2010 Standards and Interpretations for Accreditation of Master s Degree Health Information Management (MHIM) Programs

Transcription

1 2010 Standards and Interpretations for Accreditation of Master s Degree Health Information Management (MHIM) Programs Instructions Master s Degree Level MHIM Self-Assessment Document The process of accreditation by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM) includes analytical, self-assessment by the institution and a peer review process. It should be viewed as a stimulus for continued self-improvement. Please complete all relevant information requested in Section I and prepare a written response to focused questions in Section II of the Self-Assessment Document in the space provided as Narrative within this template. Supporting documentation must be numbered, labeled and indexed within the electronic media to the Standard number to which it refers, (for example IV.C. CurriculumVita Program Director; IV.C. Program Director Job Description). Please provide an index or table of the appended documents. URLs or web links should be included within the narrative documentation in this template. Ensure that your document files are saved in an electronic format on a CD or flash drive for submission. Hard copies of information may not be submitted. Required templates are provided on the CAHIIM website for the following: Synopsis of Curriculum overview of the courses and credit hours offered in the program Curriculum Map designates where required course topics appear in the program syllabi If you have any questions on this process or content, please contact CAHIIM staff: George Payan at George.payan@cahiim.org or Claire Dixon-Lee at Claire.dixon-lee@cahiim.org for assistance. Please mail your self-assessment media to: Benjamin Reed, Accreditation Coordinator, CAHIIM, 233 N. Michigan Avenue, 21 st Floor, Chicago, IL

2 Section I. Please complete all relevant program information requested below. Institution Name: The College of St. Scholastica Program Name: Master of Science in Health Information Management Mailing address: 1200 Kenwood Avenue City: Duluth State: MN Zip Code: Web URL: Program Director Name: Credentials: Position Title: Mailing Address: City: State: Zip Code: Telephone: Amy Watters MA, RHIA Program Director, Master s in HIM 1200 Kenwood Avenue Duluth MN Fax: awatters@css.edu Department Chair: Credentials: Position Title: Mailing Address: City: State: Zip Code: Telephone: Fax: klatour@css.edu Kathy LaTour MA, RHIA, FAHIMA Chair, Department of Healthcare Informatics and Information Management 1200 Kenwood Avenue Duluth MN 2

3 Institutional Chief Executive Officer Name: Dr. Larry Goodwin Credentials: Ph.D. Position Title: President Mailing Address: 1200 Kenwood Avenue City: Duluth State: MN Zip Code: Telephone: Fax: Institutional Academic Officer: Credentials: Position Title: Mailing Address: City: State: Zip Code: Telephone: Dr. Beth Domholdt Ph.D. Vice President for Academic Affairs 1200 Kenwood Avenue Duluth MN Fax: Dean or Chairperson Name: Credentials: Position Title: Mailing Address: City: State: Zip Code: Telephone: Dr. Rondell Berkeland Ed.D. OTR/L Dean, School of Health Sciences 1200 Kenwood Avenue Duluth MN Fax:

4 Is the entire program offered online? (Yes/No): No. Primarily online with two one-week intensive sessions. If NO, are portions of the program offered online? Please explain: The program is designed as a primarily online program. However, there are two on-site intensive sessions of one week each. Each of the onsite sessions includes two courses taught by adjunct faculty. The first onsite session is taken early in the program and includes the courses HIM 6502 Development of Computerized Health Information Systems taught by Margret Amatayakul, and HIM 6505 Database Methods in Healthcare taught by Dr. Merida Johns. The initial onsite session is offered once each semester (three times per year): January on the campus of Cypress College in Cypress, CA; June on the main Duluth campus; and, September on the CSS St. Paul campus. The final onsite session is a capstone session and is taken by students at the completion of the program. To date it has been offered only in June on the Duluth campus. This session includes MGT 6455 Strategic Management taught by Susan McClernon and HIM 6523 Graduate Seminar taught by Kathy LaTour. Graduate students present posters of their Final Applied Projects (FAPs) as part of the Graduate Seminar. All other required core courses and elective courses in the program are offered online. Most of the courses are 16 week semester courses but some selected courses are offered in 8-week condensed sessions. 4

5 Section II. Please provide a narrative response for each question in the space provided. Opening Statement: Please provide an opening statement to CAHIIM describing the program offered, campus support, community support or any other general information. The graduate program is a Master of Science in Health Information Management (MS in HIM) and it is offered by the Department of Healthcare Informatics and Information Management. The HIIM department also offers a dual degree in HIM/Information Technology Leadership (MS in HIM/ITL). In that program, all of the requirements of the HIM master s must be met, including foundational courses and additional courses are taken from the ITL master s program offered by the Computer Information Systems (CIS) Department. In addition to the master s degree programs, the HIIM department offers a number of graduate level certificates that can be taken either in conjunction with the full master s or as stand-alone certificates. The HIIM Department is housed in the School of Health Sciences and the Department Chair reports to the Dean of SHS. The College and SHS offer full support to the HIIM department in terms of resources and other support. Over the past year, the online HIM master s program and certificate programs as well as the HIM online BS in HIM program have been part of the College s Online Strategic Initiative. This initiative has created an infrastructure for effective and efficient online program development and offering. As part of the Online Initiative, the College created a team of online student admission counselors/recruiters, one of whom is specifically assigned to the HIM online programs. In addition, two full-time online student advisor positions were created; one for the BS in HIM online program and the other for the MS in HIM and ITL graduate programs. Laura Munson, the HIM/ITL student advisor is responsible for planning student academic programs, providing orientation, registering students for courses, monitoring progress of students in the program, and communicating regularly with students throughout their time in the program. The addition of a recruiting/admission staff and a full-time advisor has been very significant in achieving enrollment growth and student support. The HIM online recruiter and advisors have played a significant role at CSS in re-designing processes, procedures, and workflow that support students and faculty. In addition to these positions, the College added another Instructional Designer who is specifically assigned to support faculty in the online programs that are part of the Online Initiative (HIM BS, HIM MS, RN to BS, and transitional DPT). Joel Johnson, the Instructional Designer, has worked throughout the past year with HIM faculty in creating new 5

6 standardized course templates for all online courses; this work will continue through the upcoming year and the online course management system will also transition from the current WebCT platform to Blackboard 9.1. Joel will work with HIM faculty to convert all online HIM courses to the new platform by end of Finally, the Online Initiative included significant additional support for marketing and advertising the online HIM programs and this has also been a key factor in increasing enrollment in the online programs. Reviewers Comments: No comments. CAHIIM Standards and Interpretations I. A. Sponsoring Educational Institution. The sponsoring educational institution must be a post-secondary academic institution accredited by an institutional accrediting agency that is recognized by the U.S. Department of Education, and must be authorized under applicable law or other acceptable authority to award a master s degree. The health information management graduate program is designed in concert with the institutional mission and the goals of the college/university division or department in which it is located. Interpretation: The sponsoring educational institution must be accredited either by a regional accrediting agency or a specialized accrediting agency representing the type of academic institution stated, and the accrediting agency must be recognized by the U.S. Department of Education. 1. Provide the name of the regional or national accreditation organization for the educational institution, the date of last survey, accreditation status and number of years granted. 2. Describe how the health information management graduate program aligns with the sponsoring educational institution s mission and goals, and those of the division or department in which it is located. Provide the Mission statement for the institution. 6

7 The College is accredited by The Higher Learning Commission and is a member of the North Central Association 30 N. LaSalle St., Suite 2400, Chicago, IL Phone: (800) The College is scheduled for accreditation in The College Mission and Vision Statements are as follows: See full statement with commentary at The College of St. Scholastica Mission Statement Shaped by the Catholic Benedictine heritage, The College of St. Scholastica provides intellectual and moral preparation for responsible living and meaningful work. The College of St. Scholastica Vision Statement The College of St. Scholastica will be widely regarded as an academic community grounded in the rich Benedictine heritage and sending forth thoughtful leaders, sharpened and sensitized by the liberal arts, who are committed to serve and to transform the world. The School of Health Sciences Vision Statement The School of Health Sciences will be widely recognized as a premier educator of health science professionals who are known for disciplinary excellence, multidisciplinary respect, cultural competence and thoughtful leadership. Each profession strives to be at the leading edge of its discipline, to work with and respect the disciplinary knowledge of other health professionals, serve diverse human factors in different work arenas, and apply leadership principles in a values-oriented and needs-based way. The School operates in a culture of assessment, dialogue and innovation to meet the challenges and create the necessary changes for developing quality health care professionals. HIIM Mission Statement In consort with the missions of The College of St. Scholastica and of the School of Health Sciences, the mission of the Department of Healthcare Informatics and Information Management is to provide innovative professional education that is designed to prepare graduates of the traditional, progression and master s programs to meet the challenges of entry-level and advanced roles in health information management within the ever-changing healthcare industry. HIIM Vision Statement To be a national leader in innovative and high quality entry-level and advanced education in health information management. The HIIM department mission aligns with the missions of both the College and the School of Health Sciences. The preparation of students to work as HIM professionals at both the undergraduate and graduate level supports the College mission of intellectual and moral preparation for responsible living and meaningful 7

8 work. The HIIM program has long been considered a leader in HIM education and that supports the vision of the SHS to be widely recognized as a premier educator of health science professionals who are known for disciplinary excellence, multidisciplinary respect, cultural competence and thoughtful leadership. The College s Benedictine values of hospitality, community, stewardship, respect and love of learning are incorporated into day-to-day life at the College and students are well-versed in these values; faculty and staff continually try to incorporate the values into both academic and co-curricular activities. The HIIM department faculty and staff actively participate in campus activities, both academic (e.g. assessment, teaching/learning improvement, faculty governance, etc.), co-curricular (e.g. supporting the SHIMA student organization, supporting student participating in AHIMA, etc.) and social/service (e.g. participating in the College s Community Day of service, participating in the College-sponsored Thanksgiving Dinner for the Duluth community, etc.). The HIIM faculty is recognized for their contributions to the College community and are respected for their expertise in the HIM discipline. Reviewers Comments: The HIIM department and graduate program mission and goals are consistent with those of the College of St. Scholastica overall, which is accredited by the Higher Learning Commission. The academic institution will be eligible for re-accreditation in The HIIM department demonstrates high values and professional expertise in the academic program represented. The department and the college are involved in the Duluth, MN community as well as on a much broader scale through the online academic program offered at the graduate level and recent receipt of national grants, one of which is a cooperative effort with the University of Minnesota to develop and support regional extension centers (REC) in Minnesota. Such opportunities have given HIIM faculty national exposure and the ability to bring much state-of-the-art information to the academic program. _X Met Partially Met/Concern Not Met Rationale Statement for Deficiency: Guidelines for Compliance: 8

9 I.B. Responsibilities. The sponsoring educational institution must assure that governance and lines of authority are clearly defined and that the provisions of these Standards are met. Interpretation: The sponsoring educational institution must clarify the lines of authority and administrative governance of the health information management program within the framework of the sponsoring institution. The sponsoring educational institution must assure that the provisions of the Standards are met. 1. Describe the reporting relationship between the program director and the college administration. 2. Describe the communication process among the health information management graduate program faculty and faculty from other disciplines/departments teaching in the program, and how coordination of curricula occurs if applicable. Provide the organizational chart showing relationship between the program being evaluated and the institution. The HIM Graduate Program Director, Amy Watters, reports directly to the Chair of HIIM, Kathy LaTour. The department chair reports to the Dean of the School of Health Sciences, Dr. Ron Berkeland. Dr. Berkeland reports to Dr. Beth Domholdt, Vice President of Academic Affairs; Dr. Domholdt reports directly to the President, Dr. Larry Goodwin. This reporting structure is reflected in the organizational chart that is attached as Appendix A. There is ongoing communication at all levels in the reporting structure and questions and issues are resolved quickly via this communication process. The Dean, VPAA and President are very accessible and communicative and the process of communicating via , phone or personal meetings is smooth and fairly seamless. In addition to the formal reporting structure, there are also key communication groups that facilitate the flow of information between and among graduate faculty and staff. Amy Watters, HIM Program Director, is a member of the Graduate Program Directors group and the Graduate Curriculum Committee. These groups are involved in the operational aspects of graduate program management (e.g. recruiting, marketing, etc.) and curriculum approval. Either Amy or Kathy LaTour, HIIM Department chair, attends meetings of the Graduate Council, the policy-making faculty organization for graduate programs. Because the HIM graduate program is closely allied and utilizes courses from the Computer Information Systems (CIS) Department and the Management (MGT) Department, there is frequent communication between HIIM faculty and faculty from those programs. Communication is generally done on a fairly informal basis such as or phone unless policy changes are involved, in which case those are documented in writing. When curricular changes are necessary, the program director initiating the change contacts other program directors for discussion or information sharing. For example, the MGT department anticipates a 9

10 change of course title for HIM 6455 Strategic Management, effective fall 2010, and they notified and obtained feedback from Amy Watters prior to implementing the change. When HIM faculty update a competency analysis that involves courses taught by other department faculty (e.g. CIS or MGT), the faculty of that department is informed of changes or areas that must be revised in course syllabi. Because of the particularly close relationship between HIM and CIS department at both the undergraduate and graduate levels, joint department faculty meetings are scheduled at least once each semester. In general, communication at The College flows well and quickly. Reviewers Comments: The lines of authority are clearly delineated and support by the college administration for the HIIM graduate program is very apparent and complimentary. This presents as a strong academic program. It should be noted that the HIIM department is headquartered on the Duluth, MN campus with periodic course offerings at a St. Paul location and through a cooperative agreement with Cypress College in California where several foundation courses are offered. The HIIM program is completely online with the exception of a two-week onsite series of hands-on courses which afforded this site visit team to meet graduate students in person as well as all full time and adjunct faculty. _X Met Partially Met/Concern Not Met Rationale Statement for Deficiency: Guidelines for Compliance: II. The Program II. A. Program Mission. The program s mission and goals must form the basis for program planning, implementation and be compatible with the mission of the sponsoring educational institution. Interpretation: Each program will define its own mission and goals which derive from the purposes of its sponsoring educational institution, its communities of interest, faculty expertise and research initiatives. 10

11 1. Describe the mission and goals of the health information management graduate program. Append any descriptive documents or links. The mission and vision of the HIIM Department is overarching and includes the MS in HIM program : HIIM Mission Statement In consort with the missions of The College of St. Scholastica and of the School of Health Sciences, the mission of the Department of Healthcare Informatics and Information Management is to provide innovative professional education that is designed to prepare graduates of the traditional, progression and master s programs to meet the challenges of entry-level and advanced roles in health information management within the ever-changing healthcare industry. HIIM Vision Statement To be a national leader in innovative and high quality entry-level and advanced education in health information management. The Program Outcomes are specific to the MS in HIM. They can be found at Management/Online-Graduate.html Outcomes Upon completion of the Health Information Management program at The College of St. Scholastica, the graduate will be able to: Integrate advanced knowledge and skills in health care data and information management. Evaluate, select and implement information technologies to manage health care data resources. Leverage health care information to drive integrated clinical and administrative decision-making, strategic planning and outcomes management. Take the leadership role in establishing an organizational culture that embraces the ethical use of confidential information and information technologies. Apply effective communication skills and strategies in interactions with multidisciplinary and multi-facility professionals. Assume increasingly challenging administrative and leadership positions in complex provider organizations and related entities in the health care arena. Thrive professionally in a practice environment that is undergoing fundamental change. Reviewers Comment: The mission of the HIIM graduate program is clearly defined and relates to the overall College of St. Scholastica mission and goals. It is outcomes focused and pragmatic in pursuit of the outcomes to be achieved. CSS moved to a dean structure with mission and vision 11

12 statements per college and eliminated a graduate college in favor of each college managing both undergraduate and graduate programs. CSS plans to expand graduate offerings and extended programs. _X Met Partially Met/Concern Not Met Rationale Statement for Deficiency: Guidelines for Compliance: II. B. Program Goals. The program s goals must be stated in terms of educational outcomes to be achieved, are measurable, and reflect the principles and ethics of the health information management field, and fit within the mission of the sponsoring educational institution. Interpretation: The program s mission and goals must be outcome-focused and relevant to the mission of the sponsoring educational institution. 1. Describe the program s plan for ongoing self-assessment and improvements, and how such mechanisms as regular faculty/staff meetings, advisory committee meetings, graduate follow-up, faculty evaluations, and other forms of self-assessment are incorporated into measureable outcomes. 2. State the outcome measurements expected by the division/department to assess the health information management graduate program. Append the program assessment plan. 12

13 Master s in HIM Program Goals ( the goals flow from the outcomes that are outlined in IIA above: Prepare MS in Health Information Management graduates for advanced practice and leadership roles in the health care industry. For students who desire the RHIA credential, prepare them to successfully pass the national credentialing exam to become an RHIA. Provide a curriculum that reflects current and emerging practice, focuses on advanced knowledge and skills in health care data and information management, and emphasizes ethical practices. Provide ongoing and adequate support for professional development for full-time faculty in order to maintain both expert teaching and an updated and relevant curriculum. Attract and retain adjunct faculty who are recognized subject matter experts in the course content that they teach. The assessment plan for the program is included in Appendix B. Assessment takes place on an ongoing basis via regular (once per semester) graduate faculty meetings as well as, at minimum, an annual meeting with the program advisory committee. Input regarding curriculum and program design is sought on a routine basis from adjunct faculty, employers, subject matter experts, and other internal and external sources. A formalized review process occurs annually as an exit interview with students as part of HIM 6523 Graduate Seminar. Since students in the program are generally working in HIM, health informatics, or related positions, they are well-qualified to provide input into the quality and relevancy of the curriculum, program design, rigor, and other program aspects. Course evaluations are completed at the end of each course and these evaluations are also utilized to inform the faculty about the quality, effectiveness, and rigor of each course. Based on consistent feedback from students, changes are implemented in individual courses and/or in the curriculum. Reviewers Comments: The program goals have been provided and address areas of student/graduate outcomes, curriculum improvements, faculty support and community service. The evaluation plan expresses goals with realistic, measureable outcomes. _X Met Partially Met/Concern Not Met 13

14 Rationale Statement for Deficiency: Guidelines for Compliance: II.C. Program Assessment Plan. A program assessment plan exists for systematic evaluation to the extent to which the mission, goals and objectives of the health information management graduate program must be met. Interpretation: A process exists for systematic evaluation of the extent to which the mission, goals and objectives are being met, and describe how this process of assessment and continuous improvement complies with the sponsoring educational institution s overall evaluation plan. 1. Describe how the results of the program s self-assessment are shared with the division and sponsoring educational institution. 2. Comment on the effectiveness of the mechanisms used for self-assessment by the program and note any plans to alter or improve the present process. The results of the program self assessment are shared with the Dean of the School of Health Sciences and the Vice President for Academic Affairs via the department s annual report to the College. In that report, an overview of the assessment process and results are provided with detailed analysis of any deviation from expected norms. The VPAA summarizes the report of the HIM graduate program with those of other graduate programs and a final report is shared with the President and Board of Trustees. The assessment plan and the data gathering and analysis process work effectively and provide the program with the data necessary to assure the quality and relevancy of the program. The faculty review the self-assessment plan on an annual basis to add criteria and/or methods of evaluation to provide the information needed to maintain and/or enhance the program. 14

15 Reviewers Comments: The program satisfies the requirement for self-assessment and data gathering to be used in overall program evaluation. This information is transmitted via the department s annual report to the College administration and any recommendations are shared with the Board of Trustees and President. There is regular interaction between the department chair, dean and college administration. _X Met Partially Met/Concern Not Met Rationale Statement for Deficiency: Guidelines for Compliance: II. D. Annual Assessment. The program must at least annually assess and document its effectiveness in achieving its stated goals and outcomes. Interpretation: Each program must annually assess its program goals and outcomes as required by the designated CAHIIM reporting system. (Not applicable for initial accreditation) II.E. Document Program Improvements. The program must use the results of assessment to document program improvements. Interpretation: Data analysis and action plans must be documented. A program must document how it meets its target goals and objectives and how it plans to address weaknesses observed. 15

16 (Not applicable for initial accreditation) III. Program Curriculum III.A. Core Concentration or Specialized Track. The health information management graduate program must be established as a core concentration or specialized track within a graduate level program of study or culminates with a master s degree or a doctoral degree. Interpretation: The program must describe the degree(s) awarded on completion of the program of study. If a certificate is awarded explain how it is an adjunct to the graduate degree. 1. What degree(s) are awarded on completion of the program? 2. What additional courses are required of certificate students to complete a master s degree (if applicable)? Append documentation that explains choices or options given to prospective students regarding a degree or certificate pathway and the course sequencing required for each (if applicable). Append the synopsis of curriculum provided. 1. The degree awarded upon completion of the program is a Master of Science in Health Information Management. The degree plan is included in Appendix C. Students in the master s program must take 31 credits of the core curriculum courses as well as 9 elective course credits to equal a total of 40 credits. In addition. Students who do not have an undergraduate degree in Health Information Management must meet foundational course requirements. Completion of the foundational course (or transfer of those courses to St. Scholastica) as well as the requirements of the master s program establish the eligibility of the student to sit for the national exam to become a Registered Health Information Administrator (RHIA). At present, all students in the MS in HIM program must meet all 16

17 foundational requirements. 2. There are 4 certificate options that are offered under the umbrella of the MS in HIM program and provide in depth education in a specific area of HIM and/or health informatics. Each of them may be taken as a standalone certificate by a student who wants to gain competence in a particular area of practice; each may also be used to test the waters of graduate education by a student who is unsure of whether or not they are ready to proceed with a master s degree. A student who enrolls in a certificate may later enroll in the full master s degree program. The courses taken in each certificate are transferrable into the master s program either to meet core degree requirements or as elective/concentration credits. At the time a student is accepted into a certificate program, they are provided with information about the pathway to the full master s program. Both certificate and master s students receive ongoing advisement from the HIM Graduate Online Advisor, Laura Munson, and she tracks their progress throughout their time as a student at St. Scholastica. A student who wishes to move between the master s and one of the certificates is provided with a revised program plan by Laura. NOTE: None of the certificate programs offered at St. Scholastica constitutes a post-baccalaureate certificate in HIM and, therefore, the certificates do not qualify a student for eligibility for the RHIA exam. A synopsis of the curriculum as well as the College s HIM Graduate Plan Program Curriculum are provided in Appendix C. Reviewers Comments: The graduate program in health informatics and information management concludes with the award of a master s degree, but also offers several options for certificates in specialty concentrations such as EHR Strategies, Information Technology Leadership, Revenue Management and Compliance, all of which contain coursework applicable toward the master of science degree in HIIM should students wish to continue forward. All graduate students take a full complement of foundation courses which cover the core competencies required for the AHIMA RHIA exam (note that CSS has a CAHIIM-accredited baccalaureate program) qualifying all graduates of the MHIIM degree to sit for the RHIA exam. Transfer credits are handled on an individual basis for graduate students who already have the RHIA credential on application to the graduate program. Menus of suggested electives are available to students. _X Met Partially Met/Concern Not Met 17

18 Rationale Statement for Deficiency: Guidelines for Compliance: III. B. Program-Specific Curriculum. The program s curriculum must reflect the program s mission, goals and objectives. The curriculum must build on the required minimum Health Information Management (core) competencies as specified in the AHIMA Competencies for HIM Education at the Master s Degree Level. The curriculum must include evaluation methods to assess student learning outcomes. Interpretation: The curriculum must focus on the knowledge, skills and values as outlined by the program. CAHIIM will validate alignment of competencies and outcome assessments with the program s mission, goals and objectives. 1. Comment on the design and focus of the health information management graduate curriculum. 2. List required prerequisites for the program. 3. Describe the specific student outcome competencies expected of program graduates that align with the program s mission, goals, focus and objectives. 4. What types of evaluation methods are used to assess student learning outcomes in the program? 5. Describe what is expected of the student in the final phase of the program in terms of a practicum, thesis, or research and how this is determined for the student. Complete and append the curriculum map for the health information management graduate program. Append a syllabus for each required course in the health information management graduate program. Append syllabi for suggested elective courses. 1. The MS in HIM program is designed in a blended format. It is primarily online, with two, 1 week sessions required on campus. The curriculum 18

19 is focused on advanced HIM skills and competencies. 2. All students are required to meet foundational course requirements. If a student has not taken the foundational courses through previous course work, they may complete them at St. Scholastica or at another accredited college upon review and approval from the HIM Advisor or Program Director. The foundational courses are: Statistics, Accounting or Finance, Management or Business, Fundamentals of HIM, Medicolegal Issues, U.S. Healthcare System, Medical Terminology, Pharmacology, Clinical Data Management, Anatomy & Physiology. 3. Upon completion of the Health Information Management program at The College of St. Scholastica, the graduate will be able to: -Integrate advanced knowledge and skills in health care data and information management. -Evaluate, select and implement information technologies to manage health care data resources. -Leverage health care information to drive integrated clinical and administrative decision-making, strategic planning and outcomes management. -Take the leadership role in establishing an organizational culture that embraces the ethical use of confidential information and information technologies. -Apply effective communication skills and strategies in interactions with multidisciplinary and multi-facility professionals. -Assume increasingly challenging administrative and leadership positions in complex provider organizations and related entities in the health care arena. -Thrive professionally in a practice environment that is undergoing fundamental change. 4. A variety of methods are used to assess student learning outcomes. Course instructors utilize course participation, writing, projects, team work, self-assessment, debates, presentations, demonstration, and testing to assess their students. 5. The final phase of the program requires completion of a Final Applied Project (FAP) which is similar to a thesis in that it is research-based, but is intended to consist of an end product that can be applied in the professional environment. Generally, students begin working on their FAP about halfway through the program, and it takes a year to complete. There are 3 courses that bring students through the FAP process: HIM 6520 Applied Project Research and Writing which culminates in a FAP Proposal. The proposal is reviewed by the FAP Committee, and upon approval, the student is assigned a FAP Advisor, and then goes on to take HIM 6522 Final Applied Project, during which the student proceeds with the FAP independently with guidance and support from the FAP Advisor. The final course in the sequence is HIM 6523 Graduate Seminar. This course requires the students to come to campus and present their FAP via poster board presentation to faculty, students and staff at the College, as well as professionals in the community. Appendix D includes the CAHIIM-required Curriculum Map and syllabi for each required course in the Core Curriculum. Since there are twenty-five possible elective courses, individual syllabi are not included but are available upon request. 19

20 Reviewers Comments: Overall this is a very strong curriculum supported by highly experienced faculty who are nationally recognized for their expertise in the information management field. There are some documentation issues within some of the syllabi that do not clearly identify the content and/or approach to student learning that addresses or reinforces several of the required competencies. The syllabus for HIM 6509 is vague and needs revision. Some improvements in documentation of curriculum content are needed across most syllabi. Met _X Partially Met/Concern Not Met Rationale Statement for Deficiency: The syllabus for HIM 6509 is vague and needs revision. The following curriculum competencies require documentation within the syllabi indicated on the Curriculum Map: I.A.2; I.A.6; I.A.11; I.B.6; II.A.2; II.A.5; II.A.7; II.C.12; III.B.3; III.B.4; III.C.1; III.C.2; III.C.3 Guidelines for Compliance: Provide revised syllabi clearly indicating where the content deficiencies have been addressed in the curriculum. III.D. Staying Current. The program curriculum must stay current with evolving issues and practices in health information management. To ensure the relevance of curricula and individual learning experiences to current and future practice needs and opportunities, programs should regularly involve health information management practitioners and other individuals involved in health informatics or information management through such arrangements as adjunct, part-time or shared faculty appointments with other disciplines. Programs must encourage faculty to maintain ongoing practice links with health information management employers. Interpretation: The program must demonstrate how the curriculum is routinely updated and relevant. The faculty complement may need to draw on various other disciplines, regardless of the size of the student body. 1. Describe the processes used to maintain curriculum relevancy and how often this occurs. 20

21 2. How are changes or improvements to the health information management graduate program implemented and what approvals are required and what process is followed? Faculty in the MS in HIM program review the curriculum on an ongoing basis and seek both formal and informal input from adjunct professors who are industry experts in their subject matter. For example, the course Classifications and Vocabularies is taught by Kathy Giannangelo, a recognized expert in this area and the author of the book Healthcare Code Sets, Clinical Terminologies, and Classification Systems; the course Computerized Health Information Systems is taught by Margret Amatayakul, a nationally recognized expert in electronic health record implementation and a prolific author of both books and articles and Database Methods in Healthcare is taught by Merida Johns, Ph.D., a prolific author and expert in database systems and data administration. Each faculty member, whether a full time member of the CSS faculty or an adjunct, reviews and updates their courses annually. They seek input from industry experts, employers, consultants, etc. so that course content reflects state-of-the-art practice. The Advisory Committee consists of adjunct faculty; due to their geographical dispersion, virtual meetings and consultations are the general mode of communication. However, the core members of the committee, Margret Amatayakul and Merida Johns meet face-to-face with the program director and program chair at least twice each year to formally review curricula, program needs, etc. As needed, the department involves full time graduate faculty, advisory committee members and industry experts in focused strategic planning. A strategic planning session is planned for late January, 2011 and will include representatives of health informatics as well as HIM. Full time faculty in the program are well supported for continuing education in their areas of expertise. The department has an adequate budget for professional development and the college has a faculty development program from which funds may be requested. HIM faculty have used both methods to support continuing professional development. Content from CE sessions is incorporated into both graduate and undergraduate courses to keep them as relevant and up-to-date as possible. The process for updating courses can be either informal or formal: content that reflects current trends and current information may be incorporated into courses in an ongoing manner and does not require formal approval although there is generally discussion between the faculty teaching the course and the graduate program director to assure that the new content fits into the overall curriculum design and does not duplicate other courses. When major course revision is needed such as adding, deleting or making a major focus change in a course, a formal process is followed. The new or revised course or program design is presented to the Graduate Curriculum Committee (GCC); GCC must approve the changes in order for the new or revised course to be offered. While the GCC members are not expert in specific content, they have 21

22 expectations regarding course structure and rigor and these expectations are consistently applied. A new program such as a new certificate or new master s track would be first reviewed by GCC and then would need approval from the Graduate Council and College administration. The same process would be true for deletion of a program or a program component. Reviewers Comments: The graduate program in HIIM has attracted some of the industry s foremost educators and practitioners in health information management and electronic health records to serve as faculty in addition to the complement of full-time faculty at the College. The collaboration of these faculty members and their wide breadth of experiences and knowledge bring enlightenment to the classroom and positive feedback from the students enrolled in the program. Annual review of each course within the curriculum involves ongoing feedback from faculty and students, external advisory board reviews and employer feedback. A formal process for major curriculum revisions is in place. _X Met Partially Met/Concern Not Met Rationale Statement for Deficiency: Guidelines for Compliance: IV. Faculty IV.A. Faculty. The program must clearly define the roles and responsibilities of the faculty necessary to fully support and sustain the program. Interpretation: The number of full-time faculty appointed at the rank of assistant, associate, or full professor must be sufficient to ensure that teaching, research and service goals of the program are met. Part-time and adjunct faculty must be recognized as an important faculty component. The size of the faculty complement in relationship to the size of the student body must support and encourage effective and regular student/faculty interactions. An appropriate student/faculty ratio depends on a number of factors, including the nature of the institution, the range of teaching responsibilities, and teaching intensity (such as didactic material, projects, practice experiences, research). 22

23 1. Comment on the number of faculty (including the program director if appropriate) and whether this is sufficient to support the numbers of students enrolled. 2. Describe the range of responsibilities and expectations for full time, part time and adjunct faculty. 3. Program Metrics: Current Academic Year Enrollments Graduates Master s Degree/Certificate Full Time Part Time Full Time Part Time Current Year Total Graduates (anticipated) 27 Previous Academic Year Enrollments Graduates Master s Degree/Certificate Full Time Part Time Full Time Part Time Previous Year Total Graduates The program utilizes 5 full time faculty (all of whom teach courses for both our undergraduate, and graduate programs) and 11 adjunct faculty, which has sufficiently supported our students and our program. 2. Faculty are expected to be knowledgeable of the latest trends and developments in the HIM and health informatics profession, to teach their course utilizing effective techniques while presenting material in a way that adheres to the standard template adopted by the College, and to follow the College and HIM Department policies and procedures. Faculty are also expected to support students in their learning process, and 23

24 stay in close contact with the Program Director and Academic Advisor for assistance when needed. Course evaluations are shared with each faculty member after each course offering. Faculty are expected to make improvements on their course based on that feedback. In addition, faculty are expected to exemplify the Benedictine values which is the foundation of the College. Reviewers Comments: The number of faculty (5 full time and 11 adjunct faculty) support the enrollment of students. In addition to faculty, students are provided advisors on campus, 2 of whom are dedicated to the HIIM department and assist students with general issues, registration for courses and problem-resolution. Students indicate that all faculty are responsive to student s and questions, available to them and a distinctly positive part of the College of St. Scholastica academic experience. The workload of each faculty member is unclear as to regular course assignments and overloads where specific faculty teach both the undergraduate and graduate level courses. Met X_Partially Met/Concern Not Met Rationale Statement for Deficiency: Faculty workloads were not provided for the full-time faculty; since faculty teach in both the undergraduate and graduate programs, the full workload of each faculty member is important to this review. It is unclear if their workload of courses equates to college policy. The synopsis of curriculum only demonstrates the faculty workload for the core courses. Distribution of faculty for electives and undergraduate courses (since 25 courses are offered) needs to be considered as well. Guidelines for Compliance: Provide the faculty workloads for the current academic year for each faculty member. IV. B. Professional Development. The program must provide opportunities for faculty to stay current with evolving issues and practices in health informatics. Interpretation: Examples of acceptable mechanisms may include but are not limited to continuing education, memberships and contributions to professional organizations, links with industry, and partners. 24

25 1. Comment on the opportunities and funding provided by the sponsoring educational institution for faculty to stay current on the topics for which they are responsible. 2. What opportunities and services are extended to part time and adjunct faculty for continuing education or teaching support? Append any policies that address this level of support to faculty. The MS in HIM budget is administered separately from the budget for the HIM undergraduate programs. The graduate budget has funding for faculty development via workshops, conferences, conventions. In addition, the College s faculty development program funds both small grants for professional development workshops and conferences and large grants for research by faculty. HIM faculty annually attend the AHIMA convention, HIMSS convention, Assembly on Education (AOE), baccalaureate/master s faculty consortium meeting, AMIA meetings, MHIMA state convention. In addition, faculty seek out and attend specialized workshops or conferences in their area of expertise. For example, Pam Oachs attended an in-depth Workflow Analysis and Design workshop sponsored by AHIMA and developed a course in that topic area. HIM faculty also stay current through reading of relevant literature on a regular basis. Each full-time graduate faculty member has written a chapter in the text Health Information Management Concepts, Principles and Practice which is co-edited by Kathy LaTour and Shirley Eichenwald-Maki, CSS faculty members in HIM. Faculty members are also involved in several current grant projects that keep them in the forefront of changing areas of practice. The College (via its Center for Healthcare Innovation) is a partner in the ONC-funded MN and ND regional extension center (called REACH) and each HIM faculty member is identified in the grant as a subject matter expert (SME); three HIM faculty members are involved in the planning and development of educational materials for both REACH staff and provider client sites. The department is also a partner in another ONC-funded program, partnering with the University of MN in the University Partnership in Health Informatics (UP-HI) grant that provides university-level educational programs to educate healthcare professionals with skills in health informatics, health information management and HIT. Finally, the department has a 3M Vision grant to develop personal health record projects specifically aimed at vulnerable populations. Each of these grants provides real world experience for faculty and necessitates that they update and maintain skills and competence in emerging areas of HIM practice. The department does not employ any part-time faculty; if part-time faculty were employed, there would be support for continuing education/professional development for them through the same channels as full-time faculty. The department does utilize several adjunct 25

26 professors in the program. Adjunct faculty are generally not funded by the College or department for continuing education/professional development. They are responsible for their own continuing education and the department seeks out and contracts with only those faculty who are acknowledged experts in their field of practice. Appendix E includes the College Faculty Development policy. Reviewers Comments: All full time faculty in the HIIM graduate program are supported in continuing education activities through funding to attend such events as the AHIMA national convention, AOE, and other venues for opportunities to infuse new content in the curriculum offered. The faculty have been the beneficiary of several funded grants including a recent grant from 3M Vision to develop a personal health record project. Opportunities aimed at new technologies and design experiences have helped the HIIM program and department to continue to expand its offerings and faculty expertise. _X Met Partially Met/Concern Not Met Rationale Statement for Deficiency: Guidelines for Compliance: IV.C. Program Leadership. The program shall clearly define the roles and responsibilities of the program leadership necessary to fully support and sustain the program. The program director or equivalent must have at minimum of a master s degree. Interpretation. The qualifications and responsibilities of the individual(s) responsible for leadership of the health information management program must be documented. 1. State the faculty rank (if applicable) and official title of the Program Director, and indicate either full time or part time employment status. 2. Is this a tenure track position or administrative? Append a current curriculum vita or resume for the Program Director. Append a job description or document describing the roles and responsibilities of the program leadership. 26