By Cheryl A. Plettenberg, LaShunda Blanding Smith, Susan Hart-Hester and Sandra Evans

Transcription

1 Solving the Healthcare IT Worker Shortage The development and evaluation of coursework to support the initiative, Manpower Training in Electronic Health Record Use Through Community Colleges in the Delta Region By Cheryl A. Plettenberg, LaShunda Blanding Smith, Susan Hart-Hester and Sandra Evans Adoption of health information technology (HIT) was one of the major policy priorities of the federal stimulus package in the United States. 1 Implementation of electronic health records (EHR), along with additional objectives such as the achievement of governmental regulations surrounding meaningful use, quality care and an increasing focus on patientcenteredness and consumer ehealth increases the demand for skilled health information technology (HIT) professionals. 2-8 A 2008 analysis of the U.S. HIT workforce estimated more than 40,000 additional HIT professionals are needed to support EHR adoption and to meet stakeholder requirements and regulations. 9 Approximately 10,000 new health information management (HIM) workers are needed each year to fill new positions and replace those who retire or leave the field. With just 2,200 new graduates entering the HIM and health informatics each year, alternative education and training is needed to supplement the HIT workforce Quality assessment and evaluation of alternative education pathways is critical to ensure course participants enter the workforce with appropriate knowledge and competencies Comprehensive curriculum evaluation offers educators an opportunity to determine the effectiveness of curricula during instruction (formative evaluation) and post instruction (summative evaluation)

2 This article describes the evaluation and quality assessment process used by the University of Mississippi Medical Center s Institute for Improvement of Geographic Minority Health in the Delta Region [Delta Region Institute (DRI)] to create curricula to prepare the HIT workforce. The DRI collaborated with the American Health Information Management Association (AHIMA) foundation, Alabama State University (ASU), Louisiana Technical College (LTC) and Tougaloo College on a project entitled, Manpower Training in Electronic Health Record Use through Community Colleges in the Delta Region. Three courses in HIT priority areas were developed and data tested: 1) EHR implementation. 2) Privacy and security. 3) System analysis, design and workflow. Methods Funded by the Office of Minority Health (OMH) in 2009, the DRI s mission was to serve as a hub of multistate activities, services and information on health disparities and the impact on racial, ethnic and rural communities within the delta region Alabama, Louisiana and Mississippi. Five strategic elements guide programmatic activities of the DRI, with the Health Professional Shortage (HPS) Core supporting the collaborative efforts for the health IT workforce program. 2

3 Three objectives centered on pipeline education and training programs within rural and urban health professional shortage areas and medically underserved areas were aimed at: 1. Expanding the existing practitioner base. 2. Implementing recruitment and retention strategies to attract minority students to healthcare. 3. Training unemployed and dislocated members of the workforce. The DRI initiated a contractual agreement with the AHIMA foundation to develop short courses designed to increase the skills of individuals working in, or displaced from, healthcare. The project focused on developing curricula for three, 12-week online courses: 1. Implementation of EHRs. 2. Privacy, security and health information exchange (HIE) principles. 3 EHR analysis, design and workflow. Building on the context, inputs, process and product (CIPP) evaluation theory developed by Daniel Stufflebeam, a Western Michigan University professor, four dimensions were used to obtain focused data that enabled key decisions for curriculum development and evaluation (see Figure 1)

4 CIPP curriculum development and evaluation model for delta EHR project / Figure 1 CONTEXT INPUTS PROCESS PRODUCT PLANNING ORGANIZATION IMPLEMENTATION IMPACT Needs Assessment Gap Analysis Resources Activities Outcomes CIPP = context, inputs, process and product Context phase To define the functional context for the development of the courses, the AHIMA foundation conducted an assessment of the workforce market in HIM in support of Vision 2016, the organization s blueprint for reinforcing skill sets to entry levels of competency across a broad spectrum of subject matter. 21 A curriculum map was constructed that provided a crosswalk between existing Office of the National Coordinator (ONC) HIT Curriculum knowledge clusters and proposed components 4

5 of the delta courses. Process mapping fostered transparency of content for all stakeholders and enabled developers to assess unique aspects and gaps in the Delta course content, along with linkages to learning content and outcomes Students could undergo ONC competency exams, which would provide them with a value-added certificate in addition to the delta EHR project s certificate and continuing education credits. Initially, coursework for four specialist roles were planned to support HIT needs: implementation support, workflow redesign, regional extension center (REC) and HIE, and meaningful use. The implementation support specialist and workflow redesign specialist courses were equivalent to the ONC courses and addressed similar role components. The REC, HIE and meaningful use courses were specific to the Delta project. An iterative process of communication and face-to-face meetings between the DRI, AHIMA foundation and partnering colleges (ASU, LTC and Tougaloo College) established the rationale and the framework for course creation. The objectives of the project were solidified during a face-to-face meeting held at the Assembly on Education in New Orleans July In the course planning phase (context), it was confirmed the delta EHR project would collect data on outcomes and quality improvement during the duration of the subcontract. Additionally, the delta project would need a career advisor from the region to help students with career advancement and job hunting skills, and an advisory council to provide input on strategies, marketing, communication and potential job placement for graduates. 5

6 Follow-up discussions determined meaningful use would be covered in the EHR implementation course and that the REC/HIE course should be adjusted to focus on privacy and security. It was determined each course would use a hands-on approach and consist of approximately 45 hours of lectures, 30 hours of lab time and 60 hours of homework. This would allow for sufficient knowledge development and reinforcement. An additional component of the planning phase was defining eligible students. This population was defined as enrolled students (or recent graduates) who seek employment in the emerging roles of HIM or HIT in support of EHR implementation in the delta region. Eligibility also considered the enrollment in an accredited HIM program that satisfied the nine foundational domains of learning. These parameters were later expanded to include healthcare professionals who are currently working in physician offices in rural or underserved areas. Input phase The input phase of the course creation (and ongoing evaluation) established designated partner roles and internal and external resources needed to meet the project s goal: A training program to prepare workers to assume emerging roles in the HIT marketplace and to use EHRs. While DRI s funding supported collaborative efforts with the AHIMA foundation (and its subcontracts with ASU, LTC and Tougaloo College), additional technical resources were provided by Career Steps and Nortec. Specific roles and resources provided by partners included: 6

7 AHIMA foundation: DRI subcontract awardee; oversight of contractual work by participating colleges and other programmatic activities; student recruitment, evaluation of the efficacy of the educational programs; marketing and promotion during the beta period and thereafter. ASU, LTC and Tougaloo College: Provided faculty and beta tested the educational curriculum. Career Steps: In coordination with AHIMA foundation and ASU, the organization provided resources to produce a video of a physician installing an EHR. Nortec: Provided online EHRs for the virtual lab and provided training for course faculty. ASU: The IT department coordinated student registration, tracking and provided an online blackboard and laboratory via Moodle and Wimba, which are open-source online learning applications. ASU also used the Class Climate software system to track statistics required by the DRI and took the lead on developing the three courses in coordination with the design and evaluation work done by the DRI, AHIMA foundation, LTC and Tougaloo College. Process phase Initial curriculum objectives for the first online course, implementation of EHR, were completed by an AHIMA foundation consultant. Because the course targeted students and professionals, instructional design focused on an elearning delivery system and accessibility. The first course utilized Moodle for content delivery. It also incorporated AHIMA distance education modules to 7

8 support additional hands-on training with real EHRs. Although the initial training program focused on three states (Alabama, Louisiana and Mississippi) and was limited to 30 enrollees per semester, more than 150 students enrolled from six states after advertising for beta testers. In 2011, after beta testing the first course and reviewing student and instructor feedback, the AHIMA foundation subcontracted with ASU to revise the first course and develop additional courses related to privacy and security, and EHR workflow redesign. Feedback from beta students and faculty regarding Moodle prompted a change in the way ASU-supported learning management systems could be accessed. Construction of the second course privacy, security and HIE principles was completed by ASU through a contractual agreement with the AHIMA foundation (with funding and project oversight from the DRI). Instructors at ASU and Tougaloo College participated in beta testing. Communication between course developers and instructional faculty emphasized a need for the continuity of beta students across new courses only students who completed the first course could take the second course. This decreased the number of students from 157 to 35. The third course EHR analysis, design and workflow was developed by ASU in 2012 with beta testing at ASU and Tougaloo College. LTC faculty audited and assessed course content and exams. The number of beta tester students decreased from 35 to 26. Discussions relating to the issues of continuity and coursework sequencing continue. 8

9 Product phase Outcome assessments and performance measures were developed to assess student and faculty satisfaction and the impact courses had on job performance, knowledge and skills. Data collection included student evaluations at the conclusion of each course and comprehensive evaluations for students, faculty and employers via online surveys. Performance measures required by the DRI included the number of students completing the course by age, gender and ethnicity. Quality assessments of the content and structure of each course were conducted continuously via online surveys and face-to-face meetings with instructors and beta students. Students who completed training received a certificate of completion, 12 continuing education units (CEU) per course and the opportunity to take the Office of the National Coordinator for Health Information Technology (ONC) Health Information Technology Professional (HITPro) exams. Implementation managers and workflow redesign specialists would be credentialed in those areas of study. Table 1 shows data pertaining to the three courses in January The three courses are complete and received approval from the Office of Minority Health (OMH) for deployment at participating colleges. 9

10 Student characteristics by delta EHR project course / Table 1 Course Total number of students Age range Percent Caucasian Percent African-American Percent unknown Implementation of EHR % 34% 2% Privacy, Security and HIE % 43% 3% System design, analysis and % 54% 2% workflow EHR = electronic health record Discussion Most healthcare leaders agree that low HIT adoption in the United States is correlated with a shortage of HIM professionals The delta EHR project recognized that HIM professionals were needed to develop, implement and evaluate educational programming to tackle the workforce shortage that is hindering EHR implementation. The use of the CIPP curriculum development and evaluation model enabled us to identify specific actions taken within each dimension (context, input, process and product), to assess needs and gather input from students, faculty and healthcare employers, and to refine instructional design and content throughout the process. Participating faculty reviewed and revised the curriculum during project, including syllabi, examinations and learning activity construction. Course faculty had the opportunity to test concepts, ideas and suggestions until they were satisfied with beta course content delivery. Final refinements to courses were driven by feedback from beta students, instructors and 10

11 assessments of industry standards by course design faculty (ASU) and instructors (LTC and Tougaloo College). A major strength of the delta EHR project development process is that it is built on HIM disciplines and it leveraged existing programs that serve the delta region. By offering these three short courses, the project s goal of preparing workers for new roles in the HIT marketplace was achieved. Streamlining course content and completion time allowed workers to enter the HIT workforce quickly with essential EHR knowledge and skills. Conclusion and future plans The project focused on developing three courses in HIT priority areas. These 12-week, online courses were designed to address a gap in the professional workforce needed to develop, implement and maintain HIT. Assessment of the courses impact on employment status (including pay scale, job description and job location) is in progress. The current plan is to offer the courses to all healthcare workers, employed and unemployed, throughout the United States. Currently, the first and second courses are being implemented by ASU and Tougaloo College. Twenty-two students are completing the implementation of EHR course being taught by ASU faculty and nine students are enrolled in the privacy, security and HIE principles course at Tougaloo College. The courses were offered a second time beginning June

12 Acknowledgement These courses were developed through an award from the Department of Health and Human Services' Office of Minority Health (prime award # 1 CPIMP ) to the University of Mississippi Medical Center. The AHIMA foundation was issued a sub-award (# AHIMA-03) to partner with universities and colleges to offer this educational opportunity under the project named, Manpower Training in Electronic Health Record Use through Community Colleges in the Delta Region. The findings, opinions and recommendations expressed therein are those of the authors and not necessarily those of OMH or DRI. The authors would like to thank the following individuals for without their expertise, knowledge and leadership the project could not have happened. From the AHIMA foundation: William Rudman, Desla Mancilla, Bonnie Aguda and Kate Jackson. From ASU: Kenley Obas, H. Kong, Karen Chambers, Annette Stewart and Sabine Simmons. From LTC: Angela Kennedy. References 1. C. Howell, Stimulus Package Contains $19 Billion for Health Care Technology Spending and Adoption of Electronic Health Records, WTN News, Feb. 19, Centers for Medicare & Medicaid Services, EHR Incentive Program, Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/ehrincentiveprograms/. 3. American College of Physicians, Joint Principles of a Patient-centered Medical Home, March 5, 2007, 4. Institute of Medicine Committee on Health Care in America, Crossing the Quality Chasm: A New Health System for the 21st Century, National Academy Press, P. Reed, D. Conrad, S. Hernandez, C. Watts and M. Marcus-Smith, Innovation in Patient-centered Care, BMC FamPract, HealthIT.gov, Consumer ehealth Program, 7. HealthIT.gov, Health IT Adoption Programs and Workforce Development Programs, 8. U.S. Department for Health and Human Services, Health IT Safety Net Employers, 12

13 9. W. Hersh and A. Wright, What Workforce is Needed to Implement the Health Information Technology Agenda? An Analysis from the HIMSS Analytics Database, AMIA Annual Symposium Proceedings, Ibid. 11. HealthIT.gov, Consumer ehealth Program, see reference U.S. Department of Health and Human Services, HIT Workforce, U.S. Department of Health and Human Services, HHS Announces new health IT workforce grants, Dec. 23, 2009, Assessment of the Curriculum, A Different Place, Elizabeth A. Jones, Richard A. Voorhees and Karen Paulson, Defining and Assessing Learning: Exploring Competency-Based Initiatives, U.S. Department of Education National Center for Education Statistics, J. McDonald, Types of Curriculum Evaluation, Office of Educational Assessment, Program Evaluation, D. Stufflebeam, CIPP Evaluation Model Checklist, CIPP Evaluation Model: Decision-oriented Approaches, Oregon Program Evaluators Network, B. Robinson, The CIPP Approach to Evaluation: COLLIT Project: A Background Note From B. Robinson, May 4, 2002, IPP%20Approach%20to%20Evalaution.pdf. 21. Curriculum Development and Evaluation: The CIPP Model, Nova Southeastern University - Graduate School of Computer and Information Sciences, American Health Information Management Association (AHIMA), Vision 2016: A Blueprint for Quality Education in Health Information Management, AHIMA, Office of the National Coordinator, Health IT Adoption Programs: Workforce Development Program, C. Plaza, J. Draugalis, M. Slack, G. Skrepneck and K. Sauer, Curriculum Mapping In Program Assessment and Evaluation, American Journal of Pharmaceutical Education, Vol. 71, No. 2, W. Hersh and A. Wright, What Workforce is Needed to Implement the Health Information Technology Agenda? An Analysis from the HIMSS Analytics Database, see reference 9. 13

14 26. R.M. Harden, AMEE Guide No. 21: Curriculum Mapping: A Tool for Transparent and Authentic Teaching and Learning, MedTEACH, W. Zywiak, U.S. Healthcare Workforce Shortages: HIT Staff, Computer Sciences Corporation, 2010, E. Huizenga, Studies: EHR Implementation Falling Prey to Health IT Labor Shortage, March 4, 2013, 14

15 About the authors Cheryl A. Plettenberg, EdD, RHIA, FAHIMA Cheryl A. Plettenberg, EdD, RHIA, FAHIMA received her doctorate degree from Wayne State University in Detroit in 1998 in curriculum and instruction, her master s degree in Public Health Administration from the University of San Francisco in 1986 and her bachelor s degree in Healthcare Administration from Colorado Women s College in Denver in She has been a registered health information administrator (RHIA) since She serves as the chair and associate professor for the Department of Health Information Management at Alabama State University. She is a member of the editorial board for the peer-reviewed journal of AHMA, Perspectives in Health Information Management, and is a member of the National Council on Education Workforce Committee. Additionally, Plettenberg is the Executive Director of the Alabama Family Youth Initiative and serves on multiple community organizations assisting youth. She has served as a principal investigator for drug-free grants for education as well as numerous state and federal grants over the years. Recently, Plettenberg developed a post-baccalaureate, 12- week seminar to support Registered Health Information Administrator certification. LaShunda Blanding Smith, MSM, RHIA, CHDA, HITPro-IM, HITPro-TR LaShunda Blanding Smith received her master s degree in management from Troy University and her bachelor s degree in health information management from Alabama State University. She is completing her doctoral studies at Capella University. She holds RHIA, CHDA, HITPro-IM and HITPro-TR credentials and is a AHIMA-certified ICD-10 trainer. Smith is an associate professor, division director and HIM program director at Tougaloo College. She teaches a variety of courses, including EHR processing and management. Smith began her 10-year professional HIM journey in a large, acute care health system, serving on various committees including The Joint Commission readiness team and the Medical Audit and Utilization Review Committee. She owns a HIM consulting business. She has continued to work in education and was featured in For the Record in HIM as a "HIM transformer" because she strongly believes in educating for the future of HIM. She was also nominated for the AHIMA Rising Star Award and coauthored Redefining HIM Leadership: Towards an HIM Leadership Framework" in Perspectives in Health Information Management through the American Health Information Management Association's (AHIMA) foundation. Smith has presented at AHIMA national conventions, assembly on education meetings and a 15

16 host of other scholarly forums. She currently serves as a volunteer on AHIMA s Council for Educational Excellence s Research and Periodicals working group. Susan Hart-Hester, Ph.D, RHIA, HITPro-IM, HITPro-PW Dr. Susan Hart-Hester received her master's degree in psychology from West Georgia College in 1977 and her doctoral degree in curriculum development and special education from the University of Virginia in She received her RHIA in Hart-Hester served as an educational technologist for the Mississippi Department of Education and as coordinator of student teaching for the University of Southern Mississippi before joining the UMMC faculty in She is a professor and her principal responsibility is in the area of grant writing. She serves as director of the Health Professional Shortage Core in the Institute for Improvement of Minority Health and Health Disparities in the Delta Region. She has served as principal investigator and co-investigator for state and federal grants and serves as co-editor of AHIMA s national, peer-reviewed journal, Perspectives in Health Information Management. Sandra Evans, HITPro-IM Sandra Evans received her diploma from Brandon High School in She serves as the project manager for the Health Professional Shortage Core in the Mississippi Institute for Improvement of Minority Health and Health Disparities in the Delta Region (DRI). Prior to this position, Evans served as the project manager for the Center for Health Informatics and Patient Safety for the DRI. She has worked in the academic healthcare setting at the University of Mississippi Medical Center for 19 years. Evans worked in the school of dentistry and biomaterials department as a research associate before transferring to the medical school s patient safety center where she served as the grant administrator for the project Addressing Preventable Medication Use Variance in Mississippi funded through the Agency for Healthcare Research and Quality. Her areas of expertise include business administration and research. She is actively involved in community service focused on domestic violence, children s healthcare and child abuse awareness. 16