Executive Summary

The members of the Advisory Committee on Interdisciplinary, Community-Based Linkages (the Committee) represent training programs that are funded under the Federal Title VII, Part D, Sections 751 through 755 Interdisciplinary, Community-Based Training Grant Programs.  The Committee recognizes that the services offered to the respective communities are invaluable to the training and development of the country’s health care workforce and affect the Nation’s entire health care system as a whole.  To assist in this growth and development, the Committee provides recommendations on pertinent topics related to these programs.  In alignment with its Federal mandate, the Committee provides advice and recommendations to the Secretary of the Department of Health and Human Services concerning policy and program development and other related matters of significance.

Accordingly, the Committee recognized the tremendous impact of new technology on the health care delivery system and consequently, the strategies employed to educate health care professionals.   In 2007, the Committee focused its efforts on obtaining a deeper understanding specific to the use of technology on the advancement of interdisciplinary health care related pursuits.  The Committee determined that the advances with Health Information Technology (HIT) and the widespread use of the Electronic Health Record (EHR) were the most pertinent issues associated with the programs represented by the members of the Committee.

In turn, the Committee worked toward gaining insight on the developments related to both the challenges and opportunities of HIT and EHR faced by health care professionals with the goal of providing meaningful advice to the Secretary and the Congress.  A secondary objective of the Committee was to provide the leadership of the various training programs with beneficial information related to HIT and EHR based on varied experiences from the users in the field. 

As such, the Committee formulated edifying recommendations on how various aspects of the Nation’s health care system can best move forward in preparation for the increasing utilization of HIT and EHR.  The Committee’s findings and suggestions are addressed to the Secretary and the Congress with the goals of further dissemination and implementation of the recommendations to advance the positive outcomes of the various training programs that it represents.  

The importance of outcome data in evaluating performance and determining funding in the health care domain will demand that data be collected and analyzed in a systematic and thorough manner.  Health Information Technology and the Electronic Health Record offer the prospect of making those processes more complete, concise, and consistent.  Furthermore, clinical research in support of evidence-based practices will increasingly require the capacity to accumulate and manipulate large volumes of patient care data, demanding the analytical abilities that only EHR and HIT can offer.  Broad-based use of the EHR promises enhanced education of all health professionals and will contribute to studies of the effectiveness of interdisciplinary training and team functioning.  Improvement in quality of care is widely believed to be an end result of these developments.

The need for all health care personnel to be able to effectively interact with and use HIT for both patient care and research will increasingly become important as the EHR is adopted throughout the health care system in the United Sates.  The Committee received testimony from an impressive array of national experts who are leading the way in the implementation of the EHR.  Among that data, it was noted that 13 percent of health centers, 11 percent of hospitals, and 9 percent of ambulatory health care settings have already implemented some form of EHR.  These figures are expected to rise rapidly, despite the negative pressures of costs and training requirements because of the perceived benefits to patient care and clinical research.

The American Health Information Management Association and the American Medical Informatics Association are developing specific basic HIT competencies for the health care workforce as other groups are seeing the need for a common knowledge base.  Professional silos are no longer acceptable when communications focus on the individual patient.  A 2003 Report from the Institute of Medicine, (Health Professions Education: A Bridge to Quality) cited the need for skills in informatics to be considered as an overarching competency to be taught to health professions students and trainees.  How that competency will be included in the various health professions curricula remains a challenge, but interdisciplinary, community-based training sites are poised and situated to play a major role.

The Committee heard testimony regarding the success of the Department of Veterans Affairs (VA) in re-allocating resources to successfully implement an EHR within its health care facilities.  Many non-VA centers that provide education and training for health care personnel, including Community Health Centers (HCs) and many interdisciplinary, community-based activities funded through Title VII programs lack the resources to implement HIT systems and the associated training support.  

Since EHR systems are not typically supported through clinical or educational budget lines, additional funding may be needed to bring grantees to a useful standard and to maintain that posture through the foreseeable life-cycle of HIT.   Safety-net providers (such as HCs) are independent entities with fewer resources and are among those most in need of assistance, both technical and financial, in the implementation of HIT and EHR.  

Currently, HRSA grant funds are not targeted toward HIT/EHR capacity-building and training, but the establishment of a HRSA Office of Health Information Technology is a step in the right direction for the Agency.  Available EHR systems lack features of interoperability and universality, thus training tends to be isolated to one particular system.  If these important features are not incorporated as part of future systems, EHR skills may not be directly transferable to other health care settings.  Linkages of vendor-supplied systems to other systems is not a feature of most packages, nor are many systems planned around the information needs of clinicians (as opposed to administrators). 

Additionally, the clinical communication component of systems may not have the ability to incorporate information directly from the patient into the record, an element increasingly recognized as a best practice in care decisions.   In order to assist with the transition to EHR, there is a need to prepare a new health care professional, one who is dually-trained in both a traditional health profession (including an allied health profession) and in HIT.  These individuals will have knowledge in the utilization of HIT and EHR systems, as well as possess the sensitivity to the issues and needs surrounding the patient within the health care system.  Not every facility or interdisciplinary, community-based entity will need to have such experts on staff, but these individuals could serve as technical consultants in the training of faculty or even vendors to cover multiple sites.

A major concern of the Committee is the provision of a qualified health care workforce and an integral part of that concern is the education and training of health care personnel.  It follows that faculty must be available in sufficient quantity and quality.  Yet there is clear evidence that the health professions will suffer from a lack of qualified professionals who choose to prepare for an academic career.   The Committee received testimony, and discussed at some length, the necessity of new and creative support mechanisms for the development of faculty, especially from within the health professions themselves.  The issue extends beyond the topic of HIT. 

Whether through new programs or existing ones, there must be a concerted effort to grow the next generation of health professionals in allied health professions or in those further described in Title VII legislation (e.g., psychology, chiropractic, podiatry).  One model is the Geriatric Academic Career Awards Program that offers direct salary support.  Extending the concept to interdisciplinary faculty development might also lead to new fellowships, master teachers or other new positions within the framework of clinician, researcher, and educator.  Other mechanisms might be loan repayment for teachers and the expansion of the National Health Service Corps to include additional health professions.

Another well-recognized issue with HIT and the EHR relates to privacy, confidentiality, and the ethical control of personal health data.  These matters must be included in all education and training and at all levels of patient care and in research settings.  Technical capability aside, equipment and procedures associated with EHR must consider the protections that are assured by both legal requirements and by strong traditions.

The Committee understands that other advisory committees are grappling with similar issues and concerns.  These discussions and considerations should not occur in a vacuum, but in the spirit and context of interdisciplinary collaboration to the ultimate benefit of those whom the programs represented by the Committee must serve. 

In an era of declining resources, the Committee developed significant and practical recommendations in response to the findings presented in the testimonies from experts in urban and rural settings who embody the growing and diverse populations and geographical areas of the country.