Innovations and Developments in Postgraduate Health Information Management Education: Experiences from the University of Sydney

Janelle Craig, MRA, MComm and Phyllis Watson, AM, MSc

Introduction

Commencing in 2001, the School of Health Information Management (HIM) at the University of Sydney introduced five postgraduate coursework programs to its existing curriculum in undergraduate health information management education. One of these programs was the Master of Health Information Management (MHIM).

Prior to the introduction of the MHIM, the School of Health Information Management offered a Graduate Diploma of Health Science (Health Information Management) since 1992. This program was accredited by the Health Information Management Association of Australia (HIMAA). Graduate Diploma of Health Science (HIM) student evaluations and the course review indicated that there was a need to provide more flexibility and choice within the existing curriculum. Introducing a coursework master's degree to replace the existing graduate diploma was strongly supported in a student survey.¹

The MHIM was developed in response to a recognised need for skilled HIM professionals to support changes in the way healthcare is delivered. Health information systems are essential for medical decision making and for the planning and administration of healthcare services. Modern health information systems support the delivery of care and provide consumers with both access to more information and more control over their own health information. The MHIM provides participants with core knowledge and skills necessary for the effective practice of health information management. The course focuses on the information needs of healthcare professionals and facilities.

This paper discusses the challenges faced by the School of Health Information Management, the University of Sydney in the introduction and maintenance of the MHIM. It describes the multiple and diverse techniques and media used to deliver the program, and highlights logistical considerations in their conduct. The paper considers the future directions of the program and imparts lessons learned during the past three years, which we believe are valuable to share with colleagues, particularly those involved in the training and education of HIM professionals.

Structure of the Master of Health Information Management Program

The MHIM is a postgraduate profession entry program designed to prepare specialists in the design and management of health information systems. The course is full fee paying and offered on a one-year, full-time basis over a full calendar year or two years part-time to applicants who meet the admission criteria of holding a bachelor's degree. This means that students with additional life experiences and proven study ability can pursue a career in health information management. T his program reflects our contemporary society where many people have at least one career change over a working lifetime.

There is a trend in other disciplines towards preparation of professionals that recognizes prior learning from diverse fields. For example, the University of Sydney's medicine and physiotherapy programs allow students to enter on the basis of a completed undergraduate degree. The trend towards more broadly based tertiary education is also evident in courses with combinations of such disciplinary areas as arts-law and social work-law.

The MHIM consists of eight core professional units in Information Systems Management, Database Management Systems, International Disease Classification, Fundamentals of Medicine and Medical Terminology, and Professional Experience, and four electives drawn from topics such as Management (Health Services Management, Human Resource Management, Financial Management, Project Management), Research (including Research Design, Evidence-Based Health Care, Introduction to Epidemiology), Health Care Systems, Casemix Measurement Systems, Medicolegal Principles & Practice, and Microcomputing and Data Mining.

The design principles of providing both core and elective units of study is common in higher education where elective choices are used to acknowledge the prior learning and work experience of applicants. Students may receive credit transfer for core units of study, however credit transfer for elective units must be replaced with alternative units of study. Students work closely with the postgraduate coordinator to develop a suitable program. Considerable time and effort is put into ensuring that each student's program reflects the knowledge and skills the graduate already possesses and the areas that need development. As such, each student's program is individually tailored to meet his or her particular requirements.

Profile of Master of Health Information Management Students

A review of the profile of the MHIM student cohort between 2001-2004 (Table 1) reveals a number of features. There is consistency in the number of new enrollments each year with an average of 27.5 students enrolled per year. The majority of students enroll in the program on a full-time basis. It is important to consider, however, that like their part-time colleagues, many of them still undertake some form of paid employment and may have family commitments in addition to their full-time study load. "Upgrade," in the enrollment status section of Table 1 refers to those professionals holding a Graduate Diploma of Health Science (Health Information Management) who enroll in the MHIM program in order to articulate this qualification to the Master of Health Information Management. They do this by completing one 12-credit point unit of study "Research in Health Information Management." As can be seen from Table 1, the option to upgrade has been taken up by a number of HIM professionals, particularly after the initial introduction of the MHIM, and it remains available until 2006.

International enrollments in the program have increased over time and remain at a healthy level. The majority of international students in the MHIM program are drawn from India and China, and to a lesser extent from Singapore, Indonesia, Pakistan, Hong Kong, Sri Lanka, Samoa, and Korea; they have even come from as far afield as Canada and Ireland. The gender distribution in the program indicates that approximately two-thirds, and in some years, as high as three-quarters of enrollments are females. The age distribution of students in the MHIM program also varies, however 41 percent are drawn from the 25-30 year age group.

In terms of previous qualifications, Table 1 illustrates the diversity of students in the MHIM program. Many students come from clinical backgrounds, particularly medicine and nursing; however, it is interesting to note the recent growth in enrollments from students with undergraduate science and commerce degrees.

Table 1. Background Data on MHIM Students 2001-2004

One issue not raised in the table, but worth discussion is the motivation and intent of students undertaking the MHIM. Comments from students in other postgraduate programs, such as the Master of Health Science (Health Informatics) or the Master of Health Science (Clinical Data Management), reveal that many of them are studying in their program to learn more about information systems and information science or to "help me perform better in my current job." However, the overwhelming response to the question, "Why are you undertaking the MHIM program?"--is that students are "seeking new directions" or are using the program "as a leverage for career change."

Interestingly, students with a clinical background, such as in nursing, allied health, and medicine, express that they want a new career, still within health, but no longer as a "hand's on" clinician or therapist. Graduates with a computer science or IT background often see great potential in the healthcare sector and are also driven to look for new directions by the recent down turn in employment in the IT sector; hence, the application of their IT skills and knowledge to health seems a logical and "safe" move. Finally, those with a background in the arts and sciences comment that they find the MHIM attractive "because we can see the vocational opportunities," which their generalist undergraduate degree failed to provide.

Education Strategies for Delivery of the Master of Health Information Management Program

Being conscious of the fact that postgraduate students are often juggling the competing demands of paid employment, family commitments, and study, the School of HIM has tried hard to enact the University of Sydney's principles of flexible, student-centred teaching and lifelong learning. A key to the functionality of all the postgraduate programs offered by the School of HIM is adopting approaches that ensure flexibility and innovations in terms of the design, conduct, and delivery of units of study.

There are a variety of ways in which individual units of study within the MHIM are structured and delivered, ranging from block mode (that is, on-campus workshops over 3-4 days), distance mode (that is, off-campus, self-directed modules), interactive Web-based technology (for example, the Health Care Game used within the Health Care Systems subject), and shared units of study (that is, units of study that are offered in other programs, either conducted by the School of HIM, such as Evidence Based Health Care, or by other schools and departments, such as Research Methods).

The postgraduate environment is quite different from the undergraduate with increased expectations of students' capacity for self-directing their own learning. There is an expectation that students in the MHIM undertake 10-12 hours per week of self-directed study. MHIM students are full-fee paying, mature students with previous educational and work experiences, and their approach to learning is quite different from a school leaver. We find them to be well motivated, engaged with the material, and keen to get value for their financial investment in the course. Consistent with the latest education research, deep learning strategies rather than surface learning approaches are employed in the MHIM program.

Ashcroft and Foreman-Peck² describe a deep approach to learning as being characterised by "the student having the ability to relate knowledge and theory to experience, and being able to compare, test and integrate knowledge."   More often than not, students using a deep learning approach are likely to "explore the subject beyond the immediate requirements."³ In line with deep learning, the units of study in the MHIM program attempt to encourage this approach by using student-focused teaching methods that promote active interaction with learning tasks via exploration of complex issues, problem-based learning, critical analysis, and case studies; provide opportunities for discussion and debate with fellow students, teaching staff, and industry specialists; encourage students to make connections with what they already know, and in many cases, challenge this knowledge.

Impact of the Master of Health Information Management Program on the School of Health Information Management

The introduction of the MHIM program, along with the other Masters programs also introduced in 2001, has had a significant impact on the School of HIM. First, we have seen a dramatic increase in enrollments, with student numbers in the School of HIM now double what there were before 2001. An interesting by-product of the introduction of the MHIM is the increase in enrollments in elective units of study by students across the faculty. For example, Evidence Based Health Care, Project Management, and Medicolegal Principles and Practice are subjects that have all been taken by students in programs such as the Master of Occupational Therapy and Master of Behavioural Health Science. Cross program enrollments enrich the learning environment for the student and provide interest and challenges for staff teaching the unit of study.

Not only are actual student numbers a difference, so too are the needs, motivation, and expectations of postgraduate students. Academics in the School of HIM have had to recognise and address this in their teaching strategies and factor this into curriculum development, delivery modality, and assessment methodology. Upon reflection with colleagues from the school, we have all come to appreciate the diversity and richness of our postgraduate student cohort and wholeheartedly welcome the challenges and stimulation they provide.    

While student numbers have risen, the school's staffing profile has remained largely unchanged. Staff has been incredibly supportive of the MHIM program and has demonstrated this commitment by taking on larger teaching loads and adapting to the postgraduate environment. There has been the need to "buy in" the expertise of industry specialists to develop and deliver material requiring expert knowledge not contained within the School of HIM, for example in the specialised unit of study, Project Management. This has proved a worthwhile venture, as student feedback for these subjects recognise the high calibre of the material presented and of the lecturers involved. However, there is a need to balance the costs incurred, as well as to be mindful of the extra coordination effort required with casual and contract staff.

Finally, from the school's perspective, the MHIM program has been important for the growth and development of the school and has helped to ensure the ongoing financial viability and autonomy of the School of HIM. Academics within the school are also committed to undertaking research activities and supervising research students. Postgraduate coursework programs support the research strategies of the school, as there is a natural synergy between research and teaching.

Impact of the Master of Health Information Management Program on the Healthcare Workforce

A total of 69 students have now graduated from the MHIM program. While it is difficult to track the progress of all graduates, a large number of past postgraduate students stay in contact with the School of HIM and report back on their career endeavours. The majority of graduates have found employment as clinical coders and HIM professionals in medical record departments. Some have taken up roles as quality assurance managers, data managers, and clinical trial coordinators. A number have pursued roles in research, while some have ventured into information specialist roles within information services departments. A number of graduates are currently not working in HIM roles, and a small number have gone on to pursue other educational or career interests such as working in the rural doctors scheme or studying in the graduate pharmacists program. Of the graduates who were international students, a number have stayed in Australia and pursued work as HIM professionals, others have returned to their native country and are working in various HIM roles, while some now reside in other countries and practice as HIM professionals.

Impact of the Master of Health Information Management Program on the Health Information Management Profession

In general, the profession has been supportive of the MHIM program. The School of HIM has an External Advisory Committee (EAC) consisting of representatives from HIMAA and the Health Informatics Association of Australia (HISA), practicing HIM professionals, and other relevant healthcare industry representatives. This Committee participated in the development and design of the MHIM program and supported its introduction. Furthermore, the school reports back to the EAC on the progress of the program and takes advice from the Committee on healthcare trends and developments and on refinements to the program. The HIMAA endorsed the MHIM program in early 2004 based on its policies and standards for approval of educational programs for health information managers.⁴ This means that graduates of the program are eligible for membership of HIMAA.

As was the case with the introduction of the Graduate Diploma in HIM, there are some members of the profession who are not supportive of the move to profession-entry graduate HIM programs. The key issue to reinforce here is that the graduates of the MHIM program are HIM professionals entering the workforce, in the same way as the graduates from undergraduate HIM programs are entry-level HIM professionals. The thing that distinguishes the postgraduates from their undergraduate counterparts is their range of life experiences together with their past educational and employment backgrounds. The MHIM program broadens the HIM profession, and as with most professions, such programs acknowledge the need to offer postgraduate entry into the profession.

Future Directions

The School of HIM recognises the importance of continually refining and enhancing its courses. A full evaluation of the MHIM program has been planned for 2004, which will allow for the exploration of feedback and experiences learned after three years of operation of the program. At this time, a review of the curriculum will take place and consideration given to the possible extension of the program to two years. There are a number of catalysts driving the extension of the program.

First, student feedback on the program, sourced from evaluations of units of study, together with direct student comments raised at school board meetings, indicate that students find the program "heavy," "full," and "extremely busy." Their general sentiment over the past three years is that they would like more time to digest and consider issues, or as they put it   "more breathing space." In addition, they would also like more opportunities for practical experience. While field trips and practical placements have already been incorporated into units of study like Information Systems Management, an extension of the program to two years would provide the potential to enhance professional experience in the curriculum.

Second, recommendations as part of the HIMAA's endorsement of the MHIM program are that the Board of HIMAA strongly endorses the proposal to extend the program to two years.

Third, the current three-year undergraduate program offered by the School of HIM, namely the Bachelor of Applied Science (Health Information Management), is in the process of review, with the strong likelihood of its extension to a four-year program (effective from 2005). Thus, an extension of the MHIM to a two-year program would also help to promote consistency in terms of course duration for programs offered by the School of HIM.

The School of HIM is committed to the MHIM program as it offers a means by which students with additional life experience and proven study ability can pursue a career in health information management. We are convinced the MHIM is a high quality, profession-entry program that contributes another positive dimension to the health information management workforce and profession, both nationally and internationally.

Endnotes

1. Westbrook, J., Callen, J. & Tomornsak, S. "An evaluation of the Post Graduate Diploma of Applied Science in Health Information Management."  Health Information Management , 27, 2, (1997).
2. Ashcroft, K and Foreman-Peck, L. Managing teaching and learning in further and higher education. London: The Falmer Press, 1994, p.34.
3. Prosser, M and Trigwell, K. Understanding Learning and Teaching: the Experience in Higher Education. SRHE & Open University Press, 1999.
4. Health Information Management Association of Australia. Policies and Standards for Approval of Education Programs For Health Information Managers. Sydney: HIMAA, 2003.