It’s a problem many CIOs know all too well. As the pressures mount to meet Meaningful Use requirements, they’re finding resources are already stretched thin, and the supply of individuals with both clinical and technical expertise dangerously low. George Evans wanted to know how his colleagues were facing the challenge of too many high-priority tasks, too little IT talent, so he put out a survey that garnered some interesting results. In this interview, Evans reveals what he learned about how organizations are building out their clinical informatics staffs, the qualities that are most valued in staffers, and why internal poaching isn’t always a bad thing. He also discusses the application environment at St. Joseph’s/Candler, and where his organization stands in its quest for Meaningful Use.
- Core competencies for clinical informatics staff — nursing is king
- “Anybody who understands how patients get taken care of can be a good informaticist”
- Finding the (salary) range
- About St. Joseph’s/Candler Health System
- Running a Meditech Magic 5.64 shop
- eClinicalWorks in the ambulatory environment
- Medseek for physician/patient portal
- Iatrics for physician office integration
- Orion Health an option for HIE
If you did have a program that was truly a full-blown clinical informatics degree type-program—and not just something where you go sit in a class for six weeks and pass a test, but a true degree program—I might hire those people as entry-level informaticists. But I don’t think I’d take the person that’s fresh out of school with no clinical and no technical experience, and put him in anywhere.
If anything surprised me about it, it was the fact that nobody’s really adding a whole bunch of these people. I saw one place here that was adding a huge number… other than that, people were adding two, five, or six positions, and that’s not a lot, considering what most of us have ahead of us.
I am a huge fan of the CHIME member-to-member surveys. They are such a good way to get quick responses from my peers out there, and the folks at CHIME do such a good job at helping you get them set up, sending them out, compiling them and sending them back to you.
There’s a huge, just incredible amount of volunteerism here. It’s just a matter of folks here that take the mission of truly improving the healthcare of the entire community—and not just the paying community—very seriously.
We already use Medseek, and we’re sort of ramping up that functionality and expanding it to add a physician and patient portal. We’ll probably consolidate all of that data to where we’ll be able to present the physician with a longitudinal view of the patient data.
Guerra: All right, let’s continue on with the survey. One of the questions was, ‘Describe the core competencies, educational requirements, and experience you are looking for in clinical informatics staff.’ I did a search for some things that pop up repeatedly, and here are the top things that I found: ‘RN’ was mentioned 38 times, ‘nursing’ 26 times, and the word ‘nurse’ six times. So there is just a huge focus on nursing. Tell me about that.
Evans: That’s probably to be expected, but it was a little surprising to me when you went to a later question there where you said, ‘What clinical experience are you looking for?’ So in other words, this question was about core competencies. I thought we could have phrased this better. This is absolutely an amateur event that I came up with and, looking back, there are some things I’d change.
But when I look at those two questions—the one that says, ‘What are the core competencies,’ and as you say, RN/nursing is rampant through there. But then you go to question number seven, which talks about the clinical experience they want, you get a little bit more variety thrown in there. Pharmacist comes up quite a number of times, MTs come up a few times, and RTs come up a few times. I think that’s telling. Pharmacy is a very big piece of what this automation is about. They kind of sit there in the middle and are involved in a lot of stuff. I have historically had a lot of success getting good clinical analysts, which are probably today’s informaticist of sorts, which that came from the lab. The lab and pharmacy have generated a lot of folks for me historically. You get somebody out of those areas that has a technical interest, and you propagate that.
But very clearly in terms of the core competencies, they want the clinical experience. I think most people sort of summarize that into RN, but the truth of it is, I think anybody who understands how patients get taken of can be a good informaticist. It certainly helps if you’re talking about informatics staffs, and if someone is going to be training a large number of RN’s—and that’s obviously is going to be a lot of their customer base—you get some credibility if they are an RN. Again, I’ve seen plenty of respiratory therapists, pharmacists, and medical techs, radiology techs that have performed very well in clinical analysis type positions.
Guerra: Let’s talk about question number 10: Would you hire new graduates that have a clinical informatics degree. Sixty percent said yes, and 40% said no. What do you make of that?
Evans: Personally, going back to what we were talking about with government programs, I’m not sure that I would hire a recent grad. Although if you did have a program that was truly a full-blown clinical informatics degree type-program—and not just something where you go sit in a class for six weeks and pass a test, but a true degree program—those people I might hire as entry-level informaticists. But I don’t think I’d take the person that’s fresh out of school with no clinical and no technical experience, and put him in anywhere. As part of the degree program, I would want some practicum.
Guerra: Right. Going to question number 12, ‘What would you estimate as the starting salary range for the person you might hire who had the educational qualifications, but not the work experience?’ I looked through all of those answers and I would generally say it fell between $60,000 and $80,000. Does that sound right to you, and what do you make of that number?
Evans: That’s about right. There are a few outliers on either side of that you’ll see at the really small hospitals and the big academic centers. Because some of these people, for their informaticists, they were looking for MDs, BSNs, MSNs and other more highly educated people, so I think that probably explains some of the outliers there, and the small hospitals probably explain the low end of the scale.
I would definitely agree with $60,000 to $80,000. That’s also my personal opinion of what it would be fair to pay someone who was clinically qualified but maybe not technically qualified to be an informaticist. I’d probably bring them in toward the lower end. If I get somebody that was already pretty strong in regard to the technical and had the clinical, then I’d probably push them up there the higher end of that range, with the possibility for manager or director level jobs to push that income a little higher yet. But I think $60,000 to $80,000 is the bulls-eye for both my region here where I am now, and for other markets that I’ve been in. I’ve not worked in academic settings, so I’m not familiar with those, but in the areas that I have been, I think that would be a very fair salary for that kind of person.
Guerra: Any other highlights or takeaways you want to talk about from the survey?
Evans: If anything surprised me about it, it was the fact that nobody’s really adding a whole bunch of these people. I saw one place here that was adding a huge number; I figured they’re an Epic shop. Other than that, people were adding two, five, or six positions, and that’s not a lot, considering what most of us have ahead of us. I know where I am along the continuum. I’m probably up in the 8 to 12 range in terms of the number of these folks that I need. I’m actually most likely going to be converting some other folks from other analyst-type roles as everything gets automated, kind of like operators did a while back. I’m going to replacing those people with informaticists because that’s where I need the most horsepower.
The other thing is that obviously there was a tremendous amount of interest in it, and a very strong response on the survey. The responses confirmed some of my general assumptions about the sort of people that you would be looking to bring into that role, what you would pay them, what the skillset was that you were looking for, and the fact I think there is a big interest in developing these people. How do you create these people who are good at this?
Guerra: I was told by CHIME that this was the largest number of responses they got from any survey this year, so obviously it resonated.
Evans: Yes, that’s what Stephanie [Fraser] said. For me it was definitely a hot topic. I was pleased to get the response that gave me a little bit of confidence. Sometimes you get a couple dozen responses to something and you really can’t make any assumptions off of it. It’s pretty amateur, but it is enough response, I think, to validate some thinking.
Guerra: I want to jump back for a second to the number of people that organizations said they were hiring. You said it seemed a little low—that may not reflect the fact that they only need two people. It may reflect the fact that they can only afford two people. And I think it’s possible it could even reflect the fact that they don’t think there are that many people. The thinking might be, ‘I might need 10, but I don’t think there are 10 out there I can find, so I’m going to go for two’. I wonder if there could be other things that factor into that low number.
Evans: I would probably lean toward the budgetary restriction thing. I think they’re just thinking, I’ve got X and I need to grow, but they’re not going to let me grow it more than Y, and Y equals 3. That probably is a lot of that answer.
Guerra: You mentioned that when writing a survey, sometimes you get the results in and sometimes you realize that you didn’t phrase the questions as well as you could have. I do surveys every month and I’ve certainly learned that the hard way. So maybe a question you could have asked would have been: ‘If money weren’t a factor and it was just based on your workload, how many people would you hire?’ And then the follow-up question: ‘How many people could you hire with the money that you have?’
Evans: Yeah, and I would like to have gotten some clarity around that. And the other thing I wish I had one is that I can’t correlate the answers between ‘How many people are in your IS department’ and ‘how many informatics staffers do you have,’ and ‘how many are you hiring?’ I should have thought to have structured this in some manner that would let me do it.
Guerra: Yeah, I noticed that when I was going the data as well. When they said how many they’re hiring, it’s very difficult to take that piece of data and match it back to, for example, the size of the organization answering that specific question because you lose the context. So it can get a little hairy with the data, right?
Evans: Yeah. If you have 50 people in your IS department and you’re adding 10, it’s a little bit different number than if you have 300 people in your IS department and you’re adding 10.
Guerra: Right, so you could ask, ‘By what percentage are you increasing the department’ or something like that.
Guerra: Well, we all live and learn.
Evans: That’s right. I was just going to say that I always try to make better and better mistakes.
Guerra: What would your advice be to your colleagues both on doing these types of surveys through CHIME and on formulating the questions?
Evans: I am a huge fan of the CHIME member-to-member surveys. They are such a good way to get quick responses from my peers out there, and the folks at CHIME do such a good job at helping you get them set up, sending them out, compiling them and sending them back to you. They always totally exceed my expectations. So I am a huge fan of that capability. And even one, two, three quick question-surveys, they’re very good for that. In terms of structuring, probably most of us—and I don’t want to say all because I’m sure we’ve got some statisticians or somebody in our midst—are probably not professional survey designers. Stephanie prodded me a little bit on this. We’d been working with the university and trying to agree on what questions to ask, and I just said I needed to get it out and quit dabbling with it. I should have stopped and consulted with her some more. Listen to people who know more than you do, I guess I would say.
Guerra: Let’s talk a little bit about your organization, St. Joseph’s/Candler.
Evans: We’re a two-hospital, faith-based system. It was actually a merger of a Methodist and a Catholic hospital—St. Joseph’s Hospital and Candler Hospital. Candler is actually the second oldest hospital in the country. We have as part of our clinics and associated facilities here the old Georgia infirmary, which was I think the first African American hospital in the country. Mary Telfair Women’s Hospital is now incorporated into our Candler campus, and that’s something like the oldest women’s hospital. There’s a lot of history here. It don’t know it that well, I have to apologize. I’ve only been here about three years now. But it’s steeped in history.
And obviously, with the faith-based emphasis, they take the mission here very seriously. So when they go to report their community benefit, it’s not what I have seen other organizations report, such as how much charity here they did or something like that. We actually take money off of our bottom line and put it into delivering services out to the community with free clinics and things like that. We have two clinics here that are for the uninsured and underserved, plus a number of other outreach activities. There’s a huge, just incredible amount of volunteerism here. It’s just a matter of folks that take the mission of truly improving the healthcare of the entire community—and not just the paying community—very seriously here.
Guerra: When did the merger take place?
Evans: That preceded my time, but I think it was 1997.
Guerra: Okay, give me an idea of the application environment. Are both hospitals on the same system, or are they on different systems because of the merger and you’re working toward one? What’s the situation there?
Evans: This was definitely one of the situations you’ve seen where there’s the merger and the merge; Candler was the mergee. St. Joseph’s was running Meditech at the time, and so they just put in Meditech at Candler when St. Joseph’s took over. That conversion was well behind them by the time I got here.
Guerra: What version of Meditech are you running at the hospital?
Evans: 5.6.4 Magic.
Guerra: Are you good with that for meaningful use?
Evans: Absolutely. We’re staying put until we get through the next several years here, and then we’ll make a decision on 6.0 or an alternative path.
Guerra: Did you have to take some type of service pack upgrade?
Evans: We had to get on 5.6.4, and then there was one more little minor tweak. And to be honest, that was done by people who know more than I do. I’m not sure of the specifics of it. We had to take a big step and a baby step to get us to the right place.
Guerra: You mentioned clinics. What are the clinics on?
Evans: There’s one that’s grant-funded that’s currently on GE Centricity—the old Magician product that they used to have. But we’re converting them over to eClinicalWorks, and we’ll probably put our other clinic on eClinicalWorks as well. We can’t have a component of our system here where people are having care rendered and we’re not tracking it just as if they were in-patients or outpatients at one of our “for pay” facilities, so to speak.
Guerra: Are there on physician practices?
Evans: Yes, we’ve got about 27 or 28 employed physicians right now.
Guerra: What are they on in their practices?
Evans: Any of them that are not already on eClinicalWorks we’re putting on that. Most of them IDX for their practice management and one of them had Allscripts for EHR, but we’re phasing all of that out in favor of eClinicalWorks for PM and EHR.
Guerra: Are you looking at integration between Meditech and eClinicalWorks?
Guerra: Tell me how you’re going to go about doing that, or what your plan is there, if you can give me any specifics.
Evans: We’re going to accomplish that probably in conjunction with another project. We already use Medseek, and we’re sort of ramping up that functionality and expanding it to add a physician and patient portal. We’ll probably consolidate all of that data to where we’ll be able to present the physician with a longitudinal view of the patient data from both Meditech and eClinicalWorks.
We’ve also got an HIE here—the Savannah/Chatham County safety net. They use the Orion platform. We send them some data right now, but not really a full, robust set. We’ll figure what we’ll do in terms of that relationship going forward, but that would be another mechanism to share data through.
Guerra: What about the independent physicians? Are you underwriting using Stark to get them on eClinicalWorks? Are you giving them any options or are you not going down that road?
Evans: We’re really not doing a whole lot of that. We do recommend eClinicalWorks. We do have some support that we’ll offer them; I guess the best way to put it is it’s not really financial assistance, but it is a thing that allows them access to our purchase levels, and also gives them some local people to help them with the implementation and the ongoing support. In other words, we’ve got our staff trained as implementers and supporters of eClinicalWorks, and we’re allowing our affiliate physicians to access our staff.
Guerra: Would the independents or the physicians that are on EClinicalWorks have greater degree of integration with the Meditech inpatient system than physicians that are on another ambulatory EMR?
Evans: For a while at least, yes. I don’t want that to be the case on an ongoing basis. Obviously, for those doctors who are closely aligned enough with us that they care to choose eClinicalWorks on the basis of our relationship, we want to be sure we take care of them. But we also don’t want to ignore doctors that are running Allscripts or NextGen or whatever they happen to have in their offices. So we’ll certainly be sort in parallel looking at integrating those as well.
Guerra: So right now Medseek is the way they see into the hospital system?
Evans: That’s correct.
Guerra: And then eventually there would be some integration beyond that, or would it be through Medseek?
Evans: There are a couple of avenues. Number one, if you’re looking for something related to patient data within our organization—either the ambulatory or inpatient side—then you’ll get that through the physician portal. At least that will be an avenue to that. If you are an eClinicalWorks user, then we will have the integration between Meditech and eClinicalWorks done such that you will get the data in your office from your in-patients and others. If you’re an affiliated doctor out there, we have a product from Iatrix—physician office integration—that allows us to share in a bidirectional manner lab and radiology orders and results back and forth, as well as reports. So we have a means of accomplishing that sort of point-to-point. And then longer term we’re going to have to use more of a cloud technology, like possibly through the HIE here with the Orion product or alternate product of our choosing, to be sure that we can send or receive data to anybody.