Optional Pathways to RHIA Certification A CAHIIM Report 2013
Introduction The healthcare industry recognizes the long-standing Registered Health Information Administrator (RHIA) credential offered by the American Health Information Management Association (AHIMA) through the Commission on Certification for Health Informatics and Information Management (CCHIIM). Eligibility for RHIA certification occurs as a result of an individual graduating from a Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM) accredited program in health information management (HIM). Such programs are at the baccalaureate, post baccalaureate or graduate program level. Traditional baccalaureate degree programs refer to a four year course of study that includes general educational requirements and HIM related coursework. The post baccalaureate degree option often referred to as a "post baccalaureate degree certificate" requires that an individual possess a baccalaureate or higher degree and fulfills HIM and related prerequisite coursework. Graduate programming is mainly at the master's level either as an entry-level HIM degree program or may be a sub-specialty option within a graduate program of study. The post baccalaureate degree and graduate subspecialty option are formalized as a specific set of required courses and usually culminates in a certificate of completion. These pathways to RHIA certification, particularly the post baccalaureate certificate program have gained in popularity in recent years. One can speculate that this trend is due to many factors including: The economic downturn resulting in job loss and career redirection Significant time and cost commitment to seek a new degree or graduate degree Need for specialized academic study and skills with a minimum of investment Reputation in the industry of established credentials such as the Registered Health Information Administrator (RHIA) Boost in pay or promotion by obtaining a new credential representative of a unique body of knowledge Government employment reports citing opportunities in the healthcare market for health information management professionals Position openings requiring the RHIA credential According to Capuzzi Simon 1 certificate programs are market driven where evolving workplace requirements and new job opportunities appeal to adult students looking for a way to stand out or retool their careers. Thus, post baccalaureate certificate programs provide eligibility for the RHIA credential for those individuals with previously earned degrees, and can lead to new job opportunities, promotions or strengthen an individual s marketability. HIM post baccalaureate degree options have existed for many years. A 2009 study completed by the AHIMA Education Strategy Committee 2 reported that 15 programs out of 52 CAHIIM accredited baccalaureate degree programs offered optional tracks for Commission on Accreditation for Health Informatics and Information Management Education 2013 2
students with bachelor or higher degrees to return to school and obtain RHIA eligibility. Chaudhry 2 found that certificate programs were a quicker, cost-effective option for students with prior degrees seeking RHIA certification. However, colleges in the study stated that few students were enrolling in this option thus faculty time to develop courses specifically for the certificate was not justified by the student numbers needed. Limitations cited in that 2009 study were: Program length most programs accepted students into their professional phase in the same classes with junior or senior students No condensed version of a curriculum model was available to serve as a guide for certificate program development Students are not eligible for financial aid or scholarships when enrolling in certificate programs Distance learning online courses were not readily available at the time and were felt to be the more desirable option for returning students Some academic institutions would not recognize or approve development of optional pathways and specifically certificate programs based on their operational charter CAHIIM 2013 Post Baccalaureate Certificate Survey Results With recent interest for optional pathways to the RHIA through formal education, a new study was convened by CAHIIM. The study assessed the current environment and offerings by accredited baccalaureate and master's programs to determine the types of program options that are available to potential students with baccalaureate or higher degrees. The study also examined the composition of optional pathways to the RHIA to provide guidelines for program directors seeking to design such options. A survey was designed and launched in March 2013 using Survey Monkey to capture information from 63 CAHIIM accredited baccalaureate and master's level academic programs. A survey response rate of 98% was obtained for this study. Program directors were asked to complete the 15 minute online survey of their specific HIM program options and describe how they handle applicants with advanced degrees. Question Do you offer any of the following options for students with an earned baccalaureate, master's or doctoral degree to complete your program and become RHIA eligible? Commission on Accreditation for Health Informatics and Information Management Education 2013 3
Figure 1 Options Offered Options Offered for Students with an Earned Baccalaureate, Master s or Doctoral Degree Data in Fig. 1 reveals 23 of the 63 CAHIIM accredited baccalaureate and master's degree programs surveyed offer an actual post baccalaureate certificate program focused on eligiblity for the the AHIMA RHIA certification examination. An additional 8% or 5 programs offer other optional pathways. Thirty programs indicated no optional pathway and require enrollment in the university or college for a second baccalaureate degree. It should be noted that while basic information was obtained by 98% of the programs surveyed, not all responding programs answered all of the detail questions following confirmation that they offer an optional pathway to the RHIA. In reviewing the various data tables that follow, the number of respondents to a specific question is provided to clarify the basis of the responses. Of the 63 programs surveyed a total of 58% offer a post baccalaureate certificate, a master s track option for students not categorized as enrolled in the traditional HIM program, or other options for students with baccalaureate or higher degrees; 42% state that they either do not offer an optional pathway or that students interested in the RHIA credential must earn a second degree from their program to become RHIA eligible. Of the 23 (37%) programs offering an optional pathway, 4 programs are at the master s level, one of which has specific plans but has not yet launched the certificate program. Another 3 programs state that although they currently do not offer an optional pathway they do plan to offer it in the future. Anecdotal Comments Some respondents provided anecdotal comments regarding their optional pathways: Student transcripts from other institutions and programs are reviewed for transfer credit into the certificate program if the applicant completed a graduate program in health informatics, clinical informatics or similar programs Commission on Accreditation for Health Informatics and Information Management Education 2013 4
Our institution will not grant a certificate to a student unless they took all courses from our institution but we can verify pevious education elsewhere if that education met some of the AHIMA competencies Students can complete the post baccalaureate certificate concurrently with enrollment in a master of science in health informatics as a dual degree which will reduce the number of hours in the certificate program The post baccalaureate program planned will be included within the master of science degree Our institution will not permit us to use the term certificate to describe the optional pathway The HIM track of our Master s Degree in Health Informatics and Information Management program includes additional elective courses that permit the candidate to apply for the RHIA exam Students need to know that the post baccalaureate certificate program is not covered by federal financial aid Students in the post baccalaureate certificate take the same HIM courses with bachelor s degree students The program is an executive track that allows acceptance of HITECH, MBA, MPH and foreign medical school course credits. Prerequisites for Optional Pathway Programs All programs (100%, n=18) that responded to all questions in the survey and that offer a post baccalaureate certificate program state that Anatomy and Physiology were prerequisites for those entering into the post baccalaureate certificate or track program, with Medical Terminology required by 61%. Fig. 2 shows the percentages of other courses required by the programs. In addition to HIM core courses, other courses include Computer Science, Algebra and a Statistics course (Behavioral Statistics or Research Statistics). All programs offering an optional pathway require that students have a minimum of a bachelor s degree and several preferred that students had healthcare or health related work experience. Commission on Accreditation for Health Informatics and Information Management Education 2013 5
Figure 2 Require Prerequisites Prerequisites for Optional Pathway Program Applications Answer Choice # Responses HIM Work Experience 1 Healthcare Work Experience 1 Healthcare Degree 2 Pharmacology 3 Pathophysiology 5 Medical Terminology 11 Anatomy & Physiology 18 Program Application Process All of the 23 programs indicating a post baccalaureate certificate program require a formal application process. Students must complete an application to the institution and provide transcripts. The complexity of the application process and the number of prescribed prerequisites depends on the requirements of the academic institution and whether or not the optional pathway qualifies for financial aid. Figure 3 depicts the process they described. Figure 3 Application Process Commission on Accreditation for Health Informatics and Information Management Education 2013 6
Specific student application process requirements from programs offering optional pathways include: Complete a paper application to the university, submit official transcripts, two letters of recommendation, statement of goals and a curriculum vitae to the Program Director which is the same process for any graduate student Formally apply to the university and complete all compliance documents to qualify for financial aid Go through an orientation as any other HIM student Will not accept transfer credits older than 5 years and the transfer credits must be those accepted by the state board of higher education Must have a BA/BS degree from an accredited college or university recognized by USDE Must have a cumulative GPA of 3.0 on admission Some programs require an essay in addition to other application requirements Application is reviewed by the department admissions counselor including previous transcripts and subsequent approvals from the program director and department chair While applicant requirements vary across respondents, clearly an application process is in place and various institutional and program requirements must be met by students. How Content Is Delivered The majority of programs offer their optional pathway program online to a virtual student population. Several programs chose all categories: blended, online and seated as their answer to the question (which may have been a confusing question), but indicative of programs that have a hybrid form of delivery. It could also be assumed that some programs give certificate students a choice when multiple delivery modes are available for specific courses. This question yielded 26 responses in Fig. 4 with 3 responses from programs that said they did not offer optional pathways. Regardless, the majority of optional pathways (69%) are offered via online or hybrid formats. Two additional programs responded that content is delivered in an independent study format but provided no further details on the structure or requirements. Commission on Accreditation for Health Informatics and Information Management Education 2013 7
Figure 4 Content Delivery n=26 (includes master s level programs) How Content Is Delivered College Credit for Optional Pathway Courses A total of 20 of the 23 respondents indicated that credit is awarded for the courses taken within the optional pathway program. Two programs skipped this question and one program indicated that college credit was not awarded. Figure 5 College Credit n = 21 Can Students Earn College Credit for Courses Completed Answer Choice # Responses No 1 Yes 20 Skipped Question 2 The average number of credit hours reported as required to complete an optional pathway program is 48 credit hours. The range was as low as 15 credit hours (depending on the student s background, education and experience) to a high of 120 credit hours. This variation includes programs that are on a semester system, quarter system or other academic terms which was not clarified by the respondents. Most programs indicate that it takes about two years to complete the optional pathway program. The average length of Commission on Accreditation for Health Informatics and Information Management Education 2013 8
time reported to complete an optional pathway program is 18 months and many programs state the length of the program often depends on the background of each student in a customized program format. Those students that enter the optional pathway program with a healthcare or health-related background may complete within 12 months with transfer credits or credit for experience. Unique Courses or Existing Undergraduate Courses Seventy percent of the optional pathway programs responding indicate that students take courses with traditionally enrolled undergraduate students. Twenty-two percent in Fig. 6 stated that students did not take courses with the traditionally enrolled students and that all courses are offered online. Four out of five programs offer a master s track within a master s degree program which may explain why the question as asked was misread to reflect "courses with traditionally enrolled students" rather than courses designed specific to the optional pathway program. Figure 6 Use of Existing Undergraduate Courses n = 21 Optional Pathway Students Take Courses with Undergraduate or Traditionally Enrolled Students Answer Choice # Responses No 16 Yes 5 Skipped Question 0 Of the responding programs, Fig. 7 shows that 26% offer courses specifically designed for the optional pathway program. Figure 7 Special Certificate Courses n = 7 Are Special Courses Designed for the Certificate Track Program Commission on Accreditation for Health Informatics and Information Management Education 2013 9
Answer Choice # Responses No 16 Yes 5 Skipped Question 0 Professional Practice Experience Requirements Of the 23 respondents that indicated they offer an optional pathway program, only two programs stated that a professional practice experience (PPE) was not required. The majority, 91% of the programs require a PPE as shown in Fig. 8. For many programs, the students enter into the optional pathway program with a work history and previous experience, therefore the program will reduce the number of PPE hours (as required by the traditional accredited program) and some of the student PPE activity requirements are based on an individual s professional experiences and/or current job. Figure 8 Professional Practice Experience n = 23 PPE Required Answer Choice # Responses No 2 Yes 21 One program stated that a reduction in the number of required PPE hours can occur if the student is currently in a management position in HIM and can demonstrate work that supports their domain knowledge and skills for that student activity. If satisfactory they may be exempted from the PPE requirement. Another program offers the program as an executive track allowing students to receive credit for life experience in addition to education which may eliminate the need for the professional practice experience component. Commission on Accreditation for Health Informatics and Information Management Education 2013 10
Institutional Approval to Offer an Optional Pathway Program All but one of the HIM programs that identified as having an optional pathway program have institutional approval to offer these programs. Only one program in Fig. 9 stated that it did not have institutional approval and this was because certificate programs in their institution cannot offer more than 18 credit hours under their state board of higher education rules and their optional pathway program contains more than 18 credit hours. Figure 9 Institutional Approval n = 23 Optional Pathway Program Approved by the Institution Answer Choice # Responses No 22 Yes 1 Optional pathway program approvals ranged from department chair approval, college curriculum committee, dean, faculty senate, provost, and in some cases to external state boards of higher education or institutional accreditation organizations. Discussion Interest in seeking the AHIMA RHIA credential is growing within the healthcare industry. CAHIIM has experienced a 20 percent growth rate in the development of new baccalaureate degree programs since 2012. Coupled with a fluctuating economy, the dispersion of health information spurred on by technology, health information exchanges, expanded anayltics, and use of health data, expertise in managing health information is highly regarded. Many more individuals with advanced degrees are now attracted to obtain the RHIA credential and recognition of the academic body of knowledge it represents. To meet the needs of individuals undergoing a career change or professionals seeking an additional skill set and the credential, the prevalent model that immerges from this study is an optional pathway program in the form of a post baccalaureate certificate or a specialty track option within a master's degree program with components that are appealing to the working professional. These include online delivery, college credit Commission on Accreditation for Health Informatics and Information Management Education 2013 11
awarded for this coursework and opportunities for an individual to gain credits for meaningful learning gained through work or life experience. Ideally the program would be completed in 12 months and the applicant with a healthcare background or prerequisites in the biomedical sciences would move through more quickly. There are other considerations in the development and deployment of optional pathways that must be examined by HIM programs. In many colleges and universities any optional pathway programs or certificates awarded for study completion must go through the same intense review and approval process as that of degree programs, and are thus considered a rigorous program of study. According to the RHIA eligibility requirements of CCHIIM 3: (Applicants must) Successfully complete the academic requirements, at the baccalaureate level, of an HIM program accredited by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM). The academic qualifications of each candidate will be verified before a candidate is deemed eligible to take the examination. All first-time applicants must submit an official transcript from their college or university. Students interested in obtaining a Post-Baccalaureate Certificate, Certificate of Completion, or Transfer of Credits information must contact the CAHIIM-accredited program in which they wish to enroll regarding their institutional policies. While eligibility for the RHIA certification examination is stated, program directors must contact CCHIIM directly for specific information to ensure students completing the program are supported by the required documentation. It must be emphasized that CAHIIM Baccalaureate Accreditation Standards apply to all accredited programs including optional pathway programs offered by an accredited program that target RHIA eligibility. The Standards 4 are inclusive meaning that any program offered must comply with curriculum requirements, evaluation methods, faculty qualifications, professional practice experiences, and fair practices including student admission policies and processes, program completion requirements, tuition and fees, accurate published program information and outcomes reporting. Colleges and universities offering optional pathway programs and specifically post baccalaureate certificates must also ensure that they are meeting the criteria of their institution s regional or national accreditation organization. For example, the Higher Learning Commission 5 of the North Central Association states: Core Criteria 3.A The institution s degree programs are appropriate to higher education Criteria 3.A.1 Courses and programs are current and require levels of performance by students appropriate to the degree or certificate awarded. Criteria 3.A.2 The institution articulates and differentiates learning goals for its undergraduate, graduate, post-baccalaureate, post-graduate, and certificate programs. Commission on Accreditation for Health Informatics and Information Management Education 2013 12
This criteria implies that course offerings including certificates of completion beyond the baccalaureate level of instruction, must reflect a higher level of learning, therefore those programs offering a post baccalaureate certificate with specifically designed courses for the certificate program are in compliance if the learning levels are appropriate beyond baccalaureate level. The Southern Association of Colleges and Schools Commission on Colleges 6 provides a similar requirement within their core requirements: 3.6 Educational Programs: Graduate and Post Baccalaureate Professional Programs 3.6.1 The institution s post baccalaureate professional degree programs and its master s and doctoral degree programs, are progressively more advanced in academic content than undergraduate programs. There are also state-specific higher education standards that may apply to optional pathway programs which require adherence before such a program can be launched. Clearly any HIM program considering development of optional pathways to help prospective students with advanced degrees seek the AHIMA professional certification of RHIA must examine with their administration officials, the requirements of various entities and the impact to the program and the academic institution before launching an optional pathway. Summary and Concluding Remarks All CAHIIM accredited HIM programs must meet the accreditation Standards and curriculum content requirements, ensure a comprehensive method of admissions credit evaluation, provide an academic plan, and monitor appropriate completion of the program of study for each student, regardless of whether a degree is conferred or an optional pathway is offered. While this survey is a limited study of optional pathways to the RHIA credential that currently exist among CAHIIM accredited HIM programs, it reveals many components that feed into the determination to offer an optional pathway program such as a post baccalaureate certificate or graduate track option. Further studies should focus on the market need for graduate level professionals with an RHIA, new types of jobs that will emerge and whether the competencies inherent in an RHIA credential reflect employer expectations. Further study is needed on the numbers, characteristics and academic levels of students enrolled in RHIA optional pathways, specific application criteria, profile assessments and procedures, program completion rates and length of time to completion, completer satisfaction rates, outcomes data on types of jobs, placement or promotion rates, employer expectations, market need, and RHIA exam success rates. It is important that further differentiation is made of programs that offer a degree or college credit versus those that are limited to continuing education only. This information will be valuable to better assess the core curriculum content fundamental to building optional pathways for what is technically a certification reflective of undergraduate HIM education. Commission on Accreditation for Health Informatics and Information Management Education 2013 13
References 1 Capuzzi Simon, Cecelia. Certificate Programs May Be An Alternative to a Master s Degree, The Washington Post, February 16, 2012. 2 Chaudhry, Aisha. HIM Post Baccalaureate Certificate Survey, Report to the AHIMA Education Strategy Committee, 2009. 3 Commission on Certification for Health Informatics and Information Management (CCHIIM). Certification Guide: Requirements for RHIA Certification Examination Eligibility. 4 Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM). Standards for Accreditation of Baccalaureate Degree Programs in Health Information Management 2012. 5 Higher Learning Commission. Policy Criteria for Accreditation. CRRT.B.10.010. January 2013. 6 Commission on Colleges, Southern Association of Colleges and Schools. Principles of Accreditation: Foundations for Quality Enhancement. 2004. Prepared by Linde Tesch, MS, RHIA, Sr. Education Quality Officer Claire Dixon-Lee, PhD, RHIA, CPH, FAHIMA, Executive Director, CAHIIM Commission on Accreditation for Health Informatics and Information Management Education 2013 14