Portland Community College Health Information Management Program Review

Transcription

1 2014 Portland Community College Health Information Management Program Review Submitted by: HIM SAC

2 Table of Contents Introduction 1 1. Program Overview... 2 A. Goals/Objectives... 2 B. Summary of changes... 4 C. Changes made as result of last review 5 2. Outcomes and Assessments.. 6 A. Course-Level Outcomes. 6 B. College Core Outcomes 7 i. How addressed in courses/program 7 ii. Update of Core Outcomes Mapping Matrix 10 C. Degree Outcomes 12 i. Description of design/processes. 12 ii. Assessment processes.. 13 iii. Results.. 13 iv. Examples of changes Other Curricular Issues. 15 A. Distance Learning. 15 B. Educational initiatives.. 17 C. Dual Credit.. 17 D. Additional dual credit agreements 17 E. Other curricular changes Needs of students/community 18 A. Student demographics and instruction B. Changes due to demographics. 18 C. Demand and enrollment patterns 19 D. Access and diversity.. 19 E. Academic accommodation 20 F. Student feedback Faculty 21 A. Information 21 i. Quantity and quality.. 21 ii. Turnover and changes. 21 iii. Part-time faculty. 22 iv. Diversity and cultural competency. 22 B. Instructor qualifications. 22 C. Professional development.. 22

3 6. Facilities/Support 22 A. Classrooms and technology 23 B. Library and information resources. 23 C. Clerical, technical, administrative and tutoring support 24 D. Advising, counseling, disability and other student services. 24 E. Patterns of scheduling CTE programs 25 A. Advisory Committee 25 B. Admissions process.. 25 C. Job placement data.. 26 D. Barriers to degree completion 27 E. Opportunities for educational advancement 27 F. Additional changes Recommendations.. 28 A. Teaching and learning related to assessment 28 B. Curriculum, professional development, access, student success, resources Appendix 32 A. APAR 2013 Report Workbook 32 B. Associate HIM Level Curriculum Map 42 C. RHIT Exam results D. Institutional Effectiveness data. 50 E. HIM Advisory Committee meeting minutes. 61 F. HIM Graduate Survey. 63

4 INTRODUCTION Portland Community College s Health Information Management program was established in the 1970 s to serve the growing demand for medical record technicians in the Portland metro area. The program has undergone many transitions since then including a name change from the Medical Record Technology program to Health Information Management in alignment with industry standards. It has also moved its campus based program to an online environment using current technologies simulating real world experiences. Students enrolled in the HIM program complete 92 credits within the two year associate degree program. Following successful completion of the program, students become eligible to take the national examination offered through the American Health Information Management Association (AHIMA) and become credentialed as Registered Health Information Technicians (RHIT). Health Information Management professionals play a critical role in maintaining, collecting and analyzing the data that physicians, nurses and other health care providers rely on to deliver quality health care. As emerging technologies work towards a fully electronic future, Portland Community College s HIM program graduates are trained to successfully sustain and lead amidst a rapidly changing healthcare delivery system

5 1. Program Overview A. What are the educational goals or objectives of the program? How do these compare with national or professional program trends or guidelines? Have they changed since the last review, or are they expected to change in the next five years? Goals/Objective PCC s Health Information Management program adheres to the goals established by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM) and the American Health Information Management Association (AHIMA). Both organizations require accredited HIM programs to institute educational outcomes to be achieved annually, and must be measurable, reflecting the principles and ethics of the health information management profession. As required for continued accreditation through CAHIIM, the program performs annual assessments of the curriculum to determine where or when improvements are needed. Assessments are conducted using feedback from students, faculty, graduates, employers, and national RHIT exam pass rates. See Appendix A., CAHIIM APAR worksheet. This method of assessment requires continuous quality improvement in the instruction of HIM concepts and outcomes and therefore must be routinely evaluated. As a result, our goals are consistent with providing the highest quality of HIM education available for our student population

6 Comparison with National professional trends/guidelines Changing to a new coding classification system In October 2014, the United States transitions to the ICD-10 coding classification system. ICD-10 (the 10 th revision of the International Classification of Diseases) codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. HIM professionals are the experts in coding for billing and reimbursement of healthcare facility services, and therefore HIM programs must adopt major changes to their curriculum. In 2011, the American Health Information Management Association (AHIMA) suggested an outline for HIM programs to transition instruction from ICD-9 to ICD-10, at which time we revised our HIM 270, 273, and 276 coding courses to include ICD-10 training. Nationally, HIM coding certificate and degree programs complied. However, since program students would be required to have understanding of both systems upon graduation, we have been teaching dual systems for the last two years. This has been the trend with HIM programs across the country as we tackled the same challenge of providing current and future coding system instruction. More data analytical skills The HIM profession and the education of HIM workforce has also been focused on the need for improving data analytical skills and computer literacy. Electronic health records (EHR) have given healthcare staff the ability to manipulate and use data in previously unimaginable ways. But the EHR is also creating more data integrity issues due to its free-flowing, remotely accessed, and sprawling use of patient information. To address this concern, our program has been following the national trend for HIM programs to incorporate more critical thinking, analytics and real-life assignments in the course of study. See #2, Outcomes and Assessments

7 Changes in Goals/Objectives since the last Program Review In 2013, CAHIIM revised HIM AAS program curriculum competencies to adapt to the changes in the profession, particularly addressing the skills needed to work in the electronic health record environment. See Appendix B, Associate HIM Level Curriculum Map. HIM programs must now incorporate the importance of team building, consumer needs, and stronger computer proficiency into their curriculums. This has also been recognized and emphasized by our HIM Advisory Committee members as qualities that HIM employers are currently seeking. Therefore, our goal as an HIM program is to stay abreast of industry changes in order to meet recognized standards and skill set expectations for our graduates. B. Summary of changes that have been made since last review In the last five years, significant changes have occurred in the Health Information Management program. The following bullet points briefly explain those changes and accomplishments: One of the two full time faculty instructors retired in An HIM parttime instructor was hired for the full time position in PCC s HI (Health Informatics) program was created in 2010 to address the expected demand for a health IT workforce to implement electronic health record systems. This CIS department program requires their students to take four HIM program courses for the degree, with other HIM elective courses offered. Those classes including HI students has increased enrollment in those HIM courses by 20%. Revisions were made to the HIM curriculum in 2011, 2012 and 2013 including CCOG description and title changes which better define the course material. In addition, as courses are revised they have passed quality reviews and ADA accessibility inspections. The HIM practicum courses were revised in 2011, with deletion of one course thereby increasing the credits for the practicum course taken in spring of the final year. In 2013 mock exams replicating the national RHIT (Registered Health Information Technology) exam were also added to the practicum course to prepare students for passing the national examination following graduation. An adjunct instructor was hired to teach the ICD-9 coding classes in Those classes had significant changes due to the national transition from the ICD-9 to ICD-10 coding classification system. This course is still undergoing modifications since dual systems must currently be taught until ICD-10 is fully implemented in fall of

8 In 2013 math and writing were made pre-requisites to entering the HIM program, thus allowing students to focus solely on HIM program classes during the two year schedule cycle. Implemented an admissions point system in 2013, using a more uniform and equitable method of assessing and accepting new students into the program. Developed an HIM program Student Handbook in 2013 to better communicate program expectations and requirements. In 2010 we implemented a Virtual Lab offered through the American Health Information Management Association which was determined an insufficient return on investment. In fall 2013 we began using a different EHR (electronic health record) simulation product (Neehr Perfect) at less cost and with enhanced capabilities (see C below). In 2012 we initiated a Learning Assessment plan to assess first and second year student outcomes allowing us to make improvements in course instruction. C. Were any of the changes made as a result of the last review? The administrative response to the last review in March, 2009 supported our efforts to enhance student instruction utilizing an HIM simulation lab product. At the time we anticipated using AHIMA s Virtual Lab product, and we did so beginning fall of The product was still under development and we found it to be technologically challenging for users and did not warrant the annual cost to maintain program licensing. Therefore, we explored other options and beginning fall of 2013 transitioned to Neehr Perfect, a networked education electronic health record. We have found the product to be much more user friendly and have been particularly pleased with the staff support provided to us. The Neehr Perfect support staff is quick to respond and assist with creating applicable assignments for our students. The product can be purchased directly through the PCC bookstore at a reasonable cost and once an account is set up, can be utilized again in subsequent classes. The administrative response in 2009 also approved plans to transition instruction of ICD-9 to ICD-10 classification coding system before the national implementation date of October Our coding instructor obtained training and became a certified ICD-10 trainer in 2011 and at that time revised coding class curriculum to introduce students to ICD-10 with the plan to transition fully to ICD-10 within two years. Therefore, we have been teaching dual systems this last year and the coding courses will continue to undergo extensive changes as we prepare our students in coding of ICD

9 2. Outcomes and Assessment: reflection on learning outcomes and assessment, teaching methodologies, and content in order to improve the quality of teaching, learning and student success. A. Course-level Outcomes: Identify and give examples of assessmentdriven changes made to improve attainment of course-level student learning outcomes. Where key sequences exist, also include information about assessment-driven changes to those sequences. As was established in our Learning Assessment plan, we evaluate student learning outcomes via a combination of annual RHIT exam score reports and mock exams taken by students at the end of the first and last year of the program. The national RHIT exams are divided into specified domains that relate directly to the courses taught in the program. The mock exams have a multi-purpose in that they are used for students to access their own areas of weakness so can better prepare for the national exam, and also to allow HIM instructors to identify areas needing improvement in course content. Examples of assessment-driven changes: Results from the comprehensive mock exams taken in the third term of the first year of the program suggest students do not consistently retain material from the first term. Therefore, we have incorporated a review in HIM 281 (Data Management and Analysis) at the beginning of their second year of the program. This refresher assists students in addressing concepts in HIM 281 as well as other HIM program material from the first year curriculum. In addition, we are incorporating assignments in several first and second year courses that will review prior study. For instance, a medical terminology course is a pre-requisite class for the program. Students may have forgotten medical terms since taking the course and therefore we have added a medical terminology review in the first term HIM 110 (Health Record Content) course as well as the second term HIM 105 & 107 (Ancillary Information Analysis lecture and lab) courses. Areas of weakness identified from the RHIT exam results have been data management and health information technology, both of which require the student to have a good understanding of how computer systems can be used for aggregating data and data analysis. To address this: We have tightened our requirement for a computer applications course to be taken as a pre-requisite to the program, and are encouraging students to take more computer courses as electives. (HIM SAC is also considering inclusion of a higher level computer information systems course within the HIM degree). - 6

10 We have added various assignments in program courses that require students to use their computer skills to monitor display and analyze health data. For example, in HIM 282 (Healthcare Statistics) students must analyze statistical data and present the data in graph and table formats. In HIM 290, (Health Teams and Training) students create Power Point presentations to conduct inservice training. With the use of the Neehr Perfect electronic health record system, students complete assignments in HIM 286 (Data Analysis Lab) that require them to compare data in patient records and then using their critical thinking skills, must analyze and report discrepancies. B. College Core Outcomes: Describe how each of the College Core Outcomes is addressed in courses, and/or aligned with program and/or course outcomes. Communication: The majority of HIM courses have a communication element required via our online discussion postings. Discussion topics may pertain to a specific article or video viewed which relates to that week s course content. Students must post their own opinions regarding the topic of discussion as well as submit a reflective response to another student s posting. The discussions are a valuable component to our online courses as students share personal insights that may not be captured through the lecture or assigned readings. Although we include various activities to improve communication skills throughout all courses, in adherence with CAHIIM s accreditation standards for HIM programs, we have two specific courses that directly address the importance of good communication skills in the workplace. HIM 290 (Health Teams and Training) covers not only team building and conflict management within groups, but also includes how to effectively stage presentations for inservice training. In HIM 272 (Health Information Management), we speak of the barriers to effective communication, including differences in pre-conceived judgments or opinions. Community and Environmental Responsibility: Health information managers must follow the HIM Code of Ethics, which includes the ethical obligation of protecting patient privacy and confidential information. Health information ethical and professional values are based on obligations to the patient, the healthcare team, and the interests of the public. Therefore, our HIM program courses incorporate activities adopting these principles. For instance, a research project in HIM 110 (Health Record Content) has students explore cases of global natural disasters where security and privacy of health records are concerned. Students in HIM 131 (Medical Science) conduct research on the top five diseases in various countries and provide explanation regarding disease causes, prevention, and community and environmental impact

11 Critical thinking and problem solving: The national RHIT exam taken by our HIM students following graduation tests students on three different cognitive abilities: recall, application, and analysis. These levels represent an organized way to identify the performance that they will use on the job. While recall primarily measures memory, the application and analysis questions require critical and problem solving skills. Our HIM program courses include assignments, projects, and testing to evaluate the students cognitive abilities. Some examples: Exam questions used in the HIM courses include scenarios and story problems whereby the student must analyze a situation and provide the best solution given the various options. In HIM lab courses, students must complete an assignment and then submit an essay reflecting on how the assignment related to the material in their lecture course, including how they would react given the circumstances presented in the problem scenario. A project assigned in the second year HIM 283 (Health Information Management) course have students research electronic health record systems for implementation in an internal medicine office. Students must compare and report on various EHR systems and provide justification why one system would be the best option for purchase. Cultural awareness: PCC s HIM program graduates find work in a wide assortment of facilities; hospitals, public health clinics, long term care facilities, mental health, department of corrections, or any environment where medical records are maintained. It is imperative that our students be prepared to work in a culturally diverse setting, therefore we incorporate appropriate learning experiences into the HIM curriculum. In HIM 182 (Healthcare Delivery Systems) students are asked to address topical issues concerning healthcare delivery, including healthcare reform, ethics of clinical trials for research, and how the prospective payment system in the U.S. has reduced hospital length of stay. The discussions often expand to include comparisons of the U.S. healthcare delivery system to other countries as there are often students that have relocated to the U.S. and share their own experiences. In HIM 272 (Health Information Management) lectures are included that discuss barriers to effective communication, including differences in perception, preconceived opinions, and racial and cultural differences. Intercultural group communications are explored with emphasis on recognizing cultural differences, norms and practices

12 Professional competence: When students graduate from the HIM program, they should have sufficient knowledge to pass the national RHIT exam to become credentialed as a Registered Health Information Technician. This credential confirms they have passed the competency requirements to become a member of the HIM profession. In addition to our program meeting academic standards required by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM), we also ensure student professional competence in our HIM 293 (Directed Practice) course. HIM 293 is taken in the last term of the HIM program and incorporates the following: Direct supervision of clinical practicum hours that are performed in a variety of healthcare settings. Practicum objectives must be met and verified by the practicum site supervisor as meeting entry level competencies. Students must meet with the practicum supervisor prior to starting practicum as a mock interview for employment. The student and HIM program instructor will receive feedback from the site supervisor on how they presented themselves in the interview as well as professional competency upon completion of the practicum rotation. Students must complete a series of mock exams replicating the national RHIT exam they will take following graduation from the program. Self-reflection: Throughout the two year HIM program, classes allow HIM students to assess, examine and reflect on their academic skills professional competence, personal beliefs and how they impact others. The discussion postings mentioned previously are a valuable means of sharing experiences that enrich student learning. Many of our HIM program students already work in the profession and are taking the program to further advance their careers. They often convey in discussion postings their own work experiences and in sharing those experiences allow the rest of the class members an insight into real-life practices. When the students in HIM 281 (Data Management and Analysis) hear how the theory they have been learning about is put into practice it offers an additional layer of understanding. In addition to the professional competence assessments in HIM 293 (Health Information Directed Practice), our students are required to submit a summary of their directed practice experiences including reflection on what they learned at the practicum site, and where they see themselves headed in the HIM profession

13 ii. Update the Core Outcomes Mapping Matrix for your SAC. CORE OUTCOMES MAPPING SAC HIM: Health Information Management Mapping Level Indicators: 0 Not Applicable. 1 Limited demonstration or application of knowledge and skills. 2 Basic demonstration and application of knowledge and skills. 3 Demonstrated comprehension and is able to apply essential knowledge and skills. Core Outcomes: 1. Communication 2. Community and Environmental Responsibility 3. Critical Thinking and Problem Solving 4. Cultural Awareness 5. Professional Competence 6. Self-Reflection 4 Demonstrates thorough, effective and/or sophisticated application of knowledge and skills. Course Course Name CO1 CO2 CO3 CO4 CO5 CO6 # HIM 105 Ancillary Information Analysis HIM 107 Ancillary Information Analysis N/A 4 4 Lab HIM 110 Health Record Content HIM 120 Health Record Content HIM 121 Legal and Ethical Aspects of Healthcare HIM 128 Anatomy & Physiology for Health Information Management 1 HIM 129 Anatomy & Physiology for Health Information Management 2 HIM 131 Medical Science HIM 136 Medications N/A 4 3 HIM 141 Health Record Content

14 HIM 182 Health Care Delivery Systems HIM 270 ICD-10-CM Basic Coding HIM 271 HIM 272 Quality Improvement in Healthcare Health Information Management Intermediate ICD-10-CM/PCS HIM 274 Quality Improvement in Healthcare Lab HIM 275 CPT Coding N/A 4 3 HIM 276 Intermediate ICD-10-CM.PCS Lab HIM 277 Health Information Management Lab HIM 281 Data Management and Analysis HIM 282 Healthcare Statistics HIM 283 Health Information Systems HIM 285 Healthcare Financing and Compliance HIM 286 Data Management and Analysis Lab HIM 290 HIM Teams and Training HIM 293 COMM 100 Health Information Directed Practice Introduction to Speech Communication

15 C. Degree Outcomes: i. List the degree student learning outcomes, showing the alignment with the college core outcomes, and identify the strategies that are in place to assess the degree outcomes AAS: Health Information Management Health Information Management Outcomes 1. Graduates will meet the entry level certification mpetencies as defined by the American Health Information anagement Assn. in the following domains: Apply federal, state and accrediting agency standards for record content, reimbursement methodologies, and classification systems (Domain:Health Information Mgt) Collect, organize, abstract and analyze clinical data to identify trends that demonstrate quality, safety and effectiveness of health care (Domain: Health Statistics, Core Outcome mapping Professional Competence, Critical Thinking and Problem Solving, Cultural Awareness, Self-Reflection Professional Competence, Critical Thinking and Assessment Setting/Method Graduates take a national exam to become accredited as Registered Health Information Technicians through the American Health Information Management Assn. AHIMA sends result reports quarterly showing passage percentages by content area domains. To meet accreditation the program must submit annual reports to the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM) including exam results and plans for program improvement if designated domains have not met threshold standards. These reports are also used to meet college assessment reporting requirements. In addition, the HIM program assess students the end of spring term of the first year of the program with a comprehensive mock exam using test questions from first year courses. Then a comprehensive mock exam is given in the students last term of their final year covering entire HIM program content areas. Questions will be broken down by domain to determine areas of strength and weakness in order to make program adjustments as necessary, as well as to alert individual students regarding areas needing further study before taking the national exam. See above. Term of assessment Spring term each year Spring term each year

16 Biomedical Research, and Quality Management) Apply knowledge of policies and regulations relating to the organization of health care delivery to ensure compliance and protect confidentiality and privacy of patient data (Domain: Health Services Organization and Delivery) Use technology and information systems to meet health care organization needs (Domain: Information Technology and Systems) Apply general management and personnel supervision to a health information department (Domain: Organizational Resources) 2. Graduates will become gainfully employed in the alth Information Management field Problem Solving, Communication Professional Competence, Critical Thinking and Problem Solving, Self-Reflection Professional Competence Professional Competence, Critical Thinking and Problem Solving, Communication, Cultural Awareness Professional Competence See above. See above. See above. Surveys are sent to program graduates to assess current employment status. If unemployed, the survey requests the reasons for unemployment, whether currently seeking employment and/or if graduate is pursuing continued education or other reasons why they have postponed employment in HIM. Spring term each year Spring term each year Spring term each year Six months following graduation date. The following three questions are essentially the same as are asked for in the Annual Assessment report: ii. Describe the assessment design and processes that are used to determine whether students have met the outcomes of their degree See Table above. iii. Summarize the results of the assessments of these outcomes. As a requirement to pass HIM 293 (Health Information Directed Practice) in the last term of the program, students must complete a series of mock exams. Each exam question is titled by subject area domain in order to identify questions missed per content area. Then a final comprehensive exam is given comprising all domains and replicates the national RHIT exam format. The results of these exams are shared with the students in order for them to target areas of weakness and better prepare for the national RHIT exam to be taken following graduation. This method of assessment also assists instructors in where they need to make adjustments in instruction and improve their courses. In spring of 2013 the student pass rate on the mock exams in each domain, was an average of 74 79%. This compares with the national mean exam rate of 75%. Additionally, national RHIT exam scores are sent quarterly to the program director to review exam results compared with national averages. See Appendix C, RHIT Exam Score Report. In 2012, PCC s HIM program students scored above average in all areas of the exam. The reported national pass rate on the RHIT exam in 2012 was 75%, and PCC s HIM program averaged 91%. Statistics are not yet available for students who took the exam in

17 iv. Identify and give examples of assessment-driven changes that were made to improve students attainment of degree outcomes. Admissions Process changes: Effective spring of 2013 we revised the HIM program admissions process. The changes included: 1. Writing 121 was removed from the degree requirement and made a pre-requisite to entering the program. 2. Math 65 also became a pre-requisite course to the program as it had been identified that students often delayed taking their math requirements becoming a roadblock to their scheduled graduation date. 3. CAS 133, or other basic computer applications course, can no longer be waived using work experience as a substitute. 4. Applications to the program are now assessed using a point system. Points are based on pre-requisite course grades (A = 6 pts., B = 4 pts., C = 2 pts.) as well as essay questions assessing interest in the program, health related work, working with diverse populations, and experience working previously with confidential information. Students with the highest points are accepted first into the program within a limited time period (January 15 March 15). This allows for students to be better prepared for our HIM program courses and targets students with a strong incentive to be in the program. Grading rubric revisions: Beginning fall 2013, the HIM SAC began using a more standard grading rubric with % equaling an A, 80-89% = B, 70-79% = C. Since our previous grading rubric indicated a C grade to be 68-82%, the grading scheme allowed students to pass classes with a 68% although the national exam must be passed with a 70-75%. We had observed that the students that were not passing their RHIT exams were often those students averaging their HIM courses in the 68-70% range. Therefore, our hope is that in revising the C (passing) grade to 70% those students that would otherwise struggle with passing the national exam can be identified early and resources made available to reach their goal of becoming credentialed in the profession

18 3. Other Curricular Issues A. To what degree are courses offered in a Distance modality (on-line, hybrid, interactive television, etc.)? What significant revelations, concerns or questions arise in the DL delivery? The HIM program transitioned from a campus based program to completely online learning environment beginning As of 2013, all HIM core classes are offered only online, with the exception of HIM 293, which is the practicum class and therefore offered as a hybrid course. All of the classes are delivered via Desire2Learn, with course modules including lectures, assignments/quizzes, videos, and with strong emphasis on communication through weekly discussion postings. We believe that our HIM program being offered online has been successful for several reasons. Our students are pursuing education in HIM because they enjoy the idea of combining computers with medicine. They will be working with computers in the profession and much of the work will be performed reading and analyzing data online. If the HIM student is not successful with taking online classes, they will likely not enjoy or succeed in the HIM profession. However, there are challenges for our HIM students related to the online format of learning which include: 1) lack of instructional support, 2) lack of technical support, 3) offering multiple online learning strategies, 4) and poor organizational skills. PCC s HIM program has addressed these concerns in the following ways: 1) Lack of instructional support: As online instructors teaching in a fully delivered online program, HIM instructors understand the importance of student communication. We strongly believe that student success in our program is directly related to good communication between ourselves and our students. Our HIM Student Handbook and program syllabi state students must log in to their online HIM courses three times a week, or be subject to course point deductions. In accordance, HIM program instructors are directed to reply to all student communications within 24 hours or less (exemption for weekends/holidays) and return graded assignments within the designated time frame as stated in the class syllabus

19 2) Lack of technical support: Since the HIM program is offered entirely online, it is imperative our students can access their course materials. Technical issues can be frustrating for students and a deterrent to education, and as faculty we must understand and assist whenever possible. However, since we are not the specialists in this area, we must ensure that the resources are easily provided to our students relating to technical issues. All of the HIM courses provide links for students to contact the Distance Learning Help Desk and Desire2Learn resources. As we converted to a different electronic health record simulation program (Neehr Perfect) this last year it was essential that we were assured outstanding technical support from the company. There has been excellent feedback from students that Neehr Perfect support staff has responded quickly and effectively to their requests for assistance when needed. 3) Offering multiple online learning strategies: Because learners have different learning styles or a combination of styles, online educators must design online courses utilizing multiple instructional strategies. This has been particularly evident as the HIM program moved traditionally on-campus classes to online distance learning. Our online lectures need to be addressed in a variety of methods to ensure understanding of lecture material to prepare students for utilizing RHIT exam cognitive abilities, specifically for recall, application, and/or analysis levels. This is being accomplished through self-directed learning, group work, projects and case studies. Videos are often used to have students answer questions regarding video content with reflective essays. Some HIM courses have transitioned to a change in pedagogy, with instructors taking the role of facilitators while guiding students to self-study and collaborative learning. This is often accomplished through online discussion topics or assigned essay questions. For example, in Health Care Delivery Systems (HIM 182), students must research the differences in the Canadian single payer healthcare system with the current United States healthcare system. Providing websites, videos, and in sharing personal experiences the students are graded on their ability to express pros and cons of both systems. 4) Poor organizational skills: In order to be successful taking online courses, students must have good organizational skills, particularly when balancing multiple classes. Desire2Learn has several ways to assist students with this challenge, including calendars and alerts to assignment/quiz due dates, but ultimately the student must determine what works best for them to organize their time

20 B. Has the SAC made any curricular changes as a result of exploring/adopting educational initiatives? In accordance with the college s promotion of inquiry-based educational initiatives, the HIM program supports problem-based learning approaches in its curriculum. Six of the HIM core classes contain accompanying lab sections to augment understanding of lecture material via inquiry-learning activities. In addition, with the inclusion of the Neehr Perfect simulation lab product in our classes, we are now able to replicate HIM work using electronic health records. C. Are there any courses in the program that are offered as Dual Credit at area High Schools? Not at this time. D. Does the SAC plan to develop any additional Dual Credit agreements with area high schools? Not at this time. E. Identify and explain any other significant curricular changes that have been made since the last review. There have been extensive course revisions to HIM 110 (Health Record Content), HIM 120 (Health Record Content Lab), HIM 105 (Ancillary Information Analysis) HIM 107 (Ancillary Information Analysis Lab) and HIM 131 (Medical Science), effective The HIM SAC identified two concerns initiating the course revisions above: 1) learning retention as students progressed through the program, and 2) a need for stronger understanding of clinical material to prepare them for coding in the second year. To address the first concern, reviews of previous material have been incorporated into courses. For instance, in the Ancillary Information Analysis and Medical Science courses, reviews have been added to emphasize medical terminology, anatomy & physiology, health record content, procedural terms and medications. Significant changes have also been made to HIM 293 (Health Information Directed Practice) to better prepare students for the RHIT exam and employment in HIM. Students must now complete a series of mock exams replicating the RHIT exam questions (see 2.C.iii) Also, a new revision to HIM 293 includes a required interview of the student by the practicum site supervisor to critique interviewing skills. See 4B below regarding HIM 128 and 129 (Anatomy & Physiology for Health Information Management, 1 & 2)

21 4. Needs of Students and the Community A. How is instruction informed by the student demographics? Although student demographics have not changed significantly we have seen an increase in students from outside the Portland metro area since moving the program to an online format. Where we used to refer only to Oregon laws in regards to medical record keeping, we now expand beyond Oregon to include federal guidelines. We have had students that have emigrated from Japan, Eastern Europe, Vietnam, Philippines, India and other countries and we encourage them to share their own experiences with healthcare in their native countries. These discussions are always met with great enthusiasm by their classmates as we compare the US healthcare delivery system with other countries and are an important component of the class instruction. Since the last program review, we now have Health Informatics program students in five of our courses which bring an additional element. The HI students have typically taken most of their Computer Information Systems courses prior to taking HIM classes and HIM course instruction must recognize their level of ability. They often have stronger computer IT skills, but lack a more specific background in health care. Questions and answers are shared between the class members as they provide added insight into instruction with personal experiences. Again, the shared collaboration of instruction by instructor and students is an essential and vital part of our courses. B. Have there been any notable changes in instruction due to change in demographics since the last review? As stated above, since the online HIM program has grown there has been increased student enrollment from outside the Portland Metro area. This necessitated the need to have all program courses be offered distance learning. At time of last program review in 2009, there were three degree courses not offered via distance learning; the two term Anatomy & Physiology series and a two credit seminar course. At the time, Anatomy & Physiology courses were available only face to face on campus through the Biology SAC, which became an obstacle for students needing to take only online courses. Therefore, in cooperation with the Biology SAC, a two term online A&P series was created specifically for HIM students (HIM 128 & 129). The content is equivalent to BI 121 and 122 and is taught by a qualified biology instructor. The last obstacle to moving the program fully online was accomplished with the deletion of HIM 292 (the two credit seminar course) which required students to attend campus speaker engagements

22 C. Describe current and projected demand and enrollment patterns. Include discussion of any impact this will have on the program. According to the U.S. Bureau of Labor, employment of health information management technicians is projected to grow nationally by 22 percent between 2012 and 2022, much faster than the average for all occupations. However, the Oregon State Employment Department projects a 76 percent growth rate statewide, with 42 positions opening annually 26 of these positions will replace currently employed HIM technicians and with an estimated 15 new positions being created. This is a statewide approximation, but the majority of those workers will be employed in the Portland Metro area. We currently graduate an average of 28 students each spring, 90% which will be seeking employment within Portland and its suburbs, so we are now meeting market demand. We may need to consider the impact Chemeketa Community College s AAS HIM program may have on our number of graduates. Chemeketa Community College in Salem is seeking CAHIIM accreditation for an associate degree program to begin fall CCC currently has a one year HIM program which has bolstered our second year FTE by 3-4 students since we accept their transferrable credits. We can therefore expect a decline in the numbers of students in our second year cohort as CCC moves closer to accreditation. D. What strategies are used within the program to facilitate access and diversity? To facilitate access since the last program review, we have transitioned the program to an entirely online format. We have included links to pertinent websites to enhance instruction, and have provided students with increased online resources, thus decreasing purchase of textbooks which were previously required. To facilitate diversity, we encourage our students to share their distinct and varied experiences via open discussions online (see 4A), thus achieving an interactive learning approach

23 We have seen our student demographics shifting slightly, particularly with the inclusion of Health Informatics program students in some of our classes. Since health IT has traditionally been a male dominated profession, more males are taking our HIM classes as required for the HI program degree. At the time of the last program review in 2009, 91.9% of program students were female, and the Office of Institutional Effectiveness now reports that has decreased to 71.6%. See Appendix D. Some of those students have also transferred over to the HIM program after taking HIM classes and recognizing the opportunities they can achieve with the RHIT credential. This shift in student population with the Health Informatics program students has required HIM instructors to address the needs of two related but disparate disciplines. The HI students tend to be more computer savvy and they have the benefit of having completed most of the computer information system courses prior to taking the HIM program classes. In pursuing health informatics, a male dominated field, they gain insight into a traditionally female dominated profession when taking our HIM courses. As a result, we are finding that students are learning from each other as they share the skills acquired from each program, making the instruction more collaborative, robust, and diverse. E. Describe the methods used to ensure faculty are working with Disability Services to implement approved academic accommodations? As an online program we must adhere to ADA requirements for our lectures to be presented in an acceptably approved format. Our courses have undergone accessibility reviews performed by the Accessibility Advocate and staff to ensure suitable lecture formatting and video captioning are used. The Accessibility for Online Course Content has been a wonderful resource. We have also worked closely this last year with Neehr Perfect (electronic health record simulation product) to meet the ADA requirements as well as other publishers and vendors. HIM instructors also interact with Disability Services to meet each student requested accommodation term by term. With our current learning management system, Desire2Learn, it is now significantly easier to make testing accommodations and provide any ADA accommodations for our online student population. F. Has feedback from students, community groups, transfer institutions, business, industry or government been used to make curriculum or instructional changes? Receiving student feedback from course evaluations each term allows HIM faculty to continually refine course instruction and improve student learning outcomes. This feedback is important not only to evaluate course assignments and assessments but to gauge success of the methods of delivery

24 Our student practicum assessments include site supervisor observations of student proficiency which is a valuable tool to evaluate learning outcomes. This feedback, provided by the site supervisor mentoring the student, allows us to define areas of weakness and/or lack of understanding of HIM processes. We are also fortunate to have national and state professional associations which provide some excellent resources for our faculty. As members of the American Health Information Management Assn. our instructors are members of the Assembly on Education (AOE) which offer an annual faculty development symposium for HIM educators. The Assembly on Education also has an online forum for HIM faculty with more than 1,600 members. The AOE community is where educators can start discussion threads and share resources. For example, we have compared policies for acceptance of credits from nonaccredited RHIT schools following discussion of acceptable practice from the AOE community. This collaborative effort to improve HIM education assists us with keeping abreast of industry changes and to improve curriculum in alignment with national educational standards. 5. Faculty: reflect on the composition, qualifications and development of the faculty. A. Provide information on: i. Quantity and quality of faculty needed to meet the needs of the program. The HIM program currently has two full time instructors (one with release for FDC duties) and two part-time faculty instructors. The two part time faculty members teach fall and winter terms only. With the exception of the Healthcare Delivery course (offered fall term) and the Anatomy & Physiology series (in fall and winter) the instructor qualifications require the instructor to hold a current HIM credential. ii. Extent of faculty turnover and changes anticipated in the next five years. The faculty turnover has occurred primarily with part-time instructors. The challenge is in finding and retaining part-time instructors to teach the coding courses offered fall and winter terms. These courses are an essential part of the program and are the most specialized area in HIM. Finding qualified instructors is difficult as most coders work full time for hospitals and work under strict productivity standards which limits their availability to teach. The current HIM program coding instructor will be leaving that position following winter term 2014 and we will need to find a replacement prior to fall term This individual will need to have had ICD-10 training to provide the level of coding expected of our program. Additionally, after seven years occupying the position, the current HIM program director (and faculty department chair) will be retiring at the end of the academic year. This will be the first time in the history of the program that a program director will be hired from outside PCC and therefore will need training and support to be successful in the position

25 iii. Extent of the reliance upon part-time faculty and how they compare with full-time faculty in terms of educational and experiential backgrounds. Currently the Anatomy & Physiology instructor for HIM 128 and 129 (Anatomy & Physiology for HIM 1 & 2) must meet Biology SAC instructor qualifications to teach those courses. All other instructors (PT and FT) hold HIM credentials and have previous experience working in HIM departments. Updates are pending to include this wording in the instructor qualifications for HIM 128 & 129. iv. How the faculty composition reflects the diversity and cultural competency goals of the institution. The current composition of the HIM program faculty is representative of HIM professionals in general; primarily female and Caucasian. The HIM profession origin dates back to the early 1900 s when we were called Medical Record Librarians and as was typical of librarians of the time, it was predominantly a female profession. However, as the profession has evolved we have gained a more diverse workforce in all areas of HIM, including HIM education. As PCC s HIM program has grown, so has the diversity of the student population, and we would like to reflect that in our faculty as our program moves forward. B. Report any changes the SAC has made to instructor qualifications since the last review and the reason for the changes. Changes in instructor qualifications for HIM 128 & HIM 129 (Anatomy & Physiology for Health Information Management 1 & 2) will be made pending review by the HIM SAC in spring C. How have professional development activities of the faculty to the strength of the program? If such activities have resulted in instructional or curricular changes, please describe. As HIM instructors working in an ever evolving healthcare arena, it is imperative that instructors keep curriculum current. The health information management national and state associations provide ample opportunities for learning via webinars, classes and conferences. As previously stated (see 4F) the American Health Information Management Association s Assembly on Education holds an annual faculty development symposium for HIM educators. This symposium allows HIM educators to attend and converse with other HIM educators throughout the country to collaboratively improve HIM programs. Since HIM credentialed faculty must maintain continuing education units for certification, it is important for faculty to attend the annual state association conference held each spring. CEU credits must be obtained in order to meet the requirement within a two-year cycle. The Allied Health Division has supported attendance at these conventions and registration cost has been provided for the two FT faculty