The ARRA IT Staffing Crisis

When we discuss strategic planning and the ARRA, one item that requires your immediate attention is a review of your IT staffing resources.

Here’s why:

Let’s start by reviewing a few key dates. Remember that for physicians, ARRA bonus payments start in 2011, and therefore to capture those dollars your ERM needs to be up and running (and able to demonstrate “meaningful use”) by the end of 2010. (Hospitals of course have a slightly different timeline, but it won’t affect the salient points of this discussion).

Now consider that EMR and CPOE implementations take time–lots of time! Even for the smallest office this will (and should) take months, and for larger physician groups and hospitals implementations can easily span multiple years.

We’re now essentially in the last quarter of 2009–that leaves us only 15 months.

But I hear you saying: “Wait a minute…’meaningful use’ hasn’t been completely defined yet. There should be plenty of time….”

And perhaps under normal circumstances that might be the case, but now consider this from the perspective of your EMR vendor.

• Vendors know that everyone will want to have their EMR up and running in time to capture the incentives in 2011.
• They know that a typical implementation will likely run 12 months or more.
• They only have a finite number of implementation teams available–and the queue for customers awaiting implementation is growing (and perhaps is already booked well into 2011 for some vendors).

What happens to you when you call asking to buy an EMR, and have it implemented by 2010?

• Will you be told that the vendor doesn’t have the resources, and that you’ll have to wait?
• Or will the vendor sell the EMR, and worry about the implementation later?
• And if the latter is the case, what will that vendor do to get you implemented?

Most vendors know they will have to hire new employees to fill the need for this bolus of implementations that they know is coming–and they also know that these employees will be new, green and inexperienced. Perhaps yours might even be their first implementation. Yes, they may have “supervision” from a more experienced implementer in the organization, but the bottom line is that they will de facto have less experience than they might otherwise.

Not a good thing…but it gets worse.

Now ask yourself where will these new EMR implementation experts come from?

Some will be young staff, perhaps fresh from college looking for their first job. Others may be transitioning from other industries (perhaps even with some implementation experience outside of healthcare). Others might be clinicians looking to transition to IT.

But all of these folks lack the healthcare IT expertise that will be critical to a successful EMR implementation.

It would be ideal if a vendor could hire experienced EMR implementation folks, but where would such individuals be found?

Hospitals, physician groups & practices – why, perhaps even your staff!

And what about your staff? Aren’t you going to want (and need) experienced EMR staff to maintain your system once it’s up and running? You’ll need folks to keep the infrastructure running, and to make changes to order sets, and to train and bring new physicians online. Perhaps you’ve just implemented your basic EMR, and now want to bring CPOE online. Wouldn’t you want to retain your own staff to help with those efforts?

But won’t every other hospital and vendor be looking for the same thing? Good employees with EMR experience? Where are these folks going to come from?

The smart organizations have already figured this out, and we’re starting to see the effects. There is an increasing demand for EMR analysts and implementation specialists (just take a peek at all the EMR job postings on monster). There will be increasing pressure on your staff to leave your organization–they will likely receive many tempting offers– in the coming months. And as we have discussed, finding experienced replacements will be difficult, and expensive.

So what can you do now?

1. Get in the queue for your EMR implementation now. If you wait, you simply won’t be implemented in time to capture the ARRA incentives by 2011.

2. Discuss your implementation’s staffing needs with your vendor. Make sure they’ve planned for the large increase in volume that’s coming, and if possible, insist on one of their more experienced implementation teams when you’re negotiating your contract.

3. Recognize that your current EMR staff will receive offers to leave. Assess your salary and benefits structure, and make sure that you’re at least in line with prevailing wages–but recognize that wages will likely increase and adjust accordingly (supply & demand).

Consider the cost to your organization if key employees leave–you’ll have downtime due to a search, your new employee will need training and time to acclimate to your organization, and you’ll likely have to pay a higher wage to get them on board.

And after all that, remember that there will still be folks out there trying to lure away that new employee you just spent all that time and money training, and they might leave for a more tempting job after only a few months (or weeks) with you!

Most of the time, it’s more cost-effective (and just plain smarter) to retain your current good employees.

4. Have the best leadership in place that you can. Experienced managers and directors (and CIO’s!) that can “keep the troops happy” while championing maximum effort will be critical to your organization’s success! It’s not going to be easy meeting the ARRA timelines, and you will need the best team possible in order to pull it off.

5. Be realistic. Recognize that good people are more important than good software. Reward, value, develop, nurture and retain your top performers.

The ARRA has changed our environment, and we’re now just starting to see the beginnings of this increase in demand for experienced IT staff. Know that it’s coming, communicate the pending crisis to your leadership team, and plan accordingly.