And to increase her marketability, she enrolled in and completed an HIT training program at a nearby community college, a program funded by the Office of the National Coordinator of Health Information Technology's Community College Consortia program, designed to train more than 10,500 new HIT professionals a year.
But even armed with clinical and I.T. experiences, plus the program degree, she's been unable to break into the market. "I finished the program last March-and I still have not been able to find a job in a hospital," says Gebaroof, who is working as a device tester for a wireless communications company.
Gregg Hoshovsky had a different experience. When he realized his job as a senior Java developer at an e-commerce company was going to be outsourced to India, he decided to do something to increase his employment prospects here in the United States.
He enrolled in the ONC's University-Based Training Program, another workforce development program that's designed to add 1,500 workers with advanced, university-level HIT training to the labor pool.
After completing the program, he was hired as a senior application analyst, working to install electronic health records at St. Charles Health System, Bend, Ore.
"The training program made it much easier for me to make the transition to the health care industry. I was able to talk the talk during the job interview," Hoshovsky says. "The classes that Oregon Health and Science University require for the master's certificate in biomedical informatics enabled me to talk about a wide range of subjects such as evidence-based medicine, public health informatics and heath care quality."
The ONC programs, the two main initiatives under the office's Workforce Development Program, have punched the ticket for some workers trying to get into health I.T., which by many accounts faces an acute labor shortage and will continue to need more manpower for the foreseeable future.
But on the flip side, some program graduates say they are still struggling to get their foot in the proverbial door, and question the marketability of the training they received.
Likewise, many I.T. executives are seemingly reluctant to hire program grads because of a lack of specific skill sets, an issue that workforce program leaders acknowledge but are having a tough time addressing in the classroom.
The ONC effort was launched in April 2010, so it's still difficult to gauge the success of the program. But program leaders, graduates and industry execs agree that changes need to be made to better match up skill sets with market needs.
Percolating problem
The HIT workforce shortage has been percolating for quite some time. To wit: A 2008 Bureau of Labor Statistics report projected the need for an additional 35,000 health technology workers by 2018.
That need was reinforced by a 2008 analysis by William Hersh, M.D., from Oregon Health & Science University, and Adam Wright from Partners Health Care.
They took data from the HIMSS Analytics Database and extrapolated how many HIT workers would be needed to support hospital efforts nationwide to reach the higher levels of EHR adoption of the HIMSS Analytics EHR adoption scale.
Their conclusion: an additional 40,784 HIT workers were needed to get the industry to Stage 4 on the seven-stage adoption ladder. They also estimated that 108,390 HIT workers were employed industrywide in 2008.
"We started seeing the demand for health care I.T. talent grow a number of years ago. And, then of course, with the government's incentive program to implement electronic health records, the demand for workers just simply exploded," says Tiffany Crenshaw, president and CEO of Intellect Resources, a health care I.T. consulting and recruiting firm based in Greensboro, N.C.
Certainly, with health care providers clamoring to implement EHRs in an effort to take advantage of incentives emanating from the HITECH provisions of the American Recovery and Reinvestment Act, the need for manpower is growing.
The ONC, for its part, estimates that hospitals and physician practices need an additional 50,000 HIT workers during the next five years to satisfy EHR meaningful use criteria. And to fill that growing need for workers, the ONC doled out more than $100 million in grants under its Workforce Development Program to set up university and community college HIT training (see sidebar, this page) .
Another indication of a dire need for skilled technologists is that, for the first time, staffing resources was cited as the top barrier for CIOs seeking to reach goals such as meeting meaningful use requirements, according to the results of the 23rd Annual HIMSS Leadership Survey, which was released during the HIMSS 2012 conference in February.
"This is the first time lack of financial resources has been replaced as a top barrier in our study," said Jennifer Horowitz, senior director of research for HIMSS Analytics, presenting the results at HIMSS 2012. The survey received 302 responses from I.T. executives in December 2011 and January 2012.
Judy Kirby, CEO of Kirby Partners, a health care recruiting firm in Heathrow, Fla., says that she has heard from a number of CIOs who are having problems keeping the necessary staff in place to keep their information technology projects moving along.
"They are struggling with a lot of turnover. Individuals are being lured away by consulting firms, which are paying a lot more money," she says.
The Community College Consortia program at the heart of the government's workforce effort is designed to provide training to displaced or incumbent workers who are looking to forge a career in health care I.T.
Most participants have a background in either health care or information technology and use the educational programs to pick up the knowledge and skills from the other discipline.
"For dislocated I.T. workers, the goal is to augment existing skills with health care specific learning. If a network administrator completes a six-month training course, she'll likely seek a similar position in health care. The preponderance of our graduates are incumbent workers, seeking essential skills to remain viable in the workplace, improve their job and wage progression, and the garner the ability to assist in EHR adoption and maintenance," says Patricia Dombrowski, director of the Region A Consortium,, which covers 10 northwestern states.
Anthony D'Angelo, a health I.T. professional who serves as an adjunct professor in the health care I.T. program at Westchester Community College in New York, contends the community college program is providing the right training overall.
"The program is opening up their eyes, showing them how challenging information technology in the health care industry can be," D'Angelo says. "Developing interfaces and the backward compatibility is something new for them. They don't experience these challenges in a lot of other industries."
The HIT industry is reaping some benefits. Norma Morganti, executive director of the Midwest Health Information Community College Consortium, one of the five regional community college programs, for example, points to several success stories.
"We have had some really positive outcomes. For example, a number of displaced auto workers have found jobs through our program," Morganti says. In addition, a graduate of Columbus Community College was hired by Good Samaritan Long Term Care to lead an EHR implementation; eight graduates of Sinclair Community College were placed with a local hospital system, all working to support an EHR implementation; and a graduate of Normandale Community College, who had a background in educational I.T., took a position with a health system, working on an EHR implementation team.
Dombrowski adds that the program is exceeding early expectations in terms of enrollment. As of January, 3,652 students had enrolled in the program in Region A (compared with an expected 2,400), 2,510 graduated and 1,735 were placed in jobs.
On the national level, 12,000 students have graduated from the community college program as of January, according to the ONC's Health I.T. Dashboard (http://dashboard.healthit.gov/college/). The ONC is surveying schools and graduates but as of early May 2012 had not yet determined the number of graduates who have successfully landed health I.T. positions, according to an ONC spokesperson.
Harold Lehmann, M.D., training program director of the University Based Training (UBT) Program at The Johns Hopkins University, Baltimore, asserts that the government's funding is helping colleges make good on all of their health care I.T. program aspirations.
"Half of the schools that received funding under the university based training initiative already had health I.T. programs in place. We already recognized that there is a great need for this type of education. The government program is giving us the resources to fully develop these initiatives," Lehmann says.
Although Lehmann asserts that the program at Johns Hopkins is off to a good start, he acknowledges the fact that the success of the overall ONC initiative is hard to gauge.
"I really respect the gamble that the country is taking. This is an untested intervention. If I told you to take your medicine because I think it will work but it's never been tested-well, that's called malpractice. As doctors, we can't give a medication that has not been tested. Yet, the government is making this huge intervention and simply hoping that it will work," Lehmann says.
Frustration
While the federal program is filling workforce gaps for some organizations, both potential employers and employees are expressing frustration.
Consider the following: Even though many health information exchanges need staff with strong information technology skills, these organizations are not likely to hire graduates of the government funded training programs, according to a recent report from the eHealth Initiative, a Washington, D.C.-based advocacy organization.
A quarter of 196 HIE respondents to the survey are currently facing a shortage of staff with I.T. experience, with high demand for clinical software implementation and support personnel, including project managers, analysts, application coordinators, report writers, trainers, informatics staff and technical writers.
However, only three indicated that they had hired somebody from ONC's Workforce Development Program, and most respondents said they're unsure if they'll hire staff from the program in the future.
Similarly, Kirby, the consultant, says that many hospital CIOs just are not ready to hire from the program yet. "They're looking for experienced workers, and so far they're reluctant to hire from the ONC program," she says.
Steve Janego, CTO at St. Charles Health System, says that his organization is experiencing "shortages across the board"-from project managers to clinical informaticists to storage management and end-to-end connectivity professionals.
While the health system has hired one ONC program graduate, these programs are not yet filling the pipeline, he says. Janego says the hospital routinely relies on a number of recruiting avenues from Craig's List to Monster.com to local papers. In addition, the hospital advertises in the HIMSS JobMine site-hoping to find health care professionals who are willing to move to the St. Charles area.
With hiring managers still not fully vested in the ONC initiatives, some graduates are experiencing frustration as well that they're not walking into jobs in major hospitals or health systems but instead are getting offers from the "periphery" of health care.
"Many are getting positions in rural clinics or physician offices or long-term care centers," says Dombrowski, pointing out that these workers will most likely need to amass some experience before getting jobs with large hospitals or integrated delivery systems.
Other graduates, however, are struggling to find employment, program leaders says-wondering why, amidst all this demand, they can't get a health care I.T. job.
D'Angelo, the instructor, points says that some of the students are forced to struggle with the realities of the marketplace after they graduate from the training programs.
"The unfortunate thing is that they see this great need and then they go and get the certification and expect to hit the ground running with the perfect job at the local hospital up the street-and that's not always the case," he says.
Less attractive options
Instead, he says, the graduates might be met with offers from provider sites they deem less attractive, or get offers from EHR vendors that require extensive training at far-off training centers and then require heavy travel, something that many potential workers don't want to or simply can't do.
In addition, even in the midst of working with an understaffed I.T. department, many providers still are struggling with uncertain economic conditions, making it difficult to hire all the help they need. "With all the cuts in Medicare and Medicaid, they don't know where the revenue is going to come from," D'Angelo says. "So, in a lot of cases, they might not be in a position to ramp up the hiring."
Dombrowski identifies another "major disconnect" that could be hampering the success of some graduates: "The providers have a high need to implement certain systems from the major vendors that are serving the industry. They need to implement the products yet the vendors are reluctant to provide the high-level academic access to the software so the schools could teach the programs to the students."
Specific needs
Diane J. Wagner, a graduate of the community college program who took and passed the exam in December, says that is the exact problem she's running into in the job market.
"The employers want you to be certified in a specific system. It's extremely frustrating because we didn't get exposed to any commercial systems during the course," Wagner says. "They're looking for this specific experience that you can only get by working in the field. Yet, it's hard to get a job without having that specific experience."
Allscripts, a Chicago-based health care I.T. vendor, has launched an initiative designed to bridge this troubling gap. The program comprises three elements: a training course for community college instructors; software provisions of the Allscripts ambulatory EHR and practice management software that can be used to provide hands-on training to students; and an online educational solution that is designed to enable students to learn how to use the systems.
Allscripts charges $2,500 for the two-week instructor training course and $100 to $199 per student for the online educational solution. Access to the ambulatory software systems is provided free of charge. Allscripts does not provide access to its hospital systems.
"We have a large client base using our practice management system and these practices are moving toward implementing EHRs. They need people who are qualified to implement the ambulatory system," says Kelley Schudy, group vice president at Allscripts. "As a company, we also have a culture of giving back. We think this program is a great benefit to patients and doctors in local communities."
Angie Brown, department head indirect patient care/associate professor, Greenville (S.C.) Technical College, says that the initiative is indeed filling a need, as many medical groups in the area can utilize the skills of I.T. professionals who know their way around the Allscripts programs.
Hands-on
"The students love it because they get the hands-on experience with the software. They are able to learn how to enter patient data on the front end and to see how the system is used in the clinical environment," Brown says. So far, 12 community colleges have signed on to participate in the Allscripts program.
It's a start, but additional vendor-specific training would certainly help both graduates looking for work and providers seeking qualified staff members. While Dombrowski would welcome the use of other vendors' software in the classroom, she acknowledges that vendors do have competitive reasons for not providing their commercial products to the classroom.
And unfortunately, because of the price tags, buying the systems is simply out of the question for educational institutions, she says.
But program leaders and others offer up a few ideas on how to bring the real world HIT environment to the classroom:
* A library in the cloud. What might work, though, is if a nonprofit organization such as HIMSS would step up to the plate and host a vendor-neutral library where applications could be made available in the cloud for everyone to use.
"For example, each vendor could supply three pharmacy applications and three bedside applications," Dombrowski says. "This would be a big step forward in helping to get our students ready for the workforce."
* Real-world experience. In an effort to provide on the ground experience, Cuyahoga Community College is working with MetroHealth System, Cleveland, to create an internship that provides graduates with on-the-job training in I.T. and informatics areas.
The health system is using this program to help fill its labor needs, while also providing additional training to students as they transition to full-time employment.
* Collaboration for the greater good. Janego, CTO at St. Charles, has been working with the local community college to get specific vendor training to students in the HIT program. Janego said that the EHR vendor and the hospital are exploring the possibility of providing the funding necessary to bring the software into the academic environment.
"Right now the training that they are getting is too general," Janego says. "It will be a much easier transition and they will be much more marketable if they get trained on the specific systems that providers in the area are using."
* Sophisticated screening. Crenshaw, the recruiter, has started an initiative called Big Break that could help hospitals more confidently hire students with minimal health care I.T. experience. Big Break is a one-day audition process where professionals, regardless of industry experience, compete for a unique career opportunity, or their "big break" into the health care I.T. industry.
Many of these candidates come to these events with the ONC educational experiences under their belt. Similar in format to reality TV auditions, contestants are either advanced or eliminated as they are routed through audition phases, which include a series of interviews, a video Q&A, team activities and a presentation.
This process enables hospital systems to evaluate candidates' professionalism, presentation skills, communication skills, poise, attitude, teamwork and the ability to think on their feet first hand.
Because Intellect Resources supplies the recruiting and interviewing expertise to help identify the best of the candidates, the hospitals are then more likely to hire a candidate without the specific vendor credential.
"We are able to provide the insight that the hospitals need. Over a decade of dedicated HIT experience has allowed us to identify what personality traits and backgrounds will do well in a certain EHR implementation role," she says. "The hospitals don't have the time or bandwidth to do that thorough of a screening process."
John McCormack is a Chicago-based health care freelance writer.
In April 2010 the Office for the National Coordinator started awarding grants to train a new workforce of HIT professionals. Following is a rundown of the components of the office's Workforce Development program.
Community College Consortia to Educate Health Information Technology Professionals: Five regional groups of 82 community colleges in all 50 states have $68 million in grants to develop or improve non-degree health I.T. training programs that can be completed in six months or less. The funded community colleges will help annually train more than 10,500 new health I.T. professionals by 2012.
The programs are designed for professionals with an I.T. or health care background and focus on training students for the following professional roles: practice workflow and information management redesign specialists; clinician/practitioner consultants; implementation support specialists; implementation managers; technical/software support; and trainers.
Program of Assistance for University-Based Training: Nine grants totaling $32 million have been awarded to colleges and universities to quickly establish or expand health I.T. training programs for health I.T. professional roles requiring training at the university level.
The six professional roles include: clinician or public health leader; health information management and exchange specialist; health information privacy and security specialist; research and development scientist; programmers and software engineer; health I.T. sub-specialist.
Over the course of the grant, these programs will help more than 1,500 people receive certificates of advanced study or master's degrees in health I.T. Certificate programs can be completed in one year or less, master's degree programs in two years or less.
Curriculum Development Centers: $10 million has been awarded to five universities for the development of educational materials for the Community College Consortia program. The materials will also be made available to other schools across the country.
Competency Examination Program: A two-year, $6 million grant has been awarded to fund the development of competency exams for health I.T. professionals.
