHIN would be related to three independent NHIN activities: (a) EHRs in providers’ offices, (b) EHRs in hospitals and other institutions, and (c) the health information infrastructure in communities needed to create complete records. The expert panels identified 15 categories of personnel that would be needed for these three activities. Although the investigators made five site visits to specific locations where EHRs had been installed, as well as two communities that had information infrastructure, they were unable to collect much original data.

Ultimately, the study team produced a flexible tool that can work with a variety of assumptions and scenarios to estimate the additional workforce needed to install the NHIN. The size of the workforce needed to install the NHIN varies and would depend on the time frame of the implementation process. Assuming a five-year NHIN implementation period, the study team estimated that installing EHRs for the 400,000 additional physicians who need office EHRs would require 3,900 to 11,300 Full-Time Employees (FTEs), although attrition could make the number of personnel required in this category much higher. Installing EHRs for 4,000 hospitals would require 28,600 FTEs. Installing health information infrastructures for 300 communities would require 416 FTEs.

These numbers represent estimates of the additional workers who would be needed just to install the NHIN and are therefore extremely conservative. The study did not find data on the number of existing personnel and was not designed to address the question of whether there is a shortage of personnel needed to build the NHIN. There is not anything in this study that contradicts the general sense that there is a workforce shortage, especially if implementation of the EHRs takes off rapidly. Given that only 100,000 physicians have EHRs installed, it seems self-evident that the workforce needed to install EHRs for an additional 400,000 currently does not exist.

d. Don Schoen, CEO, MediNotes Corporation, and Chair, Healthcare Information and Management Systems Society (HIMSS) EHR Vendors Association

Mr. Schoen discussed the HIT workforce challenges and solutions from the perspective of the HIMSS EHR Vendors Association. He noted that EHR vendor and health care provider staffing requirements are directly related to EHR system functionality, size of the practice, or hospital and integration needs. EHR implementation never really ends, because there will be new releases and upgrades of existing products, newly certified versions, new regulations, and more.

The personnel and skills required by EHR vendors are (a) IT staff (network expertise, systems integration and interfaces, understanding of the physical environment), (b) applications analysts (depends on scope of implementation, size of practice, and complexity of system), and (c) project managers with an understanding of clinical workflow and business. The personnel and skills required by health care providers are (a) IT staff (whether an ASP or onsite data center), (b) applications analysts (clinical or business background with understanding of organizational structure and workflow), and (c) other staff depending on whether the provider is rural or urban.

Market demand will drive the supply of EHR products, and market forces will drive EHR vendors’ workforce needs. As technology and standards evolve, IT staffing levels and skill sets may level out some. EHRs will improve care delivery for providers, making more staff available for IT projects. Vendors will seek HIT workers via recruitment of new workers from the existing workforce; recruitment from other health care institutions (e.g., clinics, hospitals); realignment of health care staff from office to vendor staffing; and universities where student are obtaining degrees in healthcare, IT, and other general studies.

e. Carole A. Gassert, PhD, RN, Co-chair, Alliance for Nursing Informatics (AMIA Representative), TIGER Representative

Dr. Gassert noted that the nearly 3 million nurses practicing in the United States represent 55 percent of all health care workers and are therefore a critical component of successful HIT adoption. She discussed several topics related to preparation of the nursing workforce to use HIT, including the T.I.G.E.R .Initiative, the Alliance for Nursing Informatics (ANI), the Technology Targets Study being conducted by the American Academy of Nursing, the HIMSS 2007 Nursing Informatics Survey, and the American Association of Colleges of Nursing’s essentials of nursing education.

The T.I.G.E.R. Initiative is a grassroots initiative that aims to enable practicing nurses and nursing students to engage in the digital era in health care by preparing them to use technology and informatics to improve the delivery of care. Representatives of about 70 organizations at a summit in November 2006 developed a collective vision for nursing practice in terms of HIT for the next 10 years, along with a 3-year action plan to achieve this vision. Now nine collaborative nursing informatics workgroups are working on specific components of the 3-year action plan.

ANI represents a united voice for 26 distinct nursing informatics groups whose members believe that necessary skills for nurses’ portfolio in 2007 include computer literacy, information literacy, and informatics skills. ANI became the enabling organization for the T.I.G.E.R. Initiative in 2007.

The Technology Targets Study being conducted by the American Academy of Nursing (AAN) is seeking to create an improved process for identifying technology and HIT solutions to improve the efficiency of care delivery in medical-surgical units, incorporating nurses’ viewpoints. The HIMSS 2007 Nursing Informatics Survey found that 41 percent of nurse informaticists had no formal training in informatics, and 25 percent got their informatics training on the job. This finding is not surprising, because there are only 12 degree-granting programs in nursing informatics in the United States. More programs are needed, but expansion is difficult, because there is a shortage of nursing informatics faculty.

The AACN essentials of nursing education are under review. For the first time, the document for the essentials of baccalaureate education lists competencies for nursing informatics. The doctorate of nursing practice is a new degree and also has competencies in the area of informatics.

2. Discussion of Possible Findings and Recommendations with Regard to the HIT Workforce

Dr. Perlin reminded EHR WG members that the objective of this meeting is to define the key elements, challenges, and solutions related to the health care workforce and the widespread adoption of EHRs. Ms. Kloss suggested that the EHR WG use the recommendations for the Federal Government and for AHIC in the Building the Work Force for Health Information Transformation report as a starting point for their discussion. That work published by AHIMA and AMIA is almost two years old now, so some recommendations are no longer relevant and others need to be expanded or revised. EHR WG members made a few specific comments about these two sets of recommendations. Ms. Kloss indicated that the HIT Workforce Panel members would be happy to help develop the EHR WG develop high-impact recommendations to AHIC.

In addition, EHR WG members preliminarily proposed several recommendations that the EHR WG might want to consider:

• AHIC should recommend to the HHS Secretary that health professions education and affiliated health professions include introductory skills in health informatics.

• AHIC should consider the Centers for Disease Control and Prevention’s work on competencies in public health informatics in terms of setting policy for public health officials in the country.

• AHIC should consider recommendations for health informatics competencies among health professionals and direct health care physician and allied health professions.

• AHIC should entertain a recommendation that it consider social marketing on the importance of EHRs and related HIT.

• Explore the State e-Health Alliance in HIT training initiatives as some states are leading workforce and job retraining programs.

• Engage the DOL/ Bureau of Labor Statisticsdefining key roles, occupational classifications

There were no public comments, and Dr. Perlin ended the meeting at 4 p.m.

MEETING MATERIALS

• Agenda

• Building the Work Force for Health Information Transformation (AHIMA and AMIA report)

• Presentations:

• Linda Kloss, “Building the Workforce for Health Information Transformation”

• Don Detmer, “Building the Workforce for Health System Transformation”

• William Yasnoff, “Estimating the Workforce Needs for Building the NHIN”

• Don Schoen, “HIT Vendor Work Force Discussion”

• Carole Gassert, “TIGER Initiative and the Alliance for Nursing Informatics”

Electronic Health Records Workgroup

Members and Designees Participating in the Web Conference

Tuesday, September 25, 2007