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By Susan Chapman, MA, MFA, PGYT for For the Record
As the health care industry continues to evolve, an important question has come to the forefront: How is higher education addressing the demands and changes while also producing prospective employees who will become reliable contributors upon graduation?
Addressing Industry Demands
Peter Winkelstein, MD, Kaleida Health’s chief medical informatics officer, executive director of the Institute for Healthcare Informatics, and a professor of pediatrics in the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, says hospitals, at their core, are systems similar to those in other industries. “You have to run your servers, operating systems, desktops, and virtual environments,” Winkelstein notes. “The difference, though, is that in health care, there is a lot of very focused technology not used anywhere else. For instance, health care data are unlike information generated by and used in other fields. Health care data are not like banking data. They are very complicated and not as well structured.”
To that point, graduates who choose HIT as their career path are faced with a number of unique challenges, chief among them data security, use, and analysis. According to Winkelstein, HIT professionals have to know how best to keep protected health information from being stolen, lost, or altered from not only a privacy standpoint but also a health perspective.
“This has to do with people’s lives,” Winkelstein says. “When a doctor looks at that record from a health perspective, they are looking at it to make decisions. It is enormously important data. Not to minimize the privacy situation at all, but people’s lives depend on the information being accurate.”
He adds that HIT professionals need to understand the nuances of PHI access, which encompasses HIPAA requirements, and have an appreciation for the data’s complexity and the procedures for handling that information securely.
Recognizing the critical value of health care data, the Division of Continuing and Professional Education at the University of California, Davis (UC Davis) offers a health care analytics certificate program that focuses on data output in health care. Keirsten Mihos, chair of business, health, and leadership programs at UC Davis, says the program is designed for those employees who gather, analyze, and communicate data among hospital groups, insurance groups, and state and county agencies.
“It’s about the tools that you need to pull these data and to have the context to know what you’re looking at,” she says.
Mihos says the program is both robust and demanding. “We begin with an overview of how data are used in medicine,” Mihos says. “Very often, our students are just starting out as analysts working in hospital systems, and they need to better understand the context and the tools. They have to know how to use and communicate the data to stakeholders in order to improve patient care.”
The COVID-19 pandemic has underscored the importance of trained analysts. “When the COVID-19 pandemic first hit, there was no ICD-10 code, and the industry has been working to agree on how to code the disease and report prognoses. Analysts play a pivotal role in this process, trying to make sense of data over which they have no control. Health care is a constantly evolving field, and data analysts have to be nimble,” Mihos says.
Deshae Redden, EdD, MA, program director of health informatics and continuous improvement coach at Logan University, says, in some ways, COVID-19 has created new opportunities. “Our students have a lot of opportunities to get experience with health informatics, health information technology, and COVID decision making,” she says. “As the world can see, health informatics is being used to continuously improve the delivery of care, operations, health information technology, and processes. Health informatics is essential to evidence-informed decision making for various organizations.”
Those aspiring to a career in HIT must understand the complexities of the health care environment, Winkelstein points out. “Somebody who has some idea or who knows about clinical workflows is a good fit for HIT,” he says. “To that end, at our facility, we have clinicians who have chosen to shift their career focus to HIT. Those individuals are doctors, nurses, or other practitioners who have worked in the clinical environment and have now chosen to work on the technical side. No one expects someone coming out of a college or university IT program to have that kind of experience.”
Jonathan Mack, PhD, MSN, director of the health care and nursing informatics programs at the University of San Diego (USD), concurs with Winkelstein’s point, noting that the Master of Science in Healthcare Informatics degree program at USD is dedicated to preparing HIT employees who have a comprehensive understanding of how hospitals and other health care facilities function.
“I believe our program gets people ready to address the unique needs of a health care environment. Our faculty work in the field, and our program is bolstered by an advisory board consisting of health care professionals in the Greater San Diego area,” Mack says. “The strength of our faculty and our advisory board help us to prepare and produce graduates who are ready to go to work. If you’re in a vacuum, you don’t have that outside information, and you’re not as prepared.”
The USD graduate program offers two paths to completion: on campus and online. “The on-campus option provides a mandatory practicum with an elective practicum option for online students,” Mack explains. “Our online program was, in part, developed for students who were already in the field and wanted to have a flexible learning option without the required practicum. It includes individuals without a health care background as well as second-career students with a health care background.”
USD students with health care experience include clinicians, such as nurses, physicians, radiology technicians, pharmacists, and laboratory scientists. Others come to the program with business backgrounds.
“Many of our students have undergraduate degrees in non–health care disciplines and earn the master’s degree as an entry point to health care careers,” Mack says. “About 30% of our students are health care professionals who want to transition from the bedside to a health care informatics or data analytics role. In addition, we have unique students from the international arena who are looking for a degree in health care informatics from a US perspective.”
Mack notes that another population comprises students from the military. “We work with several branches of the military who send their active-duty officers for training with us because we train students on EHR products that are used by the military,” he says.
An Upward Trajectory
For those students who initially come to the USD program with minimal health care experience, the faculty help them become familiar with the field. “But we do require health care experience of some type, which can be paid or volunteer,” Mack says. “We want our students to know the industry, and they also have to know what they’re getting into. Still, it’s been an interesting experience for the students and us to expose them to health care before they start the majority of their courses. It enhances the experience.”
Mack believes the program has been successful in meeting market demand. “We’re constantly evaluating and revising the content to ensure we are providing the best and most current knowledge and teaching skills. As an illustration, our advisory board helped us develop our health care analytics curriculum,” he says. “Our advisory board recognized a need in the community for skilled individuals who could work with health care data expertly. We developed the health care analytics track based on the AHIMA criteria for certification in analytics. Students who graduate and meet other certification requirements are prepared to sit for certification through AHIMA.”
“A nonprofit with a for-profit view” is how Mack describes the USD program. “To be a viable program, we need to be competitive,” he explains. “I periodically look to see what other programs are offering and compare our own program and outcomes. We want to ensure we are not just graduating students with a degree but also preparing graduates to enter the job market. Part of our program’s self-evaluation is looking at where our graduates are in six months. We want to know if they were hired and what types of jobs they are they being employed in. We now know that the practicum is gold.”
Redden says one of the strengths of Logan’s program, like that of USD, is that it, too, is bolstered by an engaged group of advisors. “In 2019, we created our first health informatics advisory board, which I strategically assembled with professionals from different employers, different industries, and at different levels within their organizations,” she says. “I made this strategic move to ensure that the health informatics program would have a board representing the broad range of the health informatics field.”
Redden believes that feedback from employers, faculty, and current and former students in the industry is critical. “This feedback is used to continuously improve our courses, assignments, resources, operations, and processes,” she notes. “We are also currently working on partnerships to allow students to gain even more experience in the industry. For example, we are working on partnerships to allow students COVID-19–related projects such as creating dashboards and creating different ways to collect, analyze, communicate, and visualize health data analytics.”
Mack is confident that graduates of the USD program are highly employable and destined to be successful in the clinical informatics field. “In our program, we focus from day one on preparing for the job market,” he says. “Our program requires that our faculty and all program activities be structured toward that goal. The first step with each new student involves my meeting with them, and the first question I ask is, ‘What do you want to do when you graduate?’ This sets the tone for the remainder of the program for the student.”
Winkelstein is confident there is room for IT graduates to be trained in the health care field even if they don’t have the practical knowledge embedded in their educational programs. “We fully understand that someone who comes out of college will not know everything—nor should they. When you bring someone in, you’re going to train them on what you do in your shop. But it is helpful to know what environment you’re walking into—information security, for example—on top of the regular IT knowledge,” he says.
For students to gain that knowledge, Winkelstein acknowledges that the type of practical experience that Mack and his team provide would indeed be beneficial. “Internships, or the equivalent, in that environment would be valuable. The students will learn about the environment and whether or not they are really interested in it,” he says.
Volunteer opportunities and positions that aren’t necessarily IT are other options that can give prospective employees a sense of what they might want to do and how health care functions. Winkelstein believes that even an internship working in a doctor’s office as a data-entry clerk or as part of the front-office staff may be worthwhile.
Winkelstein adds that from an academic perspective, some courses and majors offer electives that involve health care, even if the entire program is not HIT focused. “I helped teach a course with a colleague, a math professor, for undergraduate math students,” he says. “He was teaching them data analytics, and we worked together on health care data sets. The students got a flavor of what health care data look like, and I found it fascinating how they were looking at the data, their unique perspectives.”
If students aspire to an HIT career but are not in a program that is specifically directed at health care, Winkelstein suggests they be proactive and find opportunities that will prepare them for the jobs they want. “Opportunities likely exist that are directed at, or are pieces of, the field the student is interested in,” he says. “As an example, senior undergraduate students can look at graduate courses that are focused on HIT, which they may be able to enroll in and might be helpful.”
While opinions may differ as to whether or not an employment candidate with IT skills must have dedicated HIT experience upon graduation, Winkelstein has several questions that he believes help his facility make the right hiring choice.
“When I’m hiring someone, I want to know what they know, the basics. I also want to know what else they have done. If they’ve done things related to health care, that would stand out. Why is this person applying for a health care IT job? Is it just one job among many? It can be hard to find good, well-trained IT people. So opportunities are out there, especially in the smaller markets,” he says.
Cause for Optimism
Redden believes there are many ways graduates can contribute to the health care field. “Our goal is to inspire students and educate them on what is out there, discover what they are missing, and show them how they can get there. There are many opportunities for our students,” she says.
Many of the experts are united in the belief that those students who do pursue HIT as a career path do so because they are committed to health care and patient well-being. “One of the things that impresses me when I talk with those who work in HIT is that they sought their jobs because those positions were in health care,” Winkelstein says. “Someone might graduate with an undergraduate degree in IT and have IT skills, and they are in good shape to find a job in their field. There are lots of jobs available for them. But why specifically hospitals? HIT is a good, interesting, and complex field, and it’s the health component that is an important motivator for those who choose it.”
Mihos agrees, adding, “If HIT professionals are well trained and doing their jobs well, they can work successfully with practitioners and leaders in health care to make important differences in patients’ lives.”