November 5, 2012
HIT Pro Exams: Proving Ground or False Hope?
By Mike Bassett
For The Record
Vol. 24 No. 20 P. 18
Early returns from this effort to produce more HIT professionals have yielded mixed results.
In 2008, the Bureau of Labor Statistics published a report projecting that an additional 35,000 HIT workers will be needed by 2018. This was followed by an analysis from HIMSS that estimated hospitals will need an additional 40,000 HIT workers to meet stage 4 of the organization’s EMR adoption model.
Then, in 2010, the Office of the National Coordinator for Health Information Technology (ONC) trumped these previous predictions when it estimated that hospitals and physician practices would need as many as 50,000 additional HIT workers by 2015 to meet meaningful use criteria.
The message was clear: The US healthcare industry is facing an emerging workforce crisis. The ONC’s response was the formation of a four-part, $116 million HIT workforce development program designed to train a new cadre of professionals who will be ready to help providers implement EHRs.
One piece of the program is the creation of six HIT competency exams. Launched in the spring of 2011, the HIT Pro exams are designed to “assess basic competency of individuals who are seeking to demonstrate proficiency in certain HIT workforce roles integral to the implementation and management of electronic health information,” according to the ONC.
The exams mirror another part of the HIT workforce development program: the community college consortia HIT training program. Through this endeavor, students can receive job-specific training in the following workforce roles:
• practice workflow and information management redesign specialist;
• clinician/practitioner consultant;
• implementation support specialist;
• implementation manager;
• technical/software support staff; and
“The exams are based on the key items that are in the [community college consortia] curriculum,” says Mat Kendall, director of the Office of Provider Adoption Support at the ONC. “So the exams help the healthcare IT sector know if people have the skills that have been identified as being useful.”
According to Kendall, as of September, 4,155 people had taken an HIT Pro exam. A white paper prepared in August for the ONC by Kristina Lowell, a principal research scientist in the Health Care Research Department for NORC at the University of Chicago, provides the following demographic information about who is taking the HIT Pro exams:
• Twenty-three percent have an HIT background.
• Twenty-three percent have a nonclinical healthcare background.
• Fifteen percent have a clinical healthcare background.
• Twelve percent have a non–healthcare-related IT background.
• Nineteen percent are unemployed.
The exam takers’ highest level of education breaks down into the following categories:
• Five percent have a PhD/MD.
• Nineteen percent have a master’s of art degree.
• Forty-one percent have a bachelor’s of art or science degree.
• Sixteen percent have an associate’s degree.
• Fourteen percent have a nondegree certificate.
• Five percent have finished only high school.
According to Lowell, individuals gave several reasons for taking the exams, such as assessing themselves against a national standard, validating what they had learned professionally, testing gaps in their knowledge base, and enhancing career prospects.
Ann Donnelly, MS, CMT, AHDI-F, owner of Transmedical Services Inc, a medical transcription service in south Florida, views the exam as a stepping stone. “I pretty much do traditional medical transcription,” she says, “and it [the workforce training program] was presented to me as a way into the IT sector of healthcare since we already had quite a bit of background in the healthcare environment.”
After completing the implementation manager training program, Donnelly decided to take the exam. Her reason for doing so was straightforward: “It was evidence that I had developed competency in the area I was studying.”
Sherry Roth, PA-C/DF-AAPA, CMT/AHDI-F, a physician assistant by training who currently works from home dictating discharge summaries and performing medical transcription work, was excited to expand her knowledge base. “When I heard about these HITECH courses, the only thing I wanted to know is where did I have to go to sign up,” she says. “So I took the courses [the trainer and clinician practitioner tracks] and took the exams with the goal of getting a job [in one of those areas].”
Problems and Challenges
One obstacle the ONC faces is getting people to take the exams. The 4,155 people who have taken an HIT Pro exam represent a small percentage of the 14,000 who have completed a community college consortia training program. While students are not required to take the exam after completing a community college consortia training program, “That is certainly something we are promoting,” Kendall says.
The low percentage of test takers could be a consequence of the speed in which the workforce development program was implemented, he adds.
The program’s components—including the community college consortia training program and the competency exams—were all “rolled out very quickly and on top of each other,” Kendall says. “Given the sequence of how these programs were rolled out, competency came late and we’re still getting the word out and promoting it. Our hope is that they all [along with the 5,000 people currently enrolled] will be taking the test.”
The short time period in which the workforce program was developed created some difficulties along the way for test takers. According to Cassi Birnbaum, MS, RHIA, CPHQ, vice president of HIM for Peak Health Solutions, her first cohort of students at San Diego Mesa College (where she helped set up the HIT training program) didn’t take an exam until three or four months after they had completed their training.
“The students who took the exam did well, but they said it was hard work,” she says. “I kept their access open so they could go into the learning management system and look at discussions and exercises.”
Birnbaum says that in designing a program, it was necessary to be flexible because the students come from different professional backgrounds.
“I had some folks who were health information management professionals, so it made no sense for them to take a terminology course, where it would have been critical to give that kind of training to someone who just had a business IT background,” she says. “And I had certified project managers, so it didn’t make sense for them to take a project management course. I had to customize curriculum to account for background and experience and credentials that individuals experienced in professional life.”
While that customized curriculum worked in Birnbaum’s case, it created a bit of a problem for Roth, who says that after finishing her clinician track courses, she accessed the exam blueprint to begin preparing for the test. It was at that point she found out that the exam included material from two courses she never took.
“I was told that the reason those courses weren’t part of my curriculum is that I have a medical background so I should already know the material,” she says. “There were questions on the exam that I have no idea where they came from.”
Still, most of the exam’s 125 questions were straightforward, Roth says, and by relying on some last-minute cramming as well as her own medical background, she was able to pass the exam with a plus 500 score.
Is completion of the workforce development program and the HIT Pro exams leading to more employment opportunities for midcareer professionals? “Obviously that is something that we are very interested in looking at,” Kendall says.
Birnbaum says the program has helped people who had credentials in areas such as HIM. “They felt like they were totally able to tell employers that the fact they had gone through these recent courses really helped them prepare for the EHR environment,” she says.
Birnbaum concedes that students trying to enter the HIT field may have been “a little disappointed since some of the education came in front of job availability.” Nevertheless, she knows several students who did find “really good jobs” with EHR companies such as Epic.
Roth says Broward College in south Florida, where she took courses, has been “pretty on top of things” as far as informing students about potential job openings.
Still, despite completing the programs and passing the tests, she doesn’t have a clear idea of what type of positions she’s now qualified to perform. “I got an e-mail from Broward last week telling me about a local physician’s office looking for someone to help them implement their EHR,” she says. “Now, were they looking for one individual to walk in there and help them get going or do they already have a team of people? I had no idea. So I’m coming out of these programs not really sure of what I’m qualified to do.” She adds that when she goes job hunting online, she doesn’t see listings for clinical practitioners—the type of position she was trained to execute—but instead sees postings for positions such as implementation specialists.
“Even though they keep telling us there are jobs, I barely see anything,” Roth says. “But I do believe there are jobs or there will be jobs. Because all these [meaningful use-driven implementations] have to be done, and they will be done in Florida just like they have to be done everywhere else.”
Donnelly believes the course work has been interesting, valuable, and helped prepare her for a move into an HIT position. “Unfortunately, I don’t think the vendors recognize that,” she says, adding that now that she is actively searching for a position in the field, the words she keeps hearing are “experience needed.”
She believes that’s a problem faced by many of her compatriots who have taken the exams and are trying to navigate their way around the HIT job market. “I know what I’m seeing on different [online] sites—people who are completing the course are finding it difficult to enter the field,” she says.
Donnelly suggests the reason behind the empty job searches is that employers are making experience too much of a priority. “It’s the same as any other field,” she says. “And since this [workforce] program is fairly new, vendors are still relying on people who have experience.”
John Lynn, founder of the HealthcareScene.com blog network, agrees that the issue of experience could be preventing newly christened professionals from entering the field. “From what I’ve heard, the exam hasn’t changed people’s job prospects that much,” he says, adding that it would have been useful to incorporate internships or job placement as part of the training program. “But unfortunately I think most people who took the exam are still finding placement in a health IT job pretty hard to come by. Experience in health IT seems to be the key to successful placement, so I suggest that people beg, borrow, and steal until someone lets them get some healthcare experience.”
Of course, that could be easier said than done, Donnelly says. “Everyone wants you to have experience with their products,” she says. “So the question is how do you get the experience if people won’t hire you?”
Kendall says the key players in the HITECH job market remain organizations such as large integrated delivery networks, hospitals, and smaller health practices. “We have been working closely with some of the regions across the country looking at this issue of getting people trained and filling gaps in our existing needs in the health IT environment,” says Kendall, who points to a partnership between the Midwest Community College HIT Consortium and the Ohio Workforce Board as a potential “gold model” on how to monitor and find employment for new HIT workers.
He adds that as the HIT market evolves, new job opportunities will pop up. For example, the evolution of patient-centered medical home programs should create opportunities for new staff with IT skills. “And I think our people will be in a great position to fill those holes,” Kendall says.
— Mike Bassett is a freelance writer based in Holliston, Massachusetts.
EMR Job Skills Market on the Rise, Study Says
In August, more than 15,000 jobs were advertised online for healthcare professionals who need experience and knowledge of EMRs or EHRs, according to WANTED Analytics, which deals in real-time business intelligence. The number of job ads increased 31% compared with August 2011 and 88% since August 2010 and is currently the most commonly required skill in healthcare job ads.
The most commonly advertised job titles for healthcare professionals with EMR/EHR skills are registered nurse, nurse practitioner, family practice physician, internal medicine physician, physician assistant, hospitalist, medical billing and coding, nurse II inpatient nursing, physician, and family medicine physician.
Healthcare professionals with electronic records training or experience are in demand across the United States. The metropolitan areas with the highest volume of listings in August were Minneapolis, New York, Chicago, Phoenix, and Boston.
While healthcare employers in Minneapolis placed the highest number of job ads for this talent pool, one of the highest year-over-year growth areas was New York, where demand grew more than 245% in August 2012 compared with August 2011. The second highest growth was seen in Phoenix, up 127% vs. last year.
As more employers shift their medical records to electronic systems, hiring demand is likely to continue. Currently, the limited talent supply of potential candidates with EMR or EHR experience will create challenges for employers. According to the WANTED Analytics’ Hiring Scale, employers across the United States spend an average of six weeks advertising jobs and sourcing candidates for positions that require electronic skills. Each location will, however, experience a varying degree of difficulty when sourcing. Companies in Fairbanks, Alaska, are currently experiencing some of the most challenging overall recruitment conditions. Competition has emerged as more employers are looking to fill jobs in these areas than the local talent supply can support. Job ads in this area remain online for an average of 7.5 weeks.
In comparison, the Hiring Scale also shows the locations experiencing the least difficulties recruiting this talent are Rochester, New York, and Chicago. Larger talent supply in these metro areas means that recruiters are likely to fill open healthcare positions that require EMR or EHR skills faster than the average.
The Hiring Scale measures conditions in local job markets by comparing hiring demand and business labor supply.
— Source: Wanted Analytics