If compliance with ONC regulations is challenging for healthcare providers in urban areas, with high concentrations of IT professionals, it is especially challenging for rural providers where IT resources in the form of human capital are scarce. The federal government's 2009 healthcare stimulus package, HITECH, provided funding for a national network of regional extension centers (RECs) designed to assist rural healthcare systems. While the program is considered very effective, its funding will dry up in 2014. Rural providers have devised a creative array of strategies to overcome their HIT staffing obstacles.
Via Modern Healthcare:
It took St. Claire Regional Medical Center, in the small town of Morehead in northeastern Kentucky, 2½ months to fill an open position on its computer help desk.
“We just don't see that many people who are even close to being qualified willing to work for the amount of money we're able to pay,” said Randy McCleese, vice president of information services and chief information officer of the 159-bed hospital. “That's part of what we have to deal with in the rural environment.”
The need for qualified information technology professionals to work in hospital and clinic settings has increased enormously in recent years, given the expanded use of technology such as electronic health records. But more than two-thirds of the CIOs surveyed in 2012 by the College of Healthcare Information Management Executives reported shortages on their IT staff. That's an especially big problem for providers in small towns and rural areas, who can't necessarily afford to pay nationally competitive salaries and who can't offer big-city attractions to lure candidates.
These IT staffing shortages create daily inefficiencies for small hospitals such as St. Claire Regional. New computers sit idle because there's no one there to set them up. Software fixes don't always get taken care of in a timely manner. “We really get into a backlog of the things that need to be done,” McCleese said.
To address these challenges in filling their IT staffing needs, small-town and rural providers are adopting a variety of strategies. Some are training current employees, such as nurses, in IT skills, some are partnering with other hospitals to share IT staff, and some are outsourcing IT work to consultants. Many worry that the end of federal funding for IT regional extension centers will cut off a valuable source of technology assistance.
While small-town and rural providers also have trouble filling clinical positions, McCleese, CHIME's board chairman, estimates that a typical nurse opening at St. Claire Regional might generate 10 to 15 applicants, compared with the three he received for the recent help-desk position. “Comparatively speaking, we get a much smaller number for the IT positions,” he said.
McCleese faces competition for IT workers from providers based an hour away in the bigger cities of Lexington, Ky., and Huntington, W.Va. He estimates that his hospital pays salaries that are 25% to 30% lower than in those bigger towns.
National data confirm that disparity. The median annual salary for a medical records and health IT technician averaged across non-metro areas is $31,390, compared with $33,566 for metro areas, according to U.S. Bureau of Labor Statistics data.
Across the country, the need for HIT professionals has boomed. The BLS estimated that an additional 41,100 health information technicians will be needed between 2012 and 2022. The bureau also projected that employment for medical-records and health-information technicians will increase 22% by 2022, much higher than the expected 11% increase in overall employment.
The starting gun for the HIT employment boom—and the associated squeeze in smaller towns and rural areas—was the American Recovery and Reinvestment Act of 2009, which pushed many providers to adopt EHR systems by 2014 through $25 billion in payment incentives and grants for training programs.
“The demand (for HIT professionals) just exploded when the electronic record stuff took hold,” said Mark Sonneborn, vice president of information services at the Minnesota Hospital Association. From February 2009 to February 2012, the number of online job postings in the field almost tripled from 4,850 to 14,512, according to a data brief from HHS' Office of the National Coordinator for Health Information Technology. The ONC does not break out urban and rural job listings.
Brock Slabach, senior vice president for member services at the National Rural Health Association, said the looming end of the EHR incentive payments could hurt HIT efforts at rural hospitals and clinics. “The question will be, can these facilities, with these declining reimbursements, and the incentives ending with the American Recovery and Reinvestment Act, continue to operate these information systems efficiently and effectively?” he asked.
In addition to the stimulus program, the Patient Protection and Affordable Care Act drove the need for IT development and staffing through its focus on population-health initiatives, quality-of-care measures, and preventable readmissions. Another factor is the looming implementation of the ICD-10 coding system.
Implementing EHRs is the heavier lift for Milly Prachar's hospital, however. “It's so far-reaching and really touches all users within the organization,” said Prachar, director of health-information management at Roseau LifeCare Medical Center, a 25-bed critical-access hospital in Roseau, Minn., a town of 2,600 near the Canadian border.
Tight deadlines and finances are one side of the problem, and finding qualified IT workers is the other. Prachar's hospital opted to train one of its nurses in clinical IT rather than recruit an IT specialist. That's a strategy a number of other rural-health facilities are using for their IT needs. “Because of our location—we're pretty remote—we didn't think it would be likely that there would be someone with the knowledge of the organization as well as EHR knowledge that could step into that role,” she said.
But that does not solve the problem of how to deal with the increasing number and scope of IT projects on top of the hospital's usual workload. The result for small town and rural providers is a backlog of work and delays in implementing meaningful use of EHR systems and cost-saving quality measures. It also holds them back from participating in alternative payment and delivery models such as accountable care organizations and bundled payment, which require sophisticated data systems.
“They're not keeping up with health reform,” said Joe Wivoda, a health IT consultant based in Hibbing, Minn. “There's no way in the world that you can do health reform without robust health IT capabilities.”
Chantal Worzala, director of policy at the American Hospital Association, said there are two issues for rural providers in hiring IT talent. One is whether the hospital can afford to pay enough to be competitive with urban hospitals, vendors and consulting firms, and the answer is often no. The second issue is convincing IT professionals to live and work in a small town or rural community.
A key for rural providers in recruiting students for HIT jobs is identifying candidates who want to live in a rural community or small town, said Sunny Ainley, associate dean of continuing education and workforce development at the Center for Applied Learning at Normandale Community College in Bloomington, Minn. “You have to enjoy the rural amenities of living in Minnesota,” she said.
Effectively using social media is one way to reach candidates. “People have a very high trust for social media, so we always recommend to our clients to make sure they have a Facebook page and they're very active,” said Ralph Henderson, president of healthcare staffing at AMN Healthcare. “That takes away some of the issues that, 'I don't know that health care system' or 'I don't know that city very well.'”
He also advises conducting on-campus recruiting at colleges and universities to get to know people early in their careers and establish relationships with them. In addition, he recommends having a strong training program. “The healthcare systems that do a good job of hiring new grads and then setting up training programs for them are the ones that tend to win those competitive wars for talent,” Henderson said. These programs breed loyalty to the hospital as well as the local community.
Hire and train
Another approach is to hire and train, bringing on new employees knowing they'll need skills development to do the job effectively. A related strategy is to develop existing employees' IT skill sets through onsite or off-site training, as Roseau LifeCare Medical Center did with the nurse on its staff.
Other small providers are exploring partnerships with larger hospitals, although Slabach worries this could hurt rural providers in the long run. “If the urban partner doesn't have a real keen sensitivity to rural healthcare, preserving access and maintaining traditional patterns of care, you could see patients being transferred to larger facilities,” he said.
A way around this is the IT cooperative approach, which a few small providers have pursued. The not-for-profit Illinois Critical Access Hospital Network offers IT services to its 53 member hospitals on a fee-for-service basis. “(It's at) far less cost to us than if we A, had hired that individual ourselves or B, if we were working through a third-party consulting firm,” said Harry Wolin, CEO of the 20-bed Mason District Hospital in Havana, Ill.
Even so, consulting firms are finding plenty of work with the boom in IT needs. “Small organizations have limited resources (and) limited availability to reach out to talent because everybody wants to work for a larger organization and make more money,” said Carol LeMaster, senior director of career services and professional development at the Healthcare Information and Management Systems Society. “Typically, it's just easier for them to just hire a consulting organization.”
Educators also are working to connect graduates of their HIT training programs to open positions. Normandale Community College was one of about 81 community colleges that received stimulus funding through the ONC for a program aimed at training HIT professionals to help implement EHRs as demand for these positions soared.
But a key source of support for the smallest rural providers as they strive for meaningful use is about to dry up. The HITECH provision of the 2009 stimulus law funded a nationwide network of 62 regional extension centers, run by the ONC to help rural providers implement EHRs. As of January, 3,427 of the 6,700 providers at critical-access and rural hospitals that worked with the RECs had achieved some level of meaningful use.
The RECs will run out of stimulus funding this year. “That is going to be, in certain parts of the country, really, really hard,” said Mat Kendall, who left his position running the REC program at HHS in March. Seventy-one percent of healthcare leaders surveyed by Modern Healthcare between November and January said they think federal funding for these centers should continue.
Kendall worries that the digital divide between urban and rural providers will widen during implementation of Stage 2 meaningful use of EHRs. The ONC is working with providers and vendors to help them with this process, he said. But “there's nothing we can do about the inability to find (IT professionals).”
By Catherine Hollander
“Rural hospitals get creative in staffing for IT needs,” Modern Healthcare (May 17, 2014)