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2/16/2012
03:05 PM
Paul Cerrato
Paul Cerrato
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Do Health IT Hires Need A Clinical Background?

The debate on which qualifications an IT job candidate needs to work in a hospital or medical practice rages.

If you've kept up with the news in recent months, you're aware of the shortage of qualified IT professionals to fill positions in hospitals and medical practices. The U.S. Bureau of Labor Statistics predicts that jobs in health informatics will jump by 18% by 2016 and expects there will be shortage of about 50,000 health IT workers over the next five years.

Few people challenge those statistics, but what's upsetting job candidates is that many health IT managers only want people with a clinical background.

Essentially, the debate revolves around this issue: Is it easier to teach an IT generalist the clinical principles needed to work in a hospital or practice, or teach a clinician the general IT principles?

[ Is it time to re-engineer your Clinical Decision Support system? See 10 Innovative Clinical Decision Support Programs. ]

Juliet Daniel, MD, senior director of medical informatics for Community Health Systems, which is responsible for more than 130 hospitals in 29 states, thinks the latter. During a phone interview, Daniel said it's important for someone working in health IT to "understand what it's like to use an EHR" from an end user's perspective. "Healthcare and clinical workflow are just so important, and if you're an IT person and don't understand it, it's hard for you to be influential."

At the managerial level, a clinical background certainly has advantages, especially if you're in a liaison position, as Daniel is. She spends part of her time translating the IT department's capabilities and limitations to clinicians who want to tweak the IT tools so they improve patient care. A comparable position at a company in another industry might be business analyst.

But Daniel thinks the preference for clinical training should even extend, for example, to the IT staffers who set up a clinical database. Building electronic order sets for a CPOE or modifying an order to fit the hospital's drug formulary is best handled by someone who understands clinical workflow, in her opinion.

I'm sure many experienced generalists would question that point of view and, in fact, I recently spoke with the CIO of a major health system who takes just such a contrary view.

During a phone conversation with Larry Stofko, until recently the CIO of St Joseph's Health System in Southern California and now executive VP for its Innovation Institute, he explained the partnership that existed between himself and his clinical counterpart, CMIO Dr. Clyde Wesp. Although Stofko and his managers were responsible for IT systems and Wesp for the clinical application of that technology, several of their managers have moved back and forth between the two groups.

Someone on the generic IT side who had an affinity for physician relationships, for instance, might shift to the CMIO's group to work on IT projects directly related to patient care. A clinician doing clinical data quality and analysis might transfer to the IT organization to run a data warehouse. One caveat Stofko was quick to mention about hiring someone with no medical background: St. Joseph's runs an informal "week in the life of a clinician" program to give IT pros a better understanding of patient care.

So is it easier to teach an IT generalist the clinical principles needed to work in a hospital or practice setting, or the other way around? St Joseph's has proved you can move people in either direction, regardless of their background. The bottom line: If a job candidate has drive, a high IQ--and an affinity for healthcare--there are almost no limits on what he or she can accomplish.

Healthcare providers must collect all sorts of performance data to meet emerging standards. The new Pay For Performance issue of InformationWeek Healthcare delves into the huge task ahead. Also in this issue: Why personal health records have flopped. (Free registration required.)

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Gideon
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Gideon,
User Rank: Apprentice
2/17/2012 | 12:58:03 PM
re: Do Health IT Hires Need A Clinical Background?
I think it is easiert to teach IT clinical flow in hospitals than the other way round. IT changes quickly and we (in IT) respond quickly to it. My feeling is that, hospital or medical care centers especially the nurses are afraid that we will quickly replace them with automation. That is the fear. Other than researchers in healthcare who have to break new ground, how much does it take for a nurse who simply follow the same daily routines on their jobs: give him/her his medication, turn the drips on, alert the doctor, place him /her up! My advice to clinicians is, we are taking over. Stay tuned!
jqb
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jqb,
User Rank: Apprentice
2/17/2012 | 5:20:10 PM
re: Do Health IT Hires Need A Clinical Background?
Hospital IT people do not need clinical backgounds. It helps, but it's not an absolute. There is a big resistance by the clinicians fearing job loss, that is the real problem. Especially so in unionized facilites.

Taken to a different discipline, the same argument falls apart: if you want to work for IT at Sears, then you have to have sold appliances. Or to work in Home Depot IT, you have to know plumbing and electrical. Bogus.
rpetrecca462
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rpetrecca462,
User Rank: Apprentice
2/17/2012 | 6:17:04 PM
re: Do Health IT Hires Need A Clinical Background?
I think that it speaks to the God complex that many doctors seem to have. Having MD or RN hanging after your name in no way qualifies someone for IT work. This is not to imply that they aren't qualified. But perhaps seeing as we have a shortage of GPs, the schooling they have that I don't (in medicine) might be better put to work doing clinical work rather than IT.
AFARRELL941
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AFARRELL941,
User Rank: Apprentice
2/17/2012 | 7:10:51 PM
re: Do Health IT Hires Need A Clinical Background?
The breathtaking lack of information and insight offered by Gideon and others is testimony about how out of touch IT is in HIT.

Complexities of RN workflow has been shown in academic research to be far more complex than any other HCP, with the most intensive use of EHRs and complex HIT. The increasing acuity of acutely ill and co-morbid patients in hospitals is daunting, and the fact so few vendors successfullfy automated even simpler nursing processes or understand the critical thinking in safely administering and IVs (life critical) speaks for itself.

The IT world has woefully undestimates HIT requirements and largely automated paper records. It's pitiful that some continue to spew ignorance in spite of evidence and track record.

May you be cared for by a nurse that just "hands out pills and hangs IVs".
AustinIT
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AustinIT,
User Rank: Apprentice
2/17/2012 | 8:28:31 PM
re: Do Health IT Hires Need A Clinical Background?
The issue is more nuanced than described by the author and the comments thus far.

The question is: What part of IT would you expect a clinician who is crossing over to handle? And vice-versa for IT crossing over?

It is unlikely that there is enough talent available such that they can handle both clinical and IT at a deep level within both fields. I would use a pure IT person to deal with infrastructure and probably train a clinician to handle light IT on the applications and medical interfaces. I myself come from pure IT and have trained on the clinical aspects needed to support my clients. From my perspective, it would be easier to cross train someone on the clinical side on what they need to do or to communicate what needs to be done.
JonathonT
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JonathonT,
User Rank: Apprentice
2/18/2012 | 1:28:42 AM
re: Do Health IT Hires Need A Clinical Background?
When I worked IT in a healthcare environment, it seemed to be more about the medical personnel not wanting to go into any great depth when they described IT tools that they wanted. If that carries over to even a fraction of the medical facilities that want IT personnel with clinical backgrounds, it seems to be a bit of laziness. After all, we all want to be able to focus on our core discipline (in the medical personnel's case, medicine), and not be stuck in meetings, drilling down to fine detail on a needed report or hardware configuration.

With that said, I had known a few doctors who delved into IT and built their own tools, so I think there are some rare people who can fulfill this requirement. However, those people are rare and can be high-earners, enjoying an even greater number of roles they can choose as their core discipline, depending on compensation and stress factors.

Bottom line: I think clinical IT needs to have two types of positions available: regular IT workers and IT/Clinical hybrid superstars. Naturally, the vanilla IT worker will outnumber the hybrid IT worker. Everybody wants superstars, but that can be costly to fill your entire department with them, and nearly impossible to find many hybrid workers in a specific area, when the vanilla workers that are lining up for interviews can handle the "normal" IT stuff.

--- Jonathon

cloudfilesecurity.biz
macker490
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macker490,
User Rank: Strategist
2/18/2012 | 2:03:31 PM
re: Do Health IT Hires Need A Clinical Background?
Read carefully: If you are an IT person and you want to work in a medical facility understand clearly: The Medical people run the place.
Chris Spera
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Chris Spera,
User Rank: Apprentice
2/20/2012 | 1:46:31 PM
re: Do Health IT Hires Need A Clinical Background?
I have worked in an IT shop in a hospital as Integration Test Manager for EHR implementation for a MAJOR hospital in Chicago. I can say with 100% accuracy two specific things about IT and hospitals.

1. You do NOT need to have a clinical background to work IT in a hosptial
2. If you don't have a clinical background, you need to at least be willing to learn what the EHR end user ie experiencing, or you won't be effective in supporting what they do and what they need.
3. If you don't have a clinical background, you need to know how to communicate and talk with clinical professionals. Its different than dealing with other your regular lot of IT user. Medical professionals are not IT savvy.

This is a tough nut to crack, however, as there are very few IT superstars that are also clinical superstars.
cxf
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cxf,
User Rank: Apprentice
2/20/2012 | 2:15:56 PM
re: Do Health IT Hires Need A Clinical Background?
Juliet Daniel is off her rocker. This is the same industry that's saying they'll be short qualified nurses as well. Look, if the healthcare industry is 50k people short of qualified IT staff, then that's on them. There are no areas in healthcare that aren't under extreme operational duress today. Healthcare finance has been an issues for three decades, but again, it's an issue that resides squarely with healthcare. Healthcare in general is in shambles and the more Juliet Daniel boasts about the kind of experience IT staffers need, the more she makes the case that healthcare is in need of people that don't have medical experience.
AustinIT
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AustinIT,
User Rank: Apprentice
2/20/2012 | 5:20:57 PM
re: Do Health IT Hires Need A Clinical Background?
Sorry cxf but I disagree with ya. First of all, healthcare is now going through what the manufacturing industry went thru during the build out of the Internet from the 90's forward... in that they networked their information silos, essentially created the digital age, and modernized their supply chains. Healthcare is now undergoing that same sort of renaissance. They are migrating from using paper charts for record keeping. And, they are networking their high tech silos so that information can be collected, distributed, and analyzed at a higher level.

Juliet is right in pointing out that the applications being used in the medical field DO require a significant amount of clinical knowledge in order to support them from an IT perspective. I've been there done that so I agree with her.
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