AMERICAN INSTITUTES FOR RESEARCH

Transcription

1 AMERICAN INSTITUTES FOR RESEARCH AHIMA NATIONAL WORKFORCE ASSESSMENT FINAL REPORT AHIMA NATIONAL WORKFORCE ASSESSMENT DELIVERABLE 3: FINDINGS FROM NATIONAL WORKFORCE ASSESSMENT SURVEY & INTERVIEWS Prepared by: American Institutes for Research Education, Human Development, and the Workforce Division 1000 Thomas Jefferson Street, NW Washington, DC Prepared for: Scott Mackenzie Director, Business Insight & Market Analytics American Health Information Management Association (AHIMA) 233 North Michigan Avenue, 21st floor Chicago, IL Notice of Trademark: AMERICAN INSTITUTES FOR RESEARCH and AIR are registered trademarks. All other brand, product, or company names are trademarks or registered trademarks of their respective owners THOMAS JEFFERSON STREET, NW WASHINGTON, DC

2 TABLE OF CONTENTS TABLE OF CONTENTS... I LIST OF FIGURES... III LIST OF TABLES... IV EXECUTIVE SUMMARY... 1 INTRODUCTION... 3 BACKGROUND AND RESEARCH OBJECTIVES... 3 ORGANIZATION OF THE REPORT... 4 SME INTERVIEWS... 5 GENERAL FINDINGS... 5 USE OF INFORMATION GATHERED... 7 NATIONAL SURVEYS... 8 INTRODUCTION... 8 METHOD... 8 Item-writing... 8 Pilot Testing... 9 DATA COLLECTION... 9 Assuring Respondent Access... 9 Sending Invitations to Participate... 9 Administering the Survey... 9 Tracking Survey Responses and Follow-up RESPONDENTS Respondent Characteristics Job Characteristics Qualifications FINDINGS Current and Future Market Demand Job Roles and Responsibilities Qualifications Sought Utilization SUMMARY LESSONS LEARNED & RECOMMENDATIONS LESSONS LEARNED Current and Future Demand American Institutes for Research i

3 Job Roles and Responsibilities Qualifications Sought Utilization ACTIONABLE RECOMMENDATIONS Addressing the Market Focusing Education and Credentialing Marketing Graduate-Level Professionals Summary CONCLUSION USE OF INFORMATION GATHERED APPENDIX A: INTERVIEW PROTOCOL... A-1 APPENDIX B: SME INTERVIEW FINDINGS DELIVERABLE... B-1 APPENDIX C: SURVEYS... C-1 APPENDIX D: SURVEY COMMUNICATIONS... D-1 APPENDIX E: SEARCH FIRM RECRUITER SURVEY FINDINGS... E-1 APPENDIX F: BRIEFING OFFERED AT AOE... F-1 APPENDIX G: FACTORS CONSIDERED WHEN CHOOSING TERMINAL DEGREES... G-1 APPENDIX H: INDUSTRIES HIRING HIM PROFESSIONAL OR USING HIM KNOWLEDGE... H-1 APPENDIX I: INDUSTRIES WITH AN INCREASING DEMAND FOR HIM PROFESSIONALS... I-1 APPENDIX J: HIM TASK DOMAINS: EXTENT PERFORMED AND PROFICIENCY REQUIRED... J-1 APPENDIX K: CERTIFICATIONS AND DEGREES HELPFUL WHEN APPLYING FOR HIM JOBS... K-1 APPENDIX L: CERTIFICATIONS AND DEGREES HELPFUL WHEN HIRING FOR HIM JOBS: EMPLOYERS PERSPECTIVE... L-1 APPENDIX M: HIM TASK DOMAINS: CERTIFICATION AND EDUCATION REQUIREMENTS... M-1 APPENDIX N: CERTIFICATIONS AND DEGREES IMPORTANT FOR SPECIFIC JOBS... N-1 APPENDIX O: COMPETENCIES RELEVANT NOW AND IN TEN YEARS... O-1 American Institutes for Research ii

4 LIST OF FIGURES Figure 1. Respondent Age in Years Figure 2. Respondent Tenure in the HIM Profession Figure 3. Respondent Salaries Figure 4. Respondent Credentials Figure 5. Respondent Education Figure 6. Percent of Practitioners Who Perform Each Task Domains Figure 7. Percent of Practitioners Reporting Proficiency Needed for Each Task Domain Figure 8. Percent of Practitioners Who Perform Each Task Domain Figure 9. Percent of Practitioners Reporting Proficiency Needed for Each Task Domain Figure 10. Percent of Practitioners Who Perform Each Task Domain Figure 11. Percent of Practitioners Reporting Proficiency Needed for Each Task Domain Figure 12. Percent of Practitioners Who Perform Each Task Domain Figure 13. Percent of Practitioners Reporting Proficiency Needed for Each Task Domain Figure 14. Percent of Practitioners Who Perform Each Task Domain Figure 15. Percent of Practitioners Reporting Proficiency Needed for Each Task Domain Figure 16. Percent of Respondents Who Said Qualification Helps When Applying Figure 17. Value of MHIM versus Other Master s Degrees: Practitioner Responses Figure 18. Value of MHIM versus Other Master s Degrees: Employer Responses Figure 19. Percent of Practitioners Who Agreed that MHIM is More Valuable Figure 20. Percent of Employers Who Agreed that MHIM is More Valuable Figure 21. Types of Non-HIM Professionals Competing for HIM Jobs American Institutes for Research iii

5 LIST OF TABLES Table 1. Summary of Findings (Listed Alphabetically under each Research Question)... 6 Table 2. Respondent Race Table 3. Percent of Respondents Working in Each Setting Table 4. Top Factors Considered when Choosing Terminal Degrees by Education Table 5. Organizations Hiring HIM Professionals or Using HIM Knowledge Table 6. Factors Influencing Demand for HIM Professionals or Their Knowledge Table 7. Task Domains Performed in Job and Proficiency Required Table 8. Task Domains Performed in Job and Proficiency Required Table 9. Task Domains Performed in Job and Proficiency Required Table 10. Task Domains Performed in Job and Proficiency Required Table 11. Task Domains Performed in Job and Proficiency Required Table 12. Degree and Certification Requirements for Task Domain Categories Table 13. Certification Requirements for Various Jobs Table 14. Education Requirements for Various Jobs Table 15. Certifications Needed in Ten Years Table 16. Education Needed in Ten Years Table 17. Top 5 Competencies Relevant for HIM Work Now and in the Future Table 18. Background of Non-HIM Professionals Working in HIM Jobs American Institutes for Research iv

6 EXECUTIVE SUMMARY BACKGROUND: The American Health Information Management Association (AHIMA), in conjunction with its contractor, the American Institutes for Research (AIR), has conducted a national workforce assessment to identify information about the current and future demand for health information management (HIM) professionals. A secondary objective was to identify how HIM professionals are being employed and utilized in their organizations. RESEARCH PLAN: AIR developed a strategy for conducting the national workforce assessment that consisted of three major research activities: A background research review of the extant literature; Twenty interviews with subject matter experts; and A survey of practitioners, employers, and search firm recruiters. SUMMARY OF STUDY FINDINGS: There are four major outcomes from this study: Demand is on the rise at all levels of education and credentialing! There are approximately 12,000 to 50,000 new jobs anticipated over the next 8 years. Employers believe that new skills are needed from HIM practitioners at the graduate level: o Financial Knowledge; o Hospital Organization Knowledge; o Knowledge of Systems and Policy; o Management Experience; and o Pharmaceutical Knowledge. Three types of professionals compete for HIM positions: o Allied Health Professionals; o Business Management Professionals; and o Nurses. The Master s in HIM (MHIM) degree option is considered more valuable than other graduate degrees (Master s in Business Administration [MBA], Master s in Health Administration Services [MHAS], and Master s in Public Health [MPH]) by 1 in 3 employers. The Master s in HIM (MHIM) degree option is considered more valuable than other graduate degrees (Master s in Business Administration [MBA], and Master s in Public Health [MPH]) by 2 in 5 search firm recruiters. Recruiters and employers alike make distinctions between all available credentials. American Institutes for Research 1

7 ACTIONABLE RECOMMENDATIONS: There are five major actionable recommendations based upon the findings of this study, outlined below. First, we recommend continuing to target the types of organizations that are currently hiring HIM professionals, thereby identifying their needs, filling their HIM roles, and marketing HIM professionals and knowledge to them. To expand the use of HIM professionals outside the current market, consider other industries who: (1) have been affected by changes to billing, charting, and reporting practices; utilize clinical terminology and classification systems; and are subject to HIPAA requirements; and/or (2) have a need for people who are proficient in health data management, health services organization and delivery, information technology, project operations, and leadership skills. In addition, it may be possible to increase the HIM presence in the pharmaceutical industry by drawing a clearer link between HIM qualifications and the needs of that industry. Second, AHIMA may want to explore the extent to which HIM education and credentialing focuses on data management; quality management; coding; and healthcare privacy, confidentiality, legal, and ethical issues. These types of tasks are particularly relevant for HIM practitioners right now. Furthermore, to keep pace with the increasing demand for HIM professionals, education and credentialing should continue to focus on knowledge in health information/data technical security and skills in writing, computer use, health informatics and information, data analysis, problem solving, leadership, and communication. Third, it may be helpful to place increased emphasis for education and credentialing on knowledge of healthcare organizations, organization and management, finance, systems and policy, and pharmaceuticals. In particular, focusing on knowledge of healthcare organizations and management may help market HIM professionals more competitively against the non-him professionals currently being employed in HIM roles. Fourth, AHIMA may want to consider marketing Graduate-level HIM professionals differently than those without Graduate degrees, including targeting different industries and highlighting the skills associated with the task domains most commonly performed by Graduate-level practitioners (e.g., problem solving, usability, organization and management). To further market Graduate-level HIM professionals, it will be important to clearly identify and highlight the differences between the MHIM degree and other types of Master s degrees. Fifth, AHIMA may want to explore the differences among the tasks completed by HIM practitioners with Master s degrees and those without. Do these differences illuminate important value added for graduate-level professionals or a deficit to fill for nongraduate-level practitioners? American Institutes for Research 2

8 INTRODUCTION Background and Research Objectives The mission of the American Health Information Management Association (AHIMA) is to improve the nation s health through the advancement of best practices and standards for health information management (HIM). AHIMA serves as the primary professional community and the trusted source for HIM education, research, and professional credentialing. As part of its strategic research activities to serve its membership, AHIMA solicited the help of the American Institutes for Research (AIR) to conduct an environmental scan of the HIM labor market. For this environmental scan, AIR proposed holding a kickoff meeting where project goals and the project work plan could be finalized. At this meeting, held on October 23, 2008, AHIMA and AIR jointly determined that the environmental scan should consist of both subject matter expert (SME) interviews and a national workforce survey. This document outlines the procedure followed by AIR to conduct the environmental scan and the results of both the Subject Matter Expert (SME) Interviews and the National Survey of AHIMA Workplace Trends. This introductory chapter describes the results of the kickoff meeting by detailing the prioritized project objectives and research questions that were established. The chapters that follow describe the conduct and findings of the interview and survey data. During the kickoff meeting, AHIMA and AIR jointly identified a prioritized set of research objectives for the project. These project goals were: Gaining an understanding of the future size, scope, and nature of the employment market for HIM practitioners across all levels of education and credentialing; Identifying the number of new positions that will be created outside of the contemporary healthcare (e.g., hospital) environment for all levels of education and credentialing; Determining to whom HIM practitioners can market themselves given their current and future knowledge, skills, and abilities (KSAs); Identifying the qualifications (e.g., education, certifications, KSAs) employers and search firms will demand in the future; and Examining the role of credentialing and certification in setting employment market demand. An additional objective identified by AHIMA staff was to identify the day-to-day functioning of HIM practitioners today. This objective stemmed from two core research questions: What are the realities of the jobs being performed by HIM practitioners today? What are the qualifications that employers view as minimum requirements to perform the real, day-to-day tasks of HIM practitioners? American Institutes for Research 3

9 The following four questions collectively represent the primary research questions to be addressed by the National Workforce Assessment project: What is the incremental value of various HIM degrees and credentials from practitioners, employers, and recruiters perspectives? What positions (at contemporary and non-contemporary employers) will be available to HIM practitioners in the coming years? How might HIM practitioners skill sets be attractive to emerging market employers like pharmaceutical companies and consumers of health information? What actions can AHIMA take to ensure that HIM practitioners are best served to meet the market demand? AHIMA and AIR chose a work plan that addressed each of the identified project objectives and key questions. This plan consisted of the following tasks and subtasks: Task 1: Finalizing Research Goals and Work Plan; Task 2: Conducting Background Research and Document Review; Task 3: Gathering Expert Input on Employment Market Demand; Task 4: Conducting a Stakeholder Survey; Task 5: Validating the Estimate at a SME Meeting; and Task 6: Developing a Report and Brief to AHIMA. Organization of the Report As previously stated, this report describes the work performed and findings of the AHIMA National Workforce Assessment, including the Subject Matter Expert (SME) Interviews and the National Survey of AHIMA Workplace Trends. Following this introduction to the project, the report is organized according to the critical phases of the work plan. As such, in the second chapter, a brief synopsis of the SME Interview procedures and findings is provided (the complete Findings from Subject Matter Expert Interviews deliverable is located in Appendix B). In the third chapter, the National Survey of AHIMA Workplace Trends data and findings are presented, including a description of the procedures followed to collect data, respondent characteristics, and survey finding. Following this summary, in the fourth chapter, some of the major lessons learned from the data are presented followed by actionable recommendations for AHIMA to consider. In the final chapter, broad conclusions are drawn and suggestions for use of the information gathered are provided. American Institutes for Research 4

10 SME INTERVIEWS As part of AIR s environmental scan of the HIM labor market, SMEs from various disciplines and areas of expertise were interviewed. Interviews were designed to identify general trends in HIM practitioner staffing and employment, as well as how these trends might impact future employment demand. Interviewees were asked questions based upon the primary research questions identified at project inception. To assist the interviewer in obtaining as much detail as possible, follow-up interview probes were developed for many of the questions. The protocol provided a standardized structure for asking the same basic questions of all SMEs and also served as the note-taking document for the interviews. Nineteen HIM experts were interviewed for this study (see Exhibit 1 for a list of the interview participants and their affiliations). AHIMA representatives recommended the researcher and practitioner participants and AIR identified the search firm recruiters. Practitioners were selected from among the AHIMA membership based on their education and credentials. The goal of practitioner selection was to ensure that the potential interviewee list contained individuals with a variety of educational backgrounds, continuing education (e.g., credentials), and experience. The interviews were conducted by telephone and each interview lasted approximately 90 minutes. However, the interviews tended to last longer when the interviewee had more experience (i.e., longer time in the field) and had been exposed to a variety of different HIM jobs. General Findings Valuable information about the current status and future prediction for the HIM workforce in five key areas was obtained during the interviews: current market demand, future market demand, job roles and responsibilities, qualifications sought, and employer utilization of HIM professionals. Specifically, the interviews findings were easily organized according to the following questions: What factors are driving the current market demand for HIM practitioners? Which industries will hire more HIM practitioners? What skills will be necessary for future HIM practitioners? What types of jobs are held by HIM practitioners at various levels of education? How are HIM practitioners utilized by organizations? What qualifications do employers most desire in HIM practitioners? Answers for each of these questions are identified in Table 1. It is important to note that findings represented in this table indicate consensus responses from SMEs. That is, the qualitative SME data was reviewed and popular responses across participants were identified. These consensus responses are listed in the table in alphabetical order according to their respective research question. American Institutes for Research 5

11 Table 1. Summary of Findings (Listed Alphabetically under each Research Question) What factors are driving the current market demand for HIM practitioners? Additional Academic Positions Community Programs Economy/Recession Government Regulations (e.g., Health Insurance Portability and Accountability Act [HIPAA]) Transition to Electronic Medical Records (EMRs) Use of Personal Health Records (PHRs) Which industries will hire more HIM practitioners? Academic Medical Centers Consulting Firms Insurance Companies Pharmaceutical Research Firms Pharmacy Corporate Offices What skills will be necessary for future HIM practitioners? Financial Knowledge Hospital Organization Knowledge Management Experience Pharmaceutical Knowledge Public Speaking Ability What types of jobs are held by HIM practitioners at various levels of education? Associate's Degree: Billing Coding Database Management Record Management Bachelor's Degree: Billing Management Coding Department Management Data Quality Assurance Project Management Graduate Degree: EMR Systems Management HIM Education Public Policy Systems Implementation Upper Management American Institutes for Research 6

12 Billing Accuracy and Efficiency Data Analysis Healthcare Information Systems Patient Information Security Coding Experience Table 1: Summary of Findings Continued How are HIM practitioners utilized by organizations? What qualifications do employers most desire in HIM practitioners? Computer Skills Credentials (e.g., Registered Health Information Technician [RHIT], Registered Health Information Associate [RHIA], Certified Coding Associate [CCA]) Critical Thinking Ability Data Analysis Skill Knowledge of the Healthcare Industry / HIPAA / Other Regulations Management Experience / Leadership Skills Writing Ability Use of Information Gathered The results from the SME Interviews were used by AIR, among other things, to inform the content of the National Survey of AHIMA Workplace Trends. The chapter that follows provides details on the method used to develop and distribute these surveys, a description of the HIM respondent characteristics, and a detailed explanation of the data and findings gathered. American Institutes for Research 7

13 Introduction NATIONAL SURVEYS As a second step to aid AHIMA in their mission to improve the nation s health through the advancement of the HIM profession, AIR conducted a National Survey of AHIMA Workplace Trends directed at three expert groups in the field: (1) HIM practitioners, educators, and researchers; (2) HIM employers; and (3) HIM search firm recruiters. This report presents results from the HIM practitioner, educator, researcher and employer surveys. 1 This chapter regarding the survey findings begins with a review of the data collection techniques used, including the method used to develop the questionnaire and the process by which AIR collected the quantitative data. Next, respondent characteristics are described, followed by the survey results. Results from the practitioner and employer surveys are presented together to allow for the comparing and contrasting of responses across the respondent groups. Findings are also discussed in terms of AHIMA member and non-member perspectives. These results are presented within the following topic areas: Current Market Demand; Future Market Demand; Job Roles and Responsibilities; Qualifications Sought; and Utilization. Method AIR worked with AHIMA to identify the research questions that were most critical to understanding the current state and future needs of the HIM industry. Then, we developed survey questions that would address these goals. We refined these questions through several iterations of comments by AHIMA representatives and results of the SME interviews discussed above, and then verified that the questions were unambiguous and universally understood. We then pilot tested the items and techniques using a subsample of respondents before we sent the survey invitations to the full sample. Item-writing Creation of the AHIMA Workplace Trends Questionnaire began with a meeting with AHIMA representatives to determine the specific aims of the research and the most appropriate means of answering the identified research questions. As a result of this meeting, AIR developed a set of preliminary items for AHIMA review. This process, which was repeated several times with various individuals and groups at AHIMA and AIR, resulted in a preliminary list of survey 1 The search firm recruiter survey was completed by only 36 respondents. Because this sample is so small, the findings of the survey are reported in a separate Appendix (see Appendix E). American Institutes for Research 8

14 questions. AIR then edited this list to verify that all of AHIMA s research questions had been addressed and removed redundant or irrelevant questions. Pilot Testing After the survey was refined through multiple rounds of edits, we pilot-tested the procedures by administering it to a small subsample of 25 respondents. The procedure showed a limited number of typographical errors that were resolved prior to the full-scale launch. Data Collection AIR proposed using a web survey for data collection with potential respondents for whom AHIMA provided contact information. The web survey programming utilized standard, secure HTML, enabling any respondent who could access a web site to also access the AHIMA survey. AIR provided an address and a toll-free telephone number for respondents to use in the event they experienced technical difficulty. Tasks involved in administration of the survey included: Sending invitations to participate; Assuring respondent access; Administering the web survey; Tracking survey responses/follow-up; and Developing an analysis database. Assuring Respondent Access All of the respondents who were identified by AHIMA had the opportunity to participate in the web survey. AHIMA provided AIR with addresses of 19,000 potential respondents from AHIMA membership databases. Respondents accessed the survey through customized links that allowed us to track their responses. Sending Invitations to Participate Using AHIMA s database of practitioners and employers in the HIM field, we sent invitations to participate in the survey. In order to increase response rates, we offered a chance to win one of five ipods, or one of 20 Starbucks gift cards 2, for completing the survey. The invitation is included in Appendix D. Administering the Survey The web survey was accessible to respondents 24 hours per day for a total of 8 weeks. After accessing the survey through their , respondents were sent to an introduction page that explained the survey objectives and stressed the importance of participation. Respondents completed the survey by clicking on pre-coded items and typing responses for open-ended items. 2 In addition, search firm recruiters received a $5 Starbucks gift card for responding and had the opportunity to win a Kindle 2. American Institutes for Research 9

15 Tracking Survey Responses and Follow-up AIR s web survey software tracked participation and downloaded the addresses of all nonresponding respondents. We intermittently sent reminder s to respondents who did not respond to the survey after the initial request for participation. The tracking information was used to verify that invitees from a variety of locations and demographic groups were accessing the web site and submitting valid responses and to estimate projected rates of return. We also tracked the number of individuals who were accessing the site, but who were not submitting a completed survey (i.e., the number of hits ). Respondents Characteristics of the respondents in both the Practitioner and Employer Survey data sets are provided in the following section. Included in this sample description are: (1) respondent characteristics, including practitioner and employer sample sizes, race, gender, and age; (2) job characteristics, including work setting, tenure, and salary; and (3) qualifications, including credentials and degrees. Respondent Characteristics There were 1354 respondents to the Practitioner Survey. These respondents were either practitioners (77%) or educators/researchers (23%). There were 766 respondents to the Employer Survey, all of whom currently supervise, employ, or hire HIM practitioners. Most respondents were white (86%; see Table 2) females (94% of practitioners, 93% of employers) ranging in age from 35 to 59 years (see Figure 1). It is interesting to note that over 50% of the respondents were between the ages of 45 and 59 years, and nearly 80% were between the ages of 35 and 59 years. Race Table 2. Respondent Race Practitioner Employer Count Percent Count Percent American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Other Two or more races American Institutes for Research 10

16 *Note. Counts will not necessarily add up to total sample size (practitioner: 1354 and employer: 766) because some respondents did not indicate their race. American Institutes for Research 11

17 Figure 1. Respondent Age in Years 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 1.4% 0.7% 13.0% 11.3% 22.3% 23.3% 54.7% 55.2% 8.6% 18 to to to to or Older 9.6% Practitioner Employer Job Characteristics The most common workplace setting and type of employer across respondents were hospitals (see Table 3). Table 3. Percent of Respondents Working in Each Setting Setting Practitioner Employer Count Percent Count Percent Acute Care Hospital Ambulatory Surgery Center Behavioral/Mental Health Clinic/Physician Practice Consulting Services Educational Institution Home Health or Hospice Integrated Healthcare Delivery System Long-term Care Non-provider Setting Other Provider Setting *Note. Counts will not necessarily add up to total sample size (practitioner: 1354 and employer: 766) because some respondents did not indicate their workplace setting. American Institutes for Research 12

18 Regardless of the location, 80% of the practitioners and 95% of the employers worked full-time. The respondents tended to be experienced in the HIM field (see Figure 2). Although tenure ranged from 1 year to more than 20 years, nearly 60% of the practitioners had worked in the field for 11 years or more and nearly 50% of the employers had worked in the field for more than 20 years. For employers, approximately 80% of the sample indicated tenure of 11 years or more. As would be expected, the practitioner sample reported shorter tenure than did the employers. Figure 2. Respondent Tenure in the HIM Profession Practitioner Employer > 20 yrs, 34% < 1 yr, 4% 1-4 yrs, 14% < 1 year, 1% 1-4 yrs, 5.9% yrs, 24% 5-10 yrs, 21% > 20 yrs, 48% yrs, 30.1% 5-10 yrs 15.7% The pattern of respondent salaries complements tenure (see Figure 3). For practitioners, nearly 50% of the respondents who indicated their salary range are currently earning $50,000 or more per year. Approximately 60% earn between $30,000 and $60,000 per year. For employers, nearly 50% of the respondents who indicated their salary range are currently earning $70,000 or more. Approximately 60% earn between $50,000 and $90,000 per year. Figure 3. Respondent Salaries $125,000 or more $100,000 to $124,999 $90,000 to $99,999 $80,000 to $89,999 $70,000 to $79,999 $60,000 to $69,999 $50,000 to $59,999 $40,000 to $49,999 $30,000 to $39,999 $20,000 to $29,999 Less than $20,000 Practitioner Employer 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% American Institutes for Research 13

19 Qualifications The AHIMA credentials and degrees held by participants in both the practitioner and employer samples are described below. Credentials Over 80% of the practitioners and 95% of employers were AHIMA members. Over 90% of those were active members with an AHIMA credential. The patterns of certifications were very similar across the practitioner and employer samples (see Figure 4). The Registered Health Information Technician (RHIT) certification was the most common, followed closely by the Registered Health Information Administrator (RHIA) certification. The next frequently cited certification for both groups was the Certified Coding Specialist (CCS) certification. The employers were more likely than the practitioners to have the RHIT and RHIA; whereas the practitioners were more likely than the employers to have the CCS. Very few respondents indicated that they do not hold any of the listed AHIMA credentials or that they hold other professional credentials. [The top professional organizations other than AHIMA were the American Academy of Professional Coders (AAPC) and the Healthcare Information and Management Systems Society (HIMSS). These were chosen by less than 10% of the samples. In addition, 1%-2% of practitioners and employers, respectively, indicated that they are members of the Health Care Compliance Association (HCCA).] Approximately 15% (224) of practitioners and 20% (159) of employers reported that they held more than one AHIMA certification. The most common combinations were CCS with RHIT, and CCS with RHIA. Figure 4. Respondent Credentials CCS CCS-P 8.3% 5.2% 23.7% 18.9% CCA 1.0% 8.2% CHDA CHP CHPS CHS RHIA RHIT 0.1% 0.2% 0.6% 0.0% 0.2% 1.2% 0.0% 0.1% 27.6% 45.2% 40.8% 43.2% Practitioners Employer Not Listed 8.4% 5.1% 0.0% 20.0% 40.0% 60.0% American Institutes for Research 14

20 Education As with credentials, the types of degrees held by practitioners and employers was similar (see Figure 5). Most had either an Associate s or Bachelor s degree. The occurrence of an Associate s degree was slightly less frequent with employers than practitioners. The occurrence of Bachelor s or Master s degrees was slightly more frequent with employers. Approximately 60% of practitioners and employers said they earned their degree somewhere other than the universities and colleges that were listed in the survey. A review of open-ended responses to this section of the survey showed that many respondents reported they had earned their degree through AHIMA. Undergraduate work was typically completed in Health Information Management (58.4% of practitioners, 69.7% of employers). For graduate work, practitioners most commonly studied Healthcare Administration or another area of study not listed. Likewise employers most commonly studied Business Management, Healthcare Administration, or another area of study not listed. Figure 5. Respondent Education Other, 20.9% Practitioner Master s Degree, 18.4% Other, 12.4% Employer Associate's Degree, 27.3% Associate's Degree, 35.8% Master s Degree, 10.9% Bachelor's Degree, 32.4% Bachelor's Degree, 41.9% The factors that influenced practitioners and employers decision of which terminal degree to pursue were very similar (see Table 4). The top three reported factors were: (1) the desire to work in the healthcare industry, (2) career advancement potential, and (3) earning potential. The next three factors, although rank ordered differently across samples, were also the same: location of the program, interest in the educational program, and past experience. A greater percentage of employers than practitioners indicated that career advancement potential and past experience were important factors. (For more details, see Appendix F.) This pattern was similar across respondents with Associate s, Bachelor s, and Master s degrees. The top three were the same for practitioners with Associate s and Bachelor s degrees and for employers with Associate s, Bachelor s, and Master s degrees. Differences in rank orders surfaced, however. For employers with Master s degrees, desire to work in the healthcare industry dropped to third and career advancement rose to the top. Career advancement was at the top for practitioners with Master s degrees, also, but here the desire to work in the healthcare American Institutes for Research 15

21 industry was second and earning potential dropped out of the top three, replaced by location of program (which is fourth for practitioners with Associate s or Bachelor s degrees). Table 4. Top Factors Considered when Choosing Terminal Degrees by Education Factors Desire to work in the healthcare industry Career advancement potential Associate's & Bachelor's Master's Practitioner Employer Practitioner Employer Earning potential 3 3 4* 2 *Note. Third factor for Practitioners with a Master's was location of program Findings Findings from the Practitioner and Employer Surveys are presented together below in terms of (1) Current Market Demand, (2) Future Market Demand, (3) Job Roles and Responsibilities, (4) Qualifications Sought, and (5) Utilization. These research goals drove the development of the survey by providing the basis for the questionnaire content and analyses. As such, the Current and Future Market Demand findings provide insight into the size, scope, and nature of the employment market for HIM practitioners now and in the future. The Job Roles and Responsibilities results depict the typical HIM job as it stands today and the level of proficiency needed to succeed in a variety of HIM tasks. The Qualifications Sought section focuses on identifying the education, certifications, and competencies required of HIM professionals. Finally, the Utilization findings discuss the use of non-him professionals to fill HIM positions. Current and Future Market Demand Respondents were asked about the current market demand for HIM practitioners at all levels of credentialing and education. Further, respondents were asked to speculate about the future market demand for HIM professionals. These results are presented together to illustrate similarities and differences among the current and future HIM markets. The respondents were asked the following key questions regarding market demand: Which of the following types of organizations employ HIM practitioners? To your knowledge, what types of organizations will hire workers with an Associate s degree, Bachelor s degree, or Master s degree in HIM in ten years? To your knowledge, which industries will most likely use HIM practitioners/him knowledge ten years from now? What industries have an increasing demand for HIM professionals? Which of the following factors have influenced the demand for HIM professionals and their knowledge? (e.g. changes in standard medical billing or charting practices, clinical terminology and classification systems, economic stimulus package of 2009, EMRs, government reporting, etc.) American Institutes for Research 16

22 The survey results showed that the current and future demands for HIM professionals are quite similar. In general, the types of organizations hiring HIM professionals and using HIM knowledge now will also be doing so in ten years. A majority of respondents (i.e. 67% or more) indicated the organizations listed in Table 5 as industries that are growing in their demand for HIM professionals. The industries that were not chosen by this majority are not included here (for all organizations and values, see Appendix G). Open-ended comments from the respondents provided additional insight into the future job market. Specifically, additional industries with a growing and future demand for HIM professionals include correctional/judicial systems, veterinary care settings, legal offices, public health agencies, regional extension centers for EHR, professional associations/societies/unions, health information exchanges, Human Resources (HR) departments, state department of education, rehabilitation/long-term care facilities, imaging and medical testing vendors and facilities, banking and knowledge management sectors, and publishing companies. Table 5. Organizations Hiring HIM Professionals or Using HIM Knowledge Hiring HIM or Using HIM Knowledge (2/3 or More Chose) Industry Current Future Practitioner Employer Practitioner Employer All Degrees All Degrees Associate's Bachelor's Master's All Degrees Academia/Educational Institutions Consulting Services Government Agencies Hospitals Insurance Companies Physician's Offices or Practices Personal Health Record Companies American Institutes for Research 17

23 In addition to providing a general summary of survey responses regarding the current and future demand for HIM professionals, Table 5 presents a summary of the future demand according to applicants level of education. Hospitals are among the list of organizations with growing current and future demand for HIM professionals regardless of the degree held by the professional. Although other types of organizations will also continue to hire HIM professionals with Associate s, Bachelor s, and Master s degrees, the type of organization depends on the degree. For example, the majority of practitioners felt that HIM professionals with Associate s degrees will primarily be working for hospitals or physician s offices/practices. Academia, consulting services, government agencies, and hospitals are likely to hire both Bachelor s-level and Master s-level practitioners. In addition, at least 67% of the respondents indicated that insurance companies are going to hire HIM professionals with Bachelor s degrees. It is also interesting to note that the majority of employers, but not practitioners, felt that personal health record companies or vendors have a current and future need for HIM professionals. Furthermore, the same types of industries discussed above as in demand now and in the future are currently experiencing an increase in demand for HIM professionals (see Appendix H). Specifically, 80% of respondents agreed that hospitals have an increasing demand; 60%-79% agreed that consulting service, healthcare software, physician s offices, and personal health records organizations have an increasing demand; and 40%-59% agreed that academic/education institutions, government services organizations, and insurance companies have an increased demand. Although AHIMA members and non-members agreed on most of these organizations, a greater percentage of AHIMA members than non-members indicated an increase in demand for academic/educational institutions, consulting services organizations, hospitals, and personal health record companies or vendors. Practitioners provided some insight into these findings. They identified the factors most influencing the demand for HIM professionals or their (HIM) knowledge (see Table 6). The factors chosen by at least 50% of the respondents are noted in red and include changes to standard medical billing practices, changes in standard medical charting practices, clinical terminology and classification systems, electronic medical records, government reporting requirements/auditing, and HIPAA. Table 6. Factors Influencing Demand for HIM Professionals or Their Knowledge Influencing Factors All Practitioners AHIMA Member AHIMA Non-Member Changes in Standard Medical Billing Practices 67.1% 69.0% 70.9% Changes in Standard Medical Charting Practices 50.8% 52.3% 52.9% Clinical Terminology and Classification Systems 62.6% 65.0% 60.8% Economic Stimulus Package of % 17.9% 8.4% Electronic Medical Records (EMR) 76.6% 81.4% 67.4% Government Reporting Requirements/Auditing 62.0% 65.5% 56.4% American Institutes for Research 18

24 Table 6. Factors Influencing Demand for HIM Professionals or Their Knowledge Continued Influencing Factors (Continued) All Practitioners AHIMA Member AHIMA Non-Member Health Care Reform 38.2% 40.5% 33.5% Health Insurance Portability and Accountability Act (HIPAA) 71.3% 76.7% 59.5% Information Technology Systems 48.4% 52.7% 36.6% News Releases about Health Information Leaks 17.6% 18.7% 14.1% The Patient Safety Movement 19.6% 20.5% 17.6% Personal Health Records (PHR) 46.0% 50.6% 32.2% Telecommuting Workplace Arrangements 22.9% 24.4% 20.3% Other 2.1% 2.4% 1.3% Again, AHIMA members and non-members agreed for the most part about these influencing factors. Slight differences are evident in that a greater percentage of members than non-members identified electronic medical records, government reporting requirements/auditing, and HIPAA. Furthermore, the majority (50% or more) of members but not non-members identified information technology and personal health records as important factors influencing the demand for HIM professionals and their knowledge. Job Roles and Responsibilities Practitioners holding varying levels of educational backgrounds first indicated which task domains they perform in their jobs. Next, they indicated the degree to which certified HIM professionals should be proficient in each task domain. General findings are presented below, followed by task domain-specific findings. The task domains fell into five main categories: (1) Health Data Management; (2) Health Statistics, Biomedical Research, and Quality Management; (3) Health Services Organization and Delivery; (4) Information Technology and Systems; and (5) Organization and Management. The key questions asked of the respondents concerning the daily roles and responsibilities of HIM professionals were: Please tell us which of the following activities you perform as part of your job [for each task area]. What level of proficiency in each of the following task areas should be expected from someone who has the same certification(s) as you? General Findings Across Categories For many of the task domains, respondents were fairly evenly split as to whether they perform each task domain in their jobs (for a detailed presentation, see Appendix I). Between 40% and 60% of the respondents indicated that they are responsible for about half of the task domains. There were two exceptions in which the majority (67% or more) of the group said they perform American Institutes for Research 19

25 the task domain: (1) Healthcare Privacy, Confidentiality, Legal, and Ethical issues; and (2) Data Entry, Coding, and Systems Interface. For the rest of the task domains, less than 1/3 said they are responsible for Health Statistics and Research; Patient Safety Practices and Standards; Healthcare Delivery Systems; Information Management Planning; Interoperability and Usability; and most of the (i.e., ten of the twelve) Organization and Management task domains. Although they are not necessarily performing all of these functions in their current roles, the practitioners agreed that certified individuals should be proficient in each area (for a detailed presentation, see again Appendix I). As expected, less importance was placed on Organization and Management. In addition, the extent to which people expected proficiency across the task domains depended on the certification. In general, proficiency is expected more from those with RHIA certification than anyone else and less from those with Certified Coding Associate (CCA) certification than anyone else. For many, but not all, task domains, more proficiency is expected from those with RHIA certification than from those with CCS certification, Certified Coding Specialist-Physician Practice certification (CCS-P), or CAA certification. For the Information Technology (IT) task domains, there was little difference in what was expected from those with an RHIA and RHIT certification and in what was expected from those with a CCS, CCS-P, or CCA certification. Health Data Management The extent to which HIM practitioners are performing the Health Data Management tasks is fairly uniform across tasks and education level (see Table 7). Notable differences across tasks are that more practitioners are performing Problem Solving tasks than other tasks, and fewer practitioners are performing Analysis or Clinical Classification tasks than other tasks. Table 7. Task Domains Performed in Job and Proficiency Required Task Domain Health Data Structure, Content, & Standards Healthcare Information Requirements & Standards Clinical Classification Systems Health Data Management Performed in Job All AA/AS BA/BS MA/MS Moderate to High Proficiency Required Reimbursement Methodologies Analysis & Outcomes Problem-Solving Clinical Data Capture *Note. = 67% or more chose; = 50% or more chose. American Institutes for Research 20

26 Broken down by degree, Graduate-level practitioners perform more Problem Solving and Analysis activities than do Associate-level practitioners. Associate-level practitioners do more Data Capture work (see Figure 6). Figure 6. Percent of Practitioners Who Perform Each Task Domains Health Data Management Health Data Structure, Content, & Standards Healthcare Information Requirements & Standards Clinical Classification Systems Reimbursement Methodologies Analysis & Outcomes Associate's Degree Bachelor's Degree Graduate's Degree All Problem-Solving Clinical Data Capture 0.0% 20.0% 40.0% 60.0% 80.0% Over 85% of the respondents indicated that certified HIM professionals need to be moderately to highly proficient in each of the Health Data Management task domains (see Figure 7). American Institutes for Research 21

27 Figure 7. Percent of Practitioners Reporting Proficiency Needed for Each Task Domain Health Data Management Tasks Health Data Structure, Content, & Standards Healthcare Information Requirements & Standards Clinical Classification Systems Reimbursement Methodologies Analysis & Outcomes Problem-Solving Clinical Data Capture 92.9% 96.5% 92.5% 89.6% 89.3% 96.4% 93.1% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% Health Statistics, Biomedical Research, and Quality Management Responses regarding Health Statistics, Biomedical Research, and Quality Management revealed that respondents are performing more Quality Management tasks than Health Statistics or Patient Safety activities (see Table 8). Table 8. Task Domains Performed in Job and Proficiency Required Health Statistics, Biomedical Research, & Quality Management Task Domain Health Statistics & Research Performed in Job All AA/AS BA/BS MA/MS Moderate to High Proficiency Required Quality Management & Performance Improvement Patient Safety Practices & Standards *Note. = 67% or more chose; = 50% or more chose. When taking a closer look, however, it can be seen that practitioners with a Master s degree are more frequently performing all three of the tasks within the Health Statistics domain than are practitioners with lower-level degrees (see Figure 8). American Institutes for Research 22

28 Figure 8. Percent of Practitioners Who Perform Each Task Domain Health Statistics, Biomedical Research, & Quality Management Health Statistics & Research Quality Management & Performance Improvement Patient Safety Practices & Standards Associate's Degree Bachelor's Degree Graduate's Degree All 0.0% 20.0% 40.0% 60.0% 80.0% Approximately 70% - 80% of the respondents indicated that certified HIM professionals need to be moderately to highly proficient in the Health Statistics, Biomedical Research, and Quality Management task domains (see also Figure 9). In keeping with the tasks for which these practitioners are responsible, more respondents noted that proficiency is necessary in Quality Management than in the other tasks. Figure 9. Percent of Practitioners Reporting Proficiency Needed for Each Task Domain Health Statistics, Biomedical Research, and Quality Mgmt Health Statistics & Research 72.1% Quality Management & Performance Improvement Patient Safety Practices & Standards 69.2% 84.4% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% American Institutes for Research 23

29 Health Services Organization and Delivery Within the area of Health Services Organization and Delivery, practitioners are performing Healthcare Privacy, Confidentiality, Legal, and Ethical Issue tasks more than the others (see Table 9). Table 9. Task Domains Performed in Job and Proficiency Required Task Domain Healthcare Delivery Systems Healthcare Privacy, Confidentiality, Legal, & Ethical Issues Health Services Organization & Delivery Performed in Job All AA/AS BA/BS MA/MS Moderate - High Proficiency Required Inter-Organization Health Data Exchange Issues *Note. = 67% or more chose; = 50% or more chose. The task domain for which the practitioner s degree seems to have the greatest influence on the extent to which the activity is performed is Healthcare Delivery Systems. Master s-level practitioners reported performing these tasks more than anyone else. A less obvious distinction is that Master s-level practitioners performed Inter-Organization Health Data Exchange Issue tasks more than practitioner s with Associate s degrees (see Figure 10). Figure 10. Percent of Practitioners Who Perform Each Task Domain Health Services Organization & Delivery Healthcare Delivery Systems Healthcare Privacy, Confidentiality, Legal, & Ethical Issues Associate's Degree Bachelor's Degree Graduate's Degree All Inter-Organization Health Data Exchange Issues 0.0% 20.0% 40.0% 60.0% 80.0% American Institutes for Research 24

30 Approximately 80% - 95% of the respondents indicated that certified HIM professionals need to be moderately to highly proficient in Health Services Organization and Delivery task domains (see also Figure 11). In keeping with the types of tasks for which these professionals are responsible, more people felt proficiency is necessary for the Privacy, Confidentially, Legal, and Ethical Issue tasks than the other tasks. Figure 11. Percent of Practitioners Reporting Proficiency Needed for Each Task Domain Health Services Organization & Delivery Healthcare Delivery Systems 78.6% Healthcare Privacy, Confidentiality, Legal, & Ethical Issues 95.4% Inter-Organization Health Data Exchange Issues 81.4% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% Information Technology and Systems Within the realm of Information Technology and Systems, HIM practitioners are doing much more Data Entry/Coding than Usability or Information Management (see Table 10). Table 10. Task Domains Performed in Job and Proficiency Required Information Technology & Systems Performed in Job Moderate to High Task Domain Proficiency All AA/AS BA/BS MA/MS Required Information & Communication Technologies Data, Information, & Files Structures Data Storage & Retrieval Data Security Healthcare Information Systems Information Management Planning Interoperability & Usability Data Entry, Coding, & Systems Interface *Note. = 67% or more chose; = 50% or more chose. American Institutes for Research 25

31 The extent to which those tasks are performed changes depending on the degree. That is, practitioners with Associate s degrees do more Data Entry and practitioners with Master s degrees perform more Usability and Information Management tasks (see Figure 12). Figure 12. Percent of Practitioners Who Perform Each Task Domain Information Technology & Systems Information & Communication Technologies Data, Information, & Files Structures Data Storage & Retrieval Data Security Healthcare Information Systems Associate's Degree Bachelor's Degree Graduate's Degree All Information Mangement Planning Interoperability & Usability Data Entry, Coding, & Systems Interface 0.0% 20.0% 40.0% 60.0% 80.0% Approximately 80% - 90% of the respondents reported that HIM professionals should be moderately to highly proficient in the Information Technology and Systems task domains (see Figure 13). The exception was the Data Entry domain for which only 53% said proficiency is necessary. Interestingly, the responses imply that proficiency is most important for the Usability tasks, which few practitioners currently perform, and Data Security tasks. American Institutes for Research 26

32 Figure 13. Percent of Practitioners Reporting Proficiency Needed for Each Task Domain Information Technology & Systems Information & Communication Technologies Data, Information, & Files Structures Data Storage & Retrieval Data Security 85.7% 84.6% 83.8% 88.3% Healthcare Information Systems Information Mangement Planning 78.9% 90.0% Interoperability & Usability Data Entry, Coding, & Systems Interface 79.0% 93.0% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% Organization and Management According to the survey results, HIM practitioners are not performing Organization and Management tasks very often (see Table 11). Specifically, less than 1/3 of the respondents said they perform tasks within the Human Resources Management, Financial and Resource Management, Project Operations and Management, Strategic and Contingency Planning, Organizational Change Management, Public Policy, Business Development, Return on Investment, Data Modeling, or Salesmanship Domains. American Institutes for Research 27

33 Table 11. Task Domains Performed in Job and Proficiency Required Task Domain Organization & Management Performed in Job All AA/AS BA/BS MA/MS Moderate to High Proficiency Required Human Resources Management Financial & Resource Management Project Operations & Management Leadership Strategic & Contingency Planning Education & Training/ Organizational Development Organizational Change Management Public Policy Development, Analysis, & Advocacy Business Plan Development Return on Investment/ Cost Benefit Analysis Data Modeling for the Healthcare Enterprise Salesmanship/Entrepreneurship *Note. = 67% or more chose; = 50% or more chose. As is evident in Figure 14 (see below), Master s-level practitioners are more likely to perform all of the Organization and Management tasks than Bachelor s-level or Associate-level professionals. American Institutes for Research 28

34 Figure 14. Percent of Practitioners Who Perform Each Task Domain Organization & Management Human Resources Management Financial & Resource Management Project Operations & Management Leadership Strategic & Contingency Planning Education & Training/Organizational Organizational Change Management Public Policy Development, Analysis, & Advocacy Associate's Degree Bachelor's Degree Graduate's Degree All Business Plan Development Return on Investment/Cost Benefit Analysis Data Modeling for the Healthcare Enterprise Salesmanship/Entrepreneurship 0.0% 20.0% 40.0% 60.0% 80.0% The percentage of respondents who reported that certified HIM professionals need to be moderately to highly proficient in the realm of Organization and Management ranged from 39% to 81%, depending on the task domain (see also Figure 15). The responses imply that proficiency is most necessary for Project Operations and Management; Leadership; and Education, Training/Organizational Development. Proficiency is least necessary for Salesmanship. American Institutes for Research 29

35 Figure 15. Percent of Practitioners Reporting Proficiency Needed for Each Task Domain Organization & Management Human Resources Management 53.1% Financial & Resource Management 60.0% Project Operations & Management 63.9% Leadership 80.5% Strategic & Contingency Planning Education & Training/Organizational Development Organizational Change Management Public Policy Development, Analysis, & Advocacy Business Plan Development 65.7% 77.9% 65.3% 53.5% 53.5% Return on Investment/Cost Benefit Analysis Data Modeling for the Healthcare Enterprise Salesmanship/Entrepreneurship 38.8% 54.9% 50.5% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% American Institutes for Research 30

36 Qualifications Sought Respondents were asked about the credential, educational, and competency qualifications sought by employers now and in the future. Information about certifications and educational degrees is presented in reference to applying for HIM jobs, performing HIM jobs, and holding HIM positions in the future. Next, competency qualifications are described in terms of current and future requirements. AHIMA member and non-member perspectives are also discussed where applicable. The key questions asked of respondents concerning qualifications sought were: Based on your experience, how helpful are the following certifications and degrees to someone who is looking for a job in the HIM field? How helpful are the following certifications and degrees when selecting a candidate for a HIM job/to getting a job like yours in the HIM field? What certification(s) is/are required to perform each of the following task domains? Which of these HIM degrees represents the minimum degree requirement for performing the following task domains? If it were available, a Master's degree in HIM would be more valuable to my current job/more valuable to employers than a: MBA, MHA, MHI, MHSA, MPH. If asked to hire someone for each of the positions below, what one certification or credential would be most important for a qualified candidate to possess? What is the minimum degree that you would expect a qualified candidate in each of the following positions would have earned? To your knowledge, what certification(s) will be required to get [your] job in ten years? To your knowledge, what will be the most common degree requirement for HIM positions in your organization ten years from now? Which of the following competency domains are currently relevant for the HIM practitioners you supervise? What competencies will be required of HIM practitioners ten years from now? Certification and Education When Applying. Respondents reported that having at least one certification and a HIM degree is helpful when applying for a job in the HIM field. The type of certification and degree seemed to make a difference, though. For practitioners and employers, the RHIA, RHIT, and CCS certifications (the most commonly held) and the Bachelor s degree (the most commonly held) were cited most frequently as very helpful when applying for a job (see Figure 16; for more details, see Appendix J). For employers, those same certifications were reported most frequently as very helpful when evaluating candidates for hire (see Figure 17; for more details, see Appendix K). Interestingly, according to the practitioners and employers, the RHIA and RHIT certifications may be more helpful for selecting candidates from applicant pools than are the degrees. For employers, the CCS certification was more helpful than an Associate s or Master s degree when applying for a job and when selecting candidates. American Institutes for Research 31

37 Figure 16. Percent of Respondents Who Said Qualification Helps When Applying CCA CCS CCS-P CHDA 25.7% 30.0% 42.7% 40.3% 32.1% 33.3% 64.7% 80.4% CHS 26.1% 37.2% CHP CHPS RHIT RHIA HIM Associate's HIM Bachelor's HIM Master's 30.5% 32.1% 44.6% 49.6% 75.9% 88.5% 82.6% 93.5% 64.0% 73.5% 75.2% 85.3% 66.3% 74.7% Practitioner Employer 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% The general findings that the job outlook is good for HIM professionals with RHIA, RHIT, or CCS certification or an HIM degree held whether respondents were AHIMA members or nonmembers (see again Appendices J & K). Slight differences within these categories were evident, however. For practitioners, a greater percentage of the AHIMA non-members than members felt the CCS certification is very helpful when applying for HIM jobs. The opposite was true for employers. A greater percentage of AHIMA members than non-members felt the CCS, RHIT, and RHIA were very helpful. Furthermore, a greater percentage of AHIMA member employers than non-member employers reported that the Associate s degree was very helpful when hiring. On the Job. For each of the task domains, employers indicated whether a CCS/CCS-P, CCA, Certified in Healthcare Security (CHS)/Certified in Healthcare Privacy (CHP), RHIT, or RHIA certification was required. For reporting purposes, certifications were identified as required if 50% or more of the employers said that it was necessary. When the percentage of people who chose one certification (e.g., RHIT) was nearly equal to the percentage of people who chose another certification (e.g., RHIA), both certifications were noted. Employers also chose Associate s, Bachelor s, Master s, or Doctorate degrees as the minimum degree required for performing the HIM duties. For reporting purposes, the minimum degree is American Institutes for Research 32

38 the option chosen by the largest number of employers. Again, for some task domains and categories, the percentage of people who chose Associate s degree was nearly equal to the percentage of people who chose Bachelor s degrees. In those cases, both degrees were noted. The RHIT certification, RHIA certifications, Associate s degree, and Bachelor s degree were most frequently identified as required. The specific requirements depended on the task domain (see Appendix L). Nonetheless, there was a reasonable amount of agreement across tasks within a given category (see Table 12). As would be expected, those task domains/categories that require an Associate s degree also require RHIT certification; those that require a Bachelor s degree also require RHIA certification. Table 12. Degree and Certification Requirements for Task Domain Categories Task Domain Certifications Required (At Least 50% Chose) Minimum Degree Required (Most Chosen) Health Data Management RHIT Associate's Health Statistics, Biomedical Research, & Quality Management RHIA Bachelor's Health Services Organization & Delivery RHIT / RHIA Associate's / Bachelor's Information Technology & Systems RHIT / RHIA Associate's / Bachelor's Organization & Management RHIA Bachelor's Respondents were also asked to consider the value of a Master s level education in HIM as compared to other Master s level backgrounds on the job. Specifically, practitioners and employers were asked whether a Master s in HIM (MHIM) would be more valued by an employer than a Master s in Business Administration (MBA), Master s in Health Administration (MHA), Master s in Health Informatics (MHI), Master s in Health Services Administration (MHSA), or Master s in Public Health (MPH). Practitioner responses were very neutral (see Figure 17). 50.0% Figure 17. Value of MHIM versus Other Master s Degrees: Practitioner Responses 40.0% 30.0% 20.0% 10.0% Strongly Disagree Disagree Neutral Agree Strongly Agree 0.0% MBA MHA MHI MHSA MPH American Institutes for Research 33

39 Employers were similarly neutral regarding the value of the MHIM compared to other Master slevel degrees (see Figure 18). 50.0% Figure 18. Value of MHIM versus Other Master s Degrees: Employer Responses 40.0% 30.0% 20.0% 10.0% Strongly Disagree Disagree Neutral Agree Strongly Agree 0.0% MBA MHA MHI MHSA MPH In general, the MHIM degree is considered quite valuable by approximately 40% of practitioners and employers. Of the other master s degrees, practitioners were more likely to view the MHIM as more valuable than MBA or MPH (see Figure 19). The practitioner AHIMA non-members did not agree as strongly as members that the MHIM is more valuable than these other degrees. Figure 19. Percent of Practitioners Who Agreed that MHIM is More Valuable 50.0% 40.0% 30.0% 20.0% All Practitioners AHIMA Members AHIMA Non-members 10.0% 0.0% MBA MHA MHI MHSA MPH Employers generally showed the same pattern (see Figure 20). MHIM was viewed as more valuable than a MBA or MPH by more respondents than were MHA, MHI, and MHSA. Also, more members than non-members reported that the MHIM is more valuable than MHSA. Across respondents, the MHIM degree option was considered more valuable than the MBA, MHSA, and MPH by 1 in 3 employers. American Institutes for Research 34

40 Figure 20. Percent of Employers Who Agreed that MHIM is More Valuable 50.0% 40.0% 30.0% 20.0% All Employers AHIMA Members AHIMA Non-members 10.0% 0.0% MBA MHA MHI MHSA MPH Employers also indicated which certifications and degrees were important when hiring for specific jobs (see Tables 13 and 14, see Appendix M for more details). Employers were asked to choose the one certification and one degree most needed for each job. For reporting purposes, the certification or degree listed in the tables as necessary for a given job is the option chosen by the largest number of employers. If two options were chosen by approximately the same percentage of people, both are noted. Given that the CCA certification and Doctorate degree were never the most frequently cited important qualifications, they are not included in the tables. Review of Tables 13 and 14 reveals that RHIT and RHIA certifications and Associate s and Bachelor s degrees were chosen most often across jobs. Of course, the specific requirements depended on the job. As would be expected, the RHIT certification and Associate s degree requirements tended to coincide and the RHIA and Bachelor s degree requirements tended to correspond. It is interesting to note that higher level jobs (i.e., executive-level jobs) often required a certification other than those listed and a Master s degree. Requirements were least stringent for Customer/Client Representatives, Sales Representatives, and Transcriptionist. According to the survey results, certification is not important for any of those jobs and the Sales Representative may not need a degree. Table 13. Certification Requirements for Various Jobs No Cert CCS/ CHS/ HIM Positions RHIT RHIA Other Required CCS-P CHP Administrator/CEO/COO Analyst Assistant Administrator (VP, AVP) Chief Financial Officer Chief Information Officer Client Support Specialist Coding Professional American Institutes for Research 35

41 Table 13. Certification Requirements for Various Jobs Continued No Cert CCS/ CHS/ HIM Positions RHIT RHIA Other Required CCS-P CHP Compliance Officer Consultant Coordinator Customer/Client Representative Data Quality Analyst DRG Coordinator EHR Specialist/Manager/Dir HIM Faculty Information Security Officer IS/MIS Director Medical Records Analyst Privacy Officer Project Manager QA Specialist Registrar Sales Representative Systems Analyst Team Leader Transcriptionist Table 14. Education Requirements for Various Jobs No Degree Associate's Bachelor's HIM Positions Required Degree Degree Administrator/CEO/COO Analyst Assistant Administrator (VP/AVP) Chief Financial Officer Chief Information Officer Client Support Specialist Coding Professional Compliance Officer Consultant Coordinator Customer/Client Representative Data Quality Analyst Master's Degree American Institutes for Research 36

42 Table 14. Education Requirements for Various Jobs Continued No Degree Associate's Bachelor's HIM Positions Required Degree Degree DRG Coordinator EHR Specialist/Manager/Director HIM Faculty Information Security Officer IS/MIS Director Medical Records Analyst Privacy Officer Project Manager QA Specialist Registrar Sales Representative Systems Analyst Team Leader Transcriptionist Master's Degree In the Future. When asked to consider certifications needed in the future, 50% or more of the practitioners reported that the RHIT, RHIA, and CSS will be required to get a HIM job in ten years (see Table 15). Certifications Table 15. Certifications Needed in Ten Years AHIMA All Member AHIMA Non-Member Certified Coding Specialist (CCS) 55.7% 56.1% 65.0% Certified Coding Specialist-Physician Practice (CCS-P) 25.7% 26.5% 27.0% Certified Coding Associate (CCA) 13.0% 12.6% 17.7% Certified Health Data Analyst (CHDA) 12.6% 13.5% 9.7% Certified in Healthcare Privacy (CHP) 9.2% 9.4% 8.8% Certified in Healthcare Privacy and Security (CHPS) 16.3% 17.7% 12.4% Certified in Healthcare Security (CHS) 8.7% 9.0% 8.4% Registered Health Information Technician (RHIT) Registered Health Information Administrator (RHIA) 55.6% 57.2% 58.4% 59.4% 63.5% 51.8% None of the above 5.3% 5.7% 4.4% Other 3.9% 3.8% 4.4% American Institutes for Research 37

43 When asked to choose which would be the most common degree requirement for HIM professionals in ten years, both practitioners and employers chose the Bachelor s degree more than any other degree (see Table 16). The majority of practitioners (68.7%) also agreed that 1-4 years experience will be required. It is interesting to note that the most common response was 3-4 years, with 38.5% of the sample choosing this option. Degree Table 16. Education Needed in Ten Years All Practitioners AHIMA Members Non- Members All Employers AHIMA Members Non- Members No degree required 7.6% 6.6% 12.4% 2.7% 2.4% 9.7% Associate s HIM degree 37.0% 35.7% 43.8% 32.6% 32.4% 41.9% Bachelor s HIM degree 39.1% 40.9% 30.5% 50.7% 50.7% 45.2% Master s HIM degree 10.3% 11.0% 6.2% 12.9% 13.3% 3.2% Other (please specify) 6.0% 5.8% 7.1% 1.2% 1.3% 0.0% The AHIMA members and non-members agreed that the CCS, RHIT, RHIA, and Bachelor s degree will be required in ten years. Small differences were evident, however. A greater percentage of non-members than members reported that the CCS will be required, whereas a greater percentage of members than non-members indicated that RHIA will be required. Furthermore, it seems that AHIMA members have a greater expectation for higher education than do non-members. A greater percentage of members than non-members reported that a Bachelor s or Master s degree will be required in 10 years. On the other hand, a greater percentage of non-members than members indicated that no degree or an Associate s degree would be required. Competencies: Now and In the Future The competencies most relevant to HIM work today are similar to those that will be most relevant in ten years (see Table 17 for summary). These are competencies that 67% or more of the respondents indicated as relevant. In particular, employers believed that: the (1) Privacy/Confidentiality of Health Information, (2) Basic Computer Literacy Skills, (3) Health Informatics Skills, (4) Health Information Literacy and Skills, and (5) Health Information/Data Technical Security are the top five relevant competencies now and in the future. Less than 40% of the respondents identified Organizational Change and Development Management Skills, Public Policy Skills, or Business Administration and Analysis Skills as currently relevant. These results are similar to those found for the task domains practitioners are currently performing. American Institutes for Research 38

44 Table 17. Top 5 Competencies Relevant for HIM Work Now and in the Future Competencies Privacy/Confidentiality of Health Information Rank Order for Current Relevant Competencies Rank Order for Future Relevant Competencies 1 2 Basic Computer Literacy 2 5 Health Informatics Skills 3 1 Health Information Literacy & Skills 4 3 Health Information/Data Technical Security 5 4 *Note. Leadership & Organizational Communication Skills were listed as relevant in 10 years. There are a few notable changes from the current to the future relevance of these competency domains. First, the rank order of the competencies is different. For example, Privacy/Confidentiality of Health Information ranked highest for current relevance, whereas Health Informatics Skills ranked highest for future relevance. Second, Leadership and Organizational Communication Skills are added as important in the future. Sixty-seven percent of AHIMA members and non-members agreed on four of the top five currently relevant competencies (see Appendix N). The majority of members, but not nonmembers, felt Health Informatics Skills were relevant. Alternatively, 50% of members and nonmembers agreed on all five as being currently relevant. Regardless of the decision point, a higher percentage of members than non-members felt Health Informatics Skills and Privacy/Confidentiality of Health Information were currently relevant for HIM practitioners. AHIMA members and non-members agreed on the top 6 competencies that will be relevant in 10 years (list in Table 17 and see Appendix N for more details). Their relative weights, however, differed. For example, a greater percentage of non-members than members rated Basic Computer Literacy Skills as very relevant, whereas a greater percentage of members than non-members rated Health Informatics Skills, Health Information/Data Technical Security, and Privacy/Confidentiality of Health Information as very relevant. Utilization Respondents were asked about the extent to which HIM professionals versus non-him professionals are used to fill HIM positions. The key questions asked of respondents in the surveys regarding utilization were: What other types of professionals are competing for the jobs that HIM professionals can fill? What is the background of non-him workers who fill HIM positions at your organization? American Institutes for Research 39

45 The findings suggest that not all of the HIM jobs are being filled by HIM professionals. Approximately 50% of the organizations for which the respondents worked hire professionals with non-him backgrounds to fill HIM positions. Although it is clear there are non-him professionals competing for HIM jobs, it is not entirely clear what backgrounds they possess. When asked what other types of professionals are competing for HIM jobs, 50% or more of the employers cited (1) Health Informatics, (2) Allied Health, (3) Nurses, (4) Information Technology, and (5) Health Administrators (see Figure 21). Figure 21. Types of Non-HIM Professionals Competing for HIM Jobs Health Informatics Professionals Allied Health Professionals Nurses Information Technology Professionals Health Administrators Business Management Professionals Public Health Professionals Medical Assistants Physicians Paralegal Lawyers Human Resources Professionals Not applicable Other 16.6% 16.2% 12.7% 11.3% 2.2% 1.4% 31.4% 28.7% 70.3% 69.2% 64.9% 58.4% 56.2% 52.4% 0.0% 20.0% 40.0% 60.0% 80.0% When practitioners and employers were asked about the background of non-him workers, a similar list emerged (see Table 18). The most commonly cited backgrounds were (1) Health Informatics, (2) Allied Health Professionals, (3) Information Technology, and (4) Business Management Professionals. Respondents did not agree overwhelmingly, however; none of these backgrounds were chosen by more than 35% of the respondents. American Institutes for Research 40

46 Table 18. Background of Non-HIM Professionals Working in HIM Jobs Practitioner Employer Non-HIM Background Count Percent Count Percent Allied Health Business Management Health Administration Health Informatics Human Resources Information Technology Law Medical Assistance Medicine Nursing Paralegal Training Public Health Not applicable Other Summary The findings from the National Survey of AHIMA Workplace Trends have been described in great detail above. These findings provide rich information regarding the current and future status of the HIM profession. The chapter to follow will provide a summary of these major findings, the lessons learned from them, and actionable recommendations for AHIMA to take based on these findings. American Institutes for Research 41

47 LESSONS LEARNED & RECOMMENDATIONS This chapter presents a summary of the findings from the National Survey of AHIMA Workplace Trends presented above. Next, it provides actionable recommendations for AHIMA to take based upon these findings. These recommendations focus on three key topic areas, namely, the HIM target market, the focus of education and credentialing, and the marketing of Master s-level HIM professionals. Lessons Learned The findings garnered from the National Survey of AHIMA Workplace Trends provide valuable insight into the key research questions defined by AHIMA and AIR at the start of the National Workforce Assessment project. The major findings from both surveys are summarized below according to the five key topic areas: Current Market Demand, Future Market Demand, Job Roles and Responsibilities, Qualifications Sought, and Employer Utilization of HIM professionals. Current and Future Demand The demand for HIM professionals and HIM knowledge is on the rise at all levels of education and credentialing. The types of industries with the greatest current and increasing demand for HIM professionals are academia/educational institutions, consulting services, government agencies, hospitals, insurance companies, physician s offices or practices, and personal health record companies/vendors. The factors influencing this demand include changes to standard medical billing practices, changes in standard medical charting practices, clinical terminology and classification systems, electronic medical records, government reporting requirements/auditing, and HIPAA. Survey results also suggest that the same industries with a current need for HIM professionals will have a need for them in the future. Additional industries with a growing and future demand for HIM professionals include correctional/judicial systems, veterinary care settings, legal offices, public health agencies, regional extension centers for EHR, professional associations/societies/unions, health information exchanges, human resources departments, state department of education, rehabilitation/long-term care facilities, imaging and medical testing vendors and facilities, banking and knowledge management sectors, and publishing companies. Job Roles and Responsibilities When thinking about the demand for HIM professionals, it is important to consider how HIM professionals and their knowledge are being used on the job. Overall, about half of HIM practitioners are performing the task domains to which the survey items referred. Two task domains stand out as almost universally performed: (1) Healthcare Privacy, Confidentiality, Legal, and Ethical Issues; and (2) Data Entry, Coding, and Systems Interface. The tasks performed in HIM jobs depend to some degree on level of education. Graduate-level practitioners, as compared to practitioners without a Graduate degree, are more likely to American Institutes for Research 42

48 complete tasks associated with problem solving, analysis, quality management, health delivery systems, usability/information management, and organization/management. Regardless of the tasks actually performed, certified individuals should be proficient in most of the areas (according to the responses submitted by practitioners). In particular, proficiency is expected most from those with RHIA certification and least from those with CCA certification. Qualifications Sought The survey responses indicate clearly that it is in a HIM professional s best interest to be certified, experienced, and educated. The certifications most valued by HIM professionals are the RHIT, RHIA, and CCS. Both AHIMA member and non-member stakeholders value these HIM credentials. These certifications should be helpful when applying for a HIM job now and in ten years. In addition, organizations are likely to require 1-4 years of experience from HIM applicants in the future (i.e., ten years). For education, the Bachelor s degree (especially in HIM) should be most helpful now and in the future. The MHIM degree will also be valuable, but its value relative to other Master s degrees (i.e., MBA, MHA, MHI, MHAS, or MPH) is not clear. Of the other Master s degrees considered, the MHIM is most likely to be valued more than the MBA, MHAS, and MPH. In addition to HIM-related credentials, experience, and education, the main competencies noted by respondents as important for HIM work include knowledge in the healthcare industry; knowledge of HIPAA and other regulations; and skill in computer use, data analysis, health informatics and information, data security, and leadership. HIM professionals also need to be able to think critically, write well, and approach work with flexibility. These same competencies will be necessary for HIM work in the future. Employers reported, though, that additional competencies will be needed from HIM practitioners at the Graduatelevel. These include financial knowledge, hospital organization knowledge, systems and policy knowledge, management experience, and pharmaceutical knowledge. Utilization Although HIM knowledge and background are obviously important and valued, professionals without the HIM background are competing for HIM jobs. Approximately 50% of organizations employ non-him professionals in HIM jobs. Typically, these are applicants with backgrounds in allied health, business management, and medicine/nursing. Actionable Recommendations The results of the National Survey of AHIMA Workplace Trends described within this report illustrate a few key action steps open to AHIMA, as described below. In particular, we focus on the need to target the right industries with the right information. This includes targeting specific industries, examining the focus of education and credentialing programs, and considering marketing various qualifications differently. American Institutes for Research 43

49 Addressing the Market First, we recommend continuing to target the types of organizations that are currently hiring HIM professionals, thereby identifying their needs, filling their HIM roles, and marketing HIM professionals and knowledge to them. To expand the use of HIM professionals outside the current market, also consider other industries who (1) have been affected by changes to billing, charting, and reporting practices, utilize clinical terminology and classification systems, and are subject to HIPAA requirements; (2) have a need for people particularly proficient in health data management, health services organization and delivery, information technology, project operations, and leadership; and/or (3) supplement the list of organizations with a current demand (e.g., correctional/judicial systems, veterinary care settings, legal offices). In addition, it may be possible to develop the HIM presence more in the pharmaceutical industries by drawing a clearer link between HIM qualifications and the needs of the those industries. Focusing Education and Credentialing Second, AHIMA may want to explore the specific topics upon which HIM education and credentialing focus. Continue to focus on data management; quality management; coding; and healthcare privacy, confidentiality, legal, and ethical issues. These types of tasks are particularly relevant for HIM practitioners right now. Furthermore, to keep pace with the increasing demand for HIM professionals, education and credentialing should continue to focus on knowledge in health information/data technical security and skills in writing, computer use, health informatics and information, data analysis, problem solving, leadership, and communication. Third, it may be helpful to place increased emphasis for education and credentialing on knowledge of healthcare organizations, organization and management, finance, systems and policy, and pharmacy. In particular, focusing on knowledge of healthcare organizations and management may help market HIM professionals more competitively against the non-him professionals currently being employed in HIM roles. Specifically, courses of interest for modifying education could include organic chemistry, human resources management, computer programming, and organizational behavior. These courses were highlighted by SMEs as critical for expanding the clinical context and management knowledge that HIM practitioners possess. Marketing Graduate-Level Professionals Fourth, AHIMA may want to consider marketing graduate-level HIM professionals differently than those without graduate degrees, including targeting different industries and highlighting the skills associated with the task domains most commonly performed by Graduate-level practitioners (e.g., Problem Solving, Usability, Organization and Management). To further market Graduate-level HIM professionals, it will be important to clearly identify and highlight the differences between the MHIM degree and other types of Master s degrees. Fifth, AHIMA may want to explore the differences among the tasks completed by HIM practitioners with Master s degrees and those without. Do these differences illuminate important value added for graduate-level professionals or a deficit to fill for non-graduate-level practitioners? American Institutes for Research 44

50 Summary Moving forward with any or all of these recommendations, AHIMA could improve upon best practices and standards for the HIM profession. In doing so, AHIMA may move closer to reaching its goals of improving the nation s health through the advancement of the HIM profession. American Institutes for Research 45

51 CONCLUSION AIR conducted interviews with a variety of experts on Health Information Management research and practice. We also conducted a survey of stakeholders including members of AHIMA and non-members. Valuable information about the current status and future prediction for the HIM workforce in five key areas was obtained during the interviews: Current Market Demand, Future Market Demand, Job Roles and Responsibilities, Qualifications Sought, and employer Utilization of HIM professionals. The primary and most notable finding of this study is the estimated growth of the HIM field and how it varies by level of education and credentialing. Use of Information Gathered The information gathered during this study was designed to be descriptive in nature. The findings can be used to help shape future data collection efforts and provide some insight into the concepts considered by practitioners, employers, recruiters, educators, and other professionals when examining the evolution of the HIM profession in the near future. To that end, AIR recommends the following uses of the information contained in this report: Develop a cursory understanding of the perceptions held by those in the field about career projections and potential skills needed to achieve career growth; Develop a broad estimate of the need for HIM professionals today and what societal and industrial factors cause the estimate to fluctuate; Identify the best possible ways of assessing with greater detail the current utilization of HIM practitioners in the marketplace; Inform future AHIMA workforce initiatives to ensure that workforce and professional development demands are met despite changes in health care; and Consider acting upon the actionable recommendations AIR has provided above. American Institutes for Research 46

52 APPENDIX A: INTERVIEW PROTOCOL American Institutes for Research A-1

53 AHIMA NATIONAL WORKFORCE ASSESSMENT DRAFT PROTOCOL FOR HIM SUBJECT MATTER EXPERT INTERVIEWS December 12, 2008 Prepared by: American Institutes for Research Education, Human Development, and the Workforce Division 1000 Thomas Jefferson Street, NW Washington, DC Prepared for: Scott Mackenzie Director, Business Insight & Market Analytics American Health Information Management Association (AHIMA) 233 North Michigan Avenue, 21st floor Chicago, IL 60601

54 AHIMA Draft SME Interview Protocol Table of Contents INTERVIEW PROTOCOL: HIM SUBJECT MATTER EXPERTS (SMES)... 1 INTRODUCTION AND BACKGROUND INFORMATION... 2 INTERVIEWEE/SME INFORMATION... 3 CURRENT MARKET DEMAND... 3 FUTURE MARKET DEMAND... 4 JOB ROLES & RESPONSIBILITIES... 5 QUALIFICATIONS SOUGHT... 5 UTILIZATION... 6 American Institutes for Research DRAFT i

55 AHIMA Draft SME Interview Protocol Overview The American Institutes for Research (AIR) has been working with the American Health Information Management Association (AHIMA) to identify the current employment market and future demands for Health Information Management Professionals. As part of this effort, we have determined the need to conduct interviews of subject matter experts (SMEs) from various disciplines and areas of expertise. The purpose of this document is to provide AHIMA with a sampling of the questions that will be asked of these experts as defined by the core research questions. This document is presented in the form of a structured interview script. Instructions for the interviewers are italicized and presented in parentheses. The structured interview protocol is broken into six sections: Introduction and Project Background; Interviewee/SME Background; Current Market Demand; Future Market Demand; Job Roles and Responsibilities; Qualifications Sought; and Utilization. The protocol is designed to provide interviewers with a structure for asking the same basic questions of all SMEs. Standardization and structure ensure that comparable information is gathered from all interviewees across the interview questions. Interview questions are organized within research questions. To assist the interviewer in obtaining as much detail as possible, follow-up probes are also included for many of the questions. Probes also serve to provide the interviewee with further context and clarification. For the purposes of the standardization, all will be trained on this protocol prior to conducting interviews with SMEs. Training will consist of a discussion of all interview questions and probes along with role play exercises to ensure interviewers feel comfortable asking questions. Following training, interviewers will be given the opportunity to observe a live interview conducted by senior project staff member. This protocol will also serve as the note-taking document for all interviews. A second version of this protocol will be created with spaces embedded after all questions and probes for interviews. These spaces will be used to record all responses provided. American Institutes for Research DRAFT 1

56 AHIMA Draft SME Interview Protocol Interview Protocol: HIM Subject Matter Experts (SMEs) Introduction and Background Information (Introduce self and any other interviewers present.) The American Institutes for Research (AIR) has been working with the American Health Information Management Association (AHIMA) to identify the current employment market and future demands for Health Information Management Professionals. AHIMA and AIR jointly identified and prioritized the research objectives for the project: Gaining an understanding of the future size, scope, and nature of the employment market for HIM practitioners across all levels of education and credentialing; Identifying the number of new positions that will be created outside of the contemporary healthcare (e.g., hospital) environment for all levels of education and credentialing; Determining to whom HIM practitioners can market themselves given their current and future knowledge, skills, and abilities (KSAs); Identifying the qualifications (e.g., education, certifications, KSAs) employers and search firms will demand in the future; and Examining the role of credentialing and certification in setting employment market demand. As part of our data collection efforts with AHIMA, we are interviewing Health Information Management researchers, practitioners, employers, recruiters, and labor economists to identify the anticipated demand for HIM practitioners at all levels of credentialing and education in the coming years. Specifically, our goal is to establish an understanding of all factors that might impact the number of new positions that will be created for HIM practitioners. To that end, we are also concerned with developing an understanding of the level of demand for HIM services in various industries other than healthcareproviding organizations. Finally, we are extremely interested in identifying the core knowledge, skills, and abilities needed by HIM practitioners to fill these new positions. Interview questions are organized into six sections: Background Information; Current Market Demand for HIM Practitioners; Future Market Demand for HIM Practitioners; Current Job Roles and Responsibilities; Qualifications Sought by Employers; and Utilization. We have compiled a list of subject matter experts (SMEs) based upon expertise in labor economics, HIM practice, employment, and HIM education and research. You have been selected as one of SMEs. This interview will take approximately 1 hour. We will not be recording our conversation but will be taking notes. All information you provide will be held confidential and anonymous. Should you have any questions or concerns, please don t hesitate to contact Dr. Alexander Alonso (the Project Director) at Your participation in this interview is completely voluntary and can be discontinued at any time without consequences. American Institutes for Research DRAFT 2

57 AHIMA Draft SME Interview Protocol Are you ready to begin the interview? (If SME says Yes, begin the interview. If SME responds otherwise, answer all questions and/or recommend that they speak to the Project Director.) Interviewee/SME Information We would like to begin by asking a few questions about your background, your current job, and your association with AHIMA and the HIM profession. Please describe your involvement in HIM practice or research practice. Please describe your involvement in employment or labor ecomonics research or practice. How familiar are you with HIM and the HIM profession at all levels of credentialing and education? How familiar are you with AHIMA or the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM)? Current Market Demand For the next sets of questions, we will be asking about the employment market for HIM practitioners. First, we would like to know about the current employment market demand. What is the current employer market for HIM practitioners at all levels of credentialing and education? o Who are the most common employers by industry? o What are the types of jobs offered by employers to HIM practitioners? o What are the types of jobs offered by employers for individuals with the varying types of credentials offered by AHIMA? 3 o What are the types of jobs offered by employers to HIM professionals with associate s degrees? o What are the types of jobs offered by employers to HIM professionals with baccalaureate degrees? o What are the types of jobs offered by employers to HIM professionals with master s degrees? What type of jobs do these industries want to fill with HIM professionals? For example, are they being used to fill database administrator positions? What societal factors have influenced the need for HIM practitioners and their knowledge? o What impact has the Health Insurance Portability and Accountability Act (HIPAA) had on the growth of HIM practice? o What impact has the growth of technology and the electronic medical record (EMR) or personal health record (PHR) had on HIM practice? o What impact have public leaks of information from large organizations had on the need for HIM practitioners? o What other factors might have similar tangible impacts on the growth of HIM practice? What factors most heavily influence potential employers perceptions of HIM practitioners? 3 List of credentials will be provided to all SMEs. American Institutes for Research DRAFT 3

58 AHIMA Draft SME Interview Protocol o o o Are most employers aware of the HIM profession and what skills a HIM practitioner possesses? What can be done by professional organizations and associations to better market the HIM profession? What are the key KSAs held by HIM practitioners that would be most attractive to current employers? What other types of professionals are competing for jobs that HIM professionals could fill? o Are health informatics professionals filling these positions? o Are healthcare providers filling these positions? o Are information technology professionals filling these positions? Future Market Demand Now, we would like to get your thoughts about future employment market demands. What is the anticipated market demand for HIM practitioners with HIM-specific degrees? Please specify for all education levels: associate s, baccalaureate, and master s. What future needs do employers anticipate needing to fulfill through the employment of HIM practitioners? Please specify anticipated needs for all HIM education levels: associate s, baccalaureate, and master s. What are the anticipated roles and responsibilities of HIM practitioners in the future? How do they vary from the current roles and responsibilities? o What are the key KSAs needed to fill these anticipated roles and responsibilities? o What are the new KSAs not already identified that will affect performance in these anticipated roles and responsibilities? o What is the anticipated need for HIM practitioners to fill executive and senior manager positions? How does this vary by level of credentialing and education? What industries are increasing their desire for individuals with HIM knowledge? Please specify for each level of education: associate s, baccalaureate, and master s. For example, are HIM practitioners being sought by pharmaceutical, education, defense, sports health, and other industries? What new types of employers could utilize a HIM professional? o What is the proportion of new positions that will come from these types of employers as opposed to conventional employers (i.e., hospitals and healthcare providers)? If asked to provide an estimate of the new positions anticipated for HIM professionals over the next eight years, what would your projection be? o How do you arrive at this estimate? o What factors have you taken into account in your projection? o What is the primary factor affecting your estimate? What new jobs and new roles could be filled by a HIM professional? What societal factors will influence the need for HIM knowledge and practitioners? o What impact will technological advancements have on HIM practice? American Institutes for Research DRAFT 4

59 AHIMA Draft SME Interview Protocol o o What impact will the continued growth of technology and the EMR or PHR have on HIM practice? What other factors will have similar tangible impacts on the growth of HIM practice? What factors will most heavily influence potential employers perceptions of HIM practitioners? What other professionals will fill future positions in the HIM professionals market? o Will health informatics professionals have the KSAs to fill these positions? o Will healthcare providers have the KSAs to fill these positions? o Will information technology professionals have the KSAs to these fill positions? Job Roles & Responsibilities In this section, we would like to get your thoughts on the roles and responsibilities currently performed by HIM practitioners as well as any skills that you believe will be needed in the future to perform HIM jobs. What are the current roles and responsibilities of HIM practitioners with a HIM associate s degree? What are the current roles and responsibilities of HIM practitioners with a HIM baccalaureate degree? What are the current roles and responsibilities of HIM practitioners with a HIM graduate degree? Are HIM practitioners with different education levels asked to do different things based upon their qualifications? How do the responsibilities of graduate level HIM practitioners (both HIM-specific and non-him specific) differ from those of HIM ractitioners without a graduate level degree? How do the responsibilities of baccalaureate level HIM practitioners (both HIM-specific and non- HIM specific) differ from those of HIM practitioners with an associate s level degree? Currently what skills set do employers want for HIM practitioners at all education levels, including associate s, baccalaureate, and master s? How will the desired skills set for HIM practitioners change in the future? Please specify for each education level. Qualifications Sought This set of questions is designed to elicit information about the perceived value of different types of AHIMA credentials, HIM-degree programs, and the combinations of the two in regard to job qualifications. Would an individual with an HIM degree be more or less likely to fulfill roles anticipated by employers? Please specify for each education level: associate s, baccalaureate, and master s. Do employers place value or preference on potential job candidates who hold one or more AHIMA credentials? American Institutes for Research DRAFT 5

60 AHIMA Draft SME Interview Protocol Which credentials are seen as more valuable from the employer s perspective? What combinations of AHIMA credentials are valued? Do employers prefer HIM professionals with AHIMA credentials and an educational level higher than the one specified by the credential eligibility requirements? For example, do employers give preference to candidates with RHIA credentials and a master s degree over those with the same credential and a baccalaureate degree? Does an HIM degree at any education level stand on its own merits regardless of a credential? Please specify for each education level: associate s, baccalaureate, and master s. o What value do employers place on graduate level HIM practitioners? o What value do employers place on baccalaureate level HIM practitioners? o What value do employers place on associate s level HIM practitioners? What do employers seek in a HIM practitioner in terms of qualifications related to all of the possible combinations of education backgrounds and certifications? For example, RHIA with a HIM master s degree. Do employers recognize the distinction between HIM graduate degrees and non-him graduate degrees? Do patterns of hiring provide evidence of the type and size of need for individuals with associate s level, baccalaureate level, and graduate level HIM knowledge? What value do employers place on HIM graduate degrees over non-him graduate degrees for HIM practitioner positions? (These questions are geared specifically for search firm SMEs Skip these questions for all other SMEs.) Does the presence of an AHIMA credential influence the search firm s assessment of the individual qualifications? Is there a preference for AHIMA credentials to fill HIM positions? Does the presence of an AHIMA credential affect the perceived value of the candidate in the eyes of your clients? Utilization These next questions are to help us to understand how HIM practitioners are utilized by employers. How do employers currently utilize HIM practitioners with a HIM degree? Please specify for each level of education: associate s, baccalaureate, and master s. o What are some common tasks or projects for each type of HIM practitioner? o What are some common roles and responsibilities for each type of HIM practitioner? How do employers utilize HIM practitioners with non-him graduate degrees? o What are some common tasks or projects for these HIM practitioners? o What are some common roles and responsibilities for these HIM practitioners? American Institutes for Research DRAFT 6

61 AHIMA Draft SME Interview Protocol Do employers utilize personnel to carry out HIM functions who do not have HIM training? In what circumstances are non-him personnel utilized to carry out HIM duties? What is the supporting rationale? Thank you very much for your time and input today. The information and feedback you have provided will help us assess the HIM profession. (Provide interviewee with interviewer contact information.) American Institutes for Research DRAFT 7

62 APPENDIX B: SME INTERVIEW FINDINGS DELIVERABLE American Institutes for Research B-1

63 AMERICAN INSTITUTES FOR RESEARCH AHIMA NATIONAL WORKFORCE ASSESSMENT DELIVERABLE 3: FINDINGS FROM SUBJECT MATTER EXPERT INTERVIEWS Prepared by: American Institutes for Research Education, Human Development, and the Workforce Division 1000 Thomas Jefferson Street, NW Washington, DC Prepared for: Scott Mackenzie Director, Business Insight & Market Analytics American Health Information Management Association (AHIMA) 233 North Michigan Avenue, 21st floor Chicago, IL Notice of Trademark: AMERICAN INSTITUTES FOR RESEARCH and AIR are registered trademarks. All other brand, product, or company names are trademarks or registered trademarks of their respective owners THOMAS JEFFERSON STREET, NW WASHINGTON, DC

64 AHIMA SME Interview Findings TABLE OF CONTENTS Page INTRODUCTION... 1 PARTICIPANTS AND PROCEDURE... 1 INTERVIEW FINDINGS... 3 CURRENT MARKET DEMAND... 3 FUTURE MARKET DEMAND... 9 JOB ROLES AND RESPONSIBILITIES QUALIFICATIONS SOUGHT UTILIZATION CONCLUSION..20 American Institutes for Research i

65 AHIMA SME Interview Findings INTRODUCTION The American Institutes for Research (AIR) has been working with the American Health Information Management Association (AHIMA) to identify the current and future employment market for Health Information Management (HIM) professionals. As part of this effort, we have interviewed subject matter experts (SMEs) from various disciplines and areas of expertise. The purpose of this document is to convey the findings of these interviews. This document begins with an overview of the technique that was used to collect this information, including a listing of the HIM professionals and practitioners who participated in the study. Next, the interview results are presented in the order the questions were asked during the interviews. The order of results is as follows: Current Market Demand; Future Market Demand; Job Roles and Responsibilities; Qualifications Sought; and Utilization. Finally, we offer overall conclusions and next steps for using the data to inform the workforce assessment of practitioners, employers, recruiters, and educators. Appendix A provides the protocol that was used for the interviews, and Appendix B provides detailed documentation of participants responses to the interview questions. PARTICIPANTS AND PROCEDURE The interview questions were organized based on the primary research questions identified at project inception. To assist the interviewer in obtaining as much detail as possible, follow-up probes were developed for many of the questions. The protocol provided a standardized structure for asking the same basic questions of all SMEs and also served as the note-taking document for the interviews. Nineteen HIM experts were interviewed for this study (see Exhibit 1 for a list of the interview participants and their affiliations). AHIMA representatives recommended the researcher and practitioner participants and AIR identified the search firm recruiters. Practitioners were selected from among the AHIMA membership based on their education and credentials. The goal of practitioner selection was to ensure that the potential interviewee list contained individuals with a variety of educational backgrounds, continuing education (e.g.. credentials), and experience. The interviews were conducted by telephone and each interview lasted approximately 90 minutes. However, the interviews tended to last longer when the interviewee had more experience (i.e., longer time in the field) and had been exposed to a variety of different HIM jobs. American Institutes for Research 1

66 AHIMA SME Interview Findings Exhibit 1: Interview Participants HIM Expert Employer HIM Area of Expertise Stephen Collier, PhD University of Alabama at Birmingham HIM/HIT Research Steven Cotton School of Business Administration, University of Montana HIM/HIT Research Tiffany Crenshaw Intellect Resources HIM Practice Brandy Ensley, RHIT, CCS Health Policy & Management, Boston University HIM/HIT Research Ron Festine Hip Jobs Search Firm Recruitment Katie Gaul Schepps Center, University of North Carolina, Chapel Hill HIM/HIT Research Susan Hanson, MBA, RHIA Terra Consulting HIM Employment Charles Haworth, PhD Economic Research Services Labor Economics William Hersh, MD Medical Informatics and Clinical Epidemiology, Oregon Health & Science University HIM/HIT Research Susan Hornell All Scripts HIM Practice Raymond Rogers National Center for Health Care Informatics HIM Employment Jim Rosenberger ExecSearch Carolina Search Firm Recruitment Anne Sharpton BroMenn Healthcare HIM Practice Daniel Sherman, PhD American Institutes for Research Labor Economics Sue Taylor, RHIA Global HealthCare Recruiters Search Firm Recruitment Anne Tegen, MHA, HRM Children's Hospital & Clinics of Minnesota HIM Practice Judah Thornewill Reid Hospital & Health Care Service HIM Employment Debra Whitlaw Gottlieb Memorial Hospital HIM Practice Donna Wilson, RHIA, CCS Compliance Concepts, Inc. HIM Practice American Institutes for Research 2

67 AHIMA SME Interview Findings INTERVIEW FINDINGS Current Market Demand Interviewees were asked about the current market demand for HIM practitioners at all levels of credentialing and education. Specifically, the interviewees were asked the following key questions: What is the current employer market for HIM practitioners at all levels of credentialing and education? What type of jobs do these industries want to fill with HIM professionals? What societal factors have influenced the need for HIM practitioners and their knowledge? What factors most heavily influence potential employers perceptions of HIM practitioners? What other types of professionals are competing for jobs that HIM professionals could fill? Although interviewees areas of expertise varied, there were consistencies in their responses to this set of questions. For instance, all of the respondents indicated that, in general, demand is high for HIM workers. The following section highlights general trends noted during the interviews in the following areas: (1) demand for HIM professionals by current work settings, (2) the educational qualifications sought by current employers, (3) the type of jobs being filled, (4) the influence of government regulation on current market demand, (5) the role of HIM training in creating market demand, and (6) the societal factors causing market demand to fluctuate. Work Setting Interviews confirmed findings of the Bureau of Labor Statistics (BLS) work indicating that the most common private sector employers of HIM practitioners are large healthcare providers, especially hospitals. 4 In addition to in-house staff, hospitals often outsource some of their HIMrelated work to HIM contractors. Two areas of consistent growth in demand are insurance companies and government where HIM responsibilities have grown with the need to regulate the use of electronic medical records. Insurance companies also hire many HIM practitioners, though far fewer than hospitals. The HIM practitioners working in insurance companies primarily focus on claims and coding review. HIM practitioners also work in government, including federal and state public health organizations, the Center for Medicare and Medicaid Services (CMS), and the United States Veterans Administration (VA). Pharmaceutical companies hire HIM practitioners to work in clinical trials because they are knowledgeable about the rules and regulations of data collection and can analyze data and ensure its integrity according to the study protocol. Generally speaking, small doctors offices (fewer than 200 patients) do not employ AHIMA-certified HIM practitioners, opting instead for uncertified coders because they are less expensive to employ. 4 Retrieved on February 12, 2009 from the Bureau of Labor Statistics website at American Institutes for Research 3

68 AHIMA SME Interview Findings Demand for Education There has been an increase in the number of Bachelor s level HIM practitioners who construct networks and databases or implement Electronic Health Record (EHR) systems over the last six years, but many respondents said that an advanced degree is beneficial when working with Electronic Medical Record (EMR)/EHR data. The next several paragraphs highlight likely positions or work for HIM professionals at different educational levels. HIM professionals with Bachelor s degrees are qualified to work in data quality assurance and to ensure patient safety and security. In rural areas, practitioners with Bachelor s degrees can become Directors of HIM departments. Unlike the distinction made for practitioners with Bachelor s degrees in rural versus urban settings, HIM professionals with Master s degrees are likely to be Supervisors, and are in demand for upper level management positions. Consulting firms typically hire associates with Master s degrees. Healthcare software vendors, government agencies, and academic institutions hire many Master s level HIM professionals. In addition, there is a need for Master s level HIM professionals to lead community programs and implementation projects. Many community intervention projects would benefit from being led by a PhD-educated HIM practitioner. Other positions where there is demand for PhD-educated practitioners include jobs in universities and positions that involve public health. Demand for Specific Types of Jobs Exhibit 2 Factors that Determine the Current Market Demand for HIM Practitioners Increase Demand: o o o o o o Additional Academic Positions Community Programs Government Regulations (e.g., HIPAA) Retiring Workforces Transition to Electronic Medical Records Use of Personal Health Records Decrease Demand: o Economic Recession The following section provides an indication of the largest areas of demand as listed by interview panelists. Please note that the areas of growth are mentioned from most demand to least demand as listed by panelists. The largest area of high demand relates to medical coding, and HIM professionals frequently hold jobs in this area, either as direct employees of an organization or as consultants. HIM professionals are also hired as transcriptionists, although the total number of transcription jobs that are available is decreasing due to an increase in the use of voice-recognition software and point-of-service data entry. On the other hand, many current transcriptionists are nearing retirement age, which will create numerous openings in this area. HIM professionals are also being used to fill openings in medical billing and compliance positions due to their understanding of compliance laws and their ability to ensure the company is protected if it is involved in a legal proceeding or an audit. American Institutes for Research 4

69 AHIMA SME Interview Findings HIM professionals are also in demand for jobs in health information systems. Doctors are transitioning to electronic recordkeeping in order to comply with government mandates, and some hospitals have created a new position in the revenue department called the Revenue Integrity Position. HIM professionals are well suited for this position based on their experience with coding, billing, and compliance issues. Clinical Documentation Improvement, which involves auditing medical records to find missing documentation of diagnoses, treatments, and prescriptions, is another area that has been employing an increasing number of HIM professionals. This new type of improvement program that is being introduced in hospitals is often organized under the supervision of the HIM department. Traditionally, many hospitals use HIM professionals to fill the HIM Director position, but HIM practitioners also manage other hospital departments including Revenue, Patient Financial Services, Coding, and Compliance. In years past, most HIM Departments had a Director and an Assistant Director, but many hospitals have recently eliminated the Assistant Director position. Government Influence Most respondents said that the Health Insurance Portability and Accountability Act (HIPAA) has had a substantial effect on the growth of the HIM profession, and that recent changes to HIPAA privacy standards will create a need for more HIM practitioners for years to come. Some respondents disagreed, however, saying that EMRs are a bigger driver of the growth of the HIM profession than the HIPAA Act. Until recently, CMS was the only government agency offering incentives for providers to use EHRs. Many respondents said that they believe there will be an increase in demand for HIM professionals as a result of the current administration s plans to invest a significant amount of money to automate health records. The increasing demand by government agencies to implement electronic health records has had the residual effect of opening up more avenues for HIM professionals who perform IT-related tasks such as the design and development of EHR software. EHR implementations take time, effort, and labor, however; healthcare facilities need HIM professionals to help throughout the implementation process. The consensus is that Personal Health Records (PHRs) have not yet created a lot of jobs for HIM professionals because it is still a new concept, but it is thought that as the technology improves, HIM knowledge and skills will be needed to assist PHR users. Generally speaking, working in medical records does not give HIM professionals the experience in finance that is essential for the management competency domain. Therefore, several panelists suggested that HIM programs include finance courses. According to the SMEs AIR interviewed, HIM professionals who have finance knowledge could easily move into a Reimbursement Management position. HIM Training Programs Several experts agreed that the number of HIM training programs is insufficient for the number of potential students, and that the current programs should be more evenly distributed American Institutes for Research 5

70 AHIMA SME Interview Findings geographically than is currently the case. The Toledo, Ohio area was cited as an example of a city that has too many approved programs. SMEs stated that this results in an overabundance of HIM professionals in the job market in particular geographical regions. Several other types of professionals compete for jobs that HIM professionals could fill, and, according to the respondents, one solution to this issue is to enhance the current HIM training programs. To illustrate, Health Informatics professionals and Information Technology (IT) professionals typically have more training than HIM professionals in computer hardware, database design, and computer programming. Coupled with this is the finding that increasing use of technology in healthcare facilities has created a need for professionals with IT skills. The Health Informatics and IT professionals are in the position to leverage their IT skills in response to this new demand. Generally speaking, however, these professionals do not have the knowledge of patient care, medical science, medical terminology, or healthcare systems that typify HIM practitioners. Many respondents suggested that HIM training programs add more technology and computer skill courses. Individuals with business degrees also pursue jobs that HIM practitioners might otherwise fill. Individuals with Master s degrees in Business Administration (MBAs) are key competitors for HIM management positions; similarly, jobs that require legal and compliance knowledge are often filled by lawyers. Exhibit 3 (on the next two pages) provides selected highlights of SME comments regarding the type of jobs available to HIM professionals and what other professionals might compete for these jobs. American Institutes for Research 6

71 AHIMA SME Interview Findings Exhibit 3: Selected Summary Statements on Available HIM Job Competition Type of Job Billing and Transcription Clinical Documentation Improvement Coding Compliance and Privacy Respondent Statement HIM professionals are sometimes hired as transcriptionists. The number of transcription jobs currently available is declining due to an increase in use of voice-recognition software. On the other hand, many current transcriptionists are nearing retirement age, creating the potential for openings in this area. HIM professionals may fill jobs in medical billing. Clinical Documentation Improvement is a new improvement program in most hospitals designed to reduce medical errors and complications as a result of improper and incomplete medical documentation. Clinical Documentation Improvement involves someone auditing medical records to find gaps and proper documentation of diagnoses, treatments, and prescriptions. HIM professionals frequently hold jobs related to coding. This is an area of high demand. Coding jobs often have flexible work locations. Coders may be direct employees of an organization or consultants. Coding-related jobs may include in-house coding, consultants who help with backlogs, and consultants who check the accuracy of coding. HIM professionals are also able to work in Compliance, which pays more than other HIM roles. HIM professionals may be especially suited to perform Compliance and Privacy work because they are more likely than those who are not HIM professionals to understand compliance laws to ensure an organization is protected when audited and when records are pulled for court cases. Data Quality Assurance Database Management and Database Administration HIM professionals work to authenticate the integrity of the data. Ultimately, the role of coders will go away, but the healthcare industry will still need HIM professionals to quality check the data included on EHRs. There is a fine line between HIM data quality assurance and conducting data analyses to identify outliers in personal health records. For record analysis, an HIM professional needs at least an RHIT credential. There is an increasing need for Database Administrators as health records go electronic. Database Administrators are in high demand. American Institutes for Research 7

72 AHIMA SME Interview Findings Exhibit 3: Selected Summary Statements on Available HIM Job Competition Cont d Type of Job Information Systems / Electronic Medical Record Maintenance Senior Management Teaching and Instruction Job Characteristics HIM professionals are in demand for jobs in health information systems and EMR/EHR. Currently, doctors using EHR systems are in the minority. However, more doctors are transitioning to electronic recordkeeping. Because the government seems poised to require EHR systems, the demand for HIM practitioners at the Associate s and Bachelor s degree levels is already large, is already increasing, and will continue to increase rapidly. HIM professionals are the librarians of the health records. They are crucial in ensuring the EHR systems work correctly and comply with all applicable laws/rules/regulations. Traditionally, many hospitals use HIM professionals to fill the HIM Director position. HIM practitioners also manage other hospital departments including Revenue, Patient Financial Services, Coding, and Compliance. HIM practitioners with graduate degrees and some business acumen provide the best option to employers when filling positions involving the management of healthcare quality and other healthcare measurement initiatives. There are fewer management positions within a HIM department. In past years, most HIM Directors had an Assistant Director but many hospitals have cut this position. SMEs reported seeing more job postings for academic HIM Instructors. Currently, it is difficult to fill these positions because of a dearth of practitioners with teaching experience. American Institutes for Research 8

73 AHIMA SME Interview Findings Societal Factors Affecting Market Demand Most participants cited one or more of five societal factors as having influenced the need for HIM practitioners. First, virtually every respondent said HIPAA has had a substantial effect on the growth of the HIM field. This group of federal regulations has increased the need for HIM practitioners to satisfy the layers of requirements to keep patient information confidential, and to ensure accurate federal reporting. The second societal factor that was cited as having influenced the need for HIM practitioners is the implementation of EMRs. Although fewer than 20% of doctors use electronic systems, most large healthcare providers use some form of EMR or hybrid system. These systems are changing the type of work that HIM practitioners do by allowing them to move into more IT-related positions. The third societal factor that was frequently mentioned as having influenced the need for HIM practitioners is the use of PHRs, although there was disagreement as to the effect it has on individual HIM practitioners. Some felt that the full effect might not be seen until sometime in the future after the technology becomes more developed. The fourth and fifth factors that were cited were the economic conditions of early 2009 and the federal government s financial incentives to move toward electronic medical records. Interviewees also commented that during times of recession it is likely that employers will look for less expensive employees and cut back on staff. Future Market Demand Respondents were asked to speculate about the future market demand for HIM professionals. The key questions asked of these individuals were: What is the anticipated market demand for HIM practitioners with HIM-specific degrees? Please specify for all education levels: Associate s, Bachelor s, and Master s. What future needs do employers anticipate needing to fulfill through the employment of HIM practitioners? Please specify anticipated needs for all HIM education levels: Associate s, Bachelor s, and Master s. What are the anticipated roles and responsibilities of HIM practitioners in the future? How do they vary from the current roles and responsibilities? What industries are increasing their desire for individuals with HIM knowledge? What new types of employers could utilize a HIM professional? If asked to provide an estimate of the new positions anticipated for HIM professionals over the next eight years, what would your projection be? What are the anticipated roles and responsibilities of HIM practitioners in the future? How do they vary from the current roles and responsibilities? What new jobs and new roles could be filled by a HIM professional? What societal factors will influence the need for HIM knowledge and practitioners? What factors will most heavily influence potential employers perceptions of HIM practitioners? What other professionals will fill future positions in the HIM professionals market? One respondent cited a study by William Hersh, which suggests that the demand for HIM professionals will be very great for hospital employers, and potentially for other employers as well. Respondents stressed that in the future HIM professionals will be needed to help organizations comply with increasingly stringent regulations regarding patient information privacy and security. A job task that is expected to grow in the future involves improving American Institutes for Research 9

74 AHIMA SME Interview Findings healthcare delivery by coordinating official patient records with patient-maintained PHRs. It is thought that including patient-supplied information will increase the accuracy of his or her medical record. The following section provides a review of general trends noted during interviews as they relate to future demand for HIM professionals. The findings are grouped according to factors that would increase the need for HIM professionals: (1) federal health policies; (2) industry needs for HIM; (3) overall demand estimates or requirements; and (4) estimated job growth. The Effect of Federal Healthcare Policies One factor that will likely affect the demand for HIM professionals involves changes to United States healthcare policy. Because Medicare and Medicaid are expected to continue to grow, the demand for HIM professionals is likely to change, although it is unclear in what way. Several respondents speculated that these changes are likely to affect Master s-level HIM professionals disproportionately because new systems must be implemented and monitored where no system previously existed, necessitating an advanced degree. At the Associate s level demand will remain strong, especially for coders, as organizations transition to the tenth revision of the International Classification of Diseases (ICD- 10). At the Bachelor s level, respondents predicted an increase in demand for HIM professionals who have knowledge of patient information privacy and security regulations, data analysis, database selection, networking, and HIM system implementation. Exhibit 4 Industries That Will Likely Hire More HIM Practitioners Academic Medical Centers Consulting Firms Insurance Companies Pharmaceutical Research Firms Pharmacy Corporate Offices Industries Increasing their Employment of HIM Practitioners Respondents were asked to identify the industries that are most likely to increase their employment of HIM professionals in the near future. The most common responses were pharmaceutical companies, pharmacies, academic medical centers, and consulting firms. Standards for these practitioners are expected to remain high one respondent said that it will be critically important that clinicians in these non-traditional settings select their HIM professionals carefully because many EHR implementations fail when staff have not been properly trained or when the implementation has not been planned carefully. New Requirements of HIM Practitioners In the future, HIM practitioners will need to understand the major issues in healthcare quality and policy, and have a solid understanding of medical technology, information technology, and American Institutes for Research 10

75 AHIMA SME Interview Findings computer programming. EMR/EHR implementation and the transition to ICD-10 will create a huge demand for HIM professionals with technological knowledge. Although HIM professionals currently need to understand the rules and regulations that affect the field, the regulations will only increase in number and complexity as EMR/EHR systems are implemented. In the future, HIM professionals will need to have more on-the-job experience in management positions. It is thought that HIM professionals gain little management ability through Master s degree programs. Other knowledge requirements that will increase in the future include pharmacy knowledge, an understanding of financial systems, an understanding of hospital organization, and public speaking ability. Documentation and privacy policies are becoming more complex. The majority of the SMEs stated that there will be an increase in demand for HIM professionals to help pharmacists/pharmaceutical companies handle these changes. Post-marketing surveillance, or the development of systems like MedWatch that are designed to detect adverse drug events and reactions once new products are in widespread use, is also an area where HIM professionals will be of use for dealing with increasing amounts of data. Academic medical centers will need HIM assistance to support clinical and biological research. SMEs as a whole noted that the demand for HIM professionals over the next decade will have an ancillary effect on the number of educators needed. As the demand for HIM professionals increases so will the need for new educational programs to provide training. New programs will call for new educators to fill training roles. Insurance companies will also need skilled HIM professionals for database maintenance, data extraction and analysis, possible claim review, and to use their knowledge of the healthcare system to maintain good relationships with healthcare providers. Estimates of HIM Job Growth There is a lot of speculation about the number of new positions that will become available in the next five years, but the results are based largely on panelist opinions which vary widely. One SME predicted that the healthcare industry will go completely paperless, possibly in the next 5 to 10 years. The move toward electronic health records would create jobs in software development and research. Another SME predicted that there will be 900 to 1000 new jobs nationally for HIM professionals each year in the near Exhibit 5 New Skills Necessary for Future HIM Practitioners Financial Knowledge Hospital Organization Knowledge Knowledge of Systems and Policy Management Experience Pharmacy Knowledge Public Speaking Ability future, fueled largely by the transition to EHR and the upcoming transition to ICD-10. Another expert predicted that in the next 8 years, 12,000 more HIM professionals will join the field, and that approximately 25% of that increase will be a direct result of the transition to EMRs and PHRs. Many of the experts expect that there will be a large wave of HIM professionals retiring within 10 to 15 years. This would, in turn, lead to an even larger gap between the number of jobs available for HIM professionals and the number of HIM professionals. This dearth of HIM American Institutes for Research 11

76 AHIMA SME Interview Findings professionals to fill HIM jobs would result in a national crisis much like the nursing shortage of the early 2000s. One respondent predicted that as a result, there will be a 20,000 job increase in the demand for HIM professionals in the next 8 years. She pointed out that there are already more jobs than there are qualified HIM professionals to fill them, and the gap is only expected to widen. One SME predicted that the number of HIM professionals will double over the next 8 years. The panel of experts predicted many variations in HIM job growth but no one SME identified the possibility of market stagnation or job demand decreasing. This indicates a fairly positive outlook for the HIM professions. The range of growth anticipated ranged from 12,000 to 50,000 new jobs over the course of the next 8 years. The figure (below) provides a graphical representation of expert estimates for job growth. Exhibit 6 Predictions of HIM Job Growth Current Workforce Range of Workforce Growth 129,000 91,000 79,000 Many SMEs agree that cost will be a major factor influencing the need for HIM knowledge and practitioners. HIM professionals will be called upon to provide organizational transparency in terms of billing practices and healthcare costs; HIM professionals are best suited to perform this task while maintaining HIPAA compliance. American Institutes for Research 12

77 AHIMA SME Interview Findings Job Roles and Responsibilities Respondents indicated that traditionally, the responsibilities of the HIM professional consist mainly of filing paper records, conducting billing, and managing patient records. Emerging job roles require more technical tasks, including database development and management, electronic recordkeeping, computerized billing, and monitoring electronic security. The following section provides a review of general trends noted during interviews as they relate to job roles and responsibilities being filled by HIM professionals currently. The key questions asked of these individuals were: What are the current roles and responsibilities of HIM practitioners with a HIM associate s degree? What are the current roles and responsibilities of HIM practitioners with a HIM Bachelor s degree? What are the current roles and responsibilities of HIM practitioners with a HIM graduate degree? How do the responsibilities of Bachelor s level HIM practitioners differ from those of HIM practitioners without a graduate level degree? How will the desired skills set for HIM practitioners change in the future? Please specify for each education level. SMEs referenced numerous sources of information that highlighted job roles and responsibilities that vary widely depending upon the degree that the practitioner has earned (see Exhibit 6). HIM professionals who have Associate s degrees are typically responsible for coding, and are sometimes responsible for billing and record filing. HIM professionals with Bachelor s degrees are typically responsible for data quality assurance, and may also be responsible for designing EMR systems. In rural areas, there are a large degree of job opportunities for Bachelor s degree HIM professionals. They are sometimes responsible for managing coding departments. It is possible that a HIM professional with a Bachelor s degree would be responsible for designing EMR systems and providing support for EMR systems, especially in rural settings like critical access hospitals. Other responsibilities include overseeing billing and billing systems and managing projects. American Institutes for Research 13

78 AHIMA SME Interview Findings Exhibit 7: Job Roles by Degree Earned Associate's Degree Billing Coding Database Management Record Management Bachelor's Degree Billing Oversight Coding Department Management Data Quality Assurance Project Management Graduate Degree EMR System Management HIM Education Public Policy System Implementation Upper Management HIM professionals with graduate degrees typically fill upper management roles and are often responsible for system implementation projects. For some positions, a HIM-specific Master s degree is preferred; for others, like administrative and management positions, there is no preference for a HIM-specific Master s degree. In general, a Master s degree in HIM is seen as good preparation for a variety of job roles and responsibilities, particularly at the senior management level, but several respondents warned that a Master s degree is not necessarily better, because work experience is also a key factor. In general, however, higher levels of education, including greater knowledge of privacy laws, will be necessary in the future, and there is increasing demand for HIM practitioners with Bachelor s and Master s degrees to manage EMR systems. One complicating factor is that in larger organizations, the HIM Manager is often not the person who recruits candidates for an open HIM position. Instead, recruiters in the HR department often find and sometimes hire applicants for these positions. These recruiters are responsible for all of the departments in the organization and, therefore, may not have time to learn about the education and credentials that are required for HIM professionals. Indeed, many of the respondents believed that the HR representatives at their organization view HIM practitioners as little more than file clerks. Qualifications Sought Respondents were asked to identify trends in the qualifications sought by employers today when filling HIM positions. They were asked to consider what qualifications were most relevant to effective performance on the job. There seems to be quite a bit of variability in panelist opinions when asked to identify relevant qualifications. As a result, consensus could not be reached for many of these questions. The key questions asked of these individuals were: Would an individual with an HIM degree be more or less likely to fulfill roles anticipated by employers? Please specify for each education level: Associate s, Bachelor s, and Master s. American Institutes for Research 14

79 AHIMA SME Interview Findings Do employers place value or preference on potential job candidates who hold one or more AHIMA credentials? Which credentials are seen as more valuable from the employer s perspective? What combinations of AHIMA credentials are valued? Do employers prefer HIM professionals with AHIMA credentials and an educational level higher than the one specified by the credential eligibility requirements? For example, do employers give preference to candidates with RHIA credentials and a Master s degree over those with the same credential and a Bachelor s degree? Does an HIM degree at any education level stand on its own merits regardless of a credential? Please specify for each education level: Associate s, Bachelor s, and Master s. Do employers recognize the distinction between HIM graduate degrees and non-him graduate degrees? Do patterns of hiring provide evidence of the type and size of need for individuals with associate s level, Bachelor s level, and graduate level HIM knowledge? What value do employers place on HIM graduate degrees over non-him graduate degrees for HIM practitioner positions? Does the presence of an AHIMA credential affect the perceived value of the candidate in the eyes of your clients? (Search Firm Specific) All of the interviewees indicated that it is more likely that a HIM job will be held by someone who is trained in HIM rather than someone who has traditional IT skills. One interviewee attributed this to the flexibility and diversity of HIM professionals, saying that they can mold themselves to varying roles and responsibilities. The HIM professional s knowledge of the healthcare industry is seen as an asset to employers. In general, HIM practitioners have a diverse range of skills and can perform a variety of jobs. The consensus is that practitioners with an AHIMA credential are more likely to fill jobs at every level. Other Qualifications Other qualifications that employers seek include a focus on writing ability, experience with data analysis, and evidence of critical thinking ability. Several experts stated that sometimes the benefit of higher education is overrated, and that skill sets may be more important than an applicant s educational background. Of those employers who require a four-year degree, many will allow any type of degree. Applicants with significant experience were preferred over inexperienced applicants with degrees and certifications. In fact, experience is absolutely critical for HIM professionals, particularly coders. The preference for experienced coders with at least two years of experience is so great that it is very difficult for new HIM coding professionals to find a job in a hospital. The experience requirement is firm, despite the fact that hospitals are struggling to find coders. In addition to coding experience, HIM professionals need HIM field experience in order to be on an EHR implementation team. American Institutes for Research 15

80 AHIMA SME Interview Findings Experience in the healthcare industry is seen as more important than IT knowledge or skill because the work and data flow in the healthcare industry is complicated and it is very different from other industries. Other types of HIM jobs are expected to have different or additional requirements. For example, large healthcare facilities prefer Managers to have experience managing multiple people and multiple departments, and EHR vendors prefer Sales Associates who have sales experience and experience working directly with physicians. HIM Managers work closely with multiple departments in a healthcare facility. In order to coordinate work flow, HIM Managers need good communication skills. Because HIM professionals manage the flow of patient information and data in hospitals, healthcare operations experience is necessary for upper level positions. These professionals often serve as subject matter experts for EHR implementations. The Value of Credentials When asked about the value of AHIMA credentials, many of the respondents were not aware of the credentials. Others were aware of them but were not able to say if they were influential or not. Those who had an opinion of the value of various AHIMA credentials said that the RHIA was valuable because individuals who have this certification have a wellrounded content expertise. The majority of panelists reported that credentials are more valuable in traditional healthcare settings such as hospitals than they are in non-traditional settings because of quality improvement efforts required under hospital oversight and accreditation programs. In fact, jobs that are focused on EHR system design and Exhibit 8 Most Desired Qualifications implementation do not require certification, nor do jobs that are similar to traditional IT jobs. It is thought that in a large hospital, employers are knowledgeable about various certifications, but smaller providers or consulting companies are less likely to be able to differentiate between them. Still, in general, the RHIA is seen to be incredibly valuable as it carries a lot of weight in the HIM profession. Despite having less advanced computer training, respondents felt that someone with a HIM education is more likely to be hired to fill a HIM job than someone with an IT or computer science education because the HIM professional s knowledge of the healthcare industry is an advantage over IT professionals. This is especially true if the candidate is credentialed. Respondents who disagreed said that experience is paramount, and other factors such as writing ability and critical thinking should play a role in the hiring decision. o o o o o o o o o o o Knowledge: Of the Healthcare Industry Of HIPAA and Other Regulations Skills: Computer Use Data Analysis Leadership Abilities: Critical Thinking Flexibility Writing Other: Credentials (RHIT, RHIA, CCA) Experience in HIM Management Experience American Institutes for Research 16

81 AHIMA SME Interview Findings Among other skills thought to be needed by employers represented on the panel were basic computer skills and coding and billing knowledge. Several panelists argued that credentials should be developed to address the direct needs of employers who need HIM professionals who meet a basic standard of competency in these domains. Many of our experts agree that technology and basic computer skills are essential to obtaining employment in the HIM profession. In general, the healthcare industry needs professionals who can manage EMR systems and databases, deal with issues of compliance, and ensure the quality of medical data. HIM professionals do not need direct IT experience, but they do need basic computer skills and the ability to learn new programs quickly. In addition to computer skill, HIM professionals need coding and billing knowledge. In order to code, HIM professionals need to understand physician documentation for various diagnoses, treatments, and medications. In particular, they need to know how to extract the highest legal diagnosis code in order to maximize payment to the healthcare facility. This requires that the HIM professional knows enough medical terminology so that he or she can effectively communicate with Doctors to clarify ambiguous medical documentation. Respondents also said that HIM practitioners must understand HIPAA regulations and compliance issues. Employers expect that someone with a RHIA certification or HIM Bachelor s degree will have a good understanding of this and other relevant regulations. As mentioned above, traditional employers are likely to view HIM credentials as essential to the job. Many large providers require an applicant to earn his or her certification within a certain time period of his or her hire date (e.g., 6 months). As traditional employers implement nontraditional systems (e.g., EMR), they will likely continue to require certifications. Because nontraditional employers (i.e., EHR and information systems jobs) do not usually require AHIMA certifications, there is likely to be some confusion among HIM practitioners who may be seeking credentials and certifications for employment purposes. Experts said that employers are sometimes confused by the array of credentials available. Search firms often have to explain the value of various credentials to their corporate clients. HIM practitioners with the RHIA certification are seen as possessing a well-rounded knowledge base of the HIM field. It shows a dedication to the field, a higher level of professionalism, a basic understanding of the healthcare system, and an understanding of communication within the healthcare system. The RHIT credential, on the other hand, is seen by some as a certification for coding positions. Other respondents thought the RHIT was more important than the Certified Coding Specialist (CCS) or Certified Coding Associate (CCA) because it includes coding, and also covers a broader knowledge of HIM. Some respondents did not distinguish between RHIA and RHIT, and one respondent confused the two. Companies that outsource HIM work typically want individuals with either the RHIT or RHIA certification plus experience. Most respondents felt that it was too soon to evaluate the CCA credential given its relatively new status. The preferred combination of credentials is either a RHIA or a RHIT plus a coding certification (with CCS being preferred) because it shows an overall knowledge of HIM plus a specific knowledge of coding. An HIM degree without credentials shows a strong grasp of the entire healthcare system and is an impressive educational background in and of itself. Employers ideally want someone who has a solid knowledge of the HIM profession as well as leadership and management skills. This can be demonstrated with the RHIA credential, or with the RHIT in combination with a Master s degree. Someone with a RHIA credential and a American Institutes for Research 17

82 AHIMA SME Interview Findings Master s degree is also qualified to lead a HIM department in a hospital, consult for multiple organizations, or work in academia. Utilization Respondents were asked to identify trends in HIM practitioner utilization across industries. Specifically, the goal was to establish how current employers use their HIM staff to fill roles. The key questions asked of these individuals were: How do employers currently utilize HIM practitioners with a HIM degree? How do employers utilize HIM practitioners with non-him graduate degrees? Do employers utilize personnel to carry out HIM functions who do not have HIM training? In what circumstances are non-him personnel utilized to carry out HIM duties? What is the supporting rationale? Respondents provided information about the way employers currently use HIM professionals. Four general themes emerged, including data analysis, patient information security, healthcare information systems, and billing accuracy and efficiency. Traditional HIM tasks identified included medical coding, billing, HIM systems administration, routine troubleshooting, and medical records oversight. It was suggested that someone with a background in clinical practice, such as a Nurse or Physician, can be taught to do many of the HIM job duties. Similarly, in the absence of qualified HIM professionals, traditional IT professionals can be hired and then trained to do HIM work. Employers are increasingly likely to use this strategy (i.e., training non-him IT professionals to fill HIM roles). Hiring non-him Practitioners Exhibit 9 Utilization of HIM professionals Billing Accuracy and Efficiency Data Analysis Healthcare Information Systems Patient Information Security There is very little consensus about hiring practices as exhibited by panelist responses from the employer side of the HIM profession. For example, employers commonly report using personnel who do not have HIM training to do HIM jobs; one panelist reported doing so for 40% of their openings because HIM professionals are not readily available or as cost effective. In the event that HIM professionals are not readily available or cost effective, panelists indicated a need to hire other types of healthcare professionals including IT professionals or clinical staff such as Registered Nurses. Typically, these professionals would be trained to perform HIM jobs if employers cannot find qualified HIM professionals or if they are unaware of the technical abilities that HIM professionals possess. This trend is also supported by commonly-held perception among panelists that clinical knowledge or expertise is very important to ensuring effective practice of HIM. Specifically, panelists from the employer group indicated that some American Institutes for Research 18

83 AHIMA SME Interview Findings of HIM task domains like health data management and data analyses call for a much deeper knowledge or expertise of clinical information. For instance, one panelist described a case where conducting appropriate data analyses of clinical outcomes with numerous complex variables using health information calls for a large degree of clinical expertise to understand the interaction of all variables. The need for this expertise often drives employers to hire clinical staff like nurses and provide them with training for core HIM tasks or functions rather than hiring HIM professionals and providing them with clinical training. Two factors that lead to the hiring of practitioners without HIM training or credentialing are concerns about return on investment when hiring and simple lack of knowledge about the field. For example, most employers indicated a concern that although HIM professionals are highlytrained, they have a hard time justifying a larger salary for coding positions that could be filled by an IT professional whose salary would be more cost efficient for the organization. This trend, however, was not expressed when discussing higher-level positions such as Directors or Managers. A secondary concern expressed by most panelists is that a large degree of employers and potential employers exhibit a limited knowledge of the HIM field. For instance, many physicians in large practices have yet to work with HIM professionals or recognize the risk of poor HIM. Because of these factors potential employers are turning to more familiar or cost effective solutions like hiring IT professionals. American Institutes for Research 19

84 AHIMA SME Interview Findings CONCLUSION AIR conducted interviews with a variety of experts on Health Information Management research and practice. Valuable information about the current status and future prediction for the HIM workforce in five key areas was obtained during the interviews: current market demand, future market demand, job roles and responsibilities, qualifications sought, and employer utilization of HIM professionals. These findings are summarized in Exhibit 10. Exhibit 10: Summary of Findings (Listed Alphabetically under Research Question) What factors are driving the current market demand for HIM practitioners? Additional Academic Positions Community Programs Economy/Recession Government Regulations (e.g., HIPAA) Transition to Electronic Medical Records Use of Personal Health Records Which industries will hire more HIM practitioners? Academic Medical Centers Consulting Firms Insurance Companies Pharmaceutical Research Firms Pharmacy Corporate Offices What skills will be necessary for future HIM practitioners? Financial Knowledge Hospital Organization Knowledge Management Experience Pharmacy Knowledge Public Speaking Ability American Institutes for Research 20

85 AHIMA SME Interview Findings Exhibit 10: Summary of Findings Continued What types of jobs are held by HIM practitioners at various levels of education? Associate's Degree: Billing Coding Database Management Record Management Bachelor's Degree: Billing Management Coding Department Manager Data Quality Assurance Project Management Graduate Degree: EMR Systems Management HIM Education Public Policy Systems Implementation Upper Management How are HIM practitioners utilized by organizations? Billing Accuracy and Efficiency Data Analysis Healthcare Information Systems Patient Information Security What qualifications do employers most desire in HIM practitioners? Coding Experience Computer Skills Credentials (e.g., RHIT, RHIT, CCA) Critical Thinking Ability Data Analysis Skill Knowledge of the Healthcare Industry / HIPAA / Other Regulations Management Experience / Leadership Skills Writing Ability Use of Information Gathered The information gathered during SME interviews was designed to be qualitative in nature. The findings can be used to help shape future data collection efforts and provide some insight into the American Institutes for Research 21

86 AHIMA SME Interview Findings concepts considered by practitioners, employers, recruiters, educators, and professionals when examining the evolution of the HIM profession in the near future. Despite the ability to inform theory-building efforts, it is important to note that no generalizations can be made from these findings. This is largely due to the less rigorous nature of qualitative methods and data gleaned from them. To that end, AIR recommends the following uses of the information contained in this report: Develop a cursory understanding of the perceptions held by those in the field about career projections and potential skills needed to achieve career growth; Develop a broad estimate of the need for HIM professionals today and what societal and industrial factors cause the estimate to fluctuate; Identify the best possible ways of assessing with greater detail the current utilization of HIM practitioners in the marketplace; Examine how future data collections such as surveys of the workforce should be structured to assess core competency domains that are relevant today or will be relevant in the near term; and Inform future AHIMA workforce initiatives to ensure that workforce and professional development demands are met despite changes in health care. Next Steps The information gathered during SME interviews will be used by AIR to inform the workforce assessment of practitioners, employers, recruiters, and educators. Important next steps for this effort will include: Ensuring the adequate assessment of core concepts found during SME interviews on each of the workforce questionnaires; Surveying the workforce, as well as employers and recruiters, to identify core trends in HIM employment; Validating the perceptions of employment market demand held by SME interviews using survey data from employers and recruiters; and Identifying core actionable areas for AHIMA to focus future initiatives to grow the profession. AIR has already used information from these interviews to establish conceptual areas for the workforce assessment questionnaires. Further, the information gathered from the SME interviews resulted in the addition of two sections to our workforce surveys; one to assess the societal factors influencing the demand for HIM professionals and another to measure the linkage between credentials and educational backgrounds with core competencies. American Institutes for Research 22

87 AHIMA SME Interview Findings APPENDIX C: SURVEYS American Institutes for Research C-1

88 AHIMA SME Interview Findings AHIMA Workplace Trends Questionnaire: Practitioner INTRODUCTION Dear Health Information Management (HIM) Practitioners, Employers, and Search Firm Recruiters: I hope that you are doing well and that your HIM careers are growing. You are invited to participate in a study concerning the needs for credentialing and career preparation in HIM degree programs, as well as the market demand for professionals with HIM degrees. This study is being conducted by the American Health Information Management Association (AHIMA) with the American Institutes for Research (AIR). You were selected as a possible participant because you are a professional who has received an HIM degree or credential and/or you are registered as a member of AHIMA. The goal of this study is to accurately assess the needs for credentialing and career preparation in HIM degree programs and to learn about a variety of things surrounding the HIM national workforce. This study is designed to establish an understanding of current market demand, future market demand, job roles and responsibilities, and qualifications sought by employers when looking to fill a HIM position. Your responses will be used to help AHIMA understand the need for HIM practitioners now and in the future. We ask that you take the time to complete the questionnaire that will be sent to you by AIR (AHIMA@air.org) during the week of June 15, If you agree to participate in this study, we will ask you to complete this 30-minute online questionnaire designed to capture your assessment of the existing need for HIM practitioners and how that might change over the next ten years. Please note that you will be rewarded for participating including being entered into a lottery for one of five great prizes (ipod Touch, and cash prizes) and receive one CEU credit if you hold an active AHIMA credential. There are no known risks for participating in this study. The benefits of participating in this study include helping AHIMA better serve its members, as well as developing a better understanding of the need for HIM professionals. The credentials available to HIM professionals will be shaped by the responses received as part of this study. Your participation will help HIM professionals receive the best training and credentialing possible for future market demand. We will keep your identity and the information you supply confidential and share it only with people who have agreed to keep it confidential, such as project staff and study sponsors. All data will be recorded with code numbers in place of your name. A data file that links you with your code number will be kept in a password-protected file that only the project team can access. There may be times when federal or state law requires disclosure of study data (e.g., through a court subpoena). This is extremely unlikely, but if it ever happens, we will make every effort to protect your personal information. American Institutes for Research C-2

89 AHIMA SME Interview Findings Your participation is entirely voluntary and responses will remain confidential. You may choose to discontinue participation at any time without penalty. If you have questions or concerns about this study, please contact the project director, Dr. Alexander Alonso, at , or 1000 Thomas Jefferson Street, NW, Washington, DC If you have concerns or questions about your rights as a participant, or to report a research-related injury, contact the Chair of AIR s Institutional Review Board (which is responsible for the protection of study participants) at IRBChair@air.org, toll free at or c/o AIR, 1000 Thomas Jefferson Street, NW, Washington, DC Sincerely, Alexander Alonso, Ph.D. Senior Research Scientist American Institutes for Research If you have read the above information, have had all your questions answered, and consent to participate in this study, please click on the Next Page button below. American Institutes for Research C-3

90 AHIMA SME Interview Findings INSTRUCTIONS This questionnaire takes about 30 minutes to complete and comprises seven sections: 1. Participant Characteristics 2. Job Roles and Responsibilities 3. Qualifications Sought 4. Employer Utilization of HIM Practitioners 5. Current Market Demand 6. Future Market Demand 7. Demographic Information Please note that there are several different types of questions with varying response options, so make sure to read the instructions for each section as you complete the questionnaire. PARTICIPANT CHARACTERISTICS In this section you will be asked to provide information about yourself. 1) Which of the following describe(s) your relationship to the field of HIM? Practitioner Supervisor of a HIM professional Educator/Researcher Recruiter 2) How long have you worked in the HIM profession? Less than one year 1-4 years 5-10 years years More than 20 years Not applicable 3) Which AHIMA credential(s) do you hold? (Check all that apply.) Certified Coding Specialist (CCS) Certified Coding Specialist-Physician Practice (CCS-P) Certified Coding Associate (CCA) Certified Health Data Analyst (CHDA) Certified in Healthcare Privacy (CHP) Certified in Healthcare Privacy and Security (CHPS) Certified in Healthcare Security (CHS) Registered Health Information Administrator (RHIA) Registered Health Information Technician (RHIT) None of the above American Institutes for Research C-4

91 AHIMA SME Interview Findings 4) What other professional credential(s) do you hold? (Check all that apply.) Certified in Healthcare Compliance (CHC) Certified Healthcare Financial Professional (CHFP) Certified Professional Coder (CPC) Certified Professional Coder-Hospital (CPC-H) Certified Professional in Healthcare Quality (CPHQ) Certified in Public Health (CPH) Certified Professional in Health Information Technology (CPHIT) Certified Professional in Electronic Health Record (CPEHR) Certified Professional in Healthcare Information and Management Systems (CPHIMS) Certified Tumor Register (CTR) Juris Doctor (JD) Medical Doctor (MD) Registered Nurse (RN) None of the above Other (please specify) If you selected other, please specify 5) What is the highest level of education you have completed to date? High School Diploma HIM/Coding Certificate Program AHIMA ISP Program Associate Degree Baccalaureate Degree Master s Degree Doctor of Law Doctor of Philosophy Doctor of Medicine Other Doctorate Other (please specify) If you selected other, please specify 6) What was your area of study in graduate school? Business Management Health Care Administration Health Informatics Health Information Management Information Technology Nursing Public Health Not applicable Other (please specify) If you selected other, please specify American Institutes for Research C-5

92 AHIMA SME Interview Findings 7) What was your major for your undergraduate studies? Business Administration Business Management Health Care Administration Health Informatics Health Information Management Information Technology Liberal Arts Natural Sciences Nursing Pre-Law Pre-Medicine Public Health Social Sciences Not applicable Other (please specify) If you selected other, please specify 8) What factors did you consider when choosing your terminal degree? (Check all that apply.) Past experience in the field Information from current practitioners Interest in the educational program Career advancement potential Academic challenge Earning potential Cost of education Location of program Desire to work in the Health Care industry Desire to provide direct patient care Prior experience in other areas (e.g., nursing) Suggestion from a friend Advice from a mentor Not applicable Other (please specify) If you selected other, please specify American Institutes for Research C-6

93 AHIMA SME Interview Findings 9) What is your primary work setting? Acute Care Hospital Ambulatory Surgery Center Behavioral/Mental Health Clinic or Physician Practice Consulting Services Educational Institution Home Health or Hospice Integrated Healthcare Delivery System Long-term Care Non-provider Setting (e.g. government, vendor, association, etc.) Other Provider Setting (e.g., rehab) JOB ROLES AND RESPONSIBILITIES In this section you will be asked to provide information about the qualifications that are necessary to do the work of a HIM practitioner. 10) If it were available, a Master's degree in HIM would be more valuable to my current job than a: Strongly Disagree Disagree Neutral Agree Strongly Agree Master of Business Administration (MBA) degree. Master of Health Administration (MHA) degree. Master of Health Informatics (MHI) degree. Master of Health Services Administration (MHSA) degree. Master of Public Health (MPH) degree. 11) Please tell us which of the following activities you perform as part of your job. Mark your answer in the box. Health Data Management Performed in My Job Health Data Structure, Content, and Standards Healthcare Information Requirements and Standards Clinical Classification Systems Reimbursement Methodologies Analysis and Outcomes Problem-Solving Clinical Data Capture American Institutes for Research C-7

94 AHIMA SME Interview Findings 12) Health Statistics, Biomedical Research, and Quality Management Performed in My Job Health Statistics and Research Quality Management and Performance Improvement Patient Safety Practices and Standards 13) Health Services Organization and Delivery Performed in My Job Healthcare Delivery Systems Healthcare Privacy, Confidentiality, Legal, and Ethical Issues Inter-Organization Health Data Exchange Issues 14) Information Technology & Systems Performed in My Job Information and Communication Technologies Data, Information, and File Structures Data Storage and Retrieval Data Security Healthcare Information Systems Information Management Planning Interoperability and Usability Data Entry, Coding, and Systems Interface 15) Organization and Management Performed in My Job Human Resources Management Financial and Resource Management Project Operations and Management Leadership Strategic and Contingency Planning Education and Training/Organizational Development Organizational Change Management Public Policy Development, Analysis, and Advocacy Business Plan Development Return on Investment/Cost Benefit Analysis Data Modeling for the Healthcare Enterprise Salesmanship/Entrepreneurship American Institutes for Research C-8

95 AHIMA SME Interview Findings 16) What level of proficiency in each of the following task areas should be expected from someone who has the same certification(s) as you? Health Data Management Not Proficient Minimally Proficient Moderately Proficient Highly Proficient Don t Know Health Data Structure, Content, and Standards Healthcare Information Requirements and Standards Clinical Classification Systems Reimbursement Methodologies Analysis and Outcomes Problem-Solving Clinical Data Capture 17) Health Statistics, Biomedical Research, and Quality Management Not Proficient Minimally Proficient Moderately Proficient Highly Proficient Don t Know Health Statistics and Research Quality Management and Performance Improvement Patient Safety Practices and Standards 18) Health Services Organization and Delivery Not Proficient Minimally Proficient Moderately Proficient Highly Proficient Don t Know Healthcare Delivery Systems Healthcare Privacy, Confidentiality, Legal, and Ethical Issues Inter-Organization Health Data Exchange Issues American Institutes for Research C-9

96 AHIMA SME Interview Findings 19) Information Technology & Systems Not Proficient Minimally Proficient Moderately Proficient Highly Proficient Don t Know Information and Communication Technologies Data, Information, and File Structures Data Storage and Retrieval Data Security Healthcare Information Systems Information Management Planning Interoperability and Usability Data Entry, Coding, and Systems Interface 20) Organization and Management Not Proficient Minimally Proficient Moderately Proficient Highly Proficient Don t Know Human Resources Management Financial and Resource Management Project Operations and Management Leadership Strategic and Contingency Planning Education and Training/Organizational Development Organizational Change Management Public Policy Development, Analysis, and Advocacy Business Plan Development Return on Investment/Cost Benefit Analysis Data Modeling for the Healthcare Enterprise Salesmanship/Entrepreneurship QUALIFICATIONS SOUGHT In this section you will be asked to provide information about the qualifications that employers seek in a HIM practitioner. American Institutes for Research C-10

97 AHIMA SME Interview Findings 21) How helpful are the following certifications and degrees to getting a job like yours in the HIM field? Not At All Helpful Somewhat Helpful Very Helpful Don t Know Certified Coding Associate (CCA) certification Certified Coding Specialist (CCS) certification Certified Coding Specialist-Physician Practice (CCS-P) certification Certified Health Data Analyst (CHDA) Certified in Healthcare Security (CHS) Certified in Healthcare Privacy (CHP) Certified in Healthcare Privacy and Security (CHPS) Registered Health Information Technician (RHIT) certification Registered Health Information Administrator (RHIA) certification Associate's Degree in HIM Bachelor's Degree in HIM Master's degree in HIM CURRENT MARKET DEMAND In this section you will be asked to provide information about the current market demand for HIM practitioners. 22) Which of the following types of employers currently hire HIM practitioners? (Check all that apply.) Academia/Educational Institutions Consulting Services Organizations Government Agencies Hospitals HR Organizations or Departments Insurance Companies Online Medical Resource Organizations Online Search Engine Organizations Pharmaceutical Distributors Pharmaceutical Manufacturers Pharmacies Professional or Labor Unions Physicians Offices or Practices Professional Societies or Associations Personal Health Record Companies or Vendors Research Organizations Sports Leagues or Teams Other (please specify) If you selected other, please specify American Institutes for Research C-11

98 AHIMA SME Interview Findings 23) Does your employer currently utilize professionals who do not have a HIM background to fill HIM positions? Yes No Don't Know 24) What is the background of non-him workers who fill HIM positions at your organization? (Check all that apply.) Allied Health Business Management Health Administration Health Informatics Human Resources Information Technology Law Medical Assistance Medicine Nursing Paralegal Training Public Health Not applicable Other (please specify) If you selected other, please specify 25) Which of the following factors have influenced the demand for HIM professionals and their knowledge? Changes in Standard Medical Billing Practices Changes in Standard Medical Charting Practices Clinical Terminology and Classification Systems Economic Stimulus Package of 2009 Electronic Medical Records (EMR) Government Reporting Requirements/Auditing Health Care Reform Health Insurance Portability and Accountability Act (HIPAA) Information Technology Systems News Releases about Health Information Leaks The Patient Safety Movement Personal Health Records (PHR) Telecommuting Workplace Arrangements Other (please specify) If you selected other, please specify American Institutes for Research C-12

99 AHIMA SME Interview Findings 26) The following questions ask about the job opportunities that are available to HIM practitioners with various degrees. For each degree, the first part of the question asks about the current job market, and the second question asks about the job market in the future. Strongly disagree Disagree Neutral Agree Strongly Agree It is easy to find a good job without any degree in HIM. It is easy to find a good job with an Associate s degree in HIM. It is easy to find a good job with a Bachelor s degree in HIM. It is easy to find a good job with a Master s degree in HIM. I cannot advance past my current position unless I go back to school. In order to get a good job in my organization, HIM practitioners must hold at least one certification. I will need to obtain another certification in order to advance past my current position. The job outlook for HIM professionals with an Associate s degree is very good. The job outlook for HIM professionals with a Bachelor s degree is very good. The job outlook for HIM professionals with a Master s degree is very good. The following three questions ask about the minimum qualifications for a job like the one you currently hold. 27) To your knowledge, what will be the most common degree requirement for HIM positions in your organization ten years from now? Associate s HIM degree Bachelor s HIM degree Master s HIM degree No degree required Other (please specify) If you selected other, please specify 28) To your knowledge, what degree will be required to get that job in ten years? No Degree Required Associate s Degree Bachelor s Degree Master s Degree Doctoral Degree American Institutes for Research C-13

100 AHIMA SME Interview Findings 29) To your knowledge, how much experience will be required to get that job in ten years? None Less than 1 year 1-2 years 3-4 years 5-10 years More than 10 years 30) To your knowledge, what certification(s) will be required to get that job in ten years? (Check all that apply.) Certified Coding Specialist (CCS) Certified Coding Specialist-Physician Practice (CCS-P) Certified Coding Associate (CCA) Certified Health Data Analyst (CHDA) Certified in Healthcare Privacy (CHP) Certified in Healthcare Privacy and Security (CHPS) Certified in Healthcare Security (CHS) Registered Health Information Technician (RHIT) Registered Health Information Administrator (RHIA) None of the above Other (please specify) If you selected other, please specify 31) To your knowledge, what types of organizations will hire workers with an Associate s degree in HIM in ten years? (Check all that apply.) Academia/Educational Institutions Consulting Services Organizations Government Agencies Hospitals HR Organizations or Departments Insurance Companies Online Medical Resource Organizations Online Search Engine Organizations Pharmaceutical Distributors Pharmaceutical Manufacturers Pharmacies Professional or Labor Unions Physicians Offices or Practices Professional Societies or Associations Personal Health Record Companies or Vendors Research Organizations Sports Leagues or Teams Other (please specify) If you selected other, please specify American Institutes for Research C-14

101 AHIMA SME Interview Findings 32) To your knowledge, what types of organizations will hire workers with a Bachelor s degree in HIM in ten years? (Check all that apply.) Academia/Educational Institutions Consulting Services Organizations Government Agencies Hospitals HR Organizations or Departments Insurance Companies Online Medical Resource Organizations Online Search Engine Organizations Pharmaceutical Distributors Pharmaceutical Manufacturers Pharmacies Professional or Labor Unions Physicians Offices or Practices Professional Societies or Associations Personal Health Record Companies or Vendors Research Organizations Sports Leagues or Teams Other (please specify) If you selected other, please specify 33) To your knowledge, what types of organizations will hire workers with a Master s degree in HIM in ten years? (Check all that apply.) Academia/Educational Institutions Consulting Services Organizations Government Agencies Hospitals HR Organizations or Departments Insurance Companies Online Medical Resource Organizations Online Search Engine Organizations Pharmaceutical Distributors Pharmaceutical Manufacturers Pharmacies Professional or Labor Unions Physicians Offices or Practices Professional Societies or Associations Personal Health Record Companies or Vendors Research Organizations Sports Leagues or Teams Other (please specify) If you selected other, please specify American Institutes for Research C-15

102 AHIMA SME Interview Findings DEMOGRAPHIC INFORMATION Please provide some basic demographic information about yourself. 34) What is your gender? Male Female 35) What is your age? Under to to to to or Older 36) What is your current annual full-time salary? Less than $20,000 $20,000 to $29,999 $30,000 to $39,999 $40,000 to $49,999 $50,000 to $59,999 $60,000 to $69,999 $70,000 to $79,999 $80,000 to $89,999 $90,000 to $99,999 $100,000 to $124,999 $125,000 or more Not Applicable Prefer not to say 37) Which racial category/categories best describe(s) your background? (optional) American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White No Answer Other (please specify) If you selected other, please specify 38) Which ethnic category best describes your background? (optional) Hispanic or Latino Not Hispanic or Latino No Answer American Institutes for Research C-16

103 AHIMA SME Interview Findings 39) In what state do you work? (If you are outside the United States please select Other ) Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming American Institutes for Research C-17

104 AHIMA SME Interview Findings No Answer Other (please specify) If you selected other, please specify 40) Where did you earn your degree? Alabama State University Alfred State College-SUNY Anoka Technical College Arapahoe Community College Arkansas Tech University Baker College of Allen Park Baker College System Baltimore City Community College Bishop State Community College Boise State University Borough of Manhattan Community College Bowling Green State University-Firelands Briarwood College Bristol Community College Broome Community College Broward Community College Brunswick Community College Burlington County College Camden County College Caritas Laboure College Catawba Valley Community College Central Community College Central Florida Community College Central New Mexico Community College Central Oregon Community College Central Piedmont Community College Charles R. Drew Univ of Medicine & Sci. Chattanooga State Tech Community College Chicago State University Chippewa Valley Technical College Cincinnati State Tech Community College City College of San Francisco Clarkson College College of DuPage College of Lake County College of Southern Nevada College of St Catherine College of St. Catherine College of St. Scholastica College of the Mainland Columbus State Community College Community College of Allegheny County Community College of Baltimore County Cosumnes River College Cuyahoga Community College Cypress College Dakota State University American Institutes for Research C-18

105 AHIMA SME Interview Findings Dallas County Community College Danville Area Community College Darton College Davenport University - Livonia Campus Davenport University - Online Davenport University - Saginaw Davenport University- Grand Rapids Davidson County Community College Daytona State College Del Mar College Delgado Community College DeVry University- Atlanta DeVry University-Chicago Campus DeVry University-Columbus DeVry University-Dallas DeVry University-Houston DeVry University-North Brunswick Campus DeVry University-Online Campus DeVry University-Philadelphia Campus DeVry University-Pomona Campus Duquesne University Dyersburg State Community College East Carolina University East Central University East Los Angeles College Eastern Kentucky University Edgecombe Community College El Paso Community College Erie Community College - North Campus Ferris State University Fisher College Florence-Darlington Technical College Florida A&M University Florida Community College Florida International University Fresno City College Gateway Technical College Greenville Technical College Griffin Technical College Gwynedd Mercy College Heald College Hinds Community College Hocking College Hodges University Houston Community College System Howard College Hudson County Community College Huertas Junior College Hutchinson Community College Idaho State University Illinois State University Indian Hills Community College Indian River Community College Indiana University Northwest Indiana University School of Informatics Itawamba Community College American Institutes for Research C-19

106 AHIMA SME Interview Findings ITT Technical Institute - Anaheim ITT Technical Institute - Boise ITT Technical Institute - Fort Lauderdale ITT Technical Institute - Indianapolis ITT Technical Institute - Oxnard ITT Technical Institute - San Bernardino Ivy Tech Community College - Bloomington Ivy Tech Community College-Lawrence Jefferson Community and Technical College Joliet Junior College Kaplan College-Hagerstown Campus Kennebec Valley Community College Kirkwood Community College Lake Sumter Community College Lamar Institute of Technology Lee College Lehigh County Community College Loma Linda University Lone Star College - North Harris Long Island University Louisiana Tech University Macomb Community College-Center C Macon State College Marshall Community and Technical College McDowell Technical Community College McLennan Community College Medical College of Georgia Mercy College of Northwest Ohio Meridian Community College Miami Dade College Midland College Midlands Technical College Midstate College Minnesota State Community &Tech College Missouri Western State University Mohawk Valley Community College Monroe Community College Montana State Univ. College of Technology Montgomery College Moraine Park Technical College Moraine Valley Community College National College Other (please specify) If you selected other, please specify American Institutes for Research C-20

107 AHIMA SME Interview Findings 41) Please indicate your AHIMA membership status. Not currently a member Active member with an AHIMA credential Active member without an AHIMA credential New Graduate Member Student Member Senior/Honorary Member Not applicable 42) What professional organizations other than AHIMA and your state HIM associations (Component State Associations) do you belong to? (Check all that apply.) American Academy of Family Physicians (AAFP) American Academy of Professional Coders (AAPC) American Association for Medical Transcription (AAMT) American College of Healthcare Executives (ACHE) American Medical Informatics Association (AMIA) Association for Information and Image Management (AIIM) College of Healthcare Information Management Executives (CHIME) Healthcare Financial Management Association (HFMA) Healthcare Information and Management Systems Society (HIMSS) Medical Group Management Association (MGMA) Medical Transcription Industry Association (MTIA) National Association of Healthcare Quality (NAHQ) National Cancer Registrars Association (NCRA) Other (please specify) If you selected other, please specify 43) Which of the following best describes your current work status? Full-Time Part-Time Self-Employed Not Currently Employed Other (please specify) If you selected other, please specify Thank you for participating in the survey. You have been automatically entered to win one of five great prizes (ipod Touch, and cash prizes). We will hold the drawing in July 2009 and you will be notified by if you are a winner. You can increase your chances of winning by referring colleagues to this survey. If you refer a qualified person who completes the survey he or she will be entered to win, and you will receive an additional entry. American Institutes for Research C-21

108 AHIMA SME Interview Findings 44) Employer, Supervisor, or Hiring Manager Name address 45) Employer, Supervisor, or Hiring Manager Name address 46) Practitioner Name address 47) Practitioner Name address 48) Practitioner Name address Thank you for your response! The American Institutes for Research is compiling all of the addresses of AHIMA members with an active credential that complete the survey by the closing date of July 07, When the survey is closed for data collection, the American Institutes for Research will forward the list of addresses eligible for the CEU. AHIMA will then contact eligible participants directly to inform them how to redeem their CEU. American Institutes for Research C-22

109 AHIMA SME Interview Findings AHIMA Workplace Trends Questionnaire: Employer INTRODUCTION Dear Health Information Management (HIM) Practitioners, Employers, and Search Firm Recruiters: I hope that you are doing well and that your HIM careers are growing. You are invited to participate in a study concerning the needs for credentialing and career preparation in HIM degree programs, as well as the market demand for professionals with HIM degrees. This study is being conducted by the American Health Information Management Association (AHIMA) with the American Institutes for Research (AIR). You were selected as a possible participant because you are a professional who has received an HIM degree or credential and/or you are registered as a member of AHIMA. The goal of this study is to accurately assess the needs for credentialing and career preparation in HIM degree programs and to learn about a variety of things surrounding the HIM national workforce. This study is designed to establish an understanding of current market demand, future market demand, job roles and responsibilities, and qualifications sought by employers when looking to fill a HIM position. Your responses will be used to help AHIMA understand the need for HIM practitioners now and in the future. We ask that you take the time to complete the questionnaire that will be sent to you by AIR (AHIMA@air.org) during the week of June 15, If you agree to participate in this study, we will ask you to complete this 30-minute online questionnaire designed to capture your assessment of the existing need for HIM practitioners and how that might change over the next ten years. Please note that you will be rewarded for participating including being entered into a lottery for one of five great prizes (ipod Touch, and cash prizes) and receive one CEU credit if you hold an active AHIMA credential. There are no known risks for participating in this study. The benefits of participating in this study include helping AHIMA better serve its members, as well as developing a better understanding of the need for HIM professionals. The credentials available to HIM professionals will be shaped by the responses received as part of this study. Your participation will help HIM professionals receive the best training and credentialing possible for future market demand. We will keep your identity and the information you supply confidential and share it only with people who have agreed to keep it confidential, such as project staff and study sponsors. All data will be recorded with code numbers in place of your name. A data file that links you with your code number will be kept in a password-protected file that only the project team can access. There may be times when federal or state law requires disclosure of study data (e.g., through a court subpoena). This is extremely unlikely, but if it ever happens, we will make every effort to protect your personal information. American Institutes for Research C-23

110 AHIMA SME Interview Findings Your participation is entirely voluntary and responses will remain confidential. You may choose to discontinue participation at any time without penalty. If you have questions or concerns about this study, please contact the project director, Dr. Alexander Alonso, at , or 1000 Thomas Jefferson Street, NW, Washington, DC If you have concerns or questions about your rights as a participant, or to report a research-related injury, contact the Chair of AIR s Institutional Review Board (which is responsible for the protection of study participants) at IRBChair@air.org, toll free at or c/o AIR, 1000 Thomas Jefferson Street, NW, Washington, DC Sincerely, Alexander Alonso, Ph.D. Senior Research Scientist American Institutes for Research If you have read the above information, have had all your questions answered, and consent to participate in this study, please click on the Next Page button below. American Institutes for Research C-24

111 AHIMA SME Interview Findings INSTRUCTIONS This questionnaire takes about 30 minutes to complete and comprises seven sections: 1. Participant Characteristics 2. Job Roles and Responsibilities 3. Qualifications Sought 4. Employer Utilization of HIM Practitioners 5. Current Market Demand 6. Future Market Demand 7. Demographic Information Please note that there are several different types of questions with varying response options, so make sure to read the instructions for each section as you complete the questionnaire. PARTICIPANT CHARACTERISTICS In this section you will be asked to provide information about yourself. 1) Do you supervise, employ, or hire HIM practitioners? Yes No 2) What is your job title? Administrator/CEO/COO Analyst Assistant Administrator/VP/AVP/SVP/EVP Chief Financial Officer Chief Information Officer Client Support Specialist Coding Professional Compliance Officer Consultant Coordinator Customer/client Representative Data Quality Analyst DRG coordinator EHR Specialist/Manager/Director HIM Faculty Information Security Officer IS/MIS Director Medical Records Analyst Nurse Physician Privacy Officer Project Manager American Institutes for Research C-25

112 AHIMA SME Interview Findings QA Specialist Recruiter Registrar Sales Representative Systems Analyst Team Leader Transcriptionist Other (please specify) If you selected other, please specify 3) How long have you worked in the HIM profession? Less than one year 1-4 years 5-10 years years More than 20 years Not applicable 4) Which type of employer do you currently work for? Academia/Educational Institutions Consulting Services Organizations Government Agencies Hospitals HR Organizations or Departments Insurance Companies Online Medical Resource Organizations Online Search Engine Organizations Pharmaceutical Distributors Pharmaceutical Manufacturers Pharmacies Professional or Labor Unions Physicians Offices or Practices Professional Societies or Associations Personal Health Record Companies or Vendors Research Organizations Sports Leagues or Teams Other (please specify) If you selected other, please specify American Institutes for Research C-26

113 AHIMA SME Interview Findings 5) Which AHIMA credential(s) do you hold? (Check all that apply.) Certified Coding Specialist (CCS) Certified Coding Specialist-Physician Practice (CCS-P) Certified Coding Associate (CCA) Certified Health Data Analyst (CHDA) Certified in Healthcare Privacy (CHP) Certified in Healthcare Privacy and Security (CHPS) Certified in Healthcare Security (CHS) Registered Health Information Administrator (RHIA) Registered Health Information Technician (RHIT) None of the above 6) What other professional credential(s) do you hold? (Check all that apply.) Certified in Healthcare Compliance (CHC) Certified Healthcare Financial Professional (CHFP) Certified Professional Coder (CPC) Certified Professional Coder-Hospital (CPC-H) Certified Professional in Healthcare Quality (CPHQ) Certified in Public Health (CPH) Certified Professional in Health Information Technology (CPHIT) Certified Professional in Electronic Health Record (CPEHR) Certified Professional in Healthcare Information and Management Systems (CPHIMS) Certified Tumor Register (CTR) Juris Doctor (JD) Medical Doctor (MD) Registered Nurse (RN) None of the above Other (please specify) If you selected other, please specify 7) What is the highest level of education you have completed to date? High School Diploma HIM/Coding Certificate Program AHIMA ISP Program Associate Degree Baccalaureate Degree Master s Degree Doctor of Law Doctor of Philosophy Doctor of Medicine Other Doctorate Other (please specify) If you selected other, please specify American Institutes for Research C-27

114 AHIMA SME Interview Findings 8) What was your area of study in graduate school? Business Management Health Care Administration Health Informatics Health Information Management Information Technology Nursing Public Health Not applicable Other (please specify) If you selected other, please specify 9) What was your major for your undergraduate studies? Business Administration Business Management Health Care Administration Health Informatics Health Information Management Information Technology Liberal Arts Natural Sciences Nursing Pre-Law Pre-Medicine Public Health Social Sciences Not applicable Other (please specify) If you selected other, please specify American Institutes for Research C-28

115 AHIMA SME Interview Findings 10) What factors did you consider when choosing your terminal degree? (Check all that apply.) Past experience in the field Information from current practitioners Interest in the educational program Career advancement potential Academic challenge Earning potential Cost of education Location of program Desire to work in the Health Care industry Desire to provide direct patient care Prior experience in other areas (e.g., nursing) Suggestion from a friend Advice from a mentor Not applicable Other (please specify) If you selected other, please specify 11) What is your primary work setting? Acute Care Hospital Ambulatory Surgery Center Behavioral/Mental Health Clinic or Physician Practice Consulting Services Educational Institution Home Health or Hospice Integrated Healthcare Delivery System Long-term Care Non-provider Setting (e.g. government, vendor, association, etc.) Other Provider Setting (e.g., rehab) JOB ROLES AND RESPONSIBILITIES In this section you will be asked to provide information about the qualifications that are necessary to do the work of a HIM practitioner. American Institutes for Research C-29

116 AHIMA SME Interview Findings 12) Please indicate which three competencies are most important to your organization. In ten years from now, which of the following competency domains do you anticipate will be most needed from the HIM practitioners you will employ? Business Administration and Analysis Skills Computer Literacy Skills Health Informatics Skills - Using the EHR and PHR Health Information/Data Technical Security Leadership and Organizational Communication Skills Organizational Change and Development Management Skills Privacy, Confidentiality of Health Information Public Policy Skills 13) Please indicate which three competencies are least important to your organization. In ten years from now, which of the following competency domains do you anticipate will be least needed from the HIM practitioners you will employ? Business Administration and Analysis Skills Computer Literacy Skills Health Informatics Skills - Using the EHR and PHR Health Information/Data Technical Security Leadership and Organizational Communication Skills Organizational Change and Development Management Skills Privacy, Confidentiality of Health Information Public Policy Skills 14) To your knowledge, how relevant will the following competencies be to the practice of Health Information Management at your organization ten years from now? Not At All Relevant Somewhat Relevant Very Relevant Don t Know Business Administration and Analysis Skills Basic Computer Literacy Skills Health Informatics Skills - Using the EHR and PHR Health Information/Data Technical Security Health Information Literacy and Skills Leadership and Organizational Communication Skills Organizational Change and Development Management Skills Privacy, Confidentiality of Health Information Public Policy Skills Other (Please specify) American Institutes for Research C-30

117 AHIMA SME Interview Findings QUALIFICATIONS SOUGHT In this section you will be asked to provide information about the relative value of various degrees and certifications to employers of HIM professionals. 15) If it were available, a Master's degree in HIM would be more valued by employers than a: Strongly Disagree Disagree Neutral Agree Strongly Agree Master of Business Administration (MBA) degree. Master of Health Administration (MHA) degree. Masters of Health Informatics (MHI) degree. Master of Health Services Administration (HSA) degree. Master of Public Health (MPH) degree. 16) How helpful are the following certifications and degrees when selecting a candidate for a HIM job? Not At All Helpful Somewhat Helpful Very Helpful Don t Know Certified Coding Associate (CCA) certification Certified Coding Specialist (CCS) certification Certified Coding Specialist-Physician Practice (CCS- P) certification Certified Health Data Analyst (CHDA) Certified in Healthcare Security (CHS) Certified in Healthcare Privacy (CHP) Certified in Healthcare Privacy and Security (CHPS) Registered Health Information Technician (RHIT) certification Registered Health Information Administrator (RHIA) certification Associate's Degree in HIM Bachelor's Degree in HIM Master's degree in HIM American Institutes for Research C-31

118 AHIMA SME Interview Findings 17) Which of the following competency domains are currently relevant for the HIM practitioners you supervise? (Check all that apply.) Business Administration and Analysis Skills Basic Computer Literacy Skills Health Information/Data Technical Security Health Information Literacy and Skills Health Informatics Skills - Using the EHR and PHR Leadership and Organizational Communication Skills Organizational Change and Development Management Skills Privacy, Confidentiality of Health Information Public Policy Skills Other (please specify) If you selected other, please specify 18) What competencies will be required of HIM practitioners ten years from now? (Check all that apply) Business Administration and Analysis Skills Basic Computer Literacy Skills Health Information/Data Technical Security Health Information Literacy and Skills Health Informatics Skills - Using the EHR and PHR Leadership and Organizational Communication Skills Organizational Change and Development Management Skills Privacy, Confidentiality of Health Information Public Policy Skills Other (please specify) If you selected other, please specify American Institutes for Research C-32

119 AHIMA SME Interview Findings 19) Based on your experience, how helpful are the following certifications and degrees to someone who is looking for a job in the HIM field? Not At All Helpful Somewhat Helpful Very Helpful Don t Know Certified Coding Associate (CCA) certification Certified Coding Specialist (CCS) certification Certified Coding Specialist-Physician Practice (CCS- P) certification Certified Health Data Analyst Certified in Healthcare Security (CHS) Certified in Healthcare Privacy (CHP) Certified in Healthcare Privacy and Security (CHPS) Registered Health Information Technician (RHIT) certification Registered Health Information Administrator (RHIA) certification Associate's Degree in HIM Bachelor's Degree in HIM Master's degree in HIM 20) Which of these HIM degrees represents the minimum degree requirement for performing the following task domains? Health Data Management Associate's Degree Bachelor's Degree Master's Degree Doctorate No Degree Required Don t Know Health Data Structure, Content, and Standards Healthcare Information Requirements and Standards Clinical Classification Systems Reimbursement Methodologies Analysis and Outcomes Problem-Solving Clinical Data Capture American Institutes for Research C-33

120 AHIMA SME Interview Findings 21) Health Statistics, Biomedical Research, and Quality Management Associate's Degree Bachelor's Degree Master's Degree Doctorate No Degree Required Don t Know Health Statistics and Research Quality Management and Performance Improvement Patient Safety Practices and Standards 22) Health Services Organization and Delivery Associate's Degree Bachelor's Degree Master's Degree Doctorate No Degree Required Don t Know Healthcare Delivery Systems Healthcare Privacy, Confidentiality, Legal, and Ethical Issues Inter-Organization Health Data Exchange Issues 23) Information Technology & Systems Associate's Degree Bachelor's Degree Master's Degree Doctorate No Degree Required Don t Know Information and Communication Technologies Data, Information, and File Structures Data Storage and Retrieval Data Security Healthcare Information Systems Information Management Planning Interoperability and Usability Data Entry, Coding, and Systems Interface American Institutes for Research C-34

121 AHIMA SME Interview Findings 24) Organization and Management Associate's Bachelor's Master's Doctorate No Degree Don t Degree Degree Degree Required Know Human Resources Management Financial and Resource Management Project Operations and Management Leadership Strategic and Contingency Planning Education and Training/Organizational Development Organizational Change Management Public Policy Development, Analysis, and Advocacy Business Plan Development Return on Investment/Cost Benefit Analysis Data Modeling for the Healthcare Enterprise Salesmanship/Entrepreneurship 25) What certification(s) is/are required to perform each of the following task domains? Health Data Management CCS/CCS- P CCA CHS/CHP RHIT RHIA No Certification Required Health Data Structure, Content, and Standards Healthcare Information Requirements and Standards Clinical Classification Systems Reimbursement Methodologies Analysis and Outcomes Problem-Solving Clinical Data Capture Other 26) Health Statistics, Biomedical Research, and Quality Management CCS/CCS- CCA CHS/CHP RHIT RHIA No Certification Other P Required Health Statistics and Research Quality Management and Performance Improvement Patient Safety Practices and Standards American Institutes for Research C-35

122 AHIMA SME Interview Findings 27) Health Services Organization and Delivery 28) Information Technology & Systems CCS/CCS- CCA CHS/CHP RHIT RHIA No Certification Other P Required Healthcare Delivery Systems Healthcare Privacy, Confidentiality, Legal, and Ethical Issues Inter-Organization Health Data Exchange Issues CCS/CCS- P CCA CHS/CHP RHIT RHIA No Certification Required Information and Communication Technologies Data, Information, and File Structures Data Storage and Retrieval Data Security Healthcare Information Systems Information Management Planning Interoperability and Usability Data Entry, Coding, and Systems Interface Other 29) Organization and Management CCS/CCS- CCA CHS/CHP RHIT RHIA No Certification Other P Required Human Resources Management Financial and Resource Management Project Operations and Management Leadership Strategic and Contingency Planning Education and Training/Organizational Development Organizational Change Management Public Policy Development, Analysis, and Advocacy Business Plan Development Return on Investment/Cost Benefit Analysis Data Modeling for the Healthcare Enterprise Salesmanship/Entrepreneurship American Institutes for Research C-36

123 AHIMA SME Interview Findings EMPLOYER UTILIZATION OF HIM PRACTITIONERS In this section you will be asked to provide information about the way HIM practitioners are utilized. 30) Which of the following types of organizations employ HIM practitioners? (Check all that apply.) Academia/Educational Institutions Consulting Services Organizations Government Agencies Hospitals HR Organizations or Departments Insurance Companies Online Medical Resource Organizations Online Search Engine Organizations Pharmaceutical Distributors Pharmaceutical Manufacturers Pharmacies Professional or Labor Unions Physicians Offices or Practices Professional Societies or Associations Personal Health Record Companies or Vendors Research Organizations Sports Leagues or Teams Other (please specify) If you selected other, please specify 31) Do you ever staff professionals who do not have a HIM background to fill HIM positions? Never Rarely Sometimes Often American Institutes for Research C-37

124 AHIMA SME Interview Findings 32) What is the background of the non-him professionals who fill HIM positions in your organization? (Check all that apply.) Allied Health Business Management Health Administration Health Informatics Human Resources Information Technology Law Medical Assistance Medicine Nursing Paralegal Training Public Health Other (please specify) If you selected other, please specify 33) Which of the following credentials are held by at least one of the HIM practitioners at your organization? (Check all that apply.) Certified Coding Specialist (CCS) Certified Coding Specialist-Physician Practice (CCS-P) Certified Coding Associate (CCA) Certified in Healthcare Privacy (CHP) Certified in Healthcare Privacy and Security (CHPS) Certified in Healthcare Security (CHS) Certified Professional in Healthcare Quality (CPHQ) Certified Tumor Register (CTR) Certified Professional Coder (CPC) Certified Professional Coder-Hospital (CPC-H) Certified in Healthcare Compliance (CHC) Certified Professional in Health Information Technology (CPHIT) Certified Professional in Electronic Health Record (CPEHR) Certified Professional in Healthcare Information and Management Systems (CPHIMS) Certified Healthcare Financial Professional (CHFP) Registered Health Information Technician (RHIT) Registered Health Information Administer (RHIA) American Institutes for Research C-38

125 AHIMA SME Interview Findings 34) Using the drop-down boxes beside each credential, please select the number of HIM practitioners at your organization who hold each of the following credentials Certified Coding Specialist (CCS) Certified Coding Specialist-Physician Practice (CCS-P) Certified Coding Associate (CCA) Certified in Healthcare Privacy (CHP) Certified in Healthcare Privacy and Security (CHPS) Certified in Healthcare Security (CHS) Certified Professional in Healthcare Quality (CPHQ) Certified Tumor Register (CTR) Certified Professional Coder (CPC) Certified Professional Coder-Hospital (CPC-H) Certified in Healthcare Compliance (CHC) Certified Professional in Health Information Technology (CPHIT) Certified Professional in Electronic Health Record (CPEHR) Certified Professional in Healthcare Information and Management Systems (CPHIMS) Certified Healthcare Financial Professional (CHFP) Registered Health Information Technician (RHIT) Registered Health Information Administer (RHIA) American Institutes for Research C-39

126 AHIMA SME Interview Findings 35) If asked to hire someone for each of the positions below, what ONE certification or credential would be most important for a qualified candidate to possess? CCS/CCS- CCA CHS/CHP RHIT RHIA No Certification Other P Required Administrator/CEO/COO Analyst Assistant Administrator/VP/AVP/SVP/EVP Chief Financial Officer Chief Information Officer Client Support Specialist Coding Professional Compliance Officer Consultant Coordinator Customer/Client Representative Data Quality Analyst DRG Coordinator EHR Specialist/Manager/Director HIM Faculty Information Security Officer IS/MIS Director Medical Records Analyst Privacy Officer Project Manager QA Specialist Registrar Sales Representative Systems Analyst Team Leader Transcriptionist American Institutes for Research C-40

127 AHIMA SME Interview Findings 36) What is the minimum degree that you would expect a qualified candidate to each of the following positions would have earned? Associate's Degree Bachelor's Degree Master's Degree Doctorate None Don t know Administrator/CEO/COO Analyst Assistant Administrator/VP/AVP/SVP/EVP Chief Financial Officer Chief Information Officer Client Support Specialist Coding Professional Compliance Officer Consultant Coordinator Customer/Client Representative Data Quality Analyst DRG Coordinator EHR Specialist/Manager/Director HIM Faculty Information Security Officer IS/MIS Director Medical Records Analyst Privacy Officer Project Manager QA Specialist Registrar Sales Representative Systems Analyst Team Leader Transcriptionist CURRENT MARKET DEMAND In this section you will be asked to provide information about the current market demand for HIM practitioners. American Institutes for Research C-41

128 AHIMA SME Interview Findings 37) Which of the following types of employers currently hire HIM practitioners? (Check all that apply.) Academia/Educational Institutions Consulting Services Organizations Government Agencies Healthcare Software Companies Hospitals or Health Systems HR Organizations or Departments Insurance Companies Online Medical Resource Organizations Online Search Engine Organizations Pharmaceutical Distributors Pharmaceutical Manufacturers Pharmacies Physicians Offices or Practices Professional Societies or Associations Professional or Labor Unions Personal Health Record Companies or Vendors Research Organizations Sports Leagues or Teams Other (please specify) If you selected other, please specify 38) What industries have an increasing demand for HIM professionals? (Check all that apply.) Academia/Educational Institutions Consulting Services Organizations Government Agencies Healthcare Software Companies Hospitals or Health Systems HR Organizations or Departments Insurance Companies Online Medical Resource Organizations Online Search Engine Organizations Pharmaceutical Distributors Pharmaceutical Manufacturers Pharmacies Physicians Offices or Practices Professional Societies or Associations Professional or Labor Unions Personal Health Record Companies or Vendors Research Organizations Sports Leagues or Teams Other (please specify) If you selected other, please specify American Institutes for Research C-42

129 AHIMA SME Interview Findings 39) What other types of professionals are competing for the jobs that HIM professionals can fill? (Check all that apply.) Allied Health Professionals Business Management Professionals Health Administrators Health Informatics Professionals Human Resources Professionals Information Technology Professionals Lawyers Medical Assistants Nurses Paralegals Physicians Public Health Professionals Not Applicable Other (please specify) If you selected other, please specify FUTURE MARKET DEMAND In this section you will be asked to provide information about the future market demand for HIM practitioners. 40) To your knowledge, which industries will MOST use HIM practitioners/him knowledge ten years from now? (Check all that apply.) Academia/Educational Institutions Consulting Services Organizations Government Agencies Hospitals HR Organizations or Departments Insurance Companies Online Medical Resource Organizations Online Search Engine Organizations Pharmaceutical Distributors Pharmaceutical Manufacturers Pharmacies Professional or Labor Unions Physicians Offices or Practices Professional Societies or Associations Personal Health Record Companies or Vendors Research Organizations Sports Leagues or Teams Other (please specify) American Institutes for Research C-43

130 AHIMA SME Interview Findings If you selected other, please specify 41) To your knowledge, which competency domains do you anticipate will be required of HIM practitioners ten years from now? (Check all that apply.) Business Administration and Analysis Skills Basic Computer Literacy Skills Health Informatics Skills - Using the EHR and PHR Health Information/Data Technical Security Health Information Literacy and Skills Leadership and Organizational Communication Skills Organizational Change and Development Management Skills Privacy, Confidentiality of Health Information Public Policy Skills Other (please specify) If you selected other, please specify 42) To your knowledge, what will be the most common degree requirement for HIM positions in your organization ten years from now? Associate s HIM degree Bachelor s HIM degree Master s HIM degree No degree required Other (please specify) If you selected other, please specify DEMOGRAPHIC INFORMATION Please provide some basic demographic information about yourself. 43) What is your gender? Male Female American Institutes for Research C-44

131 AHIMA SME Interview Findings 44) What is your age? Under to to to to or Older 45) What is your current annual full-time salary? Less than $20,000 $20,000 to $29,999 $30,000 to $39,999 $40,000 to $49,999 $50,000 to $59,999 $60,000 to $69,999 $70,000 to $79,999 $80,000 to $89,999 $90,000 to $99,999 $100,000 to $124,999 $125,000 or more Not Applicable Prefer not to say 46) Which racial category/categories best describe(s) your background? (optional) American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White No Answer Other (please specify) If you selected other, please specify 47) Which ethnic category best describes your background? (optional) Hispanic or Latino Not Hispanic or Latino No Answer 48) In what state do you work? (If you are outside the United States please select Other ) Alabama Alaska American Samoa Arizona Arkansas California American Institutes for Research C-45

132 AHIMA SME Interview Findings Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming No Answer Other (please specify) American Institutes for Research C-46

133 AHIMA SME Interview Findings If you selected other, please specify 49) Where did you earn your degree? Alabama State University Alfred State College-SUNY Anoka Technical College Arapahoe Community College Arkansas Tech University Baker College of Allen Park Baker College System Baltimore City Community College Bishop State Community College Boise State University Borough of Manhattan Community College Bowling Green State University-Firelands Briarwood College Bristol Community College Broome Community College Broward Community College Brunswick Community College Burlington County College Camden County College Caritas Laboure College Catawba Valley Community College Central Community College Central Florida Community College Central New Mexico Community College Central Oregon Community College Central Piedmont Community College Charles R. Drew Univ of Medicine & Sci. Chattanooga State Tech Community College Chicago State University Chippewa Valley Technical College Cincinnati State Tech Community College City College of San Francisco Clarkson College College of DuPage College of Lake County College of Southern Nevada College of St Catherine College of St. Catherine College of St. Scholastica College of the Mainland Columbus State Community College Community College of Allegheny County Community College of Baltimore County Cosumnes River College Cuyahoga Community College Cypress College Dakota State University Dallas County Community College American Institutes for Research C-47

134 AHIMA SME Interview Findings Danville Area Community College Darton College Davenport University - Livonia Campus Davenport University - Online Davenport University - Saginaw Davenport University- Grand Rapids Davidson County Community College Daytona State College Del Mar College Delgado Community College DeVry University- Atlanta DeVry University-Chicago Campus DeVry University-Columbus DeVry University-Dallas DeVry University-Houston DeVry University-North Brunswick Campus DeVry University-Online Campus DeVry University-Philadelphia Campus DeVry University-Pomona Campus Duquesne University Dyersburg State Community College East Carolina University East Central University East Los Angeles College Eastern Kentucky University Edgecombe Community College El Paso Community College Erie Community College - North Campus Ferris State University Fisher College Florence-Darlington Technical College Florida A&M University Florida Community College Florida International University Fresno City College Gateway Technical College Greenville Technical College Griffin Technical College Gwynedd Mercy College Heald College Hinds Community College Hocking College Hodges University Houston Community College System Howard College Hudson County Community College Huertas Junior College Hutchinson Community College Idaho State University Illinois State University Indian Hills Community College Indian River Community College Indiana University Northwest American Institutes for Research C-48

135 AHIMA SME Interview Findings Indiana University School of Informatics Itawamba Community College ITT Technical Institute - Anaheim ITT Technical Institute - Boise ITT Technical Institute - Fort Lauderdale ITT Technical Institute - Indianapolis ITT Technical Institute - Oxnard ITT Technical Institute - San Bernardino Ivy Tech Community College - Bloomington Ivy Tech Community College-Lawrence Jefferson Community and Technical College Joliet Junior College Kaplan College-Hagerstown Campus Kennebec Valley Community College Kirkwood Community College Lake Sumter Community College Lamar Institute of Technology Lee College Lehigh County Community College Loma Linda University Lone Star College - North Harris Long Island University Louisiana Tech University Macomb Community College-Center C Macon State College Marshall Community and Technical College McDowell Technical Community College McLennan Community College Medical College of Georgia Mercy College of Northwest Ohio Meridian Community College Miami Dade College Midland College Midlands Technical College Midstate College Minnesota State Community &Tech College Missouri Western State University Mohawk Valley Community College Monroe Community College Montana State Univ. College of Technology Montgomery College Moraine Park Technical College Moraine Valley Community College National College Other (please specify) If you selected other, please specify 50) Please indicate your AHIMA membership status. Not currently a member American Institutes for Research C-49

136 AHIMA SME Interview Findings Active member with an AHIMA credential Active member without an AHIMA credential New Graduate Member Student Member Senior/Honorary Member Not applicable 51) What professional organizations other than AHIMA and your state HIM associations (Component State Associations) do you belong to? (Check all that apply.) American Academy of Family Physicians (AAFP) American Academy of Professional Coders (AAPC) American Association for Medical Transcription (AAMT) American College of Healthcare Executives (ACHE) American Medical Informatics Association (AMIA) Association for Information and Image Management (AIIM) College of Healthcare Information Management Executives (CHIME) Healthcare Financial Management Association (HFMA) Healthcare Information and Management Systems Society (HIMSS) Medical Group Management Association (MGMA) Medical Transcription Industry Association (MTIA) National Association of Healthcare Quality (NAHQ) National Cancer Registrars Association (NCRA) Other (please specify) If you selected other, please specify 52) Which of the following best describes your current work status? Full-Time Part-Time Self-Employed Not Currently Employed Other (please specify) If you selected other, please specify American Institutes for Research C-50

137 AHIMA SME Interview Findings Thank you for participating in the survey. You have been automatically entered to win one of five great prizes (ipod Touch, and cash prizes). We will hold the drawing in July 2009 and you will be notified by if you are a winner. You can increase your chances of winning by referring colleagues to this survey. If you refer a qualified person who completes the survey he or she will be entered to win, and you will receive an additional entry. 44) Employer, Supervisor, or Hiring Manager Name address 45) Employer, Supervisor, or Hiring Manager Name address 46) Practitioner Name address 47) Practitioner Name address 48) Practitioner Name address Thank you for your response! The American Institutes for Research is compiling all of the addresses of AHIMA members with an active credential that complete the survey by the closing date of July 07, When the survey is closed for data collection, the American Institutes for Research will forward the list of addresses eligible for the CEU. AHIMA will then contact eligible participants directly to inform them how to redeem their CEU. American Institutes for Research C-51

138 AHIMA SME Interview Findings APPENDIX D: SURVEY COMMUNICATIONS American Institutes for Research D-1

139 AHIMA SME Interview Findings PRE-INVITE TO ALL Dear Health Information Management (HIM) Practitioners, Employers, and Search Firm Recruiters: I hope that you are doing well and that your HIM careers are growing. In an effort to ensure that we at the American Health Information Management Association (AHIMA) can accurately assess the needs for credentialing and career preparation in HIM degree programs, we are conducting a study with the American Institutes for Research (AIR) to learn about a variety of things surrounding the HIM national workforce. This study is designed to establish an understanding of current market demand, future market demand, job roles and responsibilities, and qualifications sought by employers when looking to fill a HIM position. Your responses will be used to help AHIMA understand the need for HIM practitioners now and in the future. We ask that you take the time to complete the questionnaire that will be sent to you by AIR (AHIMA@air.org) during the week of June 15, This 30-minute online questionnaire is designed to capture your assessment of the existing need for HIM practitioners and how that might change over the next ten years. Please note that you will be rewarded for participating including being entered into a lottery for one of five great prizes (ipod Touch, and cash prizes) and receive one CEU credit if you hold an active AHIMA credential. Please note that all of your information will remain confidential and that all information provided to AHIMA and AIR as a result of this questionnaire will be reported at an aggregate level to ensure your confidentiality. Should you have any questions or comments about this questionnaire or the project, please do not hesitate to contact Alex Alonso, Ph.D., the Project Director at AIR, at or aalonso@air.org. Thank you very much for your help in affecting the future of the HIM profession! Sincerely, Scott MacKenzie Director of Business Insight and Market Analytics AHIMA American Institutes for Research D-2

140 AHIMA SME Interview Findings INVITE: s Dear First Name Last Name, The American Health Information Management Association (AHIMA) has asked the American Institutes for Research (AIR) to study the educational opportunities and experiences that are available to Health Information Management (HIM) students and professionals. We are especially interested in the opinions and experiences of current HIM students and recent graduates of HIM programs. You have been selected to participate in this research because you have first-hand knowledge about HIM education. By sharing your experience, you will help AHIMA know more about how HIM professionals prepare for their career through formal education. Please take a moment to complete this survey; it takes about 15 minutes. Upon completion of the survey you will be automatically entered into a contest to win an ipod nano or a $20 Starbucks gift card. Your odds of winning depend on how many people take the survey (we are giving away five ipods and twenty gift cards). The link below was created just for you, so please do not forward it to anyone else. At the end of the survey you will be given an opportunity to increase your chance of winning by referring a colleague to take the survey. LINK1 Thank you for your participation. If you have questions or concerns, please contact Dr. Alexander Alonso at (202) or AHIMA@air.org American Institutes for Research D-3

141 AHIMA SME Interview Findings Dear First Name Last Name, REMINDER: This is a reminder to complete the Health Information Management National Workforce Assessment. The American Health Information Management Association (AHIMA) has asked the American Institutes for Research (AIR) to study the educational opportunities and experiences that are available to Health Information Management (HIM) students and professionals. We are especially interested in the opinions and experiences of current HIM students and recent graduates of HIM programs. You have been selected to participate in this research because you have first-hand knowledge about HIM education. By sharing your experience, you will help AHIMA know more about how HIM professionals prepare for their career through formal education. Please take a moment to complete this survey; it takes about 15 minutes. Upon completion of the survey you will be automatically entered into a contest to win an ipod nano or a $20 Starbucks gift card. Your odds of winning depend on how many people take the survey (we are giving away five ipods and twenty gift cards). The link below was created just for you, so please do not forward it to anyone else. At the end of the survey you will be given an opportunity to increase your chance of winning by referring a colleague to take the survey. LINK1 Thank you for your participation. If you have questions or concerns, please contact Dr. Alexander Alonso at (202) or AHIMA@air.org. American Institutes for Research D-4

142 AHIMA SME Interview Findings APPENDIX E: SEARCH FIRM RECRUITER SURVEY FINDINGS American Institutes for Research E-1

143 AHIMA SME Interview Findings Overview The American Institutes for Research (AIR) has been working with the American Health Information Management Association (AHIMA) to identify the current employment market and future demands for Health Information Management Professionals. As part of this effort, we have conducted a survey of the national workforce, its hiring managers, and recruiters from search firms. Although response was very high among the workforce and employers, the same cannot be said for search firm recruiters. The search firm recruiter was sent to approximately 1300 potential respondents but only 36 completed responses were received. The purpose of this document is to provide AHIMA with a summary of findings from the search firm survey that highlights specifically the lessons learned from this exploratory effort. This document is structured so that we provide findings for the following questions: What is the relative value of the MHIM degree when compared to other degrees? (Qualifications Sought); How helpful are AHIMA certifications and HIM degrees to someone who is looking for a job in the HIM field? (Qualifications Sought & Current Market Demand); What is the minimum degree/certification needed to fill a specific HIM position? (Qualifications Sought); and What industries are hiring greater numbers of HIM professionals? (Current and Future Market Demand). It is important to note that the information presented in this document does not fully cover the distribution of questions asked of search recruiters. However, when taking into account missing data and nonresponse bias for 36 participants, it became apparent that only some item sets could be used to identify clear trends and make recommendations. The findings for each of these questions are described in the next section. Findings The findings of the search firm recruiter survey are grouped according to primary sections identified for the National Workforce Assessment. First, we present results about the qualifications sought by search firm recruiters. Then, we summarize results about the current and future market demand. Qualifications Sought Participants for the search firm survey were asked to indicate their level of agreement with the following statement(s): For jobs in the HIM field, a Master's degree in HIM is more valued by employers than a: o MBA o MHA o MHSA o MPH The response options for these statements ranged from 1 = Strongly Disagree to 5 = Strongly Agree. Exhibit E-1 provides a summary of the responses to these items. American Institutes for Research E-2

144 AHIMA SME Interview Findings Exhibit E-1. Relative Value of the MHIM Degree According to Search Firm Recruiters 50.0% 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% Strongly Disagree Disagree Neutral Agree Strongly Agree 10.0% 5.0% 0.0% MBA MHA MHSA MPH As can be seen from the exhibit, the majority exhibited some neutrality when comparing graduate degrees to the MHIM degree. For example, 45% of search firm recruiters reported neutral responses when comparing the MHSA degree to the MHIM. Similar responses were provided for the MHA degree comparison. However, when compared to the MBA and the MPH degrees this air of neutrality did not hold. For these degrees, a large percentage of search firm recruiters agreed that the MHIM was more valuable than the MBA or MPH when filling HIM positions. This finding is of particular interest because search firm recruiters typically fill executive or director-level positions where MBAs and MPHs are more likely to be found. Participants were also asked the following question: Based on your experience, how helpful are the following certifications and degrees to someone who is looking for a job in the HIM field? The response options for this question ranged from 1 = Not at all helpful to 4 = Very helpful. Exhibit E-2 provides the percentage of search firm recruiters who indicated that a given certification or degree was very helpful. American Institutes for Research E-3

145 AHIMA SME Interview Findings Exhibit E-2. Recruiter Perceptions of Certification/Degree Helpfulness for Job-Seeking CCA 28.1% CCS 63.6% CCS-P 46.9% CHDA 19.4% CHS CHP CHPS 37.5% 36.4% 38.7% RHIT RHIA 62.5% 65.6% HIM Associate's 43.8% HIM Bachelor's HIM Master's 71.9% 75.0% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% As can be seen from the exhibit, the majority of search firm recruiters felt the following degrees or certifications were very helpful for filling HIM positions: HIM Master s Degree (aka MHIM); HIM Bachelor s Degree; RHIA; RHIT; and CCS. Of particular note here are the following: 75% of the respondents felt the MHIM was very helpful in filling HIM positions. This is the highest proportion of respondents indicating extreme helpfulness. The RHIT and RHIA were both considered extremely helpful and had a very similar percentage of recruiters indicating their respective helpfulness. This can be indicative of the lack of clear understanding when comparing the two. Less than 20% of respondents felt the CHDA credential was valuable when filling HIM positions. American Institutes for Research E-4

146 AHIMA SME Interview Findings Participants were also asked the following question: If asked to find HIM practitioners to fill the positions below, what is the minimum degree that you would look for in applicants? The response options for this question ranged from 1 = Associate s Degree to 3 = Very Master s Degree in HIM. Exhibit E-3 provides an overview of the preferred degree when filling specific positions. Please note that check marks represent the majority answer. In cases where the opinion is closely split between two degrees, both are checked. Exhibit E-3. Recruiter Perceptions of Minimum Level of Education for Specific Jobs HIM Positions Associate's Degree Bachelor's Degree Master's Degree Administrator/CEO/COO Analyst Assistant Administrator (VP/AVP) Assistant Director Assistant Manager Chief Financial Officer Chief Information Officer Client Support Specialist Coding Professional Compliance Officer Consultant Coordinator Customer/Client Representative Data Quality Analyst Director DRG Coordinator EHR Specialist/Manager/Director HIM Faculty Information Security Officer IS/MIS Director Manager Medical Records Analyst Privacy Officer Project Manager Quality Assurance Specialist Registrar American Institutes for Research E-5

147 AHIMA SME Interview Findings HIM Positions Associate's Degree Bachelor's Degree Master's Degree Sales Representative Supervisor Systems Analyst Team Leader Transcriptionist As seen in Exhibit E-3, the necessary minimum level of education varies widely from job to job. However, there is a clear trend indicating that an MHIM is best suited for management positions while a Bachelor s degree or Associate s degree in HIM are really a minimum qualification for operational positions conducting day-to-day coding and data management activities. The findings regarding qualifications sought indicate that there are clear distinctions among the most desired credentials or degrees. The RHIA and RHIT continue to be very valuable but there is definite agreement among respondents that the MHIM has the most value. However, it should be noted that this may be an artifact of the specific jobs that recruiters fill which are typically executive or director-level positions. Nonetheless, there is strong evidence for expanding the market for MHIM education. Current and Future Market Demand Participants for the search firm survey were asked to indicate anticipated market growth based upon current market demand. To do so, we asked them to respond to the following question and provided a list of 17 industries and an Other option. What industries are hiring greater numbers of HIM professionals? Exhibit E-4 provides a summary of the responses to this question. Exhibit E-4. Percentage of Search Firm Recruiters Reporting Increased Demand by Industry % Search Firm Industries Recruiters Academia/Educational Institutions 22.2% Consulting Services Organizations 50.0% Government Agencies 25.0% Hospitals or Health Systems 75.0% HR Organizations or Departments 11.1% Insurance Companies 25.0% Online Medical Resource Organizations 13.9% Online Search Engine Organizations 8.3% Pharmaceutical Distributors 5.6% American Institutes for Research E-6

148 AHIMA SME Interview Findings Industries % Search Firm Recruiters Pharmaceutical Manufacturers 16.7% Pharmacies (Corporate Offices) 5.6% Physicians Offices or Practices 30.6% Professional Societies or Associations 8.3% Professional or Labor Unions 5.6% Personal Health Record Companies or Vendors 19.4% Research Organizations 13.9% Sports Leagues or Teams 2.8% Other 2.8% As can be seen from the exhibit, the majority of recruiters indicated growth in two industries: 1) Hospital or Health Systems and 2) Consulting Services Organizations. Approximately a quarter of those surveyed indicated anticipated growth in the following industries: Physicians Offices or Practices; Insurance Companies; Government Agencies; and Academia and Educational Institutions. For these industries, a large percentage of search firm recruiters agreed that anticipated increased demand would result in additional jobs. The overwhelming finding resulting from responses to market demand questions is that there is growth anticipated in the number of jobs for HIM professionals. However, further specificity is needed for forecasting by recruiters. American Institutes for Research E-7

149 AHIMA SME Interview Findings APPENDIX F: BRIEFING OFFERED AT AOE American Institutes for Research F-1

150 AHIMA Market Research Results Practitioner, Employer, and Recruiter Perspectives 2009 Goals of AHIMA Study Understand future of the employment market Identify new positions that will be created Identify qualifications required in the future Examine the role of credentialing and certification in setting employment market demand American Institutes for Research F-2

151 Study Activities Interviews (n = 20) Survey of stakeholders Practitioners Employers Search Firm Recruiters Interviews American Institutes for Research F-3

152 Interview Participants 20 experts Employers Recruiters Researchers Practitioners Factors Influencing Current Demand Factors increasing demand Additional academic positions Community programs Government regulations (e.g., HIPAA) Retiring HIM workforces Transition to electronic medical records Use of personal health records Factors decreasing demand Economic recession American Institutes for Research F-4

153 Industries Increasing Demand Academic Medical Centers Consulting Firms Insurance Companies Pharmaceutical Research Firms Pharmacy Corporate /Data Management Offices Workforce 12,000 to 50,000 new positions by 2016 Nearly double the 79,000 demand Qualifications In Demand Knowledge Of Healthcare Industry HIPAA & Other Regulations Abilities Critical Thinking Flexibility Writing Skills in Computer Use Data Analysis Leadership Other Credentials (RHIT, RHIA, CCA) HIM Experience Management Experience American Institutes for Research F-5

154 New Qualifications In Demand in 10 Years Knowledge Financial Hospital Organization Systems and Policy Pharmacy Experience Management experience Clinical experience Surveys American Institutes for Research F-6

155 Key Questions Considered Who are HIM professionals? What are HIM job duties? What are the required qualifications? What is the demand for HIM professionals? Who are non-him competitors? Demographics Both Samples White (over 85%) & female (over 90%) Between years of age (over 75%) Practitioners Practitioners (77%) Educators/researchers (23%) 50% Earn $50,000/yr 50% Tenure 11 years 18% Not AHIMA members Employers Supervise, employ, or hire HIM practitioners 50% Earn $70,000/yr 50% Tenure 20 years 4% Not AHIMA members American Institutes for Research F-7

156 Task Domains Performed Health Data Management Health Statistics, Biomedical Research, & Quality Management Health Services Organization & Delivery Information Technology & Systems Organization Management Task Domains Performed Approx. 50% perform the tasks Differences across degrees Master s Degree Problem solving Analysis Health statistics Delivery systems Usability Organization and Management Associate s Degree Data capture Data entry American Institutes for Research F-8

157 Task Domain Proficiency Expected Proficiency expected more from: Proficiency expected less from: Exception: IT task domains RHIA than all others RHIT than CCS, CCS-P, and CCA CCA than all others Equal expectations for RHIA & RHIT Equal expectations for CCS, CCS-P, & CCA Degree and Certifications Required Task Domain Minimum Degree Required (Majority Chose) Certifications Required (At Least 50% Chose) Health Data Management Associate's RHIT Health Statistics, Biomedical Research, & Quality Management Health Services Organization & Delivery Bachelor's Associate's / Bachelor's RHIA RHIT / RHIA Information Technology & Systems Associate's / Bachelor's RHIT / RHIA Organization & Management Bachelor's RHIA American Institutes for Research F-9

158 Competencies In Demand Competencies Rank Order for Rank Order for Current Demand Future Demand *1 being the highest ranked competency Basic Computer Literacy 2 5 Health Information/Data Technical Security 5 4 Health Information Literacy & Skills 4 3 Health Informatics Skills 3 1 Privacy/Confidentiality of Health Information Additional Relevant Competency in 10 years 1 2 Leadership & Organizational Communication Skills Factors Influencing the Demand for HIM Professionals Changes in standard medical billing practices Changes in standard medical charting practices Clinical terminology & classification systems Electronic medical records Government reporting requirements & auditing HIPAA American Institutes for Research F-10

159 Organizations Hiring Now and In Future Industry Academia/Educational Institutions Practitioner Current Organizations Hiring HIM (67% or More Chose) Employer Associate's in HIM Future (Practitioner) Bachelor's in HIM Master's in HIM Consulting Services Government Agencies Hospitals Insurance Companies Physician's Offices or Practices Personal Health Record Companies or Vendors Increasing Demand for HIM Professionals Employers Perspective 80% Agree Hospitals 60-79% Agree 40-59% Agree Consulting Services Healthcare Software Physician's Offices Personal Health Records Academia Government Agencies Insurance Companies American Institutes for Research F-11

160 Increasing Demand by Industries Both Perspectives 80% Agree 60-79% Agree Correctional/Judicial Systems Veterinary Care Settings Legal Offices Public Health Agencies Regional Extension Centers for EHR Professional Associations/Societies/Unions Health Information Exchanges Human Resources Depts State Depts of Education 40-59% Agree Rehabilitation/Long-Term Care Facilities Imaging and Medical Testing Vendors and Facilities Banking and Knowledge Management Sectors Publishing Companies Use of Non-HIM Professionals Approx. 50% of orgs use non-him professionals Non-HIM backgrounds competing for HIM jobs Allied Health Professionals Business Management Professionals Health Administrators Health Informatics Professionals Information Technology Professionals Nurses Non- HIM HIM American Institutes for Research F-12

161 Value of MHIM Above Other Master s Degrees Majority of respondents were neutral Most likely to view MHIM as more valuable than MBA MPH AHIMA non-members did not agree as strongly Employers: more members than non-members felt MHIM is more valuable than MHAS Value of MHIM Above Other Degrees (Practitioners) 50% 45% 40% 35% 30% 25% 20% 15% 10% Strongly Disagree Disagree Neutral Agree Strongly Agree 5% 0% MBA MHA MHI HSA MPH American Institutes for Research F-13