The professional practice experience (PPE) has long been an integral part of the formal process of educating students to assume positions in the health information management (HIM) marketplace. The intent of this Practice Brief is to motivate practitioners to provide students with an opportunity to experience firsthand the rigors and realities of HIM practice. More importantly, PPEs allow students to apply theories learned in the HIM classroom to real life scenarios.
The PPE is vital to the educational accreditation process. In order to be accredited by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM), associate and baccalaureate level HIM programs are required to include some type of face-to-face PPE in their programs. Over time, the CAHIIM requirement has become more flexible in both the scope and length of time students are required to be on-site in a practice-based setting. In part, this requirement has relaxed in response to changes in both education and practice settings as well as the unique needs of non-traditional students.
This Practice Brief will educate readers on the challenges and opportunities surrounding the PPE. The desired outcome is to expand options for PPEs and increase support of the PPE throughout the healthcare industry. Providing additional options and increasing practitioner support of the PPE will result in creating a stronger and better prepared generation of new HIM professionals.
PPE Student Benefits
Students value their PPEs because it provides them with the opportunity to practice what has been learned in school. Observation of various HIM functions and the communication and leadership skills of PPE site mentors is beneficial to students.
PPE site hosts are role models whose actions are often emulated by students as they develop their own leadership styles. During the PPE, students often gain practical experience in the areas of operational HIM, release of information, human resources management, financial management, and hospital politics. Employers benefit from students’ development in these areas as these skills can be applied to their work directly after their graduation.
PPE Site Host Benefits
PPEs offer employers the opportunity to assess current students’—and possible future employees’—work habits, leadership characteristics, fit within the organizational culture, and general HIM knowledge and skills. The medical community in the area also benefits from the experience, as it helps contribute to the pool of qualified professionals in the HIM, medical coding, and medical transcription fields.
Reverse mentoring may occur when students share up-to-date skills acquired in the educational process that may not yet be known to the PPE site host. New graduates are sometimes offered coding positions over experienced coders because they are coming out of school with ICD-10-CM/PCS training and experience. PPE site hosts also have the luxury of grooming students to meet their workplace needs.
HIM Profession PPE Benefits
Even with the noted benefits of PPE to both students and site hosts, new technology and organizational challenges are emerging that threaten the PPE. Innovative approaches are required to ensure the benefits of PPE continue in the future.
In recent years HIM programs have been experiencing increasing difficulty in finding site hosts for students. The difficulties become more apparent when framed by changing HIM programs and student characteristics that are arising simultaneously with changes in practice-based organizational structure. For example, online education in HIM is growing tremendously. Traditional HIM programs have also changed their program structure to attract students with a wealth of real world experience but who may be unable to attend face-to-face classes on a full-time basis.
The number of HIM programs are also increasing at the same time the number of available host sites are decreasing, due to factors such as HIM department mergers, restructures, and remote HIM employee programs. So at a time of unprecedented need for PPE sites, the pool of sites is dwindling.
HIM professionals can be guided by the AHIMA Code of Ethics’ principle VI, “Recruit and mentor students, peers, and colleagues to develop and strengthen the professional workforce.” The guidelines for interpretation of this principle state that HIM professionals shall:
- Provide directed practice opportunities for students
- Be a mentor for students, peers, and new health information management professionals to develop and strengthen skills
Anecdotal evidence suggests the need for HIM professionals continues to increase with employers frequently citing their inability to fill positions with qualified professionals. HIM graduates are well-educated and prepared to assume these positions, with PPE being a key piece of the development process.
The current HIM curricula outlines the need for students to apply theories. The PPEs are designed to provide students an avenue to explore various aspects of the health information field while reinforcing the ability to apply theories in real world situations. Academic programs today are faced with several challenges in ensuring students are afforded the opportunity to participate in a PPE.
Limited Sites Available to Host Students
Technological advances with electronic health records and high-speed Internet connections allow newly merged organizations to combine resources to reduce staffing and limit redundancy of work. A growing trend of a virtual office allows staff to work from a remote setting while serving multiple physical locations.
The virtual office helps to reduce overhead related to a physical space and is often considered an employee benefit for trained staff. As more staff work remotely, this reduces the number of individuals who are able to supervise and work with a student placed within the health information department.
Receiving Administrative Approval
Site hosts have reported increasing difficulty in receiving administrative approval to host students. Many organizations are in the midst of training and planning for the transition to ICD-10-CM/PCS. Facilities are faced with the decision of utilizing overtime to ensure accounts receivables do not fall behind while staff are being trained. The transition to a hybrid or an electronic health record requires additional staffing time from within the health information department.
Concerns Granting Access to PHI
Many healthcare organizations and providers who have implemented an electronic health record have also implemented policies that limit access by students. Traditionally, students would be provided access to the paper record while at the hosting PPE site. Access would be limited to those specific records. Providing access to an electronic health record may require action from entities outside the department, such as information systems. While read-only access will eliminate the concern of a student inadvertently documenting within the record, an organization may not have the ability to restrict access to a subset of patients—which can concern some facilities and cause them to shy away from hosting PPE students.
Changing Student Demographics
In many of today’s academic programs, students are enrolled on a part-time basis, often juggling the demands of full-time employment and family obligations. The PPE adds to the demands of a student who may not be able to complete the experience during the daytime hours. Students who are employed in a full-time position may not have sufficient benefit time to cover the experience or the ability to change scheduled work hours to accommodate the hours needed for the experience. Additionally, travel to a host site may be cost- and time-prohibitive for the student.
Changing Academic Program Dynamics
Technology has facilitated the transition from the traditional face-to-face classroom to an online format. While this additional delivery system is very attractive to students and faculty, it has fostered additional challenges for the PPE. The distance learning format hinders the ability to ensure students can demonstrate professionalism and are adequately prepared for the experience.
The online format presents an additional challenge to faculty when trying to secure a host site in a geographical location near the student’s location and outside the program’s immediate service area. In addition, the PPE cannot be one size fits all. Student backgrounds, work experience, and fit must be considered when placing students in PPE sites. This customization is time consuming, but important to both the site host and student.
Rising to the PPE Challenge
While the previously noted challenges may be troubling, they are not insurmountable. For example, one method that some providers are starting to explore is the provision of remote system access for students. While providers have established policies to address remote access for business associates, the topic of students has not been adequately addressed by providers. HIM professionals have the opportunity to speak up on this issue. Unique PPE models which include remote access to electronic health records can be developed for future advances to the HIM profession. Practitioners in all healthcare settings must work through the security and access limitations currently acting as a barrier to hosting a student.
Remote models currently used for processes such as coding education and auditors can also be utilized to educate students on a wide variety of HIM functions including analysis, coding, information security, HIPAA, and conducting system access audits. Advances in information security allow remote access to electronic health record systems through secure and restricted record views. System access utilizing key fobs, virtual private networks, and other secure access methods can be monitored and audited.
Using the industry standard of tracking and monitoring access through audit log analysis not only deters inappropriate access attempts but also provides rich data that can be used in other ways to support current HIM practices. Adaptation of a remote education model to the PPE can provide host sites to students who are in rural or underserved areas and can be developed as a new HIM innovation.
The AHIMA Virtual Lab and other simulation programs provide exposure to a variety of software options for educational programs to use as hands-on training. Educators have worked to prepare assignments through CourseShare, and these assignments provide students with the appropriate level of learning for associate, baccalaureate, and graduate HIM programs.
While encoders are currently in use to enhance skills, the addition of computer-assisted coding software to the simulation options will be vital to updating student skills for the future. Continual environmental scanning for the profession should provide guidance to future additions and enhancements.
Although schools can provide PPE hosts with a list of competencies for student activities, an equally important resource is a list of specific projects that can be used to meet the competencies. For example, as the ICD-10-CM/PCS deadline approaches, how can students be used to fill the voids in HIM departments when all hands are on deck to ensure billing is not impacted? Other possibilities could include both facility-based and remote projects, such as:
- Policy and procedure review and revision
- Development of training materials for staff
- Time study projects
- Data analysis of case mix index
- Documentation review
- Preparing reports
- Gather information from AHIMA’s HIM Body of Knowledge, such as compiling all practice briefs on privacy and security topics
- Review the admission orders for new IPPS certification criteria
- Schedule meetings, prepare meeting agendas, record meeting minutes
- Quality improvement proposals
- Survey development, distribution, and data analysis
- Topic-specific research
- Development of community education programs (personal health records, patient portals, etc.)
- Prepare and conduct educational programs using distance learning methods
- System testing
- Perform traditional HIM department functions such as coding and analysis
Non-Traditional PPE Sites an Option for Students
If educators know what tasks students will be allowed to do on-site to assist the facility, some programs may be able to provide a temporary workforce to assist facilities while still providing the students with vital hands-on experience in a facility. With careful preplanning, this can be an opportunity to bridge the gap between the educational system and the workforce.
By more clearly understanding vendor opportunities, educators can prepare graduates for positions in that sector. Looking directly to the vendors for PPE placements is a way to address this underutilized segment. Many vendors are interested in hiring HIM professionals to improve their credibility. Exposing students to the possibilities in a PPE-based learning environment can be a winning proposition for the vendors as well as the students.
In addition to vendors and traditional PPE sites, other alternative sites where opportunities are available must be considered. These can include hospice, health departments, legislative offices in state government, and university health centers.
Forming a state consortium for educators can assist in the sharing of ideas to meet the needs of HIM programs and the needs of students in specific geographic regions. As State Department of Education requirements change, this type of advisory board can become a resource for the state as well as for the educators within the state. Students also benefit by the consistency of curricula that develops among schools in this type of configuration. Therefore, if a change of schools is required, the student’s educational progression is not impacted.
Also, as AHIMA encourages students to advance from a certificate to an associate degree or baccalaureate degree program, credit hour usage is maximized if courses can be transferred between schools. The sharing of ideas and resources must extend to PPE placements as well. Although students may be geographically close to the school, this is not always the case. Distance learners and students who are employed full-time may need options such as those provided in simulation activities.
Simulation activities have the potential to expose all levels of students to a wider variety of nontraditional HIM activities. Introducing students and new graduates to the HIM Career Map (available at hicareers.com/careermap) may guide them to unique PPE and career opportunities. Encouraging students to look beyond the traditional roles will open doors to PPEs outside the typical setting.
Hospitals have many departments, some of which did not exist even a few years ago, such as revenue integrity, clinical documentation improvement, and informatics. As the HIM department “walls” are broadened, so too are the needed skills of the HIM staff. Using the Career Map to investigate options allows current HIM professionals to see career paths of the future and also guide students into new career paths.
The workforce is aging with several thousand HIM professionals retiring each year, and approximately 2,500 students are graduating and entering the workforce.1 The HIM workforce is in a constant state of flux, as is the student body.
As accountable care organizations become more prevalent, the PPE landscape is changing. In some markets, this may mean fewer on-site opportunities for students. However, in other areas, as hospitals acquire physician practices and HIM professionals are involved with transitions in information management processes, opportunities for students to gain entry-level employment may increase as a result of these changes. It is possible that the acquired physician practices will be in the early phases of EHR transition and old documents may need to be scanned, among other duties. This hands-on experience, including the exposure to the transition itself, is a wonderful learning opportunity.
PPE Tools and Support
The existing PPE Guide has encouraged practitioner support for the hosting of PPE students through various incentives, including Continuing Education Units (CEUs) for PPE mentors. The guide is a comprehensive tool that includes great ideas for AHIMA’s component state associations (CSA) to advocate for PPE hosting at the grass-roots level.
Other potential tactics being considered by the AHIMA Foundation’s Council for Excellence in Education (CEE) to help increase PPE hosting and support from practitioners include:
- Using the PPE Guide as a tool to develop an electronic version of the guide with audio/visual resources such as testimonials from AHIMA leaders, PPE hosts, educators, and students
- Recommend action from component state associations (CSAs), including:
- Conduct an annual assessment of schools in the state to determine need and provide support
- Develop a PPE committee at the CSA level to be tasked with conducting an annual assessment and assisting in marketing to those facilities that do not participate in PPE hosting
- Establish a student liaison position on each CSA board to provide high visibility for students
- Hold a PPE luncheon for facility site hosts
- Recognize and provide thank you gifts, ribbons, or badges to site hosts, etc.
- Display the current PPE video at state meetings and provide recognition buttons for PPE hosts at the AHIMA Annual Convention and Exhibit
- Develop a student branding program to assist students in their quest to impress their host sites with top notch appearance and professionalism; HIM programs should emphasize this to ensure HIM students achieve brand recognition
- Distribute video to hosts who can download the video from AHIMA’s website, obtain a hard copy at hosting functions, or receive it via mail
- Develop a campaign to target host sites, generate enthusiasm, and bring greater prestige to the profession as a whole
Additional marketing efforts can also promote the support of PPE hosting. Marketing-related recommendations include:
- Hold informational days for PPE site hosts
- Partner with schools in the state to have a luncheon at state annual meetings—invite hosts and students and prepare a light agenda with further marketing, information, and highlights
- Ask students to send pictures of hosts and students from their site to post in state-generated e-mail messages for state association members
- Obtain a list of all schools in the state, communicate with them on where they need help with hosts
- Work with AHIMA public relations staff for specific branding on PPE to elevate the program in the HIM profession, including possible visual aids
PPE Call to Action
The spotlight is on PPE in both academic and workforce circles. To this end, the CEE has convened a workgroup to assess the PPE issue from all angles. The workgroup is composed of educators and practitioner representatives from the AHIMA House of Delegates to address this issue from both sides of the divide.
Current efforts from the workgroup include:
- Developing innovative PPE models that address current environmental changes while at the same time satisfying the longstanding need for students to be indoctrinated in the reality of HIM practice
- Collaborating with CAHIIM and the CEE to ensure the innovative models meet the intent of the PPE requirement
- Developing a repository of projects for schools and site hosts to use with students
- Updating the PPE Guide to more effectively influence practitioners to serve as site hosts
HIM practice has been in existence for 85 years. HIM continues to grow as a profession and there is a strong need to elevate awareness of the skills and abilities of HIM professionals across all healthcare settings. Where traditional hospital host sites may be decreasing in number due to environmental changes, the opportunity to introduce HIM as a valuable profession to a broader audience of potential site hosts is increasing. Along with growing the HIM profession, it is critical to maintain a focus on growing HIM professionals through PPE. This growth must also reflect the evolution of the HIM environment to non-traditional positions. This may be accomplished through provision of on-site experiences and mentoring activities.
While specific sites may not be able to host PPEs, individual HIM professionals may be able to supplement a student’s experience or mentor a student who may not receive that exposure in another area or setting. This may be accomplished through activities outside of the workplace such as speaking to a group of PPE students or meeting face-to-face at academic institutions. Time-limited shadowing opportunities may meet this need as well.
HIM professionals are obligated and responsible for ensuring the HIM profession is sustainable in the dynamic healthcare arena. The PPE Workgroup (contact: email@example.com) is seeking input from practitioners for creative suggestions to overcome some of the PPE obstacles they face in today’s HIM environment. Specifically, suggestions for projects that can be completed remotely or those that may be applicable to a variety of settings are sought.
As the HIM career field evolves, the PPE must also evolve to ensure students are prepared for HIM jobs of the future. New proposed curriculum requirements and strong PPEs can together support the goals of the AHIMA Foundation’s “Transforming Health Information Workforce: Reality 2016.” HIM practitioners must take aggressive steps in identifying opportunities and methods that defeat challenges to the PPE. Through innovation and fearless efforts to ensure continued PPE access, HIM practitioners of today can support new HIM professionals in their quest to be the HIM leaders of tomorrow.
- AHIMA. “Take Action to Educate and Expand the Health Information Management (HIM) Professional Workforce.” AHIMA Position Statement. October 2009.
AHIMA. “American Health Information Management Association Code of Ethics.” October 2011.
AHIMA. “Reengineering the Professional Practice Experience.” Journal of AHIMA 84, no. 8 (August 2013): 32-34.
AHIMA. “Clinical Practice Sites/Professional Practice Experience (PPE) Guide.” Version 2. January 2011.
AHIMA Foundation. “Transforming Health Information Workforce: Reality 2016.”
Jacob, Julie A. “HIM’s Evolving Workforce: Preparing for the Electronic Age’s HIM Profession Shake-up.” Journal of AHIMA 84, no. 8 (August 2013): 18-22.
Karen L. Fabrizio, RHIA, CHTS-CP, CPRA
Leah Grebner, MS, RHIA, CCS, FAHIMA
Jackie Jones, RHIA
Theresa Deans Jones, MHA, RHIA
Desla Mancilla, DHA, RHIA
Alice Noblin, PhD, RHIA, CCS
Sandra Seabold, MBA, RHIA
Katherine Andersen, RHIT
Marlisa Coloso, RHIA, CCS
Katherine Downing, MA, RHIA, CHP, PMP
Kim Turtle Dudgeon, RHIT, CHTS-IS/TS, CMT
Geralyn Matejcek, MBA, RHIA
Mariruth Petrik, RHIA, CCS, CCS-P
Angela Dinh Rose, MHA, RHIA, CHPS, FAHIMA
Lou Ann Wiedemann, MS, RHIA, CDIP, CPEHR, FAHIMA
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.
AHIMA Work Group.
"Evolving the PPE to Meet Changing HIM Workforce Needs"
Journal of AHIMA