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Veterans Health Administration

Office of Quality, Safety and Value

Product Effectiveness

Report of Findings

Health Informatics Workforce Survey 2013

Second Measurement

August 16, 2013

Table of Contents

Contributors to the Study 4

Key Acronyms 4

Overview and Objectives 6

Interventions and Programmatic Changes Since 2011 7

Methods 8

Questionnaire Development 8

Study Administration 8

Study Population and Participation 8

Statistical Significance 9

Results 9

Role in Health Informatics 9

Experience and Qualifications 13

Competency Development 19

Career Development 25

Collaboration & Community Participation 28

Conclusions 30

Appendices 33

Appendix A: Questionnaire 33

Appendix B: Detailed Response Tables 33

Appendix C: Open Ended Responses 33

List of Figures and Tables

Figure 1: Confidence in Understanding the Role of Health Informatics at VA 10

Figure 2: Change in Understanding the Role of Health Informatics at VA 10

Figure 3: Primary Community of Practice 11

Figure 4: Percentage of Time Spent Performing Health Informatics Functions 13

Figure 5: Types of Health Informatics Functions Performed 13

Figure 6: Years of Experience Practicing in a Health Informatics Role 14

Figure 7: Length of Time Staff Expect to Continue in a VA Health Informatics Role 14

Figure 8: Certifications in Health Informatics 15

Figure 9: Advanced Degrees and Certificate Programs in Health Informatics 16

Figure 10: Participation in Internships, Fellowships, Mentoring Programs, Residencies 18

Figure 11: Professional Organization Memberships 19

Figure 12: Continuing Education Activities Related to Health Informatics in the Past 24 Months 20

Figure 13: Change in Awareness of Continuing Education Opportunities 21

Figure 14: Health Informatics Training Needs 23

Figure 15: Ability to Complete Health Informatics Continuing Education 24

Figure 16: Barriers to Completing Needed Health Informatics Training 25

Figure 17: Clarity of Health Informatics Career Paths and Advancement Opportunities 26

Figure 18: Change in Awareness of Career Path and Advancement Opportunities 26

Figure 19: Barriers to Advancing Career in Health Informatics 27

Figure 20: Participation in Health Informatics Communities 28

Figure 21: Change in Awareness of Networking and Collaboration Opportunities 29

Figure 22: Barriers to Collaborating in Health Informatics Communities 30

Table 1: Secondary Community of Practice 12

Table 2: Courses or Programs in Health Informatics 17

Contributors to the Study

VHA Office of Informatics and Analytics

• Diane Bedecarré (Co-Lead, Health Informatics Initiative Work Stream C)

• Dr. Katherine Gianola (Co-Lead, Health Informatics Initiative Work Stream C)

• Dr. Steven Brown (Director, Health and Medical Informatics Office)

• Elizabeth Chapman (Competency Lead, Health Informatics Initiative Work Stream C)

• Barbara Andrzejewski (Career Lead, Health Informatics Initiative Work Stream C)

• Margaret “Molly” Manion (Community Lead, Health Informatics Initiative Work Stream C)

VHA Office of Quality, Safety and Value

• Jennifer Ford (Director, Product Effectiveness Program)

• Ferenc Ayer (Customer Satisfaction Program Manager, Product Effectiveness Program)

• Lauren Tovrea (Team Lead, Product Effectiveness Program)

• Melanie De Grano (Team Member, Product Effectiveness Program)

• Susan Hanzik (Team Member, Product Effectiveness Program)

• Kaitlyn O’Malley (Team Member, Product Effectiveness Program)

We also wish to acknowledge the WSC Community group who participated in the development and testing of the data call.

Key Acronyms

|Acronym |Definition |

|HI |Health Informatics |

|hi2 |Health Informatics Initiative |

|PE |Product Effectiveness (Program) |

|VA |Department of Veterans Affairs |

|VHA |Veterans Health Administration |

|WSC |Work Stream C (one of three hi2 sub-initiatives) |

|Health Informatics Workforce Survey 2013– SECOND MEASUREMENT |

|Executive Summary |

|Background |Respondent Demographics |

|The goal of the Health Informatics Initiative (hi2) is to build the capacity |1,162 total responses |

|to deliver informatics solutions for healthcare delivery. In August 2011, a |77 were not currently practicing in a HI role. |

|baseline study was conducted as part of the hi2 initiative to better |1,085 valid responses (~18% response rate) |

|understand the composition and needs of the HI community. The feedback |CACs were the most represented role (10%) in 2013 |

|gathered from that study aided in planning a variety of initiatives to |Population of respondents are experienced and dedicated members of the |

|increase general competency and awareness of HI. |HI workforce: |

|This study was conducted in May 2013 as a follow up to evaluate the impact of |68% spend most or all of their time performing HI functions (mostly data|

|these initiatives, as well as aid in further competency, career, and community|collection & analysis activities) |

|development planning. |58% have been practicing an HI role for more than 5 years |

|Since 2011 |

|Respondents were asked to rate their levels of understanding and awareness over the past two years in three areas: understanding of HI, awareness of |

|HI education opportunities, and awareness of HI advancement opportunities. |

|[pic] |

|The reported increases in understanding and awareness are thought to be from multiple initiatives put in place after the 2011 study, such as large |

|scale training programs, memberships to HI organizations, creation of virtual HI community, and presentations. |

|Summary of Findings |

|The findings of the 2013 assessment provide justification for continuing the agenda and plans of Work Stream C in supporting workforce development |

|related to health informatics. Since the baseline measurement, strong initiatives and programs have been put into place in order to disseminate a |

|breadth of information to the HI community. |

|Over half of the population reports an increased understanding of health informatics and an increased awareness of educational opportunities within |

|health informatics at VA. |

|Respondents are less favorable when asked to compare their awareness levels of HI advancement opportunities and awareness of collaboration and |

|networking opportunities. These two areas include the greatest opportunities for improvement. |

|Detailed Results & Findings |

|Definition of Health Informatics: |

|Health informatics is a discipline at the intersection|

|of information science, computer science, and |

|healthcare that designs and delivers information to |

|improve clinical care, individual and public health |

|and biomedical research. Health informatics optimizes |

|health-related information acquisition, processing, |

|and use with tools that include people and processes; |

|hardware and software; algorithms and data; and |

|information and knowledge. |

Overview and Objectives

The VA Transformational Initiative “Transforming Healthcare Delivery through Health Informatics”, which is also known as the Health Informatics Initiative (hi2), is a foundational component for the Veterans Health Administration’s (VHA’s) goal of strengthening our ability to meet the needs of Veterans and their families. The intended goal for the hi2 is to build a sustainable collaborative approach, capacity, and tools to deliver informatics solutions to transform healthcare from a medical model to a patient-centered model of care delivery. The initiative has four work streams that are tasked as follows:

• Work Stream A – Adopt a health/IT collaborative supporting rapid product development and delivery methods

• Work Stream B – Build a health management platform to transform patient care

• Work Stream C – Create health informatics capacity

• Work Stream D – Deliver communication and drive change

In 2011, “Informatics” was not formally recognized in the VA HR system, with the exception that nurses used an HR assignment code for Informatics. However, this was updated in 2013 in reference to a new Program Analyst Position Description (PD) that was approved for the Health Informatics Specialist position. While this has been a successful step forward, commonly, staff are still assigned to the role of implementing and managing software packages and other major technologies that automate clinical or healthcare processes with little or no formal training in that role. Yet, some health informatics professional communities are highly formalized and offer academic degrees, internships and/or certifications in health informatics. In this context, the VA has embarked on an effort to better ensure that medical center staff members are clinically proficient and have the technical skill set needed to implement and manage the vast information and technology resources at VA.

To help direct this workforce development effort, it was necessary to gain a better understanding of the current job roles, capabilities, and qualifications of the health informatics workforce. Therefore, WSC sponsored a comprehensive data call baseline study in 2011 to provide a description of the professional status of the VA health informatics workforce. The Product Effectiveness (PE) Program within the Office of Quality, Safety and Value (formally within the Office of Health Information) contributed to the design of the questionnaire, administered the web-based survey, and conducted the analysis. The purpose was to inform decision makers on plans to support health informatics capacities at VA through competency, career, and community development. The current data call was administered to determine whether or not workforce development efforts have produced their intended objectives, while continuing to aid in further competency, career, and community development planning for those practicing in a HI role.

This report presents the study approach, methods, and a detailed summary of the results and findings of the follow up assessment. The findings will allow the WSC team to recognize their successes between 2011 and 2013, as well as continue to determine recommendations and action plans for addressing the workforce development needs.

Interventions and Programmatic Changes Since 2011

The study in 2011 provided a better understanding of the current job roles, capabilities, and qualifications of the health informatics workforce at the VA. It also identified opportunities for improvement which helped further define key objectives moving forward. These objectives are to achieve:

• An increase in the number of available educational offerings for Health Informatics and data analytics

• An increase in the number of VA staff who hold certifications in HI

• An increase in the number of VA staff who are members of HI professional organizations

• Opportunities for VA staff to network and collaborate across disciplines, specialties, time zones and geography

• New career paths for HI in VA

• An increase in Informatics literacy across VA

The baseline data collected from over 1,700 respondents in diverse Health Informatics job roles were used to develop and augment action plans in competency development, career development, and community development. Specific activities implemented since 2011 meant to enable achievement of the key objectives include:

• Deploying large-scale training programs: VA staff have logged over 60,000 non-mandatory course hours since November 2011. The training programs include Introduction to Health Informatics (101) – Office of the National Coordinator Community College curriculum, VA Health Informatics Lecture Series (301), VA Health Informatics Certificate Program (American Medical Informatics Association (AMIA) 10x10), and Nursing Informatics Workshops.

• Offering memberships to health informatics organizations: Corporate memberships in AMIA and Healthcare Information and Management Systems Society (HIMSS) were obtained for hundreds of VA staff.

• Creating a virtual health informatics community: A virtual environment based on social business software was deployed, offering a working home for communities of practice and inter-professional collaborations.

• Standardizing the Health Informatics Specialist role: A standardized position description for the Health Informatics Specialist role was created.

• Promoting health informatics through presentations: Health Informatics presentations designed to better acquaint leaders and staff from all disciplines with this emerging field and highlighting the value it brings to healthcare organization were delivered to several VA national conferences, including the Virtual VeHU (VA eHealth University) conferences and key leadership groups.

The 2013 study seeks to determine if the aforementioned efforts implemented since 2011 have positively influenced competency development, career development, and community development as intended. The following Methods section describes how the questionnaire was designed to capture current status while assessing progress made since the 2011 baseline measurement.

Methods

The design of the data call was a collaborative effort between WSC and the PE Program. This involved reviewing and updating the 2011 questionnaire, implementing it as a web-based instrument, determining the data collection procedures and schedule, and communicating with the target population. A key to the success of the study was the ability to contact the health informatics staff at VA in order to invite them to participate. These individuals could not be identified through workforce data, and therefore communications relied on existing collaboration networks. Approvals for the study were obtained from the Deputy Under Secretaries for Health (10A), Health Operations and Management (10N), and Health Policy and Planning (10P); the Labor Unions; and the VA Organizational Assessment Subcommittee (OASC) within the National Center for Organization Development, VHA National Human Resources Committee.

Questionnaire Development

The PE Program team worked iteratively with the WSC leadership team to update the questionnaire. A pretest of the questionnaire with key health informatics staff was conducted to further refine the instrument and ensure the accuracy and quality of data being collected. The testing resulted in very minor updates from 2011.

The final questionnaire (see Appendix A) was divided into four sections. The first section gathered information about professional qualifications and health informatics roles at VA. The remaining three sections addressed selected issues pertaining to competency, career, and community development activities and experiences. Respondents were also offered the ability to comment on relevant issues at the end of the questionnaire via a free-form response text box. The final questionnaire contained the 23 original questions from 2011 and four additional questions assessing increased or decreased levels of understanding and awareness of various aspects of HI since 2011.

Study Administration

Data were collected via a web-based questionnaire from May 20 to June 12, 2013. Email invitations and reminders to participate in the study were distributed by the WSC leadership team through email distribution lists and listserv groups that had been previously established for communicating with various groups on topics relevant to health informatics. Additional encouragement was provided from within the organization through grassroots efforts including conference calls and staff meetings. Participants were informed that their involvement was strictly voluntary and their responses would remain anonymous.

Study Population and Participation

The target population was defined as the VHA and VA Office of Information & Technology staff members who are currently engaged in performing health informatics functions as part of their job roles. The actual size of the population is unknown but was estimated to be about 6,000 individuals. Of the 1,162 total responses collected, 77 (7%) of the respondents indicated they are not currently practicing in a health informatics role and were routed out of the questionnaire. Consequently, the results in this report are based on the data from the remaining 1,085 individuals who completed the questionnaire. Therefore, the study achieved an estimated response rate of 18%.

Statistical Significance

Due to the difference in responses from 2011 (n=1,710) and 2013 (n=1,085), it is important to determine which difference are real or statistically significant. In order to do this, the PE Program team conducted independent samples t-tests using the 2011 and 2013 data. Throughout the report, if a statistically significant higher or lower percentage is detected, it will be highlighted in yellow and marked in green (significantly higher) or red (significantly lower). If a significant difference was not detected, the number will not be highlighted and will remain black. While there may still be differences in the percentages, both positive and negative, if they are not highlighted as significant, they are not real differences and should be analyzed only as possible trends.

Results

The survey response data were summarized to provide a description of the health informatics staff population. First, information about health informatics roles performed by staff and their professional qualifications are presented. Second, results concerning the competency, career and community development activities of the health informatics workforce are addressed. Appendix B contains the complete results for several tables that are presented in abbreviated form in this section. Appendix C contains free response comments provided by survey respondents.

Role in Health Informatics

Respondents were asked a series of questions concerning their roles at VA and the health informatics functions they perform. They were also asked about the years of experience and their expectations for continuing their career in health informatics.

Understanding of Health Informatics

Respondents reported their understanding of health informatics and the role of a health informatics practitioner at VA. Figure 1 compares the level of confidence in understanding the role of health informatics from respondents in 2011 to 2013. While the overall trend shows an increase in respondents being at least moderately confident, there was no statistical difference according to t-tests.

|Figure 1: Confidence in Understanding the Role of Health Informatics at VA |

|How confident are you that you fully understand the definition of |

|Health Informatics and the role of a Health Informatics practitioner? |

|[pic] |

Respondents were asked if their understanding of health informatics and the role of health informatics practitioner had changed in the past 2 years. Figure 2 shows that more than half (57%) of respondents indicate that their understanding has improved, while only 6% indicate that their understanding has decreased in the last 2 years.

|Figure 2: Change in Understanding the Role of Health Informatics at VA |

|In the past 2 years, would you say that your understanding of Health Informatics and the role of a Health Informatics|

|practitioner at the VA has increased, decreased, or stayed about the same? |

|n=1,015 |

|[pic] |

In their free response comments, respondents cited online and classroom training (“boot camp”), increased email communications, and conferences as reasons for their increased understanding.

“I have had the pleasure and honor to attend nursing informatics boot camp, take some of the courses on TMS, [and] be an integral part of informatics for my division through the support of my division chief. We have a center at my site for Health Informatics; our site has always been a leader in the health informatics innovations and continue[s] to work within the framework of national structure. We are aware of limitations that have developed over the years and are trying to help leadership understand the need for increased utilization and resources for Health Informatics.” – BCMA (Bar Code Medication Administration) Coordinator

“I took the Health Informatics 101 course and learned a lot of basic underpinnings of the field. I also obtained a nursing informatics certification through ANCC and this took quite a bit of study.” – Clinical Informatics Specialist

“After taking the course related to this topic, I began to apply what I learned and matched it with various aspects of this organization. [I] developed better ways of doing things by really utilizing the present system to its full capacity. The course in informatics really opened my eyes to the possibilities and what we can do with the present system we have available to us.” – Health Informatics Specialist

Community of Practice

Respondents were asked to identify their community of practice at VA. The percentage of staff selecting each community of practice is presented in Figure 3, but only for those communities that were represented by at least 4% of the respondents. The remaining communities of practice are aggregated in the last row under “All Remaining Communities”. (See Appendix B for the full table.) The largest groups of respondents were CAC (Clinical Applications Coordinator) at 10% and Health Information Management, ADPAC (Automated Data Processing Application Coordinator), and Analytics at 8% each. In 2011, Nurses and Health Information Specialists made up the largest groups (14% and 12%, respectively).

|Figure 3: Primary Community of Practice |

|Which community of practice best describes your primary healthcare career|2011 |2013 |Difference |

|affiliation? | | | |

|CAC (Clinical Applications Coordinator) + |– |10% |[pic] |

|Health Information Management (HIMs staff) |7% |8% | |

|ADPAC (Automated Data Processing Application Coordinator) + |– |8% | |

|Analytics (e.g., VSSC staff, DSS, Data Analyst) |5% |8% | |

|Pharmacy |8% |6% | |

|Nursing Informatics + |– |5% | |

|Nurse |14% |5% | |

|Health Informatics Specialist |12% |4% | |

|Imaging/Radiology |2% |4% | |

|Other * |10% |5% | |

|All Remaining Communities |42% |37% | |

|Statistical Significance: ----- Increase, ----- Decrease, ----- No change | |

+ Added communities of practice to the questionnaire in 2013

* In 2013, “Other” included Laboratory Managers, Records Managers, and Administrative Officers

In 2011, “Other” included Decision Support System staff or Clinical Application Coordinators.

The survey also asked respondents to identify whether they belonged to an additional community of practice at the VA, a question that was added to the 2013 survey to further identify user roles. Table 1 shows additional affiliations whose percentages were greater than or equal to 5%. The most commonly cited additional affiliations were ADPAC (25%), and CAC, Nurse, Analytics, and Education-staff (each 11%). 112 respondents (11%) did not have any additional affiliations. The additional communities of practice supports the notion that users perform many different roles and identify with their clinical assignments first and ADPAC and other non-clinical roles as a secondary assignment. It also suggests that there may be some role confusion due to non-standardized titles and many roles to choose from.

|Table 1: Secondary Community of Practice |

|Aside from your primary healthcare affiliation, what other communities of |Frequency |Percentage |

|practice are you affiliated with? | | |

|ADPAC |261 |25% |

|CAC |113 |11% |

|Nurse |113 |11% |

|Analytics |112 |11% |

|Education-staff |111 |11% |

|Other |88 |8% |

|Nursing Informatics |74 |7% |

|Clinical Informatics Specialist |71 |7% |

|Quality Management |70 |7% |

|Telehealth/Telemedicine |66 |6% |

|Systems Redesign |60 |6% |

|Health Informatics Specialist |59 |6% |

|BCMA Coordinator |56 |5% |

|Information Technology (IT specialist) |56 |5% |

|Health Information Management (HIMs staff) |55 |5% |

|Healthcare Administration |52 |5% |

|BCE Coordinator |50 |5% |

|Not applicable, I do not have any additional affiliations |112 |11% |

|Total number of responses to this question = 1,040 |

Time Spent Performing Health Informatics Functions

The majority of respondents (68%) spend at least 50% of their time performing health informatics functions (see Figure 4). However, only 46% can be considered to be in a full-time role, spending 76-100% of their time performing health informatics functions. It may be challenging to promote professional development pertaining to health informatics if staff members have competing development needs in other areas. T-tests confirmed that there is no significant difference in time spent performing health informatics functions since 2011.

|Figure 4: Percentage of Time Spent Performing Health Informatics Functions |

|[pic] |

Types of Health Informatics Functions Performed

Figure 5 illustrates the proportion of time spent executing various health informatics functions. A majority of the respondents spend a moderate to large part of their time as health informatics practitioners performing data collection and analysis (64%), coordinating staff and stakeholders (63%), consulting as a subject matter expert (59%), implementing solutions (56%), and/or providing education (55%). While the overall trend is that time spent doing each of these functions has decreased since 2011, the results of the t-tests results confirmed that there is no statistical difference in types of health informatics functions performed.

|Figure 5: Types of Health Informatics Functions Performed |

|How much of your Health Informatics role involves performing each of |2011* |2013* |Difference |

|the following types of Health Informatics functions? | | | |

|Data Collection & Analysis |68% |64% |[pic] |

|Coordination |69% |63% | |

|Subject Matter Expert (SME) |58% |59% | |

|Solutions |60% |56% | |

|Education |62% |55% | |

|Needs identification/assessment |41% |45% | |

|Leadership/administration/management |45% |41% | |

|Information Stewardship |43% |37% | |

|Evaluation |46% |37% | |

|Policy/Governance |23% |20% | |

|Other |30% |23% | |

|Statistical Significance: ----- Increase, ----- Decrease, ----- No change | |

* Percentages include the responses “A moderate part of my role” or “A large part of my role.”

Experience and Qualifications

It was of interest to understand the degree to which the VA workforce is taking advantage of opportunities to establish professional credentials in health informatics. The professional status of the VA health informatics staff was addressed through a series of questions asking respondents about their professional experience as well as their qualifications including academic degrees, internships, and/or certifications.

Years of Experience

Respondents reported a wide range of experience in practicing a health informatics role (see Figure 6). Over one-third of the respondents (35%) reported being new to the role with 5 or fewer years of experience. However, 14% of respondents indicated that they had over 20 years of experience in health informatics. These results may reflect the general trends in the federal government with respect to an aging workforce. Approximately one-third (32%) expect to discontinue their role in HI at VA within the next five years, and over half (59%) expect to leave their roles in the next 10 years (see Figure 7). This is not surprising given the number of people who have held a role for over 10 or 20 years; it suggests that many users are coming up on retirement. The VA will need to consider the impact of these retirements in health informatics succession planning and recruiting. As compared to 2011, there was no statistically significant difference in years of experience practicing or expected length of time practicing in a VA health informatics role.

|Figure 6: Years of Experience Practicing in a Health Informatics Role |Figure 7: Length of Time Staff Expect to Continue in a VA Health |

|How many years in or outside of the VA have you been practicing in a |Informatics Role |

|Health Informatics role? |How many more years do you plan to practice in a Health Informatics |

|n=1,162 |role within the VA system? |

| |n=952 |

|[pic] |[pic] |

Professional Certifications

The results demonstrate that there is considerable room for growth in the professional certification of the VA workforce in health informatics and project management disciplines. The majority of respondents (78%) reported that they do not hold any type of professional certification. Figure 8 displays the percentage of respondents who reported currently holding a health informatics certification. The most common certifications were through American Health Information Management (AHIMA). This includes 6% of the respondents certified as Registered Health Information Administrators (RHIA) and 3% as Registered Health Information Technicians (RHIT). The figure shows that there was a statistical difference in Clinical Engineering Certification (CCE) and Certified Professional in Healthcare Information and Management Systems (CPHIMS) from 2011; however, overall these certifications make up a very small portion of the respondents.

|Figure 8: Certifications in Health Informatics |

|What certifications (credentials) from professional organizations do you |2011 |2013 |Difference |

|currently hold in Health Informatics related areas or Project Management? | | | |

|Select all that apply. | | | |

|Registered Health Information Administrator (RHIA) |5% |6% |[pic] |

|Informatics Nurse |2% |3% | |

|Registered Health Information Technician (RHIT) |3% |3% | |

|Certified Coding Specialist (CCS) + |– |2% | |

|Certified Coding Specialist – Physician-based (CCS-P) + |– |1% | |

|Project Management Professional (PMP) |1% |1% | |

|Clinical Engineering Certification (CCE) |1% | ................
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