An Exploratory Study Demonstrating the Health Information Management Profession as a STEM Discipline

by Dilhari R. DeAlmeida, PhD, RHIA; Shannon H. Houser, PhD, MPH, RHIA, FAHIMA; Victoria Wangia-Anderson, PhD, FHIMSS; Susan H. Fenton, PhD, RHIA, CPHI, FAHIMA; Anita Hazelwood, EdD, RHIA, FAHIMA; Amanda C. Barefield, EdD, RHIA, LNHA; Jeanne M. Freeman, PhD, RHIA; Lolita M. Jones, MSHS, RHIA, CCS; Karen Bakuzonis, PhD, MS, RHIA, CPHI; Debra L. Hamada, MA, RHIA

Abstract

It is time to make the case for health information management (HIM) to be included in science, technology, engineering, and math (STEM) education. A careful review of the HIM competencies approved by the American Health Information Management Association (AHIMA) illustrates the role of HIM professionals in informatics, data analytics, and data use. More precisely, the competency subdomains clearly align with content in the STEM disciplines of science, math, and technology, and the individual competencies or tasks in each subdomain solidify the assertion that HIM should be considered part of the STEM disciplines. Evaluation of AHIMA membership data showed that, at the education and work setting levels, AHIMA members are employed in many areas that are common to both HIM and STEM.

Keywords: STEM (science, technology, engineering, mathematics), health information management (HIM), HIM professionals, curricular competency

Introduction

Despite the International Technology and Engineering Educators Association’s definition of STEM as a new transdisciplinary educational subject that integrates the disciplines of science, technology, engineering, and mathematics into a single course of study, there is no consensus among scholars in support of that definition.1, 2 According to Zollman and colleagues,., STEM has an even broader meaning, including areas such as agriculture, environment, economics, education, and medicine.3 The National Science Foundation (NSF) also defines STEM in broader strokes and, while including the basics of mathematics, natural sciences, engineering, and computer and information sciences, also includes psychology, political science, economics, and sociology within the discipline.4 The literature suggests that the STEM movement evolved from policies within the NSF. Breiner and colleagues explained that NSF first used the acronym SMET for science, mathematics, engineering, and technology in the early 1990s but determined that this acronym would cause issues of vulgarity, and therefore SMET was changed to STEM.5 The early 2000s saw increased momentum toward STEM education with resulting interest by the federal government in funding STEM education. Since 2011, the federal government has invested several billion dollars on STEM education.6

The definition of STEM is central to the issue of STEM education and funding. In 2015, President Barack Obama signed the STEM Education Act, which expanded the definition of STEM to include computer science programs.7 In 2017, President Donald Trump reinforced this definition by expanding the access to computer science and STEM education. This encouragement to the Secretary of Education included prioritizing computer science and making the promotion of high-quality STEM education a priority for the Department of Education.8 The notice of this priority was followed with a promise from the country’s largest technology firms to dedicate money, technology, and volunteers to this initiative.9 It is time for other disciplines to make the case to be included in STEM education.

One such discipline is health information management (HIM). A look at the content of HIM curricula supports this assertion. The HIM discipline is a combination of business, science, and information technology. It is the process of acquiring, analyzing, and protecting digital and traditional medical information, which is vital to providing quality and accessible patient care.10 Health information professionals support patient care by managing their medical data. They ensure that patients’ health information and records are complete, accurate, and protected.

The AHIMA Council for Excellence in Education (CEE) is the leading force in education strategy for health information professionals, guiding the academic community and industry stakeholders through innovations in academic programs, curricula, and resources. The CEE achieves this aim through many different task-oriented workgroups.11 One of the workgroups, the Graduate Resource Alliance (GRA) workgroup, reviewed and researched STEM and HIM curricular components to identify areas of similarities and overlap between the two fields. This work outlines the workgroup’s findings and recommendations.

Educational HIM programs at the associate, baccalaureate, and master’s levels were required to incorporate the 2014 HIM Curricula Competencies into curricula by August 1, 2017.12 (See Appendices A, B, and C.) The baccalaureate-level competencies consist of six domains, which are further divided into subdomains. Specific competencies are organized and listed under each subdomain. A careful review of the subdomains illustrates the role of HIM professionals in informatics, data analytics, and data use. For example, Domain III, Informatics, Analytics and Data Use, comprises eight subdomains:

Subdomain III.A: Health Information Technologies

Subdomain III.B: Information Management Strategic Planning

Subdomain III.C: Analytics and Decision Support

Subdomain III.D: Health Care Statistics

Subdomain III.E: Research Methods

Subdomain III.F: Consumer Informatics

Subdomain III.G: Health Information Exchange

Subdomain III.H: Information Integrity and Data Quality

The subdomain titles clearly align with content in the STEM disciplines of science, math, and technology. Specific competencies under each subdomain solidify the assertion that HIM is part of the STEM disciplines. For example, at the baccalaureate level, Subdomain III.C, Analytics and Decision Support, contains the following competencies:

III.C.1:   Apply analytical results to facilitate decision-making

III.C.2: Apply data extraction methodologies

III.C.3: Recommend organizational action based on knowledge obtained from data exploration and mining

III.C.4: Analyze clinical data to identify trends that demonstrate quality, safety, and effectiveness of healthcare

III.C.5: Apply knowledge of database querying and data exploration and mining techniques to facilitate information retrieval

III.C.6: Evaluate administrative reports using appropriate software

These competencies or tasks mimic content in the area of computer science, a new discipline in STEM. For each of the competencies, a Bloom’s taxonomy level is assigned to specify at what level the material must be covered. These levels are Knowledge, Comprehension, Application, Analysis, Synthesis, and Evaluation.13 Appendix B demonstrates that many of the baccalaureate-level competencies are to be taught at higher taxonomic levels. A careful review of Appendices A, B, and C will illustrate several other subdomains and competencies that directly relate to the STEM disciplines. Further, AHIMA provides professional credentials and certifications based on specific knowledge, domains and skill sets.14 The Registered Health Information Administrator (RHIA) and Registered Health Information Technician (RHIT) credentials are designated for individuals who have completed an accredited HIM program at the baccalaureate or associate degree level, respectively. In addition, AHIMA offers specialty credentials, including Certified Health Data Analyst (CHDA), Certified in Healthcare Privacy and Security (CHPS), Clinical Documentation Improvement Practitioner (CDIP), and Certified Professional in Health Informatics (CPHI),15 that require knowledge within STEM domains, as shown in Figure 1.

The purpose of this study is to map and quantify the accreditation-required curricular education components, competencies, roles, and skills of HIM professionals with the STEM disciplines currently recognized by Department of Homeland Security. The study will make recommendations to include the HIM profession as a STEM discipline.

Methodology

The study employed two methodologies to meet the proposed objectives. Methodology 1 includes the review of current curricula in both the HIM and STEM disciplines, and Methodology 2 includes the review of AHIMA membership profile data.

Methodology 1: Review and Mapping of STEM Disciplines

This methodology involved the review of current curricula in both the HIM and STEM disciplines. This review was performed primarily by reviewing the standards and literature available on both fields. Many HIM professionals are employed in a recognized STEM occupation. A comparison of the HIM competencies to a report by Vilorio16 revealed the following STEM occupation categories that are aligned with the roles and responsibilities of many HIM professionals:

  • Computer and information research scientists
  • Database administrators
  • Information security analysts
  • Statisticians
  • Computer occupations (in general)

With these STEM occupations in mind, the GRA workgroup did the following:

  1. Compiled a listing of the STEM-related job skills and responsibilities for HIM professionals performing data analysis tasks (using AHIMA’s Health Data Analysis Toolkit17),
  2. Compiled a listing of the STEM-related competency tasks for AHIMA’s CHPS credential (using the CHPS Exam Preparation guide18), and
  3. Compiled a listing of the STEM-related competency tasks for AHIMA’s CHDA credential (using the CHDA Exam Preparation guide19).

All the data compiled for the STEM-related job functions and credential competencies are listed in Appendix D. A review of the data in Appendix D clearly illustrates that many HIM professionals are working and thriving in STEM occupations.

Another organization that is involved with the categorization of STEM-related occupations is the Occupational Information Network (O*NET). It is the nation’s primary source of occupational information, containing standardized and occupation-specific descriptors. The O*NET database was developed under the sponsorship of the US Department of Labor/Employment and Training Administration via a grant to the North Carolina Department of Commerce. Occupations are broken down into common job requirements, worker attributes, and the content and context of work performed. The O*NET database allows researchers to search for jobs with these characteristics.20 The Bureau of Labor Statistics Standard Occupational Classification (SOC) and coding structure provide further research capabilities.21 The O*NET occupations are all assigned an SOC code. Each O*NET/SOC coded occupation was compared to the AHIMA roles and competencies (see Appendix D). If an O*NET/SOC occupation did not match with the AHIMA roles and competencies, then it was not included as an occupation that is related to the HIM profession. The search identified 308 occupations that are categorized as STEM occupations. We explored each of the 308 occupations in relation to the curricular components, competencies, roles, and skills of HIM professionals. According to that review, the number of STEM occupations that were related to HIM was 26, as shown in Table 1.

Methodology 2: Review of AHIMA Membership Profile Data

We collected and analyzed AHIMA membership data using both Tableau and Microsoft Excel. The data file consisted of 71,630 records organized into nine columns. The data analysis involved eliminating entries that were null and entries indicating that a member was unemployed (if job title was the field of interest). The variables collected and displayed in columns included job title, member type, member’s credentials, job level category (e.g., director, executive, HIM technician, clerical, manager, educator, consultant), job setting, education level, state of residence, and country.

Assessment of the job level categories showed that of the 71,630 members, 12,487 did not identify their job level category and 4,578 self-reported that they were unemployed. Of those who identified their job category and are employed (55,567 members), 3.5 percent (1,969) self-reported that they were in a technology role. Other roles included clerical/administrative support, clinician, consultant, director, educator, executive/president/vice president, HIM technician, and manager/supervisor roles. The manager/supervisor and consultant roles included some job titles that were technology oriented in nature. Of the 55,567 members, 15.6 percent self-reported being in a manager/supervisor role, and 7 percent indicated that they were in a consultant role.

Analysis of technology-oriented credentials was performed for the AHIMA members who had self-reported as being in a technology role job category. The credentials considered included CHDA and CPHI. Analysis by CHDA identified 285 members who self-reported having the CHDA credential. Of these 285 members, 20 percent self-reported having a technology role. Analysis by CPHI showed that 168 members self-reported having the CPHI credential. Of these 168 members, 13 percent self-reported having the CPHI credential and being in a technology role, while 17 percent self-reported having the CHDA credential and being in a technology role.

Table 2 served as the basis for further analysis of the data. The AHIMA member job titles and job categories in the AHIMA data set do not map directly to the O*NET list; therefore, keywords closely aligned with the occupation list were selected and used as search criteria. We identified the following STEM keywords based on the occupations listed in Table 2: computer, technology, informatics, information security, business intelligence, network, data, system analyst, and database. These keywords were used as criteria to determine how many AHIMA members had the keyword in their job title and to assess whether the members with these STEM titles were pursuing STEM-related AHIMA credentialing.

Table 3 summarizes the results. The table includes the findings from the job title keyword search and the results by the three STEM-related AHIMA credentials: CHDA, CPHI, and CHPS. Of the STEM-related keywords, data ranked the highest in the job title search, followed by informatics and technology. The findings also showed that the CHDA and CPHI were mostly held by members with data in their job title. The findings also showed that a significant proportion of the members with these STEM keywords in their job titles did not pursue associated AHIMA credentials.

Results

Review and Mapping of STEM Disciplines

This search identified 308 O*NET/SOC occupations that are categorized as STEM occupations. We explored each of the 308 occupations using the HIM curricular components and competencies and the roles and skills of HIM professionals. The review revealed that 26 STEM occupations were related to HIM (see Table 1 and Table 2). This finding indicates that the role of the HIM professional falls within the STEM disciplines. The majority of the HIM professions fell within the major occupation types of Research Development, Design and Practitioners, and Technologists and Technicians.

Review of AHIMA Membership Profile Data

Of the 3,795 AHIMA members with STEM technology job titles, about 40 percent hold a baccalaureate degree and 20 percent possess a graduate degree. The vision outlined in the recent AHIMA white paper “HIM Reimagined” emphasizes the goal to increase the proportion of HIM professionals with graduate degrees in fields such as health informatics.22 Consequently, we expect to see further increase in the number of HIM professionals trained in the STEM technology discipline and pursuing careers in STEM informatics roles. This prediction is supported by the finding that HIM professionals with graduate degrees were mostly in STEM technology roles. The findings also show that a majority of the professionals in STEM technology roles hold positions in acute care hospital settings. We expect that these large organization settings will continue to offer employment opportunities for HIM professionals in STEM technology roles, specifically health informatics roles. From these findings, we can conclude that HIM professionals are employed in STEM technology roles, and having a graduate degree increases the likelihood of this being the case.

Discussion

Although the acronym STEM may seem to represent no more than a simple list of disciplines, Siekmann explains its complexity when linking the components of education, employment, and productivity.23 Because of the complexity and the broad scope of the STEM definition, Siekmann recommends identifying the components within STEM that are distinct.24 Taking this approach may pave the way for more concise identification of all disciplines that fall within the STEM realm. It would allow for each discipline to be examined on the basis of its STEM elements, rather than on the broad categories of science, technology, engineering, and mathematics.25 As Siekmann recommends, in this study we unpacked and identified the major components within HIM to build the case for its inclusion as a STEM discipline.

A careful review of the HIM baccalaureate program competencies illustrates the role of HIM professionals in informatics, data analytics, and data use. More precisely, the competency subdomains clearly align with content in the STEM disciplines of science, math, and technology, and the individual tasks under each subdomain solidify the assertion that HIM is part of the STEM disciplines.

Published reports on STEM jobs of the future demonstrate that many HIM professionals are already employed in recognized STEM occupations, particularly in roles such as computer and information research scientists, database administrators, information security analysts, statisticians, and computer occupations.26 Additionally, an analysis of the O*NET database, which allows researchers to perform searches for jobs based on STEM occupation characteristics, resulted in the finding that 26 of the 308 STEM occupations are related to HIM (see Table 2).

Some potential limitations of the results of this study should be noted. First, data were drawn from the self-reported AHIMA membership profile database. The information provided in membership profiles may be outdated or incomplete. Second, the data represent a small sample of HIM professionals within the larger AHIMA membership population. Although the sample size is small, we believe this sample is a solid demonstration of the future trend of the HIM profession.

Conclusion

The results of this study show that AHIMA members were qualified to be included in various STEM disciplines. Future study is needed to acquire more accurate and precise data on the job titles and STEM positions that are currently filled by HIM professionals. A future survey of the entire AHIMA membership is also needed to obtain additional information to expand other job titles related to STEM.

We recommend that AHIMA continue to promote the value that credentialing offers to members, as well as the career opportunities available in STEM technology fields. We also recommend that AHIMA consider adding the STEM vetted occupations to the membership database to more closely align the membership data with the vetted occupations that were considered in this study.

Acknowledgments

The authors thank AHIMA for providing the membership profile data. Special thanks to Desla Mancilla, DHA, RHIA; Christi Lower, PhD, RHIA, FAHIMA; and John Richey, MBA, RHIA, FAHIMA, who worked on identifying resources, reviewing the manuscript, and providing feedback.

 

Dilhari R. DeAlmeida, PhD, RHIA, is an associate professor in the Department of Health Information Management at the University of Pittsburgh in Pittsburgh, PA.

Shannon H. Houser, PhD, MPH, RHIA, FAHIMA, is an associate professor in the Department of Health Services Administration/Health Informatics Program at the University of Alabama at Birmingham in Birmingham, AL.

Victoria Wangia-Anderson, PhD, FHIMSS, is an associate professor and program director at the University of Cincinnati in Cincinnati, OH.

Susan H. Fenton, PhD, RHIA, CPHI, FAHIMA, is an associate professor and associate dean for academic affairs at the University of Texas Health Science Center at Houston School of Biomedical Informatics in Houston, TX.

Anita Hazelwood, EdD, RHIA, FAHIMA, is head of the Allied Health Department at the University of Louisiana at Lafayette in Lafayette, LA.

Amanda C. Barefield, EdD, RHIA, LNHA, is an associate professor of health information administration at Augusta University in Augusta, GA.

Jeanne M. Freeman, PhD, RHIA, is a program director and associate department chair in the Department of Health Information Management at Davenport University in Grand Rapids, MI.

Lolita M. Jones, MSHS, RHIA, CCS, is a medical coding educator for healthcare delivery systems in Sleepy Hollow, NY.

Karen Bakuzonis, PhD, MS, RHIA, CPHI, is a program chair at Ashford University in San Diego, CA.

Debra L. Hamada, EdD, MA, RHIA, is the chair and assistant professor in the Health Informatics and Information Management Department at Loma Linda University in Loma Linda, CA.

 

Appendices

There are four appendices for this article:

Appendix A

Appendix B

Appendix C

Appendix D

Notes

  1. Mitts, C. R. “Why STEM?” Technology and Engineering Teacher, 75, no. 6 (2016): 30–35.
  2. Ibid., 30.
  3. Zollman, A., M. Tahernezhadi, and P. Billman. “Science, Technology, Engineering and Mathematics Education in the United States: Areas of Current Successes and Future Needs.” International Journal of Science in Society 3, no. 2 (2012): 103.
  4. National Science Foundation. “NSF Scholarships in Science, Technology, Engineering, and Mathematics Program (S-STEM).” 2017. Available at https://www.nsf.gov/funding/pgm_summ.jsp?pims_id=5257.
  5. Breiner, J. M., S. S. Harkness, C. C. Johnson, and C. M. Koehler. “What Is STEM? A Discussion about Conceptions of STEM in Education and Partnerships.” School Science and Mathematics, 112, no. 1 (2012): 3–11.
  6. Ibid.
  7. “STEM Education Act of 2015.” Public Law 114-59. October 7, 2015.
  8. The White House. “Presidential Memorandum for the Secretary of Education: Increasing Access to High-Quality Sciences, Technology, and Engineering, and Mathematics (STEM) Education.” September 25, 2017. Available at https://www.whitehouse.gov/presidential-actions/presidential-memorandum-secretary-education/.
  9. Schaffhauser, D. “White House Memo on STEM Ed Followed Up by Corporate Commitments.” The Journal, September 27, 2017. Available at https://thejournal.com/articles/2017/09/27/white-house-memo-on-stem-ed-followed-up-by-corporate-commitments.aspx.
  10. “What Is Health Information?” 2017. Available at http://www.ahima.org/careers/healthinfo.
  11. Council for Excellence in Education (CEE). 2017. Available at http://www.ahima.org/education/academic-affairs/council-for-excellence.
  12. “Curriculum Requirements for Accreditation.” 2017. Available at http://www.cahiim.org/him/curriculumrequirements.html.
  13. Anderson, L.W., and D. R. Krathwohl. A Taxonomy for Learning, Teaching, and Assessing. Abridged ed. Boston: Allyn and Bacon, 2001.
  14. “Certification.” Available at http://www.ahima.org/certification.
  15. Ibid.
  16. Vilorio, D. “STEM 101: Intro to Tomorrow’s Jobs.” Occupational Outlook Quarterly, Spring 2014. Available at https://www.bls.gov/careeroutlook/2014/spring/art01.pdf.
  17. “Health Data Analysis Toolkit.” 2017. http://bok.ahima.org/PdfView?oid=302359.
  18. Brinda, D. E. Certified in Healthcare Privacy and Security (CHPS) Exam Preparation. Chicago: AHIMA Press, 2016.
  19. White, S. Certified Health Data Analyst (CHDA) Exam Preparation. 2nd ed. Chicago: AHIMA Press, 2018.
  20. O*NET Resource Center. “About O*NET.” Available at https://www.onetcenter.org/overview.html.
  21. US Bureau of Labor Statistics. Standard Occupational Classification and Coding Structure. 2010. Available at https://www.bls.gov/soc/soc_2010_class_and_coding_structure.pdf.
  22. “HIM Reimagined.” 2017. Available at https://www.ahima.org/about/him-reimagined/himr?tabid=whitepaper.
  23. Siekmann, G. “What Is STEM? The Need for Unpacking Its Definitions and Applications.” National Centre for Vocational Education Research, Available at https://www.ncver.edu.au/research-and-statistics/publications/all-publications/what-is-stem-the-need-for-unpacking-its-definitions-and-applications.
  24. Ibid.
  25. Ibid.
  26. Vilorio, D. “STEM 101: Intro to Tomorrow’s Jobs.”

 

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