Nationwide Health Information Network (NHIN) Workforce Study: Final Report. Table IV. Limitations of the Research


  1. This is the first attempt to quantitatively estimate NHIN workforce needs.
  2. Estimates are based primarily on expert opinions.
  3. Overall workforce estimates are highly dependent on activities identified using current perspectives on building the NHIN, which may change.
  4. Precision of the estimates is difficult to assess.
  5. Only five site visits were done for preliminary validation.
  6. New technologies or implementation architectures, such as improvements in EHRs, could invalidate results.
  7. 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.
  8. Only personnel needs outside existing organizations are included. Additional work required by existing personnel is not assessed.
  9. 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.
  10. Differences of EHR installation by practice specialty cannot be estimated within the framework of this project.
  11. The impact of “affiliated” versus “independent” practices cannot be estimated within the framework of this project.
  12. The impact of multispecialty versus single-specialty group practices cannot be estimated within the framework of this project.
  13. This study does not account directly for economies of scale from simultaneous installation of large numbers of EHR systems.
  14. This study does not include the workforce needed for the entire transformation of health care. Informatics skills are needed for this.
  15. 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.
  16. Differences due to the state of readiness of a practice or institution for EHR installation could not be assessed.
  17. Potential workforce efficiencies gained over time from the experience of many installations could not be estimated.
  18. 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.
  19. This study did not include estimates of the workforce needed to install personal health records.
  20. The current estimates do not account for any interactions with other related health care workforce needs (e.g., the shortage of nurses).

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