As a family physician, Jon White dealt with mountains of paperwork every day. From charts to medical histories and prescriptions, each patient came with their own bundle of papers. Sometimes the script was illegible, and sometimes sheets would get lost. When he was on call and asked to consult on a case from home, White often couldn't verify patient details since the files were back in the office. White thought there had to be a better way to address these challenges.
"I came to appreciate that in order to deliver great care, you need great information," White said.
The idea led him into the burgeoning field of health-care information technology, which includes everything from electronic health records to tracking diseases like Zika or Ebola through population health data.
White eventually became deputy national coordinator for the Office of the National Coordinator for Health Information Technology, a federal organization that helps the health-care system implement and use technology.
White didn't know it at the time, but his decision to pivot to health IT more than a decade ago foreshadowed a new era in health care.
Today health-care providers around the world spend more than $100 billion per year on health IT, an emerging field that includes electronic health records, online patient portals, health apps and personalized medicine. More than 45 percent of that spending comes from North America, according to research and advisory firm Gartner. With major market players like IBM, Cerner, GE Healthcare and many more embracing health IT, the global market is expected to increase at a rate of nearly 16 percent through 2022.
The rapid growth has brought with it a shift in the traditional roles of physicians like White, along with new jobs in health informatics. Many employers are no longer searching for just doctors and nurses. Now they need chief medical information officers, quality management officers and clinical analysts.
It is too early in the emerging sector for the Bureau of Labor Statistics to track health IT jobs yet, but it shows that the job outlook for health information technicians (involving digital and paper-based work) is projected to grow 15 percent by 2024, much faster than most occupations. Jobs in computer and information technology in general are projected to increase 12 percent, with part of the growth coming from the health-care industry.
Fast-track adoption of electronic health records in hospitals and physician's offices, fueled by the 2009 HITECH Act, paved the way for the rise of health IT.
In 2011, 71.9 percent of non-federal acute-care hospitals had adopted electronic health records that met the certified standards of the Department of Health and Human Services, according to HealthIT.gov. By 2014 that had risen to 96 percent of hospitals.
At their simplest, electronic health records are digital versions of patients' paper medical charts, but they can also include a lot more information. In many places, electronic health records sync with health data from FitBits or smartphone apps. Some feature patient portals that allow individuals to access their medical history or schedule doctors' appointments online.
Under the HITECH Act, incentive programs were developed to help health-care providers cover the cost of transitioning to electronic medical records. As of August 2016, more than 508,000 providers received nearly $35 billion through the Medicare and Medicaid incentive programs.
Today, 96 percent of hospitals and 78 percent of physicians use electronic health records. Nearly 7 in 10 hospitals give patients the ability to view and transmit their health information online.
The revenue opportunity
Hackensack University Medical Center in New Jersey is one of them. The hospital's electronic system allows users to look up symptoms, find doctors, make appointments and review test results. It also links patient-generated data from personal fitness devices and mobile apps to electronic medical records.
The system allows the hospital to see one additional patient each hour and has increased hospital revenue by 17 to 25 percent, according to chief information officer Dr. Shafiq Rab. "It improved the workflow. It improved the quality of care," he said. "It helped us to decrease bad outcomes. Hence, our revenue increase."
White said positive revenue results have been seen at some hospitals, but other experts say it is still too early to conclude that electronic health records are definitively worth the cost of implementation. In some cases, adopting the digital system can decrease costs after three years, but in other cases — especially at smaller health systems — it can cause increased costs even after six years.
According to a 2016 Medscape report, 56 percent of physicians said electronic medical records improved their documentation process, but about an equal percentage said it decreases the amount of face-to-face interaction they get with patients and often reduces the number of patients they can see.
Many doctors say the increased computerization of the medical field is one of the leading causes of burnout. That speaks to a need for employers to help clinicians adapt to new technology, new workflows and, in some cases, even new jobs.
Rab is clear about what he looks for in employees.
"Electronic health records has changed the staff. That means they have to learn how to use the iPad, the iPhone, the Android, Google," he said. "It has created new opportunities. It has created new types of jobs. And the shift of the jobs is going more toward informatics. The people who were nurses, they are now joining IT. People who were transport people, they have joined information technology."
It is now vital for clinicians to learn to use electronic medical records without alienating patients by staring at a computer screen. It is vital to look at various data sources in order to make a holistic diagnosis. It is vital to share data between providers to increase the quality of care. This requires skills that were not part of the traditional physician toolkit: database manipulation, knowledge of information systems and an ability to code.
According to a 2014 survey by the Healthcare Information and Management Systems Society, more than 84 percent of health-care organizations hired at least one health IT worker in the past year and 80 percent plan to hire more.
The shift of the jobs is going more toward informatics. The people who were nurses, they are now joining IT. People who were transport people, they have joined information technology.Dr. Shafiq RabHackensack University Medical Center chief information officer
The American Health Information Management Association says approximately 12,000 to 50,000 new health information jobs — which encompasses technical fields like health IT and informatics, as well as more administrative positions to manage the flood of data — are expected to open up by 2017.
Many of these jobs will be in data science, said Thomas Handler, a health-care provider analyst at Gartner. Employees need to analyze and make meaningful use of the data obtained through electronic health records.
David Marshall, managing director of Huron Consulting Group's health-care practice, sees great potential for health IT jobs in human resources, too. Most providers don't keep track of employee credentials and capabilities in a digital system, he said. When they have a particular task, they just pick the first person available. But if providers had someone to monitor employee skills, they could optimize processes by matching individuals with the right skill set to each task.
"Lots of productivity is lost by putting the wrong people in the wrong jobs," Marshall said.
Developing skills beyond Facebook and apps
For many employers, finding the right candidate to bridge the gap between health care and IT can be a challenge. A 2014 Burning Glass report found that listings for clinical analyst positions stay open 15 percent longer than the national average.
A quick web search for degrees in health or biomedical informatics will pull up programs from countless universities around the country, including some of the most respected names in medical training: Harvard, Stanford, Johns Hopkins.
Health informatics education has risen in tandem with the health IT industry. These increasingly common programs provide students from a variety of backgrounds — health, computer science, information management — with courses in system design, database analysis and information systems alongside health care and health policy. They teach students how to use data from health apps, electronic health records and other sources to affect change in their patients and avert public health crises.
This type of education requires more than just the basic technological comfort and literacy that most people ascribe to the younger generation, said William Hersh, chair of the department of medical informatics and clinical epidemiology at Oregon Health & Science University. The college received an ONC grant to update health IT training materials.
"Knowing how to post something on Facebook is not informatics," he said. "Implementing these information systems in health care is not like downloading an app. ... Most of these systems have complex workflows around them, so you really need expertise."
Students need to understand the complexities of the health-care industry and its financial structure.
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"Health-care data isn't as clean or clear as other kinds of data," said Eta Berner, professor of health informatics at University of Alabama at Birmingham, another ONC grant recipient.
If a patient comes in with symptoms of a heart attack, a doctor is focused on providing immediate care and not asking the patient detailed history questions. That means data available for health informatics specialists to review could be incomplete, a nature of primary health care that the data analysts need to understand, Berner said.
It is important for students to develop a thorough understanding of how health-care providers work while also mastering the more technical skills of informatics, said Marshall of the Huron Consulting Group. It is also their greatest opportunity.
"They are going to be the ones that have the fastest path to robust careers," Marshall said. "People who only know how to provide care are being left behind."
Net/Net takeways
More than $100 billion is being spent globally on health IT, 45 percent in the United States alone.
As many as 50,000 jobs will be added to the U.S. health information market starting next year.
Some health-care systems are already seeing a tech-related revenue bump.
Finding candidates with the right skill set bridging health care and tech is still a challenge.
Programs are springing up at top-tier universities to educate the next generation of health informatics specialists.
— By Aneri Pattani, special to CNBC.com
