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Addressing Health IT Staffing Challenges and Talent Gaps

August 24, 2016
by Heather Landi
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Rebecca Quammen, founder and CEO of Quammen Health Care Consultants, discusses the unique staffing challenges facing healthcare executive leaders in the area of health IT
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The ongoing demand for health IT in healthcare delivery organizations, stemming from objectives such as meaningful use attestation as well as population health and data analytics initiatives, has resulted in a corresponding demand for a skilled health IT workforce. Many studies have indicated that as healthcare continues to digitize, there is a talent gap due to growing and emerging IT demands. According to the 2014 HIMSS Workforce Study released in 2015, nearly 70 percent of providers said the lack of qualified talent was the biggest challenge to achieving a fully staffed department and 30 percent said they scaled back or put an IT project on hold due to a shortage in staffing. Healthcare delivery organizations are increasingly finding that health IT professionals with the right skills and expertise are critical to the success of health IT implementations as well as moving forward on key improvement initiatives. Healthcare Informatics Assistant Editor Heather Landi recently spoke with Rebecca Quammen, founder and CEO of Quammen Health Care Consultants, to discuss the challenges and opportunities facing healthcare CIOs and IT leaders with regard to staffing and addressing the talent gap.

What are some of the biggest IT staffing challenges facing healthcare delivery organizations right now?

One significant challenge is just the frequent change cycles required to maintain currency in deployed applications, so just the demand for people. We’re in a time when electronic health record (EHR) vendors and other vendors of smaller applications that are being developed for niche requirements, these are all coming out so fast into the industry, and it’s so fast that there’s constant change. It seems we can’t get our breath, to stop and think and plan.

I still see every day that there is a huge deficit in local knowledge of what products can and can’t do to be able to architect a solution to meet needs. If a healthcare organization is a metropolitan area, there typically is a stronger base of candidates. However, so many thousands of hospitals across the nation are in communities in rural settings, so being able to attract, retain and train experts in these products, the people that can be on the ground working fast for IT initiatives, that’s a huge challenge.

There also is a huge deficit in the actual ability to recruit specific talent with experience in various IT products and EHR products. In my firm, we watch what’s going on with our clients and prospective websites where there are postings for open positions, and we see positions open for three months, six months and even longer periods of time. And the obvious impact of that on an organization is that they’ve lost opportunities during that time to continue to move their initiatives forward.

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Rebecca Quammen

There are significant trends shaping healthcare delivery right now, such as the transition from volume-based to value-based care, which impacts clinical, business and financial operations. How is this impacting staffing demands?

The buzz around data analytics promotes the need for data scientists and data analysts as among the most sought-after roles, and that is problematic in and of itself. It’s creating a huge demand, but it’s also a demand that many healthcare organizations don’t know how to deal with right now. I see the buzz around data analytics increasing the pressure to “do something” with data, but many organizations across the nation, both large and small and in every setting of care, simply don’t have the foundational knowledge to manage the data to their benefit, and to know the database structure and how to get it the data out and what the data tells them when they get it. We are not an industry historically good at mining good, rich data out of products and doing something meaningful with it. We do traditional reporting and we may do a little bit of historical reporting, but we’re not good at looking at data to predict and promote and to work toward the future, or to see trends and do analysis across the organization. I’m excluding the largest 13 health systems across the nation that have a large staff of data analysts and data scientists. That’s not for the model for everybody in healthcare, that’s only the model for those large organizations, and they are good at it. All the other hospitals are trying to deal with changes in value-based and accountable care, and I think they have challenges there, so data analytics is a big one.

At the same time, traditional EHR vendors are not currently offering much support in this space with the exception of the emerging cloud-based solutions that are data-oriented in their design. The basic needs for report writers, so SQL, Crystal report developers, has been challenging to fulfill since the EHR deployments occurred with regard to resources who are intimate with the data structure of their clinical and financial systems.

Are there other health IT skills or expertise that are in demand now?

Cybersecurity threats have pushed security resources to the forefront, and cybersecurity is a challenge in the healthcare setting because security threats are internal and external as well as rule-based security, network-based security, and firewall-based security. Traditionally, there would be silos of knowledge in an organization for the network, for the firewalls, for the individual applications themselves.

Unlike the data analytics requirements which draw on more common skill sets, such as programming or analysis, the knowledge that is required to combat security threats with attacks occurring internally and externally is multi-faceted. A person leading security efforts in any healthcare venue must have a strong understanding of policy regarding onboarding and existing resources to include employees, contractors, other members of the accountable care organization (ACO), operational process regarding the need to access or lock down data, commercial tools and appliances available to monitor for and prevent intrusion, and role-based security.

You mentioned earlier that small, rural hospitals and healthcare providers face significant health IT staffing challenges. What can these organizations do to fill workforce gaps?

Attracting skilled talent when it is needed to the physical locations where it is needed continues to be a problem and it seems to be one that is best solved by not hiring, training and retaining knowledge workers but by renting them as needed. Gig economy, sharing economy, on demand economy has the potential to bridge the workforce gaps that exist, but it will require non-traditional thinking on the part of human resource directors and managers in the healthcare industry. I think healthcare organizations should start to participate in the “gig economy” where on-demand marketplaces connect independent human resources with healthcare organizations. Through such a model, healthcare organizations contract with independent workers for short- and long-term engagements. As such, these independent contractors could advance their careers by securing meaningful professionals assignments, while the healthcare employer organizations could hire the most qualified resources for crucial roles and assignments.

I think job boards have confused the issue a lot because they become a jumble of every kind of resume and every kind of algorithm to search those resumes. Talking to CIOs across the country, they say they get four different resumes from the same company because all are mining the same thing and they are not really vetting the resources. As the need for qualified healthcare human resources grows, we need better a way to get these needed resources in place more quickly. With on-demand economy, healthcare organizations would no longer need to spend inordinate amounts of time and money recruiting and hiring talent. At the same time, healthcare workers could concentrate solely on advancing their careers through the meaningful work that will enable them to build the skills and amass the experience that will help them rise to the highest levels of the industry.  And, they can do this without being encumbered by some of the trappings of traditional employment and without dealing with the time and energy-sap associated with seeking the next opportunity. The gig economy has transformed and improved other industries for employers and independent consultants, and we can apply the same innovation to healthcare.

Studies indicate that within health IT, as with many industries, there is significant pay gap between men and women as well as disparities with advancement. What part could the gig economy play in helping to address these gender-based disparities?

With the on-demand economy, if a professional, either a man or a woman, steps out of the workforce to raise a child or take care of a parent, they can continue to advance their careers or maintain their skills and credibility and have opportunities. The gig economy organizes marketplaces that allow people to perform services in a way that they choose, and I think that will certainly help women because healthcare organizations are looking at people based on skills and experience, so that can help to level that playing field.

 


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VCU Health Motto: ‘In God We Trust; Everyone Else Must Bring Data’

October 19, 2018
by David Raths, Contributing Editor
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CMIO Colin Banas, M.D., talks about winning 2018 HIMSS Davies Enterprise Award

VCU Health System in Virginia was recently named a 2018 HIMSS Davies Enterprise Award recipient for leveraging health IT to improve outcomes. Colin Banas, M.D., the health system’s chief medical information officer, said the organization prides itself on using data to improve patient outcomes. “I am reminded of a quote from one of our senior leaders,” he said. “She even puts it at the bottom of her meeting minutes. It says, ‘In God we trust. Everyone else must bring data.’”

HIMSS cited three use cases that demonstrate VCU Health’s commitment to using data and technology to improve outcomes. The first is an Enhanced Recovery after Surgery (ERAS) protocol that improved colorectal surgery outcomes.

As VCU redesigns processes such as this, technology is always one of the last steps.   “When you sit in on these meetings, they are not going to talk about tech solutions for the first two months,” Banas said. “We stress the mantra of people, process and then technology. In a 7-stage flow chart, you don’t see technology until stage six and seven.” Once a team is identified and a standard of care is spelled out, then they turn back to IT and figure out how to hard-wire the changes into the electronic health record.

Because the VCU mascot is a ram, Banas said, the “ninja swat team” that works on process improvement projects is called the RAM Care team. RAM stands for reliable, appropriate and measurable. “We try to remind people that the RAM Care team is not just implementing order sets,” he said. There are five stages of people and processes first and then technology, including decision support and dashboards. “The way to drive variation out of a lot of these care processes is to be data-driven and consensus-driven,” he said. “That is what RAM Care really does – it is all about reducing variation.”

The other efforts HIMSS highlighted involved new tools that streamlined the patient discharge process and automated documentation tools that reduced catheter-associated urinary tract infections (UTIs).

Banas says it is an exciting time to be a CMIO. “We are getting out of the doldrums of regulatory reform and meaningful use, and ICD-10 sucking up all the oxygen, and we are starting to get better tools and better interoperability platforms to start doing innovative things,” he said.  He pointed to SMART on FHIR and open APIs as allowing users to do new things.

VCU Health is a client of Cerner, which has an Ignite API engine. “We have one SMART on FHIR app, Visual DX, and we have just signed the paper to allow the Apple health record beta for VCU Health, so our patients will be able to link their portal data to the native Apple experience,” he said. Cerner is creating its own app store. “Some are free and others have a cost, but it is exciting,” Banas said. “A lot of these people are solving things that have really bugged us and Cerner for quite some time, and they have done it way better. Kudos to Cerner for opening up and allowing other people in this space. They openly acknowledge that some of the things people are developing are in direct competition to core functionality they try to sell to their clients. Competition is good.”

 

 


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How a Data-Driven Approach Can Bolster the Fight Against Opioid Abuse

October 12, 2018
by Steve Bennett, Ph.D., Industry Voice
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I want to tell you about Andy. Andy’s mom, Pam, is a colleague of mine. Growing up an only child, Andy was a happy kid. He was a straight-A student, loved to play the violin, and spent a year as an exchange student in Europe. Andy had two loving parents. But Andy suffered an injury in college, and needed to have some minor surgery performed to repair his sinuses. Following that surgery, his doctor prescribed opioid pain medication for him, to which he became addicted. Despite several years of effort, Andy was unable to shake the addiction, and tragically lost his life to a heroin overdose two years after his surgery. This was a normal kid with a normal family, like mine, and like yours.

Andy’s story is an important story. The opioid epidemic has led to the deadliest drug overdose crisis in the history of the United States, killing more than 64,000 people in 2016 alone – the last year numbers were available. This is a true national epidemic, and one that continues to get worse. For the first time in nearly 60 years, life expectancy for Americans has dropped for two years in a row due to the opioid epidemic.

The opioid crisis has been so difficult to curtail, in part, because of the inability to integrate data from various stakeholders and systems. With so many players and data sources, today’s information is partial, fragmented, and often not actionable.

While this disconnect applies directly to the opioid epidemic it is a systematic problem that affects the healthcare community at large. Better data and analytics can help develop better treatment protocols for a wide array of medical and public health challenges that affect the general public. For opioids, that could be to develop better pain management programs or for better, more-targeted remediation and rehabilitation for those that become dependent on drugs.

A Data-Driven Healthcare Approach: Making Information Real

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Ample data has been collected on the opioid epidemic, but disparate sources are not communicating with one another. Addressing this disconnect and lack of communication is something that can provide researchers, lawmakers and the public with improved insights.

Data-driven healthcare can help provide this guidance by using available data and analytics to help create programs that can make a tangible difference on population areas that need the most help. By looking at the data, lawmakers, hospital administrators and doctors can begin to make impactful changes throughout the system.

While much can be learned from this data, most of it is not being analyzed in a way that brings true benefits. It has been put in a silo and/or it is not organized in a way that is interoperable with other data systems.

The 21st Century Cures Act, which established the Health Information Technology Advisory Committee, shows the commitment of national leaders to improving healthcare information sharing. Analytics can take this data and turn it into something real. Subsequent visualization of this analyzed data presents the information in a way that can truly tell a story, making sense of data that analysts sometimes miss. Analytics can arrange and organize data in different ways and pick up previously undetected trends or anomalies. This information can be turned into real programs that produce real outcomes for those affected.

The data management and integration process can also help us understand where our knowledge gaps are, revealing flaws in data quality and availability. Organizations may learn that they lack sufficient data in a certain area where they want to learn more, but are currently limited. They can then make changes to data collection efforts or seek out different sources to fill these larger gaps. They can resolve data quality issues across systems and arrive at a consistent, reliable version of the truth.

As organizations get better at assembling and managing the data, automating processes to generate standard reports and file exchanges can ease the burden on analysts. Streamlining the user interfaces for prescription drug monitoring programs and other systems allows analysts and medical informatics staff to spend less time working on the data itself and more time enabling and encouraging the use of predictive modeling and “what-if” scenario capabilities.

Helping to Solve a Problem

The national opioid epidemic is a terrible and complex issue. It is not something that can be solved with just one action, approach or program. It is a layered issue that will require systematic changes to how patients are treated and how the healthcare system operates. Some of the nation’s best continue to work on providing operational solutions to these problems, but as the statistics show, they need more help.

A data-driven approach can be that help. Using data analytics to find better and deeper insights into the root problems of this epidemic can help decision-makers make real change. While opioids are the focus now, there will come a day when a new problem emerges. Having data and analytic solutions in place can prepare these organizations to tackle these future challenges as well.

64,000 people died in 2016 as a result of opioid abuse. But 64,000 is more than a large number – it’s also Andy and his family. With analytics and a data-driven approach, government and healthcare leaders can make better decisions that can help people in need.

Steve Bennett, Ph.D., is the director of SAS' global government practice. He is the former director of the National Biosurveillance Integration Center within the Department of Homeland Security


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DOJ Approves CVS-Aetna $69B Merger, On Condition Aetna Divest Part D Business

October 10, 2018
by Heather Landi, Associate Editor
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The Department of Justice (DOJ) has approved a $69 billion merger between mega-pharmacy retailer CVS Health and health insurer Aetna, after Aetna entered into an agreement with the DOJ to divest is Medicare Part D prescription drug plan business.

According to a statement released by the DOJ on Wednesday, the settlement, in which Aetna will sell off its Part D business, was a condition of the merger’s approval and resolves the DOJ’s “competition concerns.”

The deal is the latest in a wave of combinations among healthcare companies, including many pharmacy benefit manager (PBM) and insurer integrations. Last month, the Justice Department approved Cigna’s $67 billion takeover of Express Scripts.

CVS Health announced in early December 2017 its intention to acquire Aetna in a $69 billion-dollar merger, marking the largest ever in the health insurance industry. Woonsocket, R.I.-based CVS operates the nation’s largest retail pharmacy chain, owns a large pharmacy benefit manager called Caremark, and is the nation’s second-largest provider of individual prescription drug plans, with approximately 4.8 million members. CVS earned revenues of approximately $185 billion in 2017. Aetna, headquartered in Hartford, Connecticut, is the nation’s third-largest health-insurance company and fourth-largest individual prescription drug plan insurer, with over two million prescription drug plan members. Aetna earned revenues of approximately $60 billion in 2017.

Following news of the deal back in December, there was speculation that antitrust regulators might not approve the deal. Back in January 2017, a federal judge blocked a merger that would have resulted in Aetna acquiring Louisville, Ky.-based insurer Humana, which at the time was the largest acquisition of its type in the history of health insurance in the U.S., reported at $37 billion. At the time, U.S. District Judge John D. Bates in Washington said that proposed deal would “violate antitrust laws by reducing competition among insurers.” Similarly, a proposed combination of two other health insurers, Anthem and Cigna, was also shot down last year.

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According to the DOJ’s statement issued today on the CVS-Aetna deal, the Justice Department’s Antitrust Division had significant concerns about the anticompetitive effects of the merger with regards to the Medicare Part D businesses. CVS and Aetna are significant competitors in the sale of Medicare Part D prescription drug plans to individuals, together serving 6.8 million members nationwide, according to the DOJ.

In a press release issued today, CVS Health said, “DOJ clearance is a key milestone toward finalizing the transaction, which is also subject to state regulatory approvals, many of which have been granted.” CVS Health's acquisition of Aetna remains on track to close in the early part of Q4 2018, the company said.

“DOJ clearance is an important step toward bringing together the strengths and capabilities of our two companies to improve the consumer health care experience,” CVS Health president and CEO Larry J. Merlo, said in a statement. “We are pleased to have reached an agreement with the DOJ that maintains the strategic benefits and value creation potential of our combination with Aetna. We are now working to complete the remaining state reviews.”

Merlo also said, “CVS Health and Aetna have the opportunity to combine capabilities in technology, data and analytics to develop new ways to engage patients in their total health and wellness. Our focus will be at the local and community level, taking advantage of our thousands of locations and touchpoints throughout the country to intervene with consumers to help predict and prevent potential health problems before they occur. Together, we will help address the challenges our health care system is facing, and we'll be able to offer better care and convenience at a lower cost for patients and payors.”

Following the close of the transaction, Aetna will operate as a standalone business within the CVS Health enterprise and will be led by members of its current management team.

The American Medical Association (AMA), an industry group that has been opposed to the merger, issued a statement saying the agreement that Aetna divest its Part D business doesn't go far enough to protect patients.

"While the AMA welcomes the U.S. Department of Justice (DOJ) requiring Aetna to divest its Medicare Part D drug plan business, we are disappointed that the DOJ did not go further by blocking the CVS-Aetna merger," Barbara L. McAneny, M.D., president, American Medical Association, said in a statement. "The AMA worked tirelessly to oppose this merger and presented a wealth of expert empirical evidence to convince regulators that the merger would harm patients. We now urge the DOJ and state antitrust enforcers to monitor the post-merger effects of the Aetna acquisition by CVS Health on highly concentrated markets in pharmaceutical benefit management services, health insurance, retail pharmacy, and specialty pharmacy."

Agreement with DOJ Resolves “Competition Concerns”

Late last month, Aetna agreed to sell its Part D business to WellCare. According to a Securities and Exchange Commission (SEC) filing from WellCare Health Plans last month, WellCare entered into an asset purchase agreement with Aetna to acquire the company’s entire standalone Medicare Part D prescription drug plan business, which has 2.2 million members. According to the agreement, Aetna will provide administrative services to and retain the financial risk of the Part D business through 2019. In that filing, it states that Aetna is divesting its Part D business as part of CVS Health’s proposed acquisition of Aetna.

“Today’s settlement resolves competition concerns posed by this transaction and preserves competition in the sale of Medicare Part D prescription drug plans for individuals,” Assistant Attorney General Makan Delrahim of the Justice Department’s Antitrust Division, said in a statement. “The divestitures required here allow for the creation of an integrated pharmacy and health benefits company that has the potential to generate benefits by improving the quality and lowering the costs of the healthcare services that American consumers can obtain.”

In its statement, the DOJ referred to WellCare as “an experienced health insurer focused on government-sponsored health plans, including Medicare Part D individual prescription drug plans.”

The Department’s Antitrust Division, along with the offices of five state attorneys general, today filed a civil antitrust lawsuit in the U.S. District Court for the District of Columbia to enjoin the proposed transaction, along with a proposed settlement that, if approved by the court, would fully resolve the Department’s competitive concerns. The participating state attorneys general offices represent California, Florida, Hawaii, Mississippi, and Washington.

In a complaint filed to the U.S. District Court, DOJ attorneys argued that without the divestiture, the combination of CVS, which markets its Medicare Part D individual prescription drug plans under the “SilverScript” brand, and Aetna would cause “anticompetitive effects, including increased prices, inferior customer service, and decreased innovation in sixteen Medicare Part D regions covering twenty-two states.” DOJ attorneys also argued that the loss of competition between CVS and Aetna would result in “lower-quality services and increased costs for consumers, the federal government, and ultimately, taxpayers.”

Under the terms of the proposed settlement, Aetna must divest its individual prescription drug plan business to WellCare and allow WellCare the opportunity to hire key employees who currently operate the business.  Aetna must also assist WellCare in operating the business during the transition and in transferring the affected customers through a process regulated by the Centers for Medicare and Medicaid Services (CMS).

 


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