Climbing Higher: Bridging the Gap to Advanced Degrees in HIM

This practice brief has been updated. See the latest version here. This version is made available for historical purposes only.

Statistics from the US Department of Labor show the field of HIM as one of today's fastest-growing occupations. The current entry-level education for a credentialed health information management (HIM) professional is the associate degree, with the baccalaureate representing the terminal degree level.

Today's evolving healthcare environment places a greater demand than ever on HIM practitioners to function at increasingly higher skill levels. The curriculum competencies used most often by HIM programs fall short of covering these advanced skill sets as they are based on entry-level skills only and do not take into account these advanced practices.

As a result of the changes in the healthcare environment, employer expectations for HIM professionals are growing to include the needs of implementing, maintaining, and analyzing new healthcare technologies and industry regulations. The healthcare industry is rapidly expanding, introducing new technologies and healthcare delivery initiatives such as the adoption of ICD-10-CM/PCS, meaningful use of electronic health records, natural language processing, computer-assisted coding, and health information exchanges. HIM practitioners must possess an understanding of these endeavors to work effectively in the future of healthcare.

The move by education institutions to a master's-level HIM degree is critical for the development of these advanced HIM skill sets. The HIM profession is not alone; many healthcare professions already require post-baccalaureate education before qualifying for an entry-level position. In response to these market forces, AHIMA's Council on Excellence in Education (CEE) has begun work to transform "Vision 2016"¹ to "Reality 2016." Reality 2016 is based on the premise of "Learn More, Earn More," regarding HIM professionals earning more respect, opportunities, and salary.

More specifically, Reality 2016 is focused on encouraging HIM professionals to advance to a graduate degree; creating specialized tracks for associate degree programs; offering faculty and member development opportunities in research, education, and technology; and increasing the number of graduate-prepared HIM professionals by creating eligible pathways for those individuals with doctoral or master's degrees.

This practice brief provides practical tools and guidance to HIM professionals and educators for moving themselves and their programs to a master's level.

Advancing the Work Force to a Master's Level

HIM Roles for those with a Master's Degree

Attaining a master's degree can open several career possibilities for HIM professionals. Based upon AHIMA membership data from 2010, roles for those with a master's degree are typically in the managerial, executive, and academic arenas. The chart "AHIMA Salary Data: Average Salary by Degree Level" provides a breakdown of the average salary by degree levels.

As the healthcare system becomes more dependent on the use of technology, HIM professionals need to evolve as well, assuming new roles and acquiring new skills to meet the future needs of healthcare practices. A 2009 work force assessment report by the American Institutes for Research (AIR) commissioned by the AHIMA board concluded that to "keep pace with the increasing demand for HIM professionals, education and credentialing should continue to focus on knowledge in health information/data technical security and skills in writing, computer use, health informatics and information, data analysis, problem solving, leadership, and communication." While the report listed four functional areas in which HIM practitioners typically work (billing accuracy and efficiency, data analysis, healthcare information systems, and patient information security), job descriptions indicated that higher education degree levels are associated with management roles, problem solving, and analysis responsibilities. Since the report was written, privacy and security and health information exchange functions have evolved into two new HIM specialist positions: Health Information Management and Exchange Specialist and Health Information Privacy and Security Specialist. The development of these particular positions was driven in part by regulatory changes.

The AIR report also predicted that academic medical centers, consulting firms, insurance companies, and the pharmaceutical industry will be areas of growth for HIM needs, and employers recommended adding new skills for HIM practitioners to learn at the graduate level:

1. Financial knowledge
2. Hospital organization knowledge
3. Knowledge of systems and policy
4. Management experience

Salary and Unemployment Statistics

In early 2012, the unemployment rate in the United States was 8.3 percent, or 12.8 million people. Based on self-reported information compiled from an internal study conducted on AHIMA membership, members who obtained a bachelor's degree experienced lower unemployment rates than members with only associate degrees. Following the same trend, those with master's degrees were more likely to be employed than members with only bachelor's degrees in the field.

The Bureau of Labor Statistics (BLS) lists two types of medical record and health information occupations: Technician and Professional Medical and Health Services Manager.

The technician level requires either an associate degree in HIM (or related degree) or the completion of a coding certificate or cancer registry program. The number of jobs reported in 2010 for medical record technicians was 179,500. The job outlook for the period between 2010 and 2020 is projected at 21 percent, a growth rate considered faster than average, with a jobs increase of 37,700 for that period.

Professionals at the second BLS classification plan, direct, and coordinate for medical services. Positions are typically located in healthcare facilities, including hospitals, nursing homes, and group medical practices. Individuals filling these roles usually have a bachelor's degree before entering the field, and master's degrees are common. The median annual wage of medical and health services managers was $84,270 in May 2010 ($40.52 per hour). There were 303,000 jobs in this group as of 2010 with a projected overall category growth of 68,000 by 2020.

Employment of medical and health services managers is expected to grow by 22 percent from 2010 to 2020, faster than the average for all occupations. As the sizeable Baby Boomer population ages and people continue to remain active later in life, the healthcare industry as a whole will see an increase in demand for medical services, thereby creating a greater need for professionals to organize and manage medical information and healthcare resources.

The classification of medical and health services managers is further broken down into four categories, which includes health information managers. The BLS website states that health information managers are responsible for the maintenance and security of all patient records. They must remain up-to-date with evolving information technologies and current or proposed laws regarding health information systems. Health information managers must ensure databases are complete, accurate, and accessible to authorized personnel only.

Bridging the Gap between Education and the Real World

Health information management academic programs strive to keep up with the ever-changing landscape of the HIM profession, but a gap between real world needs and classroom education still exists. The following skill sets were identified by a panel of HIM practitioners at the Ohio HIMA Annual Meeting in 2012 as additional competency needs for HIM professionals:

1. Advanced computer application, to include:
   1. Performance of data analytics/querying and data mining, utilizing SQL and other databases
   2. Development and support of business intelligence products
   3. Creation of meaningful data display utilizing run charts, dashboards, and other visual tools
2. Comprehensive fundamental knowledge of the health record and flow of healthcare information that comprises the health record
3. Advanced oral and written communication techniques
4. Project management and performance improvement
5. Critical thinking

Advanced roles identified by the HIM workforce that match to these skills sets are also included in this practice brief.

Current HIM programs are often not able to provide HIM students these advanced skills due to time constraints and the amount of required content to be covered within a program's academic length. Although many HIM programs offer advanced courses in computer applications, as well as database design and analytics, the connection between the academic setting and the healthcare industry is still lacking.

Providing students with real-life experiences is a challenge in the academic setting because professional practice experiences (PPE) are often not uniform, which jeopardizes students' abilities to acquire meaningful practical experiences. Ongoing input from seasoned HIM practitioners is essential for improving the skill sets and developing the curriculum of HIM educational programs. This vital element of constructive communication can be accomplished through the development of strong HIM program advisory boards in addition to support within the community for PPE site experience.

Many HIM practitioners are not applying for emerging job roles, and those who do are often finding that they are not a good fit due to the lack of advanced technical job skills. It has become apparent that additional skills are needed for HIM practitioners to succeed and flourish in the real world. Enrolling in a master's degree program will provide HIM practitioners an avenue to gain the knowledge and skill sets needed for absolute confidence and success fulfilling advanced roles in HIM.

Educational Programs Transitioning to a Master's Level

Practical Considerations and Resources for Developing a Master's Level Program

When an academic institution is considering the addition of a master's degree program, the following should be considered:

• Competition – Are there other degree programs in your area or online?
• Will the program be able to attract qualified students?
• Will the program be able to attract qualified faculty?

Most programs will be able to draw qualified students from their undergraduate pools, which will likely come from HIM and health informatics and information management (HIIM) curriculums. Other students can be recruited by using tools provided by AHIMA. Attracting qualified faculty may prove to be more of a challenge. Depending on the type of educational setting your institution decides to pursue (traditional, online, or hybrid), the program will have different opportunities to offer. Whether through a traditional classroom or a virtual adjunct position, there are HIM professionals who will flourish sharing their work experiences to help guide new practitioners into the next generation of master's-level HIM professionals.

Type of Program

Healthcare reform and technology have changed the way healthcare is practiced, delivered, and evaluated. The creation of medical homes, accountable care organizations, and health information exchanges, as well as the use of mobile health technology, the introduction of computer-assisted coding, mapping, and data translation, and the reliance on telehealth to increase access and timeliness of care have all had an impact on the HIM profession. Consequently, the role of the HIM professional must adapt in order to remain relevant, and HIM education must expand to include a variety of new skills and knowledge domain clusters.

The Commission on Accreditation for Health Informatics and Information Management (CAHIIM) states that:

Health information management (HIM) graduate programs focus on the skills and competencies in health data management, information policy, information systems, administrative and clinical work flow. Health information management graduate programs focus on operations management essential to ensuring an accurate and complete medical record and cost-effective information processing. Health informatics (HI) graduate programs focus on information systems, informatics principles, and information technology as applied to the continuum of healthcare delivery.

Current Curriculum Maps

When comparing the current curriculum maps of associate, baccalaureate, and master's HIM programs, it's easy to see the transition from front-line application to management and leadership. As recommended by Vision 2016, the shift from baccalaureate to master's-level HIM professionals allows for our maturing profession to advance in leadership roles within the healthcare industry.

Vision 2016 was the response to a charge from the AHIMA Board of Directors:

Ensure the future of the health information management profession and the broader health informatics profession to achieve a strong leadership role to transform healthcare through quality health information, for the successful deployment of electronic health records, personal health records, and the nationwide health information network.

The key priorities identified were:

• Transforming the health information management profession to a graduate-level profession
• Realigning the health information management associate's degree with work force needs
• Preparing an effective, qualified pool of health information management faculty by 2016

The CEE is in the process of updating the curriculum for the master's and the associate degree HIM programs to reflect current market needs. The new curriculum will build on the past by including master's-level specialization tracks focused on data analytics, data governance and integrity, use of data in revenue cycle (financial management), and the legal implications of data use and distribution (e.g., HIPAA, HIE). The associate degree specialization tracks are directed toward developing technical expertise in HIT implementation and maintenance, registries, patient advocacy, and coding quality and supervision. The model curriculum is expected to be sent out for initial external review by HIM faculty and academic programs by the end of 2012.

As colleges and universities begin developing master's level HIM programs, there may be some obstacles to overcome. Many organizations will need to gather resources for startup costs and funding to sustain the program, place qualified faculty, and gain administrative buy-in. After the initial hurdles, the focus will shift to staying competitive and significant. As Vision 2016 outlines, the master's degree will only increase the choices HIM students have, not limit them. The master's degree program could enhance and strengthen existing baccalaureate programs as well.

Online vs. On-Ground vs. Hybrid

Advancing HIM professionals to the "C-suite level" is directly related to the initiative of master's degree-prepared HIM professionals. To make degrees and courses more accessible, many academic institutions now offer master's degree students a variety of options for pursuing their education. Online, hybrid, and traditional learning opportunities allow those health information professionals who are on a career track for upper management to continue with their learning experiences.

The primary elements of learning in the traditional classroom route include lectures, case studies, team projects, and similar work. Learning is conducted in a synchronous-or real time-environment. The major advantage of a traditional classroom is the face-to-face interaction between the students and the educator. Students who work full-time or have other obligations may not be able to attend courses offered during weekday business hours, however. In order to accommodate students with less flexible schedules that would still prefer learning in a classroom environment, many colleges and universities offer evening or weekend master's degree programs.

Another option is the online-or distance learning-classroom. According to a Chronicle of Higher Education survey, "more than three-quarters of the nation's colleges and universities now offer online classes." The learning environment in the online classroom is asynchronous, meaning students have the opportunity to learn independently and at their own pace. Online learning programs provide a great deal of flexibility for working professionals. Students in these programs can work on an advanced degree while coordinating classes and assignments around their work schedules and professional commitments. Learning management technologies offer students the opportunity to use the Internet to take virtual tours, view streaming video clips, listen to audio tapes, and interact with students from all over the world.

A hybrid classroom blends the traditional and online classrooms. Students receive the benefit of face-to-face interaction with students and faculty, but also take advantage of web-based learning paradigms such as virtual networking and streaming video and audio clips. The online material is viewed as an extension of the classroom. Hybrid learning opportunities blend the two worlds of education, often offering flexible course schedules to accommodate working students that want to earn a degree while they continue to progress in their careers.

As students increasingly opt for non-traditional educational delivery systems, educators face several challenges. The role of educator has evolved into a more facilitative, learner-centered role. With hybrid or blended classes, the instructor or program coordinator needs to determine what aspects of the course are best suited to presentation via the various delivery modes, taking care to effectively organize and tailor the course content accordingly.

Recruiting Educators: Career Options in Academia

Recruiting educators to fill the rising demand is a considerable challenge, even though the career options in academia are numerous and as diverse as those in the health information field. Never before has the need been greater to prepare master's or doctoral HIM professionals to fill the teaching positions in accredited associate and baccalaureate degree HIM programs.

HIM practitioners from a wide range of traditional healthcare settings-including hospitals, ambulatory care, and long term care-are needed to build the HIM educator workforce. To transition to the role of educator, these HIM professionals must have an advanced degree.

Earning advanced degrees in HIM secures graduates credentials that open doors and new opportunities. Post-baccalaureate degrees offer a higher level of professionalism and distinguish the HIM professional with prestige. For example, to earn the designation of Fellow of the American Health Information Management Association (FAHIMA), a master's degree or higher is required. HIM professionals with graduate degrees are more likely to pursue leadership roles within the profession.

With more colleges and universities adopting HIM-focused programs, health information management bachelor's degree programs are challenged to find teaching candidates with a master's degree.

Traditionally, HIM professionals earn master's degrees in:

• Master of Health Informatics and Information Management (MHIM)
• Master of Business Administration (MBA)
• Master of Health Administration (MHA)
• Master of Public Administration (MPA)
• Master of Library and Information Science (MLIS)
• Master of Public Health (MPH)
• Master of Education (MEd)

Health information management and informatics programs are challenged to find PhD-prepared candidates to fill faculty positions at the master's degree levels. 

At present, there is not a doctoral program in HIM. Common doctoral degrees among HIM faculty include:

• Doctoral degree in Higher and Adult Education
• Doctoral degree in Education
• Doctoral degree in Higher Education Administration
• Doctoral degree in Public Health 
• Doctoral degree in Healthcare Administration
• Doctoral degree in Health Informatics
• Juris Doctoral (JD)
• PhD in Information Science 

The number of online graduate and doctoral degrees give students the flexibility to earn advanced degrees while continuing to work in the field. The HIM professionals currently in teaching roles as adjunct faculty are encouraged to seek formal higher education to replace retiring faculty, as well as to satisfy the demand resulting from the increased number of HIM and health informatics programs. 

An investment in one's career must assuredly start with a solid foundation. Many career-minded individuals may find it challenging to remain competitive in the healthcare environment without a graduate-level education. The same can be said for a career in HIM. There is no doubt that pursuing higher education will be a significant investment of one's time and energy.

Unfortunately, there are obstacles to overcome on the road to a graduate education, such as restrictive testing admission requirements, financial aid needs, appropriate program delivery, and a significant investment of one's time.

Though many graduate programs require admissions testing, an increasing number of graduate programs are instead accepting other criteria such as a bachelor's degree, a minimum grade-point average, or a demonstration of satisfactory undergraduate training to lead up to successful graduate work in the chosen field.

Finances often play a significant role in the pursuit of graduate education. The costs associated with graduate study can be substantial, and some graduate students are forced to manage with inadequate funds. In some cases, debt loads are sizeable enough to interfere with timely degree progress or completion. Fortunately, there are many scholarships and grants available for graduate students to help reduce the financial burden, such as those offered by the AHIMA Foundation and many state HIM associations. Many employers offer tuition reimbursement to their employees as well.

One resource employers might use to find qualified educators is the AHIMA Career Assist Job Bank (careerassist.ahima.org), which exists to provide its membership and employers with a means of communication regarding HIM employment opportunities. Two job function areas within the job board are applicable for the recruitment of a PhD-level education-"academic administrator" and "education." The board is a valuable tool both for potential candidates seeking employment in the academic arena and for employers seeking to fill positions.

Another resource for finding qualified faculty is HigherEd Jobs (www.higheredjobs.com), a Web site for recruiting academic institutions and potential candidates. Institutions can post available positions, view potential candidate resumes within the resume database, and receive applications through the Web site. Candidates can also sign up for individualized job announcement e-mails called job agents, based upon their career interests. According to the HigherEd Jobs Web site, over 1.7 million of these e-mails are sent each month. This Web site seeks to make posting positions an easier task for academic institutions and creates a one-stop environment for potential candidates to learn about and apply for positions. Now is the time for HIM professionals to go get that graduate degree, to earn more respect, salary, and opportunities.

Notes

1. AHIMA. "Vision 2016: A Blueprint for Quality Education in Health Information Management." September 24, 2007.
2. American Institutes for Research. "AHIMA National Workforce Assessment Final Report." AHIMA Web site. 2009. 
3. AHIMA. "Student Recruitment Materials and Resources." AHIMA Student Recruitment Web page.
4. CAHIIM. "Applying for Accreditation: HIM Graduate Education Programs." www.cahiim.org.
5. CAHIIM. "Curriculum Map-Health Information Management (HIM) Master's Degree." 2010.
6. Lenhart, Amanda et al. "The Digital Revolution and Higher Education." Pew Research Center. August 28, 2011. http://www.pewsocialtrends.org/files/2011/08/online-learning.pdf.
7. AHIMA. Career Assist Home Page. http://careerassist.ahima.org/home/index.cfm?site_id=681.
8. HigherEd Jobs. "About HigherEd Jobs." 2012. http://www.higheredjobs.com/company/about.cfm.

Resources

Bureau of Labor Statistics. "Medical Records and Health Information Technicians." Occupational Outlook Handbook. March 29, 2012.

Bureau of Labor Statistics. "Medical and Health Services Managers." Occupational Outlook Handbook. March 29, 2012. 

Cassidy, Bonnie. "Teaching the Future: An Educational Response to the AHIMA Core Model." Journal of AHIMA 82, no. 10 (2011): 34-38.

Dimick, Chris. "Help Wanted: Schools Struggle Placing Students in PPEs." Journal of AHIMA 80, no. 9 (2009): 34-39.

Ernst, Jeremy. "A Comparison of Traditional and Hybrid Online Instructional Presentation in Communication Technology." Journal of Technology Education 19, no. 2 (2008): 40-49.

Hart-Hester, Susan et al. "Progression of the Roles and Functions of HIM Professionals: A Look into the Past, Present and Future." Perspectives in Health Information Management 6, Summer 2009.

Johns, Merida. Health Information Management Technology: An Applied Approach. Chicago: AHIMA, 2011.

Office of the National Coordinator. "University-Based Training Roles." HITECH Programs. August 12, 2010.

OHIMA Annual Meeting. "Panel Discussion: Bridging the Gap Between Education and the Real World." 2012.

Wilhelm, Carol and Dixon-Lee, Claire. "A New Blueprint for HIM Education." Journal of AHIMA 78, no. 8 (2007): 24-28.

University of British Columbia. "Overcome Barriers to Completion." GPS: Graduate Pathways to Success. 

University of Wisconsin-Milwaukee Learning Technology Center. "About Hybrid." Hybrid Courses. January 1, 2012.

Prepared By

Education Workgroup

Bonnie Aspiazu, JD, RHIA
Deborah Balentine, MEd, RHIA, CCS-P
Kim Bartholomew
Keeley Bowman, RHIA
Melanie Endicott, MBA/HCM, RHIA, CCS, CCS-P
Pamela Greenstone, MEd, RHIA
Sandra Kersten, MPH, RHIA
Karima H. Lalani, MBA, RHIA
Carmine LaMarca, MS, MA
Kim Lee, RHIT
Tracy Fulmer Locke, MS, RHIA
Erica S. Matteson, RHIA
Marcia Mattias, RHIA, CHPC
Erica V. Moore, MBA, RHIA, CCS, CPC
Rhonda Nielsen
Kimberly Rice, MA, RHIA, CCS
Bill Rudman, PhD, RHIA
Nanette Sayles, EdD, RHIA, CCS, CHPS, CPHIMS, FAHIMA
Rita Scichilone, MHSA, RHIA, CCS, CCS-P
Marcia Sharp, EdD, RHIA
Ed Sugai
Linde Tesch, MS, RHIA
Daphne Willis, MSA, RHIA, CPHQ

The information contained in this practice brief reflects the consensus opinion of the professionals who developed it. It has not been validated through scientific research.