By Chris Dimick
Last year 82 community colleges launched health IT training programs in a hurry. After a slow and sometimes bumpy start, the programs are picking up steam and the students are graduating. Now comes the next test: are the jobs out there?
Frank Lillo knew his field was changing, and he realized he'd have to change with it if he wanted a job.
The realization led Lillo, 57, a former manufacturing IT consultant, back to school to enroll in the Community College Consortia to Educate Information Technology Specialists in Health Care program. Created by the Office of the National Coordinator for Health IT, the consortia was designed for students like Lillo. The six-month program offers focused training in six health IT roles with the intent of moving workers with health or IT backgrounds into emerging health-based technology jobs.
Lillo had 25 years experience in business analysis, software systems implementation, and project management in the manufacturing and distribution industry. But with system implementation work scarce in manufacturing businesses, Lillo knew he had to retool his skills. With health IT booming, Lillo felt it would be a great career shift.
He enrolled in the consortia's practice workflow and information management redesign specialist track at Indian River State College, a local community college based in Fort Pierce, FL. Two months after completing the program, Lillo landed a new job with the South Florida Regional Extension Center helping physician practices implement electronic health record systems.
"I like the fact that healthcare is an industry that provides help to people, and I also like the fact that it is a growing industry and provides a great job outlook for me," Lillo says.
The consortia training program launched one year ago this month. In that time, 82 community colleges around the country have offered the six-month health IT training programs. A total of $2 billion was allocated through the federal HITECH Act for health IT programs, including funding for workforce development programs, like the consortia, intended to address a need for 50,000 more health IT professionals nationwide. While the consortia has had many successes, it's also faced its share of challenges.
An accelerated development schedule-five months from the first checks to the first class assignments-resulted in a slow start for the program. The number of students completing the program during its first year is lower than hoped, but ONC says the consortia is still on track to meet its goal of training 10,500 health IT professionals by April 2012.
Whether those graduates will actually find jobs in the health IT field is still to be seen.
Off to a Slow Start
The first students to complete the consortia program graduated in March of this year, but the numbers weren't high. By April just 1,900 students had finished the training.
It wasn't until this year that completion rates picked up steam. ONC estimates that 7,000 students will have completed the programs by September 2011, according to Chitra Mohla, director of the community college workforce program in ONC's office of provider adoption support. Many more will be in the pipeline. ONC expects more than 10,000 students will be enrolled in consortia programs that same month.
The program's slow start did not reflect a lack of interested students but the effects of its quick launch. With little time to market and develop their programs, the colleges had little time to recruit students and get them moving through the curriculum.
Region D is one of five regional consortia organized to implement and run the training programs. By the end of June 2011, only 700 students had completed training at the consortia's 20 member colleges.
The region is responsible for training 3,300 of the total 10,500 students by April 2012. This seems like a large gap to overcome, but enrollment in the region rose dramatically through the spring. By June nearly 3,000 students had signed up for the programs. Region D now expects to have 2,450 students complete the program by November, according to Kay Gooding, MPH, MAEd, RHIA, region D consortia project director, based at Pitt Community College in Greenville, NC.
Nearly all regions hope to meet ONC's target by next April. Some schools offer a new round of classes every month, hoping to entice more students who are just learning about the program.
"Our numbers are growing in enrollment, but we want students to complete," Gooding says. "We are just going to have to be patient to get them to that point, as this is a six-month commitment for each student."
Low attrition rates are encouraging, indicating that students who sign up for the programs are likely to complete them. In region C, the attrition rate is below 14 percent.
Start Up Challenges
ONC did not give the colleges much time to develop their programs. The office awarded cooperative agreements to the five regional consortia in April 2010.
An initial challenge came with finding enough educators to teach the classes.
Some in-house college faculty were hesitant to teach a noncredit course, and finding adjunct associate educators meant colleges were competing with other industries to recruit individuals with a highly in-demand health IT skill set. Despite challenges, however, the consortium regions were able to secure enough educators for the program.
Securing the curriculum was a second challenge. Curriculum content was developed by universities under a separate federal program and delivered to the consortia as completed. But most colleges started their training programs without the full curriculum in hand, presenting challenges to educators trying to develop their teaching material. Educators launched classes with the first half of the program and then integrated the second half as they went.
"The whole program's time frames are compressed, so we gave the curriculum developers less time than they normally have to develop it. We gave the community colleges less time to get that curriculum and implement it," says Mat Kendall, MPH, director of the office for provider adoption support at ONC. "And just that it is a new program, we are starting off and getting things out there, those have been some of the challenges."
This compressed development led at times to a bumpy educational experience, says Lillo, who was part of the first class of consortia students. Materials were delivered to students in different formats, and at one point educators didn't receive their teaching materials until the day they were going to present it.
"There were some tight timelines," Lillo says. "But, there was enough for us to chew on to keep us going, so we were never nonproductive."
Lillo's track required nearly 20 hours of work a week, he says, and he learned everything from the history of modern US healthcare to aspects of clinical decision support and evidence-based medicine to details of the HITECH Act and the meaningful use EHR program.
Students Taking Longer Than Six Months
While the programs are designed to be completed in six months, many students are taking longer to get through them. The reason in most cases is that the students have current jobs.
"People are using this as an opportunity in their existing jobs to move up the job hierarchy," Kendall says.
This is certainly reflected in region D. "About three-fourths of our students … already have jobs, so in trying to work that along with family and other commitments, it has often taken longer than six months," Gooding says. "So we have tried to adapt our programs in order to accommodate them."
The delay has contributed to the lower-than-expected graduation numbers in the first year of the program.
Colleges are encouraging students to stick to the six-month completion time frame if possible, some tying tuition reimbursement to on-time completion. This requirement harkens back to the program's original intent, which was to get people trained quickly and out into the workforce to both stimulate the economy and speed up health IT adoption, says Norma Morganti, executive director of region C, the 17-school Midwest Community College Health Information Technology Consortium based in Cleveland, OH.
"The community college consortium has a lot of heavy lifting right now," Morganti says. "We all signed up for it because we all know how critically important it is, but it's not just producing the graduates. It is also engaging stakeholders and understanding how our training programs are developing to meet their needs, getting them to the table. And then letting students know that going through these training programs is going to result in meaningful employment."
Handling those diverse duties while developing educational programs has been a unique challenge for consortia colleges, and though it led to a slow start, ONC and consortia directors expect the program to have a smoother second year.
"I feel like every month the program is getting stronger and stronger," Kendall says.
Colleges are increasing pre-assessment of students before accepting them into the program, which should lower the attrition rate even further by ensuring that only qualified students are accepted.
After all, the program is not meant for people just starting out in healthcare or IT. Program requirements-which vary by school but can include the need for several years of experience in IT or healthcare- are necessary because consortia training is intended to further expertise by expanding students' medical or IT knowledge, not develop it from scratch.
"This was never intended to be an entry-level training program," Gooding says.
Students with Experience
Graduates of the program are not fresh-faced students. Many are mid-career professionals with more than 20 years of experience in the IT or healthcare field, Morganti says.
While more students have been coming from the healthcare industry, a "substantial number" are also coming from IT, Mohla says. The average age of the student is 44, and many are taking the classes online.
"Some people are already in the field who want to get some skills that let them be more useful, so moving up the career ladder, using this program as a way of getting a job with more responsibility," Kendall says.
In region C during the first year, 52 percent of students had a master's or bachelor's degree, and 58 percent had more than 21 years of experience in healthcare or IT.
Consortia graduate Julie Simmons, RN, was working as a clinical documentation improvement specialist in a Texas hospital when she entered the program's clinical/practitioner consultant education track. The 53-year-old sought the training necessary to become a nurse practitioner who worked directly with telemedicine systems.
During class, she learned about the need for project managers and other specialists to help facilities implement a federal health IT initiative-the EHR meaningful use program. When a position for a meaningful use project manager opened up at a hospital in Louisiana, Simmons applied for the job.
During the interview, she discussed her background as a nurse, CDI specialist, and her other project management and quality experience. But what impressed Simmons' interviewer most was her knowledge of EHRs and the meaningful use program itself, information she obtained entirely from the consortia educational program.
"Out of 10 applicants I was the only one who had the knowledge base of what meaningful use was and understood what electronic health records were," Simmons says. "She said, 'I can work with you on the IT part of it, I need someone who has clinical knowledge and knows the stages of meaningful use in order for us to get started.'"
Simmons got the job and started while finishing up her consortia training program.
"I was really excited to accept this position because I think it is going to be such a door-opener to other opportunities later on," Simmons says.
AHIMA members are ideal candidates for the consortia training programs, ONC's Kendall says, and many HIM professionals are joining classes. For example, top certifications held by region C students include the CCA, RHIT, and RHIA.
Gooding believes more HIM professionals should take advantage of the program, especially now, when federal funding is flowing. "We are one of the few academically prepared professions to give us the edge in the electronic health record field," she says. These are not the HIM jobs of the future, but the present, she says.
Many programs throughout the country offer online and distance education options.
Landing Health IT Jobs
Solid data on the number of students either being promoted or landing new jobs as the result of consortia training are not yet available, though ONC is compiling that information. Preliminary data show that some graduates are getting jobs, typically in hospital systems as health IT consultants, implementation specialists, or workflow redesign consultants. EHR vendors and the regional extension centers (RECs) are also hiring graduates, Mohla says.
Consortia regions must actively work with the healthcare industry to promote and identify jobs for graduates. Some regions have held job fairs or partnered with employers to recommend potential employees.
When the consortia program was created, the RECs were considered a key employer. But many RECs launched in mid-2010 to help providers implement EHRs, well before the first consortia graduates hit the market in spring 2011. Industry experts wondered if the RECs would have any jobs left by the time consortia students were ready for work.
But the RECs are still recruiting workers, Mohla says. The RECs continue to grow, and they have moved from a focus on enrolling participants to actually helping them implement health IT, which requires more implementation specialists.
Frank Lillo began his part-time job as an EHR consultant at the South Florida Regional Extension Center in June. He'll be conducting EHR needs assessments for providers, a role he feels will lead to a healthy career in health IT implementation. Ultimately he'd like to work full time implementing EHR systems, but "this is a great step in the right direction," he says.
Even in areas where the RECs are fully staffed, they have served as a bridge between health IT employers and consortia colleges, enabling introductions and passing along job prospects, Morganti says.
Demonstrating the Value to Employers
But not everyone has had success following the program. Getting the word out that consortium graduates have the skills to aid providers with health IT issues has been challenging.
A complaint from some consortia graduates is that many providers and other employers have not heard about the program and do not understand the value of the training.
Part of an online networking group of former consortia students, Lillo has spoken to frustrated students who feel their training is not being recognized in the healthcare industry.
"A common trend [people discuss] is that it seems like the medical community is not even aware of this program," Lillo says. "For those who are looking for jobs, employers are saying, 'What HITECH program? What training?'
"The powers that be at the government level need to do a good PR campaign aimed at the provider community to let them know that they are cranking out these highly trained students," he says.
Additionally, ONC should make clear that graduates are not novices, but that they have a background in healthcare or IT that has been honed specifically for health IT work, Lillo notes.
ONC funded development of a competency exam that helps students (and others) demonstrate to employers they have the skills necessary to implement EHRs. The HIT Pro exams, launched in May, were initially offered free of charge. Colleges are working to better promote the exams to students, as well as communicate to employers the competencies that HIT Pro exams test. (For more on the exams, see "Standardized Testing" article.)
Through this year, ONC and the consortia will be promoting the program and recruiting students. With the curriculum now fully developed, ONC will reach out to additional community colleges interested in adopting the program.
ONC is actively partnering with regional extension centers, other federal health IT program participants including Beacon Community members, and state-level health information exchanges to promote both the consortia education program and its graduates.
"The RECs, for instance, right now have recruited over 81,000 providers across the country to participate in their program. Letting those participants know that there are community colleges out there that either (a) you can send staff to get the training they need for the job, or (b) look to hire those people coming out of the program with those skills," Kendall says. "I think that is an important network that we are going to be leveraging more and more as we get going."
Sustaining the Programs
Federal funding for the consortia will end in April 2012, but ONC wants colleges to continue their programs.
"What we are trying to do here is set up things that will live beyond the ONC funding," Kendall says. "We see our dollars more as start-up dollars, getting these community colleges the initial capital they need to get the programs going. But the real test of this is how they can sustain into the future."
ONC has offered a no-cost extension for up to 12 months to colleges wishing to continue in the consortia.
Many of the colleges have discussed continuing the training programs beyond April 2012, even sharing resources and curriculum updates.
"For employers, we want them to know that this is not a short- time, two-year deal for us," Morganti says. "This is building a workforce in region C, and we are going to continue to do that."
Chris Dimick (email@example.com) is staff writer at the Journal of AHIMA.
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Journal of AHIMA