In response to the workforce development need for health informatics jobs for healthcare delivery systems

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2 POST- BACCALAUREATE CERTIFICATE PROGRAM IN HEALTH INFORMATICS Abstract In response to the workforce development need for health informatics jobs for healthcare delivery systems in transition from paper-based to electronic health record (EHR) system, California State University, Northridge, is seeking funding to launch a one-year graduate post-baccalaureate certificate program in Health Informatics. This funding will enable three CSUN departments (Health Administration, Accounting & Information Systems, and Computer Science) to recruit industry-expert adjunct faculty from our program partner organizations hospitals, clinics and consulting EHR firms. The partners would not only help recruit experienced experts as adjunct faculty, but would also play such critical roles in all aspects of the program as offering internship host sites, providing problem sets for our Capstone Project course, providing access to commercial EHR and other HIT tools (e.g., Electronic Ordering Systems, Decision Support Tools, Clinical Data Exchange, and Communication with patients) and particular emphasis on experiential learning consisting of Capstone Project, hands-on laboratory, and employability skills. Though health informatics certificate programs utilizing fully online courses in UC schools such as UC Davis and UC San Diego have been very successful in terms of enrollment growth, we believe that a traditional in-house program like ours would be the best format for optimizing the benefit of experiential learning. Our target student populations of all backgrounds (IT, management, and healthcare/clinical) and with varying employment status (jobless workers, working professionals, and recent college graduates) would gain experience that healthcare providers are acutely looking for. By allowing graduate credit for the program courses, our program also encourages students to pursue ges offer (Health & Human Development, Business and Economics, Engineering & Computer Science).

3 Statement of Need In anticipation of benefits of the adoption and meaningful use of Electronic Health Records (EHRs) 1, the Bush Administration in 2004 initiated one of the most significant changes in the history of healthcare: establishing EHRs at all levels of healthcare and medicine. As stipulated in the 2009 Health Information Technology for Economic and Clinical Health Act (HITECH Act) signed by President Obama, starting from October 2011, states including California have begun offering billions of dollars as financial incentives to healthcare providers to adopt and demo s. A recent report of EHRs and their supporting technology adoption and use in California 2 shows that before the year , approximately half of physicians reported working at practices with EHRs in place. As of 2012, the growth in adoption and use of EHRs and supporting tools among healthcare providers in California will be accelerated. The transition from traditional, paper-based medical files to EHR technologies will expand career pathways in health information technology (HIT). To help speculate how many HIT jobs could be created in hospitals, physicia, Table 1 shows that in Los Angeles County alone, there are more than 100 hospitals in operation, along with 373 skilled nursing facilities and 779 other types of health facilities, not to mention a number of single and multi-physician practices. With the rapidly aging population, the number of health care providers will surely continue to be one of the fastest growing industries in California. Recognizing the tremendous demand for HIT workers to help healthcare providers in transition from paper-based to electronic record system, HITECH Act has also funded workforce development programs including 1 According to a study (Can electronic medical record systems transform health care? Potential health benefits, savings, and costs, Health Affairs, 24(5)), the adoption of interoperable EMR systems could produce efficiency and safety savings of $142 $371 billion. 2 HIT adoption and use in California, California Healthcare Foundation, HIT use by hospitals varied widely by type of HIT tool (e.g., Electronic Ordering Systems, Decision Support Tools, Clinical Data Exchange, and Communication with patients). While nearly 90 percent of California hospitals reported having or being in the process of installing clinical decision support systems, only 40 percent reported having order entry systems installed.

4 community college-level, university-level training programs, and curriculum development for such training. Table 1. The Number of Hospitals and Health Facilities in Los Angeles and Orange Counties Type Health Facilities Los Angeles Orange Hospitals Long-Term Care Community Clinics Short-term General Hospitals (in 2007) Short-term Non-General Hospitals; Long-Term Hospitals (in 2007) 25 9 Veterans Hospital (in 2007) 2 0 Skilled Nursing Facilities (in 2007) Nursing Facilities (in 2008) 19 2 Hospices (in 2008) Home Health Agencies (in 2008) Ambulatory Surgery Centers (in 2008) Community Mental Health Ctrs (in 2008) 3 0 Fed Qualified Health Centers (in 2008) 57 3 Source: 2009 Area Resource File, American Medical Association An analysis of employment data 4 projects that the demand for HIT workers trained at the community college level will be greater than the supply in Los Angeles and Orange Counties over the next three years. Of 82 community colleges in all 50 states where short-term (i.e. 6 months or less) health IT education and training programs funded by HITECH produce Health IT professionals, ten community colleges in California have begun to produce graduates starting in 2010, with two community colleges producing about 40 completers per cohort in the Los Angeles area. Programs at the university level have also been funded, but no such programs are located in California. Only two private schools one in Los Angeles and the other in San Bernardino County produce MS/BA graduates targeting HIT jobs. Table 2 lists names of educational/training programs (bold-italicized programs are located in our program target area). Some of the community college programs will end in 2012 when two-year funding phases out by then. 4 Environmental Scan: Health Information Technology, Center of Excellence, 2010

5 Table 2. Inventory of Training Programs for the Occupations Being Targeted School Name City Last Cohort Size Community College Butte College Oroville In the process of creating program Roles/Occupation Practice Workflow and Information Management Redesign Specialist Implementation Support Specialist Cosumnes River College Sacramento 35 Health Information Coding Specialist East LA College Monterey 57 Technical/Software Support Staff Park Fresno City College Fresno In the process of creating program Practice Workflow & Information Redesign Specialist Role Los Rios Community College District Sacramento In the process of creating program Health Care IT Implementation Support Specialist Health Care IT Technical Support Specialist Health Care IT Trainer Mission College Santa Clara 35 Practice Workflow & Information Management Redesign Specialist Clinician/Practitioner Consultant Implementation Support Specialist Implementation Manager Technical/software support staff Trainers Orange Coast College Costa Mesa Implementation Support Specialist Implementation Manager Technical/software support staff Trainers San Diego Mesa College San Diego 50 Practice Workflow and Information Management Redesign Specialist Santa Barbara City College Santa Barbara 48 Clinician/Practitioner Consultant Santa Monica College Santa Monica 43 Implementation Manager Trainers Four-Year College Loma Linda University Loma Linda Not available Medical Coding Specialist (Certificate) Health Information Administration (Bachelors) Health Information Administration (Certificate) Health Information Technology (Progression Bachelors) Graduate (Master-level) College Claremont Graduate University Claremont 7 MS in Health Informatics Management

6 Proposed Solution Since 2009, three departmental chairs from three Colleges at CSUN have identified and engaged a team of faculty from Health Administration, Computer Science, and Accounting & Information Systems to prepare for a certificate program in health informatics, administratively supported by the Tseng College State Directors of Career/Technical Education 5, the team of faculty has begun to review existing courses that the proposed program use to target careers as defined in the Health Informatics Pathway: Careers in the Health Informatics pathway include many different levels of health care related employment. This pathway includes health care administrators who manage health care agencies as well as those individuals who are responsible for managing all of the patient data and information, financial information, and computer applications related to health care processes and procedures. After discussions as to whether existing courses can be modified for use in the proposed program or new courses should be developed, the team has recommended that three new courses be created to address new skills and knowledge and that three existing courses be significantly restructured. The team has presented a draft list of proposed courses to the department chairs and the three Colleges deans for informal discussions on resource allocations among stakeholders. The new courses proposed for the program include Managing Projects in Health Informatics (3 units), Healthcare Information System Analysis and Design (3 units), and Introduction to Health Informatics (3 units). The team has also recognized the importance of two complementary features, hands-on training and new career transitions as currently utilized in Georgia Southern Polytechnic State rogram in HIT for IT professionals 6. Table 3 provides a matrix of the proposed courses and learning outcomes, organized under four components: pre-requisites for students of non-healthcare background, health 5 Under the sponsorship of the U.S. Department of Education and the National Association of State Directors of Career/Technical Education, using national advisory committees composed of educators as well as business and industry representatives, t ed in the United States about 10 years ago to help US States and schools refocus their programs of career and technical education (CTE) (formerly known as vocational education) around clusters of similar occupations. 6 <

7 Table 3. Courses, Learning Outcomes and Lead Organizations Pre-Requisite Courses Proposed Tentative Learning Outcomes Lead Organization Systems in Health Gain a fundamental understanding Health Administration Delivery in the US of the vast and complicated U.S. Department system. Introduction to Health Informatics Gain a comprehensive perspective of the issues in healthcare information technology. Health Administration Department Healthcare Information System Analysis and Design Describe Systems Analysis and Design methodologies and techniques for healthcare Information System development Computer Science Core Courses: HealthCare and IT Managing projects in health informatics Describe processes and structures necessary to understand before implementing new IT systems within a healthcare environment. Accounting & Information System Department Seminar in Healthcare Information Management Describe the electronic medical record, personal health records and clinical decision support systems; the use and integration of commercial solutions; meaningful use of these systems; and the assessment and acquisition of technology. Health Administration Department Capstone Project Tackle a real life, complex project that will demonstrate integration of knowledge gained in the courses of the certificate. Health Administration Department Experiential Learning Internship Gain hands-on experience and training in host sites Health Administration Department New Career Transitions Hands-on Lab Employability Skills Use commercial HIT tools to access, manage, integrate, and create information. Know and understand the importance of employability skills. o HIT Specific interview skills o Shadowing in potential employers o Effective Resume writing techniques o Recommendation letters Computer Science Tseng College care/it, experiential learning and new career transitions. In particular, HIT Capstone Project adheres to the format of the CSUN MBA program Consulting Project. Through this course, students have the opportunity to deliver professional level consulting services to healthcare providers in transition to EHR

8 use in the Los Angeles area. The project can be conducted solo or by a group of three students working under the guidance of. Some local healthcare providers and HIT consulting firms have agreed to play critical roles in the proposed program (Table 4). As shown in their letters of support that are attached to this proposal, they will not only provide internship opportunities they will also facilitate the recruitment of adjunct faculty for the proposed certificate program. They will recommend staff members who have extensive experience with EHR implementation and/or secondary use of EHR data to teach as instructors. Industry-expert instructors are in the best position to provide input regarding the competencies and skills that employees need in order to have successful careers. These instructors are expected to teach the students sets of skills that will increase their chances of employment. These instructors are also expected to bring real consulting project cases for our Capstone Project. Table 4. Partner Representatives Name Organization Organizational Position Sanjeev Sehgal Trinus Corporation Vice President Sam A Gowhar T & T Solutions Inc CEO Caroline L. Goldzweig Marsha Chan VA Greater Los Angeles Healthcare System St. Francis Medical Center in Lynwood Associate of Chief of Staff, Clinical Informatics Senior VP/Chief Quality Officer Weip Chen Providence Health and Services Chief Medical Information Officer Holly Ann Schij Kaiser Permanente Medical Center -- Woodland Chief Medical Group Administrator Sonali Perera Glendale Community College Director, Health Information Training Program Project Objectives and Measurable Outcomes Table 5 identifies program objectives and maps them to Commission Objectives, along with program outcome measures, which will be updated with the input from our industry advisory board.

9 Table 5. M atrix of CSUN Objectives/Outcomes Mapped to Commission Objectives Commission Objective Proposed Program Objective Outcome M easures workforce development needs Increase access to educational opportunities by serving broader constituencies Provide personal and lifelong learning opportunities Target HIT industry, which has an acute workforce development need in Los Angeles Area Target a broader range of background: working individuals: jobless workers, 4-year college graduates, completers of a community college HIT training program; Target a broader range of background IT, health care, management, and clinical science Provide curriculum keeping up with ever-evolving HIT to meet changes in knowledge and skills required by future HIT jobs Achieve retention rate of program students to 90% Track program completers to 95% Achieve employment rate of 70% At least 10% of program students who are jobless workers At least 10% of program students who are over 40 years old A balanced composition of students backgrounds, with no background composing more than 50% of the student body Fine tune projects and papers Update syllabus topics to keep up with newly evolving regulations and trends Implementation Plan The following is a detailed implementation plan where major activities are discussed with their intended outcomes and timelines. Time Line/ Activities Objectives Outcomes March-June, Set up and convene advisory board 2. Discuss the new courses and the existing courses proposed for the program. July-August, Move proposal through curriculum approval process at Department and College levels. Fall, Update and enhance proposal for submission to Graduate Studies committee (GSC). Update/refine the tentative program goals/objectives. Develop courses proposed Receive feedback on curriculum/ certificate proposal from departments and colleges Refine curriculum/certificate proposal Work with Tseng on certificate format and infrastructure. Obtain formal approval and CSUN campus sign-off on Certificate. Publish a list of advisory board members. Distribute contents of the courses to stakeholders for feedback Course/module designs/syllabi in hand and all assignments designed and linked to learning goals and the assessment plan at the course and program levels. Formal approval by department and college-level curriculum committees complete, by University-level Graduate Studies Committee Complete.

10 5. Marketing plan refined by Tseng College marketing team working with the curriculum planning team. Preliminary web site in place following approval by the Graduate Studies Committee at the campus level. Tseng College marketing team design of marketing material, websites, documents January-May, Recruit and train faculty. 6. Recruit students for first cohort. June, 2013 Program advisory members refers their staff members for adjunct faculty Launch all aspects of the marketing plan digital, print, and in-person information and orientation presentations along with visits to key organizations and agencies. 7 Enroll the first cohort. Set up the Tseng College electronic application process for this program. All instructional faculty members prepared for the state of the new program and prepared to work together as a team across disciplines. Progress report of applicants and their backgrounds A first cohort of 25 students admitted and enrolled with financial aid successfully disbursed. Impact of the Project, Replication and Dissemination Several UC campuses such as UC Davis and UC San Diego have very successful health informatics certificate programs in operation. For example, certificate/online students account for more than 80% of the health informatics graduate program enrollment growth of 300% over the past three years. By comparison, CSU campuses rarely offer certificate programs in health informatics or HIT, except for the recently launched HIT certificate program at CSU, San Marcos. Taking into account the considerable number of healthcare providers, as well as consulting firms working with them, in Los Angeles County alone and the phasing out of community college-level training programs, our proposed certificate program in Health Informatics will meet the regional demand for HIT workers. CSUN and the Tseng College are committed to collaborating with other CSU campuses to share with each other lessons learned and the practices that have proved to be the best. We plan to present our program design findings through participation in CSU meetings, as well as in regional and/or national conferences once the program is underway and the effectiveness of its learning goals can be better judged via the evaluation plan.

11 Evaluation Plan An evaluation plan is linked to outcomes and an evaluation design will be built into the program from the outset. Table 7 displays a sample table of our program performance outcomes in the final program evaluation report due by the end of grant (e.g., retention rate, program completion rate, etc.) by student characteristics of primary interest (background and employment status). Table 7. Projected Program Performance Outcomes Background Employment Status Measure Health Care IT Management /others Jobless worker Working professionals Prior Students Total Students Beginning Certificate (N=25) 40% 20% 40% 10% 40% 50% Total Students Completing Certificate 90% 90% 90% 90% 90% 90% Total Students Who Complete Certificate that Receive Advanced Degree or Other Credential 20% 20% 20% 20% 20% 20% Total Students Who Complete Certificate who Enter Unsubsidized Employment 70% 70% 70% 70% 70% 70% Total Students Who Retain Unsubsidized Employment in the First and Second Quarters Following Initial Placement 65% 65% 65% 65% 65% 65% Sustainability Plan The certificate program in Health Informatics will continue after the initial development support ceases. CSUN will offer the proposed program through the Tseng College as a self-sufficient program without funding from the State of California. The program fee is approximately $4000-$4500, with 25 students projected as being enrolled to the program per cohort. We also would consider a plan to introduce some if not all of the program courses online, which will surely increase the number of students. In addition, we plan to pursue other external grants such as the Department of Labor workforce/training grants or the Workforce Investment Act Eligible Training Provider grants for student financial aid to pay for the cost of education for eligible students.

12 Budget Narrative The proposed budget totals $218,160 for the design of Certificate in Health Informatics. We are requesting the sum of $47,160 from the Commission. The Tseng College will guarantee matching funds of $84,000, which equals 38% of the total budget. With the Commission funding for the startup, the Tseng College to cover the remaining costs of program development. Faculty/Consultant Curriculum Design Cost. The cost of designing programs mainly stems from compensation of faculty and consultants for their knowledge, expertise, and development course content with linkages to the programmatic learning objectives. Three faculty members are compensated for creating new courses ($6,000 each) and two consultants for creating technical lab and Capstone Project ($6,000 each). Evaluation Cost. It is common practice in the Tseng College to build into each pro operating budget funds for evaluation so that at the end of a first cohort and thereafter, faculty can be compensated for an in-depth review of against ne whether the curriculum is achieving its intended learning outcomes. If discrepancies are discovered, the faculty (regular and adjunct) group conducting the evaluation will recomme ve the learning outcomes. One faculty and two adjunct members will be compensated ($2,000 each). Marketing Cost. The cost of recruiting prospective students is directly related to the marketing plan. We plan to design a website specifically for this program. Furthermore, it is essential to buy advertising in professional journals for health informatics and related fields. There will be in-person marketing through information nights and agency/organization visits. Excluding Tseng College staff time, recruitment cost is estimated at $20,000. Operating Cost. Quarterly Advisory Board meeting (four times) with the program faculty will be held (4 meetings for 14 members (at $15 each for materials and lunch). For instructor training meeting, supplies/ materials and lunch for 8 participants ($40 each).

13 Reproduction and Travel Cost. Duplication of materials and possible travel to different sites and locations are estimated at $12,000. We anticipate that some traveling is required to meet with regional employers and agency at the regional and state levels and to attend conferences that would allow the program to be vetting in draft form with leading practitioners. PROPOSED BUDGET (March 1, 2012 December 30, 2013) PROPOSED BUDGET CEU REQUEST CSUN DEAN SUPPORT PROJECT TOTAL 1. PROGRAM STAFF a. Staff Salaries $40,000 $40, PROGRAM DEVELOPMENT/EVALUATION a. Curriculum Design $30,000 $50,000 $80,000 b. Curriculum Evaluation $6,000 $10,000 $16, OPERATING COSTS a. Advisory meetings $840 $0 $840 b. Instructor training meetings $320 $1,000 $1,320 a. Recruitment Expenses $10,000 $20,000 $30,000 b. Marketing & Advertising $25,000 $25,000 c. Reproduction & Dissemination $6,000 $6,000 d. Travel - Informational Sessions $19,000 $19,000 Totals- CSUN Support & Project $47,160 $171,000 $218,160 TOTAL REQUEST FROM CEU $ 47,160

14 February 21, 2012 Kyusuk Chung, Ph.D. Department of Health Sciences College of Health and Human Development California State University, Northridge Nordhoff Street Northridge, California Re: Letter of Commitment Dear Dr. Chung, The VA Greater Los Angeles Healthcare System (GLA) Informatics Division is pleased to express its commitment to collaborating with California State University, Northridge (CSUN) in its proposed Health Informatics Certificate Program. We are particularly interested in partnering with CSUN in Electronic Health Record (EHR) training. The Department of Veterans Affairs is well known for its EHR system, VistA/CPRS. The VistA system is a proven product and can be readily adapted for use in acute care, ambulatory, and long-term care settings. It has been used in public and private healthcare provider organizations across the United States and in a number of international settings. As evidence of our commitment to this program, we will serve on the program's advisory board and provide input regarding the competencies and skills that employees need in order to succeed in careers at VA GLA. We are pleased to support this project by helping recruit members from our Office of Technology and Information Services to teach as adjunct faculty for the proposed certificate program and by providing opportunities for field experience. In addition, participants in the project will have the opportunity to go on tours of our facilities and explore careers at VA LA. We are especially interested in including veterans in our workforce and have been very fortunate to recruit veterans from CSUN's programs for placement at VA GLA. Programs such as these are vital resources for the development of the skilled personnel required to meet our emerging workforce needs. We look forward to expanding and strengthening our relationship with the College of Health and Human Development and Department of Health Sciences and working with CSUN as a partner in this important project. Caroline Lubick Goldzweig, MD, MSHS Associate Chief of Staff, Clinical Informatics VA Greater Los Angeles Healthcare System Health Sciences Professor, David Geffen School of Medicine at UCLA

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17 February 21, 2012 Kyusuk Chung, Ph.D. Department of Health Sciences College of Health and Human Development California State University, Northridge Nordhoff Street Northridge, California Re: Letter of Support Dear Dr. Chung, Kaiser Permanente Woodland Hills is committed to partnering with California State University, Northridge (CSUN) in its Health Informatics Certificate Program. In many ways this is an extension of the existing partnership we have with CSUN. In the last two years we have engaged CSUN students in gaining field experience with our KP HealthConnect electronic medical record and Radiology Information Systems in the Diagnostic Imaging Department and are very proud of this on-going relationship for its obvious benefits to our hospital and physicians as well as for the CSUN students. regarding the competencies and skills that employees need in order to succeed in their future careers. We are pleased to support this project by helping find adjunct faculty for the proposed certificate program from our staff. It is our belief that this program is vital to our community and the members we serve by providing a stream of qualified professions that can be recruited as we experience tremendous growth in the patient care needs and services over the next decade. We look forward to expanding and strengthening our relationship with the College of Health and Human Development and Department of Health Sciences and working with CSUN as a partner in this important project. Sincerely, Mike Bruse Department Administrator Diagnostic Imaging Woodland Hills Kaiser Permanente

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