President Donald Trump’s recent immigration ban could have broad implications for the health IT industry that draws on overseas talent to fill a growing demand for employment, although health leaders told FierceHealthcare that the immediate impact is still unclear.
“The very easy answer is it will definitely hurt the organizations and businesses that employ people from these countries ... When they make it harder for them to come, then they will not come,” said Niam Yaraghi, a fellow at the Center for Technology Innovation at the Brookings Institution.
Yaraghi currently holds a green card, but entered the U.S. from Iran in 2010 on student visa to complete his doctorate in management science and systems at the State University of New York at Buffalo.
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On Friday, President Trump issued an executive order temporarily banning travel from seven countries, prompting backlash from several of the country’s largest tech giants, including Microsoft, Google, Apple, Facebook and Netflix. Reuters reported that a group of technology companies was planning to file an amicus brief supporting a lawsuit challenging the immigration ban.
On Monday, the New York Times reported President Trump was drafting (PDF) another executive order that would overhaul the work-visa programs and require companies to prioritize hiring American workers, a change that would directly impact the technology industry.
Although the executive order banning immigration from seven predominantly Muslim countries could have broad implications for the technology industry at large, it’s less clear how the policy could affect healthcare technology companies and hospital IT departments.
However, those in the health IT industry have expressed varying levels of concern over the ban and its impact on the workforce moving forward.
HIT hiring has global reach
John Halamka, M.D., CIO of Beth Israel Deaconess Medical Center in Boston and CIO and dean for technology at Harvard Medical School says his organization has a global reach when it comes to hiring IT employees.
“The only way for IT organizations to succeed is to find the best talent regardless of national origin, religion, race and ethnicity, creed, gender identity [or] sexual orientation,” he said.
“We recruit worldwide and leverage services throughout the international community. At this point in history, the economy is truly global. Denying that reality is an attempt to resurrect an era that no longer exists.”
According to a Census Report issued last year, 24% of the U.S. IT workforce was made up of foreign-born workers, significantly higher than the 17% employed throughout all industries. Nearly 40% of foreign-born IT employees worked in software development, applications and systems software, while 28% worked in IT research and 25% worked as computer programmers.
Ban could limit talent pool
There are no statistics regarding the number of foreign-born workers in the health IT industry specifically, let alone numbers from the seven countries included in the ban. Anecdotally, however, health IT leaders told FierceHealthcare the ban could directly impact the talent pool that the industry draws from.
Yaraghi noted that there is a “very powerful word of mouth process” among Iranians that are already working in the U.S. and those seeking to study or work in America.
Through his alma mater, Isfahan University of Technology, Yaraghi said he is frequently contacted by people interested in working in different levels of healthcare information systems. Now that Iran is included as part of the President’s temporary travel ban, he said he'll direct those prospects to places in Canada or Europe where they won’t face the same obstacles.
“Once upon a time, the U.S. was by far the best place for someone to come,” he said. “It is not the best choice anymore. For an Iranian software engineer deciding where to continue his career, Canada may be a much better option because you’re much more accepted there, you can have your residency much sooner, and by the way, there are so many Canadian companies that are as good as their American counterparts.”
“In the long run, it’s a big loss for the U.S.,” he added.
Adds to shortage of IT workforce
Others told FierceHealthcare that although it was unclear how the ban would impact recruitment of foreign workers going forward, healthcare is already facing a shortage of IT employees that can help push the industry into the digital age. According to a 2014 HIMSS survey, 56% of healthcare provider organizations hired between one and 10 full-time IT employees, and 20% hired 20 or more. Additionally, 92% of healthcare providers claimed their organization faced staffing barriers, and 69% of those respondents said the lack of a qualified talent pool was their biggest challenge.
“In general, in the world of health IT, there just isn’t enough bandwidth right now to ensure we get all aspects of it right in order to improve the healthcare system,” said Hardeep Singh, M.D., chief of the health policy, quality and informatics program at Houston Veterans Affairs Health Services Research Center of Innovation and an associate professor at the Baylor College of Medicine. “Remember, we just implemented these systems and are still learning how to optimize.”
Others noted that the number of health IT workers coming from the seven countries affected by the ban was likely to be small. According to B. Lindsay Lowell, director of policy studies for the Institute for the Study of International Migration at Georgetown University, 5,500 legal permanent admissions to the U.S. came from Syria last year, and that the seven countries identified in the executive order make up just one-fifth of the total refugee flow.
“In other words, the number likely to be healthcare IT only is likely not large,” he told FierceHealthcare. “How big an impact will that have? It is certain that the present ban, if temporary as stated, will disrupt some healthcare providers and impose hardship on some migrants. It is not clear, yet, that it will have strong longer-term impacts if it is temporary and something like today's levels of legal immigration resume.”
'Alarm' over executive order
Bob Kocher, M.D., a partner at Venrock, invests in health IT companies including Aledade, Zenefits and Doctor on Demand. Kocher, who previously served in the Obama administration as special assistant to the president for healthcare and economic policy, said he was “alarmed” by the executive order, but added that he did not have specific numbers regarding the number of H1-B visa employees within his active investments. Anecdotally, however, he says foreign-born workers contribute significantly to health IT advancements.
“I know we have lots of workers across the portfolio who are H1-B folks and immigrants,” he said. “And we are all worried and concerned and doing what we can to assure people that we appreciate people from anywhere who care about doing good work and making healthcare better. Many of them are making healthcare better for vulnerable Americans.”
The broader, long-term implications are even less clear, particularly since the executive order represents a temporary ban, but Yaraghi argued that as a businessman, Trump should consider the economic value of bringing in some of the best and brightest IT professionals.
“It’s really sad,” he says. “I’m not saying this because I’m Iranian; I’m saying this because I’m a resident of America and I really love America more than my own country, and to see this happen is really unfortunate. I think it doesn’t make any sense economically, and more importantly, it doesn’t make sense from a national security perspective.”
A spokesperson with HIMSS said the organization did not have data on foreign-born health IT workers and declined to comment further. The College of Healthcare Information Management Executives (CHIME) also declined to comment. Representatives with the American Medical Informatics Association (AMIA) and the American Health Information Management Association (AHIMA) did not return requests for comment.