Volume 2 - Issue 1 - February 2007
Industry Spotlight: MEDITECH Customers Experience First-Hand the Laws of Supply and Demand
By: Donna Carroll, VP, Business Development & Recruitment - Systems Personnel
As a professional search consultant in the Health Care Information Systems (HCIS) field, I converse with hospital Directors of Information Technology and CIOs on a daily basis. They may come from different sized facilities and from various locations across the U.S., but they all have the same question on their mind: What can we do to attract qualified MEDITECH candidates to our facility?
MEDITECH is currently the number one healthcare vendor in the United States (with roughly 25% of the market share) and continues to grow nationally. While MEDITECH sales may be better than ever, those hospitals installing or currently using their systems are struggling to keep up with staffing demands.
Why the Shortage?
If more hospitals are using MEDITECH systems, one might argue that there should be more skilled MEDITECH professionals available in the marketplace. So, what’s to blame for the shortage of skilled MEDITECH professionals? There are several reasons:
- Patient safety initiatives
- U.S. Nursing shortage
- Remote or rural location
- High cost-of-living
- Thriving employment market
Patient Safety Initiatives
Rapidly increasing numbers of healthcare providers are engaging in patient safety initiatives. Most patient safety initiatives today would not be possible without the implementation of advanced clinical applications for use by clinical staff (nurses, physicians, allied health professionals). Advanced clinical applications can help to streamline nurse workloads and incorporate clinical decision support tools that ensure safety, creating a quality environment for patients.
As a result of advanced clinical application implementations, the need for qualified MEDITECH professionals is growing as healthcare providers recognize the need for candidates with the specific software knowledge as well as a clinical background. We all know the critical role Nurses perform in the delivery of quality care to patients. But, it’s equally important to understand the role that a Nursing Systems Analyst can play as a team member in patient safety initiatives.
Let’s consider the typical profile of a Nursing Systems Analyst (also referred to as Clinical Systems Analyst, Nursing or Clinical Informatics Specialist). In general terms, a Nursing Systems Analyst is responsible for performing workflow analysis, implementation, application building, user training and support, and maintenance of clinical software applications for a healthcare provider (hospital, medical practice, or clinic). Typically, the Nursing Systems Analyst will have a Nursing background themselves and will have begun their MEDITECH experience as a ‘Super-User’ from one of the Nursing departments.
An estimated 80% of Nursing Systems Analyst positions require a Nursing background. Many hiring managers believe that only someone with first-hand experience in the delivery of patient care is able to fully understand the role of the Nurse and the clinical workflows involved. In addition, having a Nursing background enables the Nursing Systems Analyst to establish immediate credibility with their user community.
U.S. Nursing Shortage
As healthcare organizations contend with clinical staff shortages, nurses are expected to treat an increasing number of patients more efficiently, all while maintaining the highest safety standards. These increasing demands upon their time make it very difficult to participate in projects beyond their primary responsibility of patient care.
Most organizations agree that direct input from the Nursing staff during an application design and build process is critical to the success of clinical application projects. So, the Nursing shortage can be a real problem for the IT Department as well.
The Nursing shortage in the U.S. also has a major impact on how Nurses are recruited and compensated. Hospitals across the country are having to become more creative in their recruitment efforts for nurses. Some of these strategies include offering substantial sign-on bonuses, sponsoring internships with local colleges, offering unique educational opportunities, and paying retention bonuses over a period of time.
The IT Department seeking qualified Nursing professionals with MEDITECH experience can learn something from the Nurse recruitment strategies employed by many hospitals today. They should try partnering with their Nursing and/or Human Resource departments to co-sponsor some of the internships and educational programs offered. They could co-employ some candidates who might like to work 50% of their time as a Systems Analyst and the other 50% as a Nurse. They could offer retention bonuses which are paid out at a certain percentage upon completion of 6 months, 1 year, 18 months, and 2 years. They could create a trainee program which rotates clinical professionals through the IT department for 6 months at a time. There are many ways to attract and retain qualified candidates, if you just get a little creative.
The Rural Hospital Conundrum
Rural hospitals are at a particular disadvantage because, in many cases, they are the only hospital within their county or even a 100-mile radius. When seeking very specific skills, such as MEDITECH, the rural hospital often has no choice but to recruit from outside the area and to relocate individuals. Rural hospitals report that filling vacancies can take up to 60% longer than in urban hospitals. There can be several reasons for this difficulty:
- Wages are often less than in urban facilities
- There may be limited opportunities for advancement within the facility
- Candidates relocating from an urban area will experience a lifestyle change in everything from community values to shopping and entertainment
- Less or limited opportunities for spousal employment
However, it should be pointed out that rural hospitals also have a lot to offer employees which cannot be found at larger, urban facilities. The important point is that everyone involved in staffing at these facilities needs to know their selling points, be able to articulate them to candidates early and often during the interview process, provide information and resources about the community, and make candidates feel welcome.
Bigger Isn’t Always Better
The difficulty in finding and hiring qualified MEDITECH professionals, however, is not isolated to smaller, rural hospitals. Even many larger, urban facilities experience some difficulty, but for different reasons:
- Higher cost-of-living and tight housing market
- Reluctance of candidates to move to inner city locations, and reluctance to commute very far from the suburbs
- More competition for candidates due to other facilities in the immediate area
- Higher compensation requirements of candidates
- Higher turnover rate due to employees moving to competing facilities
Again, there are also a lot of advantages to working in these environments and it should be the responsibility of everyone involved in the hiring process to emphasize these advantages to candidates whenever possible.
Thriving Employment Market
There is no doubt about it: the employment market in the U.S. today is strong. The healthcare industry ranks the highest in their demand for qualified staff. When you combine this ever-increasing demand with the need for a highly specialized skill, such as MEDITECH, there’s no wonder hospitals are experiencing staffing difficulties.
With a shortage of Nurses, an increasing demand for MEDITECH knowledge, and plenty of positions available, the MEDITECH professional can really choose their own opportunity. If someone is more money-motivated, they may choose to be a Consultant where their earnings potential is significantly higher than that of their in-house counterparts.
With a number of other opportunities available, you always run the risk of losing good employees to other facilities. It’s much easier to reward current employees than to train new employees, yet many organizations don’t have any programs in place for this purpose. Retention strategies are extremely important in a thriving employment market.
Seeking Solutions
So, how do hospitals cope with supporting their system users (physicians, nurses, allied health, and business office staff) if they cannot attract the skilled MEDITECH professionals they critically need? Many rely upon the use of Consultants to provide support on a contractual basis, or they bring in Consultants to supplement their in-house staff during special projects.
Other hospitals have made the strategic decision to outsource their IT Department operations to national Healthcare IT firms such as First Consulting Group (FCG), Healthlink (an IBM company), ACS Healthcare, Perot Systems, and CTG Healthcare Solutions. This takes the staffing responsibility off the hospital’s shoulders and places it onto the outsourcer who may have better access to a larger pool of candidates.
Some facilities are recruiting candidates across borders as well. While most U.S. organizations may prefer to hire a U.S. citizen or permanent resident whenever possible, sometimes they simply have no choice but to look to other countries for the talent they need. MEDITECH currently has over 40% of the Canadian market share and is in its third decade of supplying information systems to hospitals across Canada. MEDITECH’s leadership status north of the border makes Canada a fruitful market from which to recruit qualified candidates.
Professional search firms can also be a good source for qualified candidates. Whenever possible, try to find an agent who understands your industry, knows the marketplace, and can demonstrate a record of success in recruiting MEDITECH professionals. Above all, make sure that both you and the agent work together as partners in the recruitment process, drawing upon each other’s expertise and providing prompt and detailed feedback to one another.
The most important point to remember is that there is no one solution to solving the MEDITECH professional shortage. Hospitals today, both small and large, should be staffing their IT departments through a combination of tried and true methods, outside assistance from consulting and professional search firms, and creative recruitment strategies. And, if you ask around, you’ll learn that some of the most successful hospital IT Directors remain well-staffed despite the MEDITECH shortage because they never stop recruiting -- both for future as well as their current employees!
Customer Spotlight: Centura Health Completes Its First Go-LIVE
One Giant Step Toward Interoperability: Centura Health Completes Its First Go-LIVE With MEDITECH, Standardizes Data
Reprinted from: www.meditech.com - November 30, 2006
Centura Health has had no small task ahead of them. For the past 17 months, the large health care organization in Colorado has been working to convert 12 separate facilities with at least 12 disparate work processes and hand-written paper order entries into one electronic information system. Now, Centura Health proudly announces that Avista Adventist Hospital is the first of the organization's dozen hospitals to go-LIVE with MEDITECH's clinical and administrative applications. The other Centura Health facilities are set to follow suit in the year ahead.
A major goal in Centura Health's implementation has been standardization of health care delivery via standardizing processes, terminology, evidence-based order sets, and patient registration summary. Centura Health shares a vision with MEDITECH, to use the MEDITECH system to ultimately improve quality, safety, and efficiency through integration of patient information.
"For those of us involved, this has become more than a software implementation, but rather a transformation of how Centura Health will deliver care to our patients and residents," states Dana Moore, senior vice president and CIO at Centura Health.
Getting on Track
After signing with MEDITECH, Centura Health began an intense effort by bringing together hundreds of staff associates to complete the "database build" in the MEDITECH system. Operating from the MEDITECH command center located in the Avista boardroom, a cadre of hospital I.T., First Consulting Group, super users, and MEDITECH personnel supported the go-LIVE operations. The command center was operational 24/7 and promised to operate for as long as necessary. However the go-LIVE progressed so well that the Avista command center was scaled back to day coverage, with technical assistance being routed to the Centura Health I.T. help desk a week later. According to Avista's leadership, super users, command center staff, and most importantly, the associates, "the go-LIVE went exceedingly well."
"Clinicians are already making suggestions for changes to screens and improvements to the processes. This demonstrates that they have mastered a sound working knowledge of the new system and already are beginning to help us make improvements," says Lesley Radocy, CNO at Centura Health's Avista. "Safe, quality patient care is Avista's top priority and we are pleased to announce that the MEDITECH implementation did not change this focus."
Fostering Physician Buy-In
As a strategic move and in an effort to increase the quality of patient care, Centura Health's top leadership helped to ensure that physicians were on board for the MEDITECH implementation.
Terry O'Rourke, MD, chief medical officer at Centura Health, explains, "The adoption of MEDITECH was critical not only for improving the quality of patient care, but also for remaining competitive with other health care systems that are moving to similar technologies."
Both Michael Shrift, MD, chief medical information officer at Centura Health, and Dave Ehrenberger, MD, chief medical officer at Avista, worked closely throughout implementation, and were pleased to see positive physician responses. "The 'wow' factor is playing a big role as physicians discover the ease of accessing vital signs, labs, histories and physical assessments, and consult reports," says Dr. Ehrenberger. "Physicians can access these reports on any of their patients, even after discharge, and even from home or the office."
Dr. Shrift adds, "Physicians are finding easy access to the data, especially vital sign information and nursing notes. Signing documents on-line, even remotely, has been very well received. Some physicians have even become mobile users by 'rounding' with tablet PCs on the floors. It's a testament to the teamwork and diligence of all involved."
Working Together to Create Order Sets
Another important part of Centura Health's implementation was creating evidence-based order sets in its new MEDITECH system. Dr. O'Rourke brought together CMOs from all of Centura Health's facilities to accomplish this goal. The team of passionate physicians created order sets by integrating its physicians' and other clinicians' best clinical expertise with preeminent external evidence, best practices, and evidence-based research from MEDITECH's ally Zynx Health.
"These standardized evidence-based order sets will improve the safety and quality of health care, thanks to the tremendous efforts by our physicians, associates, and consultants," says Dr. O'Rourke.
As a participant in the order sets team, Dr. Shrift agrees that, "MEDITECH will allow us to implement order sets that include better clinical decision support, clinical knowledge, and augmentation alerts."
During phase one, physicians will use in-patient order sets on paper, and the staff will input these orders into the MEDITECH system. In phase two, physicians will use order sets to enter orders electronically using computerized physician order entry (CPOE).
"The physicians have learned the new system well and most of the doctors have been complimentary. Many of the physicians have asked for additional advanced features like CPOE and on-line documentation, which will be implemented in the next stages," says Alan Mobley, I.T. physician technology analyst.
Enjoying Success in All Departments
Just one hour after go-LIVE, MEDITECH was fully utilized throughout the hospital. Participants agree that the go-LIVE process moved seamlessly throughout the hospital departments.
"MEDITECH is operating perfectly and connectivity is flawless," says Dr. Ehrenberger. "The Emergency Department was especially busy following the go-LIVE, with six patients receiving care and being processed with the MEDITECH system."
"Following almost an entire shift using the new system, those clinicians from ED, Med-Surg to OB were coping well. Most spent their shift not only caring for patients, but also working with super users to input data regarding their patient care. Physician Order Entry in the ED is working well," adds Dr. Shrift.
Although Centura Health's I.T. department and Avista's associates were excited to observe the changeover to the new clinical information system, the staff took great pride that patients hardly noticed the difference. In each patient's room, a "What's the buzz?" bi-lingual patient tent card provided information on the hospital's changeover to the new clinical information system.
Staying True to a Vision of Quality Care
As the first steps are complete, Centura Health is transitioning full speed ahead to complete 11 more go-LIVEs by the end of 2007. The organization remains steadfast in committing to its vision to increase the quality, safety, and efficiency of patient care.
"This compelling vision means that information technology offers the promise of a major breakthrough in improving the quality of care for our patients," says Dr. O'Rourke. "MEDITECH will enable multiple caregivers to interact using electronic medical records, thereby improving communications, facilitating best practices, providing instantaneous patient care updates, and improving quality of care."
Recent News: Personal Health Record to travel to new Health Care Plan by March, 2007
America’s Health Insurance Plan and Blue Cross and Blue Shield Association announced an insurer’s initiative to create an online personal health records (PHR) for 100 million patients by March, 2007. The insurers already have PHR’s for approximate 70 million patients but the problem is that the record does not travel with the patient if they change their insurance. BCBSA and AHIP have been piloting standards that will allow information such as patient history, medications, immunizations and allergies to be transferred to the new health plan if authorized by the patient.
More info: http://www.eweek.com/article2/0,1895,2074657,00.asp
Worth a Read: Articles of Interest to the Healthcare IT Field
Finding the Evidence
By: Stacey Kramer
HealthCare Informatics, January, 2007
The recent AHIMA conference took a look at Evidence Based Medicine, how far we’ve come and where we need to go. The key seems to be categorizing the research in a way that makes it easily accessible and provides a safety check list for the patient profile to help clinicians deliver better, safer patient care.
Read article
RSNA Rising
By: Mark Hagland
Healthcare Informatics, January, 2007
The annual Radiological Society of North America’s (RSNA) Scientific Assembly (Nov. 26 – Dec. 1, 2006) is widening its appeal to include CIO’s and CFO’s. The 2006 exhibit floor was notably more IT oriented than ever. The exponential growth of data collection in Picture Archiving and Communications Systems and Radiology Information Systems was a topic of great concern as these systems are requiring greater and greater storage capabilities.
Read article
Catching the P4P Wave
By: Mark Hagland
Healthcare Informatics, November, 2006
Pay for Performance initiatives washing over our healthcare system call for measured clinical and patient satisfaction quality outcomes to be documented and for payers to financially reward providers with higher quality outcomes. At a time where a wave of seminars and conferences are dealing with pay for performance this article reviews some sites and insights that are making progress towards embedding their quality initiatives into practice.
Read article
Methods to the Madness
By: Mark Hagland
Healthcare Informatics, January, 2007
Staff at Bronson Methodist Hospital, winner of the Malcolm Baldrige National Quality Award for 2005, reveal their reasons for success in quality initiatives that include people, service, quality, financial strength and growth. Because of the high degree of involvement of Information Technology within the quality initiatives in healthcare, CIO involvement is a must.
Read article
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