Ready or Not, HIM is Changing: Results of the New HIM Competencies Survey Show Skill Gaps Between Education Levels, Students, and Working Professionals

By Ryan Sandefer, MA, CPHIT, and Ellen Shakespeare Karl, MBA, RHIA, CHDA, FAHIMA

In January 2014, the AHIMA Council for Excellence in Education (CEE) released updated curricular competencies for all accredited academic programs, including those at the associate, baccalaureate, and graduate levels. The curricular competencies were intended to better align education with current and future HIM practices. The competencies include six domains, 32 subdomains, and nearly 90 specific competencies that must be met at specific taxonomic levels that range between one (basic understanding) and six (creation).

This change was seen as a positive step for the profession and the future of the association by teaching students the skills and abilities needed to perform required information-related tasks for a changing healthcare industry. But the CEE was left wondering about the current 70,000-plus AHIMA members who are not enrolled in an academic program at the moment. How do their skills match with the updated competencies?

At the July 2014 AHIMA Leadership Symposium held in Chicago, IL, AHIMA leaders had the opportunity to attend a presentation to discuss the new competencies and how they affect AHIMA members. Many questions were fielded about the competencies and it became clear to the presenters that AHIMA and the CEE should better understand the current AHIMA members' level of competence across all curricular subdomains. In part, the goal was to see if major gaps existed between the skills of current HIM professionals and the updated skills being taught to the next generation of professionals in the classroom.

Survey Details and Demographics

This survey research project was conducted by the authors of this article, and approved by the Institutional Review Boards (IRB) of both authors' institutions of higher education. The authors then sent a survey to 6,000 AHIMA members, with 1,500 AHIMA members from each of the following education categories receiving the survey: high school diploma or equivalent, two-year degree, four-year degree, and graduate degree. Out of the 6,000 recipients, 711 responded, a 12 percent response rate.

The survey was intended to measure each individual's self-rated competence across all 32 subdomains of the updated curricular competencies. Overall, 92 percent of respondents were female, nearly 65 percent of respondents were 45 years old or older, and there were respondents from 48 US states, Washington, DC, and six individuals who resided outside the US.

Recipients who held a graduate degree were much more likely to respond to the survey than those with less education (36 percent response), compared to four-year degree (25 percent response), two-year degree (24 percent response), and less than a college degree (14 percent response). Fifty-five percent of respondents had more than 20 years of experience in healthcare and 21 percent had less than 10 years of experience. Forty-four percent have been working with electronic health records for seven years or longer.

Survey Results

Respondents with a graduate degree rated their competence level greater than the other education levels for 26 of the subdomains. Among those, the greatest differences in education level related to the following questionnaire items:

• Project management
• Human resource management
• Leadership roles
• Training and development
• Design and process improvement
• Enterprise information management
• Change management
• Analytics and decision support
• Healthcare statistics

The subdomains rated highest in terms of competency by those with less than a four-year college degree include:

• Classification systems
• Coding
• Clinical documentation improvement
• Fraud surveillance

Overall, those with higher education levels indicated a higher competence level in two thematic areas:

• Leadership/management
• Data analytics, statistics, and research

Those with lower levels of education reported higher competence in clinical classifications, coding, and documentation improvement. This project has provided the CEE with a baseline measure for AHIMA members regarding the updated curricular competencies. The baseline measure provides the CEE, AHIMA, the AHIMA Foundation, and the component state associations (CSAs) with detailed information regarding how to approach educational opportunities for AHIMA members and bring all HIM professionals up to professional par.

It also provides information that could be used to potentially refine AHIMA's continuing education regarding certification maintenance. Because the curriculum is intended to cover current industry practice and the future needs of the profession, the findings of this study indicate that a large number of AHIMA members do not feel competent in AHIMA's priority areas, including information governance, informatics, and innovation.

Using the Results to Increase Competency

Where does the HIM industry go from here? The authors have some recommendations on how to use this data:

• Use the new competency structure for the maintenance of the RHIA/RHIT credentials by revising the structure of the CEU reporting domains. The Commission on Certification for Health Informatics and Information Management (CCHIIM) and the CEE recently initiated implementation of this recommendation.
• Continuing education opportunities provided by AHIMA and the CSAs should target the domains where practitioners currently self-reported lower competence and less confidence with the topic.
• Division of domain competence by educational level became clear in this study. AHIMA and the CEE should continue to use the "Learn More to Earn More" slogan and promote the tenets of Reality 2016 to challenge members to advance their education level. By increasing their education, individuals are more likely to be competent in the changing world of HIM.

A final report will be generated by the authors that will be shared with the AHIMA membership via a publication in a research journal and/or a presentation at the 2015 AHIMA Annual Convention and Exhibit in New Orleans, LA, taking place September 26 to September 30.

This valuable study presents the challenges of ensuring that each AHIMA member has all of the skills and abilities necessary to be on the forefront in HIM in the healthcare environment. The competencies demonstrate the diversity of HIM practice and the challenges associated with keeping HIM professionals educated across the spectrum of emerging content areas.

Taking those next steps to be knowledgeable in topics such as project management, information governance, and informatics will ensure that the HIM professional of today will still be the knowledgeable go-to HIM professional of tomorrow.

Ryan Sandefer (rsandefe@css.edu) is chair and assistant professor in the department of health informatics and information management at the College of St. Scholastica. Ellen Shakespeare Karl (ellen.karl@cuny.edu) is academic director of the HIM program, school of professional studies, at the City University of New York.