Health Information Workforce Research Articles

Modernizing Public Health Data Systems and Workforce Capacity: The Centers for Disease Control and Prevention's Public Health Informatics Fellowship Program.

The COVID-19 pandemic exposed governmental public health's outdated information technology and insufficient data science and informatics workforce capacity. The Centers for Disease Control and Prevention's Public Health Informatics Fellowship Program (PHIFP) is well positioned to strengthen public health data science and informatics workforce capacity. Established in 1996, PHIFP is a 2-year, full-time, on-the-job training program. PHIFP includes a didactic curriculum, applied learning through informatics projects completed at the assigned host site, short-term technical assistance projects, and a final capstone project. Fellows have learned from and bolstered host site informatics capacity through the development or enhancement of information systems, evaluations, data integration, data visualization, and analysis. Among recent graduates, 54% are employed at Centers for Disease Control and Prevention and 16% are employed at other public health organizations, including local health departments. Fellowships such as PHIFP, which recruit and train promising scientists in public health informatics, are important components of efforts to strengthen public health workforce capacity.

Building a More Diverse Public Health Informatics Workforce: Preliminary Results.

The US public health infrastructure has been historically underfunded, a condition that was exacerbated by the COVID-19 pandemic. This was especially noted in the area of public health informatics. It was also acknowledged that the lack of a diverse public health workforce made it more difficult to address biases and disparities effectively. In 2021 the Office of the National Coordinator awarded $73 million to 10 awardees to develop public health informatics and technology (PHIT) workforce training. The Gaining Equity in Training for Public Health Informatics and Technology (GET PHIT) award utilizes various methods to train and engage minority and underserved populations in the field of public health informatics. Evaluations of the bootcamps and internships to date have shown generally positive results, both in terms of skills acquired and overall experiences. These results indicate that integrating the fields of public health and data science in non-degree, short-term experiences can have positive outcomes.

Impact of Service-Based Student Loan Repayment Program on the Primary Care Workforce.

As the average level of medical education indebtedness rises, physicians look to programs such as Public Service Loan Forgiveness (PSLF) and National Health Service Corps (NHSC) to manage debt burden. Both represent service-dependent loan repayment programs, but the requirements and program outcomes diverge, and assessing the relative uptake of each program may help to inform health workforce policy decisions. We sought to describe variation in the composition of repayment program participant groups and measure relative impact on patient access to care. In this bivariate analysis, we analyzed data from 10,677 respondents to the American Board of Family Medicine's National Graduate Survey to study differences in loan repayment program uptake as well as the unique participant demographics, scope of practice, and likelihood of practicing with a medically underserved or rural population in each program cohort. The rate of PSLF uptake tripled between 2016 and 2020, from 7% to 22% of early career family physicians, while NHSC uptake remained static at 4% to 5%. Family physicians reporting NHSC assistance were more likely than those reporting PSLF assistance to come from underrepresented groups, demonstrated a broader scope of practice, and were more likely to practice in rural areas (23.3% vs 10.8%) or whole-county Health Professional Shortage Areas (12.5% vs 3.7%) and with medically underserved populations (82.2% vs 24.2%). Although PSLF supports family physicians intending to work in public service, their peers who choose NHSC are much more likely to work in underserved settings. Our findings may prompt a review of the goals of service loan forgiveness programs with potential to better serve health workforce needs.

Rural health information technology and informatics workforce assessment: a pilot study

Rural health information technology and informatics workforce assessment: a pilot study

Training the MCH workforce: the Time for Change is now

IntroductionMaternal and child health (MCH) services are critical for vulnerable populations. Workforce shortages, poor retention, and gaps in necessary trainings impede the capacity of public health systems to address needs. This manuscript characterizes the current MCH workforce, MCH program applicants and graduates, and describe findings within a national context to devise elements of a recruitment and retention strategy.MethodsData were obtained for public health program applicants, first-destination employment outcomes, and worker perceptions and demographics. Data were stratified according to the MCH and total public health workforce and by local, state, and national totals. Data were characterized by degree type, discipline, demographics, and employment outcomes.ResultsMCH staff constitute 11% of the state and local governmental public health workforce. MCH staff are approximately as diverse, have higher educational attainment, and are more likely to hold nursing degrees than the rest of the public health workforce. Yet, just 14% of MCH staff hold any type of public health degree. The MCH pipeline from academia appears modestly sized, with approximately 5% of applicants between 2017 and 2021 applying to a MCH master’s degree.DiscussionThe MCH workforce has a lower proportion of formal training or degrees in public health, though trends seem to indicate improvements. However, it is critical that a multi-faceted recruitment and retention strategy be coordinated by a broad range of stakeholders. These efforts will serve to improve the capability and capacity of the public health system to address critical needs of increasingly diverse MCH populations.SignificanceIn order to modernize and reimagine the academic-public health pipeline, it is critical to better understand how many applicants and graduates exist within Maternal and Child Health programs across the US, and their characteristics. This manuscript connects that information with the most recently available public health workforce information on demographics, workplace perceptions, and intent to leave among staff at state and local health departments. Data presented in this paper allow the most comprehensive characterization of the MCH academia->practice pipeline to-date, identifies a fundamental disconnect in those career pathways, and offers options to repair that break.

Innovation of health data science curricula.

ObjectiveThere is a growing need for innovation to prepare a well-trained health informatics workforce with data science and digital technology skills. To meet the workforce demands and prepare students for a career in health informatics, a Health Data Science (HDS) concentration was added to the Master’s in Health Informatics (MSHI) program at the University of Illinois at Chicago.MethodsFour levels of learning were incorporated into the curriculum to prepare students for highly complex jobs in health informatics. Leader interviews, advisory board meetings, and mixed faculty expertise were utilized as inputs to survey and analyze the skills employers seek in the job market. An innovative rapid infusion approach was used to design assessments across the levels of learning that simulate real-world scenarios where these competencies are used.ResultsCourse evaluation surveys revealed strong satisfaction with the quality of the course and agreed that the course was intellectually challenging and stimulating. Students reported the 3 most beneficial aspects were: the live lectures, hands-on data research and manipulation, and simulated real-world situations.ConclusionsThis article discusses using a rapid infusion approach to developing active learning assignments designed to build competencies employers are seeking. These competencies also develop creative, divergent thinking with flexible, student-defined solutions. Survey data validates the approach to active learning put into context and made relevant to the learner. The benefit of the concentration is to provide students with the preparation for a successful entry into the Health Informatics field, one of the fastest-growing careers in healthcare.

A systematic review: Unfinished nursing care and the impact on the nurse outcomes of job satisfaction, burnout, intention-to-leave and turnover.

To investigate the association of unfinished nursing care on nurse outcomes. Systematic review in line with National Institute for Health and Care Excellence guideline. CINAHL, the Cochrane Library, Embase, Medline, ProQuest and Scopus databases were searched up until April 2020. Two independent reviewers conducted each stage of the review process: screening eligibility, quality appraisal using Mixed Methods Appraisal Tool; and data extraction. Narrative synthesis compared measurements and outcomes. Nine hospital studies were included, and all but one were cross-sectional multicentre studies with a variety of sampling sizes (136-4169 nurses). Studies had low internal validity implying a high risk of bias. There was also a high potential for bias due to non-response. Only one study explicitly sought to examine nurse outcomes as a primary dependent variable, as most included nurse outcomes as mediating variables. Of the available data, unfinished nursing care was associated with: reduced job satisfaction (5/7 studies); burnout (1/3); and intention-to-leave (2/2). No association was found with turnover (2/2). Unfinished nursing care remains a plausible mediator of negative nurse outcomes, but research is limited to single-country studies and self-reported outcome measures. Given challenges in the sector for nurse satisfaction, recruitment and retention, future research needs to focus on nurse outcomes as a specific aim of inquiry in relation to unfinished nursing care. Unfinished nursing care has previously been demonstrated to be associated with staffing, education and work environments, with negative associations with patient outcomes (patient satisfaction, medication errors, infections, incidents and readmissions). This study offers new evidence that the impact of unfinished nursing care on nurses is under investigated. Policymakers can prioritize the funding of robust observational studies and quasi-experimental studies with a primary aim to understand the impact of unfinished nursing care on nurse outcomes to better inform health workforce sustainability.

Conceptualizing and implementing a health workforce registry in Nigeria

BackgroundNigeria’s health sector aims to ensure that the right number of health workers that are qualified, skilled, and distributed equitably, are available for quality health service provision at all levels. Achieving this requires accurate and timely health workforce information. This informed the development of the Nigeria Health Workforce Registry (NHWR) based on the global, regional, and national strategies for strengthening the HRH towards achieving universal health coverage. This case study describes the process of conceptualizing and establishing the NHWR, and discusses the strategies for developing sustainable and scalable health workforce registries.Case presentationIn designing the NHWR, a review of existing national HRH policies and guidelines, as well as reports of previous endeavors was done to learn what had been done previously and obtain the views of stakeholders on how to develop a scalable and sustainable registry. The findings indicated the need to review the architecture of the registry to align with other health information systems, develop a standardized data set and guidance documents for the registry including a standard operating procedure to ensure that a holistic process is adopted in data collection, management and use nationally. Learning from the findings, a conceptual framework was developed, a registry managed centrally by the Federal Ministry of Health was developed and decentralized, a standardized tool based on a national minimum data was developed and adopted nationally, a registry prototype was developed using iHRIS Manage and the registry governance functions were integrated into the health information system governance structures. To sustain the functionality of the NHWR, the handbook of the NHWR that comprised of an implementation guide, the standard operating procedure, and the basic user training manual was developed and the capacity of government staff was built on the operations of the registry.ConclusionIn establishing a functional and sustainable registry, learning from experiences is essential in shaping acceptable, sustainable, and scalable approaches. Instituting governance structures that include and involve policymakers, health managers and users is of great importance in the design, planning, implementation, and decentralization stages. In addition, developing standardized tools based on the health system's needs and instituting supportable mechanisms for data flow and use for policy, planning, development, and management is essential.

International Analysis of the Classification of Occupations for the Health Informatics and Information Management Workforce

International Analysis of the Classification of Occupations for the Health Informatics and Information Management Workforce

European School on Health Information: Strengthening Public Health Information Workforce in Europe

Abstract Background The globalisation of the world economies has increased the need for more global health approaches requiring sophisticated and sustainable Health Information (HI) systems, and the development of new technologies. These new technologies require skilled professionals to manage public health information in most efficient ways. New challenges in Public Health, such as Pandemics, are demanding more skillful people to respond to these challenges. However, currently large inequalities on availability and training of qualified Public Health Information professionals exist in Europe. Methods In order to set up a sustainable European Union HI training program, the 1st European School on Health Information (ESHI2020) was developed, an HI capacity building programme with European Experts. Based on this, PHIRI established Capacity Building as a fundamental arm for the development of health information, from which a set of training, courses and webinars have emerged. Results The ESHI2020 took place online from Oct 1 to Nov 5 2020, and was focused on Health Examination Survey, from data collection to policy-making. The course consisted of 5 sessions, including theoretical and practical classes, group work among trainees and discussion of practical cases and projects on HIS involving trainees and trainers. 20 participants from Europe, and 15 lecturers from European most important public health institutes and Universities contributed to this training. Conclusions There is a need for qualified skilled professionals in HI taking into account a changing global environment. Most of HI capacity building programmes are yet to reach maturity, and the results from the first ESHI2020 led to a new strategy on Health Information in Europe, that with the support of the PHIRI project will give rise to an European and annual program on Health Information.

Coronavirus Disease 2019 Planning and Response: A Tale of 2 Health Workforce Estimator Tools.

As coronavirus disease 2019 (COVID-19) rapidly progressed throughout the United States, increased demand for health workers required health workforce data and tools to aid planning and response at local, state, and national levels. We describe the development of 2 estimator tools designed to inform health workforce planning for COVID-19. We estimated supply and demand for intensivists, critical care nurses, hospitalists, respiratory therapists, and pharmacists, using Institute for Health Metrics and Evaluation projections for COVID-19 hospital care and National Plan and Provider Enumeration System, Provider Enrollment Chain and Ownership System, American Hospital Association, and Bureau of Labor Statistics Occupation Employment Statistics for workforce supply. We estimated contact tracing workforce needs using Johns Hopkins University COVID-19 case counts and workload parameters based on expert advice. The State Hospital Workforce Deficit Estimator estimated the sufficiency of state hospital-based clinicians to meet projected COVID-19 demand. The Contact Tracing Workforce Estimator calculated the workforce needed based on the 14-day COVID-19 caseload at county, state, and the national level, allowing users to adjust workload parameters to reflect local contexts. The 2 estimators illustrate the value of integrating health workforce data and analysis with pandemic response planning. The many unknowns associated with COVID-19 required tools to be flexible, allowing users to change assumptions on number of contacts and work capacity. Data limitations were a challenge for both estimators, highlighting the need to invest in health workforce data and data infrastructure as part of future emergency preparedness planning.

An integrated primary care workforce planning toolkit at the regional level (part 1): qualitative tools compiled for decision-makers in Toronto, Canada

BackgroundA regional health authority in Toronto, Canada, identified health workforce planning as an essential input to the implementation of their comprehensive Primary Care Strategy. The goal of this project was to develop an evidence-informed toolkit for integrated, multi-professional, needs-based primary care workforce planning for the region. This article presents the qualitative workforce planning processes included in the toolkit.MethodsTo inform the workforce planning process, we undertook a targeted review of the health workforce planning literature and an assessment of existing planning models. We assessed models based on their alignment with the core needs and key challenges of the health authority: multi-professional, population needs-based, accommodating short-term planning horizons and multiple planning scales, and addressing key challenges including population mobility and changing provider practice patterns. We also assessed the strength of evidence surrounding the models’ performance and acceptability.ResultsWe developed a fit-for-purpose health workforce planning toolkit, integrating elements from existing models and embedding key features that address the region’s specific planning needs and objectives. The toolkit outlines qualitative workforce planning processes, including scenario generation tools that provide opportunities for patient and provider engagement. Tools include STEEPLED Analysis, SWOT Analysis, an adaptation of Porter’s Five Forces Framework, and Causal Loop Diagrams. These planning processes enable the selection of policy interventions that are robust to uncertainty and that are appropriate and acceptable at the regional level.ConclusionsThe qualitative inputs that inform health workforce planning processes are often overlooked, but they represent an essential part of an evidence-informed toolkit to support integrated, multi-professional, needs-based primary care workforce planning.

Implementation of health workforce information systems: a review of eight sub-Saharan country experiences.

Globally, one of the major problems facing health systems is an acute deficit of health workforce. To ensure equitable distribution and deployment of health workers, up-to-date and timely information on the health workforce is vital. Health workforce registries (HWRs) have the potential to generate data for evidence-based human resource planning and policies. There is a lack of evaluative research on the capacity of HWRs to improve health systems. This review aims to assess the effectiveness of HWRs for improving health systems in low- and middle-income countries. We searched selected electronic databases from inception to 14 April 2020. Two authors independently screened studies and extracted data from included studies. We presented results as a narrative synthesis. We included eight studies of moderate-high quality in this review. The results suggest that HWRs can improve the distribution and skill-mix of the health workforce, quality of health workforce data, availability and use of data for policy and planning, and user satisfaction. The evidence was derived from case studies, which limited our ability to infer a causal relationship. More rigorous research from controlled experimental studies is needed to consolidate the available evidence from observational studies.

Identifying Opportunities to Strengthen the Public Health Informatics Infrastructure: Exploring Hospitals' Challenges with Data Exchange.

The novel coronavirus 2019 (COVID-19) pandemic has highlighted significant barriers in the exchange of essential information between hospitals and local public health agencies. Thus it remains important to clarify the specific issues that hospitals may face in reporting to public health agencies to inform focused approaches to improve the information exchange for the current pandemic as well as ongoing public health activities and population health management. This study uses cross-sectional data of acute-care, nonfederal hospitals from the 2017 American Hospital Association Annual Survey and Information Technology supplement. Guided by the technology-organization-environment framework, we coded the responses to a question regarding the challenges that hospitals face in submitting data to public health agencies by using content analysis according to the type of challenge (i.e., technology, organization, or environment), responsible entity (i.e., hospital, public health agency, vendor, multiple), and the specific issue described. We used multivariable logistic and multinomial regression to identify characteristics of hospitals associated with experiencing the types of challenges. Our findings show that of the 2,794 hospitals in our analysis, 1,696 (61%) reported experiencing at least one challenge in reporting health data to a public health agency. Organizational issues were the most frequently reported type of challenge, noted by 1,455 hospitals. The most common specific issue, reported by 1,117 hospitals, was the general resources of public health agencies. An advanced EHR system and participation in a health information exchange both decreased the likelihood of not reporting experiencing a challenge and increased the likelihood of reporting an organizational challenge. Our findings inform policy recommendations such as improving data standards, increasing funding for public health agencies to improve their technological capabilities, offering workforce training programs, and increasing clarity of policy specifications and reporting. These approaches can improve the exchange of information between hospitals and public health agencies.

Public Health Informatics Workforce Skills and Needs: A Descriptive Analysis using the 2017 PH WINS

Abstract In 2017, the Association of State and Territorial Health Officials fielded the Public Health Workforce Interests and Needs Survey (PH WINS), a nationally representative sample of state-level (SHA) and local health department (LHD) public health workers in the United States. The survey was an opportunity to measure the PHI workforce as well as assess the informatics needs of the broader PH workforce. We performed a cross-sectional study using the nationally representative 2017 PH WINS. A total of 17,136 SHA and 26,533 LHD employees participated in the survey. Respondents were asked to rate selected PH competencies with respect to the importance to their day-to-day work (i.e., not important to very important) and their current skill level (e.g., unable to perform, beginner, proficient, expert). We examined skill gaps, defined as discordance between self-reported importance (i.e., need) and skill level, for example, those reporting the competency as “somewhat important” or “very important” and “unable to perform” or “beginner.” Informaticians accounted for 1.1% of SHA respondents and 0.5% of LHD respondents working in a Big City Health Coalition agency, those that serve the top 30 most populous urban areas in the United States. While informaticians generally reported having the skills they needed for their jobs, other PH roles identified gaps. For example, 22.9% of clinical and laboratory workers felt the ability to “identify appropriate sources of data and information to assess the health of a community” was an important skill but they currently possessed low competency. This group similarly identified a gap with respect to collecting ‘valid data for use in decision making.' An informatics-savvy health department requires PHI competencies not just among PHI specialists but also among front line workers, program area managers, and executive leadership. Discordance suggests that agencies should examine ways to enhance training for PHI-related competencies for all PH workers. Key messages The informatics specialists’ role is rare in public health agencies. Significant data and informatics skills gaps persist among the broader public health workforce.

The geographic alignment of primary care Health Professional Shortage Areas with markers for social determinants of health.

BackgroundThe Health Resources and Services Administration (HRSA), an agency within the U.S. Department of Health and Human Services (HHS), works to ensure accessible, quality, health care for the nation’s underserved populations, especially those who are medically, economically, or geographically vulnerable. HRSA-designated primary care Health Professional Shortage Areas (pcHPSAs) provide a vital measure by which to identify underserved populations and prioritize locations and populations lacking access to adequate primary and preventive health care–the foundation for advancing health equity and maintaining health and wellness for individuals and populations. However, access to care is a complex, multifactorial issue that involves more than just the number of health care providers available, and pcHPSAs alone cannot fully characterize the distribution of medically, economically, and geographically vulnerable populations.Methods and findingsIn this county-level analysis, we used descriptive statistics and multiple correspondence analysis to assess how HRSA’s pcHPSA designations align geographically with other established markers of medical, economic, and geographic vulnerability. Reflecting recognized social determinants of health (SDOH), markers included demographic characteristics, race and ethnicity, rates of low birth weight births, median household income, poverty, educational attainment, and rurality. Nationally, 96 percent of U.S. counties were either classified as whole county or partial county pcHPSAs or had one or more established markers of medical, economic, or geographic vulnerability in 2017, suggesting that at-risk populations were nearly ubiquitous throughout the nation. Primary care HPSA counties in HHS Regions 4 and 6 (largely lying within the southeastern and south central United States) had the most pervasive and complex patterns in population risk.ConclusionHHS Regions displayed unique signatures with respect to SDOH markers. Descriptive and analytic findings from our work may help inform health workforce and health care planning at all levels, and, by illustrating both the complexity of and differences in county-level population characteristics in pcHPSA counties, our findings may have relevance for strengthening the delivery of primary care and addressing social determinants of health in areas beset by provider shortages.

Digital Health and Professional Identity in Australian Health Libraries: Evidence from the 2018 Australian Health Information Workforce Census

Abstract
 Objective – This research aimed to examine the characteristics of the current health library professional workforce in Australia. The study also sought to explore the areas of health library competency domains and job functions that may reflect progress toward a specialized digital health information capability.
 Methods – Health librarians’ responses to the May 2018 Australian Health Information Workforce Census were analysed and compared with results obtained in earlier census counts. The health librarian characteristics were also compared with other health information occupations included in the Census.
 Results – There were 238 usable health librarian responses. These indicate that the health librarian workforce continues to be a comparatively mature population, with substantial experience, increasing involvement in data- and technology-intensive functions, high levels of professional association membership, and participation in continuing education activities. Notably there are emerging role titles and job functions which point to a greater digital health focus in the changing work realm.
 Conclusion – The health librarian workforce has adapted its skills, in line with the increased digital emphasis in health information work. However, as with other health information occupational groups, it is possible that health system planners and funders are not aware of librarians’ current functions and skills. This mature workforce may undergo significant attrition and consequent loss of expertise in the next decade. Continued advocacy and strategic planning around these factors with workforce, healthcare quality, and educational organizations will be required.

A Glimpse at the Australian Health Information Workforce: Findings from the First Australian Census.

The Australian Health Information Workforce is a critical discipline in the health sector as the investment in digital technologies increases. Yet historically there was no standardized reporting about the workforce and its six professional areas: clinical coding, costing analysts, data analysts, health informaticians, health information managers and health librarians. This paper presents the findings from the inaugural Australian Health Information Workforce Census. Analysis of 1,596 responses indicates this is an aging (56.1% ≥45 years) workforce with a large (78.1%) female population. Working in permanent (82%), public hospital (72%) roles, in professional or managerial roles (84%). The majority (93.2%) of respondents hold a tertiary qualification in health information, one-quarter of these at masters or doctoral level. Fewer than 30% of respondents hold a health information credential from a professional or industry association. The data from the ongoing national census will inform workforce planning and enable forecasting of the future workforce needs.

Exploring the Health Informatics Occupational Group in the 2018 Australian Health Information Workforce Census.

There has been no empirical evidence about the health informatics workforce in Australia produced in the last ten years. This study reports the findings from an analysis of a subset of the 2018 Australian Health Informatics Workforce Census data. Analysing 420 responses that were identified as the occupational group Health Informatics, the results indicate that whilst most of the workforce is classified as aged (>45 years), many respondents are still relatively early in their health informatics careers. Furthermore, most do not possess any formal education in health informatics and almost a quarter undertake their health informatics role alongside another health-related role. The broad range of position titles and functions demonstrates the breadth within this workforce. Ongoing monitoring of this occupational group is required to inform workforce reform and renewal.

Ghosts in the Machine: Identifying the Digital Health Information Workforce.

In descriptions of digital health the role of human agency and the work of managing and governing health information and communication technology is often invisible. This paper reports preliminary results of a scoping review of the literature and a national workforce census, undertaken as part of a research program to shed light on the responsibilities and the contributions of the health information workforce. The global literature is not a good indicator of the actual proportion of health informaticians, health information managers, health librarians or other health professionals who are engaged in health information work in Australia. While the research interest in health information work of all descriptions is increasing, the practice of health information work is neither highly skilled nor easily identifiable in findings of an Australian census. Reforming this workforce may be a key to translating digital health rhetoric into measurable improvements in health system performance.