I’ve written a number of articles and a few video interviews on job opportunities in digital health recently and have received a steady stream of questions since then. Given healthcare IT professionals can make $90,000 or more annually, there has been growing interest in the industry. To help separate fact from fiction and dive a little deeper in to the realities of these opportunities, I reached out to Beth Kelly, a freelance writer from Chicago, IL to summarize the projected outlook for specialized positions within the field of health IT. Careers in healthcare IT are appealing whether your preference lies within the computer or medical sciences; what’s clear though is to succeed you’ll need to have your passion fit somewhere between both.  As positions in the industry are constantly evolving, the ability to adapt to new technology is also crucial — whatever is “cool” today will be different tomorrow. As healthcare providers and physicians strive to  implement new technology systems, the expertise of HIT professionals will guide the industry into the future so knowing the Outcome Driven Innovation (OID) and JTBD of clinical professionals will be a differentiator for those who possess such skills. The market for health care information technology continues to show enormous growth potential – with no signs of slowing down any time soon. Here’s what Beth thinks the outlook is:

General Qualifications and Useful Certifications

It’s clear that the expanding field of healthcare IT affords plenty of opportunities. But of course, making the move into this field isn’t as simple as picking up the phone and interviewing. Qualifications are important — in a recent salary survey report completed by HealthITJobs.com, it was noted that certified workers are on average making $10,000+ more than those without certifications.  If you are an IT worker currently, CISSP, CCNA, and PMP are a few technical certifications that are in high demand in Healthcare IT. But beyond the classroom, health IT requires a unique set of skills, and not all of them are related to technology. In healthcare, the right applicant needs to understand more than codes and processes. Many hiring managers look for applicants with “soft skills” who are willing to work in a highly collaborative environment. Applicants for HIT positions need to be aware that in a hospital environment, their position is not the star of the show. Ultimately the healthcare world revolves around the patient, and IT roles provide supportive care. In many cases when hiring, institutions prefer applications with a combination of IT and clinical skills.

Optimizing opportunities afforded by the changing healthcare landscape requires a lot of hard work and insight into the diverse nature of the healthcare IT job market. Whether you are transitioning to IT from a clinician position, or you have an IT background already but are new to healthcare, challenges are inevitable. But in an increasingly digital world, where people use technology in more ways perhaps than they even realize, an HIT skill set is almost guaranteed to pay off.

The healthcare sector of IT is as diverse as the industry itself. There are numerous areas in which to specialize; the following domains being several of the most promising.

Mobile Healthcare

Looking purely at the numbers, Americans are inseparable from their phones. And with nearly one third of all mobile applications being health related, the opportunity to access and utilize vast amounts of health data is there, also. As Silicon Valley tech companies take a greater interest in mobile health devices, advances in analytic software now make it possible to capture illuminating data about our daily lives. The sum of this information is aimed to transform medicine. Even as privacy concerns loom, the ubiquity of smartphones and tablets promises career opportunities in the realm of HIT.

Joseph Hobbs, CIO at Community Hospital at Anderson located in Anderson, Indiana, had this to say about mobile technologies: “This is a huge topic for any organization. Whether it is a mobile cart, a tablet or a smartphone, you need to give caregivers access at their fingertips. The [other] challenge in healthcare is that it’s not a one-size-fits-all initiative. Beyond just finding a solution for all you then have to worry about security and application presentation to all of these types of devices.”

Many health professionals agree that the data from medical devices and data from modern EHR solutions should be integrated. When mobile devices are capable of being linked to EHR, physicians can provide patients with appointment alerts and medication reminders, as well as additional medical assistance. In the remote patient monitoring space, cell service provider Verizon represents the Converged Health Management solution, one of the first products that hopes to bridge the gap between monitoring devices and EHRs. Partnering with Ideal Life, a medical device company, Verizon’s platform is capable of measuring blood pressure, oxygen saturation, glucose levels and weight.

The market for mobile healthcare apps promises many new opportunities for with room tremendous growth and earning potential. According to German market research firm research2guidance, the worldwide market for mobile health applications and their corresponding services reached $2.4 billion in revenue in 2013 and will grow to $26 billion by the end of 2017.

Mobile apps are becoming increasingly significant in the healthcare community, their influence extending throughout both the medical and insurance industries. Mobile app developer positions are in extremely high demand. With medical health app growth ahead of the general mobile market, there are tremendous number of opportunities for people interested in these positions. According to the U.S. Bureau of Labor and Statistics, from the years 2010-2020, there is a projected growth rate of 57.4% for software application developers. For software systems developers, there is a projected growth rate of 71.7%. It’s estimated that overall employment in the industry will continue to grow rapidly.

Clinical Informatics

Clinical analytics are a top priority for two reasons: data mined by those with analytic skill can be used to understand population health, helping better identify infectious disease outbreaks and other population health trends, and can also be used to help a hospital’s bottom line. Big data allows providers to better see how their resources are spent, and where they can trim the fat. The recent deal between Apple and IBM only promises to fuel the market for data analyst positions.

In the current market, an advanced degree in health informatics is very useful. Because of the move toward electronic health records, hospitals and health systems need qualified people to undertake complex projects. A degree opens the door to working for a hospital, a health system, a vendor that sells electronic records or computer software or as a professional consultant. From 2010 to 2020, the U.S. bureau of Labor has said that employment of computer systems analysts in computer systems design and related services will grow 43 percent. Businesses will typically hire them to reorganize IT departments to operate more efficiently.

HIPAA, Meaningful Use and ICD-10 Project Managers

Now that both HIPAA and HITECH are being fully enforced, affected entities can be audited for compliance at any time. At Stage 2 of the HITECH act a certain percentage of provider’s patients must use and interact with patient portals. Navigating HIPAA privacy regulations and the proprietary nature of the portal software is a convoluted process. And the transition from ICD-9-CM to ICE-10-CM is a hefty task as well; ICD-9-CM contains 13,000 3-5-character alphanumeric diagnosis codes with 855 code categories.  ICD-10-CM contains 68,000 3-7-character alphanumeric diagnosis codes with 2,033 code categories. In the transition to greater coding specificity, hospitals typically look for someone who has worked as a coder and in health information management roles.

As health organizations strive toward integrating ICD-10 throughout every aspect of their business, there is an enormous need for medical coding and billing specialists capable of working with the updated diagnostic coding system. ICD-10 skills will put you in the front running for an in-demand position such as project manager, ICD-10 coding specialist, or even ICD-10 educator.

Skills in HIPAA Compliance qualify you for a high level HIPAA Privacy Officer position, a role that typically pays over $60,000 annually. Meaningful Use Director positions, a recent addition to the healthcare landscape, can pay anywhere between $35-80,000 each year.

Privacy and Data Breach Prevention Specialists

Health Information privacy specialists are in extremely high demand. EHR applications, particularly when accessed on mobile devices, require enhanced security access and monitoring. Data breaches are expensive, embarrassing, and damaging to to health groups, but many physicians still neglect to encrypt the patient information they’ve stored on various devices. Healthcare organizations need to take security seriously, and bring on IT professionals to ensure they are doing everything they can to reduce instances of identity theft.

Information security spending is expecting to increase nationwide, especially within industries that deal with sensitive information such as hospitals. New security measures are added and reconfigured constantly, and as a result the demand for privacy and data protection specialists is always high. Job growth for this title is projected to grow upwards of 25% within the next 5-10 years.

Pharmaceutical companies, naturally interested in joining the digital health movement as well, have found it more difficult to gain traction. A 2013 Deloitte survey found that, while people trust doctors and medical professionals the most, they trust companies like WedMD next and then internet search results. Big pharma companies come in dead last. Healthcare organizations and pharma companies are competing, not within their respective sectors, but against one another. Digital pharma is only now beginning to take off. According to M2i2′s Chief Medical Information and Innovation Officer Sachin Jain in a May interview, “the ultimate incentive is that we as a company are gradually finding our way into the outcomes improvement business, as opposed to the pill and vaccine business, and as we do that, I think we realize that data and technology and HIT is going to be a critical enabler.”

Getting started in healthcare IT is not as intimidating as it may seem. For new job seekers, however, it is important to research the different types of positions available and where you may be most helpful. Additionally, for those without a background in health, learning clinical workflows and the other processes that go into healthcare is imperative. Experience, if it’s outside the realm of healthcare, can be transferable, but you will need to be sure to tailor your resume and cover letter around the language of the health industry. If possible, volunteer in a hospital or similar healthcare IT setting to obtain hands-on experience.

Unlike humans, which can handle diversity, computers hate variations. Hospitals and physicians have experienced workflow disruptions and productivity loss as they adopt more advanced EHR systems. Health IT workers, cogs in the digital health machine, fulfill hybrid roles that blend the skills of clinicians and traditional IT workers. As the nature of the healthcare industry continues to evolve, the future for healthcare IT continues to look very bright.

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I’ve been interested in the new “wearables” segment for a while. I reached out to Cameron Graham, the managing editor at TechnologyAdvice where he oversees market research for emerging technology, to give us some evidence-driven advice about wearables that entrepreneurs, innovators, healthcare providers, and payers can use for decision making. Specifically, what does the current research show and what are the actionable insights for how to incentivize patients to use them and figure out why patients might pay for them? Cameron thinks that wearable health technology could help improve patient outcome monitoring, if insurance companies and providers work together. He elaborated:

Wearable health technology (or mHealth as some call it) is one of the emerging frontiers in medicine. Fitness tracking devices could allow the healthcare industry to better measure patient outcomes, monitor patient populations for emerging trends, and give preventative healthcare advice based on quantitative measurements (such as daily step counts or heart-rate). We surveyed 979 US adults about their fitness tracking habits, in order to determine current the usage rate for this technology. We then further surveyed 419 of those adults, who identified as non-trackers, about what incentives would convince them to use wearable health monitors. Here are some of our takeaways for vendors and providers:

1. The wearable health market remains small, but is growing steadily

In order to gauge how many adults are currently generating personal health data that would be useful in either patient treatment or preventative medicine, we asked a random, nationwide sample of adults whether they currently tracked their weight, diet, or exercise using a fitness tracking device or smartphone app.

74.9 percent of respondents indicated they did not track any of those variables using either a fitness tracker or smartphone app. 25.1 percent reported tracking such stats.

Out of the roughly one quarter of adults who do track their fitness, 14.1 percent said they used a smartphone app, and 11 percent said they used a fitness tracker. There is currently little data on such demographics, although the Pew Internet Research Project conducted a survey in 2012 looking at similar trends. In their report, they noted that seven percent of adults tracked health indicators using an app. Combining these results, we can see that the market for health tracking applications has approximately doubled over the last two years.

As more consumers adopt such technology, and rely on it for monitoring their health, providers need to become involved in the discussion. There is limited data that can be draw from a sample of just 25 percent of a patient population. If providers can encourage adoption among a majority of their patients however, they will gain greater insight into current health habits, and be able to provide more tailored advice.

2. Physicians can play a large role in encouraging tracking but there are are few incentives in place for them to do so

Looking into what incentives could convince non-tracking adults to use such devices, we found great potential for healthcare providers to encourage tracking habits among their patients. It appears patients want their physicians involved more in monitoring but our healthcare system doesn’t have the right incentives or payment structures available to compensate providers.

48.2 percent of adults said they would use a wearable fitness tracker if their physician provided one. While this may be financially unrealistic for smaller practices, wearable activity trackers (like the FitBit or Jawbone UP) will likely become cheaper as more sophisticated, multi-purpose devices enter the market, such as the forthcoming Apple Watch.

If physicians were able to get half of the three-quarters of non-tracking adults to start measuring their fitness with wearable devices, it would create huge amounts of patient-generated data for the healthcare industry to analyze.

The infrastructure for handling this data is largely in place. The most popular electronic health record provider, Epic Systems, recently announced a partnership with Apple that will allow hospitals to easily integrate wearable data through Apple’s HealthKit platform into patient portals and records.

Promoting the use of such devices should now be a goal for physicians looking to gain greater insight into their patient population. The question would be why Physicians would do this without additional compensation either directly from their patients or indirectly through insurers.

3. Insurance companies and providers need to form partnerships

While a significant portion of adults would use physician-provided devices, health insurance companies may be the ultimate key to promoting widespread fitness tracker adoption.

A total of 57.1 percent of respondents said they would be more likely (or much more likely) to wear a fitness a tracker if they could receive lower health insurance premiums. In fact, this was a more compelling incentive than the possibility of receiving better healthcare advice from their physician (just 44.3 percent of respondents said that would make them more likely to use a tracker).

By agreeing to use a fitness tracker, insurance customers would become eligible for special discounts, perhaps for walking a set number of steps each day, or raising their heartbeat for a certain period of time. Discounts could be given out directly or through an employer.

Some companies are already experimenting with such systems. Humana insurance has a new Vitality program that allows employees to opt-in to fitness tracking in exchange for possible discounts. Car insurance companies have also found success by offering lower rates for safe-driving, as measured through in-car tracking devices.

If providers want to encourage fitness and health tracking among their patients, they should evaluate the possibility of providing devices to their patients, either for free or at a reduced cost. At the very least, they should make patients aware of the benefits of such devices, and encourage them to automatically share such data through their patient portal.

Long term, providers will likely need to collaborate with insurance companies in order to establish a data sharing system for such information, which can allow for physicians to better monitor their patient population, and provide more accurate, tailored diagnoses. A universal patient record system would be ideal, although given current interoperability standards, an insurance-provider arrangement is more likely.

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MedCityNews invited me to attend their ENGAGE “Innovation in Patient Engagement” Conference and I found the content, speakers, and overall quality quite good. Since I chair several conferences every year I know how hard it is to pull off a good one so I’d like to congratulate MedCityNews for pulling off a great event. I asked HITSphere‘s Vik Subbu, our Digital Health editor that focuses on Bio IT and Pharma IT, to summarize what we learned at the event. Here’s Vik’s recap of the conference:

The goal of the ENGAGE was to highlight the importance of patient awareness and engagement in developing and managing novel digital health innovations. The conference was attended by industry experts from various disciplines ranging from academic hospitals, non-profit organizations, digital health start-ups, venture capital, service providers and pharmaceutical companies. The interactions between product developers and patients proved to be worthwhile as it is often rare to get both ends of the spectrum together. The point of the conference, driven home in almost every session, was that having patient (i.e. customer) input early on shapes better product development decisions and viewpoints.

Top Nine Insights for digital health innovators and providers:

  1. Engage patients upfront prior to developing ANY digital health solution. This seems obvious but it’s not always done well — we just assume patients have various needs without testing our hypotheses.
  2. Healthcare providers need to look at existing information for patient care – let’s use what we already have to improve care. This means innovators should not be creating new data collection or data entry screens if that same information can be integrated from an existing solution (such as an EHR, lab system, etc.)
  3. Stay away from the “hype” – providers do not have the time to test out digital health solutions/applications. Do your homework with patients, payers and providers before embarking on developing a digital health solution. It’s easy to create software, it’s very hard to find clinicians willing to spend time testing your software-based hypotheses.
  4. Clinical work flows will change in the future – consider these changes and integrate your digital health solution into these work flows. This means you should abstract your workflows, protocols, procedures, etc. from the core software into distributed workflow or BPM style systems. Whatever you assume the workflow to be, it’s likely to be wrong as it gets into complex environments like hospitals and health systems. Do yourself a favor and abstract it so that you can flex the software as move from enterprise to another.
  5. Do not compete with physicians – digital health applications should support not supplant physicians. If you’re creating educational systems for patients give them data that they can share with their physicians. If you’re creating diagnostic systems, create them so that the data they generate can easily be shared with clinicians and existing systems.
  6. Enhance the patient experience in the clinical setting through digital health. This can be done in many ways, starting simply as digital signage — going to patient navigators and even as far as digital avatars. Don’t think about the current experience and try to slightly improve it; instead, think of completely new ways of solving old problems.
  7. Consider “slow” technology – design the digital health as you go along while incorporating patient input and reflections and find the right solution, not focus on the technology – the best technology fades into the background. Create solutions with Clayton Christian’s JTBD model in mind — what problem are you really solving?
  8. The common saying that “everyone is a patient” is untrue. There is a clear line between REAL patients with chronic illnesses that have to deal with the day-to-day challenges with our healthcare system vs. someone with a cold/cough
  9. Do not underestimate the importance of patient family groups and caregivers — sometimes your solution for patients might best be targeted at caregivers and not the patients.

Did you attend ENGAGE? What did you learn? Please share your thoughts below.

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It’s getting easier and easier to build unregulated software these days but it’s still pretty hard to create regulated/certified systems such as EHRs, medical device software, and government IT. To help create better systems we all know we need better user requirements; however, “heavyweight requirements” efforts have been shunned, especially in unregulated systems, over the past decade in favor of “user stories” and more agile specifications. But, are agile user stories the best way to go in regulated systems where requirements traceability and safety analysis is a must?  I invited Abder-Rahman Ali, currently pursuing his Medical Image Analysis Ph.D. in France, to come back and give us advice on whether there’s room for both user stories and SRSs in regulated industries or if we’re stuck with formal requirements specs. The following is Abder-Rahman’s third installment for this blog and I’m excited he’ll be tackling such an important topic. As always, he can be reached via e-mail or twitter.  Here’s what Abder-Rahman says about User Stories vs. Software Requirements Specifications:

It was on February, 2001, when seventeen practitioners formed what was called The Agile Manifesto. It seems that since then, we started to hear of the term User Story, although, as will be shown below, it seems that the term appeared before that date.

The questions that may pop-up on someone’s head are, is the User Story just a fancy name to the user requirement? Or, it is actually a new mindset of thinking in the way of dealing with user requirements?

Referring to Wikipedia about the history of user stories, I found that user stories originated with Extreme Programming (XP), but, it wasn’t until 2001, when Ron Jeffries proposed the Three C’s formula: Card, Conversion, Confirmation, where the components of the user stories were captured.

But, what are User Stories after all?

I really liked how Mike Cohn described User Stories, when he said:

User Stories are short, simple description of a feature told from the perspective of the person who desires the new capability, usually a user or customer of the system. They typically follow a simple template:

As a <type of user>, I want <some goal> so that <some reason>.

User Stories are often written on index cards or sticky notes, stored in a shoe box, and arranged on walls or tables to facilitate planning and discussion. As such, they strongly shift the focus from writing about features to discussing them. In fact, these discussions are more important than whatever text is written.

Before moving ahead, and comparing User Stories with Software Requirements Specifications (SRS), let us see how SRS is defined. Based on Chambers, SRS describes the essential behavior of a software product from a user’s point of view, where the purpose of SRS is to be a basis for agreement between the customers and the suppliers on what the software product is to do; a basis for developing the software design; a basis for estimating costs and schedules; a baseline for validation and verification; reducing the development effort; facilitating transfer; and serves as a basis for enhancement.

After knowing what they mean, how can we compare User Stories with SRS? I saw that rather than bringing theory to this part, why not monitor some discussions related to this issue? I thus went through some discussions at a Programmers Stack Exchange thread, and came up with the following:

One of the people involved in the discussion mentioned: To be honest, after spending close to two years immersed in Agile development, I still think “User Story” is just a fancy term for “functional requirement”. That person continues: What User Stories almost never capture, in my experience, are non-functional requirements like performance and security. These kinds of requirements are very difficult to write properly and the format of the User Story simply isn’t very good for capturing them, because they’re more about general product quality and mitigating (but not eliminating) risks rather than meeting a specific user’s need. So, I really think of User Stories as a subset of requirements, with a specific formula, and still use the terms pretty much interchangeably. The one major advantage User Stories do have over requirements is that the word “requirement” suggests that a feature is required where it is often just desired. User Stories can in theory be prioritized and slotted in for any release, whereas requirements appear to be a prerequisite for every release.

Other opinions arise mentioning that SRS focuses on “how” the user interacts with the system, and “how” to implement the functionality. On the other hand, User Stories focus on “what” (interaction between user and system) purpose do features have, such that, the task of a User Story would be a functional requirement, and is the expected work product after the functional tasks have all been completed. Thus, they are completely different things.

Requirements assume that the design of the application is done beforehand, and development is considering the implementation of that design.

User Stories insist that the design of the product is done at the last minute, and is a collaboration between a product person and a developer person, and the details are decided during implementation.

So, as can be noticed, the amount of details provided is different using the two approaches, such that, in the User Story for instance, there is a lot of information that is available not available in the requirement, namely, what is we are trying to achieve with the feature.

Others go and mention that a functional requirement is a formal specification that allows one to know exactly if the software works or not. Whilst a User Story is an informal way to describe a need of one of the User Stories, such that, it doesn’t specify a rigid specification to determine if the software is valid or invalid. Although you can test some part of the User Story, its real completion is when the user says : “Yes, this solves my problem”.

We thus realize that the User Story is a huge paradigm shift in the way to approach the work to be done. A contract here is not made, rather, you are trying to help your user to solve a problem. If you don’t see your user stories as discussion tools with a real user, then you are actually not using User Stories.

This post can grow bigger and bigger, and seems that when people attempt describe the notions “User Story” and “user requirement”, such descriptions come from their experience, and how they use each of them. Going through the comparisons above may not reveal clearly the differences between both terms. For that, we chose to interview Agile experts about this issue, for which answers will be shown in the next post.

Stay tuned until then, and don’t hesitate to share your views in this topic, and how you approach those two terms.

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When you’re looking to buy or replace your EHR, follow these common sense Dos and Don’ts for comparing EHR software

By some accounts, almost 30% of EHR users will be interested in replacing their software as they move from Meaningful Use Stage 1 to 2 to 3 over the next few years. Although I’ve written and spoken extensively in the past about how to make sure you pick the right digital health and EHR software, […]

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Patient portals have a future as a patient engagement tool if clinicians are on board and encourage their use

I wrote my first patient portal site, built into my first EMR software, back in 1998. At that time I mistakenly thought that portals would take off and patients would embrace them. What I quickly learned was that patient portals aren’t really portals in the sense of Yahoo! or Google but enterprise software’s customer-facing front-ends. The enterprise software in this […]

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How to improve your SRS by distinguishing between vague and ambiguous requirements in health IT and medical device systems

Because it’s so easy to build software these days we’re seeing a proliferation of healthcare apps — what’s hard to figure out is whether we’re building the right software. Abder-Rahman Ali, currently pursuing his Medical Image Analysis Ph.D. in France, has graciously agreed to give us advice on how to write good software specifications for health and medical […]

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ENGAGE can help pharma and biotech learn how to benefit from patient engagement

Patient engagement is something that physicians have done for thousands of years as they cared for patients (whether going to their homes or having them come to hospitals or clinics). With new digital health technologies the way providers can engage with patients is changing significantly but we’re not quite sure about the best ways to apply […]

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The future of medicine and the incredible innovations we can expect by 2064

The Fred Alger Management team reached out to me recently asking what innovative changes I thought the medical and healthcare industry will be going through over the next 50 years. It was for their innovative “Think Further” series: As Yogi Berra famously quipped “It’s tough to make predictions, especially about the future” but Alger’s “Future […]

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Top Ten Insights for Digital Health Innovators from the Next Generation Point of Care Diagnostics Conference

Cambridge HealthTech Institute (CHI) invited me to attend their Next Generation Point of Care Diagnostics Conference and I came away thoroughly impressed with the content, speakers, and organization. Since I chair several conferences a year I know how hard it is to pull off a good one so I’d like to thank CHI for a […]

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