Electronic Health Reporter

Guest post by Jeff Urban is the Area Vice President of MedSys Group.

With the introduction of the affordable care act, the ubiquitous feeding frenzy for HIT talent began in 2009, and has yet to slow down. As the shortage of individuals escalates, pay has accelerated to levels unseen. Hiring full-time employees by hospitals has become less commonplace, as the demand and upside of consulting is too lucrative for talent to turn down.

Prices are increasing, and the current model is becoming unsustainable. As competition becomes fiercer and decisions are being made faster and without adequate time for proper due diligence, many hospitals and staff augmentation firms feel they have found a way out. The belief that a pure information technology individual, once trained, can fill the role of a healthcare IT subject matter expert (SME) is becoming more widely accepted, and if perpetuated, has the chance to create more issues than it solves.

With baseball season, we will undoubtedly hear more baseball rhetoric. I tend to think of a hospital’s IT individuals as a baseball team. The everyday players have an understanding of the entire game, fielding, hitting, base running, etc., while the designated hitter, or DH, is an individual that only hits. He has lots of power, and the team wants him to focus on hitting, nothing else. He is, in all accounts of the word, a specialist. You can think of IT and HIT in the same context. SME’s are just that: Specialists. They focus on their niche, and know every aspect of it.

When a market changes and the specialists are in more in demand, organizations (including baseball teams) look for less costly alternatives to fill the void. An everyday player at a lower rate, if trained correctly, can certainly take the DH role, they believe. However, the results are all too many times, in complete contrast to the ultimate goal.

Everything comes down to the intricacies of the role. At the specialist level, the slightest mistake can quickly become a glaring issue. In baseball, ½ inch can mean the difference between a home run and a lazy fly ball. Thus, the attention to detail needed is extremely high.

SME’s, not unlike the designated hitter, have more specific issues than typical IT individuals. None of which are more prevalent than trust. The users (physicians and clinicians) must have trust that the SME has an understanding of what they face on a daily basis. Change management can be a very demanding task and this is made dramatically more difficult if the users do not believe the SME has a strong understanding of how one clinical workflow intertwines with another. Without this experience, the non-specialist can unknowingly prioritize certain goals without the needed correlation to user adoption. With no clinical background the ability to deliver customizable products with an ease of use, as to not weaken patient safety and timeliness, is diminished rapidly.

If you have ever listened to the play-by-play analysts of a baseball game, you can become lost in what they are talking about. With terms like RBI, ERA, OBP, WHIP, etc. it can seem like they are speaking a foreign language that only they can understand. One may get pieces, but disseminating that information can be very difficult. Healthcare is no different. Thus, the other glaring weakness of the transitioning pure IT individual is terminology.

Communication is a key component to a successful implementation. If the learning curve of terminology is drastically high, the project can screech to a crawl. More importantly if communication is misunderstood, it can dramatically influence the final outcome’s success or failure. Thus, in a sense, SME’s have developed more art than science in language and processes. This makes transition very difficult.

If just training won’t cut it, what can a hospital do to alleviate the costs? One thought becoming more common is the training of tech-savvy clinicians, often called super-users. While a clinician shortage has tamed this somewhat, the idea of giving a super-user the necessary classroom knowledge, is still much less painful than the alternatives. Another practice rapidly becoming popular is teaming a super user with a SME.

The knowledge transfer can be relatively seamless, and will perpetuate trust. Once the super user is fully trained, the hospital gained another specialist, making the entire team stronger. While both thought processes hold merit, they do come with drawbacks. Most importantly taking clinicians from an already understaffed area can have far reaching affects. Also, as a hospital organically grows, it opens itself up to competition. The specialists are valuable, and with other hospitals willing and able to take talent, the primordial revolving door can take hold quickly.  There is nothing more frustrating for a hospital executive than to train an employee to only lose them to a competitor.

While an everyday player can substitute for the DH on some things, and relieve some stress, the possible downside makes the transition a tricky one at best. An everyday player may make contact, but is that what is needed at this time? With deadlines approaching quickly, I’d rather have my specialist at the plate, as he gives my team the best chance at a home run, and thus winning.

Jeff Urban is the Area Vice President of MedSys Group where he is responsible for the management of business development in the West, Great Lakes, and Desert regions. He is in charge of the development of Regional Account Executives and Area Account Managers for each region. Jeff is also a member of the strategy management team, which is comprised of the core leadership of the organization. He also participates in the process improvement team.