2013 VA Health Informatics Workforce Assessment Summary of Findings and Action Plans Presentation to the Certification/Adoption Workgroup HIT Workforce Subgroup Margaret “Molly” Manion, MSN, RN-BC, CPHIMS Health Informatics Initiative (hi2) Office of Informatics and Analytics (OIA) Veterans Health Administration (VHA) Department of Veterans Affairs (VA) March 28, 2014

Introduction In 2010, the Department of Veterans Affairs (VA) launched major initiative “Transforming Healthcare Delivery through Health Informatics (hi2). The goal is to build capacity, tools, and a sustainable collaborative approach to deliver informatics solutions to transform health care from a medical model to a patient-centered model of care delivery. A workforce that is knowledgeable and skilled in informatics tools and methods is fundamental to this transformation.

Purpose of the Assessment To assess the readiness of the Health Informatics (HI) workforce to support its transformational goals. August 2011: baseline study conducted as part of the Department of Veterans Affairs (VA)’s Health Informatics Initiative (hi2) to better understand the composition and needs of the HI community. Results aided in strategic planning for workforce development needs. May 2013: A repeat assessment to evaluate the impact of actions taken to address 2011 findings, as well as aid in further competency, career, and community development planning.

Contributors to the Study VA Office of Informatics and Analytics, Health Informatics Diane Bedecarré Dr. Katherine Gianola Margaret “Molly” Manion Elizabeth Chapman Barbara Andrzejewski   VA Office of Quality, Safety and Value Jennifer Ford Ferenc Ayer Lauren Tovrea Melanie De Grano Susan Hanzik Kaitlyn O’Malley VA Office of Informatics and Analytics, Analytics and Business Intelligence Dr. Stephan D. Fihn Ron Freyberg

Demographics 1,085 respondents Participants reported their Primary and Secondary Healthcare Career Affiliations such as: Nurse, Physician Pharmacy Informatics, Clinical Application Coordinator, etc. 68% full time or near full time in performing HI functions 58% have been practicing in an HI Role for more than 5 years One third expect to leave HI practice in the next 5 years Key Points: Many practicing in HI roles are not full time or have multiple roles- therefore have more than one healthcare career affiliation

Percentage of Time Performing HI Role Functions Key point(s): The top 3 role functions are Data Collection & Analysis, Coordination, Subject Matter Expert (SME)

Certifications in HI Key Point(s): The top 2 certifications held are RHIA, Informatics Nurse, and RHIT. Most respondents do not have certifications or credentials in HI.

Advanced Degrees and Certificates in HI Key Point(s): Most respondents do not have University-based degrees in HI nor any University or Community College certificates in HI

Course or Programs in HI Key Point(s): 20% of respondents reported to have completed the Bellevue College (ONC Sponsored) VA HI 101 course. 730 VA staff completed the course.

Membership in Professional Organizations Key Point(s): The top 3 informatics related professional organization to which respondents belong are AMIA, HIMSS and ANIA. 62% report no membership, this is a significant increase from 2011

HI Training Needs Key Point(s): The top 5 learning needs identified were Healthcare Analytics, Project Management, Networking and HIE, Workflow Analysis and Redesign and Health Information Systems

Barriers to Completing Training Key Point(s): Lack of time (work and personal) and funds (travel and tuition) were listed a top barriers to completing training

Barriers to Career Advancement Key Point(s): Lack of time and opportunity for career advancement were significantly increased as reported barriers since 2011. Lack of knowledge about positions and education and skills needed to advance, lack of mentorship opportunity as well as lack of organizational incentives to advance were also prominently reported. The Health Informatics Specialist PDs were released only a few months before the 2013 survey

Barriers to Collaboration Key Point(s): Reported lack of personal and on-duty time to participate in collaborative activities were significantly increased in 2011 as was a lack of organizational support or approval. Uncertainly about collaborative communities and tools available was also frequently reported. ForumForUs was not launched until after the 2013 survey.

Key Findings: Since 2011, over half of the respondents report an increased understanding of HI and an increased awareness of educational opportunities within HI at VA. Respondents are less favorable when rating the change in their awareness of HI career advancement and collaboration opportunities since 2011. These two areas include the greatest opportunities for improvement.

Timeline of Interventions Since 2011

Action Plan: Competency Development Increase opportunities for VA supported certification prep courses and encourage the formation of study groups using the collaborative site “ForumForUs” Collaborate with Training Strategies to develop a training plan to further support growth and development of Health Informatics Specialists and Clinical Applications Coordinator Increase frequency of the VA AMIA 10x10 course from once to twice per year Promote the HI 101 course for a wider audience ( e.g.; Department of Defense, Clinical staff) VHA supported certification prep courses (i.e.; American Board of Preventive Medicine (ABPM) Clinical Informatics, Health Information and Management Systems Society (HIMSS) Certified Professional In Healthcare Information and Management Systems (CPHIMS), American Nurses Credentialing Center (ANCC) Informatics Nurse)

Action Plan: Competency Development (continued) Identify strategies for increasing leadership support for release time for staff to engage in HI training opportunities Increase recognition for staff who complete HI courses Explore the feasibility of tuition support for advanced degrees in HI for VA staff Develop leadership training on the value of health informatics

Action Plan: Career Development Promote memberships in professional organizations as a career-enhancing strategy Develop a qualification assessment tool for the Health Informatics Specialist position to enhance recruitment of suitable candidates Increase mentorship opportunities in HI-related career fields (e.g.; Technical Career Field, Field Health Informatics Leader group mentor program, academic partnerships) Socialize HIS Recruitment and Retention Plan with Human Resources Staff, informatics supervisors and other stakeholders Create sample job descriptions for other informatics roles Continue to promote HI careers in VA through MyCareer@VA Collaborate with industry and federal partners to define HI occupational roles

Action Plan: Community Development Expand interdisciplinary collaboration and promote an inter-professional identity for HI in VA and federal partners through membership in ForumForUs and other community development efforts Continue to advocate for face-to-face meeting and training opportunities as an effective method for developing strong networks of HI professionals across VA, while leveraging the ability of social business software like ForumForUs and learning platforms such as MyVeHU Campus, and Moodle to support these networks in the absence of travel opportunities Communicate the efforts underway in VA to develop the HI workforce through wide dissemination of this report and through contributions to publications and presentations to national HI organizations internal and external to VA.

Field Based Analytics (FBA) Program Expansion Veterans Integrated Service Network (VISN) Engagement: While the program continues to offer support to individual facilities, FBA has started engagements with a more VISN centric approach. The goal is to tailor FBA support to the individual needs of the VISN/facility. FBA will advise on infrastructure development, identify educational and training needs and match these needs to either existing products or assist with customized solutions. Expand virtual training opportunities Hold Monthly Calls to promote best practice and provide education Incorporate new items into VA All Employee Survey to provide baseline and trending data for measuring “data-driven-ness” in the organization Develop Reports and Analytics Field Training (RAFT) Portal. This new site will provide a central location for training related to data and analytics.  

Lessons Learned Required dedicated resources and high level leadership support Results take years to achieve full effectiveness Programs need ongoing support, maintenance and refresh The development and administration of a comprehensive workforce development program across the entire VA organization would only have been possible with dedicated resources and high level leadership support Many programs will take efforts that span years to achieve their full effectiveness and then require ongoing maintenance and growth to support new staff and the continuing educational requirements of existing staff

Sharing for the benefit of all organizations The initiative has benefited by learning from and sharing with organizations engaged in similar efforts as AMIA, AHIMA, HIMSS and the Office of the National Coordinator Initiative team members are contributing to the larger conversation about how to define health informatics occupations such as those being led by the Office of the National Coordinator, Office of Personnel Management, AMIA, AHIMA and industry partners VA will continue to contribute to the education and development of informaticists through fellowships, residencies and internships and other training programs

For More Information For more information contact: margaret.manion@va.gov

Q&A Thank you! Are there any questions?