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					  RECOMMENDATION TO THE AHIMA BOARD OF DIRECTORS


DATE:             June 26, 2008


GOAL: To advise the AHIMA Board of Directors regarding the impact of
a change in the eligibility criteria for the RHIA certification
examination, on current and new HIM academic programs.

Education Strategy Committee Background:
The current HIM Education Strategy Committee was formed in 2003 to advise the
AHIMA Board of Directors on HIM education issues, support faculty development
initiatives and specifically examine curriculum models, resulting in the Framework for
HIM Education that would prepare graduates to succeed in an electronic practice
environment, facilitate progression and provide distinct entry and exit points. This was a
direct result of a 2002 report prepared by an external consultant which emphasized the
following:

The AHIMA Curriculum Committee (now HIM Education Strategy Committee) should develop, gain
support, implement, and sustain a seamless educational continuum, which attracts, upgrades, and retains
an adequate number of highly qualified professional, continuing, and advanced HIM personnel, who are
recognized for their value to the healthcare industry. A multi-year transition process, which respects the
skills of existing HIM employees while preparing for future occupational demands, is now critical. HIM
needs a vision of its future relationship within the interrelated healthcare, education, and information
communication system. Sustained, coordinated, multi-faceted, powerful, yet flexible reengineering is
required for the sustainability of health information management as a discipline and as a profession. This
revamping of the field is expected to be a multi-year, accumulative process. Progressively structured
priorities and coordinated planning throughout the HIM field and its neighboring fields will result in a
transformed field with the combination of strength and flexibility that foresees future sustainability.
Roberta Albom Liebler, PhD 2002

By 2006 a revised set of curriculum competencies and knowledge clusters issued by
ESC became the fundamental guidelines for HIM academic programs and were
designed to clearly distinguish the academic levels of instruction and outcomes of
graduates at the associate (technical experts) from the baccalaureate (supervisory,
managerial) academic level. This effort came at the time of closure of the proviso
permitting RHITs with baccalaureate degrees to sit for the RHIA examination where prior
to the revised curricula, little differentiation between associate and baccalaureate core
content was evident. Today’s college programs in HIM demonstrate these distinct levels
of educational preparation.




                                                                                                             -i-
AHIMA REPORT TO THE BOARD OF DIRECTORS
HIM Education Strategy Committee
Submitted by: Don Kellogg, Chair

ISSUE/IMPACT OF THE PROPOSED CHANGES TO RHIA CERTIFICATION
ELIGIBILITY

I. Impact on development of Masters’ Degree Programs in HIM and Health
Informatics.

   A negative impact would be a lost incentive by colleges and universities to
    create HIM Masters programs when students can go through existing graduate
    programs in related disciplines to achieve the same goal to learn advanced
    content in health information/informatics. This is in direct opposition to Vision
    2016’s goal of increasing graduate level programs in HIM, and in furthering the
    discipline of HIM at an advanced degree level.

   Decreased enrollment in existing master’s degree programs. Students who
    would have enrolled in HIM masters programs for the eligibility to sit for the
    RHIA exam can now under this proposal pursue any graduate level program.


II. Impact on Baccalaureate Degree HIM Programs.

    HIM baccalaureate programs traditionally have served full time campus based
     students. Today, programs may serve a variety of students including 1) full-time
     and part-time students, as well as 2) progression or bridging students and 3)
     post baccalaureate certificate students. Offerings are on campus, distance, or
     follow a hybrid approach.

    The progression or bridging option offers RHITs the opportunity to complete
     their bachelors in HIM, thus making them eligible to sit for the RHIA
     examination. Post-baccalaureate programs provide an avenue for students with
     baccalaureate degrees in other disciplines to sit for their RHIA examination. The
     proposal would weaken or eliminate the “bridging” programs offered by
     baccalaureate HIM education

     A negative impact on baccalaureate HIM programs exists when the core of the
      proposal considers years of experience as equal to and as representative to
      formal education in HIM. Fundamentally the proposal questions the value of an
      HIA educational program. On-the-job training does not equate to a formal
      education. Historically, AHIMA moved away from hospital-based training in the
      1940’s to formal college–based education programs. This proposal would
      reverse this philosophy and return the profession to a “journeyman” approach.
      The HIM profession would move from a profession to that of a trade building on
      associate degree HIM programs and work experience.


                                        2
AHIMA REPORT TO THE BOARD OF DIRECTORS
HIM Education Strategy Committee
Submitted by: Don Kellogg, Chair


   The proposal presents a negative impact by eliminating the need for post-
    baccalaureate certificate programs offered by approximately 25% of HIA
    programs currently and with several more certificate programs in the
    planning/consideration stages as reported in the 2008 faculty survey. Student
    enrollment in programs that offer post baccalaureate certificates range from
    programs where the entire student population are post baccalaureate students to
    HIA programs that have one or more of their students enrolled as post-
    baccalaureate certificate students already holding another degree.

   A significant number of baccalaureate programs are moving away from the
    traditional on-campus, full-time model to online, encouraging part-time students
    (37% of the current HIM baccalaureate enrollment) in order to address the
    needs of career-change, adult students. Consequently, this has continually
    improved and increased enrollment numbers over the past 5 years. This
    proposal weakens that market segment, as on-the-job experience and a
    previously earned baccalaureate degree supersedes the appeal of pursuing
    additional education for these potential students.

   Further reducing the number of current HIA programs in an academic
    environment which is constantly threatening specialized baccalaureate programs
    (for example, although 2 new baccalaureate programs were accredited, 2 older
    programs have closed in 2008), presents a negative message on the viability
    of specialized baccalaureate HIM education.

   Current programs are already in competition with other health programs (i.e.
    Health Services Administration) for students. Students could by-pass the more
    rigorous accredited HIA program for another program’s bachelor’s degree, thus
    further diminishing the pool of student applicants.

   Colleges may question the need to support or finance an HIA program given
    the cost inherent to comply with accreditation standards and necessary program
    resources such as the Virtual Lab, if there are other baccalaureate pathways
    offered to students to reach the same goal.

   Vision 2006 provided a window of opportunity for RHITs with any bachelor’s
    degree to sit for the RHIA examination. At Vision 2006’s inception there were 54
    HIA programs. However, by 2002 there were only 46 HIA programs, a number
    that has varied little to this day. Unlike programs in community colleges,
    baccalaureate programs take longer to start and once eliminated, have not
    historically restarted.



                                       3
AHIMA REPORT TO THE BOARD OF DIRECTORS
HIM Education Strategy Committee
Submitted by: Don Kellogg, Chair


III. Impact on Associate Degree HIM Programs.

    Given a direct pathway to the RHIA exam, graduates of associate degree HIM
     programs may choose not to sit for the RHIT exam, but wait instead to go on for
     the RHIA credential after earning a baccalaureate degree in another discipline.


IV Further Concerns of the Committee


    The RHIA examination has been constructed upon the premise that those eligible
     to sit for the exam have successfully completed an accredited program. This
     provides assurance that they have the body of knowledge and competencies
     required for our profession. Furthermore, these eligible individuals have
     achieved validated proficiency in the full spectrum of HIM core competencies
     that are needed in today’s and tomorrow’s practice. Therefore, the RHIA
     examination as it stands today is not designed as a stand alone vehicle to test
     competencies which have not been validated thru an accredited educational
     program. Furthermore, the RHIA exam represents sample testing of the
     competencies that are a subset of the full HIM Baccalaureate curriculum
     competencies, such that almost 50% of the newer topics and EHR content are
     not tested by the exam. Without additional education, the question remains
     where will these credentialed individuals under this proposal obtain these
     competencies?

    HIM fundamentals are taught at different taxonomic levels and from different
     perspectives in associate and baccalaureate HIM programs. At the master’s
     degree level HIM does not and will not teach these fundamentals of practice,
     but rather is addressing a higher set of competencies related to HIM leadership
     and executive management of health information. Are we prepared as a
     profession to accept the professional foundation as one of associate degree-level
     technical expertise coupled with advanced degrees in any subject as the core of
     the HIM profession?


V. BENEFITS

The ESC in its deliberations considered how educational programs may benefit under
this proposal. Although the proposal does not specify how many individuals
could/would take advantage of this alternative pathway to credentialing, if the numbers
are sufficient, some programs may have the ability to offer RHIA exam preparation
workshops, seminars, and the like.

                                        4
AHIMA REPORT TO THE BOARD OF DIRECTORS
HIM Education Strategy Committee
Submitted by: Don Kellogg, Chair

RHIA exam prep workshops/seminars, while potentially revenue enhancing, clearly do
not fulfill the core mission of educational programs which is to advance the theory of
research and practice of its profession.


   RECOMMENDATION

It is the recommendation of the ESC that the CoC proposed alternative pathway to sit
for the RHIA examination be rejected. The identified negative impact on both
baccalaureate and graduate degree HIM programs are severe and detrimental to the
survivability of existing programs, growth of new programs, and student enrollment.
Furthermore, eroding the educational foundation and the inherent value of HIM
education by moving to a journeymen approach to the profession is a step backwards
and greatly outweighs any short-term anticipated benefits.




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