HIMAA coding qualification seeks to bridge employer divide

From July 1, the Health Information Management Association of Australia (HIMAA) will be offering a full AQF qualification in clinical coding – the 22274VIC Certificate IV in Clinical Classification.

HIMAA hopes that the new qualification will encourage employers to engage with the registered training organisation (RTO) to ensure work-readiness for graduates.

HIMAA has been offering distance education in clinical coding at the vocational education and training (VET) level since 1990, but even though total throughput since a major Australian Institute of Health and Welfare study into clinical coding in 2010 is barely half of the need forecast by researchers, employers seem to be resistant to engaging with training providers to ensure employability of graduates.

HIMAA commenced clinical coder training by distance education in 1990. By 1992 the service was nationally available. Today, as an RTO, HIMAA is the largest provider of clinical coding training at VET level in Australia.

The bulk of HIMAA’s training is at the entry level – providing comprehensive medical terminology (CMT) and introductory clinical coding courses. Each of these courses is structured to deliver course achievement to the student over a 12-month period. They are offered on a fee-for-service basis as they do not result in qualifications at the VET level that attract student subsidy, such as VET Fee Help or traineeships.

According to a presentation at HIMAA’s Health Information Workforce Summit in October last year, a total of 726 clinical coders have graduated from HIMAA’s introductory clinical coding course since 2011. However, this does not meet even half the minimum need of 1757 FTE predicted by the AIHW study.

The total graduates of HIMAA’s intermediate and advanced clinical coding courses over the same period was 327, which is barely 22 per cent of the 1476 FTE net gain projected by the 2010 AIHW report.

Yet even this clinical coder supply is not guaranteed a welcome by Australian employers.

Industry expectations

Some employers have unrealistic expectations of what an entry level coder should be able to do. In other health professions, all new graduates are considered entry level and go through continuous on the job training before they become autonomous professionals.

So why has the industry failed to build sufficient support networks in the workplace to allow this same period of supervision in health information?

The tendency has been for industry to complain about the non-work-readiness of HIMAA graduates and, in the public sector, work with state government to develop their own workplace-based training equivalents independent of the profession’s expertise in education and training and competency standards in the sector.

Many hospitals have, however, identified that clinical coding educators and auditors are needed on the ground to support their clinical coder workforce. This trend needs to continue if new graduates are to find jobs and continue learning and growing, but it also needs to be in conjunction with training providers.

In 2015 the Victorian government recognised this reality, providing funding to support local RTOs to team up with local public health facilities to deliver the 22274VIC Certificate IV in Clinical Classification, which the Victorian departments of health and education successfully registered as a course with the Victorian Qualifications and Registration Authority in June the year before.

Access to medical records

A clinical coder needs to be exposed to a large number of medical records before they become proficient. Accessing medical records is difficult and time consuming for training organisations. Confidentiality and privacy considerations require extensive manual redactions, often on already PDF documents.

The more records a training provider makes available, the more work it is to update the answers with every ICD-10-AM edition change to maintain their currency and relevance.

A further challenge is that with the introduction of the EMR, the record no longer looks like it used to. How do we replicate this in a training situation? What is really needed is access to records in the workplace, under confidentiality agreements.

It is known how important student access to a real workplace to code in context is, but with prohibitive insurance costs this is difficult for a small non-government training provider to resource. If expansion of independent training providers such as RTOs is desirable, industry will need to address workplace access for students.

HIMAA has often been advised anecdotally that once coders are trained many struggle to find a job. Most employers want previous experience. Without workplace exposure and experience, however, previous experience ’is impossible to produce. This is a conundrum.

Time expectations

Industry is often frustrated at how long it takes to complete the training program. Employers do not seem to understand that as a foundation prerequisite subject, medical terminology along with anatomy and physiology is a lot to learn in and of itself, notwithstanding the complexities of learning ‘how to code’ from scratch.

Many of the people who undertake HIMAA courses are already working full time so there’s often no opportunity to complete the training any faster. It takes even longer for a clinical coder to become proficient in the workplace.

HIMAA offers the status of certified clinical coder only to graduates of its advanced clinical coding course, who have to complete an examination to achieve the credential. Such a graduate will have been working as a clinical coder for between one and four years.

Collaboration between RTOs and public health

There is evidence that a collaboration between a national training provider such as HIMAA and the public hospital system is not only achievable, but it can lead to tangible recruitment and retention benefits.

The Health Information Workforce Summit heard of a successful collaboration between HIMAA and NSW Health whereby the state government funded a clinical coding workforce enhancement project in which 33 new entry trainee coders participated at the Certificate III level, employed by 10 of NSW Health’s 17 Local Health Districts (LHDs).

Of these, 30 completed the Certificate III, including the HIMAA introductory clinical coding course and 29 are still engaged in the sector.

This was a piloted statewide traineeship model which looked at the value and achievability of these kinds of traineeships at a state government level.

For the existing NSW clinical coding workforce, enrolments in HIMAA’s intermediate clinical coding coursework over the two-year project (59 people) almost exceeded HIMAA’s annual national average intake over the same period (65.5 people).

The same is true for advanced clinical coding (30 people in NSW Health CCWE vs HIMAA’s national average equivalent intake of 34.5.

It is clear that if the support is available, clinical coders will engage in professional career development and participants reported tangible improvements in workplace performance as a result.

The model showed HIMAA that jurisdiction-funded traineeships in conjunction with an RTO like HIMAA or the NSW Health RTO can lead to the fulfilment of entry-level workforce needs and funding of the professional development aspirations of existing clinical coders can lead to work-based quality improvement outcomes.

Secure workforce supply

In April of this year, HIMAA successfully applied to the Australian Skills Quality Authority (ASQA) to bring the 22274VIC Certificate IV in Clinical Classification course onto its scope of registration.

In order to meet HIMAA’s standards as the peak body for the health information management profession in Australia, the HIMAA course will take the full two years expected of a Certificate IV (many are delivered in much less), and 840 study hours instead of the 510 hours nominated by the Victorian government.

Nevertheless, while HIMAA supports the local collaboration model pioneered by the Victorian Department of Health, the RTO believes there are benefits to employers recruiting trainees or existing staff as trainees in a nationally delivered clinical coding qualification.

Being part of a national cohort of students by distance learning, local recruits to clinical coding have access to nationally consistent coursework and nationally validated assessment. With student permission, HIMAA can offer reports on student progress to employers, which will assist local coder educators and supervisors to provide better on the ground support for recruits.

In addition to providing a national qualification, which improves the recruit’s sense of entering a national career with professional continuity into other health information management occupations, HIMAA’s 22274VIC Certificate IV in Clinical Classification takes the student up to the doorstep of the RTO’s advanced clinical coding course and, potentially, national HIMAA credentialing as a certified clinical coder.

In addition to recruitment, then, the HIMAA qualification leads into a career development pathway that can improve retention for employers.

HIMAA is interested in forming partnerships with employers who value the longer term recruitment and retention benefits of engaging with a national provider of the 22274VIC Certificate IV in Clinical Classification in return for meaningful workplace support for employees and trainees.

A report from the Health Information Workforce Summit, in which HIMAA was partnered by the Australasian College of Health Informatics (ACHI) and Health Informatics Society of Australia (HISA), is currently in press.

Richard Lawrance is CEO of HIMAA. References are available on request.

Tags: HIMAA, clinical coding

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