The woes and goes of health information workforce supply

The Health Information Workforce Summit, presented by Health Information Management Association of Australia (HIMAA) in association with the Health Informatics Society of Australia (HISA) and the Australasian College of Health Informatics (ACHI) last week, heard from a variety of sources on the vicissitudes of workforce supply in the health information professions.

The shortage in health information workforce (HIW) was discussed by former HIMAA president Vicki Bennett, who was also the principal researcher on an Australian Institute of Health and Welfare (AIHW) study of the clinical coder and health information manager (HIM) workforce in 2009.

The AIHW data was complemented by more indicative membership research conducted by HIMAA in December 2014 which, according to HIMAA acting president Jenny Gilder, suggested that as many as one in three health facilities in Australia are facing clinical coder vacancies they cannot fill, while one in five facilities face the same challenge with HIM vacancies.

The HIMAA research indicated that capacity to supervise incoming clinical coders and/or HIM or coding student placements was between 41 per cent adequate and 37 per cent 'poor-to-none'.

HIM supply

HIM course coordinators Merilyn Riley, from La Trobe University, and Maryann Wood, from Queensland University of Technology, outlined the university challenges from the workforce supply side.

Ms Riley said the relatively modest HIM degree and masters courses needed to serve four authorities – the Tertiary Education Standards and Quality Agency (TESQA), the Australian Qualifications Framework (AQF), university requirements in relation to graduate attributes and, unlike many other courses, professional accreditation by the health information management’s national association, HIMAA, to the profession’s entry level competency standards for practising HIMs.

HIMAA has been accrediting degree-level HIM courses since 1992.

Ms Riley said there was the further challenge of staffing HIM courses at the university level. Advanced academic qualifications are expected, preferably at PhD level, but HIM qualifications begin at Bachelor level, including graduate-entry masters (GEM), and these are often the best educational staff for the purpose. Industry also pays better at this level than the university.

Engagement in research is another university expectation that HIM course educators find hard to meet, given teaching load pressures and the need to locate and support suitable workplace placements for students.

Maryann Woods spoke of the threat to HIM courses of low student enrolments. Low interest can lead to acceptance of lower Year 12 scores, which in turn lowers the standing of the course in the context of higher ATAR high-enrolment courses in the health professions, she said.

On the other hand, HIM courses risk being amongst the low fruit for cancellation when there is pressure to increase revenue and university rankings.

Loss of a course in a jurisdiction leads to supply issues in that state. QUT has only just restored its HIM course after losing it in 2010.

NSW is regaining a HIM degree through Western Sydney University after the University of Sydney HIM degree disappeared in 2007. A distance learning bachelor level HIM course from Curtin University in WA has often filled the gap, but Curtin is phasing out GEM access to that course.

However, a new distance learning Master of HIM course from the University of Tasmania, for practising HIMs, brings the national HIM offering to five universities once more.

ACHI president Klaus Veil, an adjunct associate professor at Western Sydney University, spoke about similar woes for the health informatics courses available around the country. Western Sydney University and the University of Tasmania are two institutions in which HIM and health informatics courses sat side by side.

It was Karen Day, a health informatics academic from the University of Auckland and ACHI fellow, who pointed to a potential solution for workforce supply at the university level.

Dr Day said the update of New Zealand's health strategy of 2000 and its alignment with the 1998 national health IT plan, which builds on the development of health informatics capability as a key to success, provides a structural pull factor into which the academic providers of workforce capacity-building can supply.

NZ's national health IT plan is updated every three to five years, and a similar structural leadership from Australia focused on a health IT capability framework may provide similar certainty for Australian HIM course providers.

The need for a capability framework, and for continuity in the delivery of core HIM skills as a basis for supporting the specialisation and diversification already occurring in the health information management profession, were among the key topics of discussion in an open forum at the end of the summit’s morning session on workforce shortage.

Clinical coder supply

A number of recent solutions to clinical coder workforce shortages were also discussed.

HIMAA has a 25-year history of distance learning clinical coding education and training, initiated in direct response to our perception of workforce need in 1990. Despite being Australia’s largest provider of entry-level clinical coding graduates at the vocational education and training (VET) level, HIMAA has constantly grappled with an employer expectation of work readiness in graduates and reluctance to engage with the professional association on student workplace experience.

This is despite the fact that internships and work placements are readily accepted practice in other, more therapeutically frontline health professions.

A recent solution to this challenge for HIMAA was presented by Maria Stephanou, project manager on a NSW Health collaboration with HIMAA to deliver HIMAA coursework from its introductory, intermediate and advanced clinical coding courses to NSW Health coding employees.

At the introductory level, NSW Health offered 30 traineeships with successful employee placement outcomes in 29 cases. At the intermediate and advanced levels, practising clinical coders were offered on-the-job supervision and mentoring in addition to the HIMAA coursework.

The results for the practising coders showed tangible improvements in workplace performance in the context of career advancement. A total of 59 clinical coders completed the intermediate course, compared to HIMAA’s equivalent national average intake of 65.5, and 30 completed the advanced course, compared to HIMAA’s equivalent national intake of 34.5 – an indication of what strategic government-led support can achieve in terms of career development with productivity enhancement.

The chair of HIMAA’s workforce working group, Julie Brophy, spoke in her professional capacity as manager of productivity and the health information workforce with the Victorian Department of Health and Human Services.

Ms Brophy discussed Victoria's six-year strategy to address clinical coder workforce shortages, including an alumni strategy, transition to work project, capability framework and, most recently, the accreditation of a Certificate IV course in clinical classification with the Victorian Registration and Qualifications Authority in 2014.

A number of registered training organisations (RTOs) are being supported to deliver the Certificate IV course in conjunction with local public health providers in Victoria, and HIMAA is developing its coursework for the certificate, incorporating material from its existing benchmark comprehensive medical terminology, introductory clinical coding and intermediate clinical coding courses.

Advantages of the Cert IV Clinical Classification are that it is a recognised VET-level course with a certificate-level qualification, which will enhance the career prospects of graduates, and it places RTO providers in a position to negotiate traineeship options with participating jurisdictions and providers.

HIMAA hopes to apply to the Australian Skills Quality Authority to secure the Certificate IV Clinical Classification on its scope of registration early in 2016 and, if successful, plans to deliver the new qualification nationally from July 2016.

Richard Lawrance is CEO of the Health Information Management Association of Australia (HIMAA).

Posted in Australian eHealth

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