1. EU-US eHealth/Health IT Cooperation Initiative Workforce Development Work Group Creating New Pathways in HIT Workforce Development 0 DRAFT

2. BACKGROUND AND INTRODUCTION EU-US eHealth/Health IT Cooperation Initiative Workforce Development Work Group 1

3. HIT Workforce Development Background: EU-US eHealth Collaboration Initiative Memorandum of Understanding (DRAFT) It started with a Memorandum of Understanding In December 2010, the European Commission and the US Department of Health and Human Services signed a Memorandum of Understanding (MOU) to: – Help facilitate more effective uses of eHealth/Health IT; – Strengthen their international relationship; and – Support global cooperation in the area of health related information and communication technologies 2

4. Genesis of the EU-US eHealth Collaborative Initiative (DRAFT) In June 2013, an key stakeholders and interested parties were invited to participate in the EU-US eHealth Collaborative Initiative In August 2013, two work groups were launched, from the two initiative work streams of Interoperability and Workforce Development 3

5. 4 Workforce Development Community (DRAFT) Work Group Members represent 13 countries Canada England Finland France Germany Greece Ireland Israel Italy Mexico Norway Scotland United States

6. EU-US eHealth Collaborative Initiative Vision (DRAFT) The vision and roadmap set the framework for progress Vision – “To support an innovative collaborative community of public- and private-sector entities working toward the shared objective of developing, deploying, and using eHealth science and technology to empower individuals, support care, improve clinical outcomes, enhance patient safety and improve the health of populations.” 5

7. Workforce Development Vision (DRAFT) The Workforce Development work group aims to develop a skilled Health IT workforce in the EU and US Goal of the Workforce Development Work Group: – “To achieve a robust supply of health professionals highly proficient in the use of health IT, assuring healthcare, public health and allied professional work forces have the technology skills needed to enhance their professional experience and performance with eHealth/Health IT” 6

8. ROADMAP AND TIMELINE EU-US eHealth/Health IT Cooperation Initiative Workforce Development Work Group 7

9. Workforce Development Roadmap (DRAFT) Roadmap – From the Memorandum of Understanding, a roadmap was created to help guide the work of the Workforce Development Work Group The Roadmap contains these major tasks: – Identify Project Champions – Complete analysis of competencies required by the diverse healthcare and eHealth/IT workforce – Identify and map curricula that addresses the competencies identified in the US and EU – Explore new models of education/employer collaboration – Pilot innovative ways to develop a healthcare IT workforce These tasks were broken down into the following key milestones: 8

10. 9 Assessment of the scope, scale and characteristics of the healthcare workforce in the US and EU, and assessment of healthcare settings Categorize Health Care Settings into domains, and map to HIT-related roles in the EU and US Collect Competencies from various EU and US Sources to evaluate and map to roles; launch interactive competencies tool (HIT COMP) Define HIT Competencies for domains, assign levels, and integrate Bloom’s Taxonomy (completed for Direct Patient Care – Clinical bucket) Identify and map learning resources that promote competencies identified in the US and EU; develop white paper Create a needs analysis that looks at what current formal and informal curricula and training exist, identify the gaps, and develop solutions to bridge the gap Define and agree upon common eHealth standards of competence and professionalism Ongoing Completed Ongoing Completed November 2014 March 2015 Ongoing Roadmap Milestones (DRAFT)

11. Workforce Development Proposed Project Timeline (all dates are tentative) (DRAFT) Kick-off eHealth Cooperation Initiative (6/20) September May 10 June 2013 Launch of Workforce Developme nt Sub Workgroup (8/20) January 2014 Group reached agreement on Health IT Setting (9/12) Group reached agreement on Classification Schema for Competencies and Roles (11/12) Finalized mapping Roles to Classification Scheme Setting (01/02) March Finalized applying Classifications to Competencies; defined domains, levels and buckets (03/31) Finalized first Role to Competency Mapping (4/24) Presented work at eHealth Week in Athens (5/14) Finalized all Direct Patient Care Domain mapping (7/10) Finalize second domain Competency Mapping (Administration) (11/30) Present at eHealth Week in Boston (Oct 21-22); Begin to Draft White Paper for Peer Review and potential publication on Methodology and Process (10/30) Develop solutions to bridge gaps; create interactive tools; devise pilot(s) (3/5 onward) Develop Marketing Materials; Launch online interactive competency tools (HIT COMP); Communicate Progress to Stakeholders (9/4) Begin Curriculum to Competency Gap Analysis and Mapping (8/6) November July 2014 September January 2015March 2015October August Finalize work on curriculum needs/gap analysis (1/29) Key: Completed In Progress Future

12. BRIDGING HIT GAPS EU-US eHealth/Health IT Cooperation Initiative Workforce Development Work Group 11

13. Bridging the Gaps Between Healthcare IT and Health Information Management (DRAFT) The EU-US Workforce Development Workgroup, in Creating New Pathways in Health Information Technology, is helping to bridge the gaps between traditional healthcare roles, information technology roles and healthcare information management roles, as well as building bridges between previously disconnected HIT skills and roles 12

14. One of the ways in which the WDW does this is by mapping areas where information technology “touches” traditional healthcare roles (in addition to mapping roles and skills usually associated with healthcare IT, such as HIM, clinical informatics, administration, etc.) These HIT competencies supplement the core skills in many areas of healthcare delivery not commonly associated with information technology Examples: 13 Bridging the Gaps Between Healthcare IT and Health Information Management (cont’d) (DRAFT) Nurse Core Skills: Patient Care Clinical Interventions Care Protocols Medication Delivery Triaging Vital Sign Assessments Wound Care … Nurse HIT Skills: Clinical Decision Support Orders Management Electronic Documentation Bar Code Administration Medication Reconciliation … Pharmacist Core Skills: Drug Compounding Drug Distribution Intravenous Preparations Prescription Processing Prescription Packaging … Pharmacist HIT Skills: Order Processing and Management Clinical Decision Support Build Electronic Distribution Systems Management Medication Systems Implementation …

15. MAPPING A COMPETENCY FRAMEWORK EU-US eHealth/Health IT Cooperation Initiative Workforce Development Work Group 14

16. The Skills Mapping Forms a Competency Framework (DRAFT) A competency framework is based on skill sets used as building blocks. It could be shown in a progression such as this… However, a competency level needs to be able to accommodate a variety of roles and job types

17. Competency Framework Progress to Date (DRAFT) To date, we have accomplished the following tasks and subtasks in the mapping of skill areas: – Developed classification schema for HIT areas, roles, competencies and levels – Classified over 3000 competencies, with comprehensive mapping across 14 silos – Categorized healthcare roles into domains, levels and buckets – Created proof of concept competency mapping, including developing competencies, assigning levels, codifying and integrating Bloom’s taxonomy for over 250 Direct Patient Care – Clinical competencies – Begun an HIT curriculum requirement and gap analysis, identifying and mapping both formal and informal educational resources and needs – Created an interactive tool (HIT COMP) that can be used to search, aggregate and filter roles and competencies based on a variety of categories and levels 16

18. CURRENT WORK STREAMS EU-US eHealth/Health IT Cooperation Initiative Workforce Development Work Group 17

19. Current Work Streams: Classification (DRAFT) Classification Schema: Settings, Roles, Silos, Domains, Subdomains/Buckets, Levels, Quadrants and Competency Areas – Settings: First we looked at settings for health care. Our task was to select one as our starting point in order to begin outlining the appropriate skills sets needed to perform the desired tasks in that setting – We looked at the following list of health care settings: 18 Long-term care Ambulatory care Rehabilitation center Pharmacy Acute Care Clinics (Flu, HIV, etc.) Health record banks Diagnostics facilities (e.g. facility that only performs MRIs) Public health agencies Patient Centered Medical Home Mobile Medical Care (healthcare delivered via vehicle transport) Personal Health Care Home Health Care Consumer Health – engaging the consumers Primary Care

20. Finally, we decided upon Acute Care, In order to manage the immense task of assigning competencies to roles and domains, the acute care setting was chosen due to the relative consistency and commonalities in hospital settings between the US and EU Acute care was defined as: “A level of health care in which a patient is treated for a brief but severe episode of illness, for conditions that are the result of disease or trauma, and during recovery from surgery. Acute care is generally provided in a hospital by a variety of clinical personnel using technical equipment, pharmaceuticals, and medical supplies.” 19 Current Work Streams: Classification (cont’d) (DRAFT)

21. Classification Schema: Roles – Roles: Next, we mapped a variety of roles in acute care, across the European Union and the United States. 20 Current Work Streams: Classification (cont’d) (DRAFT)

22. Classification Schema: Roles We first took a look at all roles in Acute Care, and began to narrow down the focus to the most common roles in this setting in the US and EU. 21 Current Work Streams: Classification (cont’d) (DRAFT) Direct Patient Care - Clinical

23. Current Work Streams: Classification (cont’d) (DRAFT) Classification Schema: Silos – Silos: We collated over 3000 competencies from 13 derivative areas for competencies and curricula, including AHIMA-AMIA, IMIA, US Department of Labor, National Health Service UK (NHS-UK), Cuyahoga Community College, Texas HIT, HIMSS worldwide, and the European e-Competency Framework and others*. 22 AHIMA/AMIA IMIA DOL NHS-UK Additional UK Resources/Scottish Government American Academy of Nurses Cuyahoga CC America’s Job Bank Texas HIT HealthIT.gov European e- Competence Framework NOS-UK HIMSS worldwide Created Competencies *Disclaimer: "Our final competencies have their basis in the Silo/Origin, but in many cases do not reflect the actual or original language due to our community development and consensus process."

24. From each silo, hundreds of competencies were categorized into domains and divisions, and assigned a preliminary level. We chose the Direct Patient Care domain, clinical division, as our first set of competencies to review. 23 Current Work Streams: Classification (cont’d) (DRAFT)

25. After several months of careful examination, reworking and revision, in some cases, the competencies were finalized after subject matter expert review and group consensus 24 AHIMA/AMIA Differentiate data versus information Describe the differences between health data and health information (EB01) Identify classification and systematic health- related terminologies for coding and information retrieval. Understand terminologies used in electronic health records and health information technology pertinent to your role (EB02) Current Work Streams: Classification (cont’d) (DRAFT)

26. Classification Schema: Domains – Domains: We developed 5 domains of HIT settings, including Direct Patient Care, Administration/Finance/Law/ Management, Engineering/Information Systems, Informatics and Research. – Our first domain tackled was Direct Patient Care 25 HIT Domains Direct Patient Care Admin/ Finance/ Law/Mgmt Engineering / Info Sys Health Informatics Research Current Work Streams: Classification (cont’d) (DRAFT)

27. Classification Schema: Subdomains/Buckets – Buckets: We then broke the domains down, dividing them into divisions of clinical and non-clinical, and subdomains such as Professional/Operational/Managerial, revenue/compliance, etc. 26 Clinical/ Non-Clinical Clinical/ Non-Clinical Professional/ Operational/ Management HIT Domains Direct Patient Care Admin/ Finance/ Law/Mgmt Engineering / Info Sys Health Informatics Research Current Work Streams: Classification (cont’d) (DRAFT)

28. Classification Schema: Levels – Levels: We classified the competencies into five levels: Baseline (the baseline set of skills for all healthcare workers), Basic, Intermediate, Advanced and Expert. To assist us in this effort, we incorporated Bloom’s taxonomy to help determine the appropriate level for a competency. 27 Competency Levels BaselineBasicIntermediateAdvancedExpert Current Work Streams: Classification (cont’d) (DRAFT)

29. Interoperability is the backbone of Health IT – it ensures interoperability of our work when we use existing standards Bloom's Taxonomy of Educational Objectives provides standard classifications for the many nebulous terms often encountered in competency/curriculum development and evaluation The interoperability of this process can be leveraged when mapping competencies and curriculum (using the Blooms Taxonomy), or when consolidating this work with similar initiatives, etc. Bloom’s Taxonomy Wheel Current Work Streams: Classification (cont’d) (DRAFT)

30. 29 Classification Schema: Levels – After deciding the competency levels, we applied Bloom’s taxonomy to the competencies, with each level corresponding to a Bloom’s level Synthesizing Evaluating Analyzing Applying Understanding Knowing ExpertAdvancedIntermediateBasicBaseline Bloom’s Taxonomy Competency Level Current Work Streams: Classification (cont’d) (DRAFT)

31. Classification Schema: Competency Quadrants – Competency Quadrants: So the competencies can be more effectively aligned with other internal and external workforce development initiatives, we grouped them into four major areas of interactions, called Quadrants. These quadrants correspond to major areas of information technology related activities specific to health care. Each quadrant contains five key competency categories, described next. 30 Health Data Access to Information Data Compiling, Analysis and Reporting General HIT Knowledge Policies and Procedures Privacy and Security Clinical Clinical Decision Support Clinical Practice and Workflows Documentation Process Medications and Allergies Order Entry Patient Care Coordination Patient Access and Engagement Population Mgmt/Public Health Protected Health Information/Pati ent ID Quality and Safety Communications Coding and Terminologies Communications and Change Mgmt eHealth/mHealth /Telehealth Issue Management HIE/Interoperabil ity/Interfaces Current Work Streams: Classification (cont’d) (DRAFT)

32. Classification Schema: Competency Categories – Competency Categories: Finally, we placed five related competency areas in each of the four quadrants, resulting in 20 categories – These categories can be further aligned to our and other initiatives’ eCompetence Proficiencies, such as “Can correctly access information”, “Follows security procedures”, etc., and followed or built upon through skill levels 31 Current Work Streams: Classification (cont’d) (DRAFT)

33. Understand that implementation of new systems may require change to business processes or service redesign to maximize achievement of benefit Bringing it All Together: Tools (DRAFT) 32 We have taken thousands of HIT competencies, hundreds of HIT roles, and many HIT areas and domains, and aggregated, catalogued and synthesized them into useful mappings and tools Promote the need for good governance processes to ensure systems developed or procured are able to provide the functionality required to deliver the greatest benefits to the patient, end user and the organization REWORDED COMPETENCY: Promote positive change management techniques and good governance process in clinical workflows

34. Creating the Framework for Interactive Tools and Pilots (DRAFT) 33 Codes: AB01, AB02… EU Role Names: bereavement counsellor (UK), chargé decompagnement (FR), Trauerbegleiter (DE), consejero de duelo (ES), consigliere lutto (IT) Role Description: A bereavement counselor or coordinator monitors and manages the bereavement services for people dealing with terminal illness or death. They act as the main manager of the volunteers, medical staff, and others who are working with the bereaved. These professionals can work in a variety of settings including hospice, nursing homes, hospitals, and home health. Job duties for this position include offering counseling, assessing needs, and explaining the services available to the bereaved. Additional job duties include organizing and scheduling support groups, creating bereavement materials, documenting bereavement services given to clients, and training new staff.counseling Competencies: Be familiar with the concepts of primary and secondary health data Locate and retrieve information in the electronic health record, according to your job role Codes: AB01, AB02… EU Role Names: medical orderly/ward assistant (UK), aide-soignant(e) (FR), Krankenwärter(in) (DE), camillera del hospital (ES), attendente (IT) Role Description: Orderlies are often utilized in various hospital departments. Orderly duties can range in scope depending on the area of the health care facility they are employed. For that reason, duties can range from assisting in the physical restraint of combative patients, assisting physicians with the application of casts, transporting patients, shaving patients and providing other similar routine personal care Competencies: Be familiar with the concepts of primary and secondary health data Locate and retrieve information in the electronic health record, according to your job role Codes: AB01, AB02… EU Role Names:* nurse aide (UK), soigne l'aide (FR), Krankenpflegehelfer(in) (DE), cuida al asistente (ES), infermieri aiutante (IT) Role Description: Nurses' aides (NAs) work under the supervision of nurses or physicians to address the most fundamental elements of a patient’s care. They feed, dress, bathe and groom patients, contributing enormously to their sense of normalcy and well-being. NAs are sometimes given more medically-oriented duties such as measuring and recording temperature, blood pressure, and other vital signs. Nurses' aides also assist with the administrative duties and record-keeping that accompany patient care. Competencies: Be familiar with the concepts of primary and secondary health data Locate and retrieve information in the electronic health record, according to your job role *We are incorporating different naming conventions, and also different role definitions, for various EU member countries, so there is not just one definition for all of EU

35. HIT COMP: Tools: Presenting The HIT COMP: Our HIT Competency Tool 34 HITComp: An Interactive Tool for Discovering “Health IT eSkills” in the United States and European Union The EU-US Workforce Development Workgroup’s Health Comp e-mapping tool is a searchable database that workforce developers, staffing experts and interested parties in healthcare and the healthcare information technology can use to compile information on skills and competencies needed for a variety of healthcare roles, levels and areas of knowledge. You can sort over 250 competencies in the Direct Patient Care – Clinical sector by level, quadrant (health data, clinical, communications or patient interactions), or 20 areas of competency. Competencies e-Mapping Tool:

36. HIT COMP: Tools: Presenting The HIT COMP: Our HIT Competency Tool 35 HITComp: An Interactive Tool for Discovering “Health IT eSkills” in the United States and European Union Roles e-Mapping Tool (includes roles in five EU languages):

37. PLANNING FOR THE FUTURE EU-US eHealth/Health IT Cooperation Initiative Workforce Development Work Group 36

38. Supporting Concurrent Initiatives (DRAFT) In addition to developing a framework and tools for HIT workforce development, our work also aims to enhance and support other parallel and complementary initiatives, including: – AHIMA - Global Health Workforce Council – AHIMA’s Career Tool – European e-Competence Framework – CAMEI – Technology Informatics Guiding Education Reform (TIGER Summit) – TransAtlantic Business Council – "NEW SKILLS AND NEW JOBS IN THE HEALTH CARE AND SOCIAL WORK SECTOR “: a project developed by 13 partners of 5 Member States in response to a European Tender of the 2009 Progress Program – Others 37

39. Next Steps (DRAFT) Communicate Progress to Stakeholders and Leadership Draft White Paper for Peer Review and potential publication on Methodology and Process Continue work on Formal and Informal Curriculum Mapping Present at eHealth Week in Boston (Oct 21-22) Finalize second domain Competency Mapping (Administration/Finance/Legal/Management) 38

40. ABOUT US… EU-US eHealth/Health IT Cooperation Initiative Workforce Development Work Group 39

41. Workforce Development Project Support Team (DRAFT) 40 US Point of Contacts – Mera Choi, Mera.Choi@hhs.govMera.Choi@hhs.gov – Jamie Parker, jamie.parker@esacinc.comjamie.parker@esacinc.com – Gayathri Jayawardena, gayathri.jayawardena@esacinc.comgayathri.jayawardena@esacinc.com – Christina Nguyen, christina.nguyen@esacinc.comchristina.nguyen@esacinc.com – Amanda Merrill, amanda.merrill@accenturefederal.comamanda.merrill@accenturefederal.com – John Feikema, John.Feikema@hhs.govJohn.Feikema@hhs.gov EU Point of Contacts – Mary Cleary, mary@ics.ie mary@ics.ie – Benoit Abeloos, Benoit.ABELOOS@ec.europa.eu Benoit.ABELOOS@ec.europa.eu – Frank Cunningham, frank.cunningham@ec.europa.eufrank.cunningham@ec.europa.eu US/EU Point of Contact – Rachelle Blake, shelblake@omnimicro.com shelblake@omnimicro.com

42. Initiative Resources (DRAFT) EU-US Wiki Homepage – http://wiki.siframework.org/EU- US+eHealth+Cooperation+Initiative http://wiki.siframework.org/EU- US+eHealth+Cooperation+Initiative Join the Initiative – http://wiki.siframework.org/EU- US+MOU+Roadmap+Project+Sign+Up http://wiki.siframework.org/EU- US+MOU+Roadmap+Project+Sign+Up EU-US Initiative Reference Materials – http://wiki.siframework.org/EU- US+MOU+Roadmap+Project+Reference+Materials http://wiki.siframework.org/EU- US+MOU+Roadmap+Project+Reference+Materials Workforce Development Homepage – http://wiki.siframework.org/Workforce+Development+Work+Gr oup http://wiki.siframework.org/Workforce+Development+Work+Gr oup Workforce Development HITCOMP Tool – http://hitcomp.siframework.org/ http://hitcomp.siframework.org/ 41