Study Reveals HIO Staffing Challenges, Hiring Needs

A comprehensive study of Health Information Exchange Organizations (HIOs) presented at the Centers for Medicare and Medicaid Services’ (CMS) eHealth Summit on December 6 showed that many exchange operations are still developing financial sustainability models, working with small start-up sized staff, and searching for properly trained individuals to fill open positions.

The study, which was conducted by AHIMA and HIMSS starting in 2011 and released earlier this year, was done to analyze the staffing make-up, needs, and challenges of HIOs.  Representatives from AHIMA and HIMSS, as well as the HIE coordinator of an Oklahoma HIO, presented the findings of the HIO staffing environmental scan during CMS’s live-streamed eHealth Summit.

HIO About More than Just Technology

The US Bureau of Labor Statistics estimates that there are still 35,000 health IT jobs that need to be filled in the US, according to Robert Anthony, a deputy director at the Office of E-Health Standards and Services at CMS, who moderated the summit panel presentation.

“Skilled IT staff is essential to the overall success for HIEs,” Anthony said, giving context to why AHIMA and HIMSS created the HIO staffing environmental scan—which was to shed light on current staffing models and what roles HIOs need to fill, what challenges they have filling those positions, and illustrate how the healthcare industry can help train individuals to take those roles and make health information exchange possible in all areas of the country.

While technology is important, it takes skilled people to make a HIO succeed, said Meryl Bloomrosen, MBA, RHIA, FAHIMA, vice president of thought leadership, practice excellence, and public policy at AHIMA, who presented several findings from the study along with Scott MacLean, MBA, CPHIMS, FHIMSS, chair of HIMSS’ Board of Directors and deputy CIO and director of IS operations at Partners HealthCare.

“An entity needs human resources to get its work done. Tech is the tool, it is not the answer,” Bloomrosen said.

Executive and Data Roles Hardest to Fill

A total of 35 HIOs participated in the study, representing 14 percent of the 255 HIOs identified in the 2011 eHI Annual HIE Survey. Twenty-eight HIOs were operational and exchanging data at the time of the study, with 48 percent exchanging mainly inpatient, outpatient, primary care and emergency room data with 50 or less providers.

Most of the HIOs were operating with a skeleton crew—with 86 percent reporting 25 or less employees. One of the hardest positions for HIOs to fill was executive level positions, which Bloomrosen said was likely attributed to the many HIOs still developing their sustainability and financial models. In the study most HIOs reported provider fees, hospital fees and government grants as their main funding sources, with the majority of HIOs saying they planned to use subscription service fees and membership dues to fund their organization in the near future.  

Since HIOs are in competition with other more stable healthcare organizations and health IT firms, it can be difficult to land top talent willing to take a risk on the up-and-coming HIE business.

“It is difficult to find the right executive to lead [a HIO] with the sustainability issues that were, and still are, banging around,” MacLean said. “Saying ‘we are a new organization, come on board,’ that is a hard sell when there are other organizations.”

But the biggest staffing challenge for HIOs was finding individuals to do data integration and software support. It is not just HIOs, staffing agencies have also reported challenges filling these roles due to a lack of expertise in the workforce. Filling roles working with the master patient index is also a challenge.

HIOs Hiring, But Candidates Lack Skills

While some staffing challenges were due to competition with other entities, the study showed the most common staffing challenge for technical positions was a lack of available, skilled candidates, MacLean said. The skills most HIOs were looking for are data integration, help desk and tech support, data integrity connectivity, and software support, said Cynthia Hilterbrand, MBA, RHIA, health information exchange network coordinator for the Greater Oklahoma City Hospital Council.

One skill set that was not identified  a priority for HIOs in the study was privacy and security experts, which have many HIM experts worrying. As HIOs grow and handle more and more personal health information, the need for strong privacy and security will be vital.

“Privacy and security, as a concern, needs to emerge,” Bloomrosen said. “As these organizations hold increasing amounts of data from diverse sources and in new forms of information, how will this be safely integrated into the healthcare continuum?”

Bloomrosen and MacLean said AHIMA and HIMSS have many resources available on their respective websites to help HIOs find qualified staff and for potential candidates to gain HIO-related skills, like AHIMA’s Health Information Career Map.

New HIO Study Being Developed

A follow-up study conducted by AHIMA and HIMSS on HIO staffing is planned, Bloomrosen said, with the hope further study will help HIOs become a fixture in healthcare and a vital component of healthcare reform. The study will in part look at the staffing differences between for-profit and non-profit HIOs, and staffing and skill differences between traditional and merging HIO models.

The goal of nationwide health information exchange will only become a reality through the hard work of well-trained individuals, Bloomrosen said.

“We are often ourselves patients and when we present in one state or another we would like our data to be there so there don’t need to be costly, repeated tests,” Bloomrosen said. “For these HIOs to stand up, we need both the right technology and staff to make them successful.”

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