The Canadian Health Information Management Association: health information management in Canada Kelly Abrams and Gail Crook Abstract The development and deployment of the electronic health record (EHR) accelerates the need for a workforce with new knowledge and enhanced skills. The Canadian Health Information Management Association (CHIMA) and partners have undertaken many initiatives since 2007, including long range scenario planning, strategic planning, and a human resource sector study. These projects highlight the opportunities and challenges facing the Canadian health information management profession in this time of rapid change and technological advancements. Keywords (MeSH): Forecasting; Health Planning; Personal Electronic Health Records; Health Information Management; Canada Long Range Scenario Planning In 2008, CHIMA began Long Range Scenario Planning (LRSP). LRSP envisioned possible futures for the health information management profession, anticipating future trends and events. Using the LRSP process, three exaggerated scenarios for future Health Information Manager (HIM) roles 10 to 20 years in the future were developed. Key internal and external stakeholders were interviewed to discuss the scenarios and the HIM role. Three recurring themes were identified and validated: (i) the individual is at the centre; (ii) collaboration; and (iii) transformation and the pace of change. The individual is at the centre In future, it is envisioned that the primary purpose of health information will be to actively engage individuals in the participation of their own healthcare. They will contribute to the maintenance of their record and provide access to care givers at the point of care. There will be widespread use of e-health information by both health providers and the individual. Collaboration Integrated health care information goes beyond one organisation or care giver. Collaboration is key if health care information is to be used to its fullest extent. Transformation and the pace of change The transformation and pace of change in health care technology will continue to develop. The implementation of the EHR requires more than the adaption of current health information management practices to new technology and modes of delivery. The LRSP report also identified priorities for CHIMA: Listen to the voices of our future, not our past. Keep company with the front-runners. Spend time with those who are designing (and funding) the jobs that will replace us. Merge for strength connect with others who are keen to change. Identify where CHIMA s value lies. Stop: What can we stop doing? Protect: What is most precious amongst all that CHIMA does? Invest: What has a future? Pick and occupy only those spots where our voice as CHIMA adds value. Following the LRSP, two key initiatives were undertaken: a sector study for Health Informatics (HI) and health information management; and a comprehensive Strategic Planning process (CHIMA 2008). Health informatics and health information management: human resources report CHIMA partnered with the organisations and government agencies funding and/or leading EHR activities within Canada on the 2009 Health Informatics (HI) and HIM Sector Study. This partnership provided detailed metrics on the supply of professionals in health informatics and health information manage- HIM-INTERCHANGE Vol 1 No 1 2011 ISSN 1838-8620 (PRINT) ISSN 1838-8639 (ONLINE) 17
ment occupations with forecasts for future industry demand. The sector study was intended to: estimate the current supply of health informatics and health information management professionals in both private and public sectors who have formal training or experience in working with electronic health information systems (EHIS) project the impact on human resource requirements over the next five years of announced and expected investments in EHIS technologies estimate the imbalances that will develop if human resource requirements exceed the supply of health informatics and health information management professionals with formal training and experience in implementing and working with EHIS technologies recommend strategic human resources planning initiatives to address these imbalances. The final report, the Health informatics and health information management: human resources report, outlined the current and five-year requirements for health informatics and health information management professionals who have formal training or experience in EHIS (CHIMA 2009). The sector study results were based on the analysis of available data; however, limitation or gaps in the data do exist. Based on these estimates, the report identified where there will be serious risks of skills shortages and proposed initiatives to avert these shortages. The study reported that substantial investments in EHIS are planned across Canada with the expected result of broader EHIS adoption. The EHIS investments will generate significant requirements to increase the number of health informatics and health information management professionals which will compound an already existing problem. Key findings in terms of the health information management profession include: Approximately 32,450 health informatics and health information management professionals are currently working in Canada. Current vacancy rates of over 10% exist for six of the 27 occupational groups studied. By 2014, the number of health informatics and health information management professionals who will require broader skills will increase from 8,880 in 2009 to between 13,690 and 32,170. EHIS technologies will reshape all aspects of health information management and increase the need for standard terminologies, privacy controls and compliance with policies and regulations. It is anticipated that this will have an impact on the skill requirements in the health information management occupational groups. Current shortages in health information management include 23% in standards, 14.4% in decision support, 11.6% in privacy, 5.7% in data quality, 3.9% in records management and 2.5% in coding classification. The results confirmed the suspicions of the partners. As Carol Adam, CHIMA Chair of the Board of Directors has stated: While we had anecdotal evidence that there is an increasing need for HIM professionals across Canada, a formal study was needed to confirm this perception and to get an idea of the depth of the human resource challenge. The sector study has confirmed the growing need for qualified HIM professionals with a broadened skill set (CHIMA 2009). Three major recommendations from the Sector Study Report aim to establish: a national initiative to monitor the human resources implications of implementing EHIS forecast of health informatics and health information management human resource requirements supported by expert consultations, strengthened data sources, and systematic industry validation strategies to address skills shortages through education, professional development, cooperation and internship, and the integration of international health informatics and health information management professionals. The recommendations and results of the health informatics and health information management Sector Study have been widely circulated in Canada. Professional associations, educational institutions and employers are very interested in the study and are encouraging the partners to implement the recommendations. Ideally, implementation will support the successful implementation of the EHR through providing qualified health informatics and health information management professionals (HIMs) to meet the demand. The creation of new Steering Committee (cochaired by COACH and CHIMA), will begin the next phase, which will develop a business case, budget and strategy to prioritise and address the recommendations. It is anticipated that the business case and the implementation plan will be ready in the Spring of 2011. Strategic planning 2010 was the year of strategic planning. The executive team met in May 2010 with a strategic planning specialist and a communication expert. One of the questions asked was: Why change? The executive team 18 HIM-INTERCHANGE Vol 1 No 1 2011 ISSN 1838-8620 (PRINT) ISSN 1838-8639 (ONLINE)
believed that CHIMA s sustainability was at risk for the following reasons: The healthcare industry is changing and CHIMA needs to keep pace. CHIMA is not always present at key decisionmaking tables. CHIMA has limited resources and a small corporate staff. HIMs have not been sufficiently responsive to the changing demands and are not as engaged as they could and should be in shaping the future. However, CHIMA executive were adamant that CHIMA needs to influence the change process to create the HIM of tomorrow who will be: technology savvy actively engaged in the use and development of the EHR with core health information management functions in an electronic format more actively engaged in decision support roles key members of the EHR team. It was recognised that for CHIMA to be seen as relevant, the organisation will need to contribute to making this change possible for the membership. The Board of Directors met in June and four strategic directions were approved. The four new strategic directions are (and in no particular order): strengthen member relations focus on knowledge, research and business development evolve the college strengthen marketing and communications capability. Over the next year, the strategic planning process will be completed with the development of organisational, tactical, and work plans, and an implementation strategy to develop key initiatives. Learning outcomes in health information management (LOHIM) 2010 With disparate record systems across the country and within jurisdictions, how do we prepare the new graduate for the hybrid and electronic world? How do we engage stakeholders in focusing on the integrity of the record and the records management principles that help maintain that integrity? In 2010, CHIMA completed a major review and redevelopment of the health information management curriculum. The result is a very thorough curriculum for the two levels of health information management education in Canada: diploma and undergraduate education. The review stated: This document is used for program development, program review, and for the creation of National Certification Examination (NCE). The skills listed can be developed at any level for continuing education, graduate program development, or increasing core competencies in health information management. This document may be used as a comparison between HIM and HI curriculum content. Such a comparison would show the similarities in specific content areas as well as the differences in application. Prospective HIM students can review the learning outcomes to familiarize themselves with what the program will offer. The public can use the document to educate themselves about the role HIM professionals have in regard to their personal health information and the safekeeping thereof (CHIMA 2010). The competency areas for the new document are: Biomedical sciences Healthcare systems in Canada Health information management: data collection and grouping information and data standards data quality records management Health information analysis and business intelligence statistics research design and methodology epidemiology decision support and data analytics Health information: privacy, confidentiality and access privacy the legal basis and requirements of accountability including access, collection, use, disclosure, retention and disposal of health information management of access, privacy and confidentiality obligations in relation to personal health information Information systems and technology Management Ethics and practice Practicum. There are also seven appendices to support the learning outcomes in more detail. These include: Appendix A Records management. Appendix B Information technology procurement. Appendix C Systems evaluation. Appendix D Systems maintenance. Appendix E Common administrative, technical and physical control methods for security of personal health information. HIM-INTERCHANGE Vol 1 No 1 2011 ISSN 1838-8620 (PRINT) ISSN 1838-8639 (ONLINE) 19
Appendix F Entry level role statements diploma graduates. Appendix G Entry level role statements degree graduates. Current role statements were updated and new role statements were developed. The new role statements include: Data Integrity Analyst Junior Data Analyst Registry Administrator Registry Integrity Coordinator Business Intelligence Analyst Wait Time Strategy Health Systems Analyst Team Lead Data Standards Terminology Asset Manager Mapping Business Intelligence Analyst Wait Time Strategy. All new health information management programs must incorporate the LOHIM 2010 curriculum to meet recognition requirements. The current health information management programs have until September 2013 to incorporate the new content. Each program is expected to incorporate changes to the curriculum as they occur to minimise gaps during the transition period 1. Health information management transition pathway While the new Learning Outcomes document is updated for current and prospective health information management students, there is a need to update HIMs working in the healthcare environment. In planning for the next three to five years, CHIMA anticipates that the speed and impact of technology, as well as the dynamics of the workforce, will culminate in an exciting future for the HIM and also for CHIMA. A transition roadmap for the HIMs that reflects the breadth of skills required in the different HIM career tracts has been created. The roadmap supports health information management continuing education and skills development in the increasingly technological health care environment. The schematic diagram in Figure 1 represents the transition path for the HIM and the options for career development. The transition road map is not workplace-centric the skill sets are the same whether the person works in a hospital, the community, education, government, or research. Health information management transition road map The large circle to the left includes the core health information management competencies and skill sets that all HIMs have (e.g. privacy, data quality, clinical content, risk management). On the right, four pathways flow out of the circle and members may choose to travel down any one or a combination. To enter any of the pathways, leadership skills are essential and need to be highlighted and strengthened. Along each pathway is a skill necessary for that competency. CHIMA is in the process of determining how best to turn this transition road map into an action plan for members. For example, once a HIM chooses a path, where do they go to look for courses and certification? Balanced against this support for the individual is the question of clarity of roles for CHIMA in providing direction for the professional. That is, what is the responsibility of the individual versus the obligation of CHIMA? Conclusion CHIMA has completed a mapping of health information management current and future roles and skill sets and from there a listing of current and future tool sets was developed. These listings will require updating as LOHIM 2010 is complete and new role statements are developed. CHIMA will map the current tool kits to these roles and skill sets and then develop the products required to assist our members prepare for and progress into the future. Supporting the new roles are new skill set requirements. CHIMA will investigate the need for specialty certifications, different levels of certification, and a strategy to train more HIMs (students, international graduates and professionals who want to transition to health information management). It is an exciting time to be a health information management professional in Canada. As HIMs, we need to embrace change and continue to increase our knowledge in the EHR. As we continue to build and enhance the core health information management skill set, the opportunities for impacting positive change in the electronic world of health information management will continue to grow. 1 The LOHIM 2010 document and role statements can be found on the CHIMA website at https://www.echima.ca/him-curriculum-lohim-2010. 20 HIM-INTERCHANGE Vol 1 No 1 2011 ISSN 1838-8620 (PRINT) ISSN 1838-8639 (ONLINE)
Figure 1: Health information management transition road map 2 References CHIMA (2008). Long Range Scenario Planning (LRSP) & Health Informatics (HI) Credential Model Briefing Paper. CHIMA. Available at: https://www.echima.ca/media/documents/ LRSPUpdate_08Oct_Condensed.pdf CHIMA (2009). Health Informatics (HI) and Health Information Management (HIM) Human Resources Report. Available at: https://www.echima.ca/sector-study-report (accessed 12 Dec 2010). CHIMA (2010). Learning Outcomes for Health Information Management: Diploma and Degree Programs. CHIMA. Available at: https://www.echima.ca/him-curriculum-lohim-2010 Corresponding author: Kelly Abrams MPA, CHIM Vice President Education and Professional Practice Canadian Health Information Management Association (CHIMA) 1404-148 Fullarton Street London, Ontario, N6A 5P3 CANADA email: kelly.abrams@echima.ca Gail Crook CHE, CHIM CEO and Registrar Canadian Health Information Management Association (CHIMA) 1404-148 Fullarton Street London, Ontario, N6A 5P3 CANADA email: gail.crook@echima.ca 2 https://www.echima.ca/him-transition-pathway, accessed December 14, 2010 HIM-INTERCHANGE Vol 1 No 1 2011 ISSN 1838-8620 (PRINT) ISSN 1838-8639 (ONLINE) 21