Health information technology initiatives created the framework for a national health information infrastructure that concomitantly fostered a need to build intellectual capacity within our current and future health information management (HIM) work force.
Results from the 2008 HIM Educator Survey are discussed. Developed for voluntary electronic participation, the survey comprised a series of questions about educators’ professional interests and responsibilities. Summary data from the 402 respondents are provided and highlight areas such as academic rank, teaching status, salary range, levels of interest in various issues, and use of virtual learning tools. Data from this survey provide insights into the concerns and challenges many HIM educators face in today’s training institutions and suggest implications for future directions in work force training and professional development within the HIM field.
Key words: health information management, educator survey, faculty survey
Over a decade ago, economist Robert McTeer noted the importance of continually reeducating and training our work force to meet the challenges of a changing world.1 The significance of this statement to the current education of the health information management (HIM) work force is reinforced by initiatives heralding the transformation of health information technology (HIT) by 2014. HIT initiatives have established the framework for a national health information infrastructure in both public and private sectors; however, they have created a parallel need for additional investments in reeducating and training a health information management work force with specialized skills to address the evolving HIT landscape.
The American Health Information Management Association (AHIMA) work force studies recognized the need for more qualified people in the transition to an electronic health record era and identified education as the key to adapting the HIM profession to developing technologies.2, 3 In 2007, the AHIMA white paper Vision 2016: A Blueprint for Quality Education in Health Information Management addressed challenges and key priorities for preparing an effective and qualified pool of health information management faculty by 2016.4
In order to address the need for reeducating and training the HIM work force, we need to examine the characteristics and expertise of this work force, especially faculty educators. These educators are charged with training qualified HIM professionals in the face of such challenges as increased enrollments and diversity among students, needed transitions in instructional methodologies, funding issues, and increased demands for qualified HIM applicants by public and private employers. The continuing evolution of the healthcare industry requires that the HIM profession foster skills of lifelong learning and leadership among its current and future work force.5
This paper provides 2008 HIM Educator Survey data that describe HIM educators’ characteristics and opinions regarding their perceived need for and concerns about work force development, student characteristics, program support, and their current roles and responsibilities within their respective academic settings. Implications of HIM educators’ opinions about the issues and challenges they face as educators are also discussed.
Survey Development and Measures
The 2008 HIM Educator Survey was developed as a collaborative effort of the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM) and the AHIMA Education Strategy Committee. A similar survey was conducted in 2006 with a different set of questions.6 The purpose of the 2008 survey was to collect updated data about the issues and challenges facing HIM educators and HIM academic programs today.
The survey included a total of 60 questions that were derived from a variety of sources including the 2006 HIM Educator Survey, the Chronicle of Higher Education, and questions developed by members of the survey committee.
The survey instrument consisted of two parts and was developed for voluntary electronic participation. The first part, with 35 questions, was open to all participants and comprised a series of questions about the educator’s professional interests and responsibilities, classroom environment, and personal details relevant to experience in HIM education. Questions in this part were presented in a multitude of formats, including yes/no and multiple-choice questions. All questions were closed ended or partially closed ended. Likert scales were used for questions in which participants self-rated their level of interest or concern related to various issues. The second part of the survey was made available only to participants who identified themselves as program directors. Questions in this section focused on the program director’s workflow and responsibilities, program characteristics, and the program’s student population. This analysis includes only the results from the first part of the survey.
Study Sample and Selection Procedures
Survey participants included HIM educators as identified by their active membership in either the Assembly on Education, Associate Degree, or Baccalaureate Degree AHIMA Communities of Practice (CoP) discussion forums. To join the CoP, a member must first be vetted as an HIM academic educator. Membership information from these discussion forums was used to create a list of 1,667 HIM educators. These potential participants were sent an e-mail regarding their participation in the study, along with the survey. The data collection period was April 9–May 22, 2008. Interested participants could at any time during this period electronically link to and voluntarily complete the survey. A total of 434 surveys were received, which included 25 duplicates and 3 blank surveys. The final data analyses were conducted based on 402 valid surveys. Descriptive analysis was performed using SPSS version 15.0.
Characteristics of Respondents
Data were collected from 402 survey respondents from more than 45 U.S. states, with three respondents from other countries. Among the respondents, 37 percent were from the Midwest, 12 percent were from the Northeast, 37 percent were from the South, and the remaining 14 percent were from the western region. About 70 percent of the respondents were full-time educators on 9-to-12-month contracts. Approximately one in four respondents was an adjunct faculty member or lecturer with teaching responsibilities on an as-needed basis. Nearly half of the educators had academic titles of professor (11 percent), associate professor (16 percent), or assistant professor (18 percent); the others were instructors or lecturers (Table 1). In addition to the faculty appointment, nearly half (48 percent) of the respondents also served as HIM program directors at their respective facilities.
As shown in Figure 1, more than half (56 percent) of the respondents held a master’s degree. Another 12 percent were currently pursuing a master’s degree. Only 10 percent of the respondents had a doctoral degree, although an additional 11 percent indicated that they were in the process of getting a doctoral degree. Approximately one in four respondents had a baccalaureate degree, and another 9 percent of respondents had an associate degree.
Almost all the respondents (96 percent) had at least one of the AHIMA credentials. Common credentials listed by respondents include Registered Health Information Administrator (RHIA; 76 percent), Registered Health Information Technician (RHIT; 24 percent), Certified Coding Specialist (CCS; 21 percent), Certified Coding Specialist—Physician-based (CCS-P; 8 percent), and Certified in Healthcare Privacy and Security (CHPS; 3 percent). Because the sample selection for survey distribution was based on AHIMA membership, all respondents were AHIMA members and AHIMA state association members. In addition, respondents were involved in many other associations, such as the Healthcare Information and Management Systems Society (HIMSS; 10 percent), the American Academy of Professional Coders (AAPC; 10 percent), and the American Medical Informatics Association (AMIA; 6 percent).
Almost 22 percent of respondents taught courses for more than one HIM program, and one in three taught courses in disciplines outside of the HIM profession. The teaching load varied from one course per term (15 percent) to six or more courses (19 percent), while 22 percent of respondents indicated that they taught four courses per term. Nearly 43 percent of those courses were taught as classroom-based courses.
About 40 percent of respondents had been engaged in teaching for more than 10 years, while another 24 percent had been teaching for less than three years (Table 1). When asked about future plans for teaching, approximately one in three indicated that they would quit teaching within the next five years. Another 30 percent of the respondents planned to teach for 6 to 10 more years. Of those respondents who indicated that they were planning to quit teaching within five years, half had been teaching for more than 10 years (one in three had been teaching for 16 years or more), and more than half had an academic ranking of instructor.
When asked about their salary, 28 percent of respondents indicated that their annual contract salary with the HIM program was $30,000 or less. The most common salary range for respondents was $40,000 to $70,000, accounting for 48 percent of total responses (Figure 2). A large majority of respondents earning $30,000 or less were instructors (88 percent) and adjunct lecturers (87 percent) who teach on a per-course basis (87 percent). The average salary range was positively associated with education level, more years of teaching, academic ranking, and full-time employment status (see table 2, table 3, table 4 and table 5).
Use of Virtual Learning Tools
About 76 percent of respondents utilized learning management systems, more than half used standalone HIM software applications, and 44 percent used the AHIMA Virtual Lab. Other virtual learning tools included webinar conferencing (15 percent), video streaming (12 percent), Educode (12 percent), a program virtual lab (12 percent), and e-books (10 percent; Figure 3).
Level of Interest
Respondents were given a three-point scale (no interest, interested, or very interested) and asked to rate their interest level on issues related to teaching and learning for self- or professional development, e-HIM, and coding. More than half of the respondents were interested or very interested in e-HIM issues such as electronic health records (58 percent) and data mining, warehousing, and analytics (53 percent). A large majority were interested or very interested in coding-related issues such as ICD-10 (84 percent), coding practices (78 percent), finance and reimbursement (87 percent), and nomenclatures and taxonomies (77 percent; Figure 4). A large number of educators were interested or very interested in issues related to professional development and teaching such as test writing (79 percent), methods of evaluating student learning (89 percent), designing courses and program content for distance learning (89 percent), current healthcare legal issues (88 percent), project management (82 percent), leadership development (75 percent), and grant-writing skills (63 percent; Figure 5).
Challenges and Concerns
The respondents were asked to rate their concerns about faculty issues (inadequate faculty salaries, quality of faculty, heavy course load, pressure to publish or research), student issues (students insufficiently prepared academically, lack of diversity among students, rising cost of student services, student retention), and other issues (decline in federal, state, and program support; lack of ability to meet enrollment targets; lack of recruitment money) on a five-point scale (not a concern, somewhat concerned, concerned, very concerned, or extremely concerned). When asked about faculty-related challenges, almost half (47 percent) of the respondents were very or extremely concerned about inadequate faculty salaries, and others were concerned about heavy course loads (41 percent), too many part-time faculty members (29 percent), and lack of quality of faculty (33 percent). A large majority indicated that they did not have pressure to write publications and conduct research (Figure 6).
Another area of concern noted by respondents relates to students. More than half (55 percent) were very or extremely concerned about the perceived lack of academic preparation of entering students, and 42 percent noted concern for student retention (Figure 7).
Educators were also very or extremely concerned over other issues, including declines in federal support (35 percent), state support (41 percent), and program funding support (34 percent); competition from other schools (37 percent); and the ability to meet enrollment targets (39 percent; Figure 8).
The 2008 HIM Educator Survey captured the characteristics of a cross section of today’s HIM educators. With 402 survey respondents, the data represent a sampling of HIM educators from across the United States. The majority of respondents listed themselves as instructors or lecturers, with more than half of the 402 respondents serving in full-time faculty positions. Moreover, nearly half (48 percent) of the respondents served as HIM program directors in addition to their teaching responsibilities.
With 40 percent of the respondents indicating that they had been teaching for more than 10 years and nearly one in three stating that they would quit teaching within the next five years, a concern for the continuity of our work force is evident. This is especially true given that half of those intending to quit teaching in the next five years were also program directors. Additional consideration must be given to reasons surrounding respondents’ plans to quit teaching, particularly because the data show that salary is positively associated with level of education, years of teaching, academic rank, and full-time employment status. Requirements for promotion within respondents’ academic settings are not known; therefore, additional investigation is needed regarding issues surrounding the low academic rank of the majority of respondents.
More than half of the respondents listed concerns over the lack of preparation of students entering the profession as well as the increasing diversity of the student population. Issues of heavy course loads, too many part-time faculty, and inadequate faculty expertise confound these concerns. While the data show that a majority of respondents utilized learning management systems, more than 75 percent of the respondents expressed interested in some form of professional development related to teaching and evaluating student learning. The large number of educators interested in project management, leadership development, and grant-writing skills speaks to the need to advance professional development training outside the traditional boundaries of “teaching”-related issues. These results indicate a need for more opportunities to strengthen HIM educators’ preparation in teaching techniques and evaluation methods.
The educator survey data show that only 10 percent of the respondents possessed a doctoral degree, with approximately one in four educators having a baccalaureate degree. These figures highlight the need for increasing the academic professional skills of HIM educators, especially in light of Vision 2016 and the call for graduate-level HIM education.7 The need for academically prepared HIM educators requires access to advanced educational opportunities and assistance programs such as the AHIMA Foundation’s Dissertation Research Assistance Award, which supports research undertaken as part of a doctoral-level academic program relevant to health information management.
Traditional, HIM educators have a major focus on teaching. Approximately two in three survey respondents (educators) indicated that they did not have concerns or responsibilities in the areas of research and publication. However, the transformation of e-HIM and increased attention to the full implementation of digital health records will require extended effort in developing visibility and leadership in HIM research.
Several limitations of this study can be noted: 1) self-reported data, 2) a low response rate, and 3) missing items in the survey design. Respondents voluntarily participated in the survey, which provides a cross-sectional sampling of today’s HIM educators and program directors. Responses are representative of opinions and beliefs of the current educators and their own professional development.
Survey results provide a cross-sectional sampling of HIM educator characteristics and opinions regarding their perceived need for and concerns about work force development, student characteristics, and program support. While the results represent current educator views and beliefs regarding professional development, the data suggest concerns over the increasing diversity of the student population and inadequate preparation of the students entering training programs. In addition, the survey data suggest that HIM educators may be feeling the impact of increasing responsibilities and teaching loads concomitant with pressures related to growing student enrollment. Furthermore, challenges related to the provision of training through distance learning require HIM educators to further develop their own expertise in e-learning technologies. Data from this survey provide insights into the concerns and challenges many HIM educators face in today’s training institutions and suggest implications for future directions in work force training and professional development within the field of health information management.
The authors would like to acknowledge the CAHIIM Board of Commissioners and the AHIMA Education Strategy Committee. Thanks are also extended to survey committee members Gerald Glandon, PhD; Carol Wilhelm, MPH, RHIA; Elizabeth Bowman MPA, RHIA; Martha Smith Sharpe, EdD; and Patt Peterson, MA, RHIA. Their contribution of collaborative effort in the survey design and data collection process made this analysis possible.
Shannon H. Houser, PhD, MPH, RHIA, is an assistant professor in the Health Information Management Program at the University of Alabama in Birmingham, AL.
Linde Tesch, RHIA, is the education quality manager at the American Health Information Management Association in Chicago, IL.
Susan Hart-Hester, PhD, is a professor in the Department of Family Medicine at the University of Mississippi Medical Center in Jackson, MS.
Claire Dixon-Lee, PhD, RHIA, FAHIMA, CPH, is the vice president for education and accreditation at the American Health Information Management Association and the executive director of the Commission on Accreditation for Health Informatics and Information Management Education in Chicago, IL.
1. American Health Information Management Association (AHIMA). Building the Work Force for Health Information Transformation. Chicago: AHIMA, 2006. Available at www.ahima.org.
3. AHIMA. Data for Decisions: The HIM Workforce and Workplace—Recommendations to the AHIMA Board of Directors. Chicago: AHIMA, 2004. Available at www.ahima.org.
4. AHIMA. Vision 2016: A Blueprint for Quality Education in Health Information Management. Chicago: AHIMA, 2007. Available at www.ahima.org.
6. AHIMA. 2006 HIM Educator Survey Results. Available at www.ahima.org/academics/.
7. Wilhelm, C., and C. Dixon-Lee. “A New Blueprint for HIM Education.” Journal of AHIMA 78, no. 8 (2007): 24–28.
Article citation: Perspectives in Health Information Management 6;4, Spring 2009