By CAROL GENTRY The Tampa Tribune
Published: Jul 30, 2007
TAMPA – A decade ago, Cynthia Smith had five children and a high school diploma but no skills, scraping by on welfare and food stamps in Okeechobee.
Today, she’s a systems analyst for Tampa General Hospital, having worked her way up from a clerical job there in 1998. She was promoted a year ago from database specialist, she said, winning a pay boost to $43,000 from $29,000.
“I’ve been blessed,” she says modestly. But, she adds, “I was willing to learn anything and everything to get to where I am.”
Taking night classes, she earned an associate’s degree in computer science and plugged on. Now she lacks 10 classes for a bachelor’s and owns a home in Palm River near Brandon.
“I fell in love with computers,” says Smith, who had never heard of a computer mouse when she applied for aid to go to school. “It’s so much fun!”
The Bureau of Labor and private-sector employers say this country needs more Cynthia Smiths. Health information management, sometimes still called health information technology, is one of the fastest-growing fields around.
Efforts to computerize medicine have been going on for decades, but the field has lagged behind other industries. President Bush has declared the development of an electronic health network by 2010 a national priority.
Health information management careerists say they are a breed distinct from the software engineers and technicians who write computer code and keep networks running. Claire Dixon-Lee, vice president for education at the American Health Information Management Association, says her members serve as a bridge between information technology workers and health care professionals.
Her favorite analogy involves a water pipe.
“IT folks maintain the pipes, but we have to make sure the water is pure going through them,” she says.
The Bureau of Labor forecast in 2001 that the health information work force would grow by 49 percent by 2010. Two- and four-year health information management college programs are turning out about 3,000 graduates a year, only half as many as needed, Dixon-Lee says.
Meanwhile, some medical, nursing and public health schools are starting “informatics” programs as specialties or offshoots of the professional disciplines.
Because of the shortage, some companies that develop electronic health records are recruiting doctors, nurses and administrative staff from hospitals, health plans and medical offices – people who know the quirks of the U.S. health care system, patient flow, jargon and billing codes.
Not just any techie can build electronic medical records and networks that work in health care, employers say, because health care is even more complex than computer technology.
“Understanding the industry is key,” says Jason Patchen, chief executive officer of Visionary Medical Systems. “They’ve seen a million charts, and they know the work flow.”
Patchen says he would much rather teach information technology to a health care worker than explain the health system to a coder or network manager. He’s a living example; he gravitated to health IT from running health plans and medical groups, as did Visionary’s chairman, cardiologist Kiran Patel, who founded and sold WellCare Health Plans of Tampa in 2002. Patel’s son Shilen is president of Visionary.
Visionary, chief subsidiary of American Healthcare Holdings of Tampa, employs 68 at its Tampa base and more than 200 in Maryland, Miami and India, Patchen said. The cubicle farm at the Visionary offices off West Shore Boulevard mixes nurses and other health professionals with technical experts who have no background in the health field, and they help one another.
A health worker with no technical background would be hired at $50,000 to $60,000, he said. A nurse who walks in with some programming or technology background can start at $70,000 or more, he said, and a seasoned clinician with a technology background can make more than $100,000.
“We never stop hiring or looking for the best people,” Patchen says. “They are our most important asset.”
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Mary Anne Brunelli was the ideal hire for Visionary: She was a software engineer in the 1980s and became a nurse in the mid-1990s because she missed contact with people. “I’m not a sit-in-front-of-the-computer type,” she said.
Now she travels to see clients or prospects in medical offices, customizing software to fit the needs of the doctors, nurses, billers and front-desk clerks. Unless all of them find the electronic record system easy to use, they won’t use it.
“This really is my love,” Brunelli says. “I want medicine to make use of the computer.”
Most nurses, doctors and health administrators don’t have Brunelli’s software training, so Visionary puts them through six to eight weeks of in-house IT training. They need to understand code even if they’re not writing it themselves, Patchen says.
Doctors and nurses provide content for the health records, arranging time-saving lists of likely symptoms, diagnoses, tests and prescriptions so their client clinicians can substitute quick clicks for handwritten charts. That provides a solid audit trail to back up the billing.
They also tell the computer what kinds of prompts to give the clinical staff. Did Mr. Smith stop at the lab for blood tests, as instructed? Are the results in? Did Mrs. Jones fill her prescription this time, or has she stopped taking her medicine again?
Hospitals’ information needs are even more complex because patients are often unable to communicate and in many cases are desperately ill. They need a rapid series of tests and treatments conducted by different departments, and monitoring by a broad variety of health professionals who work on different shifts and seldom communicate except through electronic records.
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Tampa General Hospital spends about $20 million in operating funds and at least $5 million in capital expenses annually on information systems, says Ginger Oliver, its vice president for information systems.
Although that represents only 2.5 percent of TGH’s billion-dollar budget, she said, it’s a vital fraction that affects every department. “If I break down,” Oliver said, “they break down.”
A pediatric nurse who switched to information systems in 1982 when the hospital got its first computers, Oliver acquired an MBA and worked her way up to senior management. Nurses are an increasing presence among chief information officers in health care, she said, and she employs five former nurses who have shifted to programming.
It’s not hard to see why. Unlike nursing, IT requires no heavy lifting, no blood or other body fluids, and higher pay. Oliver was losing her IT staff to other industries until she persuaded the hospital’s human resources staff that the pay scale had to conform to the IT industry, not to that of a hospital.
Given the nursing shortage, some worry whether health care can afford to lose more nurses to information management. But the question is moot unless the industry is willing to increase nursing salaries by 50 percent.
Reporter Carol Gentry can be reached at (813) 259-7624 or cgentry@tampatrib.com.
