A comment on the last set of awards: the Healthcare High Growth grants. The overarching goal of ARRA was to stimulate the economy and to help create jobs, but a quick review of the grant recipients and their websites raises questions in my mind as to the efficacy of this strategy, at least in this instance.

If we are to meet the goals of HITECH and the Obama administration’s HIT adoption objectives, tens of thousands of physician practices, thousands of hospitals, thousands of other healthcare service providers, hundreds of health information exchanges and dozens of vendor companies will need tens of thousands of additional staff. Even before ARRA, the shortage of skilled personnel was acute and will only grow more acute if the level of HIT implementation activity increases, as expected, over the next several years.

To meet this need, the industry will demand that successful candidates possess not just IT skills, but also at least fundamental – sometimes even advanced — knowledge of clinical practice, terminology and workflows. So the key question is whether the jobs that need to be filled can be filled with those these programs are likely to produce.

Frankly, I doubt it. We need thousands of systems analysts, business analysts, system architects and implementation specialists with clinical and technical knowledge; we need thousands of physicians and nurses to augment their efforts and work with the physicians, nurses and other clinicians whose participation and commitment to these goals is essential for this journey to be successful. Where will these resources come from, the local community college? Unlikely.

I see a problem in not providing funding for any HIT initiatives that are addressing the education of physicians, and especially the looming challenges associated with the revolution in genomics and pharmacogenomics directly related to clinical care.

This seems like funding for job creation without first defining where the education is most critically needed.

It is also of interest to see that many of the RECs have significant lobbying representation here on Capital Hill.

The thing that no longer surprises me is that their largesse always seems to come without a plan, standards, guidance, or accountability.

Providers have little if any assurance that their EHR efforts will be met with any success. Why? Because their individual attempts at implementing EHR are being undertaken by the unique framework developed by each provider.

There is no defined target, no concrete way to know if in fact their efforts will hit the target. Where do we lack clarity?Certification. Meaningful Use. Standards. HIEs. N-HIN.

Is there a unified detailed plan describing what the RECS are to do and how they are to do it, or is each REC expected to develop their own plan to add value? If it is up to them, does that bring the leadership and clarity that is needed, or does it further confuse the situation.

For the RECs to add value, it seems that at a minimum there should be:

* an articulated definition of the areas where the providers need help
* a list of the skills the RECs need to deliver the services
* a list of the tasks the RECs need to deliver the services

In an industry whose subject matter expertise is fifty percent below what is needed, from where will the resources come?

What else could be done with a billion dollars? How about paying however many EHR vendors comprise 90% of the market to agree to a set of standards, refit their applications to those standards, and convert their installed base. Wouldn’t that do a lot more towards making interoperability viable?