A Retrospective on the HITECH Workforce Development Program

William Hersh | March 10, 2014

For those of us involved in educating the workforce of health information technology (HIT) professionals and leaders, the past few years have been quite a journey. While funding for the HITECH Workforce Development Program has ended, the longer-term goal of creating the experts who develop, implement, and evaluate health IT across the health care system goes on.

A big driver in the creation of the program was the funding from Health Information Technology and Economic and Clinical Health Act (HITECH). This support helped us increase our capacity, led to the development of new curricular content, and highlighted the value that careers in health IT offer for both those in rewarding jobs and the organizations in which those individuals work.

The idea behind the HITECH Workforce Development Program was that meaningful use of HIT could not take place without a competent professional workforce. Based on the projections that about 51,000 additional professionals would be needed, the program provided $118 million in funding for four programs. (The need for 51,000 was based on a number of research studies, including one that I published in 2008 estimating that over 40,000 additional personnel would be required as most healthcare organizations moved to Level 4 of the HIMSS EMR Adoption Model External Links Disclaimer, which included functionality such as clinical decision support and computerized provider order entry.)

The HITECH Workforce Development Program consisted of four grant programs, each of whose funding has now been completed. The program was organized around 12 defined workforce roles, half for whom education would take place in community college programs and the other half that would take place in university programs.

The specific programs, and their major accomplishments, included:

  1. Community College Consortia – training individuals in six-month programs at 82 community colleges, grouped into five regional consortia. The program resulted in a total of 19,733 graduates as of 9/30/13, exceeding the target of 10,500 trained.
  2. Curriculum Development Centers – curricular materials initially targeted for the community college consortia but used by a much wider audience, including university programs. The materials continue to be available (see below). Through 9/30/13, a total of 44,078 unique users created accounts on the dissemination site and downloaded over 187,683 files. In addition, a version of the open-source Veterans Administration electronic health record, VISTA for Education, was made available for use in exercises in the curriculum.
  3. University-Based Training Programs (UBT) – training individuals in 1-2 year programs at nine universities or consortia of universities. The program resulted in a total of 1,704 graduates as of 9/30/13, exceeding its target of 1,684 trained.
  4. Competency Examination Program – competency exams for individuals trained in the six community college workforce roles. A total of 9,524 exams were delivered as of 9/30/13, nearly reaching the target of 10,000. The program has transitioned to become the Certified Healthcare Technology Specialist (CHTS) External Links Disclaimer and is overseen by the American Health Information Management Association (AHIMA) External Links Disclaimer.

It turns out that the estimated need for 51,000 personnel was an underestimate. An ONC analysis found that the HIT workforce increased by over 60,000 between 2008 (the time of my initial analysis) and 2011 (when the meaningful use program was fully launched). A further analysis External Links Disclaimer found over 434,000 health IT job postings between 2007-2011.  This came against reports from the health IT leadership organizations CHIME External Links Disclaimer and HIMSS External Links Disclaimer that workforce shortages still existed and threatened the completion of health IT projects.

I am pleased to have played a significant role in two of the workforce programs. One involved serving as the National Training and Dissemination Center (NTDC) for the Curriculum Development Centers project. In addition to contributing curricular materials with four other universities, Oregon Health & Science University (OHSU) External Links Disclaimer also maintained the NTDC Web site that distributed the materials and supported their use among the community colleges. Although the NTDC site has now been retired, the curricular materials live on in an archival home in the AMIA Knowledge Center External Links Disclaimer, where they will continue to be freely available and distributed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License External Links Disclaimer.

It is important to remember the main audience for these materials is educators, even though many others use them. But the materials are more designed to be fashioned by teachers into courses than to be used directly, even though many people do the latter. I am hopeful that continued usage of the materials will occur (we plan to do so in our graduate program at OHSU), and that some academic programs will undertake innovations with them. One example of an innovation is their organization into a Massive Open Online Course (MOOC) External Links Disclaimer by the Health Informatics Forum External Links Disclaimer. It may be possible that someone might someday find additional funding to maintain, update, and expand the materials as well. But for now, they still remain a valuable resource to the health IT community.

The second role I played in the workforce program was as a professor teaching at one of the nine universities funded under the UBT Program. Our enrollment exceeded our targets, and during the same time as our UBT funding, students who did not have the time or interest to seek funding also graduated in comparable numbers from our informatics educational program External Links Disclaimer. In other words, we were able to develop the workforce both with UBT funding as well as in our regular manner. Our UBT training program resulted in a number of great stories of health IT accomplishments External Links Disclaimer and employment in accountable care External Links Disclaimer and meaningful use, some of which were part of this blog posted in 2011.

Although the workforce program was successful by any measure, it did have some limitations. One was that the short-term nature of the stimulus funding required rapid start-up, and since other programs, such as the Regional Extension Centers, were launching at the same time, there were workforce needs that the workforce program was unable to fulfill. Another limitation was that getting the word out was difficult, as evidenced by the CHIME report External Links Disclaimer described above which found that only two-thirds of healthcare CIOs had heard of the workforce program and only 12% were able to hire graduates of it. An additional limitation was the “chicken and egg” problem of employers wanting highly experienced personnel for their quick needs to achieve meaningful use, while like all educational programs, those graduating had little or no experience. While the community college and university programs addressed this with internship programs, the reality was that the substantial experience desired by employers could not be met with those relatively new to the field.

In retrospect, I consider the HITECH Workforce project a great success, resulting in new trained professionals, curricular materials, and new certifications for these professionals. My involvement in health IT workforce development will certainly continue after the end of the HITECH funding.

The program I direct at OHSU will continue to flourish and adapt with the times, for example adding courses on healthcare data analytics and big data External Links Disclaimer. Our program has blazed a number of trails. For example, we started offering distance learning programs in 1999, when the majority of students were still accessing the Internet via telephone modem. Another innovation has been to re-package portions of our curriculum for other initiatives, such as the AMIA 10×10 (“ten by ten”) program External Links Disclaimer. Careers in HIT will continue to be rewarding for individuals and contribute to the benefit of healthcare.