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Officials for the Centers for Medicare and Medicaid Services announced on Wednesday that the agency plans on distributing billions in stimulus monies to upgrade the nation’s paper medical records to electronic ones. Under the proposal, doctors and hospitals that keep UPDATED electronic medical records (EMR) of their patients could receive bonus payments for using EMR-based software systems. While the proposal that was floated is not definite, it was posted to the agency’s website and is open for public comment for 60 days before the final guidelines are issued. 

According to agency spokespersons, healthcare professionals (HCPs) who use EMR for 80 per cent of their medical instructions could receive bonus payments. This means that HCPs would have to provide patients with printouts of their medical history and use computers for potential drug-drug interactions. Further, hospitals would be required to complete 10 per cent of medical orders electronically. Separately, the agency laid out technology standards that EMR software should meet to qualify for the program.

Although technology standards for government-based EMR systems have now been delineated, similar standards for private sector EMR keeping systems have yet to be clearly enunciated by the government. Many hospitals and HCP organizations hastily threw together EMR plans to qualify for stimulus monies that were disbursed early last year. Unfortunately, at present, there is still no general consensus on the software platforms and middleware programs that will need to be developed so that different EMR systems can communicate with one another! Consequently, the national drive to digitize paper medical records is occurring in a haphazard and piecemeal fashion. To realize improved efficiencies and cost savings, I contend that general guidelines ought to be issued before too much private sector work goes on. Allowing the private sector to dictate technology standards may not be in the best interest of a national EMR effort. Nevertheless, as I mentioned an earlier post this week, healthcare informatics is one of the fasted growing industries in the US!

Until next time...

Good Luck and Good Job Hunting!!!!!!!

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Healthcare informatics (HCI) is one of the fastest growing professions in the US. This is because the Obama administration has allocated billions of stimulus dollars to create electronic healthcare records (EHR) in an attempt to reduce healthcare costs. 

To qualify for EHR stimulus monies organizations must develop a plan and then take steps to implement it! Not surprisingly, because of the short ramp up phase for EHR, the number of available jobs far outstrips the numbers of qualified and skilled employees to fill them. The acute shortage of qualified HCI employees resulted in a cover story in the December 2009 issue of Health Informatics entitled “Got People?” It is a great read and provides insights into the types of employees that HCI companies are looking to hire.  The EHR Initiative will likely create over 500,000 new jobs in the next few years. For those of you, who may be interested in pursuing a career in HCI, check out this list of the top 100 HCI companies to work for.

Finally, a group of bioinformatics and genomics PhD students and postdoctoral fellows approached me to help them find sponsors for a Health Informatics Career Development symposium that they are trying to develop for the 2010 Intelligent Systems for Molecular Biology (ISMB) conference that will be held in Boston, MA from July 9-13, 2010.  

If you are interested in sponsoring the HCI symposium please contact me.

Until next time...

Good Luck and Good Job Hunting!!!!!!!!

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Advances made in DNA sequencing technology and genomic analysis has lowered the cost of sequencing a genome from millions of dollars a decade ago to less than $500 today. And, because of this, there are a growing number of companies that are willing to quickly and cheaply sequence and analyze your DNA. While this may be medically beneficial and appealing to some, it may not be for everyone. Moreover, and perhaps more importantly, who will control access to and insure the privacy of your genetic information if you choose to have your genome sequenced and analyzed. 

Alan McHughen, PhD, a molecular biologist and Professor of Botany and Plant Sciences at the University of California-Riverside, who has previously written about privacy and access to personal genomic data, wrote an article for BioJobBlog that explores the ramifications and possibility of DNA identity theft in the future. Also, he has written a book 'Pandora's Picnic Basket; The Potential and Hazards of Genetically Modified Foods' to refute the myths and explore the genuine risks of genetic modification technology

Genetic Privacy

By Alan McHughen

For just $399 (plus shipping and handling), the scientists at 23and me.com will scan your complete genome. The DNA analysis reports on 118 different medical and health dispositions, your maternal and paternal ethnic ancestry, and a curious bunch of genetic trivia concerning your persona (is your earwax sticky or flaky?). All you do is pay the money and spit into a collection tube; they extract your DNA from the spit and look for half a million single nucleotide polymorphisms (SNPs) scattered throughout your genome, including many in or near genes associated with particular traits. Other companies offer similar services. For example, Decodeme.com charges $985, but catalogs twice as many SNPs, and you collect your DNA with a cheek swab.

Alternatively, if you don’t need the complete genome scan but are curious about specific medical conditions or family lineage, you can get less expensive gene tests from an increasing number of companies willing to take your money and DNA sample in exchange for the genetic information their scientists reveal. If heart disease runs in your family, you may either relieve or exacerbate your anxieties by shelling out $200 to have a cardio scan for relevant genetic predispositions. Or, for as little as $99, a man can have his Y chromosome probed to confirm his place in the family patrilineage, and possibly connect to ancient and famous princes or pirates.

These genetic information services, with prices now well into recreational and hobby budget range, provide the most personal, private — and unchangeable— information possible about you. The sinister side of this fascinating field is all too often overlooked—it can reveal your most intimate genetic details to strangers and nosy neighbors. While the various testing labs assure confidentiality, there is little to no control over personal genetic information. In the US, anything you discard is salvageable by anyone else, and your trash can become another’s treasure if it carries blood, saliva, hair, semen or any other DNA-laden bodily secretions.

While we worry about identity theft, personal financial or other private information, our uniquely personal information is up for grabs. The Genetic Information Nondiscrimination Act (GINA) of 2008 offers some protection, but it is limited to employment and medical insurance issues. GINA does not protect your genetic information from being abused by life insurers. Or nosey neighbors. 

Genetic privacy raises a whole spectrum of social, ethical, legal and medical issues. Suppose your neighbor salvages your trash and has your DNA analyzed. This local gossip then shares the juicy news that you have a “higher than average predisposition” to, say, alcoholism. Soon, everyone in the community shuns you as a latent alcoholic, and you have no idea why. The community knows more about your genetic makeup than you do. And, because they don’t know how to interpret statistical language such as “a higher than average predisposition”, those conditions may easily be exaggerated into probabilities, if not certainties.

If people have a right to know their own genetic information, they have the obverse right to NOT know. People can choose to remain ignorant about their genetic makeup. Consider, for example, Huntington’s disease (HD). This death sentence is one of the few health conditions almost due to genetics, and the DNA assay has been available for years. Curiously, most people at risk, i.e., those with HD in their direct lineage, choose NOT to take the test; they prefer not to know until (or if) symptoms appear. What happens when the local busybody lets the cat out of the bag on HD? Word will get around and the at-risk person will inevitably find out, if only by the ‘different’ treatment by neighbors, thus obliterating the exercise of their right to remain ignorant. Whether the test result is positive or negative on HD is immaterial at this point, the rights will have been violated. The DNA test for HD is currently more elaborate than the simple SNP analysis, but because SNPs associated with HD are being reported, it’s only a matter of time before they come generally available.

Perhaps you’ve suspected the woman down the street had a child from an adulterous one night stand a few years ago, and the cuckold husband remains a doting, if clueless, dad. Now, with just $89 (including overnight FedEx delivery!) and a little misdemeanor creativity, well within the standard ethical bounds of busybodies, you can satisfy your suspicions with a surreptitious and discrete paternity test. And, to provoke some real excitement in your sleepy small town, show the results to the husband.

A few minutes of thought and discussion generates many other issues and examples of the precarious security of personal genetic information and identity, and the potentially dire consequences of genetic information getting out. Society is yet to discuss the privacy issues surrounding genetic identity as vigorously as we have with personal financial or medical records. It’s getting late. Do you know where your DNA is?

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I don’t want to brag but I have been touting career options in health informatics and health information technology (HIT) for the past year or so. Today, I came across a post by CareerBuilders declaring health informatics and HIT are the hottest new career trends to hit the market in recent years. As the drive towards digitizing medical and healthcare records continue, there will be literally thousands of job opportunities for people with the right skill set. This is what the post had to say about health informatics and HIT careers and job opportunities. 

Health Informatics
Health informatics will put technology in place that provides hospitals and other health-care providers with access to an electronic network of vital patient information such as like medical histories and prescriptions. The information age finally meets healthcare administration.

The facts
The health informatics initiative won’t succeed unless employees — that’s you! — bring the specialized skills needed to build and expand the network. All other pieces are in place:

• The American Recovery and Reinvestment Act of 2009 includes $20.6 billion to help providers drive adoption and development of the IT infrastructure needed
• The U.S. Bureau of Labor Statistics (BLS) projects health information management employment to grow nearly 18 percent by 2016
• The BLS projects a need for more than 6,000 new professionals each year through 2014 — but only 2,600 graduates have entered the field this past year 

Your opportunity
To succeed, health informatics (HIM) will demand a wide variety of specialized positions across IT and health care. It will engage conventional experience from both areas — such as registered nurses and LPNs/LVNs, or IT implementation specialists and IT project managers — if you’re looking for a new twist on your current career.

But new positions will also thrive in this hybrid field. Look for new HIM job titles in your next job search, like health IT professionals, HIM coders, HIM medical records professionals and various health informatics specialists, including trainers, researchers and analysts.

Get online to check out the job titles mentioned above and listed below for related descriptions, and see if you might need any additional training to meet requirements: 

Nursing
- Telemedicine clinical professionals

- Chief nursing information officers

- Clinical IT liaisons 

Health-care administration
- Medical and health services managers

- Document scanners

- Data entry clerks

- File clerks

IT specialists
- Senior programmers

- Senior clinical analysts

- Database analysts

- Developers

- Business analysts

- Software engineers

- Data integration specialists

Not too shabby of a list! In a previous blog post I identified a variety of training options for people interested in pursuing careers in health informatics and HIT. Check it out!

Until next time....

Good Luck and Good Job Hunting!!!!!!!

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In a previous post I lauded health information technology (HIT) aka health informatics as a possible new career choice for scientists with life sciences PhD degrees who also have a proclivity for software development and data base management. Shortly after I posted the piece, I happened to read an article in a local publication about a NJ-based company called the MISI Company that is at the forefront of the HIT field and developing software to help digitize American healthcare records. 

I invited Dave Roth, an MISI executive, to share his views on the future of HIT and what ought to be done to insure that e-medical records are appropriately and successfully created. BTW, for my bioinformatics and genomics friends, MISI is looking to hire a few talented men and women who are interested in HIT careers.

HIT: The Other Missing Link

by Dave Roth

Health information technology (HIT) is hot. There’s every reason to believe that HIT will play a major role in the reforms envisioned for our health care system. From President Obama announcing $5B in grants to aid medical research, to bioinformaticists developing tools for predicting genetic predisposition to diseases, to software developers working on electronic medical records (EMR) systems, HIT is a burgeoning field. What concerns people like me – read: people who are users of technology rather than the developers of it – is that all this HIT talk seems to have very little mention of us in it.

Not long ago, I wrote an article called The Missing Link in Healthcare IT: The Consumer. In it I pointed out that none of the current government definitions being proposed for "meaningful use" of electronic medical record (EMR) systems define meaningful from the healthcare consumer's perspective. I also noted that whatever rules the government establishes for receiving stimulus money for the development of HIT solutions, none of them will exclude technologists from collaborating with consumers in the development of their solutions. I posited that technologists would be doing us all a favor if they would stop to consider for a moment how their systems will affect the consumer’s experience of health care services.

I was encouraged when David Goldhill, in his cover story in the September 2009 issue of Atlantic Monthly, How American Health Care Killed My Father, wrote, “[A] guiding principle of any reform should be to put the consumer, not the insurer or the government, at the center of the system.” Goldhill’s prescription for a better health care system begins with advocating for the consumers of services and focusing on how to get the best outcomes for those consumers at a reasonable cost. He was channeling the views of many people, such as Harvard Business School professor Regina Herzlinger, who believe consumer-driven health care is the only reform that will truly be meaningful.

The growing visibility of the consumer in this debate has gotten me to thinking there is real opportunity in the HIT job market for another missing link: Consumer-centric Health IT Developers. It is a rare developer who brings to his/her craft an appreciation of the importance of understanding who you are developing for. Rarer still is the developer who is aware of and employs tools and techniques for capturing end-users’ feedback during the development process. More often than not, user-centered design (UCD) is considered a luxury that burns up time and precious dollars. This misconception is largely the result of development teams typically waiting until they are too far into the development cycle before engaging with those who will be using their creation. Inevitably, problems are discovered with the usability or utility of the system that will hinder adoption. But the problems are discovered too late to be fixed by the target launch date and/or within budget. Users/Consumers become the enemy in this scenario.

There is another way. HIT technologists should understand how and why to engage their target audience at the beginning of the development process, long before anything is actually developed. They should begin by understanding who they are developing for, what these people are looking to accomplish, and how they can best help them accomplish it. Using such techniques has been shown to actually reduce downstream development work and increase adoption. I believe technologists schooled in the techniques of consumer-centered design will be central to any successful, long-term health care reform.

Dave is Vice President and  heads MISI Company's Experience Design (XD) group - a group of strategists, experience architects, visual designers and technologists whose mission is to help ensure the success of every interaction between a business and its target audience. His career spans 30 years and includes award-winning work in documentary and corporate film/video, print advertising, and interactive software application development for computers and the Internet. Dave is a Stanford University grad, a SF 49ers fan and a member of the Single Malt Scotch Whiskey Society.

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Are you a life sciences or healthcare professional with a passion for computers, IT or software development? If so, you might want to consider a career in health informatics—one of the hottest, new fields in the life sciences and healthcare industries. Health informatics specialists typically have expertise in medical records and claims, clinical care and programming. In other words, they have a foot in two worlds— medicine and technology — and can easily bridge the often daunting gap between them. It is important to point out that there is a difference between healthcare IT and informatics personnel. The health IT people run the servers and install software, but the informatics people are the ones who analyze and interpret clinical/ medical information and work with clinical and other healthcare staff to advise and help them.

According to an article in this Sunday’s NY Times, health informatics specialists usually start as computer programmers or as doctors, nurses, pharmacists or health record administrators. After earning a graduate health informatics degree, they find jobs as mid level or senior employees at hospitals, doctor’s offices, insurance companies, pharmaceutical companies or other organizations concerned with health data. Mid level jobs, like those for clinical analysts or informatics analysts, are usually about $70,000 a year, but salaries can be much higher for more senior level positions.  Senior level jobs, which sometimes require a Ph.D., include chief clinical information officer or other management/leadership roles at medical devices, life sciences or insurance companies. Consulting firms are also hiring health informatics experts to serve many of their health care clients who frequently don’t have the resources to hire permanent informatics staff.

At present there are no educational, licensing or credential requirements to become a health informaticist. However, a growing need for health informaticists has resulted in the creation of a number of degree programs at two and four year colleges and universities. For example, within the past four years, Columbia University, St. Louis University, the University of Minnesota and Oregon Health and Science University have all added master’s programs or certificates in health informatics. Other schools offer short courses or part-time certificate programs to healthcare employees or programmers. Still others are adding undergraduate majors or associates degrees programs to their curricula.

While many schools are beginning to offer health informatics programs, not all informatics programs are “created equal.” Generally speaking, “medical” or “biomedical” informatics programs focus on data that doctors need for treating patients. Bioinformatics” programs concentrate on biological or genetic data, while “health informatics” programs often emphasize clinical data and health records. Even among programs with the same name, the emphasis and expertise may vary at different institutions that offer the training.

By all accounts, health informatics —despite some early confusion—is one of the fastest growing careers in the bioscience and healthcare fields. Unlike other fields in the shrinking life sciences industry, there are plenty of jobs out there for health informaticists. Ironically, the failing US economy is what is driving the growth of the health informatics industry. The US government’s economic stimulus package has allocated $19 billion to hastening the adoption of electronic health records, so demand for health informatics specialists is skyrocketing. “My rough estimate is that we need about 70,000 health informaticists,” said Don E. Detmer, president and chief executive of the American Medical Informatics Association, a nonprofit industry group.

However, as a word of caution, it usually takes more than technical skills and an understanding of health care to succeed as a health informaticist. Diplomacy and conflict resolution skills are crucial when dealing with two potentially contentious groups: healthcare workers and programmers. Nevertheless, healthcare informatics is an ideal field for bioscientists and healthcare workers who also like to work with technology, computers or develop software. Based on my recent experiences as a bioscience career counselor, I know that there are thousands of you out there that fit this description. Now be the time to take a closer look at the exciting, new field of health informatics to determine whether or not it may be a career option for you!

Until next time...

Good Luck and Good Job Hunting!!!!!!!!!!

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