Assuming a 5-year time frame for NHIN implementation, about 7,600 (+/- 3,700) specialists are needed for installation of EHRs for the approximately 400,000 practicing physicians who do not have them already. For the hospitals needing EHRs (about 4,000), approximately 28,600 specialists are needed. Finally, about 420 people are needed to build the health information infrastructure systems in communities to interconnect all these EHR systems.
These estimates are admittedly imprecise and preliminary, and should be interpreted in the light of the numerous limitations of the current research (Table IV). Since no quantitative data is available regarding the existing NHIN workforce, it is not possible at this time to determine whether these workforce needs are indicative of a shortage of personnel. In addition, further research is needed to determine the accuracy and reliability of these estimates. Nevertheless, these first-ever estimates of the NHIN workforce requirements will provide critical help and guidance in our ongoing efforts to bring the benefits of electronic health information to all Americans.
Table I. Types of Personnel Identified
- Project Manager – Overall responsibility for all aspects of implementation of an information system, including supervision and direction of other involved personnel
- Implementation Coordinator – Overall responsibility for ensuring that the implementation team works effectively together with the end users
- IT Interface Builder – Creates effective data communications interfaces between systems, including (as necessary) connecting hardware and installing, modifying, and developing software
- Change Management Specialist – Works directly with end users to ensure a smooth and effective transition of their current business processes to an EHR system
- Desktop Specialist – Works on PC-related issues for implementation, such as configuration, software installation, and establishment of communications
- Database Administrator – Responsible for the definition, operation, protection, performance, and recovery of a database
- Network Engineer – Responsible for design, implementation and support of local-area and wide-area computer communication networks
- Records Management Specialist – Ensures accuracy, integrity, and completeness of medical records as a practice makes the transition to an EHR
- Quality Assurance Specialist – Works with end users to test each component of the information system and assure that the components work effectively with each other as they are integrated
- Privacy Officer – Ensures that privacy policies for medical records follow all relevant laws and regulations and that the organization's policies and operational practices are consistent with them
- Security Officer – Ensures the implementation and operation of reliable and consistent mechanisms that effectively enforce privacy and confidentiality policies in health information systems
- Technical Analyst – Works with system personnel and end users to identify and correct any problems with operational information systems
- Trainer – Works with end users to educate them about the features and proper operation of their information system
- Help Desk Specialist – Works with end users to troubleshoot problems and questions that arise in the course of routine use of their information system
- Chief Medical Information Officer (CMIO) – Ensures that all medical information systems are working effectively for patients, providers, and the organization
Table III. Assumptions
- NHIN creation requires three identifiable infrastructure development activities:< >Implementation of EHRs in provider offices
Implementation of EHRs in institutions (e.g., hospitals)
Implementation of the infrastructure to make complete records available for each patient (HII)
Within each activity, there are subsets that depend on the size and type of the organization (e.g., small provider offices vs. large group practices); these subsets influence the workforce needs
- Within each activity and organization size or type, the specific architecture for implementation (e.g., independent system vs. ASP model) will impact the workforce needs
- By estimating the workforce needs for each specific activity and architecture, a model can be created to estimate workforce for any specified mix of activities and architectures
Table IV. Limitations of the Research
- This is the first attempt to quantitatively estimate NHIN workforce needs.
- Estimates are based primarily on expert opinions.
- Overall workforce estimates are highly dependent on activities identified using current perspectives on building the NHIN, which may change.
- Precision of the estimates is difficult to assess.
- Only five site visits were done for preliminary validation.
- New technologies or implementation architectures, such as improvements in EHRs, could invalidate results.
- Only personnel needed for implementation are addressed. Workforce needs for pre-implementation planning and post implementation maintenance, support, and upgrades are outside the scope of this study.
- Only personnel needs outside existing organizations are included. Additional work required by existing personnel is not assessed.
- The impact of the ongoing establishment and selection of standards and use of structured versus free-text data cannot be estimated within the framework of this project.
- Differences of EHR installation by practice specialty cannot be estimated within the framework of this project.
- The impact of “affiliated” versus “independent” practices cannot be estimated within the framework of this project.
- The impact of multispecialty versus single-specialty group practices cannot be estimated within the framework of this project.
- This study does not account directly for economies of scale from simultaneous installation of large numbers of EHR systems.
- This study does not include the workforce needed for the entire transformation of health care. Informatics skills are needed for this.
- Estimates of workforce for HII deployment in communities are limited by the small amount of available data, the uniqueness of each current instance, and the absence of any fully operational HII systems today.
- Differences due to the state of readiness of a practice or institution for EHR installation could not be assessed.
- Potential workforce efficiencies gained over time from the experience of many installations could not be estimated.
- The effect of retention of installation personnel by practices and institutions for ongoing operation and support (after initial EHR installation) was excluded and may result in substantial underestimates of the numbers of personnel required.
- This study did not include estimates of the workforce needed to install personal health records.
- The current estimates do not account for any interactions with other related health care workforce needs (e.g., the shortage of nurses).