Hospital IT Jobs | Hospital EMR and EHR

Health IT Worker Shortage Worse Than Expected

Battered by growing needs and increasing competition, managers hiring for health IT face a worse shortage than previously expected, according to research by PwC. Because hiring needs are so acute, many healthcare hiring executives are expecting to change strategies for hiring over the next year, the consulting firm reports.

Right now, 75 percent of providers are currently hiring health IT employees, PwC found. But it’s not the same old same old when it comes to recruiting approaches. Over the next year, more than three-quarters of health execs expect to shift strategies in hiring, thanks to mounting pressures both internal and external.

These pressures are varied. Seventy-nine percent of those surveyed by PwC expect an increase in technology investments in the coming year, 62 percent are worried about the availability of needed skills, and 51 percent are threatened by the speed of technology change, PwC’s research found.

Meanwhile, it’s not just competition with other providers that has healthcare CIOs worried. According to PwC, they face health IT labor competition from drug and device companies, HIT vendors and health insurance firms as well.

When it comes to skills, providers said clinical informatics was most important in meeting their goals. But they’re willing to compromise, and are increasingly borrowing IT specialists from other industries to meet their hiring needs.

To gain an advantage in health IT hiring, employers must pull off a neat trick, the building of their reputation as a place to work, PwC advises. Researchers note that providers who build their IT identity and brand will be in the best position to hire, manage and most of all keep key health IT workers on board.

Health Management Associates Makes System-Wide Deal With athenahealth

Cloud-based EMR vendor Athenahealth has struck a deal with hospital chain Health Management Associates that its vendor competitors would die for.

HMA has signed an agreement with athena under which the chain’s 1200+ employed physicians — cutting across 15 states and 300 locations — will now use the vendor’s practice management, EMR and patient communication services. HMA’s 10,000-odd independent physicians will also have access to the systems.

In the announcement, HMA and athena took pains to emphasize that the selection process was a fair and thorough one:

Health Management selected athenahealth after a twelve-month review and due diligence process that involved more than 350 clinical experts, including more than 200 physicians. The evaluation process included detailed questionnaires, onsite and virtual demonstrations, site visits, and clinical template shootouts.

Perhaps those details were included to convince observers that the deal didn’t include some kind of payola. I don’t think doctors are going to be too impressed by the IT talk. (If it were me I’d care about only one demonstration — how it worked for me on Day One.)

HMA may not be the country’s largest hospital chain, but it’s still a heavyweight, operating 66 hospitals spanning 10,330 licensed beds. Its hospitals span Alabama, Arkansas, Florida, Georgia, Kentucky, Mississippi, Missouri, North Carolina, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Washington, and West Virginia.

Particularly given its scale, this deal intrigues me for a few reasons. It raises what seem to me to be important questions:

* Is HMA expecting its independent physicians to dump whatever EMR they may already have in place and switch it out for athena? Or adopt its practice management module instead of what they use now? That seems, uh, a bit unrealistic?

* I don’t know what enterprise EMR system HMA uses (do you, readers?) but whatever it is, I doubt it will plug seamlessly into to the athena cloud. How do the IT types at HMA plan to connect the whole schlemiel?

* If the independent physicians don’t want to adopt the athena package, what will HMA do? Club them like baby seals? Or just accept that a large percentage of its docs aren’t connected?

Healthcare Pros Learning IT

Ever since I wrote my post about the Old Boys Club of Healthcare IT, I’ve been meaning to write a follow up piece about healthcare pros learning IT. In fact, many of the following comments came from or were inspired by discussion with Tom Roberts. So, let’s give him credit where credit is due.

The discussion of whether to only hire someone with healthcare experience and no IT experience versus someone with IT experience and no healthcare experience is a complicated one. Let me provide some quotes that will hopefully cause some hospital CIO’s and other senior level IT management to pause and think about their hiring choice.

First a few quotes that could apply to the idea of being multi-disciplinary:

“One thing we know about creativity is that it typically occurs when people who have mastered two or more quite different fields use the framework in one to think afresh about the other.”
— Marc Tucker, pres. National Center on Education and Economy

“We begin where others leave off” George Szell

I think one thing that’s generally been missing from healthcare IT has been people with an outside framework that can apply afresh that framework to healthcare. It’s amazing what fresh eyes can do to help find creative solutions. Funny thing is that in hindsight they don’t seem that creative, but we’re so blinded by tradition that we can’t see even simple creativity.

This next story is one that will strike many at the heart.

I know of an RN who had quite a bit of IT background that was working for one of the early adopter hospitals. One day he put a set of scrubs on his managers desk. When the manager asked what they were for he said ‘ I thought you might want to give them to one of your IT guys and we’ll give him an assignment on the floor today. The manager said ‘what? Are you crazy’ ? To which he replied ‘ well you just gave IT analyst positions to some RNs here!’

The reality is that learning has to take place in both directions. Someone who can cross the chasm is unique, but it is doable and will be needed in the future. Instead of only hiring those with healthcare experience or only those with healthcare and IT experience, we should consider creating processes that allow you to hire either side of the chasm and provide a bridge for those people to learn both sides.

Hospitals Adjusting to Meaningful Use Stage 2 Rules

We knew the final draft of Meaningful Use Stage 2 was going to come with as many complaints against it as Stage 1. Given the scope of the new rules, and the importance of following them, hospitals don’t seem to be up at arms to the extent one might have expected.

To start with, it’s worth noting that hospitals are very happy about one change from the draft, the provision that requires Stage 2 compliance to begin in 2014 rather than 2013, though they still have some significant Meaningful Use worries, according to an AHA official quoted in Modern Healthcare. Presumably, the AHA is also psyched that providers will only be required to demonstrate MU for a three month period in 2014, rather than an entire year.

But that doesn’t mean they’re perfectly content. Senior vice president of public policy analysis and development Linda Fishman said in a statement that hospitals are “disappointed” that the rule sets an “unrealistic” date by which hospitals must meet Stage 1 goals in order to avoid being slapped with reimbursement penalties.

Other provider groups are focused on a new provision requiring 5 percent of patients to view, download or transmit health information during a three month period. The College of Healthcare Management Executives’ noted, quite fairly, that providers can’t control what patients do on their own time. If nothing else, making sure patients meet these goals is going to take marketing, workflow changes and some arm-twisting, to say the least, so I feel their pain.

Meanwhile, some non-hospital groups think Stage 2 didn’t go far enough. The requirement that physicians submit an electronic summary of care docs for 10 percent of patients being transferred to a hospital or another provider does far too little to promote data exchange, critics in the HIE world say.

I too am surprised that HIE-type requirements are relatively light (and focused on Direct Project specs). I’m sure that Meaningful Use Stage 3 will address these issues further, but given what our guy Farzad has said about interoperability, it might have been nice to see more progress now.

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August 30, 2012 I Written By Anne Zieger

Filed Under: Community Hospitals HIE Hospital EHR Hospital EMR Hospital Healthcare IT Hospital IT Budget Hospital IT Jobs Meaningful Use Mid-Size Hospitals

Tags:AHA CHIME Hospital EHR Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Hospital Meaningful Use Meaningful Use

CMS Now Auditing Meaningful Use Documentation

It’s been a while since our beloved Recovery Audit Contractors (RAC) were on the front page of the trades every day, but they’re far from gone. In fact, CMS has started to get aggressive in a few new ways, according to the Fox Group:

Meaningful Use Attestation Audits: So you’ve collected EMR data, you’ve attested, and you’re waiting for your check. All is well, right? Not necessarily. CMS has begun requesting documentation from providers that supports the attestation, largely data from your EMR but also possibly info from internal audits you’ve conducted to see that you’re meeting objectives. This is big stuff; if you fail your audit by CMS, there goes your money. And in the future, if you fail multiple audits, you could be seen as submitting false claims. Mega-ouch.
MACs Look At Documentation: Medicare Administrative Contractors (MACs) have been auditing medical records for years to make sure documentation supports the services billed. Now, they’re going to start looking at “auto-generated data” produced by EMR medical record documentation systems. If the auto-documentation looks “cookie-cutter” and possibly out of line for some specific patients, providers could be in trouble.

And if you somehow get entangled with a RAC investigation, don’t count on carefully-spelled-out EMR documentation to save you. According to a recent study by the American Hospital Association, 77 percent of claims denied by RACs were restored upon appeal, suggesting that most of the time, claims targeted by the RACs weren’t bad to begin with. In other words, I think it’s fair to say that they’re out for blood, so prepare yourself.

An internal audit of your documentation can work wonders, Fox Group suggests. And keep an eye out for copy-and-paste documentation across bunches of patients; it’s gone from questionable to perilous.

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August 15, 2012 I Written By Anne Zieger

Filed Under: Hospital EHR Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Hospital Healthcare IT Hospital IT Jobs Meaningful Use

Tags:EHR Electronic Health Records Electronic Medical Records EMR Hospital Meaningful Use Meaningful Use Meaningful Use Audits Medical Billing RAC Recovery Audit Contractors

From The Horse’s Mouth: What Scribes Are For

If you’re like me — and from your comments, I sense you are — most of you don’t think too highly of the scribe concept. The idea, as presented at trade shows, involves an assistant running the EMR stuff while the doctor has a patient encounter. To many, it seems to many to be a bad temporary patch on a bad situation.

Well, that might be true in some cases, but in others, scribes do a lot more, even in situations where a hospital or clinic doesn’t have an EMR at all. That’s the good word from Scott Hagood, director of business development at Fort Worth, TX-based PhysAssist Scribes (www.iamscribe.com). PhysAssist has been in business about 17 years and has about 700 scribes in place around the U.S., largely working in emergency departments.

While EMR use is increasingly becoming a part of their scribes’ job, the company began among a single group of ED physicians who wanted help making their practice run more smoothly. The scribes not only took medical notes, they also performed a wide variety of clerical tasks, such as digging up radiology films and checking with nurses to see if a patient was ready to see the doctor.

That’s still the case today, he says: “EMRs are certainly the biggest reason why scribing is growing today, but over time it’s been the assistance that they provide in improving physicians’ productivity. Clerical flow support is critical.”

Hagood’s scribes are largely pre-med students, or at least some form of pre-health industry student, who work a year to 18 months then move on in their careers. PhysAssist trains the scribes in process, terminology and technology at a facility in Fort Worth, including detailed training on the EMR they’re going to use.

So, the big question for many readers is probably “How much does this cost?” Hagood said that the scribes make more than minimum wage but less than a medical assistant, though he said numbers vary depending on what part of the country they’re serving. (PA doesn’t charge a placement fee.) Bottom line, they’re not doing it for the fabulous cash.

But Hagood says that this approach has worked very well over time, since the pre-med students PhysAssist recruits are very motivated to learn the jargon and excited to be getting hospital experience. ”We just keep hiring very bright people, losing them and starting all over again,” Hagood says. “That’s the way our business works.”

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July 24, 2012 I Written By Anne Zieger

Filed Under: Hospital EHR Hospital EMR Hospital Healthcare IT Hospital IT Jobs

Tags:EHR Scribes EMR Scribes Hospital EHR Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR PhysAssist PhysAssist Scribes Scribes

Epic’s Youthful Horde

Being the remarkably smart and talented readers that you are, I have no doubt you were particularly smart youngsters too. I’m betting that as 20-somethings, many of you stepped up and took on difficult projects that seemed to be over your heads, persevered, and somehow got them done anyway. Being an upwardly-mobile young pro has its place, definitely.

The question is, is that place at the heart of a multimillion-dollar EMR installation project? Can a young man or woman with modest amounts of healthcare experience really make the right calls, time after time, required to make the EMR battleship turn on command?

Our beloved industry figurehead, Epic, has made that bet. Epic famously floods the halls of hospitals with overworked, feverishly ambitious 20-somethings who are supposed to make up in genius what they lack in long-term healthcare experience.

The experience can be bumpy. CIOs have complained to KLAS that the hip young Epic gang doesn’t have everything it takes. The 20-somethings, in turn, have lashed back, in one case allegedly trying to get a CIO fired who apparently wasn’t doing things their way.

If Epic can ride herd on its young hires, it can doubtless pad its profit margins substantially. Staffing up for the giant projects it takes on, and seeing them through years of growing pains, could be ludicrously expensive if if Epic insisted on only hiring grizzled HIT veterans.

Eventually, though, my prediction is that something’s gotta give. If you’re pitching yourself as the backbone of billion-dollar enterprises, there’s a limit to how long you can convince CIOs to work with consultants their childrens’ age. What’s more, as the pace of Meaningful Use requirements picks up, hospitals will have more to lose if the cut-rate genius squad can’t cut it.

Epic does have a huge level of momentum, so it’s not going to get penalized for a while. But my guess is that at some point, a few influential CIOs are going to call Epic out on its inexperienced bench and break the spell the industry has been under.

EMR Disasters May Be The Best Training Ground

Today I was talking with an enterprise software veteran who’d worked with ERP vendors for quite some time during his career. (In other words, he knows how big, expensive, kludgy but mission-critical installations work.)

My colleague, who’s developing an EMR training program, had this to say, and I think it’s worth thinking about: “You know, the only EMR installations which are really successful are done by people who have handled a previous EMR install which was a disaster.”

Hmmm. I would have thought that the biggest predictor of success would have to be whether someone had successfully completed an EMR installation before. After all, wouldn’t that give them the extra “oomph” and knowledge of project pitfalls that they need?

Perhaps not, if my colleague is right.

Nothing exposes the fault lines where a project can fall apart like a flaming failure. Until you’ve seen doctors reject your installation completely, had massive problems integrating a system or had consultants completely fumble the ball, you may miss it when such things are about to happen.

Besides, once you’ve navigated a failure, it’s less likely that you’ll be paralyzed when a project begins to slide. It’s just human nature. Having had the miserable, but edifying, experience of having a project die in front of you, it will never sting again quite as much. (Especially because you’ll have learned that if the EMR rollout dies, it may very well not have been your fault.)

To be honest, I’m not sure if HIT leaders should specifically hire for those whose previous EMR project failed. On the other hand, having reflected on my seasoned colleague’s words, I don’t think hiring managers should reject such candidates either.

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March 8, 2012 I Written By Anne Zieger

Filed Under: Healthcare CIO Hospital CIO Hospital EMR Hospital Healthcare IT Hospital IT Jobs

Tags:EMR Failure EMR Project Failure Hospital EHR Hospital Electronic Health Records Hospital Electronic Medical Records Hospital EMR

Hospitals: Don’t Just Fatten Consultants, Train New Talent

I’m going to do some speculation here — when I researched this issue, hard numbers were, well, hard to find — but maybe you’ll find the following to be worth considering.

Right now, every statistic I read suggests that most CIOs feel unprepared to move through the stages of Meaningful Use.

In fact, in a survey by the estimable healthsystemCIO, 46 percent of hospital CIOs reported that they plan to spend a “significant amount” on consultants to meet MU goals, and a whopping 62 percent said that their institutions don’t have the right resources or expertise in place to complete IT projects on their own. Sounds ugly.

On the other hand, though, more than two thirds (69 percent) of respondents said that getting funding in-house for consultants won’t be any harder than securing funds for software investment. Read: the board and C-suite are nervous enough to throw whatever resources they need at the Meaningful Use problem.

I’d argue that this is a rare opportunity for chronically understaffed hospitals and CIOs on the verge of a nervous breakdown. What if, given that the money pump is flowing, hospitals spent some of the money on consultants and some on consultants who can train the right people to be a permanent support.

After all, universities continue to pump out master’s prepared IT graduates, some of whom are aware of the problems hospitals face. There’s bright young architects and experienced folks from other industries to consider, too.

And what about training physicians with an IT bent to come over to IT full time? My own contacts suggest that this might work, given that there’s a definite subset of doctors who are geeky types comfortable with technology. (For some reason, this seems to be more common among middle-aged physicians than the old or young, but that might just be my own experiences.)

Even if you try a small pilot program, CIOs, I’d argue that it’d be difficult to lose under these circumstances. If it works, you squeeze more benefits out of your huge consulting investment AND get staffed up further. If it doesn’t, well, nobody expects every pilot project to work, right?

Health IT Staff May Not Mature Fast Enough To Handle EMR Growth

Getting enough bodies in the door to roll out and stabilize your EMR the first time is labor-intensive enough. After all, mounting an enterprise EMR isn’t just a job, it’s a project that combines the delicacy of painting the Sistine Chapel roof on your back with the complexity of a thousand-way chess game.

But that’s just the beginning. The truth is, once the dust begins to settle, the EMR isn’t done, it’s just completed its first stage of evolution. It’s at that critical point, where your youthful EMR begins to mature and grow more diverse, that the real health IT staff crunch is likely to hit, according to a new PwC study.

To make sure they have staffers who can handle not only launch but also ongoing development of their EMR, healthcare organizations have been investing in informatics specialists, particularly those who can handle EMR implementation, data integration and interoperability.

The thing is that (not surprisingly) they’re having trouble finding the specialists they need. PwC’s Health Research Institute’s recent survey concluded that four in ten hospitals surveyed feels that a lack of skilled informatics team members will hold back their clinical informatics programs.

In what may be worse news, PwC researchers found that half of hospital and physician respondents found that clinical and technology teams are misaligned right now, and that unless the two sides come together, it’s unlikely they’ll be able to put advanced analytics in place in doctors’ daily workflow.

It’s hardly surprising that there would be a shortage of clinical informatics specialists, given that theh American Board of Medical Specialties approved clinical informatics as a board-certified medical subspecialty in just September 2011. On the other hand, my gut feeling is that there are more IT friendly doctors and nurses who could be cross-trained relatively quickly than they’ve accounted for yet.

I think hospitals are more likely to meet their informatics recruitment goals if they do as much to develop internal talent as hunt for fresh blood. How about you?

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Health IT Worker Shortage Worse Than Expected

Health Management Associates Makes System-Wide Deal With athenahealth

Healthcare Pros Learning IT

Hospitals Adjusting to Meaningful Use Stage 2 Rules

CMS Now Auditing Meaningful Use Documentation

From The Horse’s Mouth: What Scribes Are For

Epic’s Youthful Horde

EMR Disasters May Be The Best Training Ground

Hospitals: Don’t Just Fatten Consultants, Train New Talent

Health IT Staff May Not Mature Fast Enough To Handle EMR Growth

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