Fierce Q&A: Vanderbilt University Medical Center CIO on health IT's staffing shortage

The difficulty in hiring health IT pros is only getting worse, according to a new survey from the College of Healthcare Information Management Executives. Nearly two-thirds of the 163 participating CIOs said they're experiencing shortages, compared with 59 percent who said so in 2010. And there's no relief in sight.

"Staff needs aren't likely to abate over the next couple of years, as CIOs continue to push to achieve Meaningful Use targets and switch to ICD-10 compliant applications," Randy McCleese, CIO at Morehead, Ky.-based St. Claire Regional Medical Center, said in a statement.

George McCulloch (pictured), deputy CIO of Vanderbilt University Medical Center and a CHIME fellow, spoke with FierceHealthIT about the survey and organizations' technology needs.

FierceHealthIT: Has the delay of ICD-10 combine with the political climate caused any hesitation on IT projects?

McCulloch: No. Pushing off ICD-10 was helpful, but not enough, with all the pressure that's on for Meaningful Use. Life would certainly be much worse if ICD-10 were still staring us in the face for this fall. So that's one of the few pleasant reprieves that we've gotten on the technology side, but there's still so much to do.

FHIT: So what did this survey tell you about the health IT hiring trends?

McCulloch: We're still behind in some areas--in almost all areas. For Meaningful Use, depending on the tools you use, the vendor you use, you need the whole range of people--business analysts, project managers, people who can configure your application your particular way, people who are going to make the technology happen under the cover--so it's really a big need across all the demands that this technology is pushing them to.

And given where we've been with computer physician order entry and other components involved with Meaningful Use and those dollars, it's a big stretch for most organizations to make this giant leap into this technology.

FHIT: Do you see IT staffing shortages limiting organizations' abilities to meet these deadlines?

McCulloch: I think people are shifting priorities. They're also trying to hire consultants at some cost to go do that. I think, by and large, they've scaled back things that are not Meaningful Use-related. They're saying, "I wanted to do this, but I can't." I think it's a combination of prioritizing their own internal goals and spending money on consultants that they wouldn't have wanted to do before.

FHIT: Everybody wants to hire people with experience, but because this is so new on so many fronts, are there that many people out there with experience? Are they drawing in IT people from other industry sectors?

McCulloch: In some areas, the infrastructure area, we certainly can grab outside people. A project manager we can get from another industry, but they're probably not going to be as good as someone with healthcare experience. The application component is very unique to healthcare and probably very unique to your vendor.

So there are some things--and support people, implementation folks--where we say, "I can't steal from other industries. They really need to have some healthcare experience." And I think that's the toughest one. You can supplement in some areas, and others are just really, really hard.

FHIT: Is the talent shortage driving salaries up?

McCulloch: We're seeing more competition, that's clearly there. I'm seeing people really worried about burnout of the people they do have. I'm seeing more perks and incentives [for workers] to keep on going. So over time, it certainly could increase salaries overall.

What I'm seeing in the short term is more competition for particular resources, not changing the whole grade just yet. It's getting the one or two people you really need and paying them more than you'd want to, but not necessarily moving everybody up at this point, though that is likely coming.

FHIT: Are there not that many job candidates out there, or is it that the salaries they can command are exorbitant?

McCulloch: It's getting to be uncomfortable on the salary side, especially on vendor-specific applications. Experienced people are not there and I think [employers] are making do with what they can get. They'll hire people with some experience, but they're not experts--a level I kind of person who has maybe a year or two [of experience]. They kind of know their way around, but you couldn't put them as a lead on a project; they might be able to support it. [Employers] are just trying to work with the resources they can get.

FHIT: So it's really a market for consultants, isn't it?

McCulloch: Yes, it's a market for consultants. But even on the consultant side, sometimes people are asking, "So where are you getting them from?" And [the consultants] are getting rookies. So that's part of the dialog with them. It's saying, "So who am I really getting? Am I just getting a warm body or am I getting an experienced person in here." The consultant folks are really working that, because they know it's an issue. They're saying, "OK, if I'm using a rookie, maybe I need to wrap something around them."

One of them said, "I'm creating my own boot camp. I've got rookies and I'm taking several weeks, about a month and a half, and getting them up to speed before I place them." This [consultancy] has a long-term relationship with healthcare providers. She said, "I might put them out there and make a sale for a while, but my reputation becomes soured if I can't deliver and I can't afford that."

FHIT: One thing that struck me from the survey was that not that many employers are hiring out of the short-term training programs funded by the Office of the National Coordinator for Health IT.

McCulloch: It's a tough situation. This is a really tough industry. When you get the specific products and processes, the way healthcare is organized, that's not a natural thing for somebody who hasn't been in it. So taking someone who has some skills, from an implementation support standpoint, you could probably find a decent match.

Once you go up the complexity scale, it gets harder. … I think they're doing the right thing and we need to get focus on those. These [students] just need some experience.  

FHIT: Was there anything else in the survey that stood out to you?

McCulloch: I was a little surprised that people said they were coping as well as they were. … Some of the smaller organizations I think are struggling a lot with the resources they have. Larger organizations have more resources, and it's really where you are in the lifecycle and how complete your product line is as to whether you say you're struggling or merely uncomfortable.

Editor's note: This interview has been edited for length and clarity.

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