Leila R. Kalankesh
Throughout the past decade, membership in the community of healthcare professionals has required nothing so much as an adaptable spirit. Every practitioner has been touched in some way by the revolutionary changes in the industry, which seem set to transform healthcare in the coming century. Healthcare is experiencing a paradigmatic shift, and this shift will affect all healthcare professionals. Health information management grows increasingly complex and reliant on information technology each year. Due to the fact that the rate of change in healthcare, and technology in general, is so rapid, it is necessary to forecast and plan industry-wide changes rather than just plan for operational changes as they emerge. The transformation of HIM management has to start from schools. A report of the AHIMA's Assembly on Education (AOE) notes that graduates of today's HIM programs must be "innovative and adaptable, critical thinkers and problem solvers who are capable of using available services and technologies to support the operations, management and decision-making within an enterprise." To fulfill this goal, some academic programs will have to be drastically rethought, while others may require only minor restructuring or expansion.
Given the above-mentioned developments and the worldwide changes in healthcare standards, HIM requires an overall rethinking of its methods to streamline and update its educational programs, and the simplest way to fulfill these aspirations is the expansion of comparative studies in educational programs.
Materials and Methods
The research method in this article was cross-sectional, descriptive, comparative, and case study. In this research, we studied the curriculum of the course of Medical Records in several countries, we attempted to propose a suitable paradigm aimed at updating and boosting the functionality of this profession in Iran. The views and analyses of several experts in this field were collated and a final paradigm was presented based on their views.
The universities offering a master's degree in Medical Records and Health Information Management, collectively form the study community. The study sample consisted of the universities, and the Medical Records or HIM curriculum that was available to the researchers. In fact, the sampling method was non-probability, meaning that we evaluated the curriculum of the accessible universities. The study sample included Sydney University, Alabama University, Scholastica University, Portsmouth University, Pittsburgh University, Iran Medical University, and Loma Linda University.
Data collection was carried out through the information from the universities' Web sites and e-mails sent to the relevant university authorities. The means of data collection were the Internet and the electronic mail. The software Excel and descriptive statistics methods were applied in order to analyze data.
The results of the comparative study of the Medical Records master's programs, revealed that the courses studied at the universities of Sydney, Australia, and Scholastica, US, are identical and are both entitled "Health Information Management." The titles are parallel but slightly different at Loma Linda and Pittsburgh Universities; at Pittsburgh University, it is called Health Information Management with an emphasis on health information systems and at Loma Linda University, it is entitled Health Information Systems.
In the universities of Alabama and Portsmouth, this course is offered under the title of Health Informatics, the difference being that at Portsmouth University, there are two options--Health Information Management and Health Information Systems. In Iran, the title of this discipline is far different from the others and is called Medical Records Education.
Concerning the objectives of the course, the results revealed that at Sydney University, the course is aimed at educating experts capable of designing and managing health information systems; at Scholastica University, the aim was to train experts in collecting, managing, analyzing, and disseminating patient data. At Pittsburgh University, the aim was to train experts to design, analyze, implement, evaluate, and maintain health information systems, and in Loma Linda University, the course was aimed at training professionals to facilitate the flow of information throughout healthcare centers (see Table 1).
Course objectives at Alabama University are training individuals capable of strategic planning, managing, designing, integrating, executing, and evaluating clinical and administrative information systems all of which bear a strong resemblance to course objectives of Portsmouth University. There the aim is to train individuals to pinpoint the strategic and operational role of health information and to be agents of healthcare policy implementation.
In the Medical University of Iran, the objectives of the course are different, and they are aimed at training professionals well versed in the science of medical records in its global scope and capable of managing and planning educational programs in the field.
The course lasts for 1-2 years in the universities of Sydney and Portsmouth and 2-3 years in the other case universities. The numbers of credits were all different from university to university, and at the universities of Sydney, Scholastica, Pittsburgh, Loma Linda, Alabama, Portsmouth, and Medical University of Iran, the required credits were 50, 36, 39-40, 53, 56, 120, and 32 credits respectively.
The course was offered in unit structure at all universities except for Portsmouth University where the course was offered in modular structure.
Most universities offered educational programs in both full-time and part-time mode. In the Medical University of Iran though, part-time educational planning is carried out under the aegis of the Ministry of Higher Education, whereas part-time education is not included in the higher education system of Iran (see Table 1).
The results depicted in Table 2 reveal that in most universities a course on Management and Organization is offered, whereas in the Medical University of Iran such a credit is still missing. Most universities offer a course on Information Technology except for Loma Linda University. When it comes to education, most universities fail to offer a course on Education except for the Medical University of Iran.
Most of the universities under investigation offer a course concerning Health Information Systems except for the Medical University of Iran. Concerning Coding and Classification Systems, the universities of Sydney, Scholastica, and the Medical University of Iran were similar and have offered courses on them, whereas the universities of Pittsburgh, Loma Linda, Alabama, and Portsmouth do not offer any courses in this field.
Concerning Research Methods, all the universities under study offer such courses. The universities of Sydney, Scholastica, Pittsburgh, Loma Linda and the Medical University of Iran offer courses related to Statistics, whereas the universities of Alabama and Pittsburgh do not.
Concerning Evaluation, the universities of Scholastica, Alabama, and the Medical University of Iran offer courses, whereas other universities do not. The universities of Pittsburgh, Sydney, and Loma Linda offer courses on Health Information Standards and Requirements but others fail to do so. While only the University of Sydney offers a course related to Biology, in the Medical University of Iran this credit is offered merely as a prerequisite.
About Medical Records/Health Information Management, the three universities of Alabama, Portsmouth, and the Medical University of Iran offer relevant courses.
Seminar courses are offered by the universities of Scholastica, Alabama, Portsmouth, and the Medical University of Iran. Concerning Internship, the universities of Pittsburgh, Loma Linda, and Alabama offer courses. Thesis courses are offered by the universities of Sydney, Pittsburgh, Alabama, and the Medical Sciences University of Iran.
Based on the above findings a model aimed at boosting the curriculum of the Medical University of Iran was proposed. The model was then presented for the scrutiny of professors and experts in Tehran, and then the final model emerged.
The existence of a viable health information system is integral to any health policy, as it will form the backbone to any decision made by the health policymakers of the country. Such a system is missing from our country (Iran). Unless there is a determined initiative to launch a strong and feasible health information system, the present situation will continue to prevail.
Medical records experts are professionals possessed of the ability to master the required expertise in health information management and if trained in health information systems management, they are capable of managing health information and systematically integrating health information in the country.
The current study reveals that the general trend in the profession is toward health information systems in most universities. To keep pace with other countries and to meet the current demands, it is essential that the master's degree program attempt to train professionals capable of designing, analyzing and implementing health information systems. To this end, a model has been proposed for the curriculum of the postgraduate course of medical records based on the findings of the present comparative study.
The proposed model was put to a poll consisting of professors and experts (professionals in the field possessing a master's degree in Medical Records Education) within reach in Tehran. A questionnaire consisting of five closed questions (on the Likert scale) and two open questions was prepared, and it was agreed that an acceptance rate of 50 percent high or very high would mean that the model is suitable or it would be rejected altogether. Twenty-one professors and experts operating in Tehran were consulted and eventually the following results were obtained.
The findings revealed that 47 percent of the respondents deemed the title of the proposed model as very high suitable, 24 percent as high suitable, 10 percent as relatively suitable, 5 percent as not very suitable, and 14 percent as not suitable at all. Forty-two percent of the respondents believed that the objective of the proposed model was extremely apt, 29 percent believed it was very apt, 14 percent relatively apt, 14 percent not so apt, and 10 percent believed it was not apt at all.
Thirty-three percent of the respondents regarded the duration of the proposed model as very high suitable, 29 percent as very suitable, 14 percent as relatively suitable, 5 percent as not very suitable, and 10 percent regarded it as not suitable at all. Thirty-three percent of the respondents thought the proposed basic credits was extremely apt, 38 percent thought they were very apt, 19 percent believed they were relatively apt, and 5 percent thought it was not apt at all. Thirty-eight percent of the respondents viewed the proposed core credits as very high suitable, 29 percent as very suitable, 19 percent as relatively suitable, 10 percent as not very suitable, and 5 percent thought it was not suitable at all.
Final Model Presentation
Due to the fact that the model obtained an acceptance rate of more than 50 percent high or very highly suitable , the final model, having been modified after the experts' suggestions, was presented (see Figure 1).
Figure 1. Final Model of Master degree
Discussion and Conclusion
The aim of the comparative study of the postgraduate curriculum of the course of medical records in several countries was the presentation of a final model for implementation in Iran. The study analyzed the curricula of the universities of Sydney, Scholastica, Pittsburgh, Loma Linda, Alabama, Portsmouth, and the Medical University of Iran.
Seven aspects of the overall objective were studied. They were as follows:
- The title of the course of medical records in the universities listed above
- The number of course-credits required for completion of the course of Medical Records in every university
- The duration of the course of medical records in every university
- The educational method applied for the course of medical records in every university
- The variety of course credits in every university
- The training program for the postgraduate students of the discipline
- Educational Model presentation for the postgraduate course of Medical Records in Iran.
Aspect 1 of Table 1 reveals that the title of the course in most of the universities under examination is Health Information Management or Health Information Systems , and it is only in the Medical University of Iran that this course is called Medical Records Education. This may be due to the fact that so far, we have been incapable of coming up with an unambiguous definition of this profession. The outcome of a crystallized definition would be a clear knowledge of the operational field and the requisite skills thereof and an eventually definite definition.
The aim of the course of Medical Records differs from university to university. The distinction is at its narrowest between the universities of Pittsburgh and Alabama and at it's widest between the Medical University of Iran and the rest. The distinction could be put down to the divergence of the objectives pursued by the different universities.
Aspect 2 of Table 1 highlights the fact that most of the universities under study offered different numbers of credits for the postgraduate course of Medical Records. The number of credits offered by Portsmouth University is explained by the modularity of the course credits in this university, which is not the case in the others.
Aspect 4 of Table 1 is indicative of the fact that only in the Medical University of Iran do we have an exclusively full-tim e educational program whereas in other universities there also exists a part-time alternative . The restrictions are the outcome of the Iranian higher education policies. Aspect 5 of Table 1 reveals that the course credits offered in the University of Scholastica enjoy the highest variety whereas in the university of Loma Linda, this variety plummets to minimum. The fields emphasized in most universities were Management and Organization, Health Information Systems, Information Technology, and Statistics. In Iran though, Health Information Systems does not figure in the curriculum of the postgraduate course of medical records. The course credits are offered in Iran around Education. And all of the universities offer the course credits about Research Methods. Taken as a whole, it turns out to be the case that every university offers courses in line with its course objectives and the prevalent emphasis on learning Research Methods is the visible symptom of the importance attached to it on a postgraduate level.
The study of aspect 6 of Table 2 revealed that only the three universities of Pittsburgh, Loma Linda and Alabama offer Internship courses and this is an index of the importance attached by these universities to skills learning and experimentalism. Offering such courses requires a strong infrastructure, a necessity currently missing in the Iranian educational make-up. Furnishing healthcare and educational centers with a workable health information system is essential, and it will be helpful in implementing a functional and effective internship course.
The findings of the current comparative study of the way different countries approached health information systems led to the final proposition of a model aimed at enhancing the postgraduate course of Medical Records in Iran and to this end a number of professors and professionals in the field were consulted. It was agreed that an acceptance rate of 50 percent high or very high would be construed as the feasibility of the model or else it would be dropped. The results revealed that more than 50 percent of the respondents were highly pleased with the propositions put forward in the model. Some modifications arising from the constructive comments of the aforesaid professionals were brought to bear on the model and eventually the model emerged in its final shape.
The professors and other professionals operating in the field were in favor of the adoption of the improvements in associate and bachelor degrees of Medical Records in Iran if ever there would be an alteration in the postgraduate course of medical records.
Table 1. Comparative Study of Characteristics of Medical Records (Health Information Management) Programs in Universities of Selected Countries
| Country ||Iran ||England ||United States of America ||Australia |
|University ||Iran Medical sciences University ||Porthsmouth ||Alabama ||Loma Linda ||Pittsburgh ||Scholastica ||Sydney |
| Item || || || || || || || |
|Title ||Medical Records Education ||Health Informatics (Health Information Management/ Health Information Systems) ||Health Informatics ||Health Information Systems ||Health Information Management (Emphasis on Health Information Systems ||Health Information Management ||Health Information Management |
|Purpose ||Training professionals well versed in the science of medical records in its global scope and capable of managing and planning educational programs in the field ||Educating of persons for recognizing strategic and operational roles of health information and implementation requirement of healthcare policies ||Strategic Planning and managing, designing, merging, implementing and evaluating of clinical and managerial information systems ||Facilitating of information flow through healthcare centers ||Analysis, design, implementation, evaluation, and maintenance of health information systems ||Collection, management, analysis, dissemination of patient information ||To provide experts for designing and managing of health information systems |
|Duration ||2-3 year ||1-2 year ||2-3years ||15 month ||2-3 years ||2-3 years ||2-3year |
|Unit numbers ||32 ||120 ||56 ||53 ||39-40 ||36 ||50 |
|Course Structure ||unit ||modular ||unit ||unit ||unit ||unit ||unit |
|Education Mode ||Only full-time ||Full-time/ part-time ||Full-time/ part-time ||Full-time/ part-time ||Full-time/ part-time ||Full-time/ part-time ||Full-time/ part-time |
Table 2. A Comparative Study of Courses in the Curricula of Master's in Medical Records (Health Information Management) in Universities of Selected Countries
| Country ||Iran ||England ||United States of America ||Australia |
|University ||Iran Medical Sciences University ||Porthsmouth ||Alabama ||Loma Linda ||Pittsburgh ||Scholastica ||Sydney |
|Course field || || || || || || || |
|Organization and management || ||x ||x ||x ||x ||x ||x |
|Information Technology ||x ||x ||x || ||x ||x ||x |
|Education ||x || || || || || || |
|Health Information Technology || ||x ||x ||x ||x ||x ||x |
|Classification and Nomenclature systems ||x || || || || ||x ||x |
|Research Method ||x ||x ||x ||x ||x ||x ||x |
|Statistics and quantitative methods ||x || || ||x ||x ||x ||x |
|Evaluation ||x || || || || ||x || |
|Health information standards and requirements || ||x || || || ||x || |
|Healthcare services system || || || ||x ||x || ||x |
|Biological sciences || || || || || || ||x |
|Health information management ||x ||x ||x || || || || |
|Seminar ||x ||x ||x || || ||x || |
|Internship || || ||x ||x ||x || || |
|Thesis ||x || ||x || || || ||x |
|Project || ||x || || || ||x || |
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|Source: 2004 IFHRO Congress & AHIMA Convention Proceedings, October 2004|