Clinical Informatics Workforce Development in the United States Army Medical Command (MEDCOM)

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Clinical Informatics Workforce Development in the
United States Army Medical Command (MEDCOM)

• Lieutenant Colonel Nicole L. Kerkenbush, Chief
  Medical Information Officer, US Army
  MEDCOM/Office of The Surgeon General

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Objectives

• To provide an overview of our Comprehensive
  Workforce Development Approach
• To describe the Clinical Informatics Workforce
  Development Project, Outcomes and Lessons Learned
• To discuss how the US Army MEDCOMs Workforce
  Development approach can be applied in other
  organizations

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A Day in Army Medicine

• 41,986 clinic visits
• 374 patients admitted
• 1,214 patient beds occupied
• 26,600 dental procedures
• 5,879 immunizations
• 64 births
• 12,494 radiology procedures
• 54,048 outpatient pharmacy prescriptions
• 50,420 laboratory procedures
• 1,961 veterinary outpatient visits
• 23.2 million-worth of food inspected

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Army Medicine CMIO

• Mission The CMIO will be the premier advocate
  for clinical information systems for providers
  and serve as the liaison between the healthcare
  community and Army Medicine leadership.
• Mission Essential Task List
• Establish and maintain trust among the healthcare
  provider community
• Advocate for improving provider/user satisfaction
  by improving meaningful use of information
  systems, with focus on improving the Department
  of Defense Electronic Health Record (EHR)
• Improve business and clinical information systems
  by engaging the user population, the information
  management governance bodies, and the program
  management offices
• Improve business and clinical processes by
  leveraging systems, best practices, training, and
  business intelligence tools in the daily workflow
  of providers and users

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Informatics Core Business Units
System Integration
Business Process Management

• Optimize use of CIS / technology in healthcare
  workflow.
• Integrate innovation into enterprise.
• High level functional requirements management
  (customer focused).
• Standardized, reliable approach.
• Culture / ownership / leadership for BPM.

• Strategic, tactical and operational alignment in
  deploying, sustaining and integrating systems.
• Technical and strategic liaison.
• System Change Requests and configuration
  management.
• Project assistance and decision support for HIT
  solutions.

Clinical System Training

• Clinically and customer-focused.
• Consistent, Competency / Standards-Based.
• Role-based curricula.
• Not button-ology.
• Training Material Development.
• Work flow / BPR.
• Workforce development.

Clinical Business Intelligence

• Point of care delivery of actionable, timely,
  accurate information to multiple stakeholders
  (largely clinical).
• Data stewardship / governance.
• BI infrastructure and analytic platform.
• Culture / ownership / leadership for BI Data
  Competency Center and BI governance.

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Informatics Implementation for Transformation

• Ensure right people, in the right roles at the
  right time, with the right motivation to deliver
  results.
• Strategic Workforce Planning Performance
  Management
• Competency Development Compensation Rewards
• Succession Planning/Talent Development
• Engagement and Retention

Areas of Focus for Transformation
Enterprise Organization

• Clarify and communicate strategy from the board
  room to front line employees.
• Strategy Clarification
• Strategy Alignment

Strategy
Leadership

• Build strong leadership teams with the right
  knowledge, skills and abilities to execute with
  focus and discipline.
• Leadership Models
• Leadership Development
• Leadership Alignment

CMIO Organization

• Rebuild to efficiently get work done and realize
  the full capability / creativity of its
  workforce.
• Organization Design Restructuring
• Governance
• Operating Company Model

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What is Strategic Workforce Development?
Typical Strategic Workforce Components Typical Strategic Workforce Components
Workforce Planning Forecasting talent supply and demand
Role and Competency Design Defining job roles and the knowledge, skills, and behavior requirements for success in those roles
Succession Management Clarifying leadership criteria, identifying critical positions and potential replacements for those positions, developing leadership bench strength
Talent Assessment Assessing individuals to identify top talent, clarify talent gaps, and identify career development and training priorities
Career Development Tools and processes for employees to develop and grow
Performance Management Tools and processes for setting performance expectations, providing performance feedback and coaching, and evaluating and recognizing performance results
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Strategic Workforce Development Trends
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Aligned and Interdependent

• Strategy
• Clarifying and communicating strategy from the
  board-room to front line employees
• Strategy Clarification
• Strategy Alignment

• Talent
• Ensuring they have the right people, in the right
  roles at the right time, with the right
  motivation to deliver results
• Strategic Workforce Planning
• Competency Development
• Succession Planning
• Talent Development
• Performance Management
• Engagement and Retention
• Compensation Rewards

• Organization
• Organizations are rebuilding to efficiently get
  work done and realize the full capability and
  creativity of its workforce
• Organization Design Restructuring
• Business Process Improvement
• Governance Operating Model

• Leadership
• Building strong leadership teams with the right
  knowledge, skills and abilities to execute with
  focus and discipline
• Leadership Models
• Leadership Development
• Leadership Alignment

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Strategic Workforce Development
Acquisition Programs, processes, and means by
which the organization attracts and selects
individuals that align with the organizations
talent needs and enables them to fulfill their
mission

• Onboarding
• Programs, processes, and means by which the
  organization ensures individuals are oriented and
  integrated into the organization

Learning Development Programs, processes, and
means by which the organization ensures that
individuals have the skills, competencies, and
behaviors necessary to be successful
PROGRAMS
Performance Management Programs, processes, and
means by which the organization measures
individuals contributions and ensures they are
rewarded for contributions that are meaningful to
the organization

• Retention
• Programs, processes, and means by which the
  organization ensures individuals are emotionally
  and rationally involved in, motivated by, and
  committed to their work

Succession Planning Programs, processes, and
means by which the organization develops a cadre
of leaders that are capable to assume key
clinical informatics leadership roles
Talent Management Principles
FOUNDATIONAL
Role Profiles Competency Models
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Demand for Clinical Informatics Workforce
Development

• Growing the Informatics Workforce identified as a
  key priority for the MEDCOM Chief Medical
  Information Officer in 2008
• The CMIO role was designated at various
  organizational levels, however roles,
  responsibilities, competencies and experience
  vary tremendously
• MEDCOM AHLTA Provider Satisfaction (MAPS) program
  established common roles and position
  descriptions, as well as foundational
  competencies for Clinical System Trainers and
  Clinical Workflow Analysts
• Key deliverables Workforce Development Strategy
  that addresses Recruitment, Retention, Competency
  Learning Development, Career Development and
  Succession Planning for this highly specialized
  career field
• Take away Message Very few organizations are
  doing this work in Clinical Informatics. The
  focus is on education training of entry level
  Health IT practitioners, not comprehensive
  workforce development

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Workforce Development Project Plan
Key Artifacts - Operational Plan - Final Report -
Marketing Collateral
Key Artifacts - Job Family / Role Profiles -
Competency Model - Performance Metrics
Key Artifacts - Proof of Concept Plan - Gap
Analysis - WFD Strategy Plan
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Workforce Development Approach and Timeline
FY11
FY12
Role profile assessment
Workforce Development Strategy
Implementation Plan
Role profiles for key informatics roles
Where do we have gaps in the competencies and
technical skills that we know are critical to
success? What is the nature of those gaps (e.g.,
systemic, role-specific)? Where do we have
strengths that we need to better leverage?
What steps are we going to take to close the gaps
that weve identified through the assessment?
What will our key talent programs (e.g.,
acquisition, learning development, career
planning, and succession) need to entail?
Where is it critical that we leverage the
current contract work?
What is the detailed plan (tasks, timeline,
deliverables) for implementing the
Strategy? Where is it critical that we leverage
the current contract work?
What competencies, technical skills, and
experiences are critical to success at the
AMEDD? What does a career path in informatics
look like at the AMEDD? What does it take to
progress?
Detailed talent program designs
What exactly is the AMEDD doing to support
informatics workforce development? What
processes and tools are now available to support
acquisition, learning development, career
planning, and succession?
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Job Family Matrix (Current State)
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Job Family Matrix (Future State)
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Role Profile Assessment and Gap Analysis

• Online survey for employees and managers to
  assess skills, competencies, behavioral
  indicators of assigned role profile
• The assessment was launched on August 10, 2012
  and closed on August 23, 2012
• 80 of those invited to participate in the
  pilot completed the assessment
• The output of the assessment was used to create a
  targeted Clinical Informatics Workforce
  Development Strategy that leverages the
  identified strengths and closes the gaps
• Individually identified data is being kept
  anonymous and confidential and will only be
  shared in an aggregate report
• Assessment was limited to a focused pilot
  within Western Region, and participation was
  broadened to other individuals across the AMEDD
  when additional data was needed. The table below
  provides additional details on the assessment
  data sources for each role

Western Region data collected AMEDD-wide data
collected
Strategic Leadership Clinical Systems Trainer Clinical Workflow Analyst
Deputy CMIO (MTF) CST 1 (MTF) CWA 2 (MTF)
CMIO (MTF) CST 2 (MTF) CWA Supervisor (MTF)
Deputy CMIO (RMC) CST Supervisor (MTF) CWA 2 (RMC)
CMIO (RMC) CST 2 (RMC) CWA Supervisor (RMC
CST Supervisor (RMC)
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Gap Analysis Methodology

• Blended scores were calculated for each
  competency and technical skill for every employee
  where assessment data (manager, employee, or
  both) was provided based on the following
  parameters
• In cases where both manager and employee scores
  were provided, a blended score was calculated
  with a 60 weight applied to the manager ratings
  and a 40 weight applied to the employee ratings
  for each competency/technical skill
• In cases where only manager or employee scores
  were provided, that individual score was used as
  the blended score for each competency/technical
  skill
• Average blended scores were compared to the
  target proficiency level for each
  competency/technical skill and for each role. The
  gaps were then calculated, and placed into one of
  the following categories

Red Gap is greater than or equal to .25 below
the target proficiency level, indicating a strong
gap exists
Green The blended score is at or above the
target proficiency level, indicating no gap exists
Yellow Gap is less than .25 below the target
proficiency level, indicating a moderate gap
exists
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Clinical System Trainer Assessment
ResultsCompetencies
Note data points for the CST Supervisor (MTF)
role are limited, and therefore caution should be
exercised when drawing conclusions based on the
data.

• Competency gaps primarily exist at the Training
  Supervisor level
• The competency gaps among the Supervisory roles
  primarily fall within the functional
  competencies, with the exception of Teamwork,
  which is a foundational competency
• Strengths in People Management and Talent
  Development will be critical to leverage as the
  Workforce Development Strategy is implemented

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Clinical System Trainer Assessment
ResultsTechnical Skills
Note data points for the CST Supervisor (MTF)
role are limited, and therefore caution should be
exercised when drawing conclusions based on the
data.

• There are more gaps in technical skills than in
  the competencies
• The presence of significant Clinical Systems gaps
  is surprising given that the primary purpose of
  the training role is to train end-users on the
  clinical systems
• The gap in Essentris was expected as CSTs
  transition to the Essentris training support role

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Learning Development - FY12/13

• This section of the Strategy is focused on the
  programs, processes, and means by which we will
  ensure that individuals have the skills,
  competencies, and behaviors necessary to be
  successful
• Key highlights of this strategy element
• Use the role profiles to develop career maps and
  life cycle models that provide employee with an
  understanding of career opportunities at the
  MEDCOM and what is needed to progress
• For each of the competencies and technical skills
  captured in the role profiles, create a
  development actions library containing
  Practice, Read, and Study/learn actions
  that one can take to support their development in
  the specific area (see below)
• Actions will be highly specific and applicableto
  what we do at the MEDCOM
• Use of different development tools will
  varydepending on role/level
• Will coordinate with the AMEDD Center School
  and other existing training anddevelopment
  programs to ensure we arealigned and to leverage
  existing programs
• Refresh the role profile assessment on eithera
  rolling 12 or 24-month cycle
• Create individual development plans

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Learning Development Program

• Employees required to complete solutions in the
  Top 3 Competency Technical Skills Gaps
• Four (4) hours per month to complete solutions
  many of which are practice solutions
• Employees can choose to complete one or all
  solutions for the competency or technical skill
  gaps, based on individual competency gaps and
  development plans
• Employees will maintain a written record of
  completed solutions using Tracking Formstill
  pending completion of the tracking feature in
  SharePoint
• Complete an enterprise-wide Competency Assessment
  after 1 year

Comp Gap 1 Comp Gap 2 Comp Gap 3 Tech Gap 1 Tech Gap 2 Tech Gap 3
CMIO Resource Management Teamwork Talent Management N/A N/A N/A
CWA Change Management Project Management Organizational Agility Excel BPA Clinical Data Flow
CST Adult Learning Teamwork Relationship Building Essentris CHCS PowerPoint
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Training

• Delivered via Defense Connect Online (DCO) VOIP
• Recorded and stored via SharePoint
• Training Packages available via SharePoint

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Acquisition - Projected FY13

• This section of the Strategy is focused on the
  programs, processes, and means by which we will
  attract and select individuals that align with
  our talent needs and enable fulfillment of our
  mission
• Key highlights of this strategy element
• Over time, role profiles will be developed for
  every key clinical informatics role at the MEDCOM
  use the 2016 role matrix to document the
  evolution
• Meet our acquisition needs through the approach
  at right
• Includes three rounds of selection screening post
  identificationof the candidate list
• Flexible to whichever role we are hiring for
  (e.g., individualcontributor, leadership role)
• Easily customizable and can be streamlined, as
  necessary
• Selection tools based on the competencies,
  technical skills,and experiences in the role
  profiles

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Onboarding - Projected FY13

• This section of the Strategy is focused on the
  programs, processes, and means by which we will
  ensure individuals are oriented and integrated
  into the clinical informatics workforce and
  MEDCOM, more broadly
• Key highlights of this strategy element
• More consistent onboarding approach for our new
  hires that supports them in five key areas (below
  left) and follows a pre-defined schedule and set
  of tools (below right)

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Succession Planning - Projected FY13

• This section of the Strategy is focused on the
  programs, processes, and means by which we will
  ensure the MEDCOM has a cadre of leaders that are
  capable to assume key clinical informatics
  leadership roles
• Key highlights of this strategy element
• Deploy a four-step approach (see right)
• Initially, focus on the leadership roles (see
  below) and aim tohave three individuals
  groomed for each leadership role
• Individuals on succession lists receive targeted
  development
• Leadership training
• Action-learning
• Coaching and feedback

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Retention - Projected FY13

• This section of the Strategy is focused on the
  programs, processes, and means by which we will
  ensure individuals are emotionally and rationally
  involved in, motivated by, and committed to their
  work
• Key highlights of this strategy element
• Methods for assessing the key elements of our
  Employee Value Proposition (EVP) what we offer
  to employees in return for their efforts and
  contributions (see graphic below)
• Employee survey to assess each EVP element on two
  criterion the relative importance that employees
  attribute to it and employee perceptions about
  how effective the MEDCOM is in meeting employee
  expectations
• Employee focus groups to follow up on key
  findings reported in the employee survey and gain
  more context for the gaps that exist
• Assessment of industry best practices to
• understand how our competitors fulfill their
  EVPs
• Annual review process led by CMIO and a
• leadership team of OTSG branch chiefs to
• Review survey results and input from employee
• focus groups to identify key gaps in our EVP
• Benchmark our Strategy to industry best practices
• Recommend new or revised programs to the
• Strategy to address gaps

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Performance Management Currently Out of Project
Scope

• This section of the Strategy is focused on the
  programs, processes, and means by which we will
  measure individuals contributions and ensure
  that they are rewarded for contributions that are
  meaningful to the MEDCOM

Of all of the elements of the Strategy, this
section on performance management is the most
forward-looking. Moving forward with changes in
this area requires that we first get the other
elements of the Strategy implemented and working
effectively. As such, weve included this
section so as to have an all inclusive Strategy
however, we do not expect to implement these
changes until the other pieces of the Strategy
are in place.
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What have we learned so far?

• Clear need and support for the clinical
  informatics capability
• Growing alignment around informatics
  strategy/vision and tactics
• A lot of effort around workforce development, but
  not all integrated and clear to the end-users
• Leadership development critical to the speed of
  evolution ofclinical informatics
• Hunger for clarity around roles and
  responsibilities and howArmy Medicine will
  support learning and development

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Opportunities Challenges

• Opportunities
• No one is doing this work in the private or
  federal sectorAMEDD is providing a best practice
  for Clinical Informatics and IM/IT
• Providing a systematic approach to
  operationalizing Workforce Developmentcan be
  used for other disciplines
• Publishable work to inform industry, which has
  focused on academic programsdebate about
  required competencies for HIT professionals
• Finally formalizing the role and creating
  processes and programs to grow talent
• Challenges
• Socializing the Strategy and gaining unity around
  priority program design, implementation and
  sustainment
• Coordination of multi-site implementation over
  the next yearbandwidth of resources to support
  the project moving forward
• Competing priorities
• Integrating Informatics WFD strategies into
  overarching IM/IT and MEDCOM WFD/ Talent
  Management strategies
• Sustainability of WFD programs

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The Road Ahead

• Full implementation of the Strategy will take
  several years. The three-year timeline below
  illustrates the major steps that will be taken to
  fully implement the Strategy by September 2014

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Questions

• Lieutenant Colonel Nicole L. Kerkenbush, AN, USA
• AMEDD Chief Medical Information Officer
• Nursing Informatics Consultant to The Surgeon
  General
• nicole.kerkenbush_at_us.army.mil
• Cell 571-274-1621
• Office 703-681-0124
• Twitter _at_OTSG_CMIO

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