Appendix I Wide Variation in Staffing Levels FTE Distribution Across Selected IT Functionalities Functionalities Size Min Max Median Std. Dev. Our surveys demonstrate a high degree of variation in IT staffing levels across the industry. This adjacent data from our 2012 IT Strategy Council survey shows the degree of variation even within specific job functions like clinical systems support, security, or business intelligence. This observation may be attributable to variations in vendors, technology, and strategy although the data on the next slide show wide staffing variation, even among providers using the same EMR. We also acknowledge that staffing levels change and that staff can be deployed on multiple systems and projects throughout the year. Given this variation, we believe that the range (min/max) is more useful as a staffing baseline than the median or the mean. Clinical Systems Implementation and Support (EMR, Home Health/LTC, CPOE, CDS, etc.) Administrative Systems Implementation and Support (AR, GL, Payroll, HR, Supply Chain, etc.) Revenue Cycle Management Applications Support (Billing, Scheduling, Registration/ADT, etc) Data Administration (Database Administration, Interface Support, and Data Architecture/Modeling) Business Intelligence and Enterprise Data Warehouse Web Services, Web Development, Clinician Portal, and Patient Portal Privacy and Security Compliance Small 2.5 52 10 14.18 Large 30 136 50 39.32 Small 1 5 2 1.61 Large 2 120 16 34.14 Small 1 8 3 2.30 Large 8 41 15 10.60 Small 0.8 15 2 4.34 Large 4 29 13.5 7.42 Small 1 6 1 1.56 Large 1 18 9 5.62 Small 0.2 5 2 1.42 Large 2 25 9 7.37 Small 0.2 8 1 2.12 Large 2 22 6 6.05 2013 The Advisory Board Company 20 advisory.com
Appendix I Continued: Wide Variation in Staffing Levels FTE Distribution for PC Support n = 534 organizations with 500 or more FTEs Min Max Mean Median Std. Dev. An analysis of staffing levels for PC support from January 2013 further illustrates the lack of consistency in the industry, even when ratios such as number of computers supported per administrator or number of FTEs supported per administrator are used. A detailed analysis of this data also failed to find any clustering of the data with staffing levels distributed relatively evenly across most of the range, which indicates that the differences cannot be solely accounted for by variations in technology like the use of virtualization. Similarly, an analysis of overall IT staffing levels for organizations using a specific EMR (MEDITECH) had ranges from a low of 2 IT FTEs to a high of 52 for hospitals with 1,000-2,000 total employees. While these wide variations in staffing levels mean that precision benchmarking is not possible, it may be possible for organizations to draw some value from the range of the data. Number of Overall FTEs 500 65212 5258 3288 6977 Number of FTEs PC Support 1 296 18 10 28 Number of Computers 15 18400 1741 1010 2117 Ratio of FTE to PC Admin 12 2469 381 326 266 Ratio of Computer to PC Admin 3 800 127 103 101 FTE Distribution for MEDITECH Support n = 52 organizations Min Max Mean Median Number of Overall FTEs 1000 2000 1379 1334 Number of Staffed Beds 114 478 221 205 Total Number of IT Staff 2 52 22 24 Source: 1) Advisory Board analysis of PC support staffing data available through HIMSS Analytics. Report generated on 1/11/2013. 2) Advisory Board analysis of MEDITECH hospital staffing data available through HIMSS Analytics. Report generated on 3/8/2012. 21
Appendix II Advisory Board IT Strategy Council Staffing Survey Questionnaire To better understand our member organizations' staffing models and to help address questions around staffing needs and how they compare with peer organizations, we conducted an exclusive survey in 2012 which served as the basis for much of this report. The following pages contain the survey questions that were used. 1. Please indicate the organization s IT operating budget in fiscal year 2012. (Answers are in $ millions) 25,000,000 or Less 250,000,001-275,000,000 500,000,001-525,000,000 750,000,001-775,000,000 25,000,001-50,000,000 275,000,001-300,000,000 525,000,001-550,000,000 775,000,001-800,000,000 50,000,001-75,000,000 300,000,001-325,000,000 550,000,001-575,000,000 800,000,001-825,000,000 75,000,001-100,000,000 325,000,001-350,000,000 575,000,001-600,000,000 825,000,001-850,000,000 100,000,001-125,000,000 350,000,001-375,000,000 600,000,001-625,000,000 850,000,001-875,000,000 125,000,001-150,000,000 375,000,001-400,000,000 625,000,001-650,000,000 875,000,001-900,000,000 150,000,001-175,000,000 400,000,001-425,000,000 650,000,001-675,000,000 900,000,001-925,000,000 175,000,001-200,000,000 425,000,001-450,000,000 675,000,001-700,000,000 925,000,001-950,000,000 200,000,001-225,000,000 450,000,001-475,000,000 700,000,001-725,000,000 975,000,001-1,000,000,000 225,000,001-250,000,000 475,000,001-500,000,000 725,000,001-750,000,000 More than 1 billion 2. Does percentage of the IT operating budget indicated above also include any of the following? (Please select all that apply) HIM Biomed Telecom Informatics Business Intelligence/ Analytics Other (please specify: ) 22
3. In fiscal year 2012 what percent of the IT operating budget is dedicated to the following IT staff in your department: Employed FTEs? 1-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 More than 50 Temporary contract labor? 1-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 More than 50 Purchased/outsourced staffing services? 1-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 More than 50 4. Please indicate the number of IT FTEs employed by your organization in fiscal year 2011 (excluding temporary staff, contract staff, and purchased/outsourced services): 10 or Less 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100 101-110 111-120 121-130 131-140 141-150 151-160 161-170 171-180 181-190 191-200 More than 200 5. How will the percentage of budget dedicated to IT staff change in fiscal year 2012? Decrease by more than 20% Decrease by 6-10% Increase by 1-5% Increase by 16-20% Decrease by 16-20% Decrease by 1-5% Increase by 6-10% Increase by more than 20% Decrease by 11-15% No change Increase by 11-15% 2013 The Advisory Board Company 23 advisory.com
6. What was the percentage of IT staff turnover (include only employees who left the department and were replaced; exclude promotions or job changes) in fiscal year 2011? 0 1-5 6-10 11-15 16-20 21-25 26-30 More than 30 7. Please provide data on how many FTEs you currently employ across each of the following functionalities and how you anticipate the number of staff devoted to each functionality to change in the next 3 years. Notes on reporting data: Column 1: Please indicate "Not Applicable" if your IT department does not support the functionality or "Outsourced" if your IT department outsources the functionality. Column 2: Recognizing that one IT staff might perform different tasks and function, in the second column please indicate the number of IT staff by FTE and not headcount. Column 3: For the next 3 years please indicate the anticipated annual change of IT staff regardless of whether you internally support or outsource the functionality. Please select any of the following options: Significant decrease Moderate decrease No change Moderate increase Significant increase Functionality Outsourced or Not Applicable IT staff FTEs currently in place Anticipated change of IT staff in the next 3 years Clinical Systems Implementation and Support (EMR, Home Health/LTC, CPOE, CDS, etc.) Administrative Systems Implementation and Support (AR, GL, Payroll, HR, Supply Chain, etc.) 24
Functionality Outsourced or Not Applicable IT staff FTEs currently in place Anticipated change of IT staff in the next 3 years Revenue Cycle Management Applications Support (Billing, Scheduling, Registration/ADT, etc.) Data Administration (Database Administration, Interface Support, and Data Architecture/Modeling) Business Intelligence and Enterprise Data Warehouse Telecommunications (Both Data and Voice) and Network Other Operations (Server Support, Help Desk, Storage Management, Workstation/Mobile Device Support, etc.) Web Services, Web Development, Clinician Portal, and Patient Portal Privacy and Security Compliance Change Management (People and Process Change) Informatics/ Clinical Content Management Biomedical 25
8. Please provide data on how many FTEs you currently employ across each of the following initiatives and how you anticipate the number of staff devoted to each initiative to change in the next 3 years. Please report data following the guidelines set forth in the previous question. Functionality Outsourced or Not Applicable IT staff FTEs currently in place Anticipated change of IT staff in the next 3 years ICD-10 Conversion Meaningful Use Initiative Accountable Care Organization Initiative Medical Home Initiative Health Information Exchange 26
9. For each of the functionalities listed below, please indicate the quality of skills possessed by your staff (Skills) and the quantity of staff (Staffing Level). Functionality Clinical Systems Implementation and Support (EMR, Home Health/LTC, CPOE, CDS, etc.) N/A Skills (1 = Very Poor and 5 = Outstanding) Staffing Level (1 = Scarce and 5 = Abundant) 1 2 3 4 5 1 2 3 4 5 Administrative Systems Implementation and Support (AR, GL, Payroll, HR, Supply Chain, etc.) Revenue Cycle Management Applications Support (Billing, Scheduling, Registration/ADT, etc) Data Administration (Database Administration, Interface Support, and Data Architecture/Modeling) Business Intelligence and Enterprise Data Warehouse Telecommunications (Both Data and Voice) and Network Other Operations (Server Support, Help Desk, Storage Management, Workstation/Mobile Device Support, etc.) Web Services, Web Development, Clinician Portal, and Patient Portal Privacy and Security Compliance Change Management (People and Process Change) Informatics/ Clinical Content Management Biomedical 27
10. For each of the following types of IT staff, how many IT personnel (in FTEs) does your IT department currently have and in the next 3 years what is the anticipated change in number of staff? Type of IT staff Not Applicable Number of IT staff FTEs currently in place Anticipated change of IT staff in the next 3 years Significant decrease Moderate decrease Software Engineer/Programmer No change Moderate increase Significant increase Physician Informaticists Nursing Informaticists Other Informaticists Clinical Analysts (e.g., Nurse, Pharmacist, Physician, etc.) Financial Analysts Biomedical Technicians Hardware Technicians Managers, Supervisors, and Department Liaisons Privacy and Security Specialist Clinical and Financial Application Supporters and Trainers Mobile Application Supporters Technical Writer Change Management Specialist (People and Process Change) Quality Improvement/Six Sigma/ Lean (etc.) Specialist 28
11. Have you developed a comprehensive work force plan for IT that identifies both current and future staffing needs and created a long-term plan for meeting those needs? a. Yes b. No 12. Please indicate the degree to which each of the following factors are a problem for your current IT staff on a scale from 1-5 with 1 indicating not at all a problem and 5 indicating a severe problem. Factor 1 (Not at all a problem) 2 3 4 5 (Severe problem) Overwhelming workloads for the IT staff Requirement of new skills among the IT staff Lack of health care experience Expectations regarding salary and benefits among IT staff Insufficient budgets to retain existing IT staff Competition for IT staff with other industries Recruitment of IT staff by health care competitors in the market area Recruitment of IT staff by vendors and consultants Retirement of existing IT staff Lack of a career path for the IT staff If there are other factors affecting your IT staff, please provide in the space below: 2013 The Advisory Board Company 29 advisory.com
13. Please indicate the degree to which each of the following factors are a problem for the recruitment of IT staff on a scale from 1-5 with 1 indicating not at all a problem and 5 indicating a severe problem. Factor Geographically unbalanced distribution of IT workers (i.e., fewer number of IT workers in small towns or rural areas) makes it difficult to recruit IT workers in my area 1 (Not at all a problem) 2 3 4 5 (Severe problem) The majority of IT workers applying for a position at my institution lack up-todate, necessary skill sets Budgets dedicated to hiring new IT workers are insufficient It is costly to recruit IT workers with the right skill sets and experience Pay levels and benefits set by my organization do not meet IT workers expectations It takes time (at least 6 months to 1 year) to train new IT workers without experience on HIT applications before they can be productive Lack of overall health care experience 14. How often do you use the following strategies to recruit new IT staff? Strategy Never Rarely Sometimes Usually Always Compete on salary and benefits Well defined career path Flexible work hours Telecommuting Training and development programs Mentorship program Open communication and transparent work environment Referral programs 30
Strategy Never Rarely Sometimes Usually Always Recruiting and training staff from within the organization Use of recruitment companies Establish flexible staffing relationships with staff augmentation providers Build relationships with schools and colleges in the community and/or work with them to define curriculums for healthcare IT needs The use of social networking sites for recruiting such as LinkedIn and Facebook Provision of innovative environment for state-of-the-art, cutting edge technology Work with the community colleges to recruit students trained under the ARRA Health IT Workforce Development Program If you use other strategies to effectively recruit new IT staff, please provide in the space below: 15. How do you deploy the following strategies to retain existing IT staff? Strategy Never Rarely Sometimes Usually Always Competitive salary and benefits Incentive bonuses Job sharing Well defined career path Flexible work hours Telecommuting Training and development programs Opportunity to work on what they always wanted to do Mentorship program Open communication and transparent work environment If you use other strategies to effectively retain new IT staff, please provide in the space below: 31
Appendix III List of Acronyms ACO Accountable Care Organization ADT Admissions-Discharge-Transfer AR Accounts Receivable ARRA American Recovery and Reinvestment Act BI Business Intelligence Biomed Biomedical CDS Clinical Decision Support CIO Chief Information Officer CPOE Computerized Physician Order Entry DBA Database Administrator EDW Enterprise Data Warehouse EHR Electronic Health Record FDA US Food and Drug Administration FTE Full-Time Equivalent/Full-Time Employee GL General Ledger HCO Health Care Organization HIE Health Information Exchange HIM Hospital Information Management HIT Health Information Technology HR Human Resources LTC Long Term Care M&A Mergers and Acquisitions MU Meaningful Use RCM Revenue Cycle Management VPMA Vice President of Medical Affairs 2013 The Advisory Board Company 32 advisory.com
2445 M Street NW I Washington DC 20037 P 202.266.5600 I F 202.266.5700 advisory.com