# Presentation: 924263

- Presentation to
-  AHIC EHR Workgroup
- Workforce Panel Meeting
- September 25, 2007
- Don Schoen
- CEO, MediNotes Corp.
-  and Chair, EHR Vendors Association

## HIT Vendor Work Force Discussion

- General Assumptions
- Skills and Training
- Staffing Levels vs. Market Demand
- Between Now and 2014

## General Assumptions

- Staffing requirements for both vendors and providers are directly related to system functionality, size of the practice or hospital and integration needs
- As technology and standards evolve and are mandated, IT staffing levels and skill sets will level out
- EHRs will improve care delivery for providers, making more staff available to work on IT projects

## General Assumptions (cont.)

- EHRs will improve care delivery for providers, making more staff available to work on IT projects
- EHRs implementation and support require clinicians on both vendor and provider teams
- Variable nature of clinical workflow
- Clinician-to-clinician trust
- “Implementation” never ends
- New releases/features
- Newly certified versions
- New regulations and reporting requirements
- Technology upgrades

## Vendor Staff:  Required Skills and Training

- IT staff
- Network expertise
- Systems integration/interfaces
- Understanding of the physical environment
- Applications analysts
- Depends upon scope of implementation
- Size of practice or hospital, complexity of system – e.g., small practices require little support, large health systems have 1-2 per department

## Vendor Staff:  Required Skills and Training (cont.)

- Application analysts (cont.)
- Clinical and/or business background
- Understanding of specific system
- Typical training time – 6-12 months
- Project managers
- Understanding of clinical workflow and business environment
- Small practices – 1 project manager/multiple implementations
- Hospitals – multiple project managers per implementation

## Provider Staff:  Required Skills and Training

- Variable based on type and size of provider organization
- Smaller practices are more labor intensive and have little IT expertise
- Hospital organizations have larger, more diverse IT staff as well as more complex systems and integration requirements

## Provider Staff:  Required Skills and Training (cont.)

- IT staff
- Varies based on technical platform, other systems to be integrated and nature of product delivery (e.g., ASP vs. on-site data center)
- Applications analysts
- Clinical and/or business background, with understanding of organizational structure and workflow
- Rural vs. urban

## Vendor Staffing Levels vs. Market Demand 

- Long-standing business challenge
- Sales cycles vs. hiring/training time
- Successful vendors understand cycle
- Consultants
- “Boutique” firms that specialize in specific vendor products
- Big firms provide project management, process change management, less emphasis on vendor-specific expertise
- Many vendors have business relationships with consulting firms to fill gaps
- Market forces – demand will drive supply

## Work Force Sources

- Recruitment of new workers from existing workforce
- Recruitment from other healthcare areas (I.e. clinics, hospitals)
- Realignment of healthcare staff from office to vendor staffing
- Universities where student are obtaining degrees in healthcare, IT and other general  studies

## Evolution of HIT Adoption

- Adoption of standards and increased utilization of EHRs will impact work force availability
- Fewer IT resources required to support standards-based applications
- Efficiencies in clinical processes that result from EHRs will realign provider resources making them available to work on HIT projects

## Evolution of HIT Adoption (cont.)

- Market forces will drive work force needs
- Practice consolidation reduce market size
- Hospitals donating EHRs via Stark provisions will shift IT support
- Not a sprint but a *marathon*
- First use of EHRs in the early 1970s

## Summary: To Reach 2014 Objectives of Broad EHR Adoption

- Mandates to accelerate adoption of EHRs must be based on reasonable timeframes
- Given normal market cycles, vendors are adept at managing variability in resource demands
- Timeframes for mandates – i.e., 2-3 years will create shortages vs. 5-7 years as a more natural market cycle

## Summary: To Reach 2014 Objectives of Broad EHR Adoption (cont.)

- Efficiencies driven by EHR utilization will realign available IT and clinical resources for both vendors and providers
- Technology and standards will evolve so fewer IT resources will be required
- Efficiencies will be achieved by broader use of EHRs, freeing up provider staff

## Summary: To Reach 2014 Objectives of Broad EHR Adoption (cont.)

- Incentives to support small provider organizations and to provide education and training are key
- Tax credits to support small providers’ IT initiatives
- Training programs and funding to develop required skills