By Mary Butler
Would any housing co-op board ever hire a self-described all-purpose handyman who might perfectly connect the plumbing systems of a 40-unit new construction condo building, but may only semi-competently replace a dining room light switch? Probably not. The board would more likely hire a person who can competently fix backed-up toilets, switch out electrical fuses, repair a garbage disposal, patch holes in the drywall, and mend broken windows. Homeowners want an on-site engineer who can fix a lot of unit mishaps, rather than hiring a specialist only able to expertly do one thing but not others. In short, they want a jack of all trades for the job. For years, this model also served healthcare well—HIM in particular. But changing technology has shifted the industry to the point that new specialized skills are also now needed from HIM professionals, leaving many to supplement their jack-of-all information expertise with specialized knowledge in things like informatics and data analytics in order to stay relevant and versatile.
Hospitals, health plans, vendors, and other entities that hire health information management (HIM) professionals face a similar conundrum when hiring HIM positions. The market is demanding that HIM professionals be routinely able to master core domains such as coding and classification, privacy and security, and billing and revenue cycle. But as electronic health records (EHRs) have flourished and the need for accurate, clean data has grown, organizations have started requiring that workers also know their way around databases.
Matt Schuller, MS, RHIA, director of health IT for a national health insurance trade association and a former AHIMA Foundation board member, says there’s an outcry from those already in the field for more specialization of knowledge. This is true for HIM professionals at all degree levels. Industry recruiters and their hiring managers are looking for professionals with informatics and data analytics experience and credentials. However, the problem is more pronounced for individuals with an associate’s degree or an RHIT, which comprise the majority of AHIMA’s members, since these levels of training are particularly general in nature. While there are coding professionals with higher degrees, especially trainers and consultants, it’s generally associate level RHITs or specialty credential holders that hiring managers look to for filling basic coding positions—positions that may be thinning out in the coming years. Schuller says he is the most worried about this group of HIM professionals and the threat posed by computer-assisted coding (CAC), outsourcing, and other emerging technologies.
“There will be people who tell you the technology is not there yet today… we don’t want to build on that misconception. But it [CAC] is a form of artificial intelligence and it learns every day. This is exactly where we saw the transcription industry 30 years ago. Back then they said ‘Oh, no, that voice recognition stuff is never going to work.’ Well, it works. There are not as many transcriptionists today,” says Desla Mancilla, DHA, RHIA, vice president of academic affairs and certification at AHIMA.
To keep HIM professionals and their skills firmly in the 21st century, AHIMA and its Council for Excellence in Education (CEE) have launched a campaign to ensure current HIM students are taught the “new” HIM skills, such as information governance, leadership skills, informatics, data analytics, and project management—in addition to the “old” or more traditional HIM domains such as privacy and security, release of information, coding and classification, and clinical documentation improvement (CDI).
One way AHIMA and the CEE are doing this is through curriculum changes that add additional competencies to all degree levels. Curriculum enhancements and competency additions or revisions are developed by AHIMA and the CEE. The changes are then enforced by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM). These new competencies will be incorporated into HIM curricula beginning in the fall of 2017.
Then there’s HIM Reimagined (HIMR), an AHIMA initiative that will provide guidance on how to take the newly updated competencies and use them in the profession to help students prepare for the “new” HIM of the future, centering on newer areas of specialization. Workforce research going on this summer that surveys employers will inform the CEE about the type of specialization content that should be developed. This research will help consolidate the RHIT curriculum. It will still cover a little bit of everything HIM, but it will give students and college programs room to focus on specialized domains that match best with students’ interests, workforce needs, and provide sturdier career viability.
“The competencies are an iterative process and generally change every three to five years. The 2014 competencies that are required by CAHIIM for implementation in 2017 are a great start. And, as HIMR becomes more ingrained, it too will bring additional changes in competencies,” says Dilhari DeAlmeida, PhD, RHIA, assistant professor at the University of Pittsburgh, who teaches master’s and bachelor’s level HIM courses. “Change is constant and unless our competencies are keeping pace with industry changes we are not doing what is needed to advance the HIM profession.”
Maintaining a balance between teaching old and new HIM is a struggle for educators. While there has been great movement toward using EHRs and information technology systems to manage health information, there are specialty settings and geographic areas that have not yet adopted these changes—meaning standard HIM skills are still in demand. Educators have to create a program that has the right cocktail mix of current and new skills in it to land people a job.
As far as creating that educational mix known as the brave new HIM, it’s important to hear from educators at various levels of education, new graduates entering the workforce, and employers hiring members of the workforce on what their definition of an adequate HIM workforce member is in 2017 and the near future.
HIM’s ‘New’ Skills Emerge in the Classroom
Educators have been tasked with finding a balance between old, current, and new HIM skills in order to prepare students for any and all HIM-related jobs. Skills vary with the different levels of HIM education available, meaning that associate’s degree, baccalaureate degree, and master’s degree educators all need to update their programs in slightly different ways.
Associate’s/RHIT Level Changes Needed
It’s not just AHIMA that’s trying to spread the word that HIM students need analytics and informatics skills, it’s also people working in the industry—especially industry professionals that have adopted educator roles.
One of those people is Barbara Flock, RHIT, CPHQ, interim director of the HIM program at Spokane Community College, in Spokane, WA. “I came from the industry a little over a year ago and I’ve seen how much we need to have informatics in place. We need to be able to manage that because there’s a big gap in the industry,” Flock says. “We have nurses getting hired to those positions. But they got into nursing to do patient care, not to do reporting and analytics.”
To compensate for this gap at the associate’s degree level, Flock is trying to make sure her students have solid database and database querying skills, as well as proficiency with Excel—skills which she found lacking out in the field. Students in her program are also taught how to participate in the conversion to a new EHR system and participate in the selection of EHRs and other new IT systems. When Flock was working in the industry, she found that HIM departments wound up doing all the quality reporting and running reports that informed executive decision making. The IT department was too busy scheduling jobs to run and complete system updates, and the clinicians were swamped by heavy patient loads—so the job fell to HIM.
It can be overwhelming, Flock says, to fit all the coursework required by AHIMA and CAHIIM into the associate degree curriculum.
“Our curriculum committee here at the school doesn’t want us to have more than 90 credits in the program total, and we just can’t do that. We’re currently at 104 [credits]. So we’re over the number of credits you need to get an associate’s, but in order to get everything in and meet all the domains AHIMA’s listing out for us, we need to have more classes. We’re actually at the point right now that we need to add more assignments to those classes,” Flock says.
Because the associate’s program is so intense, Flock says students can get a little burned out, but they are plenty qualified for the jobs they get after leaving school—and they’re definitely finding jobs. Flock says students are prepared for a lot of entry level job tasks, doing things like scanning and indexing, quality assurance, recording audit trails for release of information, etc. Many find jobs in coding. They are also well versed in how information flows through the industry.
Flock admits that it can be a challenge to recruit instructors. The industry is changing at the speed of light, and that’s very exciting for professionals, but it also makes it more difficult to find instructors with this new blend of expertise.
Updating HIM at the Baccalaureate, Master’s Levels
While a lot of the focus of HIMR is on RHIT-level curricula, educators teaching at the baccalaureate and master’s levels can also expect to incorporate more information governance (IG), data analytics, and informatics skills into their coursework. Of course, forward thinking programs are already doing this.
Melinda Wilkins, PhD, RHIA, FAHIMA, is a professor of HIM and the director of the HIM and health informatics programs at Arkansas Tech University. Wilkins teaches bachelor’s and master’s level classes, and says that early in her teaching career it occurred to her that the profession constantly needs to pause and re-evaluate where healthcare is going, and adjust the curriculum accordingly. So change isn’t new.
“I have this problem that I’m always thinking ‘What if?’ and as soon as we started using EHRs I was thinking ‘What do we do with all the data?’ I started thinking about that and started adding stuff to classes before it became required,” Wilkins says. “In a real-world situation this is going to help students.”
Yet other baccalaureate programs are still trying to find the right balance between the “old” and “new” HIM skills.
Alice Noblin, PhD, RHIA, CCS, associate professor and program director for the health informatics and information management undergraduate program at the University of Central Florida (UCF), says it’s definitely been a challenge to fit in some of CAHIIM’s new requirements with existing RHIA requirements but feels it is worth it to ensure students are prepared for the industry. She says starting this summer, bachelor’s level HIM students will have to take their RHIA exams in order to graduate. RHIA candidates at her school aren’t pushed to gain specialized credentials such as AHIMA’s CDIP or CHDA, but UCF’s master’s program strongly encourages them.
To fulfill the 2014 competencies for data analytics (competencies required to start in 2017), her program added a course called “Health Data Management” that consolidates a lot of the data analytics assignments interspersed among other classes into one. Noblin also includes more analytics projects and assignments to the classes she has always taught. Her school has also tweaked the privacy and security classes and started calling it cybersecurity instead.
“We created a class around fraud and abuse, so we put breach reporting in there and make sure students have some familiarity with audit trails so they can recognize when something’s amiss,” Noblin says. “That would be some of the newer skills that we’ve had to add, and it helps round out their [students’] education.”
One challenge her program faces is that the HIM track doesn’t “own” all of the courses. It shares courses with another undergrad program called health services administration (HSA), and some of the courses in the HIM curriculum are HSA courses. “It’s getting harder to get higher level assignments in those courses because we don’t teach those… so that’s an internal struggle,” Noblin says.
Because there are 102 competencies in the undergrad curriculum, Noblin says it can be hard to fit everything in. Some other HIM programs at other schools have cut back on CPT and ICD-10 coding classes to make room, but Noblin says it’s still important that HIM students have a strong understanding of clinical data and are able to understand where data comes from, so UCF has kept it in the curriculum.
DeAlmeida, the educator from the University of Pittsburgh, says she’s been integrating more informatics and data analytics into the curriculum for several years based on feedback from graduates and her department advisory board. She doesn’t see HIMR’s new objectives as being difficult to implement.
“When you look at HIMR’s core framework, embracing skill sets and new categories, and advancements in HIM, I think our graduate programs at Pitt are aligned with the core infrastructure of HIMR. For example, one recommendation is increasing the number of graduate-level programs. At Pitt we do have two different master’s level programs—one in health information systems, and one in healthcare supervision and management. We are graduating these professionals into great job opportunities,” Dilhari says.
In fact, Dilhari got her doctorate in HIM at the University of Pittsburgh and is seeing strong interest from other students looking to do the same.
But things are a little different for Wilkins at Arkansas Tech University. Wilkins herself is one of only two PhDs in the entire state with a background in HIM. She says it’s been easy to recruit adjuncts to teach bachelor’s classes but harder to find people for master’s level courses—which teach high-level skills. However, she’s encouraged to see more interest from students in the PhD.
“I think they see me as a role model, honestly. I tell them how many doors it’s [the PhD] opened for me. You can never learn too much. I’ve encouraged some to go into teaching because we have such a huge need for doctorally prepared people to go into teaching—we don’t have enough,” Wilkins says, since her school wants doctorates to teach at the master’s level.
Using ‘New’ HIM Skills on the Job
For recent HIM students with internship experience working with data or even for those with proper data analytics training, the job market is bright and their skills are in demand. But there’s room for improvement when it comes to education.
Kyle McElroy, MS-HSA, RHIA, vice president of HIM for Iasis Healthcare, says there’s a huge demand for HIM professionals with a broad understanding of how interconnected systems within a hospital work together. He has seen a knowledge gap in long-time HIM directors who understand explicitly how to run HIM operations, but who have trouble when it comes to the technical parts of implementing a new EHR system.
“It’s a challenge, and I’m sure it’s a challenge that AHIMA tries to address every day… at the end of the day you can’t force anyone to learn new skills,” McElroy says. “…It’s not even pure HIM stuff. It’s understanding how systems work. It’s also keeping up with news and literature in the industry and being able to apply things like that to information exchange, and information governance, and understanding how to move information from point A to point B.”
And in any HIM role, there needs to be a comfort in communicating with and supporting physicians. That’s a skill that isn’t really taught in a class but is learned through internships and career experience. The importance of having this skill is growing.
McElroy says that the newly graduated job applicants he’s seeing are able to dive right into the jobs they’re hired for and have a broader knowledge base. Like many in the industry—from educators to long-time practitioners—knowledge in data analytics and informatics is increasingly important. Where the rubber meets the road, he says, is the ability to really understand—in a fast-paced or high adoption of technology environment—that there’s data coming from a lot of places now. That is the case for both new graduates and long-time HIM professionals—who need to be able to mentally sort through those things. In other words, broader knowledge may be okay for now, but there is a need for more specific and detailed knowledge in the future.
“If a physician says to an HIM person, ‘Well, I’ll just call IT to figure it out,’ that won’t work. You need to understand what location data is coming from in order to triage it. You need to have people who can understand the difference between data and information,” McElroy says.
It’s in tasks like this that Andi Hila, RHIA, a product manager for IBM/Watson Health, excels. Hila graduated from Ohio State University in 2014 and had his pick of jobs. He started working for the vendor Explorys, which was eventually bought by IBM. In college, his thesis was on data analytics, and his first job was a perfect fit. He was a product analyst focused on the data governance and interoperability of the solution he was working on, to ensure it could support an array of different types of data governance needs. In addition, he had to help determine if it could be embedded and transfer data into a provider’s EHR.
Now, Hila is working to figure out how to embed a lot of Watson Health’s services so Hila’s team can do things like predictive analytics. He says working with Watson—the famous supercomputer—is high pressure but also high reward in terms of its potential benefits.
Hila says he was able to find such a rewarding job because he was so well prepared by the HIM curriculum—and he had an advisor who shared his passion for data analytics. His college internship with Health DataWorks, which has been acquired by Health Catalyst, put him right where he wanted to be when he was done with college. What’s more, the skills he obtained in college were some of the most in demand during his job search.
“Based on the types of positions I was looking for [employers wanted] the ability to understand and articulate the various components of healthcare data,” Hila says. “Being able to understand that CPT and ICD are clinical codes and that they’re used for reimbursement [is important]. And also being able to speak up intelligently to more technical components of how data is stored, why SQL is an important tool, all while understanding the general context of the healthcare system.”
Mary Butler (firstname.lastname@example.org) is associate editor at the Journal of AHIMA.
"Teaching the 'New' HIM: Educators Integrating Informatics, Data Analytics, and Information Governance Into HIM Programs"
Journal of AHIMA