2014 HIMSS Workforce Survey AUGUST 2014

critical to the success of the health IT industry.

Indeed, the successes and failures of IT implementations in many hospitals for example, can be directly tied to IT workforce issues. Yet, evidence from HIMSS Analytics suggests the unprecedented growth the health IT industry has experienced during the last two decades, is starting to slow.

Recognizing the implications this changing market has for IT professionals, HIMSS commissioned HIMSS Analytics in 2013 to benchmark and track the IT staff hiring practices among healthcare providers, industry vendors and consultants. This year’s report is the second installment of the annual HIMSS Workforce Survey.

As in last year’s study, this year’s report covers a number of topics critical to organizations involved in the hiring of health IT

We are pleased to once again present this important study to the market to provide context around current and projected IT hiring practices. We are confident the insights contained within will be beneficial to those who are involved in some way in hiring IT workers.

The successes and failures of IT

implementations in hospitals can be directly

tied to IT workforce issues.

Executive Summary | 3

Methodology/Respondents | 5

Staffing Environment in the Past Year | 7 Hiring Plans for the Next Year | 21

Candidate Characteristics | 27

Employee Recruitment, Hiring and Retention | 32

Barriers and Concerns in Hiring Qualified Professionals| 39 Conclusion | 43

About HIMSS | 44

How to Cite This Study | 44

For More Information | 44

The findings in this report are based on responses from 200 individuals representing healthcare providers, vendors and consulting organizations. Contacted during the May through June 2014 time- period, the 200 individuals participating in the 2014 HIMSS Workforce Survey can be considered generally representative of the health IT staffing needs and experiences of healthcare providers, vendors and consulting organizations operating in the United States.

Evidence from this year’s study suggests healthcare presents as an attractive market for IT

professionals for three main reasons. First, health IT workers have been in high demand (albeit via recruiting/hiring workers or outsourcing the tasks to external companies), with vendor organizations being more active in recruiting and hiring health IT personnel than provider organizations. Second, the market expects to need health IT workers this coming year. Four out of five (80 percent) healthcare organization respondents, for example, reported their organization had plans to hire additional IT staff in the next year, with almost all vendors indicating similar plans. We did observe a notable decline in organizations planning to outsource an IT function this year suggesting the possibility that the outsourcing market may be constricting. Third, health IT continues to be a stable industry. While the percentage of healthcare provider respondents reporting their organization laid-off any IT personnel the past year is relatively low (13 percent), this year’s figure does reflect an uptick in lay-offs and is something we will want to carefully watch in subsequent years.

With respect to the types of employees organizations are seeking, provider organizations are most likely to hire clinical application support positions while vendors plan to target field support staff.

These findings should be particularly encouraging to seasoned professionals with relevant industry experience as both healthcare provider and vendor organizations indicated they were most interested in hiring these types of workers. That said the percentage of organizations interested in training current employees to fill needed roles or willing to hire recent graduates increased this year over last,

suggesting good news for workers with less relevant experience.

Regarding the recruitment of desired health IT professionals, all organizations tended to rely heavily on

“employee referrals” although vendors seemed to be much more aggressive in their use of this

recruitment source than providers. Vendor organizations were also more likely to use social media and relationships with local universities as a way to recruit for open positions than healthcare providers.

But of all the recruitment tools available to employers, recruiters/executive search firms were deemed

to be the most effective in helping an organization fill IT staffing voids. To entice candidates to accept

a job offer, organizations most often used a competitive salary and benefits package as their preferred

hiring strategy. Finally, in order to retain staff, organizations tended to offer professional development

opportunities and flexible work schedules. Vendor and healthcare provider organizations differed

The availability of qualified workers in the area emerged as the most significant challenge for vendor and provider respondents, a challenge which seemed to worsen between 2013 and 2014. Healthcare provider organizations in particular face challenges completing IT initiatives because of staff shortages.

In fact, over one-third of respondents working for a healthcare provider organization reported scaling

back or putting an IT project on hold because it could not be fully staffed. The implications for

healthcare provider organizations delaying IT projects include allowing workflow and automation

inefficiencies to continue, project management struggles and the risk of aging equipment breakdown,

each of which can ultimately affect patient care.

A total of 200 individuals, including hospital and health IT executives and executives from health IT companies completed the 2014 survey. Data was collected via a web survey in May and June 2014. In comparison, the 2013 survey received 224 responses.

Approximately two-thirds (65 percent) of survey respondents were employed by a healthcare provider organization with the remaining respondents representing a vendor organization (Figure 1). All respondents were based in the United States.

Figure 1

For purposes of analysis, respondents were grouped into two broad categories based on their work

hospital are classified as “healthcare provider organizations”. These respondents answered questions specifically regarding IT staffing at their organization. Respondents representing consulting firms, vendor organizations and “other” types of organizations (e.g. non-profit associations; health

information exchanges) are reported as “vendor organizations”. These respondents answered general

hiring questions.

The findings from this year’s study clearly show health IT workers continue to be in high demand.

Over 84 percent of survey respondents reported their organization hired at least one staff member in the past year; a finding consistent with the 2013 finding (86 percent). A larger percent of vendor organizations (91 percent) hired staff compared to provider organizations (81 percent). This is similar to 2013, when 91 percent of vendors and 82 percent of healthcare providers reported hiring at least one IT staff member.

Healthcare Provider Organizations

The array of IT full-time equivalents (FTEs) hired by healthcare provider organizations reflects a

bifurcated pattern (Figure 2). Over half (56 percent) of healthcare provider organizations indicated

they hired between one and ten IT full-time equivalents (FTEs) in the past year, while 20 percent hired

twenty or more staff this past year. A similar pattern emerged in last year’s survey although the findings

this year appear to suggest a shift towards hiring twenty or more staff members.

Figure 2

The 2014 survey included a new question regarding the incumbency status of the jobs they were filling (new positions, replacement hires or a combination of both). As depicted in Figure 3, of the provider organizations that hired at least one IT FTE in the past year, 72 percent hired at least one individual for a new position (12 percent hired exclusively for a new position; 61 percent hired both replacement and new hires). Only 27 percent limited their hiring efforts to replace existing positions.

Figure 3

Among the 81 percent of healthcare provider organization respondents that hired at least one health IT FTE in the past year, the most commonly sought personnel were clinical application support professionals (64 percent). Help desk and IT management professionals were other common staffing needs, reported by 57 percent and 45 percent of respondents, respectively. These were also the top three reported staffing needs in the 2013 survey (Figure 4).

Figure 4

One strategy healthcare provider organizations can pursue in meeting their IT staffing needs is to outsource select tasks to an external company. This strategy appears to be widely embraced by provider organizations. In fact, three-quarters of healthcare provider respondents indicated their organization outsourced at least some of their IT staffing needs to a vendor or consultant rather than hiring the workers directly. Clinical application support (30 percent) was the most commonly

outsourced area, followed by project management and system design and implementation (25 percent each). While the percent of healthcare provider organizations reporting a specific outsourced area varied slightly from the 2013 survey, the top five areas remained the same. See Figure 5 below.

Figure 5

There is great consistency in the outsourcing/hiring practices of provider organizations. When

comparing the top 10 areas where healthcare provider organizations hired IT staff and the top 10 areas where they outsourced services, nine of the roles appeared on both lists (Figure 6). Clinical application support was the most commonly sought after position, both as an IT FTE hire and as an outsourced position.

Figure 6

Respondents were also asked whether their healthcare provider organization had laid off any IT staff during the past year. While the vast majority (87 percent) of healthcare provider organizations

indicated that no health IT staff was laid off during this timeframe, the percentage of staff layoffs crept upwards this year; eight percent in 2013 and 13 percent in 2014 (Figure 7). While these numbers are in within the margin of error of one another, we will want to closely monitor this question in future studies to see if a directional trend in the data emerges.

Figure 7

Given the small sample of healthcare provider organizations that had IT staff layoffs, the analysis for the next two figures should be interpreted cautiously.

When asked to detail the number and type of IT FTE layoffs experienced this last year, two-thirds of the effected respondents reported their healthcare provider organization laid off less than six FTEs (Figure 8).

Figure 8

In terms of the positions most commonly targeted for layoffs, provider organizations tended to focus on clinical application support (40 percent), followed by help desk and IT management roles (33 percent each (Figure 9). As these three areas are also reported as the areas with the most hires and are in the top four areas where providers plan to hire, these positions may experience turnover more frequently than other areas.

Figure 9

For the first time in 2014, respondents were asked if their IT staff decreased due to attrition, where a

position becomes open after an employee retires or resigns. Nearly one-quarter (22 percent) of

healthcare provider organizations experienced a decrease in their IT staff because of attrition.

Vendor Organizations

Most (91 percent) of the respondents working for vendors and consulting firms reported that their organizations had hired staff in the past year. This is identical to what was reported in 2013. Nearly half (47 percent) of vendor organizations hired more than 20 FTEs, a decrease from 58 percent in 2013 (Figure 10). Again, because these organizations serve the broader healthcare industry, this study surveyed a broad range of positions, not just specific IT areas.

Figure 10

For the first time in 2014, vendor respondents were asked to identify if hires were for new positions, replacement hires or a combination of both. Interestingly, 92 percent of these respondents hired at least one individual for a new position (18 percent hired exclusively for a new position; 73 percent hired for both). Stated differently, only eight percent of vendors hired exclusively to fill existing positions, (Figure 11) suggesting there is much growth and opportunity in the vendor workforce.

Figure 11

Among respondents working for vendor organizations that hired staff this past year, the most

frequently reported roles hired were for the sales/marketing team (78 percent) followed closely by field support staff, such as system implementers (75 percent), and support staff, such as human resources, finance and web teams (73 percent). The percent of vendor organizations reporting hires for

sales/marketing and field support staff decreased from the 2013 survey, while support staff and executive team hires saw a slight increase (Figure 12).

Figure 12

Slightly more vendor organizations initiated layoffs in 2014 (31 percent) than in 2013 (29 percent).

Given the small sample of vendor and consulting organizations that had staff layoffs, the analysis for the next two figures should be interpreted cautiously.

Of the respondents from vendor organizations that reported layoffs, over half (53 percent) had laid off less than six FTEs. Another one-quarter (26 percent) laid off between six and ten FTEs (Figure 13).

This question was not asked in 2013.

Figure 13

The most frequently reported area from which vendor organizations laid off FTEs was field support staff (50 percent). Support staff and those on the sales/marketing team (45 percent each) also experienced FTE layoffs (Figure 14).

Figure 14

For the first time in the 2014 survey, respondents were asked if the organizations’ staff decreased due

to attrition, where a position becomes open after an employee retires or resigns. One-fifth (20 percent)

of respondents working for vendor organizations reported that their staff decreased due to attrition.

The outlook for IT professionals is positive. Survey respondents were asked about their organizations’

hiring plans for the next year; 82 percent of all survey respondents indicated that they planned to hire at least one FTE which reflects a slight increase from the 2013 survey where 79 percent of respondents reported plans to hire at least one FTE.

Healthcare Provider Organizations

Nearly three-quarters (74 percent) of provider organizations plan to hire at least one IT FTE in the coming year, similar to the figures reported in 2013 (73 percent). Half of the respondents plan to hire between one and five IT FTEs, a decrease from 59 percent in 2013 (Figure 15). Another 16 percent plan to hire between six and 20 IT FTEs. Increasing from two percent in 2013, eight percent of healthcare provider respondents for the 2014 survey reported plans to hire more than 20 IT FTEs.

Figure 15

The most sought after position for healthcare provider organizations in the next year will be clinical application support staff (58 percent). This year’s figure represents a notable increase compared to the 2013 study, when only 34 percent of provider respondents planned to hire clinical application support staff (Figure 16).

Figure 16

Use of outsourced services by healthcare provider organizations is expected to continue in the next year. Over two-thirds (70 percent) of respondents reported at least one area of anticipated outsourcing.

This is a notable decrease from the 93 percent of healthcare provider organizations that planned at least one outsourced service in the 2013 survey. This is certainly an area we closely monitor in next year’s study. The areas of IT security (26 percent) and project management (25 percent) were the roles most commonly cited for outsourcing opportunities. With the exception of help desk and database administration, the 2013 and 2014 outsource plans were very similar (Figure 17).

Figure 17

Vendor Organizations

Among the respondents working for vendor organizations that were aware of their organization’s hiring plans in the next year, virtually all (98 percent) planned to hire at least one FTE. The number of professionals that vendors plan to hire reflects a bifurcated pattern with 54 percent of vendors planning to hire 10 or fewer workers and one-third (34 percent) planning to hire more than 20 FTEs.

The total number of planned FTEs for vendor organizations appears to have decreased in the past

year. The number of respondents reporting their organization planned to hire more than 20 FTEs in

the next year decreased from 43 percent in 2013. Conversely, the percent of respondents reporting

their organization planned to hire between one and five FTEs increased in the past year (Figure 18).

Figure 18

Each of the pre-defined staff positions – executive team, field support staff, sales/marketing and support staff – saw a decrease in the number of vendor organizations planning to hire in these roles (Figure 19). Field support staff (75 percent) was the most frequently reported area in which vendor organizations planned to hire FTEs, followed by sales/marketing (70 percent). The percent of respondents reporting other position types increased to 18 percent from 11 percent in 2013; specific write-in areas supplied by respondents included IT, interface engineer and programmer.

Figure 19

Recognizing the market’s continued interest in hiring IT professionals, respondents were then asked to share their thoughts on select candidate characteristics, most notably the importance of industry certifications

and industry experience.

Interestingly, providers and vendors differed on the intensity and priority assigned the 14 industry

certifications considered. Respondents working for vendor organizations generally rated certifications

more important than provider respondents, averaging a rating of 4.78 across the 14 areas compared to

an average rating of 4.20 from healthcare provider respondents. Compared to the 2013 study, overall

importance of these certifications decreased among vendor respondents (5.05 in 2013) and increased

among healthcare provider respondents (4.14 in 2013).

The most important certification area identified by healthcare provider respondents was for security personnel (5.26), followed distantly by project manager (4.86) and network/architecture support (4.83).

Security personnel and network/architecture support were the two most important certification areas in the 2013 survey (Figure 20).

Figure 20

Respondents working for vendor organizations were most likely to report that network/architecture support (5.33) and security professionals (5.26) were the two most important areas for certification.

While the ratings for the importance of certification in each area decreased from the 2013 study (Figure 21), the top three areas were the same for both years – network/architecture support, security professional and informatics professional respectively.

Figure 21

When asked to describe the types of individuals they would likely hire for their open positions

, all respondents favored seasoned professionals with relevant industry experience (combined average rating of 6.11). This year’s score reflects a slight decrease from the 2013 rating of 6.12 (Figure 22).

Employers also seem to have a growing interest in current employees with the correct qualifications when considering open positions, as the rating for these types of candidates increased from 5.74 in 2013 to 5.93 in 2014. Finally, while new graduates represent employer’s least desired candidate pool, this year’s findings show that employers seem to be more receptive to hiring recent graduates (average score in 2013 was 3.96; average score in 2014 was 4.39).

Figure 22

Respondents working at vendor organizations were more likely to use professionals with industry experience, recent graduates and professionals with experience in another industry than respondents working for healthcare care provider organizations (Figure 23). Healthcare provider organization respondents were slightly more likely than those at vendor organizations to promote qualified staff internally for open positions.

Figure 23

Recruitment

Given the high demand for health IT professionals, the type of recruitment and retention efforts an organization pursues should be important to the organization’s overall success. When asked to identify the types of tools their organizations used to recruit staff in the past year, employee referrals were the most commonly cited tool with three-quarters of all survey respondents using this tool (Figure 24).

This was also the most reported recruitment tool in 2013 (69 percent). Nearly two-thirds (65 percent) of all survey respondents reported using public job boards as a recruitment tool, while over half (56 percent) indicated use of professional society job boards

. Survey respondents were least likely to use advertisements (online and print) for recruitment with just over one-third (39 percent) using this type of tool, a decrease from the 2013 survey findings (50 percent).

Hiring and Retention

Figure 24

There are a few notable differences in recruitment tools based on respondent organization type (Figure 25). While employee referrals was the most reported tool for both healthcare provider and vendor organizations, vendor organizations tended to be more dependent on employee referrals (90 percent) than provider organizations (66 percent). In addition, vendor organizations were more likely to use social media and relationships with local universities as a way to recruit for open positions than provider organizations. Healthcare provider organizations, on the other hand, were more likely to create online/print advertisements in their local newspapers to recruit staff for their IT departments.

Figure 25

Respondents were also asked to identify specific sources used in their recruitment efforts. Each source saw a notable increase in use from 2013 to 2014, but this change may be due in large part to a change in the way this question was presented. In 2013, this question was an open-ended question while in 2014 respondents were provided with a list of sources to select from. LinkedIn was the most commonly reported recruitment source, used by 40 percent of all survey respondents (Figure 26).

Figure 26

Finally, respondents were asked to identify the level of success they had with each of the recruitment tools utilized by their organization

. While recruiters/executive search firms were used by just over half of survey respondents (a notable increase over the percentage of organizations relying on this resource in 2013), respondents generally considered recruiters/executive firms the most successful approach to use in meeting their recruitment needs (average score of 5.45). This is similar to the 2013 rating of 5.49. The most commonly used recruitment tool, employee referrals, had the second highest success rating (5.34), which was a slight decrease from the 2013 rating (5.68). The success rating for the remaining recruitment tools also tracked in the 2013 each experienced a slight decrease in their rating from last year (Figure 27). Public job boards received the lowest success rating of 4.08.

Figure 27

Hiring

Respondents working for both vendor and healthcare provider organizations were most likely to report that offering a competitive salary/benefit program was crucial to hiring qualified staff (Figure 28). Those working for vendor organizations were more likely than their counterparts at healthcare provider organizations to indicate that their employer included telecommuting (53 percent) and time off for volunteer participation (36 percent) in their compensation packages (26 percent and eight percent respectively). Including sabbatical leave was the component of compensation packages least likely to be offered by healthcare provider or vendor organizations. Interestingly, 19 percent of healthcare provider organizations indicated that they did not offer any of the listed components in their compensation packages.

Figure 28

Retention

In an effort to retain qualified staff, organizations were most likely to offer professional development

opportunities, identified by 64 percent of healthcare provider organizations and 66 percent of vendor

organizations (Figure 29). Professional development was the most reported strategy for retaining

qualified staff in the 2013 survey. Offering flexible work schedules was a strategy to retain staff

reported by 60 percent of respondents. Respondents working for healthcare provider organizations

were more likely to offer paid tuition (64 percent) than vendor organizations (37 percent), while

vendor organizations were more likely to pay for membership in professional associations (54 percent)

and offer telecommuting (51 percent) than healthcare provider organizations (45 percent and 31

percent respectively). Offering loyalty programs was the least reported strategies to retain qualified

staff.

Figure 29

Hiring Qualified Professionals

The last section of the 2014 HIMSS Workforce Survey queried respondents on the challenges in hiring health IT professionals as well as the impact of operating with staffing voids.

The results of the survey not only reinforce the idea that healthcare provider organizations do face barriers in their attempt to operate fully staffed environments, but that these challenges are increasing.

To illustrate, 85 percent of all respondents (92 percent of healthcare provider respondents and 74 percent of vendor respondents) claimed their organizations faced barriers in fully staffing their

environments. The results this year reflect a notable increase in the percentage of vendor organizations claiming the presence of barriers in achieving a fully staffed environment. In 2013, 57 percent of vendor respondents claimed their organization faced hiring barriers.

Of the respondents who indicated that they faced hiring barriers, the lack of a qualified talent pool in

their area was cited as the biggest challenge to achieving a fully staffed environment (69 percent for

providers; 71 percent for vendors) (Figure 30). The lack of a local qualified talent pool was also the

most reported barrier for all survey respondents in the 2013 survey. Half of respondents working for

provider organizations indicated that hiring vendors/consultants was too expensive compared to only

six percent of vendor respondents. At least 19 percent of respondents working at vendor companies

and 21 percent of those working at healthcare provider organizations reported other barriers to fully

staffing their environments, such as budget and financial limitations.

Figure 30

Respondents working for healthcare provider organizations were asked two questions about the

impact staffing shortages could have on IT initiatives. The feedback suggests staffing challenges do

impact a segment of providers, but that an equally sizable percentage of the market is not impacted by

these challenges. More specifically, just over one-third (36 percent) of provider respondents did not

scale back any IT projects due to being short staffed, while approximately the same percentage (38

percent) claimed that they did have to scale back at least one IT project. An addition one-quarter (24

percent) of respondents noted that they had not scaled back an IT project but were considering doing

so.

In comparison to the 2013 study, healthcare provider respondents were more likely to report putting a project on hold in 2014 than they were in 2013 (Figure 31). Over one-third (35 percent) of provider respondents had to place at least one IT initiative on hold due to staffing voids, up from 31 percent in 2013. Another 24 percent of respondents indicated that while they had not yet placed an IT initiative on hold, they were considering doing so.

Figure 31

Nearly one-third (30 percent) of healthcare provider respondents indicated that their organization had

both scaled back an IT project and had to put an IT initiative on hold due to staff shortages. Another

17 percent were considering scaling back an IT project and putting an IT initiative on hold because the

healthcare provider organization did not have to scale back an IT project or put an IT initiative on hold.

Respondents working for a provider organization that had to either scale back an IT project or put an IT initiative on hold because of staffing issues were then asked to describe the impacted initiatives. In a theme reminiscent of the 2013 survey, respondents most frequently cited software and equipment upgrades and replacements. These types of projects were typically delayed until Meaningful Use or ICD-10 requirements could be met or implemented in a phased approach rather than all at once.

Finally, respondents were asked to identify the implications for their organization in scaling back/putting projects on hold. Numerous implications were identified including:

• Creating inefficiencies for staff leading to end user frustration and dissatisfaction.

• Disruptions in patient care.

• Increased reliance on manual processes.

• Increased concerns of potential security breaches.

Evidence from the 2014 HIMSS Workforce Survey not only reinforces the argument that IT professionals are critical to the success of the healthcare industry, but that healthcare presents as an attractive market for IT professionals. Indeed, IT workforce voids have forced many healthcare providers to delay or scale back IT initiatives resulting in negative impacts for patients and staff. As a result, health IT professionals enjoy a stable work environment with many opportunities at their disposal. Obviously, the advantage in this type of environment favors the IT worker.

In order to satisfy the demand for desired workers, healthcare employers typically attempt to recruit workers away from other healthcare organizations using a multiplicity of approaches. According to the respondents in this survey, IT recruiters/executive search firms have been most effective in this regard and will likely emerge as a preferred resource as the demand for select IT professionals increases.

The longer term solution for the healthcare industry though, is to increase the supply of IT

professionals. One of the positive findings from this study in this regard is the increased willingness of

healthcare providers to consider training from within as well as hiring new IT graduates. Yet the

evidence from this study suggests the health IT industry is varied enough that the training programs

should be sensitive to nuanced needs of both healthcare providers and vendors.

About HIMSS

HIMSS is a global, cause-based, not-for-profit organization focused on better health through

information technology (IT). HIMSS leads efforts to optimize health engagements and care outcomes using information technology. Visit www.himss.org.

HIMSS is a part of HIMSS WorldWide, a cause-based, global enterprise producing health IT thought leadership, education, events, market research and media services around the world. Founded in 1961, HIMSS WorldWide encompasses more than 52,000 individuals, of which more than two-thirds work in healthcare provider, governmental and not-for-profit organizations across the globe, plus over 600 corporations and 250 not-for-profit partner organizations, that share this cause. HIMSS WorldWide, headquartered in Chicago, serves the global health IT community with additional offices in the United States, Europe, and Asia.

How to Cite This Study

Individuals are encourage to cite this report and any accompanying graphics in printed manner, publications or any other medium, as long as the information is attributed to the 2014 HIMSS Workforce Survey.

For More Information, Contact:

Joyce Lofstrom

Senior Director, Corporate Communications HIMSS

33 West Monroe Suite 1700

Chicago, IL 60603

312-915-9237

[email protected]