Teaching the Future: An Educational Response to the AHIMA Core Model

By Bonnie S. Cassidy, MPA, RHIA, FAHIMA, FHIMSS; Valerie J.M. Watzlaf, PhD, RHIA, FAHIMA; Ellen Shakespeare Karl, MBA, RHIA; Rebecca B. Reynolds, EdD, RHIA; Leah Grebner, MS, RHIA, CCS, FAHIMA; Xiaoming Zeng, MD, PhD; Vanda Crossley, MS, RHIA; Cindy Zak, MS, RHIA, PMP; Cindy Glewwe, MEd, RHIA; Leslie Gordon, MS, RHIA; Samir Chatterjee; Christine Staropoli, MS, RHIA, CCS, PhD; Patt Peterson, MA, RHIA; and William J. Rudman, PhD, RHIA

Health information management (HIM) is the practice of collecting, assessing the completeness of, maintaining, and sharing (as authorized) patient information through paper-based and electronic means. It is practiced in provider, payer, research, and governmental settings, as well as in health information exchanges and other settings that provide healthcare or maintenance of health records. As healthcare evolves and becomes more dependent on technology, the role of the HIM professional must evolve.

With the widespread adoption of electronic health records and other technology-based information sources and the use of the electronically available data for healthcare management measurement purposes, research functions, and governmental initiatives, health informatics and health information technology are being increasingly utilized in HIM practices in the healthcare industry.

As a profession, HIM must become savvy in its use of technology and data analytic tools in order to better serve patients, inform policy leaders, and move into the twenty-first century and beyond. To meet the needs of various healthcare organizations in their use of emerging technologies HIM professionals need to be involved at an executive level where decisions are made regarding the design, implementation, and use of technology from a systems approach.

From an operational perspective this would suggest involvement in the adoption and implementation of systemwide technology; the use of data to improve patient care and reduce cost; and a role as leaders who define future policies and procedures as they relate to the privacy and security of the organization.

To meet this new demand AHIMA must re-engineer academic curricula and programs in a proactive manner to both anticipate and define the evolving roles of the HIM professional. The fluid, iterative model allows the profession to both respond to and help define the evolving healthcare market. It is important that academic programs prepare students for the future of healthcare and not become reactive to what has happened in the past.

AHIMA Core Model

In 2011 AHIMA brought together HIM experts to identify the roles, settings, and impact of the profession through the next decade. The group extended and advanced a draft core model of HIM functions into a description of the desired future state of HIM roles as they will be performed across the healthcare industry. The primary objectives were to:

• Articulate desired HIM professional roles across industry settings in order to:
  • Identify and specify the future scope of HIM practice functions and roles
  • Identify and specify the value of such roles to society, the health industry, current and future employers of HIM professionals, and current and future HIM professionals
  • Differentiate HIM from other related disciplines
• Provide a professional scope of practice that clarifies the role of AHIMA in serving the industry
• Enable follow-on work (phases)

From this work, a general core model was developed, shown in the figure above. In this model the primary role of the HIM professional is focused on the governance and stewardship of health information. The roles to be expressed within the model are determined by four drivers: education, research, policy, and standards. The base of the model is education. This article examines the educational response to the core model. Future articles will focus on the impact of the other drivers.

Read more about the core model at http://journal.ahima.org.

Education's Response to the Core Model

As a profession, HIM is at a tipping point where it has the ability to control its future and to grow. In order to prosper, the educational curricula must change to address the rapid growth within healthcare.

AHIMA is well positioned to take on these opportunities in information management at all levels within the healthcare system. In response to the evolving role of the HIM professional, the AHIMA Council for Excellence in Education (CEE) is proposing new educational initiatives to address both those entering the field as well as those already in the HIM workforce. Moreover, the initiatives address both entry-level and senior leadership positions.

As shown in "HIM Core Model Components" on above, the primary role of information governance and stewardship will depend on the profession's ability to capture and document data; analyze data in a meaningful way for both quality improvement and research; and then implement and control both the content and use of data within the organization. To fulfill these roles, HIM professionals must have a wide breadth of educational experience at various levels within the academic landscape.

The following five educational initiatives can anticipate these future changes by preparing HIM professionals to move into these new roles:

• Focus on the HIM degree
• Restructure the RHIT curricula to include areas of specialization
• Shift the entry level into the profession from a baccalaureate to a master's degree
• Invest in faculty and workforce development in the areas of research and quality improvement
• Create a workforce development degree focus: a road map to the C-suite for HIM professionals (e.g., chief knowledge officer)

Focus on the Educational Degree

The first educational initiative is focused on shifting the emphasis away from certifications and credentialing to the HIM educational degree.

This focus is not intended to diminish the importance of the credentialing process or certifications, but to enhance the importance of the degree in conjunction with credentials and certifications. In other words, the foundation of the following four initiatives are based on amplifying the importance of the degree and the knowledge associated with the degree and the importance of a national certification based on stringent standards that will separate the AHIMA credentials and certifications from other association initiatives.

RHIT Specialization Tracks

The healthcare market has become increasingly diversified and has steadily moved away from a need for new graduates who have received a "generalist" education. Employers demand work-ready staff who can be productive without a traditional extended overtime period. A specialization approach to the associate degree program, leading to a "RHIT+" model, would support this new reality.

In this model, the student takes core courses comprising fundamental HIM knowledge in the first year. In the second year, the student selects a specialty program offered by the program. In general, the underpinnings of this approach include the following recommendations:

• National agreement facilitated by CEE of what courses comprise the year 1 core. This content will then make up part I of the RHIT credential examination.
• National agreement facilitated by CEE of what specialty tracks to offer. These tracks should support the student's ability to acquire a second credential that reflects the track specialty (and part II of the credential exam). Existing exams that could serve as examples for the year-2 specialties include:
  • CTR-Certified Tumor Registrar. A new federal requirement that hospitals with more than 100 beds employ a CTR will make this a desirable field for those looking to fill a "required" healthcare position.
  • CCS/CCS-P-a specialty track that emphasizes deep learning of coding systems and reimbursement methodology. The switch to ICD-10-CM/PCS in 2013 will provide opportunities for new coders to enter the workplace, because candidates with "two years of ICD-10 experience" will not be available.
  • CHPS-a privacy and security specialty to provide a ready workforce to support an increase in healthcare reform and a shift to patient-centric record storage (e.g., Web-based EHRs and PHRs).
  • EHR credentialing: developing new credentials in areas such as EHR implementation and EHR training. It is expected that today's HIT Pro exams, currently funded by Office of the National Coordinator, will develop into a form of credential.

Programs would have the flexibility to determine which tracks best fit their community of needs.

An option to maintain an "RHIT generalist" program would be available for any degree program. Such a program would be especially appropriate for rural areas, where today's associate degree graduates are finding a welcome reception in their transitions from student to employee. The generalist model is not always working in urban settings, where a preference for workers with in-depth knowledge in specialty areas is forcing new graduates out of the marketplace.

Entry-Level Master's Degree

In a highly educated and competitive field such as healthcare, it is important that AHIMA provide students with every advantage to advance in their respective organizations. As an association AHIMA is in a position to help students better understand how the field will change and to push for educational reform on their behalf. Similar to changes made by the physical therapy and occupational therapy professions several years ago, the HIM profession must shift its entry-level degree to a master's degree level.

If HIM graduates are to achieve the status, occupational attainment, and roles that will define the future of healthcare, they will require the educational qualifications for this career path. If, as the profession claims, health information managers are at the heart of healthcare and serve as the liaison between the clinical, management, and business operations of the healthcare organization, they need to have the educational credentials to serve in high-level management positions.

By completing an entry-level master's degree, graduates enter into organizations at higher levels, have opportunities to transition into management positions of influence in a more direct career trajectory, and will be positioned to seek doctoral degrees in management and healthcare.

This will require an advanced degree in healthcare along with an appropriate credential. In keeping with the proposed philosophical shift to an emphasis on the degree, this type of initiative is important in creating a highly educated HIM workforce, engaged with and well served by AHIMA. This shift is essential in setting the stage for the final two initiatives focused on faculty and workforce development. Furthermore, the entry-level master's degree will elevate the prestige and position of AHIMA and the HIM profession in the healthcare field.

Investment in Faculty and Workforce Development

As healthcare becomes increasingly dependent on technology it becomes increasingly dependent on data. The ability to transform data into information is at the heart of current and future healthcare reform.

To meet the demand for a highly trained research faculty and data analysts, HIM faculty and workforce require expanded educational and research training opportunities. One example would be an extension of the AHIMA Virtual Lab beyond students to faculty and current professionals.

By creating programs that address the need to train faculty and provide data for secondary research (as shown in the core model), AHIMA will enhance the level of HIM faculty doing research, train future HIM professionals in the areas of research and quality improvement, and create a more competitive faculty in obtaining grant funds.

This rippling effect will further enhance the prestige of the profession, allow academic expansion into tier 1 and tier 2 research universities, create new job opportunities for HIM graduates and career pathways into C-level occupations, and serve as the impetus to begin developing doctoral programs.

Workforce Development: Roadmap to the C-Suite

Growing the HIM profession requires a focus on both those who are beginning their education as well as those already in the workforce. It is important to offer current professionals educational opportunities for growth and development that can lead to decision-making positions within healthcare organizations.

A "Roadmap to the C-Suite" initiative would provide an educational career path that moves the current workforce into decision-making positions. There are many possibilities and opportunities for HIM professionals to advance. The creation of a chief knowledge officer master's degree program is one example of a development that would further senior-level positions and advancement opportunities.

Healthcare is in the middle of an information evolution-the ICD-10, ARRA/HITECH, and meaningful use EHR initiatives are converging over the next two years. The explosion of information fuels a vision for care developed by payers and regulators that is predicated on the mitigation of preventable complications, readmissions, and untoward events across the continuum of care. The aggressive transition to the EHR powered by the meaningful use program will further promote the use of healthcare information. The proliferation and use of health information will intensify even further throughout the industry as information and technology evolve.

Throughout healthcare, industry models for cost reductions, clinical outcomes, pay-for-performance, competitive advantage, and best practice are the result of improved technology and expanded data assets. As information and technology become richer and more sophisticated, they will create the need within healthcare organizations for a systematic approach to converting data and information into knowledge for strategic value.

The goal of organizations will be to access and use the right information at the right time so the right decisions are made at the right level. HIM professionals are the workforce members most suited to address this need. They have deep understanding of information management, coding, data integrity, and information workflow.

The steady stream of change in healthcare and the rapid shift of paradigms challenge and expand the traditional HIM role as the medical record custodian and keeper of clinical information. This necessitates a transformation in the HIM professional. The medical record will cease to be a tangible product or tool as it becomes electronic. Information accuracy and content will continue to be critical; however, clinical information will become intellectual property, organizational capital, and competitive intelligence. Payers, providers, researchers, lawyers, and regulators will require credible information to create knowledge that provides sustainable competitive advantages for their organizations.

As healthcare organizations increasingly rely on information converted to knowledge, the knowledge base of an HIM professional educated in a bachelor's program must expand to include knowledge management. This expertise can be gained through a master's degree in knowledge management.

The knowledge management curriculum may consist of a mix of knowledge management courses with practical application to health information management and health informatics courses and business and health administration courses.

The outcome would lead to jobs that blend cultural, business, and technical responsibilities; focus on improving productivity, profitability, and customer value; drive the adoption of knowledge; and report to the organization's CEO with the ultimate goal of maximizing the creation, discovery, and dissemination of knowledge.

Are We Ready to Change?

Findings from core model work identified several near-future and future roles and careers for health information managers. The ability of HIM professionals to successfully meet the new challenges will directly depend on how the profession's academic and educational institutions change to meet these new challenges. Some questions the HIM profession must begin to ask itself include, Are we willing to:

• Let go of the past and accept a new paradigm of agility and change?
• Restructure our educational offerings to meet market demands?
• Change the way we think about ourselves and adopt a new mindset of leadership in the healthcare environment?

The answers to these questions will directly determine the future of the HIM profession within the new healthcare environment.

Bonnie S. Cassidy is vice president of HIM product management at QuadraMed. Valerie J.M. Watzlaf is an associate professor in the HIM department at the University of Pittsburgh. Ellen Shakespeare Karl is program coordinator at Raritan Valley Community College in North Branch, NJ. Rebecca B. Reynolds is chair and associate professor of health informatics and information management at the University of Tennessee Health Science Center. Leah Grebner is director of the health information technology department at Midstate College in Peoria, IL. Xiaoming Zeng is chair and associate professor of the department of health services and information management at East Carolina University in Greenville, NC. Vanda Crossley is assistant national dean of the College of Health Sciences at DeVry University, based out of Downers Grove, IL. Cindy Zak is director of health information management at Milford Hospital in Milford, CT. Cindy Glewwe is faculty manager for the school of allied health at Rasmussen College. Leslie Gordon is assistant professor and HIM program director at the University of Alaska Southeast in Sitka, AK. Samir Chatterjee is Samir Chatterjee is a professor in the school of information systems and technology at Claremont Graduate University, CA. Christine Staropoli is HIM program director at Gwynedd-Mercy College. Patt Peterson is director of education and workforce at AHIMA. William J. Rudman (bill.rudman@ahima.org) is vice president of education and workforce at AHIMA.