Creating Capacity for a Health Informatics Workforce: Recruitment and Retention Plan Health Informatics Specialist

Workstream C, Deliverable C3d v 1.2

February 2013

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Revision History

Date Revision Description Author August 2, 2011 0.1 Initial Draft WSC Career

Workgroup, WSC Leads

September 22, 2011 1.0 Draft submitted for hi2 Leads review Diane Bedecarré September 29, 2011 1.1 Final Diane Bedecarré

Steven H. Brown Barbara Andrzejewski

February 2013 1.2 Updated Diane Bedecarré Katherine M. Gianola Barbara Andrzejewski Juanita Reta Stephanie Kondrick Pamela Foss

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CONTENTS

SECTION PAGE

1. Purpose ............................................................................................................................. 1

2. Introduction ...................................................................................................................... 1

3. Strategic Direction ............................................................................................................. 2

4. Recruitment & Retention Strategies for the Health Informatics Specialist Role ................... 3

Recruitment ................................................................................................................................. 3

Retention ..................................................................................................................................... 5

5. Next Steps ......................................................................................................................... 7

Resources and Related Websites ........................................................................................... 9

Appendix A: Health Informatics Initiative .............................................................................. 10

Appendix B: Position Descriptions for the Health Informatics Specialist ................................. 11

Appendix C: Health Informatics Initiative – Health Informatics Workforce Survey 2011 .......... 12

Acknowledgements ............................................................................................................. 14

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1. PurposeThe Bureau of Labor Statistics estimates a shortfall of 35,000 Health Information Technology (HIT)workers by 2018.1 Competition for skilled workers resulting from this shortfall will impact VA’s ability torecruit and retain informatics staff necessary for healthcare operations. The purpose of this plan is toaddress the impending HIT worker shortage by identifying recruitment and retention strategies for anewly defined VA Health Informatics Specialist role.

The intended audience of the plan includes VHA National, VISN and Field Leaders and Managers, HRStaff, and Workforce Planning and Development Staff. Field Leaders and Managers should work closelywith their local HR offices and facility leadership to coordinate the implementation of the localstrategies outlined in this plan.

2. IntroductionA predicted national HIT worker shortage has arisen, in part, from two pieces of federal legislation: the2010 Patient Protection and Affordable Care Act2 and the American Recovery and Reinvestment Act(ARRA) of 2009.3 These federal programs with their related financial incentives for adoption andcertification of electronic health records will impact the supply and demand for skilled workers that arecapable of innovating, implementing and using health information technology. The VA Major Initiative“Transforming Health Care Delivery through Health Informatics” (hi2) is working to address thischallenge by increasing the capacity of the VA informatics workforce through competency, career andcommunity development efforts and a number of interrelated deliverables (Appendix A).

Health informatics is an emerging discipline without a consistently defined professional identity.4 Anearly task undertaken by the Career Group of the hi2 Workforce Development Team (also known asWorkstream C Career Workgroup) was to define health informatics in the VA:

“Health informatics is a discipline at the intersection of information science, computer science, and health care that designs and delivers information to improve clinical care, individual and public health and biomedical research. Health informatics optimizes health-related information acquisition, processing, and use through resources and tools that include people and processes; hardware and software; algorithms and data; and information and knowledge.”

1 Zywiak W. 2010. US Healthcare workforce shortages: HIT staff. Computer Sciences Corporation. Accessed September 17, 2011 at http://www.himss.org/Content/Files/CSC_US_Healthcare_Workforce_Shortages_HIT.pdf 2 Public Law 111–148 The Patient Protection and Affordable Care Act 2010 http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf 3 Public Law 111 - 5 - American Recovery and Reinvestment Act of 2009 http://www.gpo.gov/fdsys/pkg/PLAW-111publ5/content-detail.html 4 Hersh W. A stimulus to define informatics and health information technology. BMC Medical Informatics and Decision Making. 2009; 9(24): 1-6. Accessed September 17, 2011, at http://www.biomedcentral.com/1472-6947/9/24

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The HIT or health informatics workforce is heterogeneous and multidisciplinary, with various points of entry and career paths, levels of educational preparation, professional certifications and credentials, position descriptions and communities of practice. The VHA Clinical Application Coordinators (CACs) have been instrumental in the design, build, configuration and support of the largest electronic health record system in the world. They represent an extremely heterogeneous and multidisciplinary health informatics community. They have been and continue to be a true VHA HIT asset.

Workforce statistics for CACs are lacking because there are no unique occupational series codes in the Office of Personnel Management system to identify CAC positions. In the VHA today, over 22 different occupational series codes and numerous job titles are used to identify CAC’s. Based on the national CAC roster, there are approximately 587 CAC’s in the VHA system.

The hi2 Workforce Development Team is addressing this lack of data in a companion deliverable entitled “Informatics Job Family Proposal” and via a national survey of current informatics incumbents to gather essential data. The hi2 team has also developed a standardized position description (PD) that defines responsibilities and expectations for Clinical Applications Coordinators and related health informatics personnel. This PD titled “Health Informatics Specialist” (HIS) is applicable to all Title 5 Clinical Application Coordinators. In December 2012, the position description was nationally classified by the Office of Human Resources Management (OHRM) as Program Analyst (Informatics), GS-343-5/7/9/11/12. (Appendix B). Note: The local HR offices will use the title Program Analyst (Informatics) when referring to the Health Informatics Specialist positions. OHRM and the Office of Informatics & Analytics have teamed up to transition the incumbents of these positions into the new position descriptions. The recruitment and retention plan outlined below specifically targets strategies for the newly established HIS position. Some of these strategies will be addressed at the national level by the Office of Informatics & Analytics and/or hi2; others can be implemented at the local level by Informatics Managers. These local strategies are not all inclusive but should give managers an idea of the some of the things that can be done to recruit and retain talented health informatics staff.

3. Strategic DirectionThe development of the HIS career field provides VHA leaders with the means to ensure that an amplepool of talented employees are available with the right skills, experience, and competencies for the rightjobs at the right time to fill critical HIS vacancies. In addition, the HIS career field helps VHA remain agileand forward-looking over the long term to help accomplish its core mission and meet client andcustomer expectations. To that end, the recruitment and retention strategies outlined in this plansupport many of the VA and VHA strategic goals including:

VA Strategic Goal:• Improve internal customer satisfaction with management systems, support services, and make

VA an employer of choice by investing in human capital.

Secretary of Veterans Affairs Major Initiatives: • Establish strong VA management infrastructure and integrated operating model.

• Transform human capital management.

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• Health Care Efficiency: Improving the quality of health care while reducing cost.

• Transform health care delivery through health informatics.

VHA’s Workforce Succession Goal: • To recruit, develop and retain a competent, committed, and diverse workforce that provides

high quality services to Veterans and their families in a healthy, ethical environment.

4. Recruitment & Retention Strategies for the Health Informatics SpecialistRole

Recruitment

Driving Considerations:• Demand for trained health informatics workers is increasing due to federal mandates and

incentives for adoption of electronic health records.

• The number of trained health informatics workers will not suffice to keep pace with growingindustry needs.5

• The limited number of trained health informatics workers will lead to recruitment competitionwith other healthcare and HIT vendor organizations.

• An aging and retiring workforce of HIT workers in VHA will increase demand for new staff totake their place. For example, forty-three percent of Informatics Nurses in VHA are eligible toretire as of 1st Quarter FY 2013 (no figures available at this time for any other informatics role).6

Recruitment Goals and Strategies: Goal One: Realign and/or recruit existing (internal candidates) VHA Title 5 staff performing CAC duties into the HIS Position Program Analyst (Informatics), GS-034305/7/9/11/12.

National Strategies: 1. Develop program guidance for the VHA field managers to use in the realignment and/or

recruitment of current staff into HIS positions. 2. Track the employees that are transitioned into the new Program Analyst (Informatics) positions

and provide periodic reports.

Local Strategies: 1. Work with local and VISN HR Offices to identify and transition all employees in Title 5 positions

currently performing CAC duties to the Program Analyst (Informatics) position descriptions.

5 Zywiak W. 2010. US Healthcare workforce shortages: HIT staff. Computer Sciences Corporation. Accessed September 17, 2011 at http://www.himss.org/Content/Files/CSC_US_Healthcare_Workforce_Shortages_HIT.pdf 6 The VA Nursing Outcomes Database, Demographic and Financial Cube http://vssc.med.va.gov/products.asp?PgmArea=17

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2. Communicate the application process with identified staff to ensure they have opportunity toapply for the HIS positions.

Goal Two: Ensure that VHA has a diverse and talented HIS workforce that is prepared to support healthcare modernization and improved care delivery through health informatics.

National Strategies: 1. Market health informatics as a potential career choice for VA staff.

2. Establish Technical Career Field (TCF) opportunities for HIS positions.

3. Promote the use of VA for Vets as a hiring tool.

4. Sponsor/Participate in health informatics related job fairs/career fairs.

5. Post job opportunities on hi2 website and MyCareers@VA.

6. Explore possibilities for offering Student Loan Repayment Program as an incentive for new hires.Market VA as an employer of choice for health informatics by sponsoring booths at professionalconferences.

7. Use of the Healthcare Recruitment and Marketing Office National Recruiter Program to assist inrecruitment efforts.

8. Collaborate with the VHA’s Healthcare Recruitment & Marketing Office to develop “A Day in theLife of VA Employee” video clip for a Health Information Specialist employee.

Local Strategies: 1. Develop upward mobility promotional opportunities for current Medical Center and/or VISN

staff.

2. Use career ladder position descriptions to enhance career opportunities for current MedicalCenter and/or VISN staff.

3. Encourage the use of VA for Vets as a hiring tool.

4. Sponsor/Participate in health informatics related job fairs/career fairs.

5. Post job opportunities in USAJOBS, My Career@VA, health informatics journals, healthinformatics job boards

6. Use of the Healthcare Recruitment and Marketing Office National Recruiter Program to assist inrecruitment efforts.

7. Develop or adopt mentoring and training programs locally or VISN wide.

Goal Three: Create a diverse pool of HIS candidates by promoting and using various student training and mentorship programs.

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National Strategies: 1. Establish partnerships with academic institutions that provide health informatics curriculum to

market employment opportunities with VA.

2. Promote use of Student Pathways Program, internships, preceptorships, mentorships and work-study opportunities for individuals in health informatics educational programs.

3. Work with the VHA Succession Workforce Development Management Subcommittee toestablish internship/trainee program opportunities for students enrolled in health informaticsprograms.

Local Strategies: 1. Participate in career days at local high schools and colleges or universities to promote health

informatics as a field of study.

Retention

Driving Considerations: • Because of the newly established single occupation the ability to gather meaningful workforce

metrics is evolving.

• Data gathered via a national VA Health Informatics web-based survey in July/August 2011(Appendix C) demonstrated:

o Ninety-two percent of health informatics staff indicated they are pursuing careeradvancement in HI. However, twenty-two percent of respondents indicated that VAhealth informatics career paths were unclear or only somewhat clear to them.

o Twenty-seven percent of current health informatics staff in VA report intent to leave theoccupation within the next few years.

• Aging and retiring workforce in VHA increases need for succession planning.

• A follow-up VA Health Informatics workforce survey will be completed in Spring 2013, which willprovide updated information about the workforce.

Retention Goals and Strategies: Goal One: Support the retention of HIS employees in order to facilitate the delivery of high-quality care to Veterans and meet the transformational efforts of the organization.

National Strategies: 1. Encourage VHA field facility management to conduct exit discussions with employees and

provide link to the VA Employee Exit Survey.

2. Analyze VA Employee Exit Survey data and workforce demographics periodically for ProgramAnalyst (Informatics) to identify trends and root causes for attrition.

3. Engage the VHA HIT communities of practice to identify and share best practices for retention ofHIT employees.

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4. Explore the options for conducting pay comparability of the occupation with private industry.

5. Leverage established VA/VHA web portals to publicize education, career and communitydevelopment efforts.

6. Market the Healthcare Recruitment & Marketing Office ” Toolkit for Managers” to the field HRmanagers.

Local Strategies: 1. Conduct exit discussions with employees and provide link to the VA Employee Exit Survey.

Goal Two: Foster a flexible and inclusive work environment that enables employees to achieve their highest potential.

National Strategies: 1. Analyze All Employee Survey Data for the “Other administrative, technical, or professional

employee at GS-9 through GS-12” group to identify trends in employee satisfaction/dissatisfaction.

2. Promote use of social technology tools to encourage health informatics employees to “tell theirstories” that demonstrate value of health informatics to the organization.

3. Educate field managers on personal developments plans, retention incentives, tele-workpolicies, etc. to promote competency in maintaining a fair, high-performing and healthy workenvironment.

Local Strategies: 4. Use Individual Development Plans (IDPs) to promote self directed continuing education and

career development.

5. Provide relevant education and training opportunities to employees that will keep them currentin their field.

6. Use retention incentives such as awards, tele-work/flexible hours and tours of duty asappropriate.

Goal Three: Identify, assess, and develop staff to ensure they are ready to assume key HIS roles and tackle future challenges.

National Strategies: 1. Identify the responsibilities, skills, and competencies that will be needed to ensure a high

performing workforce now and in the future. 2. Provide education and training opportunities for staff interested in expanding their knowledge

base in health informatics.

3. Explore the options for Phased Retirement or similar programs that will allow for knowledgetransfer between experienced employees and new employees.

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Local Strategies: 1. Develop a cadre of potential leaders in the HIS field by advertising existing leadership

development opportunities such as the VISN and Facility LEAD programs to provide high potential staff the skills and competencies needed to fill critical positions.

2. Provide education and training opportunities for staff interested in expanding their knowledgebase in health informatics.

3. Use knowledge transfer techniques such as cross training, mentorship, development of standardoperating procedures/polices to organize, capture, create, or distribute information to ensurethat valuable organizational knowledge is not lost.

5. Next StepsThe following activities are planned by the hi2 Workforce Development Team to support implementationof the hi2 Recruitment and Retention Plan.

Short Term Activities:• Presentations to the following audiences to raise awareness and gather support of workforce

development efforts are ongoing:• hi2 Collaborative Project Team• Office of Informatics and Analytics• Field Health Informatics Leadership• Network Directors• Clinical Application Coordinators• VHA Informatics Council

• Draft standardized HIS job postings, job analyses, and modified qualification standards to assistlocal HR staff in their recruitment and retention efforts.

• Solicit participation in workforce development efforts from federal and industry partners such asIndian Health Services, Department of Defense, and the Office of the National Coordinator forHealth Information Technology, the Department of Labor, the American Health InformationAssociation and the American Medical Informatics Association.

• Utilize hi2 web portal and MyCareers@VA to highlight health informatics education, communityand career development opportunities.

Longer Term Activities: • Repeat the hi2 Health Informatics Survey in Spring 2013 to identify workforce trends.

• Collaborate with other federal partners such as Indian Health Services and Department ofDefense to propose new occupational series for HIS role to Office of Personnel Management.

• Collaborate with external partners to propose to the Department of Labor a new occupationalseries for the HIS role.

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Authorizing Signatures

_____________________________________ Marcia Pickard DATE VHA Lead, Health Informatics Initiative Office of Informatics and Analytics (OIA)

__________________________________________ ______ _ Michael Braithwaite, PMP DATE OIT Lead, Health Informatics Initiative Office of Information Technology

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Resources and Related Websites

Resources: American Hospital Association. April 2010. The road to meaningful use: What it takes to implement electronic health record systems in hospitals. Accessed September 17, 2011 at http://www.himss.org/content/files/AHAWhitePaper.pdf American Health Information Management Association & American Medical Informatics Association. 2006. Building the workforce for health information transformation. Accessed September 17, 2011 at http://www.amia.org/sites/amia.org/files/Workforce_2006.pdf

Related Websites: The Office of the National Coordinator for Health Information Technology Workforce Development Program http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__workforce_development_program/3659

The Health Informatics Initiative Portal http://hi2.med.va.gov/

The VHA Office of Informatics and Analytics http://vaww.vhaco.va.gov/oia/ MyCareer@VA.gov http://mycareeratva.va.gov/Pages/default.aspx VHA Succession Planning http://vaww.succession.va.gov/workforce_Planning/default.aspx

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Appendix A: Health Informatics Initiative The VHA Transformational Initiative “Transforming Health Care Delivery through Health Informatics” - herein referred to as the Initiative or the Health Informatics Initiative (hi2) - will shape the future of VHA clinical information systems through deliberate application of health informatics and health information technology (IT) to deliver solutions that transform health care delivery to Veterans. These ground breaking solutions will improve quality and accessibility while optimizing value to ensure VA regains and continues its industry leadership in the use of health informatics and health IT. The Initiative has two main goals:

1. Assist with VHA’s transition from a medical model of care to a patient-centered model of care;

2. Build a sustainable collaborative and collegial relationship between Veterans Health Administration (VHA) and the Office of Information and Technology (OIT).

The work to achieve these goals has been organized into three Workstreams:

• “Build a Health Management Platform” (Workstream 1). This effort integrates health informatics and IT in the delivery of health care IT products and provides a succession plan to transition CPRS to the next generation of browser-based EHR. The Workstream partners with OIT to pioneer software solutions using an agile development model that involves clinical subject matter experts throughout the software development life cycle. Furthermore, the Workstream is focused on restructuring the working relationship between VHA and OIT and provides an organizational foundation for reengineering existing processes and piloting VHA clinical software prototypes in a rapid, agile and iterative fashion.

• “Create Health Informatics Capacity” (Workstream 2). This effort builds health informatics capacity by developing the health informatics workforce and enhancing organizational informatics literacy through competency, career and community development.

Workstream C deliverables for FY11-13 include: o Informatics and Analytics Training Plans o Informatics Education and Training Programs o Community Engagement Methodology o National Informatics Conference o Clarification for Establishing Chief Health Informatics Officers at VISN and Facility Levels o Standardization of Roles and Responsibilities for Health Informatics Personnel o Proposal for Career Tracks and Job Family Series for Health Informatics o Recruitment and Retention Plan o Sharing of Educational Programs with Federal Partners

• “Deliver Communication and Drive Change” (Workstream 3). This effort provides the communication and stakeholder engagement strategy to directly support achievement of Initiative milestones and deliverables through a coordinated communications approach that increases collaboration across the organization, positions deliverables for successful stakeholder engagement and effectively drives field and organizational buy-in while managing expectations.

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Appendix B: Position Descriptions for the Health Informatics Specialist The Health Informatics Position Descriptions are currently posted on the hi2 website. Click on the appropriate URL to access each position description. As a reminder, the official title of the position for HR purposes is Program Analyst (Informatics). The functional title is Health Informatics Specialist. These position descriptions are also available in the VA e-Class system.

Health Informatics Initiative website: http://hi2.med.va.gov/index.php/join/workforce-development.html

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Appendix C: Health Informatics Initiative – Health Informatics Workforce Survey 2011

Purpose: The purpose of the survey was to gather baseline information regarding the VA health informatics community. This information is intended to support evaluation activities and development of strategies to support healthcare modernization and improved care delivery through health informatics specifically in the area of developing health informatics capabilities among VA staff.

Objectives: The survey provides information on the size and composition of the VA health informatics workforce, their professional qualifications, continuing education activities, career advancement, and community collaboration and participation. The specific goals of the survey are as follows:

• Gather data to be used for health informatics competency, career, and community development planning activities as part of the Health Informatics Initiative.

• Obtain a baseline that can be compared with later data collections to measure the effectiveness of competency, career, and community development activities as part of the Health Informatics Initiative.

Intended Recipients: The intended target population for participation in the survey includes the Health Informatics workforce, individuals in the following roles:

• Chief Health Information Officers (CHIOs) • Health Information Management (HIM) leadership • Associate Chief Nursing Officers, Informatics (ACNO) • Chief Medical Informatics Officers (CMIOs) • VA staff who perform Health Informatics Policy & Oversight Functions • Clinical Application Coordinators (CACs) now known as Health Informatics Specialists • Automated Data Processing Application Coordinators (ADPACs) • Health Informatics Personnel in discipline-specific fields (e.g. Nursing, Pharmacy, Health

Information Management, Laboratory, Dental, Biomedical, Medical Librarians, Physicians, Clinical Providers, etc.)

• VA Medical, Pharmacy, and Nursing Informatics Fellows • Analytics staff

Methodology: Web-based, anonymous and voluntary. Survey dates July-August 2011.

Results: The final analysis of the Health Informatics Workforce Survey was released and publicized to the field in early 2012. These results provided valuable information that was useful in the development of the Recruitment and Retention Plan and other Career Group deliverables. WSC-Creating Capacity for a Health Informatics Workforce

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Responses: Approximate 60% (1,697 Respondents) of the estimated 3,000 health informatics staff in VA responded.

Pertinent Findings: • The Health Informatics (HI) workforce is relatively experienced (42% tenured in an HI role for

over 10 years). However, 37% are new to the role (5 or fewer years). • Only 60% of participants were at least moderately confident that they understood HI and the

role of a HI practitioner at VA. • Many (43%) expect to pursue an HI role for 10 or more years, but others (27%) expect to

discontinue practicing HI at VA within a few years. • Less than half (44%) perform HI functions full-time on their jobs. • Nearly all respondents (92%) are pursuing career advancement in health informatics. • Only 22% of respondents indicated that career paths were clear or moderately clear. • Top barriers to career advancement cited by participants were:

o Lack of awareness of necessary education or skills (35%) o Lack of knowledge of HI positions at VA (32%) o Lack of opportunities (26%) o Lack of organizational incentives (26%).

Key Recommendations: • Workforce planning efforts account for diversity of contexts in which health informatics is

practiced. • Forecast the impending retirement of staff and loss of institutional knowledge in informatics. • Increase the visibility of available training opportunities. • Offer leadership and management training providing an overview of health informatics. • Establish mentoring programs leveraging experienced health informatics staff at VA. • Encourage management to identify and remove local barriers to education and training. • Establish tangible career path progressions with linkages to the training curriculum. • Identify ways to promote consistency in health informatics positions across the VA networks and

centers. • Encourage the establishment of full-time positions/roles of health informatics practioners in VA. • Work with Healthcare Talent Management Office to develop health informatics recruitment and

retentions plans.

Full report is available at: http://hi2.med.va.gov/images/flippingbook/attachments/hi2_report_of_findings_final.pdf

Survey points of contact: Margaret.Manion@va.gov: Ferenc.Ayer@va.gov: or Diane.Bedecarre@va.gov

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Acknowledgements

Health Informatics Initiative WSC Leads & Career Workgroup Members The Workstream C Career Workgroup is comprised of subject matter experts from distinct fields and varied geographical locations.

Barbara Andrzejewski WSC Career Workgroup Lead Program Analyst, Informatics Birmingham, Alabama

Diane Bedecarré WSC Co-Lead San Francisco, California

Steve Brown WSC Co-Lead Nashville, Tennessee

Elizabeth Chapman WSC Competency Workgroup Lead Health Systems Specialist, Informatics Chapin, South Carolina

Zandrew Covington Clinical Application Coordinator Portland, Oregon

Pamela Foss Consultant Washington DC

Katherine Gianola WSC Co-Lead Richmond, Virgina

Denise Gleave Program Analyst, Applied Informatics Service Buffalo, New York

Marlene Haddad Health Information Management Bay Pines, Florida Lois Hooper Health Information Management Morrill, Maine

Judy Ingebritson HR Classification Specialist VACO

Sally Kellum ACOS Clinical Informatics Durham, North Carolina

Stephanie Kondrick Workforce Analyst, Healthcare Talent Management Oklahoma City, Oklahoma

Tomi Lilly Clinical Application Coordinator Beckley, West Virginia

Molly Manion WSC Community Workgroup Lead Lebanon, Pennsylvania

Sean McFarland Clinical Application Coordinator Fresno, California

Emily Mellecker IT Specialist Iowa City, IA

Diane Montella WSC Competency Group Lead Nashville, Tennessee

Brian Neil Chief of Clinical Informatics VISN 23 Minneapolis, Minnesota

Robert O’Hara Health IT and Health Policy Hines, Illinois

Deonne Pitts HR Classification Specialist VACO

Mark Proctor Consultant Washington DC

Adelaide Quansah Health Systems Specialist, Pharmacy Informatics Perry Point, Maryland

Juanita Reta HR Specialist, Healthcare Talent Management Los Angeles, California

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