Many hospitals seeking to obtain federal stimulus funding under the ARRA-HITECH legislation passed by Congress in February will be faced with a major dilemma.
On the one hand, the federal government has provided funding that truly is stimulating hospitals (as well as physicians and physician groups) to implement clinical information systems. Chief among these are CPOE, physician and nurse documentation, medication reconciliation, clinical decision support, performance measurement, and health information exchange. On the other hand, because the number of hospital organizations that have implemented any of these technologies remains a small minority, the number of individuals with expertise, particularly in the rubber-meets-the-road area of actual implementation, is very small.
The question is, could this potential demand for IT professionals with experience create a stampede of need? As organizations that have not already implemented CPOE and other core technologies move to do so in the coming months, what will happen? Are CIOs in danger of having some of their best and brightest IT professionals “poached” by consulting firms and vendors?
John Glaser, Ph.D., senior vice president and CIO of Partners HealthCare in Boston, predicts an industry-wide shortage of truly qualified implementers and has a warning for healthcare organizations that are ahead of the curve: “The organizations that have implemented CPOE or outpatient EHR could indeed be very vulnerable to poaching.” History, says Glaser, may repeat. “I remember at the turn of the millennium where, if you were a Web developer, you were the cat's pajamas.” The same was true, he says, when those who had experience with PeopleSoft were in demand.
And although Glaser says he personally isn't worried about losing many Partners IT professionals, others are.
“The potential for poaching is very much a concern here,” says Paul Conocenti, senior vice president, vice dean and CIO of 1,000-bed New York University Langone Medical Center in Manhattan. Like Glaser, Conocenti and other CIOs whose organizations have long been live with CPOE have a great deal of advice with regard to human resources issues (see sidebar, p. 40).
Conocenti says he has made certain his organization's pay scales are geographically appropriate. In addition, as NYU moves beyond CPOE implementation (the initial version of which was created nearly 30 years ago), Conocenti has worked to insure his staff is involved and enthused.
The numbers game
A look at the numbers, widely debated as they might be, offers a bit of perspective. Using its EMR Adoption Model, Chicago's HIMSS Analytics recently estimated the percentage of hospitals that have reached stage four of its seven-stage schematic (which means CPOE and clinical protocols) at only 3.6 percent nationwide. HIMSS says those that have reached stage six (and have implemented both closed-loop medication administration and physician documentation) are even fewer, at 1.0 percent. More generously, in April, Orem, Utah-based KLAS Enterprises estimated that 12.5 percent of U.S. hospitals had implemented CPOE at that point. It also found that 265,000 physicians in private practice had done so.
Even if, extrapolating from KLAS' estimate, one doubles the figure to include hospitals that are currently moving towards full CPOE implementation, one would come up with an estimate of only one-quarter of hospitals nationwide that have had any meaningful experience at all with CPOE. But if one-half of acute-care hospitals end up applying for stimulus funding (and no one knows at this point how many will do so), the industry will face massive shortages of skilled IT professionals, particularly at the technical implementation level. And that scenario is further complicated by the fact that organizations which fail to meet the series of meaningful requirements will face penalties under Medicare after 2015.
Nonetheless, many vendors and consulting firm executives believe they have the situation well in hand. For example, Andy Vassallo, senior vice president in the Provider Consulting division at Dallas-based ACS, says, “We're anticipating a rise in demand, and we're working to meet it. We've got practices focusing on all the large vendors: McKesson, Epic, Cerner, Eclipsys.” Unlike boutique firms that specialize in one of the big vendors and may not be able to meet the demands of other projects, Vassallo says ACS has experience across the board. Its areas of competency, he says, include teaching customers about project management, Six Sigma, and internal methodology training, in addition to specific CPOE training.
So how are the ACS folks bulking up for CPOE specifically? “We're focusing on our retention of clinicians, mostly of nurses,” Vassallo says. “We're also beefing up our recruiting and sourcing capabilities,” which includes looking to hire both consultants at other firms and people working at hospitals.