In addition, while the industries looking for HIM knowledge continues to diversify, the greatest concentration of employment is expected to remain within seven industries that are today’s major employers.

What will change, however, is the breadth and depth of the competencies required to do the work. The fundamental knowledge of health informatics that may serve today, for example, won’t go a long way in 10 years, according to survey respondents.

Following are the top five competencies that respondents believe are required for health information management now and in 10 years, ranked by their current importance.

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The level of competency in privacy, health information literacy, and basic computer literacy are expected to remain relatively consistent. The skills that will gain increasing importance as health IT becomes more prevalent and sophisticated are health informatics skills in using electronic records and technical security.

The rank order changes, also. In 10 years, respondents believe that health informatics will be the most relevant competency required—higher than the current leading competency of privacy and confidentiality.

Respondents also identified a fast-emerging need for a softer skill—leadership and organizational communication skills. While just 43 percent of respondents consider it a relevant competency for HIM work now, 70 percent believe it will be necessary in 10 years.

Who’s Hiring?

Seven industries represent the greatest concentration of HIM employment, either employing HIM professionals directly or staffing roles that require HIM skills. Shown here are employer responses greater than 66 percent.

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HIM practitioners gave similar replies. Both employers and practitioners foresaw these same industries having the greatest demand in 10 years, also. The research delved deeper with practitioners, asking them to rate the level of education demanded in each industry in 10 years. Educational institutions, hospitals, consulting services, and government agencies are expected to be the most likely to require master’s degrees. Those with associate’s degrees in 10 years are most likely to find demand in hospitals and physician offices.

The survey consisted of 20 interviews with subject matter experts and a survey of practitioners, employers, and search firm recruiters. It was conducted for AHIMA by the American Institutes for Research. The survey covers a much wider range and depth of information than excerpted here. The full results will be available this fall from AHIMA.

What Are the Informatics Skills Related to the EHR?

In 2008 AHIMA and the American Medical Informatics Association published core competencies expected of a healthcare workforce that uses EHRs in its daily work. The recommendation originated in a workforce summit the two associations convened in the preceding year.

The competencies for health informatics skills using the EHR include the following:

• Create and update documents within the electronic health record (EHR) and the personal health record (PHR)
• Locate and retrieve information in the EHR for various purposes
• Perform data entry of narrative information
• Locate and retrieve information from a variety of electronic sources
• Differentiate between primary and secondary health data sources and databases
• Know the architecture and data standards of health information systems
• Identify classification and systematic health-related terminologies for coding and information retrieval
• Know the policies and procedures related to populating and using the health data content within primary and secondary health data sources and databases
• Apply appropriate documentation management principles to ensure data quality and integrity
• Use software applications to generate reports
• Know and apply appropriate methods to ensure the authenticity of health data entries in electronic information systems
• Use electronic tools and applications for scheduling patients
• Educational and training programs, healthcare organizations, and professions can use the core competencies matrix to:
• Support the design of in-service and on-the-job training programs for the current workforce
• Serve as a reference for healthcare workforce job descriptions
• Plan professional development activities
• Build specific professional competencies (after review and expansion by various health professions)
• Develop new employee orientation programs
• Improve formal health professional academic curricula

The matrix is described in the report “Health Information Management and Informatics Core Competencies for Individuals Working with Electronic Health Records.” The full matrix is available as an Excel spreadsheet.

Jill Burrington-Brown, who teaches in an online HIM program at Missouri Western State University, shares with her students the communication skills she has learned in a career that has covered a range of settings and roles.

Burrington-Brown, MS, RHIA, FAHIMA, has been an HIM director; managed quality improvement, medical staff, and risk management departments; taught; worked in a law firm; and for eight years, she was a professional practice manager at AHIMA. Communication skills may not be a chapter in standard HIM and health IT textbooks, but she assures her students that communicating well will fundamental to doing their jobs well.

Burrington-Brown really started to learn about communication when she began managing a risk management department that encompassed patient relations. Until then, she says, she hadn’t considered that people who are upset may not know exactly what they are upset about. “They just know they are upset,” she says. “They had a bad experience at your facility, and you had to find out what made that experience bad.”

The job taught her that “you really have to listen hard to people who are upset. Because what they’re complaining about is often not what they are really upset about.”

Many times, she says, once discovered, the fundamental problem turned out to be easy to fix. Often a patient call that began with a threat of litigation was resolved with an apology.

But one of the first things she learned from that job, she says, is what she didn’t know about communicating. Fortunately, the CFO she reported to was interested in the communication process and offered staff classes on better communication.

“That’s where I found out, too, that if you don’t agree on what you’re talking about, you could walk away from the table and have totally different ideas of what went on. Communication is much more basic than any of us believe it to be. It’s got to be at a level where everyone understands what the topic is.”

It may sound simple, but she assures her students that it requires conscious effort.

Being Open to Communication

She also has learned how important it is to be open to communication with staff and colleagues. That can be invaluable when difficult situations arise.

“You have to be approachable, because people aren’t going to tell you things you don’t want to hear,” she says. “And they have to—you have to get them to tell you those things.”

Working in a long-term care facility, Burrington-Brown once had to approach a staff member who appeared to be involved in billing misconduct. If something was wrong, she says, she wanted to find out about it from the staff member, not from the Centers for Medicare and Medicare Services.

When she left practice to begin teaching, Burrington-Brown didn’t simply take with her the communication lessons she had learned, she took the classes that her former CFO had taught for staff. “I said [to my class], ‘These are things you guys have to know if you want to go out into the healthcare world. You have to know how to communicate with people.’”

In the first class she taught, Burrington-Brown gave a two-hour lecture on communicating. “I came back the next time and several people in the class said, ‘We would like to have another two hours on that,’” she says.

Real-Life Stories

After working in risk management, Burrington-Brown worked in a law firm specializing in healthcare. It was an opportunity to test out her interest in law school. She didn’t stay in law, but the experience gave her a firsthand look at a wide range of cases that she took to later jobs and ultimately to teaching.

The firm handled six or seven hospitals in the Seattle area. “I got to look at all sorts of different cases and see what kinds of things happened, how they happened, and what legal principles were violated—some really great examples for students,” she says. “What could have been avoided with proper training? What was something that maybe couldn’t have been avoided?”

The experience provided her with more material for her communications lessons, too. The cases she reviewed contained “tons of examples of poor communication,” she says.
 
Of course, real-life stories also make teaching fun, she says. Students “can’t believe some of the stuff—I can’t believe some of the stuff—that has gone on.”

Many of Burrington-Brown’s students are beginning second and third careers, and so they bring their own career experiences with them. “I have several students in my HIT 101 who work in hospitals and are bringing a real richness to the discussion boards,” she says.

Share Your Experience

Educators, what “extracurricular” lessons has the working world brought to your teaching? Students, what real-world lessons have teachers shared that helped prepare you for your career? Comment below!

Getting busy HIM professionals to host an HIM student for a professional practice experience can be a challenge. As important as the internships are in giving students real-world experience, PPE coordinators say it takes a mix of professionalism, emotion, and incentives to place students in today’s hectic work world.

Securing sites has become increasingly harder as more HIM departments face major health IT installations and reduced staffing, says Kathy Cliggett, MA, RHIA, an assistant professor and PPE coordinator at Gwynedd-Mercy College in Pennsylvania. HIM directors often feel stretched too thin to host a student, she says.

Other HIM professionals may be hesitant because they don’t know enough about the programs and responsibilities, says Stephanie Donovan, MBA, RHIA, assistant professor of HIM at Gwynedd-Mercy. “I think communicating realistic expectations to our clinical sites is one of the key components of them accepting students,” she says.

Gwynedd-Mercy holds an orientation with PPE site supervisors each year to discuss expectations of both the facility and the students.

Barb Glondys, RHIA, has placed PPE students for University of Illinois at Chicago for 13 years. She recommends that coordinators provide a detailed, organized list of the activities PPE students need to perform during their internship.

Planning the curriculum is the educator’s responsibility, not the HIM director’s, agrees Patricia Cunningham, RHIA, the senior director of revenue cycle operations at Rush-Copley Medical Center in Chicago. Cunningham has hosted PPE students every year since she became a director in 1991.

Appealing to Professional Responsibility

Placing students may require more than being organized. Another way to recruit HIM volunteers is to tug at their heartstrings, says Linda Galocy, RHIA, who coordinates PPE sites for Indiana University Northwest, based in Gary.

HIM directors were once eager students looking for a break. Now they are in a position to help a new generation. “They were all students at one point, and they all had to do clinical practice experiences, and staff took time out to work with them,” Galocy says. “I feel it is our professional responsibility to return the favor.”

Gwynedd-Mercy keeps track of their HIM program graduates, and routinely asks them to host PPE students.

“We say to [graduates], ‘We will be coming to you for clinicals,’” says Christine M. Staropoli, MS, RHIA, CCS, Gwynedd’s HIM program director. “I think they appreciate it then, they know what is involved. And they make the time because they understand that it is key for [a student’s] education to take that theory and actually apply it.”

Offering CE Carrots

In addition to feeling good about helping, PPE mentors can receive educational credit themselves. As a thank you to its PPE mentors, Indiana University Northwest hosts free educational sessions that qualify for continuing education credit. Mentors may transfer the classes to other staff, also.

At Gwynedd, college staff sometimes offer a trade to prospective PPE sites. “You take our students, we will come to your facility and offer free continuing education sessions,” Staropoli explains.

Tuition waivers are another carrot. For each Gwynedd student a site takes, PPE mentors receive a free tuition waiver for a three-credit class worth about $1,800, Staropoli says.

In addition to offering AHIMA continuing education credits, Gwynedd also offers two additional CE credits and a thank-you banquet. One credit is for the PPE mentor, and the other can be given to a staffer who helped during the PPE visit, Cliggett says.

Do you have tips for getting a yes from prospective PPE sites? Ways to find the time to host a student, or experiences to share? Please share them below.

You can read more about the challenges—and rewards—of placing junior-year students in PPEs in the story “Help Wanted” in the September issue.

The long-standing coding shortages weren’t magically solved in the past year. Only 60 percent of respondents to this year’s poll reported that their departments are completely staffed for all approved positions. About a quarter (23 percent) have coding positions that have been open for more than 3 months. The balance reported positions that have been open 3 months or less.

A lack of qualified candidates appears to remain the root cause. The vast majority of respondents (46 percent) said their departments are short on coders due to a lack of qualified candidates in the market. Many respondents commented that candidates lack on-the-job experience.

A minimal number of respondents said their staffing shortages are the result of hiring freezes or layoffs. Layoffs were the cause of coder shortages in only 1 department.

Thirty-eight percent said they were under no restrictions on hiring for approved positions. Nearly half (48 percent) reported that their departments are able to recruit for open positions, though no others. The final 14 percent reported a complete freeze on hiring.

The lack of experienced candidates in the market is requiring organizations to be flexible, creative, and committed when filling positions. Respondents commented that their departments commit to training hires that lack experience, grow coders from within, and work with community colleges to boost the local pool of candidates.

The survey was conducted online June 29–July 12, with 95 responses.

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As healthcare expenses continue to erode household, government, and provider budgets, the industry needs better methods to reduce the cost of care. One tool that can increase efficiency and value is a change management technique called lean thinking.

Lean thinking is based on the Toyota Production Model and is built upon five steps to identify and eliminate waste: value, value stream, flow, pull, and perfection. The ultimate goal of lean thinking as applied to healthcare is to provide services and products that add value to the patient by improving care in the most efficient manner possible.

Lean thinking can also be used to implement technology within healthcare. A leading reason why so many health IT projects fail is because organizations do not perform a workflow analysis.

Workflow analysis examines how current processes are performed and then reengineers those processes to make them more efficient. When health IT is overlaid on efficient processes, chances are greater that healthcare professionals will adopt and use it on a daily basis.

Watch, Assess, Reengineer

At East Carolina University we use a video simulation of a patient transfer to teach health services and health information students how to use lean thinking to perform workflow analysis. The simulation was created by the College of Nursing’s Video Simulation Laboratory and produced by a former emergency room nurse and a former director of a neonatal intensive care unit.

The simulation depicts an infant undergoing a Norwood procedure and the subsequent transfer of the infant from the surgical theater to a neonatal intensive care unit. Throughout the whole process, the nurses and medical and nursing students in the simulation make errors; for example, they contaminate the sterile field and fail to perform a proper SBAR. It is up to the health services and health information students watching the video to detect the errors and reengineer the transfer process to eliminate them.

Students use each step in the lean thinking model to create what is known as a future state. The future state represents how the process will be carried out once appropriate changes have been made. Students also consider how health IT can be used to record important patient health information and make the transfer process flow more efficiently.

The video simulation serves two main purposes. First, it provides students with a visual depiction of a clinical process and the ways a process can be performed incorrectly. This provides students with a mental picture of the process, which allows them to manipulate the process in their minds and think of ways to improve the process.

Second, the video simulation allows students to work with the techniques associated with lean thinking and workflow analysis in a nonthreatening and safe environment. No one will die if the students don’t get the transfer correct the first time.

Both students and sponsoring facilities new to PPEs might not know what to expect. To help them properly prepare and get the most out of their site visits, the AHIMA House of Delegates Team on HIM Higher Education and Workforce has created the Clinical Practice Sites/Professional Practice Experience Guide.

The 25-page guide provides information and best practices on serving as a clinical PPE site as well as advice to PPE students looking to get their first glimpse at HIM work. It offers tips on how to make the most of the program. The guide can be used by site managers, HIM department mentors, academic programs, and students.

The guide is divided into chapters addressing each participant in a PPE experience. The student section, for example, outlines the expectations of a PPE student. The affiliation site guide chapter lays out what is expected of the organization and helps prospective sites develop their PPE programs.

The April practice brief “Transitioning to ICD-10-CM/PCS—An Academic Timeline” outlines how and when HIM academic programs should begin integrating ICD-10-CM/PCS education into their curriculum. The article lays out the academic transition into three phases: preparation, hybrid, and full implementation. The countdown to integrating ICD-10-CM/PCS begins on August 1, 2010, when educators should start expanding curriculum content on courses affected by ICD-10-CM/PCS changes.

By August 1, 2012, certificate programs (one year or less) should have completely integrated ICD-10-CM/PCS in all coding courses, and associate and baccalaureate programs should have completely integrated ICD-10-CM/PCS in second-year coding courses.

The article includes a readiness checklist to help educators ensure their academic institutions are ready for the move. It also outlines training opportunities for the current HIM work force staff.

“The key to a graceful evolution of all curriculum throughout the ICD-10-CM/PCS implementation is early planning for curriculum revisions, creative use of teaching tools, and adequate faculty preparation,” the authors write.

Maybe not.

The behavior would seem to fly in the face of the HIPAA privacy rule, but virtually all public schools and most private and public postsecondary institutions are covered by a different federal law.

The Family Educational Rights and Privacy Act, or FERPA, regulates the privacy of students’ education records. These can include student health records if the institution chooses to classify them as such. The HIPAA privacy rule does not apply to records covered by FERPA.

It’s a complicated intersection of federal law, and the Department of Health and Human Services and the Department of Education have issued guidance to help schools navigate it. See “When FERPA and HIPAA Collide” in the Winter 2009 issue of AHIMA’s Academic Advisor e-newsletter.

She writes, “With EHRs has come the need to better understand and explain how data are defined, analyzed, and interpreted. That includes everything from knowing the ins-and-outs of relational databases, grasping the evolving definitions of the legal medical record, and creating the ability to reproduce data consistently. There also is a burgeoning body of standards, vocabularies and terminologies, and the human factor of managing the transition from paper to electronic media.”

Rebecca B. Reynolds, EdD, RHIA, associate professor at the University of Tennessee, tells Rollins, “All of our students are working healthcare professionals who found themselves in a position where they need to know more about data standards or what to do with data. They are in our program to be able to perform their current jobs more effectively and efficiently.” Students a the University of Tennesee Health Science Center can earn a master of health informatics and information management.

At present there are 12 master’s degree programs, up from three just five years ago. Four are accredited by CAHIIM, the Commission on Accreditation for Health Informatics and Information Management Education, an independent accrediting organization. A fifth is awaiting review. CAHIIM maintains an online directory of approved programs.

The four currently approved programs are College of St. Scholastica, University of Illinois at Chicago, University of Pittsburgh, and University of Tennessee Health Science Center.

Also available on the CAHIIM site is the program approval manual.

The commission is in the process of updating standards and interpretations for master’s program accreditation. A draft version is available, though the public comment period has now closed. CAHIIM expects to issue final standards and interpretations this fall, with a May 1, 2009, application deadline for programs seeking accreditation for the 2009–2010 academic year. Look for announcements on the CAHIIM site.

AHIMA discusses the need for advanced-level HIM study in the 2007 white paper “Vision 2016: A Blueprint for Quality Education in Health Information Management.” The paper includes model graduate level program curriculum guide for health information management or applied health informatics education.

CAHIIM also accredits HIM education programs at the baccalaureate and associate degree levels. It maintains a directory of approved programs searchable by institution name, state, or availability of distance learning.

More about careers in HIM is available at HealthInformationCareers.com.