- Research Article
1- 10.2345/0899-8205-46.3.224
The Broad Impact of EHR Implementation
- May 01, 2012
- Biomedical Instrumentation & Technology
- Jeff Kabachinski
The focus on healthcare information technology (IT) has led to remarkable growth in healthcare IT staffing.The federal government is moving ahead with its plan to advance the use of electronic health records (EHRs) in the U.S. healthcare system. The Centers for Medicare & Medicaid Services (CMS) recently collected public comments related to its proposed rule for Stage 2 of the “meaningful use” program. Under the three-stage program, hospitals and other healthcare facilities that demonstrate a meaningful use of EHRs are eligible for Medicare and Medicaid incentive payments.1 Stage 2 builds on Stage 1, laying out the requirements for healthcare providers.The push for EHRs got a huge boost with the American Recovery and Reinvestment Act of 2009, which committed billions of dollars to support the adoption and use of EHRs, building on an earlier goal that every American should have an electronic medical record by 2014. Fundamentally, EHRs are digital documentation that includes data from a visit to the doctor's office or office, including the patient's histories, exam notes, tests ordered and their results, drugs prescribed, and any other results or updated information. Some systems also check for drug interactions, can access X-rays, and even deliver a reminder for the patient to get a flu shot.2In certain quarters, hopes are high about the benefits of EHRs. Some talk of millions of dollars and thousands of hospitalizations saved—seemingly based on extrapolated data. Generally, there is the anticipation, especially by the government, that the use of EHRs will improve the quality, safety, and efficiency of healthcare delivery, as well as reduce medical errors, healthcare costs, and paperwork.On the other side of the coin, there are several who warn that it's premature to start talking about the benefits of EHRs, saying the transition will not be easy or fast. Take, for example, the benefits expected from data sharing. Peter Gabriel, director of informatics with the Department of Radiation Oncology at the University of Pennsylvania's School of Medicine, said that it could be 10 or 15 years before data sharing in health IT is widespread, because it's “a lot harder to achieve than most people appreciate. Simply implementing computer systems won't dramatically improve quality overnight.”3Obviously, health IT growth must also be tempered with risk assessment every step of the way. The development of 80001-1, the standard that deals with the application of risk management for IT networks that incorporate medical devices, indicates that risk analysis is getting woven into many health IT growth game plans. This kind of due diligence will likely stretch original timelines as they relate to the use of EHRs.CMS seems to be sensing that it will take a lot longer than initially anticipated as well. Its recent announcement, a notice of proposed rulemaking (NPRM), attempts to strike a balance between sustaining forward momentum toward meaningful use goals and ensuring that providers with greater obstacles to EHR adoption have the time, support, and incentive to catch up.4A survey published late last year by the Centers for Disease Control indicated that there is a wide variation among states in EHR adoption rates, ranging from a low of 40 percent to as much as 84 percent. As those numbers grow, so will healthcare IT staffing needs. According to the Bureau of Labor Statistics, the projected job growth rate for information security analysts, web developers, and computer network architects is 22% between 2010 and 2020. That's well above the average growth rate of 14% for all occupations during that same period. In its projection, found in the latest edition of the Occupational Outlook Handbook, the bureau makes note of the changes in healthcare and of their impact on this significant job growth.5“As the healthcare industry expands its use of electronic medical records, ensuring patients' privacy and protecting personal data are becoming more important,” the handbook reads. “More information security analysts are likely to be needed to create the safeguards that will satisfy patients' concerns. Demand for computer network architects will increase as firms continue to expand their use of wireless and mobile networks. This occupation will be needed to design and build these new networks, as well as upgrade existing ones. In addition, the expansion of healthcare information technology will cause an increase in the use of networking technology in that industry, and more computer network architects will be employed there.”The bureau makes a similar point in its projection of a 28% growth rate for jobs for network and computer systems administrators, again emphasizing the role of healthcare in fueling the demand.“Growth is expected in healthcare industries as their use of information technology increases,” says the handbook. “More administrators will be required to manage the growing systems and networks found at hospitals and other healthcare institutions.”To help meet the expected demand for health IT workers, the Obama administration launched training programs for such workers. Funded under the auspices of the Office of the National Coordinator for Health Information Technology (ONC), this training is offered through 82 community colleges and nine universities across the country. As of January 2012, the administration says that community colleges have trained more than 9,000 students for health IT jobs, with nearly as many currently enrolled. For the participating universities, more than 1,200 have enrolled and almost 600 have already graduated as post-graduate and masters-level IT professionals. And there is an expected increase to about three times as many by the summer of 2013.There are other support mechanisms in place as well, such as the Health IT Workforce Curriculum from the ONC, which provides teaching materials at no cost to instructors. Yet another is the HIT Pro Exam, also from the ONC, with more than 2,000 examinees since its launch in May 2011. The exam shows perspective employers that the job candidate has the knowledge and skills required to work in health IT. If you've ever seriously considered moving to healthcare IT, there may not be a better opportunity.For some, the only incentive in participating in the meaningful use program may well be the immediate financial reward rather than the long-term gains. There are experts who say that the EHR program, as it currently stands, means more work and less efficiency. For example, the EHR collects data on a patient's smoking status which requires the provider to fill out another form to track smoking status for the meaningful use program. As Farzad Mostashari, MD, the national health IT coordinator said, “No wonder providers are saying that meaningful use is adding work and not making sense to them. We have a lot of learning to make meaningful use of meaningful use.”5To date, more the $3 billion has been paid out to some 2,000 hospitals and 41,000 physicians. In January 2012 alone, $519 million was paid to eligible providers with up to $44,000 each under the Medicare EHR Incentive Program and $64,000 each under the Medicaid program.3The transition to EHRs is expected to extend well into the next decade. The incentives for building a meaningful EHR system eventually turn into penalties for not complying under the federal program. Since Medicare and Medicaid reimbursements can mean more than 50% of a hospital's revenue, eligible providers have a significant financial interest in demonstrating meaningful use of EHRs.For healthcare technology management professionals, the time is ripe to learn new skills and take advantage of new job opportunities. We're already seeing health IT adopt more mainstream computing and networking initiatives and technologies such as virtualization and software defined networks. These kinds of technologies also generate risk analysis— another form of health IT growth requiring staffing. Once in place, newer technologies will relieve IT techs and engineers from some of the mundane network administrative duties. Automated network and software management protocols will also help keep track with and compliance to an ongoing and dynamic risk analysis.All of this adds up to a safer system, while improving the quality and efficiency of healthcare delivery. Healthcare IT organizations are going to need the staffing to keep pace with providing the newer technology to healthcare's advantage.
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