Whether you're a medical student on the cusp of graduation, a physician who has been practicing medicine for years, or an up-and-coming healthcare information technology (IT) specialist, you...
Whether you're a medical student on the cusp of graduation, a physician who has been practicing medicine for years, or an up-and-coming healthcare information technology (IT) specialist, you already know that it takes more than clinical skills and a degree to make it in this business. Healthcare is currently undergoing a revolution when it comes to the application of information technology. From the ways in which patient encounters are documented, stored, and accessed to the collection and analysis of outcomes data in order to create best-practice algorithms nearly every healthcare process and procedure is being radically reworked and reconfigured through the application of IT.
Because these massive changes will likely accelerate and expand in years to come, knowledge of informatics and other tech-driven disciplines will soon become part of the basic skill set at all levels of healthcare delivery, from physicians, nurses, and other providers all the way up to health system executives. In the meantime, healthcare professionals who get ahead of the health IT curve will have an advantage over their competitors.
Information Is Power
"If you're talking about a clinician in a clinical environment, one of the skills people talk about often now is their [knowledge of] informatics," says Morgan Passiment, Director of Information Resources Outreach and Liaison for the American Academy of Medical Colleges (AAMC), an organization that "represents the nation's nearly 400 major teaching hospitals and health systems and their associated clinical physicians. Comprising only six percent of all hospitals, AAMC members operate 47% of all organ transplant centers, 60% of all level one trauma centers, 67% of all burn beds, and provide nearly half of all hospital charity care nationwide."
The AAMC realizes that increasing potential physicians' knowledge of IT must begin early in the educational process. "When it comes to medical students, there's a certain level of information literacy that [AAMC] is trying to get incorporated into the curriculum, because even though students come into the schools very quickly with technology skills, they don't really know how to evaluate information and understand whether it's valid& that not everything you get off of Google is going to be correct," says Passiment. "There are different levels [of knowledge]: one level is actually more of an information literacy level" understanding how to evaluate information. Another level is "how do you gather information and utilize that to improve care?'"
Beyond merely possessing a rudimentary understanding of the basic dynamics of an increasingly information-driven industry, healthcare professionals who wish to thrive in a changing practice environment will soon find they must expand their understanding of the field of informatics and its applications in medicine. Informatics is defined as "the science of information and the practice of information processing." A health informaticist solves healthcare-related information problems; for example, he or she might design better ways for healthcare providers (HCPs) to access and manage patient records, telemedicine systems, patient-tracking and billing processes, and the efficient delivery of consumer health information over the Web. A nurse informaticist "knows healthcare and the work processes within it," says Donna Gloe, Chair, ANCC (American Nurses Credentialing Center) Informatics Content Expert Panel. (See our recent Web Exclusive, "Nurses are the Key to Linking IT With Better Patient Care," for more on this topic). "That's an important part of the job. The other part is knowing the informatics part. "How do you use the database? How do you manage a project? How do you choose a vendor? How do you develop an ROI [return on investment] for this, and what are those factors?"
"The field of informatics nursing is growing very quickly because technology is so prevalent," says Todd W. Peterson, Senior Communications Specialist, ANCC. The ANCC represents more than 150,000 nurses throughout the US in 40 specialty and advanced practice areas of nursing. A national certification body of the American Nurses Association (ANA), the ANCC offers certification in approximately 30 different nursing specialties, including certification for Informatics Nurse.
"The [ANCC Content Expert Panel] of nurses who have a certification and are selected to speak for fi ve years keep [the informatics exam] current as technology changes or as the fi eld progresses," says James Finley, RN, MBA, Senior Manager for Healthcare Practice at Deloitte Consulting in San Francisco, CA. Finley, a member of the Panel, says that although the field is expanding, informatics is still a relatively small niche in the career marketplace for nurses.
The ANCC Content Expert Panel's process of evaluating and updating its certification examinations, including that for informatics nurses, involves a logical job analysis conducted every time the scope and standards are updated. Recommendations are made in between content outlines, and the committee reviews all of the submitted test questions and answers for the validity of the content. The written portion of the examination for informatics certification requires information on the length of time worked in a nursing specialty and any educational background specific to informatics that qualifies a nurse applicant.
The nursing informatics certification is not an advanced practice certification, however, meaning interested providers don't have to be a nurse practitioner (NP) or clinical nurse specialist (CNS) to be certified in informatics. Download an application.
License to Skill
Many professional medical associations have specific guidelines in place to ensure the highest caliber of its members. The American College of Physicians (ACP), for example, requires a medical degree, a current license to practice medicine, and certification in internal medicine to qualify as an applicant for their society. Information technology expertise may soon be added to that list, and not just for practicing physicians. "At the association level, we increasingly need people, particularly in our policy area, who understand the problems that hospitals face, adapting these technologies, and the regulatory and the legal barriers that they may face, as well as the resource constraints," says Rick Wade, Senior Vice President, Communications, at the American Hospital Association (AHA). "We increasingly look for people who understand the world that our members are going through."
To illustrate one area of need, Wade mentions the limited ability of small rural hospitals to adopt new technology because of their limited budgets, compared with those of larger multi-hospital systems and those in more urbanized areas. "You need someone who can use the technology at the association level to communicate with the members and to make the best use of the member's resources," he says. The transformations being wrought by the application of new technologies throughout the healthcare system have changed the qualifications being looked for in healthcare executives and consultants. "The ideal candidate [now] is the one that can handle interfaces at the programming level--service-oriented architecture, system maintenance, and business continuity," says Jeffrey C. Bauer, PhD, a Chicago-based partner in management consulting for ACS (Affiliated Computer Services, Inc.).
Part of the challenge in finding the right physician or healthcare IT specialist is hiring the right recruiter or human resources staff. "You almost always hire a CIO to be part of your executive team and then lean on that person entirely to navigate those waters," says Wade. "Some of them have been very happy with the outcome and others have ended up with an ice bag on their head, wondering how they got there because they poured a lot of money into something and six years later, it's junk and they don't know what to do with it." Bauer agrees, citing lack of understanding about job roles as a reason for the high health system CIO turnover rate.
Passiment suggests that the people who are most successful in managing the clinical information and faculty in a medical school environment "have a broad understanding of where healthcare is going, where their institution is going, and have a good business sense." The modern healthcare industry needs people "who understand the practice of medicine and the operation of healthcare, who can influence the development of our solutions and software, and who understand the workflow and how that can change," says Julie Wilson, Chief People Officer and Vice President, Cerner Corporation, a healthcare technology solutions company that designs and implements software and services for healthcare organizations and clinicians. Professionals who want to get ahead in a changing healthcare environment "need to be adaptive to technology."
The Long and Short of IT
Physicians and allied healthcare professionals are expected to treat an escalating number of patients efficiently while maintaining the highest quality standards. Meanwhile, healthcare organizations must increasingly deal with clinical staff shortages. One solution to the personnel shortage in nursing and other medical specialties is to promote widespread adoption of cutting-edge information technology to streamline workloads and incorporate the clinical decision support tools that ensure safety, creating a quality environment for patients. Successful implementation of this strategy requires recruiting the right people for the job.
Witt/Kieffer, a national executive search firm based in Oak Brook, IL, specializing in healthcare recruitment, understands that the healthcare industry is placing greater emphasis than ever on clinicians and executives who possess the skills and knowledge necessary to shepherd an organization through the often painful process of health IT adoption and implementation. Its Vice President and Region Co-director, Carson F. Dye, FACHE, developed a list of "Health Care's Top 10 Recruiting Mistakes" to aid health systems in hiring the best people for this new data-centric environment:
1. Placing haphazard emphasis on the importance of hiring senior leaders in health care.
2. Developing lackluster position specification documents.
3. Writing qualifications that detail the "walks on water" characteristics.
4. Interviewing in a haphazard fashion.
5. Letting "the bias factor" take control.
6. Sketchy position responsibilities and relationships.
7. "Hurry-up-and-wait" philosophy.
8. Seeing executive recruiting as a one-way process.
9. Relying on ineffective evaluation techniques.
10. Failing to drive the process.
Conducting "more than 400 executive search assignments on behalf of leading hospitals, health systems, teaching hospitals and academic medical centers, and physician group practice organizations," Witt/Kieffer has 35 years of experience to back its initiatives. With more than 125 new, current job listings posted "from such well-known,
reputable hospitals as Sacred Heart Health System and Columbia University Medical Center" the firm has a clear understanding of the candidate search process.
"I look for people with [informatics] experience when recruiting, putting information into a clinical information system as an analyst," says Finley, although this is not always currently possible. "Recruitment is a challenge in any area, for a staff physician, or hospital, or informatics person," he says. "It's probably more difficult because the area is so focused and there's not a plentiful supply of programs; most learn it on the job at hospitals or after being on a project, then become an informaticist that way. Those are hard positions to recruit for and there's a lot of people falling into it."
"You hope the [candidate] understands the computer and how it works and some of the limitations and advantages of it, and you hope some of your highly technical people understand what they build or it won't be used," says Gloe.
"Quite frankly, just interfaces with the telephone system are some of the most vexing problems I've seen in the last couple months," says Bauer. "I wouldn't be surprised if in three or four years organizations like HIMSS (Healthcare Information and Management Systems Society) realize that telecommunications is as important as [IT]."
One Among Many Skills
Good-old-fashioned clinical skills will never go out of style, but physicians who want to stay ahead of the game must also supplement them with other key secondary skills. As this article has demonstrated, IT expertise is an increasingly important job skill in the evolving healthcare marketplace. However, it's not the only hallmark of a successful healthcare professional. Passiment also mentions good business sense as an important attribute for practicing physicians. The key is to keep up with the constantly changing trends in healthcare.
"Things are changing so fast [in healthcare], if you called me again in six months, I'll be telling you things neither you nor I thought about as being important," says Bauer. In a nutshell, "if you can bring the skills and outside
experience, you're golden."