College of St. Scholastica Deans believe HIT transition constitutes a significant paradigm shift – and they’ve adapted their programs accordingly.

By Alex McEllistrem-Evenson, Editor, Health Workforce News

Nationwide, Health Information Technology (HIT) is one of the hottest topics in health care. Between the billions of federal dollars devoted to improving HIT infrastructure in the HITECH Act as part of the American Recovery and Reinvestment Act (ARRA, or the stimulus bill), shifts in policy towards achieving “meaningful use” standards to receive Medicare incentive payments, and state-level initiatives, the question is no longer whether HIT will be adopted, but rather, how an already-taxed health care infrastructure will go about making these significant transitions.

Perhaps it’s surprising, given all of this attention, that a small, private college in Northern Minnesota is receiving recognition for innovative efforts in training a technology-savvy health workforce.

The College of St. Scholastica in Duluth has a total enrollment of only about 3,700 students, but the school offers four different programs in Health Care Informatics and Information and faculty have emphasized the importance of Electronic Health Records (EHR) in the classroom for students in nursing, occupational therapy, physical therapy, exercise physiology, athletic training, and social work for years.

Dr. Marty Witrak and Dr. Rondell Berkeland at the 2010 Rural Health Policy Institute in Washington, DC.

“In 2002, we started a partnership with the Cerner Corporation to use their Electronic Health Record as a teaching and learning tool,” states Dr. Marty Witrak, a professor and Dean of the College of Nursing at St. Scholastica. “We like to think that we are producing cutting-edge professionals in every health professions discipline within our schools,” she continues.

“They all keep medical records, they all have to manage information about their clients,” remarks Dr. Rondell Berkeland, Dean of the School of Health Sciences at the College of St. Scholastica. Berkeland is quick to clarify, however, that it’s not about teaching students how to operate the computer and input data. “That’s a no-brainer,” he adds. “Any student today can step up to any system and do that. It’s more about learning what this technology allows you to do as a health professional, learning what other information is immediately available.”

For Witrak and Berkeland, HIT places unique demands on health professionals, providing them with opportunities to work in ways that may not accord with the various skill-sets instilled through traditional classroom pedagogy. “In the old days when we would graph lab results,” states Witrak, referring to her experience as a Registered Nurse, “we’d put the red blood cell count on a graph and the white blood cell on another, and the temperature and all of that. Now, you can pull all of that—and more—up on a screen and you can see which information goes together and which does not. Students are able to make associations in a visual way and they need to learn how to think within this environment.

“This electronic environment changes the work that the professional does,” states Witrak. “You have to be able to think about how to put information together, how to make critical decisions.” In her opinion, the key question for a health provider working with an EHR now becomes, “’Where within this record do I go?’ I think physicians and nurse practitioners and PAs are going to be more like puzzle-solvers than strictly following a diagnostic tree. Nurses in hospitals are going to be more about trying to figure out what the meaning of what they’re seeing is rather than just cataloguing what they’re seeing. It’s really requiring a different level of student in these programs.”

This approach, fundamentally different in both Witrak and Berkeland’s opinions, allows students and providers to make large-scale connections and conclusions previously only the province of the research professional. “The informatics courses help our students learn to aggregate data about patients and patient care delivery methods, and then understand what that means differently than we’ve ever been able to do before,” states Witrak. “I think it’s one of the things that both scares and excites professionals. We’ll be able to see what nursing programs or nursing care plans produce the best outcomes for asthmatic kids, for cardiac patients, and for teaching people. We’ll be able to see whether individual nurses perform differently or the same.”

“It really is a paradigm shift,” Berkeland adds. “It really has all these characteristics we associate with a paradigm shift, a different way of doing something, a change in the culture. That’s neither good nor bad; it’s just the fact that change is so profound sometimes.”

Of course, any significant change or paradigm shift is met with resistance, something both Witrak and Berkeland have been dealing with as Deans, marshalling both students and faculty through this process as well as working with workforce professionals outside the ivory tower. “It isn’t necessarily the fact of what’s happening that’s hard for people to adjust to,” Witrak clarifies, “it’s the idea of it. It is a change and it’s different than it’s been before. When we have big changes like that, a lot of people have an immediate pushback.”

“It’s going to take a lot of savvy on the part of the people in charge of directing the change process,” she adds. “I’ve been a part of the Rural HIT Coalition and we’ve been looking at workforce issues nationally, considering what kinds of people we need to make this whole move to EHRs work.”

“We’ve got essentially three basic categories,” she elaborates. “First, there are the people whose job it is to work with the record system such as technicians and health information management professionals. The second major category is the clinicians who use it – that’s who most people think about.”

“The third group that’s really important, however, is comprised of administrators in charge of managing this change in hospitals or clinics. Everything we know about large changes in health care tells us that if they’re not managed properly, they don’t succeed. These managers and administrators need to know how to manage the change process. It is a profoundly different way of doing work.”

In a recent presentation, Dr. David Blumenthal, National Coordinator for Health Information Technology, likened the EHR to the stethoscope, stating that “in fifteen years, you won’t want to be caught not knowing which end to put in your ear.” Given the massive amounts of funding and policy attention which have been devoted to adopting HIT usage nationwide, what’s the likelihood that this transition might fail?

According to Witrak, the biggest potential pitfall has to do with workforce. “You hear a lot, especially in rural facilities, about professionals who say ‘I don’t want to take the time to learn how to use this, I’d rather retire.’ It’s a huge challenge for the revenue stream for a lot of these already-stressed clinics and hospitals because it does in fact slow you down when you’re first learning this, just like when you get a new cell phone or computer. It’s important because of workforce issues that we bring everybody along that we can. We can’t afford to lose experienced doctors and nurses and PTs and OTs, we need every single one of them. Every single one.”

Aware of this, the Federal government designated certain ARRA funds, through the HITECH Act, to establish HIT Regional Extension Centers intended to “offer technical assistance, guidance, and information on best practices to support and accelerate health care providers’ efforts to become meaningful users of Electronic Health Records.” According to an official statement by the Health IT division of the Department of Health and Human Services, “The extension program will establish an estimated 70 (or more) regional centers, each serving a defined geographic area. The regional centers will support at least 100,000 primary care providers, through participating non-profit organizations, in achieving meaningful use of EHRs and enabling nationwide health information exchange.” Blumenthal likens this technology extension program to the USDA’s Agricultural Extension Service, established by the federal government to educate citizens about best practices in agriculture.

“It’s going to be absolutely important that these regional extension centers help professionals learn in a positive way to make this change,” states Witrak. “It’s going to be a challenge. There aren’t enough consultants to really deploy overnight to make this transition happen as quickly as it’s going to need to,” she adds. “The concept of the regional extension centers is an acknowledgement of that. The goal is to look at those primary care providers, so that at that level there’s some attention given to getting those folks where they need to go. Like Ron said, it’s going to be an amazing change.”

Berkeland elaborates: “Newt Gingrich has said that Congress is not capable of making a transformative change; Congress has only been capable of making incremental changes. That’s probably accurate more often than not, but what I find so interesting from a change perspective is the fact that even with all the resistance to health reform, the most transformative change on the health care system is, ironically, already going to occur. These EHRs are being implemented on a nationwide basis through ARRA money.”

According to Witrak, these changes are far-reaching. “We’ve not been able to say what our best practices within our disciplines are, because we haven’t had everybody in the data. One thing about meaningful use is that we will have as many people as possible within the [EHR] system.”

Both Witrak and Berkeland believe that current or looming obstacles will be reduced as EHR adoption becomes more widespread. Witrak concludes: “At the end of the day, it’s a really great idea. If we can get to where we want to with meaningful use we’re going to see big changes in [reducing] health care costs, in the way that patients become involved in their own care. We are on the cusp of really producing a workforce that’s going to be working very differently.”