by Sallyanne Wissmann, CHIM
Many challenges are facing the health information management (HIM) profession across the world. This article describes the current situation in Australia in relation to the role of the health information manager and the HIM profession, competencies that have been developed for health information managers, the role of the Health Information Management Association of Australia (HIMAA), challenges facing the HIM profession in Australia as evidenced by recent research activities, and HIMAA’s response to these challenges in the form of the 2014–2016 HIMAA strategic plan.
Keywords: competencies, strategic plan, health information management (HIM), health information manager, Health Information Management Association of Australia (HIMAA)
In Australia, the health information management (HIM) profession has been recognized for more than 65 years. While medical record management and now more broadly HIM have arguably been in existence since the evolution of medicine, in recent years the HIM profession has become more clearly defined and more widely recognized around the world.1
HIM at its core represents all the activities associated with the collection and management of health information, in all settings across the healthcare spectrum, in relation to all recipients of healthcare and for multiple purposes to support the healthcare ecosystem.
Quality, effective HIM is critical to the provision of healthcare. Decisions about diagnoses, treatment, medications, preventative health, and all aspects of healthcare depend on accurate information being available at the right time to the right healthcare provider about the right patient or consumer of healthcare.
Decisions about population health, healthcare spending, and service planning depend on population health indicators and healthcare outcome data being available to governments and organizations.
Healthcare is data and information rich. The amount of healthcare data created and needing to be managed and used on a daily basis is enormous. There is no time like the present for the HIM profession to be recognized as the experts in HIM and as an important part of the healthcare system.
The occupation of health information manager is recognized in a number of countries, including Australia. While no internationally accepted definition of a health information manager currently exists, the following definition has been endorsed by the Health Information Management Association of Australia (HIMAA):
The health information manager . . . plans, develops, implements, evaluates and manages health information systems, including clinical and administrative data, and healthcare records in health care facilities and other types of organisations. The combines knowledge of healthcare by analysing processes, healthcare records, information management, health administration, quality improvement processes, clinical classification and human resource management to provide services that meet the medical, legal, ethical, administrative and reporting requirements of the healthcare delivery system.2
In Australia, health information managers complete tertiary-level qualifications in HIM, which is a requirement to be eligible for full membership in HIMAA. While clinical coding is part of the HIM degree, clinical coding qualifications can also be obtained at the vocational education and training (VET) level. As a result, clinical coders may be either HIM degree qualified or VET qualified. Although HIMAA’s position is that people working in HIM roles should have completed suitable qualifications, education, or training in HIM, this background is not mandatory as there is no requirement in Australia for health information managers or clinical coders to be registered or credentialed. HIMAA offers an optional professional credentialing scheme that is based on continuing professional development and quality improvement activity.
The HIM profession is the collective term for people who work in HIM.
HIMAA is the professional association for HIM professionals in Australia. HIMAA members work in a variety of roles within and supporting the healthcare system, with the primary occupations being qualified health information managers and clinical coders. The majority of health information managers work in the hospital sector.
HIMAA recognizes that the HIM profession is broader than HIMAA itself. However, HIMAA considers itself to be the key influencer and definer of the profession in Australia.3
In 1968, the International Federation of Health Information Management Associations (IFHIMA), formerly known as the International Federation of Health Records Organizations (IFHRO), was established to support national HIM associations and health record professionals to implement and improve health records and the systems that support them.4 Today, IFHIMA has 18 member nations; that is, its members are the 18 country HIM associations that exist to support the global HIM profession in Australia, Barbados, Canada, China, Germany, Indonesia, Israel, Italy, Jamaica, Japan, Kenya, Korea, the Netherlands, Nigeria, Spain, the Philippines, the United Kingdom, and the United States.5
For any profession to be recognized and for practitioners within the profession to be able to identify with the profession, a clear statement of knowledge and skills is required. One way to define the knowledge and skills is through competencies. Ideally these competencies should be endorsed by the profession or professional association, they should inform curriculum requirements for qualifications in the profession, and practitioners should be assessed against them.
In 2014, the American Health Information Management Association (AHIMA) and the AHIMA Foundation, together with IFHIMA, convened the Global Health Workforce Council (GHWC), which consisted of 13 appointed members from 12 different countries with representatives from each of the World Health Organization regions, to produce a global workforce curricula standard. The AHIMA CEO stated: “The curricula standard will guide educational programming and workforce training, and contribute to an increase in the quality and number of highly trained professionals around the world with expertise in health information management (HIM), health informatics (HI) and health information technology (HIT).”6
This development is exciting from an international HIM perspective because it marks the first time that internationally endorsed competencies in HIM will be produced.
In Australia, HIMAA has been defining HIM competencies since 1991. In January 2013, a revised set of Health Information Manager Entry-Level Competency Standards was released, and currently a new set of Intermediate and Advanced Competency Standards is being finalized for endorsement by mid 2015. These competencies were developed through industry consultation including the education and employer sectors. These competencies reflect the current knowledge and skill requirements for health information managers in Australia.
The Australian HIM competencies reflect the diversity and depth of knowledge and skills that a health information manager needs to master across the continuum from entering the profession to being an advanced or expert practitioner. The competencies include 125 competency tasks, each defined in relation to entry-level, intermediate, and advanced requirements across nine domains and associated subdomains, as reflected in Table 1.
HIMAA is a vibrant professional association for HIM professionals with approximately 800 members.
Recently HIMAA produced a new strategic plan for 2014–2016. At this time, the vision and mission of HIMAA were reaffirmed. The vision of HIMAA is “HIMAA positions the profession to foster leadership in health information best practice to support quality healthcare,” and HIMAA’s mission is as follows:
HIMAA promotes and supports our members as the universally recognised specialists in information management at all levels of the healthcare system. We do this through positioning and advocacy, education and training, quality standards, publications and resources, and HIMAA membership networking activities at local and national levels, including an annual national conference of international standing.7
HIMAA is the accrediting agency for tertiary-level qualifications in HIM in Australia and at the Higher Colleges of Technology in the United Arab Emirates. The accreditation process utilizes the HIM competencies endorsed by HIMAA and requires universities to demonstrate how each of the competency outcomes is achieved by students entering the profession.
HIMAA is also a registered training organization within Australia and offers nationally recognized distance education in medical terminology and clinical coding in ICD-10-AM (the Australian version of the International Classification of Diseases, Tenth Revision). These courses are popular both in Australia and internationally, with students enrolling from Ireland, Romania, Saudi Arabia, Qatar, India, South Africa, Hong Kong, Singapore, Japan, Tonga, Fiji, and New Zealand.
The HIM profession is facing many challenges that need to be considered and addressed in order for the profession to remain relevant, be responsive to change, and continue to add value to the healthcare system.
In preparation for defining the 2014–2016 strategic plan, HIMAA undertook an extensive set of activities to understand the challenges and issues facing the profession that need to be addressed in the short to medium term.
Other countries’ HIM associations have been undertaking similar analyses in recent years. Contained within AHIMA’s 2014–2017 strategic plan are the results of AHIMA’s environmental scan of HIM issues and trends that are expected to affect the future of healthcare and have influenced AHIMA’s strategic plan. These issues and trends are documented within the categories of business/economic climate trends, demographic trends, legislative/regulation trends, political/social value trends, technology/science trends, and other key trends.8
In early 2013, the Canadian Health Information Management Association (CHIMA) released the document Transforming Health Information Management: The Evolution of the HIM Professional. This document includes an analysis of the challenges facing the HIM profession in Canada and CHIMA’s response.9
While the challenges facing the HIM profession in different countries are likely to be similar, there are also likely differences due to the state of the healthcare system in the country, specific health information workforce challenges, and the positioning of the profession within the country.
In May and June 2013, the 2013 HIMAA Strategic Planning Survey was distributed to HIMAA members, and 30 percent of the HIMAA membership responded. Members were asked to provide qualitative feedback on, among other things, the issues facing the HIM profession currently and in the next 5 to 10 years, and the top three priorities HIMAA should be addressing strategically and/or operationally.
The findings from the survey were supplemented by a series of focus groups in August and September 2013 with members and nonmembers to assess HIMAA’s strategic performance to date and identify the strategic direction HIMAA should be taking in the next three to five years.
In October 2013 at the HIMAA National Conference, a strategic plenary session was held with conference attendees to present the findings of the membership survey and focus groups. Attendees were asked to prioritize a range of themes and subthemes that had emerged from the research.
The results of the strategic planning survey, focus groups, and prioritization exercise clearly articulate the challenges to the HIM profession in Australia.
A key challenge is that the environment within which HIM professionals work is constantly changing and becoming more demanding. Within Australia these changes include a number of health reform initiatives, including recent changes to the national healthcare funding model, and an increase in the adoption of e-health and electronic health record (EHR) systems, including the recent rollout of a national EHR (summary) system.
At an organizational level, health information managers are experiencing an increase in the volume of information to be managed; an increasing uptake of clinical information systems, which is adding to the complexity of managing and providing an integrated medico-legal health record; and increasing competition from the information technology workforce to manage the systems and data within them.
Many healthcare organizations are embarking on implementing EHRs. While there are currently no national incentives or drivers for doing so, the primary driver is enhancing patient safety and enabling greater efficiency and effectiveness of healthcare. The implementation of EHRs is new territory for many health information managers.
There continues to be a focus on producing accurate and timely clinical coded data to represent inpatient care with greater attention on improving clinical documentation in order to optimize revenue as seen through coding and DRG (diagnosis-related group) outputs. The funding models now in place have resulted in increased organizational attention and pressure on healthcare activity data for funding purposes, that is, capturing and reporting all patient activity accurately and promptly.
Many health information managers are responding to organizational pressures requiring greater strategic input, broadening responsibilities, and demanding work schedules.
The fact that the traditional HIM role is being challenged by the changing healthcare environment, and the need to preserve the fundamentals of HIM as the base from which diversification into e-health, information and communication technology (ICT), and other domains takes place, were often raised in HIMAA’s 2013 member research in the context of the need to strengthen the standing and value of the profession. The standing, visibility, and positioning of the HIM profession was a key theme that emerged across the survey and focus groups and was identified as the highest priority for action by HIMAA.
Historically, the HIM profession has, in general, had a low profile within the Australian healthcare system. While the value and recognition of health information managers occurs at an organizational level, where the role exists, the profession has not yet had a strong influencing position at a national level. The need for this to occur is increasing.
Issues and concerns in relation to the health information workforce also emerged as a key theme. An increasing shortage of HIM professionals exists in all sectors in an environment of increasing demand for HIM expertise given the strong emergence of e-health. The lack of available HIM professionals has led to a concern about role substitution, that is, people not trained in core HIM skills taking HIM roles, such as clinicians and health informaticians.
The need for an increase in HIM graduates has been identified for many years. Visibility of the HIM career remains a problem even though plenty of employment opportunities exist.
In October 2013, Health Workforce Australia released its Health Information Workforce Report, the result of an Australian government initiative to define the health information workforce including its composition, and provide an analysis of the workforce.10 HIMAA was a key stakeholder in the study underpinning the report.
The report found no existing definition of the health information workforce and concluded that establishing such a definition needs further consensus and work. Data about the health information workforce is lacking. Stakeholder groups (such as HIMAA) need to strengthen strategic relationships with agencies that significantly influence workforce demand. While the report identified existing workforce shortages, these shortages were difficult to quantify because of the lack of definition and data. However, it was clear that enrollment in appropriate undergraduate courses is declining.
The report made a number of recommendations; however, no formal progression of the recommendations has occurred from government.
HIMAA members are aware of the need to keep up to date with ICT and e-health developments and embrace the diversification of the HIM profession. They have asked HIMAA to provide more resources and continuing professional development to embrace the changing HIM landscape.
The management of changes in the workforce, to practice and functional structure, in response to emerging technologies and economic and health policy drivers, along with the increasing workforce shortage, is a key strategic focus desired of HIMAA.
As a result of the strategic planning survey, focus groups, and prioritization exercise, HIMAA has received a clear direction from HIM professionals in Australia: the workforce is the overall area of concern the membership wants HIMAA to address through the following:
HIMAA has taken into account the challenges faced by the HIM profession in the development of its current strategic plan, which was published in May 2014. Three key strategic priority areas are identified: positioning and advocacy, education, and membership. Table 2 is an excerpt from HIMAA’s 2014–2016 strategic plan that describes these strategic priorities.
HIMAA is in a position to have a mature strategic focus, to deliver increasing capability as a professional association, and to positively influence and position the HIM profession to be recognized and valued as an important contributor to the healthcare ecosystem.
While the current environment of change and challenges is having both positive and negative impacts on the HIM profession in Australia, we are confident that the profession will rise to the challenge, adapt to change, be recognized and valued throughout the healthcare system, and continue to be a great profession to be a part of.
Sallyanne Wissmann, CHIM, is the president of the Health Information Management Association of Australia in Queensland, Australia.
Sallyanne Wissmann, CHIM. “Addressing Challenges to the Health Information Management Profession: An Australian Perspective.” Perspectives in Health Information Management (International 2015): 1-10.