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How To Build Your Team Now So You Can Play (Not Pay) Later

August 20, 2009
by Gwen Darling
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Last week, I uploaded a blog post entitled, “When Looking for Healthcare IT Talent, How Creative Are You Willing To Be?” In case you missed it, the basic premise was that at the present time, there are not enough properly trained and educated Americans to fill the Healthcare IT jobs that are projected to materialize in the next several years. I posed the question in the title of the blog post, and offered a few examples of creative approaches to the upcoming employment demands. Shortly after uploading the post, Healthcare Informatics’ Editor-in-Chief Anthony Guerra added his insightful comments in the form of a CIO call to action, which outlined just the type of creative thinking I was hoping would come out of the post. Just as I was getting ready to respond, a funny thing happened on the way to the forum. The following job description was posted by Parker HealthcareIT on


Epic Inpatient Trainer Need - Come get certified!
We are currently recruiting for two Epic Inpatient Trainer positions for a hospital in New York City. The Clinical Documentation (ClinDoc) and CPOE Trainer will each support the hospital’s clinical systems implementation.

Not Epic certified? That’s okay; our client will certify the selected candidate within a year! Our client also offers a competitive salary, excellent benefits, and career development opportunities.

• Create lesson plans and training materials
• Provide classroom training to hospital staff (nurses, doctors, technicians, etc.) on Epic
• Collaborate with analysts during system optimization

• Requires previous Epic classroom training experience
• Bachelor’s degree
• Requires relocation to New York
I was very excited to see this opportunity, for this is exactly the kind of creative, flexible, realistic approach to tackling the upcoming technology professional shortage that needs to be emulated! But so far, from where I’m sitting, this hospital seems to be in the minority, for many of the recruiters I speak to tell me that their hospital clients insist on a 100% match for their job descriptions, and wait weeks and sometimes months to find the “perfect candidate.” Sure, ideally, all new employees would be contributing, brilliant, productive assets from Day One, and the costs and headaches of training and developing new team members would not be an issue. Unfortunately, though, as the demand for Healthcare IT professionals increases, the dream of an “out of the box” perfect candidate is just not going to be realistic for long.

As I write this post, I’m reminded of one of my favorite movies of all time, “Rudy.” I’m guessing you’ve seen it, but if not, the movie is an

account of the life of Daniel "Rudy" Ruettiger who harbored dreams of playing football at the University of Notre Dame despite significant obstacles, and "second string" status. Here’s the pivotal scene:



The thing is, like Rudy, your superstar candidates are out there – they just need to be given a shot (no pun intended). If I had a dollar for every motivated, well-educated, polished, polite, potentially-fantastic-with-extra-training IT professional who writes to tell me they are willing to do just about anything to get their foot in your hospital’s door, well… I’d be floating on a raft with a drink holder, signaling the cabana boy for . . . something or other, and we wouldn’t be having this conversation. But since neither of us live in a perfect world, here’s something to think about: As the government is scrambling to dot their “i’s” and cross their “t’s” and the few truly 100% qualified “perfect” Healthcare IT professionals are being snapped up despite ransom-like demands, savvy hospitals like the one in NYC with the Epic needs are positioning themselves for the future by actively seeking out the best of the so-called “second string” and investing now in their development to build a solid, cohesive, loyal because of the opportunity, qualified team so that they don’t have to pay later. Dearly. RUDY! RUDY! RUDY! RUDY!



Though I can understand why a hospital would want to hire individuals with certifications, which is something they can currently do, I do not comprehend EHR vendors will not certify individuals with implementation experience outside a given project. HR departments confuse certification with knowledge and experience. A certification may indicate a level of knowledge but little else.

Granted a programmer that is required to use a given tool set should have training and get a certification, just like a doctor. But who would like to get treated by a freshly baked MD before they have completed their residency? Accessing experience and the ability successfully implement clinical applications requires more effort than looking for a certification.

I would argue that the large EHR vendors would be better served to have a program certifying individuals with prior experience. This would ensure that sufficient skilled people would be available when the tidal wave of Meaningful Use implementations crests.

Hello to those whom I've yet to meet. This is rather long, so you may wish to grab a sandwich.

I write to share a few thoughts on Gwen's post. One thing I enjoy about Gwen is that she resides where those who refuse to drink the Kool Aid reside. For those who haven't been there, it's a small space where only those who place principle over fees dare to tread.

Where to begin? How to build your team? (Those who wish to throw cabbages should move closer to the front of the room so as not to be denied a decent launching point.) There are two executives, I hasten to add, who will defend what I am about to offer, a CIO, and a CMIO, ideas from both of whom you've probably read.

I comment on behalf of those in the majority who have either not started or hopefully have not reached the EHR points of no return—those are points at which you realize that without a major infusion of dollars and additional time the project will not succeed. Those who have completed their implementation, I dare say for many no amount of team building will help. Without being intentionally Clintonian—well, maybe a little—I guess it depends on what your definition of completed is.

If I were staffing, to be of the most value to the hospital, I'd staff to overcome whatever is lying in wait on the horizon. I believe that staffing only to execute today's perceived demands will get me shot and will fail to meet the needs of hospital. I need to exercise an understanding of what is about to happen to healthcare and to build a staff to meet those implications for healthcare IT.

Several CEO have shared that they are at a total loss when it comes to understanding the healthcare issues from an IT perspective. They've also indicated that—don't yell at me for this—they don't think their IT executives understand the business issues surrounding EHR and reform. I disagree with that position.

Here's a simplified version of the targets I think most of today's CIOs are trying to hit.

1. Certification
2. Meaningful use
3. Interoperability—perhaps
4. Budget
5. Timing
6. Vendor management
7. Training
8. User acceptance
9. Change management
10. Work flow improvement
11. Managing upwards

There are plenty of facts that could allow one to conclude that these targets have a Gossamer quality to them. Here's what I think. You don't have to believe this, and you can argue this from a technology viewpoint—and you will win the argument. I recently started to raise the following ideas, and they seem to be finding purchase—I like that word, and since I'm writing, I used it.

Before I go there, may I share my reasoning? From a business perspective, many would say healthcare is being moved from 0.2 to 2.0. The carrot? Stimulus funding—an amount that will prove to be more of a rounding error than a substantive rebate. Large providers are being asked to hit complex, undefined, and moving targets. They are making eight and nine figure purchase decisions based in part on solving business problems they can't articulate. If success is measured as on time, in budget, and fully functional and accepted, I estimate for any project in excess of $10,000,000, the chances of failure are far greater than the chances of success.

The overriding business driver seems to be that the government has told them to do this. Providers are making purchasing decisions without defining their requirements. Some will spend more on this than they would to build a new hospital wing. They don't know what it should cost, yet they have a budget. They don't know if they need a blue one or a green one, if it comes in a box, or if they need to water it.

So, where would I staff—this is sort of like Dr. Seuss', "If I ran the Circus"—the one with Sneelock in the old vacant lot. I'd staff with a heavy emphasis on the following subject matter experts:

• Planning & Innovation
• Flexibility
• Change Management
• PR & Marketing

None of these high-level people need to have much if any understanding of healthcare or IT. You probably already have enough medical and IT expertise to last a lifetime. That will account for about fifty percent of the success factors.

Here's why I think this is important. Here's what I believe will happen. Six to eight years from now there will not be a network of articulated EHRs with different standards, comprised of hundreds of vendor products, connected to hundred of Rhios, and mapped into a NHIN. Under the current model, standardization will not occur if only for the fact that there is no monetary value to those whose standards are not ed. This discussion is orders of magnitude more complex that cassettes and 8-tracks.

Interoperability, cost, and the lack of standardization will force a different solution. I think the solution will have to be something along the lines of a single, national, open, browser-based EHR. Can an approach to solving this be pieced together by looking at existing examples like airline reservations, ATM, OnStar, Amazon, FaceBook, and others? I believe so. Are some of my words and examples wrong? Count on it. Please don't pick a fight over my lack of understanding of the technology.

The point I am trying to drive home is that from a staffing perspective, lean towards staffing the unknown. Staff it with leaders, innovators, and people who can turn on a dime. Build like turning on a dime is the number one requirement. Don't waste time and money on certification or meaningful use. If anyone asks you why, you can blame me. If you want a real reason, I have two. First, they won't mean a thing three years from now. Second, if I am the person writing a rebate check, I want to know one and only one thing can your system connect with the other system for which I am also writing a check.

However, when all is said and done, I call upon us to remember the immortal words of Mel Brooks, "Could be worse, could be raining."

To Certify or not to Certify, that is the question?
Excellent article, I concur! In these times and during this job search I've had multiple calls from recruiters who find my skills enticing but then hit the skids when they learn that I don't have certification for a particular vendor. This despite my deep skills with multiple vendor platforms and having worked in nearly every aspect of hospital operations with regard to information systems, I've been there and done that.
How valuable and what a comparison between a newbie right out of college with certification as opposed to someone that has years of implementation experience? If someone has the vision to scoop me up and send me through vendor certification they get a great deal. Years of implementation experience coupled with huge motivation, and finally certification. So, some years ago I decided to go down another path.
I'm focused on Healthcare IT Security. I earned my Certified Information System Auditor (CISA) designation from the Information Systems Audit and Control Association (ISACA). I'm applying these principles and best practices to Healthcare IT. All of these Healthcare IT Systems have components of security. All of them have need for audit to be able to comply with HIPAA, so it makes more sense to me to have a certification that is broader based and applicable to all as opposed to only one vendor. During implementation how interesting it is to see the "certified" vendor security folks struggle with some basic and advanced concepts.
It does indeed take a village to raise a consultant!

Dan K. Anderson CISA

Gwen, I couldn't agree more. It's about time more hospitals took the approach of hiring hard-working people that may not have the exact experience required, but are willing to learn, as opposed to overpaying for those with the "right" experience. People can be trained, and this type of investment can indeed pay off.

I can't tell you how many times in my early career I was denied jobs at magazines because my experience was in newspapers. If the hiring managers had a bit more vision, they would see that the reporting/researching/writing experience would definitely translate from one form of media to another. So much of the time, it comes down to short-sightedness.

Let's hope hospitals expand their vision!

p.s. I got goosebumps watching the Rudy clip! Great movie.