Vision 2016 to Reality 2016: Building a Profession

By Mona Calhoun, MS, RHIA, Bill Rudman, PhD, RHIA, and Valerie Watzlaf, PhD, RHIA, FAHIMA

Creating a profession of health information managers ready for the digital world of the 21st century

As healthcare evolves, the need for higher levels of education and specialized skill sets is becoming a firmer reality. With advancement in technology, the need to manage and use data to improve patient care, streamline services, extend patient care into underserved and rural areas, and reduce costs becomes increasingly important.

As a profession, HIM must recognize these changes and respond. HIM educators must look beyond their own institutional requirements and recognize the needs of other institutions, students, and the workplace. The goal should be to provide as many options as possible for academic colleagues to support new and innovative change in how educational programs are developed and delivered, and promote HIM within the academic community as a viable and necessary field of study. The sidebar "HIM Education and Training" alludes to the importance of education in HIM going forward. If HIM professionals are to remain relevant and employable, they need to obtain an advanced degree, provide additional training in specialty areas, and move toward training in administration, research, and quality improvement.

In 2006, AHIMA brought together educators and HIM professionals from around the country to provide a vision of where they believed the HIM world would be in 2016. The result was the 2007 report "Vision 2016: A Blueprint for Quality Education in HIM."¹ This document provided key priority areas and suggestions for the future of education in the HIM field, calling for leadership and grassroots involvement from both HIM educators and academic programs with the hope of enabling HIM academic programs and education to remain competitive and flourish in the 21st century.

To meet this goal, the report called for three specific educational priorities to be implemented by 2016:

1. Transformation of HIM to a graduate-level profession
2. Realign the HIM associate degree with workforce needs
3. Prepare an effective, qualified pool of HIM faculty

Between 2007 and 2010, some limited progress was made on the ideals expressed in the 2016 document:

1. A job analysis was conducted to assess the tasks and competencies for HIM professionals with graduate degrees, which became the 2008 master's degree curriculum requirements
2. Master's degree-level accreditation standards for health information management and health informatics programs were implemented by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM)
3. Seven colleges and universities achieved CAHIIM accreditation at the graduate degree-level, with another seven programs in current phases of development and accreditation
4. A new credential, Certified Health Data Analyst (CDHA), was approved by the AHIMA House of Delegates and implemented to expand the scope of HIM practice and strengthen professional development in data analytics
5. The online research journal Perspectives in Health Information Management generated significant increases in manuscripts received, accepted, and published
6. In research done for AHIMA, the American Institutes for Research (AIR) released employer survey results indicating that a master's degree in HIM is considered more valuable than other graduate degrees³

In 2010 AHIMA's Education Strategy Committee (ESC) revisited Vision 2016 and set several steps in motion to not only discuss but further promote and put into action its goals and ideals. The first step was the creation of the Council for Excellence in Education (CEE). The CEE, a council of educators and practitioners responsible for helping to determine strategy for the academic community, was established as an affiliate council within the AHIMA Foundation. The CEE consists of a 12-member council and six workgroups: community, faculty development, educational programming, research and periodicals, curricula, and workforce.

Following its formation, the CEE began to develop the implementation strategy for the transition of Vision 2016 to what is now called Reality 2016. In 2010, the CEE's strategy focused on precision by providing the academic community with information directly from the Vision 2016 document. The purpose was to obtain responses and information relating to implementation concerns and barriers. Building on that feedback, the goal for 2012 developed by the AHIMA Foundation and CEE is to begin the implementation process.

The CEE is gathering information from both the academic community and general AHIMA membership in stages. The proposed changes are based on both enhancing the profession's image and meeting market demands for HIM students.

Based on stakeholder responses and input, the following four initiatives are being developed by the CEE:

1. Increasing the number of HIM professionals who hold graduate degrees: A core theme often repeated by AHIMA during this discussion is "Learn More, Earn More." Data suggests that having a master's degree may result in better job opportunities and higher salaries. Given the increasing complexity and demands of HIM jobs, graduate education is a great way to improve HIM's professional stature. For those HIM professionals pursuing advanced positions in either their own or other organizations, a graduate degree may facilitate this advancement. A greater number of HIM professionals in senior leadership positions allows those who best understand the profession to have greater influence on its expertise in delivering quality care. A variety of educational options are planned to encourage HIM professionals to obtain graduate degrees. As always, AHIMA will continue to support associate and baccalaureate education programs and the RHIA and RHIT credentials.
2. Associate degree specialty tracks: The CEE also recommends enhancing the associate degree to include areas of specialization, such as coding, health data analytics, management, e-HIM, physician practice, and registry management. The current two-year associate program will remain as the core education required to take the RHIT examination. However, the ability to take one or more specialty tracks as add-ons allows more options for post-associate specialization.
3. Faculty and member development: Investing in faculty and member development to boost skills in statistics and research methodology, data integrity, and data governance is another area under consideration. These are skills all HIM professionals need in a competitive job market, and they'll especially help HIM faculty teach these subjects for their students and assist our members to stand out for advancement. Support for this educational initiative will be provided through a variety of programs such as a grants process for dissertations and a research boot camp.
4. Increasing the workforce with additional qualified professionals: AHIMA is currently exploring two options: 1) creating a proposed post-graduate certificate model for doctoral and master's-prepared individuals to obtain an RHIA credential, and 2) expanding opportunities for those who hold the RHIA credential to obtain master's and doctorate degrees. The ultimate objectives are to increase the number of professionals who can lead HIM education in academic institutions and continue to prepare students for the future, as well as to increase the presence of HIM professionals in executive or C-suite jobs.

Reality 2016 is intended to ensure that the HIM profession will further sustain and serve in leadership roles in a rapidly changing healthcare environment. As we seek to prepare HIM professionals for the future, Reality 2016's goal is to create educational pathways that will lead to new leadership opportunities for HIM professionals and position them to increase HIM influence and respect, as well as command higher salaries.

The CEE will continue to collaborate with stakeholders to ensure that future education continues to be the cornerstone of a thriving HIM profession. Through innovation, research, communication, and transparency, the council will continue to elevate and promote HIM professionals as recognized knowledge brokers who are the trusted source for accurate health information.

Increasing the Number of HIM Professionals Who Hold Graduate Degrees

A 2012 report by the Lumina Foundation, "A Stronger Nation through Higher Education," illustrates that occupations requiring a higher level of education and skills-like most professions in healthcare-are in demand.⁴ The report compares this trend to two games of musical chairs. As one chair is taken away from one game for lower-level skills, chairs are added to the game for higher-level skills. With higher-level skills comes the need for higher levels of education and more diverse training.

Only 10.7 percent of individuals aged 25-64 in the United States have a graduate or professional degree. The table "BLS Employment and Earnings Data by Degree" demonstrates that education pays. It shows that the unemployment rate of those with a master's degree or higher is significantly less compared to the unemployment rate of those with less than a master's. Those with a master's degree had an unemployment rate of 3.6 percent compared to those with a bachelor's degree at 4.9 percent. Furthermore, the median weekly earnings in 2011 for an individual with a master's degree was more than $200 higher than those with a bachelor's degree, and approximately 65 percent higher than that of an individual with an associate degree.

As HIM professionals move up the corporate ladder, an increased salary increases their leverage to obtain higher-paying jobs, allowing individuals to bargain for even higher salaries as they get promoted from within or move outside to a new position.

With the boom in healthcare IT, opportunities are abundant. In the table "Salary Comparison: Bachelor's versus Master's Degrees," 2011 data from CareerBliss, an online community devoted to career development, indicates careers where a master's degree pays off, including several jobs that HIM professionals are likely to hold. For example, the job title of "business manager" with a four-year degree earns an average salary of $62,723.68, compared to $80,439.55 with a master's degree. Furthermore, those working as program directors in education earn 19 percent more with a master's degree. Working as a managing partner of a professional or consulting firm can lead to a 20 percent increase in salary with a master's, and if you are a database administrator you will see a 21 percent increase with a master's degree.⁶

Upon examining data from AHIMA's salary survey of AHIMA members, the same trend is reaffirmed. The average salary for those with a master's is $86,187, whereas for those with a bachelor's and associate's the average salary is $66,064 and $49,769, respectively.⁷

In addition to the data on the general impact of earnings by degree level, data from the AHIMA salary survey shows that for each additional degree, on average, those in the HIM profession will earn an additional $15,830, controlling for experience, gender, and organizational size. Over the course of a 40-year career in the HIM field, this would be more than $620,000 in earning per degree level.

Associate Degree Specialty Tracks

These data and reports strongly support the suggestion that the more one learns in HIM, the more they earn, and the more job opportunities will abound. This would suggest the need to provide opportunities for educators and students to enhance the associate degree curricula to include areas of specialization. These specialization areas could be embedded in the curriculum or offered as post-associate degree certifications.

In support of the second priority of Vision 2016, academic programs will determine which tracks best suit their community of interest and reflect the strengths of the faculty. In certain areas a generalist degree might be more appropriate, while in others a specialization track may better reflect market needs. Some of the proposed tracks might include:

• Coding
• Health data analytics
• Project operations (management)
• e-HIM implementation
• Physician practice e-HIM conversions
• Registry (cancer registry, trauma registry, birth defect registry, etc.)
• Generalists for programs that have determined this as a need for their community of interest
• Other: skills and knowledge as identified by HIM educators, employers, and affiliates needed to remain competitive and of value to the healthcare industry

One of the recommendations that came from the AIR report was to focus on specialty areas that were of particular relevance to HIM practitioners and the healthcare industry for HIM to remain marketable and competitive.⁸ The CEE will partner with colleges throughout the US that are willing to support this initiative and transition their programs to specialty tracks.

Faculty and Member Development

For Reality 2016 to succeed, HIM faculty must develop their grant writing and research skills. This faculty development will help faculty meet the criteria for tenure and promotion and will provide students with the necessary skills to compete for senior-level positions within the healthcare industry.

This suggests that AHIMA is willing to help provide resources to promote HIM faculty development. One such program has already begun at Texas State University. Under the guidance of Sue Biedermann, MSHP, RHIA, FAHIMA, and Susan H. Fenton, PhD, RHIA, FAHIMA, Texas State University has reinstated the Faculty Development Research Bootcamp. This bootcamp is designed to bring together faculty members in the HIM field to work both on research projects and to engage in training in the areas of statistics and research methodology. As the CEE moves forward with other faculty development initiatives, the focus will be on helping the HIM faculty leverage themselves for tenure and promotion, gaining skills to help their students become more market ready, and to advance within the healthcare organization. (See "Bootcamp and Beyond: A Research Journey")

Educators report that one of the major challenges they face in furthering their education is the lack of financial support. The AHIMA Foundation is committed to providing financial incentives and support for professionals interested in furthering their education, not only to increase the faculty pool for academic programs, but to generate interest in research and data analytics as well.

Increasing the Workforce with Additional Qualified Professionals

In order for the HIM profession to move forward in the academic community to a graduate-level profession, there is a need to have doctorally-prepared RHIAs. Doctorally-prepared RHIAs will allow the profession to expand into various academic institutions and will add the credibility and prestige necessary for our profession to grow. According to data from AHIMA membership, out of more than 64,000 AHIMA members only 129 (.2 percent of membership) have both the RHIA and PhD. Furthermore, of those 129 only 55 (.09 percent of membership) listed an academic institution as their primary place of employment.

It is important to recognize that having PhD faculty teach HIM classes may help in the short term, but is not a long-term solution. To achieve this goal, the CEE proposes both short-term and long-term courses of action.

There are two general ways to increase the number of doctorally prepared RHIAs:

1. Internal: RHIA-credentialed individuals move through the academic ranks from the baccalaureate to master's to doctoral degrees; or
2. External: recruit individuals who already have a doctorate and offer executive or graduate certificate programs where the individual can receive an RHIA

To build the profession, HIM professionals must move in both areas. As noted earlier, the AHIMA Foundation and CEE are working with HIM professionals in the process of developing several faculty advancement initiatives to promote and grow the number of PhD faculty within the current academic ranks. This initiative will allow educational institutions to recruit PhD faculty who have worked and are interested in HIM in a much shorter period of time. Moreover, as HIM stakeholders build the profession, this will provide greater diversity in research interests, experience, funding, and scholarships as well as the development of AHIMA's educational offerings.

Ready for Tomorrow

As the HIM profession positions itself for the 21st century, HIM professionals must understand that data is at the heart of the healthcare system. Without being able to appropriately manage and use patient health data, America will not be able to adequately address issues of patient care and cost. HIM educators need to produce a qualified workforce that is prepared to meet the many challenges of the healthcare system. In order to be market ready, students must have the appropriate skills and training to collect, process, analyze and apply information in the digital world. This means HIM professionals must provide the appropriate level of education for students to become leaders in the field of healthcare as well as the necessary training for them to contribute to the quality of patient care.

Notes

1. Barrie, Leslie. "Growing Health Care Careers." 2012. http://education.yahoo.net/articles/growing_health_care_careers.htm?kid=1LSCQ.
2. AHIMA. "Vision 2016: A Blueprint for Quality Education in HIM." 2007. 
3. American Institutes for Research. "AHIMA National Workforce Assessment Final Report." 2009.
4. Lumina Foundation. "A Stronger Nation through Higher Education." 2012. http://www.luminafoundation.org/states_landing/a_stronger_nation_through_education.
5. US Department of Labor. "Labor Force Statistics from the Current Population Survey." http://www.bls.gov/cps.
6. Career Bliss. "CareerBliss Data Reveals the Top 10 Jobs Where Having a Master's Degree Pays Off." August 2011. http://www.careerbliss.com/press-releases/careerbliss-data-reveals-the-top-10-jobs-where-having-a-masters-degree-pays-off.
7. AHIMA internal salary survey, 2010. See also: AHIMA 2010 salary data at http://www.hicareers.com/Toolbox/salarystudy.aspx [web page no longer available].
8. American Institutes for Research. "AHIMA National Workforce Assessment Final Report."

Mona Y. Calhoun (mcalhoun@coppin.edu) is chair of the HIM program at Coppin State University in Baltimore, MD, and chair of the CEE. Bill Rudman (bill.rudman@ahimafoundation.org) is executive director, AHIMA Foundation and vice president, education visioning at AHIMA. Valerie J.M. Watlzaf (valgeo@pitt.edu) is associate professor at the university of Pittsburgh, PA, and vice chair of the CEE.