Health IT and Job Creation

In the recent post-bubble economic environment of high unemployment and underemployment, one of the bright spots in the landscape has been Health Information Technology. The Health IT sector itself has been a growth area, and the healthcare sector that has been implementing modern Health IT, including Electronic Health Records (EHRs), has also experienced growth.

Health IT, both in its creation and its implementation, bridges two different domains of expertise – technology and health care. The kinds of jobs being created are skilled positions, requiring new competencies, and contribute to fostering a robust middle class workforce, and not marginally self-employed project workers.

Government efforts
The Office of the National Coordinator for Health IT (ONC) has recognized that in order to carry out the intended scale of adoption of Health IT in this country that is envisioned under the EHR Incentive Program (Meaningful Use), a much larger skilled workforce will be needed. Thus, the ONC has created a Workforce Development Program to foster University-Based Training (creating 1,500 new advanced study or master’s degree professionals) as well as Community College non-degree training programs for more than 10,500 new Health IT professionals annually.

To support these efforts, there have also been grant programs for Curriculum Development Centers, as well as Competency Examination Programs, in order to assist the Community College Consortia in their efforts to train the new health IT professional students.

Much of the presumption behind these efforts has been that Health IT will mainly be deployed in institutions as enterprise-based local installations. This has certainly been the experience in hospitals, academic institutions, integrated delivery networks, and large clinics. But, since this kind of effort was first undertaken, we have seen a shift in the market, and cloud-based (web-based) EHRs have emerged as a preferred pathway for smaller, independent medical practices. What impact does this have on the job-creation picture?

Impact in doctor offices
Some critics of the Meaningful Use program have claimed that implementation of EHRs in doctors offices have resulted in job loss, as the need for personnel to manage paper medical records has dropped. In fact, in 2009 MGMA had conducted a survey of return on investment (ROI) for EHR use, finding that the main cost savings experienced by medical groups was in staffing changes, although eventual increase in productivity and efficiency was significant after about a year. On average, IT staffing per full-time-equivalent (FTE) physician increased by 0.13 FTEs, while medical records staffing fell from 0.34 to 0.19 FTEs per physician.

In smaller practices (MGMA is an association of medical groups), the staffing shifts are more lateral, needing to re-purpose employees to do different things. No longer is staffing needed to manage paper medical records, but instead there is a new need to scan, upload and categorize documents that are received into the EHR.

In a setting where an EHR is locally installed, there is on-site IT help needed to maintain and support the local servers, hardware and network. This is an additional cost burden to small practices that was not present before, often done through IT consultants outside the practice (hospitals, generally, have their own in-house IT staff). However, web-based EHRs remove most of this cost burden. Thus the improved efficiency seen with EHR usage is realized more quickly (without the cost drain of local network support), and without medical support staff job loss (the support staff is re-purposed from paper chart maintenance to electronic chart maintenance).

Growth in the technology sector
The EHR technology industry has been a growth segment in the economy. Spurred by increased demand for EHR products resulting from the federal Meaningful Use program, demand for products is up from all EHR vendors. Our own experience has certainly been an example of this, with dramatic job growth in the past year.

The kinds of jobs being created have been, in part, engineering and software development jobs. In addition, customer support and implementation jobs have been an even larger growth area. These jobs have been in-house and on-shore, largely – particularly when very high customer satisfaction is critical. The free business model of web-based EHRs is heavily based on very-high customer support and satisfaction, given that active use of the product is critical to the ad-supported model.

Another area of job growth has been a result of the open-platform approach to Health IT, seen particularly in the web-based arena. The closed, “walled garden” traditional enterprise EHRs, dominant in the past 15 years (with interfaces that look remarkably like 1990s programs) have grown, but to a more limited extent. The area where entrepreneurial job growth has exploded has been in the Health 2.0 space, where web-based consumer-facing and healthcare-facing products have appeared everywhere. Many of these companies fail (the survivors from one year to the next in the Health 2.0 conventions is somewhat low), and new ones are constantly emerging in this incubator environment – the result in all of this is regular job creation in the sector as a whole.

The “big data” effect
Another effect of Health IT growth is the effect of gathering “big data.” Many open platforms are evolving and gathering huge amounts of data – this is true in the general market as well as in health care (data both outside and inside the privacy-wall of HIPAA). Social media platforms (Facebook, Twitter, LinkedIn) have the result of collecting massive amounts of user-recorded data, to be shared socially.

EHR data, particularly with the expansion of web-based offerings in the market, are also hosting very large stores of data (though it is different – it is behind the walls of HIPAA privacy protection). However, a similar effect on the economy can be seen.

Similar to how the tremendous growth of peripheral products to the public social media “big data” platforms has emerged (Facebook apps, smartphone apps), we are starting to see the development of healthcare products that might make use of privacy-protected health data. In fact, a new frontier of Health IT is seen in apps that pull from consumer-created data (outside of HIPAA), as well as from EHR data (HIPAA protected) – anything from medical device data (e.g. glucometer outputs for diabetics) ported into a connected patient-facing PHR, and electively shared with one’s physician through their PHR-connected EHR, to social platforms that promote healthy behaviors (walking, exercise, diet, etc.) which can be shared socially with “friends” as well as privately shared with one’s physician. The possibilities are mind-boggling.

The net effect of the emergence of “big data” platforms – both in the general public domain, as well as in the healthcare domain – is the creation of startup businesses (and therefore jobs) in large numbers. These jobs require skills, are not marginal jobs, but represent a middle-class growth industry in this country. A supportive policy framework from the government is something that can significantly help this arena of U.S. job growth.