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Health Information Workforce Summit ReportPART ONE: Planning for HIW ActionPART TWO: Themed Proceedings and Discussion

ACKNOWLEDGEMENTSThe Board of the Health Information Management Association of Australia (HIMAA) wishes to acknowledge the many members and stakeholders who contributed to the development of the 2015 Health Information Workforce Summit and its Report, including:

y HIMAA’s Workforce Working Group, chaired by Julie Brophy, members Vicki Bennett, Kerryn-Butler-Henderson, Janine Carter, Jen Lee, Bhawna Sehgal, Cheryl Waugh, Mary-Ellen Wetherspoon

y Australasian College of Health Informatics, Adjunct Associate Professor Klaus Veil (President) and Professor Karen Day (FACHI)

y Health Informatics Society of Australia (HISA), Louise Schaper (CEO), Dr David Hansen (Chair), and Philip Robinson (Treasurer)

y Health Information Workforce Working Group (HIW WG) of the Health Workforce Principal Committee (HWPC) of the Australian Health Minister’s Advisory Council (AHMA), Dean Raven (Chair)

y NSW Health Workforce Branch Associate Director Timothy Burt and staff, and Maria Stephanou of the NSW Health RTO

y Ann Ritchie, Convenor of the Health Libraries Australia group of the Australian Libraries and Information Association

y Merilyn Riley, Maryann Wood, and other University HIM Coordinators on HIMAA’s Tertiary Education Sub-Committee

y Alex Toth, Chair of HIMAA’s tertiary Education Sub-Committee y Cassandra Rupnik, President of the NSW Branch of HIMAA and member of HIMAA’s

Practice Quality and Safety Standards Committee y Dr Joan Henderson and Dr Julie Gordon of the Family Medicine Research Centre,

University of Sydney y HIMAA members Michelle Crook, Paula Love, Lisa Quick and other contributors to

HIMAA’s practice journal, HIM Interchange y Summit Facilitators Christine Bodkin, Julie Brophy, Kerry Butler-Henderson, Merilyn Riley,

Cassandra Rupnik and Klaus Veil y Summit Rapporteurs Kim Campradt, Karen Day, Catherine Garvey, Travis Ingram, Nina

Lean, Jenn Lee, Stella Rowlands, Bhawna Sehgal and Linda Westbrook y HIMAA Staff Richard Lawrance (CEO), Ralph La Tella (IMIT & PD Manager), Lyn

Williams (Training Manager), Stephanie Zbik (ESO), Milla Krivozhnya (Marketing and Events Coordinator) and Richard Cornish (Membership Officer)

y The Dockside Waterfront Conventions, Darling Harbour, Sydney

With sincere thanks,

Jennifer Gilder, PresidentHealth Information Management Association of Australia

ISBN-978-0-9946206-0-6

Suggested Citation: Health Information Management Association of Australia, Health Information Workforce Summit Report 2015; Sydney, Australia, 2016.

First published by the Health Information Management Association of Australia Limited, July 2016, Sydney, Australia.

Table of Contents

SECTION ONE1. Executive Summary.............................................................................................................................................................32. Introduction ..........................................................................................................................................................................63. The Professions – a Unified Voice .......................................................................................................................................84. Workforce Data on Shortage and Configuration ................................................................................................................105. HIW Supply Challenges and Solutions ..............................................................................................................................13

5.1 Education and Training ..............................................................................................................................................135.2 Work-based HIW Supply Challenges and Solutions ..................................................................................................18

6. HIW Configuration – Present and Future ..........................................................................................................................257. Planning For HIW Action ...................................................................................................................................................32

SECTION TWO1. Introduction ........................................................................................................................................................................352. The HIMAA ACHI HISA Health Information Workforce Context ........................................................................................38

2.1 HIMAA Workforce Strategy .......................................................................................................................................382.2 HWA HIW Report 2013 Context .................................................................................................................................40

3. Workforce Data on Shortage and Configuration ................................................................................................................443.1 Health Information Workforce – The Need for Data ...................................................................................................443.2 Clinical Coding Workforce and Recruitment ..............................................................................................................473.4 SGD 5: Workforce Configuration – data gathering and monitoring ............................................................................51

4. HIW Supply Challenges.....................................................................................................................................................534.1. Education and Training .............................................................................................................................................534.2 Work-based HIW Supply Challenges .........................................................................................................................62

5. HIW Supply Solutions ........................................................................................................................................................735.1 NSW Health Clinical Coding Workforce Enhancement (CCWE) Program 2012-14 ..................................................735.2 Victoria’s Health Information Workforce Strategy .......................................................................................................755.3 The CHIA Solution ......................................................................................................................................................765.4 Health Informatics - A National Health Information Strategy in New Zealand ............................................................785.5 International Models ...................................................................................................................................................79

6. HIW Configuration – Present and Future ..........................................................................................................................816.1 The HWA HIW Report (2013) on Workforce Configuration .......................................................................................816.2 Open Forum: Curriculum – Core Competencies vs Specialisation and Diversification ..............................................836.3 Open Forum – The Separation of Clinical Coders and HIMs in HIM curriculum ........................................................846.4 HIW Role in Primary and Community Care ................................................................................................................856.5 The HIM Executive .....................................................................................................................................................906.6 SGD 1: Organisational Structure and the Role of the HIS Unit ..................................................................................936.7 SGD 4: Future Workforce Configuration and the Role of HIW ...................................................................................966.8 SGD 6: Health Informatics .......................................................................................................................................100

7. Unified Voice – The Action Imperative .............................................................................................................................1037.1 Open Forum – Capability Framework ......................................................................................................................1037.2 Open Forum - Unified Voice .....................................................................................................................................1047.3 Action is Imperative ..................................................................................................................................................106

APPENDICES .....................................................................................................................................................................107APPENDIX 1: Health Information Workforce Summit Program ...........................................................................................107APPENDIX 2: HIW Report Glossary ...................................................................................................................................109

HIW Summit Report Part One – Planning for HIW Action

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Health Information Workforce Summit ReportPART ONE: Planning for HIW Action


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1. Executive Summary

This report summarises discussions and findings generated at the Health Information Workforce (HIW) Summit, held on 30 October 2015, initiated by the Health Information Management Association of Australia (HIMAA). The purpose of the summit was to actively discuss and address the workforce challenges facing the health information workforce, particularly those relating to workforce shortages and future workforce configuration identified in the 2013 Health Workforce Australia (HWA) Health Information Workforce ReportThe outcome sought was a realistic profession-led action plan to assist both government and industry in ensuring development of a sustainable and skilled future health information workforce. The resulting report, however, suggests planning for the HIW professions, employers and for governments to address HIW shortage and configuration based on actions resulting from delegate discussion. An action plan, as such, was deemed outside the governance of Summit proceedings.HIMAA was joined by peak HIW organisations the Australasian College of Health Informatics (ACHI) and the Health Informatics Society of Australia (HISA) in presenting this Summit.Over 100 attendees of the summit heard from a range of speakers on current workforce trends and were provided with the opportunity to participate in small group discussions as well as provide feedback to through a facilitated forum. The program for proceedings on the day is appended as Appendix 1 to Part Two of this report.

ThemesThe following issues, challenges and solutions were discussed by delegates and presenters.

� Workforce Data on Shortage and Configuration � There was clear consensus that there is inadequate HIW data on which to base any

evidence based decisions and that addressing this should be a priority for government. � Research is also required to support evidence based approaches to developing the

future configuration of the workforce and providing the value proposition for employment of a skilled workforce.

� Despite the lack of conclusive data there are strong indications from the available sources of an acute shortage in Clinical Coder workforce, role substitution and industrial award shifts for Health Information Managers (HIMs) and shortages of skilled Health Informaticians.

� Failure to address these shortages will place considerable pressure on the health system as we move to greater reliance of quality information to support delivery, evaluation and evolution of health care, particularly through eHealth.

� HIW Supply Challenges � Education & Training - Universities face challenges in changing curriculum, finding

professional staff to teach, attracting sufficient numbers to make courses viable, and finding placements for students.

� Work-based - Recognition of the workforce and its shortages is required of employers, who should support recognised qualifications and credentials, appropriate industrial awards and professional development.

� Future HIW Configuration � Digitisation of information is becoming mainstream and will be a disruptor that will require

changes in the workforce skills. � HIW leaders will be required to drive the change process, achieve effective uptake of

technology, generate value from investment and turn data into information that can be communicated and used.


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� Methods of validating the skills and competencies of the workforce need to be progressed to develop recognised professional career pathways into the future.

� Definitions of this workforce need to be multiple and inclusive. A framework for the future based on profession-led capability development with industry and education providers, rather than individual job descriptions, was preferred as roles and functions will change.

� Such a framework would assist in developing workforce skills, and also measuring performance and quality and future proofing role definitions.

� Clinicians of the future will also require health informatics and information management skills.

A sustainable HIW is vital for ensuring future quality of health data, implementation of digital health systems, integration of health systems (both within streams and across sectors such as primary and tertiary care) and containment of burgeoning health care expenditure. The challenges of HIW are relatively inexpensive and cost effective to address but require planning and collaboration across industry, professional bodies and government.

Suggested ActionsEighty five (85) actions suggested by delegates and presenters are recorded in this report. They recommend key areas of planning and work for the HIW professions, employers and governments to address HIW shortage and future configuration needs.A majority of delegates also supported a call for a unified voice for HIW. Peak bodies and delegates alike recognised the value of joint advocacy in addressing HIW shortage and configuration needs.

� Workforce Data on Shortage and Configuration � The development of a minimum dataset on which to base HIW data gathering and

monitoring, developed in consultation with the HIW professional peak bodies. The AIHW 2010 research into clinical coding workforce, as the most substantive study to date, may inform dataset development and more current work undertaken in some jurisdictions.

� A census-style research program to populate the dataset in the first instance, and then refreshed periodically. Jurisdictions may form the ‘engine room’ of this research program.

� Use findings to work with industry, government, professional bodies and education/training providers to plan for future HIW configuration needs.

� Develop a HIW Capability Framework, resulting from this research, based on professional competency standards and qualifications, to form the basis for future HIW configuration.

� HIW Supply Challenges and Solutions � Education & Training

y Provide a career pathway for existing clinical coders through existing professional development such as the HIMAA intermediate and advanced competency levels to achieve HIMAA Certified Clinical Coder status.

y Develop a traineeship approach to entry-level education and training in the Certificate IV in Clinical Classification.

y Clinical coding educators to be structured and remunerated as a career step nationally.

y Structure clinical coders as part of the health information management profession, requiring and deserving workplace experience in order to optimise work readiness on graduation.

y Self-regulated registration of health information professionals and the realignment and renaming of industrial awards across jurisdictions to ensure identifiable career


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paths to improve HIW recruitment. y Maintenance of core HIW professional competencies as the centre of education and

training at the same time as supporting diversification and specialisation to meet the demands of a rapidly changing HIW configuration.

y Improve HIW recruitment at degree and VET levels through coordinated and targeted actions.

� Work-based y The development of a coalition of health facility executives to support credentialing of

HIW professionals as a requirement of employment. y This credentialing to form the basis of HR recruitment in HIW, with accredited

qualifications preferred uniformly; and generate a mechanism for tracking changes in HIW configuration, both demographically and in occupation mobility.

y Promotion of the Certified Health Informatician Australasia (CHIA), both in the hospital sector and in primary care.

y Targeted initiatives to raise the profile of the HIW professions within the healthcare system to maximise the effectiveness of eHealth reform (health services digitisation).

y Address industrial award differentiation between jurisdictions to reduce HIW population aggregation to the “better paying state across the border”.

y Clarify industrial awards so that they reflect the roles of the HIW professions rather than generic HR structures driven by health system bureaucracies.

y Support in-service professional development for HIW to enable the specialisation and diversification required of HIW configuration to meet the rapidly changing demands of eHealth.

� HIW Configuration – Present and Future � Governments and employers to work with the peak HIW professional bodies as the

primary source of HIW workforce configuration intelligence, based on the research, credentialing and registration initiatives recommended above.

� The expansion of HIW into primary care to ensure the interoperability of digitised health information management between primary and hospital care to: y Maximise the benefits of care integration along the patient’s health journey; and y Ensure interoperability of health data classification to support regional and population

health planning. � The integration of health informatics and information management into clinical education

and training, and into multidisciplinary healthcare teams. � Fund and support continuing education (professional development) for HIW to develop

leadership potential within the health system, and to credential for the diversification and specialisation required by eHealth development

� Establish and promote the value proposition for HIW within the health system, so that changing HIW configuration is understood and change for the benefit of all embraced.

� Preparation of the health information management professional for the changing demands of HIW configuration through the strategic structuring of transition initiatives and programs.

The HIW professions clearly see a role for themselves in planning for future HIW workforce supply and configuration. But government and employers should also perceive from this report a role actively engaging in the planning process. This report indicates where planning could start, and start now as a matter of urgency.


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2. Introduction

The Health Information Workforce (HIW) Summit, held at the Dockside conference facilities at Darling Harbour, Sydney, on 30 October 2015, was initiated by the Health Information Management Association of Australia (HIMAA), prompted by a number of stimuli:

� HIMAA dissatisfaction with uneven coverage of the Health Information Management profession in the Health Workforce Australia Health Information Workforce Report 20131;

� Perceived lack of government or industry action as a result of this report; � Lack of substantive data from which to analyse HIW supply and demand, current

configuration and future configuration needs in the context of eHealth reform; � Indicative data from HIMAA membership research in 2014 that workforce shortages in the

health information management profession were exacerbating rather than improving; � The development of a workforce strategy by HIMAA which involved addressing workforce

shortage, and the identification of workforce as the overarching theme for its 2014-16 strategic priorities.

HIMAA was joined by HIW peak organisations the Australasian College of Health Informatics (ACHI) and the Health Informatics Society of Australia (HISA) in presenting this Summit.A range of relevant stakeholders were invited to attend and participate in Summit proceedings, including from federal and state governments at Ministerial and departmental levels. On the day, the federal government was represented by the Health Information Workforce Working Group (HIW WG) of the Health Workforce Principal Committee of the Australian Health Ministers Advisory Committee (AHMAC) of COAG, which has carriage of responding to the HWA HIW Report 2013 for government. The NSW government was represented by a director and senior officers with NSW Health’s Workforce Planning & Development branch.Just over a hundred delegates attended the Summit. Three quarters of these (75%) were HIMAA members, an eighth (12.5%) HISA and/or ACHI members, and further eighth (12.5%) non-members. A number had flown in from interstate specifically to attend the Summit. Just over half of the delegates had also attended the HIMAA NCCH2 National Conference immediately preceding the Summit, many of whom were also from interstate and, indeed, from New Zealand. During Summit introductions, delegates identified themselves as a mix of employers, senior managers, academics, health informaticians and frontline health information management professionals. The aim of the Summit, as stated at the outset of proceedings, was not to formalise recommendations or make decisions but, rather, to raise issues associated with health information workforce, identify challenges presented by those issues, and discuss solutions and actions that might lead to those solutions. Discussion at the Summit was cultivated by dedicated facilitators to ensure optimum input by delegates. This was captured by a team of volunteer rapporteurs. The proceedings of the Summit, including discussions in which issues, challenges, solutions and actions were explored, is presented as Part Two of this report. The Summit program is appended. The proceedings in Part One of the report here, however, are not presented exactly as chronologically occurring in the program. Rather, discussion is assigned to the themes around which the program was structured:

� Workforce Data on Shortage and Configuration � HIW Supply Challenges and Solutions

� Education & Training � Work-based

¹Health Workforce Australia.[2013] Health Information Workforce Report.

²National Centre for Classification in Health, University of Sydney


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� HIW Configuration – Present and FutureA further theme, which emerged unexpectedly from delegate driven discussion, was a call for a unified voice amongst the peak organisations representing health information workforce. This theme leads to a premise of this report: that although the Summit was dominated by HIMAA members, and actions are often assigned to HIMAA by delegates, from an HIW perspective they are relevant to the professions that make up the health information workforce (See section 3 below). Actions suggested during proceedings have been edited where relevant to reflect this premise.

Purpose of the ReportInvitees to the HIW Summit were informed that its aim was to produce a plan of action to address HIW shortage and configuration issues. The purpose of Part One of this report is to take the actions suggested by delegates as the main driver for an initial analysis of the planning required to address workforce shortage and workforce configuration needs in the HIW. As a review of these actions suggests, this planning will involve three key stakeholder groups:

� The HIW Professions � Employers of HIW � Governments

The structure of this report, Part One of the HIW Summit Report, will be to, for each theme: � summarise the predisposing material presented under each theme as a background to

discussion, including any presenter recommendations; � detail the actions suggested by delegates; � review these actions from three planning perspectives:

� What can the professions do? � What can employers do? � What can governments do?

The report suggests eighty five (85) actions to contribute planning to address HIW workforce shortage and future configuration.

Context of Summit Program reportingHIMAA Workforce Working Group StrategyThe Health Information Management Association of Australia, in response to the emergence of Workforce as an overarching theme during membership consultation for its 2014-16 Strategic Plan, formed a Workforce Working Group of the HIMAA Board to oversee strategic action on this issue across the strategic priorities of the plan. This working group has drafted a strategy that identifies some Priority Strategic Directions for HIMAA, which have been approved by the HIMAA Board as a work in progress. This strategy includes:

� Workforce Definitions � Workforce Data inadequacy � HIM Value Proposition � Issues and Challenges � Standards and Qualifications � Professional Advocacy � Sustainability and Relevance.

It is expected that the outcomes of the HIW Summit will further influence these priorities.


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Health Information Workforce Working Group UpdateIn 2014, the then Health Workforce Australia (HWA), generated the Health Information Workforce Report 2013, which included recommendations to develop the HIW. In 2014 the Health Workforce Principal Committee (HWPC), agreed in 2014 that it would create a cross jurisdictional working group – the Health Information Workforce Working Group (HIW WG) – to review the recommendations of the 2013 HWA Report and provide feedback to HWPC on actions that warrant a national approach. The HIW WG also reviewed proposals from HIMAA and HISA that were provided to the HWPC in response to the issues and recommendations raised in the HWA report.The HIW WG provided a response to HWPC that was endorsed in May 2015. It is now progressing with the first agreed action, to develop a shared understanding of the HIW, before it addresses any further agreed actions. The working group will be consulting with stakeholders, including those represented at the summit, which will allow input into the work. This timeframe provided Summit delegates with space to not rush with recommendations but, rather, consider fully the issues and develop considered responses to inform future work of the HIW WG.

3. The Professions – a Unified Voice

ContextThree of the peak organisations prominent in HIW – HIMAA, ACHI and HISA – were involved with presenting the Summit. They already share a history of joint advocacy on eHealth issues such as the PCEHR (now My Health Record). The three organisations are joint partners in the academic and program governance of the Certified Health Informatician Australia (CHIA) program featured during the Summit (see Section 4 on Work-Based HIW Supply Challenges and Solutions). There are memoranda of understanding to govern cooperation between the three organisations. A fourth body, the Health Libraries Australia (HLA) group of the Australian Libraries and Information Association (ALIA), declared an interest during Summit proceedings in being part of peak body representation of HIW. A fifth, the Australian College of Health Services Management (ACHSM), was also suggested by two delegates for collaboration. Significant work has been undertaken by the HIW WG of the Health Workforce Principal Committee of AHMAC in identifying and developing a shared understanding of the professions that make up the HIW, as per Recommendation 1 of the HWA HIW Report 2013, in consultation with the peak bodies of these professions. Industry consultation since the HIW Summit by the HIW WG, and further interaction by the peak HIW bodies themselves, can be expected to further joint advocacy and policy articulation where there is common purpose and value for HIW as a whole. What the Delegates SaidSummit discussion about the need for workforce data to address workforce shortage led to the need for definitions of what would constitute the roles making up the workforce. This in turn pointed to the value of qualifications and competencies as the basis for capability framework for HIW development instead of definitions and/or position descriptions, or roles and responsibilities.“People like to label,” one delegate commented. “We need to see blending of roles, an image change from HIM and HI to health information professionals with diversification.”“Future proof workforce definitions by way of a capability framework,” said another delegate. This delegate advocated such a framework identifying the roles and functions needed of


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individuals based on the actual requirements from an organisation-wide perspective. There was not delegate consensus on exactly what form a capability framework should take, but agreement that one should guide HIW development. Similarly, there was agreement that a united voice by the professions would progress the collective interests of HIW. This led to the suggested actions that:3.1 The peak health information bodies to work together with other allied bodies to form

a unified voice for health information workforce. 3.2 The peak health information bodies to: 3.2.1 Reach agreement on the core skillset shaping the HIM/HI professional identity as a

starting point for any capability framework;3.2.2 Work with the professions and stakeholders to determine the appropriate capability

framework needed to future proof the professions e.g. one based on roles and responsibilities or on competencies and qualifications?.

The three peak bodies presenting the Summit, HIMAA, ACHI and HISA, point out that there are already core competencies established that shape the HI/HIM identity. The CHIA, for instance, is based on 52 competencies agreed by the three partners, and ACHI confers a Fellowship of the College. HIMAA’s Entry Level HIM Competency Standards consist of 127 individual competency tasks in 9 domains of knowledge/skill. The latter have been responsive to changes in industry and education since their introduction in 1992.

What Can The Professions Do? � Support their peak bodies in working together to provide a united voice on common HIW

issues. � Peak HIW bodies to form alliances with other allied bodies to strengthen the HIW voice,

perhaps based on the HIW WG’s “shared understanding” response to HWA HIW Report 2013 Recommendation 1 on delineation of the HIW.

� Develop a capability framework to lead HIW development based on the combination of shared and differentiated competency standards and qualifications.

� Collectively work with industry employers and HIW education providers to ensure that competency standards respond to changes in roles, responsibilities and functions required in a workforce configuration constantly and rapidly emerging in a context of eHealth reform.

What Can Employers Do? � Recognise the HIW professions, perhaps in conjunction with HIW WG’s “shared

understanding” response to HWA HIW Report 2013 Recommendation 1 on delineation of the HIW.

� Incorporate any HIW capability framework developed by the HIW professions into employer HR structure, specifying framework qualifications in job descriptions and recruitment collateral.

� Work with the professions through their peak bodies to ensure that a HIW capability framework can respond to changing roles, responsibilities and functions in HIW configuration to meet their needs.

What Can Governments Do? � Work through the HIW WG to finalise their ‘shared understanding’ of the HIW. � Support the development by the HIW peak bodies of a capability framework from the

HIW WG’s ‘shared understanding’, based on HIW peak body competency standards and qualifications.


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� Work with the professions through their peak bodies to incorporate their HIW capability framework into workforce policy, strategy and planning.

� Prioritise consultation and collaboration with the peak HIW bodies as a whole to ensure that HIW’s central and vital role in eHealth development and the digitisation of health information services and capability can deliver the national and jurisdictional benefits in quality of care and containment of rising costs expected of the integration of care across primary and hospital sectors.

4. Workforce Data on Shortage and Configuration

Delegates at the Summit heard from HIMAA of the unreliability of existing workforce estimates from sources such as the Australian Bureau of Statistics (ABS) census data and the Australian Institute of Health and Welfare (AIHW), even though such sources are advocated in the HWA HIW Report 2013 as bodies that should be consulted to improve HIW data collection. Research into the Clinical Coder workforce by the AIHW in 20093, in which every Australian hospital was sampled, at a 75% response rate in general, and an 86% response rate in the public sector, represents the most substantive research to date in the HIW field. Health Informatics (HI) workforce data is less available than for HIMs and Clinical Coders. This is exacerbated by the fact that HI does not have an Australia & New Zealand Standard Classification of Occupations (ANZSCO) code allocation, and thus does not even appear in ABS data. Compared to the more robust and reliable AIHW research data from 20104, ABS data on Health Information Manager (HIM) and Clinical Coder self-report prevalence in the population are routinely higher by more than 50%.This noted, both AIHW and ABS data show a consistently downward trend in Clinical Coder workforce, and markedly variable prevalence of HIM workforce numbers in the context of an overall downward trend in the health information management profession numbers.Indicative membership research by HIMAA in 2014, however, suggests that workforce shortages in both HIM and Clinical Coder occupations are worsening rather than improving, with expected future unmet needs per health facility of 2.25 FTE HIMs and 3 FTE Clinical Coders over the next three years in the face of poor supply in over 50% of facilities. HIM and Clinical Coder workforce as identified by ANZSCO (Australia and NZ Standard Classification of Occupations) in census data make up 65% of the frontline HIW identified by the HWA HIW Report 20135. As such, indications of expected unmet need of the above magnitudes do not bode well for HIW capacity in the next few years. The AIHW report forecast a minimum 2010-15 employer need for 1,757 FTE Clinical Coders in addition to simple attrition replacement. However, the largest provider of non-HIM Clinical Coder graduates in the country, HIMAA, has only been able to supply 726 graduates of the entry level Introductory Clinical Coding course in the AIHW forecast period (see Section 4.1.3 of Part Two of this report).Since the Summit HIMAA has learned of a census-style survey of health information management workforce by NSW Health (including clinical coders), and recent studies of Clinical Coder workforce in Queensland and WA. It was suggested to Summit delegates that the AIHW study might be a useful benchmark to revisit with contemporary national research. An evaluation of the effectiveness of action to implement AIHW 2010 recommendations, for instance, compared to the outfall of unaddressed AIHW recommendations, may inform future

3Australian Institute of Health and Welfare 2010. The coding workforce shortfall. Cat. no. HWL 46. Canberra: AIHW4Australian Institute of Health and Welfare 2010. The coding workforce shortfall. Cat. no. HWL 46.Canberra: AIHW.5Health Workforce Australia.[2013] Health Information Workforce Report, Adelaide:14; Lawrance R, 2014, Messages home – A HIM perspective on the HWA’s health information workforce report: significant issues for our industry. HIM Interchange; 4(2):7.


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supply/demand strategy. The use of the AIHW survey as a template for further research might also allow for similarly benchmarked comparison.

What the Delegates SaidDelegates agreed upon the need to conduct research to obtain up-to-date data on current workforce issues to provide evidence for increased funding and support for HIW supply and configuration. It was also suggested that the HI and HIM professions need to work together to obtain this evidence as an urgent cornerstone for all other HIW action.There was also consensus on the need for a substantive ongoing research and evaluation program with industry and education and training providers on supply and demand in the health information workforce. The supply of the Clinical Coder workforce in partricular needs to be examined to determine if there has been a shift in where this supply is coming from, given that the findings of the 2010 AIHW report show a move away from using HIMs as Clinical Coders in all states. One summit delegate also identified the opportunity to examine role substitution and specialisation in this workforce, particularly in relation to data analytics, given the eHealth reform currently and advances in technology that may have an impact on the clinical coding workforce.Actions suggested by delegates were:4.1 Key stakeholders, led by the peak professional organisations, need to work together,

using agreed definitions, to campaign for an ongoing data collection and evaluation program for this workforce.

4.1.1 Such data collection should include the examination of the existing workforce, future workforce configuration, workforce shortfalls/demand, roles and functions, competencies and qualifications. An evaluation framework based on professional competencies and qualifications, rather than position titles and job descriptions, would guide industry and government, identify gaps and establish national priorities for workforce development.

4.1.2 As the health information professions are not regulated by AHPRA, self-regulation against agreed competencies, as opposed to professional titles, should be pursued to provide evidence to government and employers of the value of HIW configuration as this changes.

4.1.3 A minimum data set as part of an ongoing periodic census program is an appropriate option, but the frequency of the census needs to be manageable.

4.1.4 Competencies and professional standards are required data fields for evaluation over time, and revision of competencies to ensure the professions are meeting the needs of employers.

4.2 The scope of this program would include:4.2.1 Quantifying and qualifying the workforce to build a capabilities-driven HIW

development framework, 4.2.2 Negotiating future workforce configuration requirements and trends with industry,

and identifying areas for role diversification and specialisation, 4.2.3 Specific demand forecasting in Clinical Coding to determine the level of demand

met by existing actions since the release of the AIHW 2010 Clinical Coding Workforce report, and the future demand required.

What Can The Professions Do? � The HIW professions peak bodies to, as a whole, lead a campaign to implement actions 4.1

and 4.2, including � Developing a framework for self-regulation based on agreed competencies and


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professional standards rather than professional titles or position descriptions, and lead an application to AHPRA for recognition of HIW self-regulation as a basis for employment and ongoing professional currency

� Developing an ongoing census of HIW data collection, based on a data set determined by government and industry, in order to ensure the responsiveness of self-regulatory professional competency sets and practice standards to the emerging industry and government needs for HIW configuration

� Secure a funding base for both self-regulation and HIW research � Work with education and training providers to ensure professional competencies respond

to industry and government needs in terms of curriculum relevance for profession entry and professional development.

What Can Employers Do? � Support by advocacy to governments the identification by peak HIW bodies of a

minimum HIW data set as a basis for periodic, census-style HIW data gathering to inform workforce configuration development to meet emerging industry needs

� Cooperate with peak HIW bodies in establishing a minimum HIW monitoring data set to ensure it meets industry needs

� Actively support the implementation of such an HIW workforce capability development framework by ensuring a response to the proposed census-style survey, and by engaging with the HIW peak professional bodies to analyse census results and forecast future HIW need, particularly in relation to changing workforce configuration and numbers.

� Advocate with the peak professional bodies for the ongoing funding for this research for as long as the HIW professions continue to fulfil a key role in the achievement of the national outcomes in quality of care and healthcare cost containment through the integration of care across hospital and primary care sectors, through the digitisation and management of health information.

What Can Governments Do? � Prioritise the development of HIW as an immediate priority for government strategy at

ministerial levels in order to staunch without delay any further exacerbation of HIW shortage, and to plan strategically for a profession-led responsiveness to HIW development that will meet a rapidly changing demand for HIW configuration in near future, without which the digitisation of health care and its expected benefits will fail.

� Through the HIW WG of AHMAC’s HWPC and the federal Department of Health’s workforce function in the first instance, work with the state and territory governments and the HIW peak professional bodies as a whole to establish a minimum data set for an initial comprehensive survey of HIW and, as a result, analysis of current workforce configuration and future workforce need.

� Agree upon a COAG funding model for the implementation of the research requirement to implement the research program that will bring the application of this agreed HIW data set to the operational level of an HIW Capability Development framework, guaranteed until the national outcomes in quality of care and healthcare cost containment through the integration of care across hospital and primary care sectors, through the digitisation and management of health information, are achieved.

� Again perhaps through HWPC’s HIW WG, determine the extent to which the jurisdictions are capable of delivering key elements of this research program, such as data gathering and engagement with employers on a jurisdictional or even regional basis.


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� Ensure that the peak professional HIW bodies as a whole, as custodians of an HIW Capability Development Framework, are funded and supported in a key coordination role for this data gathering and monitoring program, and are involved in employer liaison at state, territory and regional levels as relevant.

� Develop a mechanism of working across jurisdictions and federal government to support the peak HIW professional bodies in evaluating the outcomes of the research program supporting an HIW Capability Development Framework.

� The HIW WG to review and redraft the HWA HIW Report 2013 Recommendations 5 and 6 to effect their joint relevance to both HIM and HI professions.

5. HIW Supply Challenges and Solutions

In the summit proceedings in Part Two of this report, the examination of health information workforce (HIW) supply challenges is divided into two sections, supply through education and training, and supply through work-based initiatives. There is often crossover between these two supply contexts, but that also have their distinctive issues and challenges.

5.1 Education and TrainingIn the HIM and HI professions, three key education and training issues were discussed by presenters:

� The challenge for small HI or HIW departments in universities in maintaining low enrolment, niche courses;

� Student recruitment � Workplace experience for students

Degree LevelSummit delegates heard from university coordinators of HIM courses how challenging it was to serve four priorities:

� The national TESQA/AQF framework by which universities are accredited - a TEQSA audit can burrow down to the level of the number of words required of a specific assessment per certain credit-point subject

� The institutional level for each university’s own self-accrediting academic requirements in relation to approval of new courses or changes to existing courses – the comparative income-generating value of an HIW or HI course is not as attractive as higher-enrolment clinical and therapeutic health courses, and even relatively minor course changes can take up to two years to achieve

� Professional association accreditation is a further level of governance for the HIM course – while this provides a professional entry dimension that heightens the work-based relevance of the HIM courses, HIMAA’s accreditation framework is nevertheless another level of bureaucratic requirement that needs to be met and maintained and, in some cases, justified to the university

� The professional placement was the fourth level of challenge – employers have differing expectations and requirements of student placements, sometimes outside HIMAA’s Entry-Level HIM Competency Standards, and qualified HIM supervision can be difficult to find in a busy workplace. Some hospitals are even wanting to charge for placements.

The value of finding regional and rural placements for students, where richer and more comprehensive HIM experience is available, can be a challenge that:


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� Doesn’t interest the university � Is difficult to interest students in – even those of regional or rural origin � Are difficult to locate and resource financially.

A further challenge faced by the university HIW courses is recruiting profession-qualified education and academic staff. The reasons for this are threefold:

� Universities require at minimum Masters preferably PhD attainment for academic staff, and do not recognise in HIW degree-qualified teachers and researchers in the same way as they do, for instance, in medical faculties

� Academic HIW staff earn less in the university setting than they can in their professional practice

� Research opportunities for academic HIW staff can be difficult to pursue given the teaching load, especially with the additional demand of finding and monitoring workplace placements.

A Health Informatics presenter informed delegates of the emergence of a Joint Statement of Principles for Professional Accreditation, which was signed subsequent to the Summit (February 2016) by the not-for-profit professional associations advocacy organisation, Professions Australia with their university equivalent, Universities Australia. Both HIMAA and ACHI are members of Professions Australia.This statement of principles can only strengthen the role of professional associations in accrediting HIW courses against professional entry competency standards alongside the academic accreditation processes already undertaken by the university itself. One of the principles is to avoid duplication in the professions’ accreditation processes of those already undertaken in academic accreditation. There is certainly room for greater cooperation between HIMAA and its accredited University courses from this perspective to overcome some of the bureaucratic demands of professional accreditation.

VET levelSummit delegates also heard from HIMAA on some of the challenges in supplying Clinical Coder graduates for the HIW. These paralleled issues raised at the degree level including:

� Accreditation as a registered training provider (RTO) by the Australian Skills Quality Authority (ASQA), and the rigorous compliance requirements of ongoing registration and changes to scope of registration (by, for instance, adding new units of competency, courses or qualifications)

� Student recruitment – in the example of HIMAA, for a modest not-for-profit professional association, access to expensive careers advisory lists, expos, advertising in trade or professional journals, and access to internal hospital communication channels were all significant barriers; HIMAA recruitment is largely a matter of chance.

� Workplace Placements – industry expectations of what a Clinical Coder graduate at VET level should be able to do are unrealistic in the light of industry’s reluctance to engage in workplace placements.

� Industry employers expect work readiness and will go to the extent of generating their own on-the-job training programs rather than engage with the education and training provider to incorporate workplace experience into the course itself.6

� Even in this context, Clinical Coder employers can be reluctant to recognise the value of clinical coding educators and auditors with career-step status and salary increments.

� Employers also complain of the time required to reach qualification (HIMAA’s Comprehensive Medical Terminology and Introductory Clinical Coding courses take 12 months each), without looking to existing options (HIMAA’s Accelerated Course can be completed with RPL in as little as 6 months).7

6See GippsTAFE, Human Capital Alliance & Pavilion Health. The Clinical Coder Capability Framework, Victorian Department of Health, 2013, p.7-87HIMAA notes that since the HIW Summit the RTO has achieved ASQA approval for the inclusion of a 22274VIC Certificate IV in Clinical Classification course onto its scope of registration, which will change the composition of HIMAA’s VET level clinical coding offerings.


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The Summit heard of a successful collaboration between HIMAA and NSW Health in which 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 � 29 are still engaged in the sector � This was a piloted state wide traineeship model, which looked at the value and achievability

of these kinds of traineeships at a state government levelFor existing NSW Clinical Coding workforce:

� Enrolments in HIMAA’s Intermediate Clinical Coding coursework over the two year project (59 pax) almost exceeded HIMAA’s annual national average intake over the same period (65.5 pax).

� The same is true for Advanced Clinical Coding (30 pax in NSW Health CCWE vs HIMAA’s national average equivalent intake of 34.5 pax).

� It is thus clear that if the support is available, the Clinical Coders will engage in professional career development and tangible improvements in workplace performance can result.

The model showed HIMAA that jurisdiction funded traineeships in conjunction with an RTO like HIMAA or 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. These challenges, and the CCWE experience, have led HIMAA to make its own recommendations to government and employers as part of this report:5.1.1 HIMAA to work with State Governments to support a career pathway for Clinical

Coders by funding access to HIMAA’s Intermediate and Advanced Clinical Coding Courses, and the subsequent exam leading to the credential HIMAA Certified Clinical Coder as an employer-recognised standard for career-step advancement.

5.1.2 HIMAA to work with State Governments to develop a funded traineeship approach to the education and training of entry-level Clinical Coders, with suitable workplace support to enable work-ready graduates and employment.

5.1.3 Advocate to state health departments the HIM workforce value of providing scholarships to Clinical Coders to undertake HIM university coursework, by distance education if unavailable locally or as the student’s preference.

5.1.4 Advocate to hospital management the occupation of clinical coding as part of the health information management profession, requiring the same ‘internship’ approach as other health professions.

5.1.5 Advocate the role of clinical coding educators and auditors in the hospital system as germane to health information management staffing structure, and in need of appropriate financial reward and seniority of status to promote recruitment and retention.

5.1.6 Work with employers to extend workplace experience opportunities to students of existing clinical coding training providers such as HIMAA, instead of ‘reinventing the wheel’ by developing their own on-the-job training outside national competency standards.

5.1.7 Employers need to work with existing authorised providers of clinical coding education and training to provide students access to real or simulated records to code in the workplace.


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What Summit Delegates SaidDelegates to the Summit focussed on the recruitment challenge facing the education and training sector of HIW supply. Their focus was clearly on the entire career pathway for the health information professional, not just at recruitment to education and training but beyond. They advocated the promotion of existing health information professional career pathways in core occupations, such as HIM, Clinical Coder, and Health Informatician to young people considering a future career, as well as to graduates in health information degrees entering the workforce, and to others working in the health system who might consider a step sideways or upwards into the HIW.In the HIM profession specifically, delegates advocated the promotion of the full range of career avenues for HIMs and Clinical Coders as the sound basis for further diversification and specialisation as the future configuration of HIW requires. The same could equally be said of the Certified Health Informatician Australia (CHIA) credential as an entry point for individuals from a diversity of related professional backgrounds, promoting the full range of career options open to the Health Informatician.

Professional RegistrationSummit delegates voiced a need for clear and identifiable career governance for the future of the HIW through professional registration. Delegates refracted previous calls for self-regulated registration as a means of counting and tracking change in or required on the competency standards and qualifications of the HIW professions. Delegates also expressed the need for industrial protection of HIW careers, under the auspices of the professions and their peak professional bodies. Industrial career protection was also raised in discussion in on work-based supply challenges. Actions recommended by Summit attendees in relation to registration and industrial awards included:5.1.8 Consider options for registration of Health Information Professionals.5.1.9 Realign and rename industrial awards so that they clearly identify the profession

and improve salary and conditions of existing staff.5.1.10 Peak bodies of the HIW professions to champion review and alignment of awards

to enable clear career milestones for HIW, incorporating certification/credentialing of HIW professionals and accreditation of their qualifications.

5.1.11 Provide a budgeted proposal to government to create accreditation and certification frameworks in HIW, and ensure concepts and recommendations are easily understood by non-health professionals.

Delegates participating in small group discussions generated a number of recommendations to address recruitment and retention including:5.1.12 Introduce Scholarships, Internships, and Traineeships* 5.1.13 Provide appropriate training for non-HIM clinical coders at the appropriate level

(Certificate IV in Clinical Classification)*5.1.14 Ensure recruits to Clinical Coder training have realistic expectations of the

training, understand the work they will undertake as a result, and have the appropriate aptitude for the role of Clinical Coder.*

5.1.15 Find a “role model” for the HIM profession: someone who is inspirational, really passionate about what they do and can be a champion for HIM. The champion could also spread the message that there are other avenues for HIMs outside the health information service.

5.1.16 Provide incentives for profession retention.5.1.17 Re-engage trained but non-working HIMs, Clinical Coders, HIs and other HIW.


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5.1.18 Target other health professionals likely to enter the health information profession.5.1.19 Work with professional associations to expand HIM, Clinical Coder and other HIW

profession nominations on immigration skills shortage lists.5.1.20 Identify and engage with potential employers who will support HIW profession

recruitment and retention.5.1.21 Advocate the profession to young people through careers advisers, careers expos

and university open days*.5.1.22 Promote to future students in a way that is more attractive, showcasing roles for

HIMs and HIs who have diversified and followed a range of career pathways. 5.1.23 Use passionate, current HIW students to showcase the profession to prospective

students. 5.1.24 Provide more diverse placements for HIW students so that they can be aware of

possibilities for diversification. 5.1.25 Provide diverse field trips as part of courses to show HIW students from an early

stage the possibilities in their career. 5.1.26 Encourage mentoring by relevant qualified HIW professionals.*5.1.27 Support programs for young leaders who are HIW qualified to be act as role

models for their generation, and the next generation.To support diversification and specialisation of career, delegates in a small group discussion on this topic also recommended:5.1.28 Showcase HIW professionals i.e. as a snapshot in a broader promotion of the

profession (such as videos on websites)*. 5.1.29 Buddy up with other organisations to gain exposure to different sectors.5.1.30 Encourage mentoring by HIW specialists who have diversified. 5.1.31 Reinforce to employers the constant need for on the job support programs to

encourage HIWPs to upskill to improve their value to the employer, both in meeting current workforce configuration but also future needs.

5.1.32 Use exemplars as role models to show how they can project their roles into the spotlight.

To achieve this, delegates through their peak HIW bodies need to:5.1.33 Partner with each other and other relevant stakeholders.5.1.34 Work with Career Advisers’ associations in each state and territory*.5.1.35 Partner with HIM universities in joint advocacy and career promotion*.* HIMAA is keen to point out that these actions are already underway with HIMAA, either in part or in full.

What Can The Professions Do? � The peak professional bodies to individually develop strategies to implement agreed actions

and to consult as a whole to support each other and identify initiatives generic to HIW that they might implement across the professions or seek funding to implement across the professions

� HIMAA to implement actions in relation to Clinical Coding as a matter of workforce priority.

What Can Employers Do? � Approach HIMAA and government to offer their support for and interest in working to

address the chronic and escalating shortage of Clinical Coder workforce. � Endorse the implementation of a self-regulated registration of the HIW professions, in the


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interests of providing career entry and development stability for employees and quality assurance accountability for employers.

� Engage with the peak HIW professional bodies and government to develop the funding framework for scholarships and internships and actively embrace its implementation.

� Work with the peak HIW profession bodies and governments to develop implement the incentives for profession retention, such as an ongoing on-the-job program of upskilling for HIW employees to improve their value to the employer and prepared for changes in workforce configuration demand.

� Make contact with the peak HIW profession bodies as employers who will support HIW profession recruitment initiatives, including

� To young people through careers advisers, expos and university open days. � Offering more diverse placements for HIW students so that they can be aware of

possibilities for diversification. � Supporting mentoring by qualified and specialist HIW professionals. � Accommodating programs for young leaders who are HIM qualified to act as role models

for their generation, and for the next generation.

What Can Governments Do? � State Governments can work with HIMAA to:

� support a career pathway for Clinical Coders by funding access to Clinical Coding Courses, and the subsequent exam leading to the credential HIMAA Certified Clinical Coder as an employer-recognised standard for career-step advancement.

� develop a funded traineeship approach to the education and training of entry-level Clinical Coders, with suitable workplace support to enable work-ready graduates and employment.

� support HIMAA in advocating actions. � Plan now with strategies and policies to support the peak HIW profession bodies in

actions to achieve self-regulated registration, including active engagement to receive and fund the budgeted proposals.

� Work with the peak HIW profession bodies as a whole to develop the appropriate combination of scholarships, internships and traineeships, including funding model and funding.

� Provide access to the peak HIW profession bodies for the recruitment targeting of employees likely to respond positively to HIW professions as a career option.

� Provide financial and infrastructural support for HIW recruitment and retention initiatives in workplace placements, mentoring, leadership and role modelling.

5.2 Work-based HIW Supply Challenges and SolutionsThis section examines the complex range of work-based challenges influencing HIW supply once graduates enter the workplace.

Career StructureAs one delegate pointed out, for Clinical Coders and HIMs entering the profession, lack of clear professional development options either sideways or upwards can lead to disillusionment and attrition. HIMAA’s Workforce Working Group has identified at least 7 career avenues commonly pursued by HIMs entering the workforce.


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Entry level HIM ► Senior HIM ► HIS Manager ► Executive Manager

Entry level Clinical Coder ► Senior Coder ► Coding Manager / Educator / Auditor

Project Officer ► Project Manager ► Health Informatics Leadership

Data Analyst ► HIM Specialist ► Contractor / consultant

Data Manager ► Clinical trial Coordinator ► Clinical Research Associate

Entry level government Policy Officer ► Policy Adviser ► Senior Adviser ► Manager/Director

Lecturer ► Senior Lecturer ► Professor ► Head of School/Faculty

Table 1: Seven career avenues for entry-level HIM graduates

Such depiction of career path options should be possible for all HIW professions and occupations. Since the Summit, the HIW WG of AHMAC’s Health Workforce Principal Committee has developed draft career pathways for six such professions based on the HWA Health Information Workforce Report 2013 Recommendation 1 on the delineation of the HIW.While availability of such career paths prior to and during education and training may motivate student interest in professional options, active promotion of career structure to graduates on entry into their profession of choice will aid in-service recruitment and retention. What was clear to the HIMAA Workforce WG in developing its current depiction of the HIM workforce career was that the HIM role is evolving. Depicting the range of existing options will also predispose all professionals in the HIW to the specialisation and diversification that will lead to workforce configuration responsiveness in the rapidly developing eHealth environment. Configuration will be discussed more in Section 6.

International ExperienceHIMAA reported to the Summit on workforce measures undertaken overseas in the countries of fellow members of the International Federation of Health Information Management Associations (IFHIMA). One to which delegate attention was drawn was in Japan, where HIM certification was first introduced in 2005 by 5 associations including the Japan Society of Health Information Management and the Japan Hospital Association. Almost 30,000 HIMs have been certified nationally to date as a result. The Japan Hospital Association has been offering a 2 year distance education course in medical records management since 1972. They currently have records of over 45,600 graduates to date, which yields an almost comprehensive register of HIMs they continue to track either in or out of the hospital system. With the introduction of certification in 2005 the potential for workforce supply and configuration analysis is impressive. But it takes buy in from the employers, the Japan Hospital Association.On the strength of this example, HIMAA makes the following recommendations in this report:5.2.1 Peak HIW bodies to foster with a coalition of health facility executives a long term

strategy of credentialing health information management professionals and health informaticians as a requirement of employment as part of an achievable process for self-regulation in these professions. This could apply to all HIW professionals, as discussed under Registration in Section 5.1.

5.2.2 Peak HIW bodies to work in alliance with a health facility executives coalition to maintain an active database of credentialed HIW, which tracks their career history. This could link in with the census-based workforce research model proposed in section 4.

5.2.3 Feed data from this register into a national HIW monitoring and research program as recommended in Section 4 to support the ongoing development of HIW under a profession-led national capability framework


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Certified Health Informatician Australia (CHIA)Another workforce solution in the health informatics profession available to those either already working in the HIW or interested in entry to health informatics from a related occupation presented to the Summit was the CHIA. The Certified Health Informatician Australia is Australia’s first certification for health informatics/e-health. The certification was jointly developed and is now jointly governed by HIMAA, HISA and ACHI. It provides independent recognition of health informatics knowledge and skills. Launched in December 2013, it is part of a global movement to certify professionals in health informatics. CHIA was developed because the industry recognised that health informatics is fundamental to the delivery of healthcare. As such there is a need for highly skilled, knowledgeable & experienced individuals in order to successfully implement and maintain the wide range of e-health initiatives which are essential for delivering sustainable health reform in Australia.The CHIA is attained through examination. The CHIA examination covers six (6) competency areas with their fifty two (52) competencies, through a selection of 104 multiple choice questions, and takes two and half (2 ½) hours to complete.With employers and funders wanting to know their employees have the requisite skills, and professionals wanting to be able to distinguish themselves as individuals with health informatics credibility, this credential is one key piece in raising the awareness of the health informatics workforce.From the CHIA presentation to the Summit, three actions were inferred by Summit rapporteurs:5.2.4 Improve exposure of CHIA to relevant professionals, including an understanding of

personal and professional benefits.5.2.5 Provide more information to employers on benefits for the organisation in upskilling

employees to undertake certifications such as CHIA. 5.2.6 Increase promotion of CHIA to professionals who work in primary care

Victorian Clinical Coding FrameworkOf research or programs address HIW capability or supply presented to the Summit, those in clinical coding were the most prevalent. In addition to the AIHW 2010 research reported in Section 4, and the HIMAA Clinical Coding Education and Training program’s 24 year experience and the NSW Health Clinical Coding Workforce Enhancement Project detailed in Section 5.1, the Summit also heard from the Victorian Government Department of Health’s Health Information Workforce Framework activity between 2010 and 2015. The Victorian HIW Framework’s activity overwhelming focussed on clinical coding workforce development, identifying not only a shortage in the clinical coding workforce and a gap in education and training for non-HIM-trained clinical coders, but also a perception amongst employers that graduates of available clinical coding education and training were not ‘work ready’ upon presentation for employment8. Solutions explored included researching and developing a Clinical Coding Capability Framework, a work-readiness bridging course into clinical coding, Clinical Coding Educator training, and the development of a full qualification in clinical coding, a Certificate IV in Clinical Classification, which was accredited as a course with the Victorian Registration and Qualifications Authority in July 2014. The Department of Health has since funded local registered training organisations (RTOs) to partner with local health authorities to deliver the Certificate IV qualification.

8See GippsTAFE, Human Capital Alliance & Pavilion Health. The Clinical Coder Capability Framework, Victorian Department of Health, 2013, pp.7-8


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Solutions presented to the Summit as resulting from the first five years of the Victorian government’s Health Information Workforce Strategy are:

� Appropriate training is needed for Clinical Coders � Right level has been found – Certificate IV � Content has been developed – 6 new coding subjects in the 22274VIC Certificate IV in

Clinical Classification, and entry level competency guidelines � Consistency of curriculum is essential – content and assessment � Method for delivery of education and training – mix of new and old methods

� Recruitment – recruits need: � Realistic expectations and an understanding of the work they will undertake � Basic skills level – e.g. computer literacy, � Aptitude - attention to detail, independent worker, enquiring mind, etc. – has been found

a key to on-the-job training9

� Professional experience/ work readiness will always be an issue due to local requirements and procedures, so coder educator support is essential.

� Employer role – to provide: � Workplace placements for students, traineeships in Clinical Coding, mentoring for

students and trainees � Professional development for existing Clinical Coders eg in coder education, auditing

Between 2010 and 2014 an individual health information management team at Ballarat Health Services attempted its own version of traineeships with reported success10.Since the Summit, the WA Department of Health has released its own Clinical Coding Workforce Report11 which reflects many of the workforce concerns identified by the Victorian HIW Framework.

What Summit Delegates Said.

Role SubstitutionThe concern with industrial award structures highlighted as a barrier to recruitment was also a strong focus on both recruitment and retention disincentive for graduates entering or already in the workforce. A number of case studies offered by Summit attendeeshighlighted the negative impact on the HIW professions of jurisdictional awards that have been introduced and developed without reference to professional roles and responsibilities. In NSW, for instance, HIMs are moving from the old Health Records Manager award, which is specific to the HIM profession, to the Health Services Manager award because:

� Employers are decreasingly offering positions under the Health Records Manager award; � Remuneration and career advancement is more readily structured under the Health Services

Manager awardOne of the results of this award shift, however, is that the HIM occupation itself is becoming invisible. Employers decreasingly seek HIMAA-accredited qualifications for employees in what are clearly HIM or HIM-related roles, and roles for which HIMs are by education and experience the most likely occupational group to fulfil requirements to not, when advertised, prefer HIM applicants.

9 Catterson P, 2014,Transitioning newly qualified coders to work readiness; HIM-Interchange, 4(2):23-2510See Catterson P, 2014,Transitioning newly qualified coders to work readiness; HIM-Interchange, 4(2):23-2511Alloway K. 2015. Clinical Coding Workforce Report. Western Australian Government Department of Health.


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This “deprofessionalisation” of the HIM role by default of industrial award drift has two negative effects for the HIW:

� Role substitution actively sidelines HIMs as members of the health information management profession

� HIMs move out of the profession, dispirited by lack of recognition of professional value by employers.

At a time when the development of a capability framework for the HIW was seen by Summit delegates as a key to the management of HIW configuration in response to a rapidly developing eHealth environment, this default “deprofessionalisation” of the HIM role was seen as counterproductive as well as an adverse workforce outcome.Summit attendees emphasised strongly elsewhere in proceedings the need to build on existing professional competency standards if future configuration of HIW is to occur in a planned fashion, preferably to a developing workforce capability framework that is responsive to industry need.As one delegate phrased it, “HIM has evolved into a profession that is distinguished from other health managers. Research, quality, health insurance etc. are all involved in what our profession represents. But we still know who we are and have the ability to do better. IR awards are created on a state by state basis with local authority, but this needs to be with the involvement and endorsement of the profession.”Examples of HIM role substitution are available in Part Two of this report, particularly section 4.2.2.This concern with the contraction or attrition of needed occupational roles due to poor industrial curation of professions and occupations by employers was also strongly expressed by New Zealand delegates to the Summit. One delegate, an Australian HIM graduate, described an archetypal career pathway through almost the full gamut of HIM and HIM-related roles, including clinical coding manager, lead IT consultant over 400 projects such as codefinding automation, document automation, and second in command to the CIO. Yet she has never been recognised as a Health Information Manager. Employers insist on branding her as, at best, a Health Informatics Consultant.Another delegate told the summit: “In New Zealand our role in clinical coding is shrinking. Managers and leaders should be obligated to ensure the skills and knowledge requirements to ensure the profession is future proofed rather than defined.”This delegate called for a 2-5 year plan to build Clinical Coding and HIM proficiency and prevalence in the NZ HIW structure. NZ delegates called for inclusion of New Zealand HIW in future workforce symposium for HIW in Australia.Delegates also learnt of a unique intersection of national strategies in New Zealand, such as New Zealand’s Health Information Strategy, National Health Strategy and a Deloittes’ EHR Maturity Staircase, that were leading to positive strategic opportunities for HIW planning. ACHI Fellow Professor Karen Day of Auckland University informed delegates that there is an opportunity in New Zealand to achieve two important improvements to eHealth implementation nationally:

� The training of clinicians in health informatics � The central involvement of health information professionals in implementation.

As a result of discussions, Summit delegates suggested the following actions to result from the Summit:


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NEW ZEALAND5.2.7 In New Zealand, develop a rapid-implementation 2-5 year workforce development

framework to turnaround the decline of clinical coder numbers and contraction of coder role and responsibilities by addressing roles and responsibilities rather than academic definition.

5.2.8 At the same time, develop a recognition in NZ of the role of the HIM to assist the contribution of core HIM competency standards available in Australia that generate the adaptability of the HIM to workforce configuration demands within the auspice of a professional accreditation.

AUSTRALIA5.2.9 In Australia, the profession is to address with the states and territories industrial

awards issues to minimise “HIMs being drowned out” and to embrace workforce recognition of other HIW professions and occupations.

5.2.10 Government and employers to recognise that work-based capability development in HIW education and training is essential if workplace solutions to workforce development are to be feasible.

5.2.11 Increase awareness of the profession, and its range of already defined roles, with employers and industry.

5.2.12 In particular, increase the knowledge at a health executive level in all jurisdictions to ensure that they understand the importance of clinical coding, not only for ABF funding but also for predicting future health care requirements.

5.2.13 Rationalise standard ASO levelling across states to prevent stigma attached to the lower rates in some jurisdictions .

5.2.14 Increasing award structured pay rates for coding staff to reflect 2-3 years training required to become a clinical coder, rather than as currently the same as other admin staff who only require on the job training.

5.2.15 Resource scholarships for undertaking pre-employment coding courses for potential public sector staff so that we can increase qualified people, and offer them a traineeship at the end of their study so they can become further qualified eg. at intermediate and advanced levels of clinical coding.

5.2.16 Provide support to employers to be able to access HIM qualified staff from other geographical areas. Encourage, for example through a bursary, HIM graduates to undertake rural and remote posts.

5.2.17 Employer support for upskilling and to allow HIM staff to specialise and diversify to meet future workforce configuration needs.

5.2.18 Employers to require HIMAA-accredited qualifications and specify HIMs as preferred applicants for roles that are traditionally HIM roles, and specialisations into which HIMs are qualified to diversify as preferred candidates.

What Can the Professions Do? � The peak HIW bodies can support HIMAA in working with health facility executives to form

an HIW alliance pursue the national certification and workforce data tracking outcomes proposed in actions 5.2.1-5.2.3

� The profession, with its HIW peak bodies, can support CHIA through actions 5.2.4-5.2.6 � Through their peak HIW bodies, the profession can work to implement actions 5.2.9 to 5.2.16


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What Can Employers Do? � Support an approach from the peak HIW bodies to form a coalition of health facility

executives to support the credentialing of HIW professionals in order to achieve the workforce monitoring aims of actions 5.2.1-5.2.3, and address other recruitment and retention issues such as career structure and industrial conditions.

� This could link in with the capability framework referred to in Sections 3 & 4, the self-regulated registration system identified in Section 5.1 and the health executives coalition proposed by HIMAA in section 5.1

� Seek engagement with HIW education and training providers to develop work-based capability to support workforce graduate supply so that graduates meet employer expectations through educationally sound workplace exposure to them.

� Supporting traineeships with authorised training providers of the new Victorian Certificate IV in Clinical Classification is a ready example of such support.

� Supporting employees interested in undertaking the CHIA (actions 5.2.4 & 5.2.5) is another example.

� Fund and support professional career development for existing Clinical Coding workforce eg. through Intermediate and Advanced Clinical Coding courses to attain the career status of HIMAA Certified Clinical Coder.

� In Clinical Coding, employers should provide: � Workplace placements, traineeships, and mentoring for clinical coding students � Professional development in clinical coding training for existing Clinical Coders eg.

Coder Educator, Coding Auditor Educator � Actively promote career pathways for professions and occupations in their HIW to promote

retention and predispose HIW employees to the diversification and specialisation that will be necessarily to support a responsive HIW configuration during a rapidly developing eHealth environment (5.2.17).

� Support for upskilling to retain existing HIW professions in current roles, but also to specialise and diversify within accredited qualifications and credentialing frameworks to meet future workforce configuration needs. (5.2.17)

� Provide support as a group to the recruitment of appropriately qualified HIW staff from and to rural and remote areas, for instance through a bursary to HIW graduates to undertake rural and remote internships (5.2.16).

� Require HIMAA-accredited qualifications and specify HIMs as preferred applicants for roles that are traditionally HIM roles, and specialisations into which HIMs are qualified to diversify as preferred candidates, and require the same for CHIA and FACHI qualified applicants in HI roles. Avoid role substitution as a default response to workforce shortage (5.2.18).

� Embrace the consciousness-raising campaigns advanced by the HIW professions as a result of actions 5.2.9, 5.2.11, and 5.2.12.

What Can Governments Do? � In New Zealand, support the HIW profession in achieving actions 5.2.7 and 5.2.8 � In Australia, in collaboration with the peak HIW professional bodies as a whole, proactively

develop strategy and initiate policy development and funding resourcing to � increase awareness of existing HIW professions and roles as the capability basis of

future HIW configuration, rather than HIW growth through role drift and role substitution (5.2.9, 5.2.11, 5.2.18);

� support the development of work-based capability for HIW education and training in order to ensure that employer needs for work readiness can be met;

� support the rationalisation of industrial award structures across jurisdictions so that these support entry into identified HIW career structures, career development through


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standardised remuneration structures, and the equitable movement for HIW workforce between states without status or remuneration disadvantage (see Actions 5.2.11, 5.2.12, 5.2.13,5.2.14, 5.2.16, and 5.2.18); and

� support career diversification to meet the emerging HIW configuration needs in industry (5.2.17)

� Strategically support through policy and networking health facility executives in forming a national coalition to work with the peak HIW bodies to embrace and structure a credentialing program for HIW professions and occupations, through which ongoing configuration needs can be met and changes in existing configuration tracked.

� This could link in with the capability framework referred to in Sections 3 & 4, the self-regulated registration system identified in Section 5.1 and the health executives coalition proposed by HIMAA in section 5.1

6. HIW Configuration – Present and Future

A focus on HIW configuration in the second half of the 30 October HIW Summit in Sydney was structured to re-define the context for Recommendation 4 in the HWA HIW Report 2013. This recommendation confined the future configuration of the HIW to just one of the professions comprising it, health informatics. To redress this imbalance, the Summit presented evidence from the report itself on other occupations, such as Clinical Coder and Health Information Manager, from the health information management profession, that comprise the majority of the frontline HIW. It then explored existing diversification of HIM and HI professions upwards, into executive roles, and sideways into primary care, that already give some indication of the future direction of HIW configuration.This is in addition to the exploration of existing career structures presented by HIMAA’s Workforce WG in section 5.1 of this report, clinical coding workforce developments, and the CHIA program referred to in section 5.2.

An Inclusive HIWHIMAA presented to Summit delegates research from the HWA HIW Report 2013 which drew on the Australian Health Informatics Education Council (AHIEC) HIW framework of 201012 which identified three levels of HIW, Level 1 being the HIW frontline. The report identified 14 occupations from the Australia and New Zealand Standard Classification of Occupations (ANZSCO) that conformed to the AHIEC Level 1 workforce description. Of these, health information management professionals comprised 64% - 50% being Health Information Directors, Managers and Officers and 14% Clinical Coders (including Coding Educators). The remaining 36% was made up of data analysts, costing experts and health IT specialists13.By the time the report reaches future HIW configuration and Recommendation 4, four of these 5 occupations groups disappear and the fifth, the health IT specialist, becomes the health informatician. The HIW configuration of Recommendation 4, according to HIMAA analysis, consists of a clinician driven workforce supported by health informaticians.

12Health Workforce Australia.[2013] Health Information Workforce Report:13,Figure 213See Lawrance, R. (2014). Messages Home - A HIM perspective on the HWA’s Health Information Workforce Report: significant issues for our profession. HIM-Interchange 4(2):7, Table 2.


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HIMAA pointed to the system-wide importance of the health information management professions in HIW, inviting delegates to view a video by the Independent Hospitals Pricing Authority14 which indicates that the clinical information abstracted and coded by health information management professionals can lead, through the ABF cycle, not just to activity-based costing and pricing but also to improvements in clinical care.HIMAA recommended to the Summit:6.1 Promotion of the full view of health information management professionals as a key

component of the future configuration of the HIW workforce is needed now. HIMs and Clinical Coders are essential to any improvements in patient care based on the coded and costed data.

6.2 Collaboration amongst the broader HIW to develop appropriate advice to government that reflects strategic directions to support an appropriate HIW configuration now and for the future.

HIW Role in Primary and Community CareThe Summit heard from a number of HIMs already working in the primary care and community health sector. Traditionally HIW is thought of as servicing the tertiary sector of health care, based primarily in hospitals. If, however, eHealth is to achieve its potential in improving quality of care at the same time as containing burgeoning national health care costs, through the better integration of primary and hospital care sectors, the management of health information across these two sectors is essential.One HIM working with a major primary care software provider introduced Summit delegates to the key role played by health information management in enabling GP clients of the software provider to embrace the Personally Controlled Electronic Health Record (PCEHR, now My Health Record) so they could secure their government incentive payments for PCEHR adoption. This HIM observes the strength of her profession in this context thus:

“Sitting in the middle of healthcare we are unlike other health professionals. It is our business to understand the patient, the service, the data and how it all comes together (both patient-facing and back office). A technical data integration professional may understand the data but not the patient and the patient services that come together to give us all the unique and integral parts of the electronic patient health record. That is where this profession is so unique and we could and should be capitalising on this.”15

Another HIM, from Queensland, spoke of the value of HIMs in sub-acute hospital care, linking multiple electronic and paper-based record systems in community health care, and the value of professional networking in sharing and solving the challenges along this journey of adaptation and innovation16. A third HIM who was unable to attend the conference, but whose HIM Interchange article was provided to delegates as pre-reading, describes a similar example of the HIM’s value in bringing together disparate data systems in a major Melbourne primary and community care facility17.Such examples of health information management professionals moving outside traditional hospital-based roles into community and primary care are not uncommon. An academic HIM from the University of Sydney’s Family Medicine Research Centre (FMRC) illustrated the value an HIM would have to every general practice, combining the roles of scanning and practice management with information management. Staff rationalisations (at the moment the practice nurse often undertakes records scanning, which wastes a valuable skill set) and incentive payments alone would more than justify the human resourcing.

14https://www.youtube.com/watch?v=InTVzRggwJ415Quick L. 2015. The PCEHR is complicated! HIM-Interchange 5(2):21-2516Love R, Glynn H, Hart E. 2015. Managing public sector health information: hurdles in the community. HIM-Interchange 5(2):17-1817Crook M. 2015. 2015. Health information management in primary care settings. HIM-Interchange 5(2):6-10


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HIMs and Clinical Coding services in general practice would also serve another valuable purpose in the integration of care across the patient’s primary~tertiary journey of care. As a second academic HIM from the FRMC demonstrated to Summit delegates, for meaningful data to emerge from managed information to enable planning for care integration across the My Health Record between hospital and primary care sectors, classification is essential. Different classification systems, however, are used in each sector. In hospitals, the International Classification of Disease version 10 Australian Modification (ICD-10-AM) is ubiquitous. For primary care, the International Classification of Primary Care version 2 Plus is used in Australia, but currently not by GPs themselves. The FMRC’s BEACH general practice audit data is ICPC2 PLUS coded, and ICPC codes are used by the Royal Australian College of GPs to classify GP quality assurance recognition, but GPs themselves simply do not code their records. Hence the appeal to GPs of the medical language based SNOMED CT for My Health Record classification. For health planning at regional and population levels, however, classification will be essential. The sooner GPs embrace it, the sooner Primary Care Networks and Local or Regional Health Districts from the hospital sector will be able to adequately measure and plan for integration of care benefits. The mapping of ICD-10-AM and ICPC2 PLUS to SNOMED CT is a first step in this process. Readers will remember that an action inferred from the CHIA presentation in Section 5.2 was the promotion of CHIA to professionals who work in primary care. The full value of HIW to primary care merits extensive exploration.Summit rapporteurs inferred the following actions relating to the role of health information management professionals in primary care.6.3 Promote to General Practitioners through Primary Health Networks:

� the skills that HIMs can offer to Primary Health Care in bringing clinical classification and information integrity to practice information management

� the general practice management and medico legal skills HIMs can also bring to a practice position

� the income the practice will gain in currently missed PIP and CPIP payments, and save on scanning

6.4 Advocate to Primary Health Networks how well placed HIMs and Clinical Coders are to assist in the process of classification of health data to ensure it is meaningful for information integration, particularly with local hospital/health districts.

6.5 Use the skills of HIMs to support a semantic interoperability role for SNOMED CT between ICD-10-AM, ICPC-2, and other software systems.

6.6 Support the development HIM and Clinical Coder local networks to assist HIM professionals support each other in adapting to practice in community health and general practice.

6.7 Raise the profile of HIM professionals and their skill sets with peak community health bodies.

6.8 Provide advice and support to HIMs (in recruitment and existing HIMs) for opportunities in general practice and community health.

Actions 6.5 – 6.8 could equally apply to health informatics professionals.

What Summit Delegates Said.

Core Competencies vs Specialisation and DiversificationIn discussing the paucity of research in HIW available in Australia, Summit delegates became involved in a discussion of definitions and delineation of the HIW that continued, as a theme,


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across many small group discussions subsequently. A strong and early discussion in relation to the health information management profession was whether HIM curriculum should confine itself to core competence sets, or whether these competency sets should be allowed to support diversification and specialisation of student interest at the degree level. There strong affirmation from some delegates of the importance of clinical coding as a core HIM skills set, with a number of senior HIMs in a diversity of HIM settings (including health informatics and primary care) declaring that education and experience in clinical coding had informed much of their subsequent professional development, even if not used in direct application.The separating out of education and training for Clinical Coders and HIMs from the beginning of the 1990s, with the development of separate competency standards for the two occupations by HIMAA, has exacerbated an ideological tension in curricular continuity between the two occupations.Four core HIM competency streams were put to Summit delegates:

� Management � Health Informatics � Health data analysis (which includes research methodologies and all related activities) � Health classification (which includes all of the clinical subjects which underpin the ability

to code (eg. anatomy and physiology, pathophysiology, medical terminology and coding/classification subjects)

Advocates for the construction of degree level education around core competencies alone stated that specialisation and diversification were the preserve of postgraduate education and work-based experience – more of a professional credentialing career concern. Proponents for the inclusion of specialisation and diversification options in HIM curriculum were not denying the centrality of core HIM competency sets, and their value to the essential advantages in professional flexibility and adaptability their graduates bring to HIW. The interest was more in introducing specialisation and diversification options at the degree level to ensure flexibility and responsiveness in curriculum to a rapidly changing environment of HIW configuration demands.This discourse was clearly germane to the issue of HIW configuration facing the summit and the HIW professions in a rapidly developing eHealth environment: the need for professions to maintain core value-creating competencies that characterise the profession, but at the same time to be responsive to the demands of changing industry configuration of the workforce. Understandably, the discourse was opened up rather than resolved at the Summit.It led, however, to a number of actions suggested by small group discussions.6.9 Seek strategic and policy support and resourcing to develop a meaningful

mechanism between federal and state/territory jurisdictions to foster the responsiveness of providers of HIW education and training to meet HIW needs now and into the future configuration of HIW with an equitable distribution of supply across jurisdictions.

Vision, Leadership and Value PropositionA lively small group discussion on health informatics (HI) provided an interesting counterweight to the HIM competency standards discourse. The emphasis in this group was on the complementary nature of HI and HIM as distinct professional groupings in the HIW, and the need therefore to clarify the respective roles of HI and HIM professions in order to be able to communicate to industry and government the value of both separately, as well as the complementarity of both together as the two primary components of HIW as a whole.This group looked to the influence on future HIW the professions of HI and HIW could begin to collaborate on now. The group recommended the following actions:


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6.10 Clarify the roles of Health Informatics and Health Information Management6.11 Collaborate and Communicate – demonstrating the value of HI & HIM6.12 Integrate HI & HIM into Clinical Education and Training6.13 Integrate HIs & HIMs into the multi-disciplinary healthcare teamsIt should be noted in relation to 6.10 that HISA, ACHI and HIMAA have commenced work on the definitional differentiation of HI and HIM as part of their collaboration in joint program and academic governance for the CHIA. The ‘shared understanding’ of HIW developed by the HIW WG of the Health Workforce Principal Committee of AHMAC, circulated to the peak HIW bodies after the Summit, also works for clarity in delineating the 6 key professional groupings that make up the frontline HIW

� Health Information Manager � Clinical Coder � Data Analyst � Data Manager � Costing Specialist � Health Informatician

Three presentations to the Summit, one by a senior HIM and two by senior HIs, led to the rapporteur inference of the addition of leadership to the complementarity of HIM and HI roles. 6.14 Promote continuing education for HIMs to take up leadership roles. This may

be in the form of credentials (CHIA, CHIM, CHIP, CCC), Continuing Professional Development workshops and conferences, or Masters courses.

A small group discussion on the future of the Health Information Services (HIS) unit added to the delineation of roles the delineation of value propositions with the following suggested action:6.15 Research the value proposition to create points of difference for the HIM

profession.** HIMAA notes that it has already completed substantial work on its value propositions to various stakeholder segments.Another small group discussion, on the future of HIW configuration, added to the value proposition the need for an HIW vision, as referred to in Section 3. As one delegate in this group phrased it: “We need a vision for the future HIM profession and evidence of the value proposition”. The group suggested the following actions: 6.16 Research to support the value proposition i.e. superiority of quality outcomes from

employment of profession-qualified HIW. 6.17 Selling the value of the profession by raising its profile with Government, Corporate,

University, Unions, Employer and Health Care System stakeholders6.18 Transition strategies from technologist to strategist, information management to

information specialist, data analyst to data change agent, management of staff to management of content – establish professional alliances and framework to facilitate transition

This group saw a clear line of development for the HIM profession towards the roles of “Data Scientist” or “Data Change Agents” in the future configuration of the HIW. They depicted a radical transition of core HIM competencies as follows:


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Existing Core Competencies New Directions

Classification (Coding) Ontology

Management Data Science

Financial Management Modelling (big data)

Research Method Management/Professional agility

Information Management Governance (IM)

Knowledge Management Semantic Interoperability (Data/Management Perspective) Communications

Health Science

EVOLUTION FROM:

Health Information Manager ► Health Data Scientist

Technologist ► Strategist

Manager of Staff ► Manager of Content

Health Data a Requirement ► Health Data an Asset

The small group discussion on the future of the HIS was less radical in the change it envisioned for the HIM profession. Group members felt there would still be paper-based health information management, but the dominant management mode would be electronic. However the skill set needed to manage this future does not yet exist and there will be a need to buy in skill sets if HIMs do not develop them. There will also be an increase in the Health Informatics workforce as we move to an Information Management organisation. This will require more involvement with IT, management and clinicians and more focus on data governance, audits and reviews. At the same time there will be a need to move away from in-house to cloud based services with decreased costs. Technical IT skills in-house will then be less important. HIMs will need to become part of a multi-disciplinary team implementing eHealth.The demand will be for a higher skilled workforce, with less lower skilled and HIMs with health informatics skills in demand. New graduates may want to change the career pathway with many not opting for traditional roles. Non-HIMs managing HISs may increase as others can manage staff. The skill set of a HIM needs to be broader than just staff management as these roles and the need to manage clerical staff will decrease.Coding will focus more on editing, data verifying and quality checking role, predominantly based on digital data and potentially automated components. Future areas of work demand include the MHR, eHealth and data analysis, including managing and gaining insights from big data. HIW should also be considering the Asian market as part of its space.Like many other discussions at the Summit, this group saw industrial issues and the need for certification/registration and credentialing through professional development as keys to the transition of the HIW professions into future workforce configuration.


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The group’s recommended actions were about preparing the professional for transition:

6.19 Prepare the health information management professional for: � Coding from home � Coder focus on digital data - editing, integrity, quality � Managing the hybrid scanned/digital record � Integrated care with external providers eg GPs � Move from In-house to Cloud-based IT support � The IM rather than IT organisation � Increased Health Informatics demand on HIMs � MHR, eHealth, data analysis, big data, and the Asian market

6.20 HIM education and training in semantic interoperability, information security, data analytics and analysis.

What Can The Profession Do? � Advocate to the HIW WG of the Health Workforce Principal Committee of COAG’s AHMAC

the review and rewriting of Recommendation 4 of the HWA HIW Report 2013 to include all of the health information professions/occupations identified as frontline in its ‘shared understanding’ of the HIW in response to Recommendation 1.

� Promote HIW to primary health care, particularly in General Practice and Primary Care Networks , as per actions 6.3 to 6.8

� Work with the HIM peak professional body, HIMAA, to implement actions 6.9 to 6.13 in relation to HIM curriculum and competency standards

� Support the HI and HIM peak professional bodies in clarifying their inter-relationship as primary HIW professions, as per Actions 6.14 to 6.17

� With the support of their peak HIW professional bodies, research and advocate the differential as well as joint value proposition for the HIW professions in complement as well as a whole (Actions 6.18 – 6.21)

� Support their professional peak HIW bodies in developing strategies for transition to future HIW configuration in consultation with Employers and Governments (Actions 6.22 to 6.24).

What Can Employers Do? � Collaborate with the peak HIW professional bodies to ensure that all HIW professions are

involved in determining, with industry, the future configuration of HIW (Actions 6.1& 6.2) � Employers in primary and community care can familiarise themselves with the respective

and complementary competencies offered by HIM and HI in order to incorporate these two professions into their health information workforce configuration so that, through clinical classification, their capability in regional and population health planning with Primary Care Networks will be optimised, and ensure informational interoperability between general practice health information and health information in the hospital sector (Actions 6.3 to 6.8)

� Support the promotion of and structural support for different HIW professions for their full differential value now, and through transition into future HIW configuration (Actions 6.12, 6.13, 6.14 to 6.18, 6.21 and 6.22).

What Can Governments Do? � Through the HIW WG of the Health Workforce Principal Committee of COAG’s AHMAC,

ensure that Recommendation 4 of the HWA HIW Report 2013 is not further considered for implementation without a radical review and rewrite to include all of the health information


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professions/occupations identified as frontline in its ‘shared understanding’ of the HIW in response to Recommendation 1.

� The Australian Government’s Department of Health to immediately develop strategy and policy, and with the peak professional HIW bodies, developing business modelling to support Primary and Community Care in embracing HIW in order to develop a health information workforce configuration to optimise, through clinical classification, their capability in regional and population health planning with Primary Care Networks and Local Health Districts, and to ensure informational interoperability between general practice health information and health information in the hospital sector (Actions 6.3 to 6.8)

� Through the HIW WG, support the continued clarification of the roles of HI, HIM and other professions on the HIW frontline (Action 6.14)

� Work with the peak HIW professional bodies to communicate the differential and complementary roles of the frontline HIW professions, as well as their value as a whole, to employers and industry (Action 6.15)

� Seek strategic and policy support and resourcing to develop a meaningful mechanism between federal and state/territory jurisdictions to foster the responsiveness of providers of HIW education and training to meet HIW needs now and into the future configuration of HIW with an equitable distribution of supply across jurisdictions (Actions 6.9-6.11, 6.13, 6.16, 6.18, 6.22, 6.23 and 6.24.)

7. Planning For HIW Action

This report has not developed the substantive plan of action to improve HIW shortage and build a specific configuration of HIW in the future. It has, however, established:

� The need to develop now a data gathering and monitoring program for HIW to enable informed response to a quantified HIW shortage and build a mechanism for future workforce configuration based on structured collaboration between employers (industry), the HIW professions (peak bodies) and governments;

� A number of features to underpin HIW recruitment and retention: � A self-regulated registration and credentialing system for HIW, with employer mandating of

accredited/approved HIW qualifications for employment; � A profession-led capability framework for HIW, to enable HIW recruitment and retention to

an HIW Development Capability Framework; � A combination of recruitment scholarships, traineeships and incentives; � Career pathways for HIW that indicate diversification and specialisation already achievable; � Trans-jurisdictional alignment and re-naming of industrial awards to ensure reliable and

identifiable career pathways for employees that incorporate professional development for future workforce configuration, rather than workforce dissipation and role substitution;

� Core profession-led competency standards on the basis of which diversification and specialisation can occur to supply future HIW configuration needs, in consultation with curriculum providers.

The HIW professions clearly see a role for themselves in planning for this future. But government and employers should also perceive, from this document, the benefits of actively engaging with the planning process. This report does not propose the creation of new pillars, agencies or NGOs, nor nominate new sources of funding nor name amounts. Such instruments are the result of planning. This report indicates where the planning could start, and start now as a matter of urgency.

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HIW Summit Report Part Two – Themed Proceedings and Discussion

Health Information Workforce Summit ReportPART TWO: Themed Proceedings and Discussion


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1. Introduction

Welcome to Part Two of the Health Information Workforce (HIW) Summit Report. The aim of this section of the HIW Summit Report is to detail the proceedings of the Summit more closely to the chronological delivery of the Summit, so that interested readers can mine further into the information presented to Summit delegates, and into the actual discussions facilitated between delegates which led to delegate suggested actions. An important exception to the chronological detailing of proceedings is the capture of delegate discussion. This has been analysed and divided up according to the themes by which the Summit program was structured, and allocated to these themes as they occur in the proceedings. We hope that by placing delegate discussion in the context of the presentation groupings to which it relates thematically, the actions suggested by delegates will become clearer. The Introduction to Part One of the HIW Summit Report details the objectives of the Summit and demography of attendees, so we do not intend to repeat that detail here. We will instead provide more insight into the structuring of the Summit itself that leads to the capture of these proceedings.

PartnersWhile HIMAA had assumed a lead agency role in organising the Summit, HIMAA was pleased to be joined by fellow peak organisations ACHI and HISA. HISA CEO Dr Louise Schaper told delegates that it was an honour to be invited to contribute to the Summit. She said that HIMs have an advantage over the workforce of health informaticians in that they are a recognised profession. Health Informaticians have very similar issues to HIMs, as very little research has been done about their workforce needs, even though at anecdotal level there is much need for this. So if the professions of Health Informatics and Health Information Management continue to work strongly together hopefully with a combined voice we can make some changes.ACHI President, Adjunct Associate Professor Klaus Veil identified one of the challenges for health information workforce is to be seen as part of essential health infrastructure. In reality, Adj Assoc Prof Veil told delegates, “We provide better, more timely data, on the right person at the right place to the right clinicians so that they can provide better healthcare to all Australian

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people. We have a good system in Australia but there’s always room for improvement. And that should be the common denominator for the Summit.”

Program The Summit was structured as a series of short presentations to lay out the landscape of workforce issues to inform Summit discussion of issues and challenges, and solutions and actions to address these. The Summit program, designed by the Workforce Working Group of the HIMAA Board, divided the day into two sessions: a morning session focussing on workforce shortage and an afternoon session on workforce configuration. An open forum allowed delegate discussion to conclude the morning session, and six small group discussions provided concentrated opportunities for delegate contribution in the afternoon.Delegates were also informed both during and after the Summit of an opportunity for ‘post-Summit’ contribution via online submission form. This input is identified as SUBSEQUENT INPUT in the body of this report. The Summit’s purpose was not to make decisions about actions or recommendations but rather to generate the discourse from which a plan of action could be developed. Six rapporteurs volunteered to capture Summit proceedings in order to assist in the development of that plan.Topics covered by the Summit, which aimed to address shortcomings of Recommendations 2, 4, 5 & 6 of the Health Workforce Australia Health Information Workforce Report of 2013, ranged from:

� the absence of current accurate and substantive data on a nevertheless acutely felt workforce shortage, through

� challenges of workforce supply encountered by the universities and HIMAA, � consequences of workforce shortage such as role substitution, and � recent solutions in clinical coding and the Certified Health Informatician Australia program, to � the diversification and specialisation already indicating future directions in HIW configuration

from an HIM perspective, such as the move into community and primary care. Discussion in the open forum to complete the morning session on workforce shortage focussed on:

� the need for a live and ongoing HIW data gathering and monitoring capability in conjunction with industry,

� the importance of core Health Information Management (HIM) competencies in building support for specialisation and diversification,

� the value of an overall capability framework for both HIM and HI professions, and � the need for an overarching HIW body to present the unified voice for the various peak

bodies such as those present. The forum was scribed on flipcharts and content captured by four rapporteurs.Small group discussions, based on afternoon HIW configuration presentations, covered separate topics such as the organisational future of the traditional HIS unit, career pathways upwards and sideways, recruitment, the potential of the health information management profession in future HIW configuration, workforce data gathering and monitoring, and health informatics. The discussions were scribed by their facilitator and content captured by a rapporteur. A copy of the Summit program is appended (APPENDIX 1).

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In concluding the Summit, Facilitator and HIMAA CEO Richard Lawrance cited John Kotter’s eight steps to influencing change18, and asked interested delegates to sign an exit register if they felt the Summit had established the first of these steps: a ‘sense of urgency’, and were interested in being part of the second step: ‘forming a guiding coalition’. Just over a quarter of delegates (29%) volunteered that a sense of urgency had been created, and 22% were interested in being part of a guiding coalition. A total of 34% of delegates responded to the exit register.

Managing Summit Information CaptureSix (6) Subsequent Input Forms were received in the prescribed period after the Summit (9 November 2015), along with one pre-Summit contribution. Rapporteurs were asked to submit their Summit content capture in an agreed reporting format within this same timeframe (9 November 2015). Permission from presenters to publish their PowerPoint presentations was obtained and these were posted on the HIMAA website. After the Summit the flipchart sheets were transcribed into Word. The rapporteurs’ reports were compiled according to the Summit’s program structure and flipchart notes added where relevant. Subsequent Input was appended to this document. An initial pass of the compilation was made in order to integrate rapporteurs’ reports to reflect program flow and emerging themes from discussions. From this integration resource, the following themes were consolidated from both program structure and proceedings:

� HWA HIW Report 2013 Context � Workforce Data on Shortage and Configuration � HIW Supply Challenges

� Education & Training � Work-based

� HIW Supply Solutions � HIW Configuration – Present and Future � Unified Voice – The Action Imperative

These are the themes that form the structure for the assembly of this second part of the report, Themed Proceedings and Discussion, from the various sources of information capture. A glossary is appended for reader convenience in APPENDIX 2.Small Group Discussions held at the Summit are referred to in section headings by the acronym SGD.

18http://www.kotterinternational.com/the-8-step-process-for-leading-change/; Kotter JP.Leading Change. Boston, Harvard Business School Press, Boston, 1996.

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2. The HIMAA ACHI HISA Health Information Workforce Context

In this section, three presentations from the Summit proceedings set the context for Part Two of the Summit Report. These are: HIMAA’s Workforce Strategy (Priority Directions); HIMAA’s concerns with the HWA HIW Report 2013 that prompted the Summit; and the presentation made to the Summit by the Chair of the Health Information Workforce Working Group of AHMAC’s Health Workforce Principal Committee, Dean Raven, on progress with the HWA HIW Report 2013 from a federal government perspective.

2.1 HIMAA Workforce Strategy

Julie Brophy, HIMAA Workforce Working Group ChairThe Health Information Management Association of Australia, in response to the emergence of Workforce as an overarching theme during membership consultation for its 2014-16 Strategic Plan, formed a Workforce Working Group of the HIMAA Board to oversee strategic action on this issue across the strategic priorities of the resulting plan. The working group has drafted a strategy that identifies some Priority Directions for HIMAA, which have been approved by the HIMAA Board as a work in progress. It is expected that the outcomes of this Summit will further influence these priorities. Victorian HIM and Chair of the Workforce Working Group, Julie Brophy introduced these Priority Directions to the Summit.

Workforce Definitions – One of the key priorities for the working group and HIMAA is understanding the profession. This involves defining the workforce, their skills and capabilities, as a basis for engagement with stakeholders, promoting professional identification and recognition, marketing to attract the future workforce, and developing educational pathways. As a result HIMAA revised its definition of the profession in February 2015 to use Health Information Manager and Clinical Coder as two examples of occupations making up the profession. These occupational definitions were based on existing ANZSCO definitions for the sake of consistency. The definition document is available on the website at http://himaa2.org.au/index.php?q=node/2438.

Principles of Professional Practice were developed to replace an aging Code of Ethics, also approved by the HIMAA Board in February 2015 and available on the same web page as the definition. From these principles HIMAA’s Practice Quality & Safety Standards Committee prepared more extensive Professional Practice Guidelines, which were launched at the Association’s 50th Annual General Meeting on 29 October 2015. The aim of these guidelines is to underpin standards of practice for the profession.

Other standards-based documents published on the HIMAA web site are Entry Level HIM Competency Standards, and draft Intermediate and Advanced Competency Standards developed by HIMAA’s Education Committee. These can be found respectively at http://himaa2.org.au/sites/default/files/HIMAA_HIM_Entry_Level_Competencies_Version_2_January_2013_0.pdfand http://himaa2.org.au/sites/default/files/HIM_Competencies_Version_3_0_Consultation_Draft_October_2014.pdf.

Workforce Data – Measuring and assessing the existing workforce will provide a basis for understanding the sector we represent and developing evidence-based action to support a sustainable future workforce. HIMAA seeks to identify more sources of factual evidence on the profession.


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Value Proposition – Articulating the roles workforce can undertake and the value these offer the sector will facilitate engagement and marketing with stakeholders, including the promotion of the profession, attraction of educational providers and expansion of roles to strengthen the profession in the sector. A first step has been the development of a value proposition document, a copy of which is also on the HIMAA web site (http://himaa2.org.au/index.php?q=node/2439).Issues and Challenges - Identifying existing and emerging challenges will enable the profession to be proactive rather than reactive. We all come with our own perspectives, but HIMAA really needs to understand what the issues are out in the workforce; what are the main problems and opportunities. It is expected that the HIW Summit will add valuable insight into such understanding.

Standards and Qualifications – Adoption by members of agreed standards and qualifications that underpin credentialing will provide certainty to employers on skill levels, promote credibility in the profession, provide an articulated career pathway and support industrial advocacy. HIMAA already has a professional credentialing scheme based on recognition of continuing professional development activity of evidence-based educational and quality improvement rigor. A question raised by members during HIMAA’s 2013 membership consultation was whether, in addition to certification, HIMAA should embrace professional registration.

Professional Advocacy –The HIMAA Value Proposition is a starting point to inform engagement with stakeholders, but it’s what follows engagement that’s important:

� Employers – to promote an understanding of the profession; its skills, capabilities and the value proposition they can provide to the multiple employers including the health, research, government and education sectors.

� Educators - to build strong relationships between educational providers and HIMAA to ensure future training produces the skills mix required of the sector.

� Unions – to ensure support for the sector in industrial negotiations that is aligned to and recognises the professional standards and strategic directions of HIMAA as the profession’s association.

� Other professional bodies – alignment of synergies with other relevant professional bodies such as HISA and ACHI to capitalise on opportunities.

Sustainability and Relevance – HIMAA needs to ensure that education and training is relevant to sector needs. As a profession we need to be engaging with HIM educational institutes and stakeholders that are represented at the Summit, in order to make sure there are recognised training pathways, such as VET qualifications, tertiary qualifications, as well as other professional development activities - conferences, mentoring, communities of practice, that are going to assist with future workforce development.

Initial ActionsAmongst initial actions the Workforce WG has undertaken include exploration of the evidence base for HIW, and examination of career pathways for the health information management profession. This has included:

Literature search – including previous reports by Health Workforce Australia and the Australian Institute of Health and Welfare, which will be explored extensively in the Summit.

International perspectives – a strong international contingent from the International Federation of HIM Associations presented Workforce perspectives from around the world at the recent HIMAA national conference. HIMAA also has an active International HIM Special Interest Group, and reports by members from HIM and related conferences around the world appear in the Association’s HIM-Interchange practice-based journal. The Workforce Working Group also has a US-based member.

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Data – a HIMAA Workforce Survey of its membership in December 2014 is reported to this Summit by HIMAA President Elect, Jenny Gilder (see section 3.1 below).

Member Feedback - HIMAA network, this HIW Summit

Engagement with stakeholder’s i.e. educational providers, employers, fellow professional organisations, government.

Career Pathways – seek to articulate career path options for health information management professionals through the documentation of career pathway options for the Health Information Manager, based on a mind-mapping exercise. See Section 4.2.1 of this report below for more on this initiative.

HIMAA’s Workforce Working Group is also monitoring initiatives to provide career pathway development for new graduates.

2.2 HWA HIW Report 2013 ContextAt the outset both of the Summit and in its initial media releases about and invitations to the Summit, HIMAA was clear that the need for a summit at this time was threefold:

� The HWA Health Information Workforce Report of 2013 acknowledged preceding research that established a workforce shortage in the health information occupations and professions, and accepted this as a given in formulating its content and recommendations.

� HIMAA was dissatisfied with four of the six recommendations of the report – Recommendations 2, 4, 5 & 6. In particular, concern was with the disappearance of the health information management profession from Recommendations 4 and 6 despite a strong showing early on in the report as a frontline HIW profession.

� Indicative research by HIMAA in December 2014 suggested that not only was workforce shortage not improving, but that both workforce shortage and workforce configuration were deteriorating dramatically.

HIMAA’s analysis of available HIW research indicated that the coalition of institutions suggested in Recommendation 2 was unlikely to produce the needed data. Its December 2014 membership research (see section 3.1 below) indicated that Recommendations 4, 5 and 6 required urgent attention. HIMAA was aware that, with the demise of Health Workforce Australia, federal responsibility for consideration of the HWA HIW Report passed to the Health Workforce Principal Committee (HWPC) of the Australian Health Ministers’ Advisory Council of COAG. In preparing for the HIW Summit, HIMAA approached this Committee for an update on progress. In response, the Chair of the Health Information Workforce Working Group (HIWWG) created by the HWPC to consider the HIW Report 2013, Dean Raven, agreed to address the Summit. His presentation established that the HIWWG was considering Recommendations 1 & 2 in the first instance, and that Recommendations 4-6 were further down their timeline.

This news created a window of opportunity for the three peak organisations presenting the Summit – HIMAA, HISA and ACHI – as well as the rest of the delegates attending, because it became clear that there was time to prepare a well formulated submission to the HIWWG on Recommendations 4-6, which were the main foci of the Summit.

Rapporteur capture of Dean Raven’s presentation is summarised here.

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2.2.1 Health Information Workforce Working Group

Dean Raven, Director Health Workforce, Victorian DHS & Chair HIWWGDean Raven acts as Chair of the Health Information Workforce Working Group (HIWWG). He represents Victoria on the Health Workforce Principal Committee (HWPC) of the Australian Health Minister’s Advisory Council (AHMAC), which is chaired by the Secretary of DHHS and includes representatives from all other jurisdictions including Commonwealth Department of Health. The HWPC is one of six principal committees which manage the business of AHMAC and provide advice.The HWPC agreed in 2014 that it would create a cross jurisdictional working group – the HIW Working Group – to review the recommendations of the 2013 Health Workforce Australia Health Information Workforce Report and provide feedback to HWPC on the actions that warrant a national approach. The HIWWG also reviewed proposals from HIMAA and HISA that were provided to HWPC in response to the issues and recommendations raised in the HWA report.The Working Group provided a response to HWPC that was endorsed in May 2015. In reviewing the HWA recommendations, the working group used the following criteria:

� Applicability - the applicability and feasibility for national action on the proposed recommendation;

� Support – if the recommendation was supported, not supported or should be modified; � Priority - the relative prioritisation (high, moderate, low) of supported recommendations; � Response – recommended relevant national response; � Actions – initially only covering unfunded initiatives that could addressed through

jurisdictional collaboration � Resources – the contribution from jurisdictions required to deliver recommended responses.

HWA provided recommendations across six broad areas. The first recommended delineating the workforce - the Working Group considered that rather than delineate roles, which could prohibit future changes, we needed to gain a shared understanding of the workforce, and that this is the first priority of work as it provides a basis for all other work. There is currently no fully agreed definition of the HIW (although HIMAA have contributed greatly with a definition of HIMs and Clinical Coders), including the roles that fit under this broad definition; the skills required of various roles; and the training required to ensure staff can perform optimally in such roles. Unless the HIW can be defined, it cannot be classified, counted, evaluated and improved. Current workforce classifications provide a limited description of the HIW, with only Clinical Coders and Health Information Managers recognised in ANZSCO, and no source of information to describe the broader HIW. This limits the ability to describe and plan for the future HIW, promote educational pathways and attract people to the profession. Confirming national definitions will enable jurisdictions to articulate the skills and capabilities, and provide examples of roles and functions, health services should be considering, allowing them to understand the possibilities these roles can provide. Substantial duplication of effort and variation in outcomes would occur if jurisdictions addressed this issue separately, serving only further to confuse the profile of this workforce and hinder efforts to address shortages. A number of jurisdictions have already done valuable work in this area, and therefore a collaborative approach where jurisdictions share this information is to be undertaken in the first instance. The outcomes of this work would be a document that provides a clear understanding of the HIW as it currently exists in Australia, including the types of roles and job titles and the skills

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required that can promote a common understanding and provide a basis for future workforce classification, data collection, career pathway development, training and professional development. Further work is also required to identify relevant classifications, their use, the process for change and the implications for this workforce so that informed decisions can be made on recommended changes.

Recommendation 2: Workforce DataBuilding on the shared definition of the HIW, it will then be feasible to review and consider how to improve data collection recommended in the second HWA recommendation. Since publication of the HIW Report the health and education sectors have responded to immediate needs with a variety of responses that will have changed the training and supply pathways for some HIW roles. This includes initiatives such as the recommencement of HIM university training for HIMs in QLD and NSW, and significant investment in coding workforce development in NSW. The impact of these changes may not be sufficient but needs to be assessed before it can be confirmed that shortfalls still exist. It is recognised however that issues of distribution of this workforce still exist, for example in rural areas and smaller jurisdictions. There would be benefit in initially identifying recent initiatives, sharing lessons and findings and potentially extending effective responses nationally. Future national initiatives may be required, but should build on jurisdictional work and target only areas where a national response is required.

Recommendation 3The HWA report recommends the creation of a single body that represents and advocates for all HIW stakeholders. The HIW Working Group recognised that there are existing professional bodies, as represented at the Summit, that have already formed collaborative arrangements to support this workforce. Creation of a new single body is therefore not necessary, however there is benefit from establishing inter-organisation collaboration to share findings, steer future national work and gain broader stakeholder input. The Working Group also recognise that there are also several government bodies that have an interest in supporting and developing the HIW including the National Health Information and Performance Principal Committee (NHIPPC) and – until its shut-down in 2016 - the National eHealth Transition Authority (NeHTA). The recently announced Australia Digital Health Agency (ADHA) is also expected to have a major interest in the HIW.. The sector would benefit from ensuring that the work of these bodies is aligned on HIW issues and that each is contributing in the most appropriate manner.As the roles and functions of the current health informatics workforce is not clearly understood, nor the training needs identified, the Working Group considered it would be premature to suggest any immediate initiatives in this area. Future initiatives in this space may be more appropriately guided at the jurisdictional level to address their specific needs however it should not be discounted that changing needs may become evident that may require a national approach as information demands and technology changes impact further on the sector. The Working Group has commenced developing an Issues Register to help them consider and respond if applicable to this changing landscape.

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Recommendations 5&6 Career PromotionRaising the profile of the HIW requires multiple levers.

A starting point to assist with promotion of health information careers is to define the workforce, then have it recognised in national classifications, allowing appropriate counting of the workforce and the ability to plan and train to support future demand for this workforce.

There is also need to consider integration of training in health informatics and health information management into existing clinical training to develop awareness and skills in all future clinicians to enable them to leverage the benefits of, and contribute to, the future effective use of ICT and IM in health. Work has been undertaken by the Commonwealth Department of Education’s Office for Learning and Teaching which should be used to guide future national initiatives in this area. There is a need to start a dialogue with educational providers and governance bodies on the inclusion of health informatics and health information management in clinical training which the Working Group recommended HWPC plan a role in.It should be noted too that given the lack of a shared understanding of the HIW the Working Group considered it was premature to accept the proposals by HIMAA and HISA.The Working Group however welcomes the initiative of HIMAA in facilitating this Summit and hopes that the findings can contribute to this national work. The also look forward to working more closely with HIMAA, HISA and ACHI to progress this work.

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3. Workforce Data on Shortage and Configuration

This section summarises presentations to the Summit on the availability and reliability of workforce data on the health information management profession by HIMAA, the AIHW 2010 report on clinical coding workforce, Open Forum discussion on the need for workforce data gathering and monitoring during the Summit, and a Small Group Discussion (SGD) on workforce data gathering and monitoring – one of 6 SGDs held towards the close of the afternoon Summit session on workforce configuration.

3.1 Health Information Workforce – The Need for DataJennifer Gilder, HIMAA National President

ISSUEHIMAA has previously reported concern with Recommendations 2, 5 & 6 of Health Workforce Australia’s (HWA) Health Information Workforce (HIW) Report 2013.19 The Health Workforce Australia Health Information Workforce Report of 2013 does not contain any current workforce data, instead reporting previous research now dating more than five years old. The report accepts the workforce shortage demonstrated by previous research and makes the following recommendations out of the six in all:

Recommendation 2 – Improve data collection – in consultation with and through the Australian Bureau of Statistics (ABS), Australian Workforce and Productivity Agency, the Department of Immigration and Border Protection, Department of Health, and the Australian Institute of Health and Welfare (AIHW).

Recommendation 5 – Address known health information workforce shortfalls – increase the national supply of clinical coders and health information managers by:

� For coders, adding workplace-based training to existing vocational education and training (VET) level coursework and improve remuneration;

� For health information managers, by addressing degree enrolments and improving the appeal of the profession

Recommendation 6 – Promote health information training and careers - Raise the profile and status of the health informatics discipline and develop the three different types of education in health informatics identified in the report.

Recommendations 5 and 6 are clearly delineated between workforce supply initiatives for the health information management (HIM) profession in Recommendation 5 and career promotions for the health informatics (HI) profession in recommendation 6. But both recommendations have similar implications for both HIM and HI Professions. In Recommendation 5 it is also unclear just how ‘known’ existing workforce shortfalls are. The Australian Health Informatics Education Council in 2010 developed the following workforce framework20:

y Level 1: Workers who self-identify as part of the health information workforce and work full-time with health information systems.

19Lawrance R. Messages Home - A HIM perspective on the HWA’s Health Information Workforce Report: significant issues for our profession; HIM Interchange, 2014, 4(2):6-9.20In Health Workforce Australia.[2013] Health Information Workforce Report, Adelaide:13 (Figure 2)

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y Level 2: Healthcare professionals and administrators/managers who develop or help develop health information systems and use health information systems heavily in their work.

y Level 3: All healthcare professionals who must be able to properly input data to and extract information from health information systems.

The HWA HIW Report identified 5 key Level 1 roles from 14 ANZSCO occupations operating in the level. The two main health information management occupations recognised by the Australian & New Zealand Standard Classification of Occupations (ANSCO), Health Information Manager (HIM) and Clinical Coder, easily occupy the majority position of about 64% compared to the other three occupations. And of these at least one, Data Analytics, has a strong workforce origin in Health Information Management. This would indicate a dominance of the health information management profession in HIW. The 2011 census (Table 1) demonstrates the number of Clinical Coders (1069) had halved since the 2006 survey (2183), which had followed a dramatic increase from the 2001 survey (1805). There is no reported or anecdotal evidence to suggest why there is such variation over this ten year period in the Clinical Coder workforce numbers and anecdotal evidence would suggest an increase in this workforce following the 2010 National Health and Hospitals Network plan in Australia.Furthermore, data reported in the AIHW Coding workforce shortfall study suggest the ABS figure may not be an accurate reflection of this workforce. Table 1 shows a comparison of the ABS Census data against the AIHW data in 2010. There was also a discrepancy in the HIM workforce figures between these two sources, with the ABS reporting a steady increase in the workforce, from 865 (2001) to 1473 (2011), yet the Universities were reporting a decrease in the number of graduates in the AIHW study, and the number of HIMs identified was 630. There is no explanation available for this magnitude of discrepancy.

Table 1: Comparison of ABS Census Data with AIHW Report 201021

ABS Census Data 2001 2006 2011 Census01-06 /06-11 / 01-11

2009 FTE AIHW

Clinical Coders [ANZSCO 599915] 1805 2183 1069 21%/51%/41% 1186

Health Information Managers [ANZSCO 224213] 865 1255 1473 45%/17%/70% 630

Total Profession 2670 3438 2542 29%/26%/5% 1816

Lack of data and identification of workforce shortage is a real issue for HIMAA. In our 2013 membership research in preparation for our 2014 – 2016 Strategic Plan, workforce emerged as the overarching theme for strategic concerns of the membership. Workforce shortage emerged as the second highest issue facing the profession, second only to the standing of the profession. Focus groups and a strategic plenary at the 2013 national HIMAA conference confirmed the magnitude of membership concern about workforce. Concerned that the HWA HIW Report of 2013 seemed not to be producing any response from government, in December 2014 we surveyed 650 HIMAA members, the association’s financial complement at that time. Key findings from this survey are summarised in Table 2. Based on 2011 Census figures, on indications in HIMAA’s 2014 survey the HIM/CC workforce

21Lawrance R. HIMAA Workforce Summit: CEO strategy update October-November 2015; HIM-Interchange, 2014, 5(3):35

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shortage could be: � HIMs – down x 525 FTE, need 660-1025 FTE, supply poor with 51% of employers � Clinical Coders – down x 780 FTE, need 265-995 FTE, supply poor with 53% of employers

Table 2: Key findings from the 2014 HIMAA membership survey22

RESPONSE RATE RESULTS

HIM vacancies 21% (N=136)

Coder vacancies 21%

Demand for HIMs growth 32%

Supply for HIMs 45.1%

Poor = 51.1%

Adequate = 31.6%

Good to excellent = 12.03%

Demand for Clinical Coder growth 61.65%

Supply for Clinical Coders Poor = 53.4%

Adequate = 30.1%

Good to excellent = 12.03%

In the coming 1-3 years, new HIM needed Average of 2.25 FTE per respondent

In the coming 1-3 years, new Clinical Coder needed Average of 3.12 FTE per respondent

Capacity to supervise incoming coding staff Adequate = 40.8%

Capacity to provide student placements in HIM and coding Poor – none = 36.9%

Poor – none = 44.8%

Adequate = 33.3%

As an aside, the AIHW Study 2010 projected a: � Net gain of 1,476 Clinical Coders over 5 years (2010-2015) � Need for between 1,757 and 3,101 FTEs in the same period.

The indicative nature of the HIMAA 2014 survey highlights the need for more reliable, substantive and ongoing HIW workforce data gathering, monitoring and evaluation.

CHALLENGES

The challenge is the lack of a reliable workforce data collection system.

The combination of the ABS, Australian Workforce & Productive Agency, the Department of Immigration & Border Protection, the Department of Health and the Australian Institute of Health & Welfare in HWA HIW Report (2013) Recommendation 2 is a non-solution if the ABS discrepancy with AIHW is anything to go by.

22MacDonald K. HIMAA warns of workforce crisis putting eHealth at risk. Pulse+IT; 21 April 2015: http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=2388:himaa-warns-of-workforce-crisis-putting-ehealth-at-risk&catid=16:australian-ehealth&Itemid=327&utm_source=Pulse%2BIT+-+eNewsletters&utm_campaign=fd49fe6b88-Pulse_IT_eNews_22_4_2015&utm_medium=email&utm_term=0_b39f06f53f-fd49fe6b88-413038141.

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With capacity to supervise student placements for HIM and clinical coders at 44.8% poor, adding workplace-based training as recommended in ‘Recommendation 5’ doesn’t present as a viable solution without considerable capability building.

SUGGESTED ACTION Section 3.1 1. Recommendations 5 and 6 need to be redrafted to reflect their relevance

to both HIM and HI professions. 2. We need a substantive ongoing research and evaluation program with

industry and education and training providers on supply and demand in the health information workforce.

3. Work-based capability development in HIW education and training is essential if workplace solutions to workforce development are to be feasible.

3.2 Clinical Coding Workforce and RecruitmentVicki Bennett, Principal Author, The coding workforce shortfall, Australian Institute of Health and Welfare 201023.

With concern about the shortfall in the coding workforce in Australia raised in a number of national bodies, the AIHW Coding workforce shortfall study in November 2010 aimed to qualify the scope of the known workforce shortage, to project future numbers that would be required to sustain the workforce and to provide recommendations to address identified issues. For the purposes of the AIHW study, the coding workforce was described as comprising Health Information Managers (HIMs), Clinical Coders (CCs) and Costing Specialists (CSs) and the report focused mainly on the clinical coding workforce shortage. The driver was the perceived need for reform with the implementation of Activity Based Funding, Electronic Health Records, Local Health Networks & Health Reform, and Performance Reporting.The method undertaken was:

� Every Australian Hospital was surveyed – there was a 75% response rate; 86% of all Public Hospitals responded. Most non-responses were small private and day procedure facilities

� The study looked at previous workforce surveys, the 2001 & 2006 census data &also international experiences

� Case studies & interviews were conducted with HIM professionals undertaking non-hospital based work (consultancy firms/ contract coding companies etc)

� University and VET output data was analysed.

The Survey Results indicated that: � Approx 66% of Clinical Coders were not HIMs (except in Victoria) � 93% were female with 50% of these working part time � More than 50% were over 45 years old � A higher number are VET educated than university educated � 2/3 of coders were employed in the public sector � There were 177 FTE vacant positions

23Australian Institute of Health and Welfare 2010. The coding workforce shortfall. Cat. no. HWL 46. Canberra: AIHW

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� Nearly 1 in 5 facilities used the services of contract coding companies to assist in managing their coding requirements.

An important area highlighted in the report was the consideration of the future workforce need for the proceeding 5-year period, with calculations indicating that a HIM and Clinical Coder workforce of between 3,101 and 1,757 FTEs would be required by 2015.The report recommended that this could be achieved by:

� Increasing workforce numbers and hours worked � Retaining the existing workforce � Increasing the output of the existing workforce.

The report split recommended strategies to achieve the above as immediate, short term and long term goals, as detailed in Table 3.

Table 3: The AIHW Coding workforce shortfall study recommendations24.

Recommendations.Immediate: 1. Find non-working HIMs and CCs to fill current vacancies 2. Promote immediate improvement in current work arrangements for

existing staffShort-term actions: 3. Support a more in-depth body of work on the Costing Specialist

Workforce, with the aim of developing a set of competencies and training packages

4. Finalise the development of an Australian Qualifications Framework (AQF) qualification for Clinical Coding, and assist existing coders to obtain Recognition of Prior Learning (RPL)

5. Promote careers in Clinical Coding, HIM and Clinical Costing nationally 6. Seek to have these careers listed on skills shortage lists 7. Investigate the value of coding software for improving quality and speed 8. Enhance continuing professional development opportunities 9. Undertake a national review of salary and industrial conditions for CCs

HIMs and CSsLonger-term actions: 10. Provide scholarships, internships and training incentives 11. Establish Coding Workforce Units at the Local Hospital Network (LHN)

level 12. Use technology to improve access to records to allow remote coding 13. Conduct national clinician training on diagnosis assignment and

documentation 14. Establish a national coding auditing, education and support function 15. Define a career path for the coding workforce to integrate the existing

workforce and create promotional pathway

24Australian Institute of Health and Welfare 2010. The coding workforce shortfall. Cat. no. HWL 46. Canberra: AIHW: 61-62

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Recommendations that have progressed since 2010 include: � Engaging more non-HIMs as Clinical Coders � Improving the salary and conditions of existing staff � Finalising an AQF (Australian Qualifications Framework) qualification for Clinical Coders � Listing Clinical Coding on the skills shortage lists for the States & Territories � Implementing scholarships, internships & training incentives � Starting & Re-Starting university programs

With the release of the HWA HIW report, which included more than just the Clinical Coder workforce, and the impending health reform that may see some states moving away from Activity-based funding, it appears further work to meet the recommendations of the AIHW report has stalled.

SUGGESTED ACTION Section 3.2 1. Given the impending health reforms in Australia, demand forecasting is

needed to determine the level of demand met by existing actions since the release of the AIHW 2010 report and the future demand required.

2. The supply of the Clinical Coder workforce also needs to be examined to determine if there has been a shift in where this supply is coming from given the findings of the AIHW report showing a move away from using HIMs in all states.

3. There is also the opportunity to examine role substitution and specialisation in this workforce, particularly in relation to data analytics, given the impending health reform and advances in technology that may have an impact on this workforce.

3.3 From the Open Forum - HIM, Clinical Coder and Health Informatics Workforce Solutions – The Need for Research

ISSUESThere was general agreement at the Summit about the need to develop a “definition” of the Health Information Workforce before we can start counting and quantifying the actual workforce, but it was acknowledged these discussions have been ongoing for the last 2-3 years without any progress. There is also a fear that some roles (e.g. clinical coding) are shrinking in terms of their scope and that too much time spent on definitions will be to the detriment of progress. Government is looking for a “well-oiled machine” that can inform the discussion, such as they find in the professional medical colleges.

A clear, collaborative message about this workforce to government is required. Funding will continue to be focused on other things until we can deliver clear messaging to politicians who can speak further with influencers and cheque writers.

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The need for a rigorous data collection and evaluation program on this workforce has been discussed above. But who should collect and monitor this data and what would be their scope? Consensus that ongoing research on the relationship between curriculum and workforce, and core HIM competencies in the context of specialisation, is required.

CHALLENGES There is disparity in professional context between State and Territories. For example, historically the Clinical Coding workforce in Victoria was predominantly HIM graduates compared to New South Wales where Clinical Coders are predominantly certificate qualified. Another challenge is the low visible profile of HIMs and the need to balance the genders through profession, which is recognised as being dominated by the female gender. A final challenge is the changing competencies in the HIM profession and specialisation.

POSSIBLE SOLUTIONS � Build a capabilities framework � Those present agreed that the professional association needs to liaise closely with each

State government. � Promote career pathways to students � Further research into the HIM Workforce

SUGGESTED ACTIONS Section 3.31. Key stakeholders, led by the peak professional organisations, need to work together, using agreed definitions, to campaign for an ongoing data collection and evaluation program for this workforce. 2. The scope of this program would include:

y quantifying and qualifying the workforce, building a capabilities framework, y proposing the future workforce configuration and identifying areas for role

substitution and specialisation the impending health reforms in Australia, y demand forecasting to determine the level of demand met by existing actions

since the release of the AIHW 2010 report and the future demand required.

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3.4 SGD 5: Workforce Configuration – data gathering and monitoring

Facilitator: Kerryn Butler-HendersonSmall Group Participants = 16±

ISSUESMembers of this group agreed that research was required to understand the workforce composition and future configuration. A minimum data set as part of an ongoing census was considered a viable option, however the frequency of the census needs to be manageable. Competencies and professional standards were again mentioned as required data fields for evaluation over time.

As the health information professions are not regulated by AHPRA, self-regulation against agreed competencies, as opposed to professional titles, will provide the evidence to government and employers of the value of the HIW.

It was noted that professional development and the revision of competencies must occur to ensure the professions are meeting the needs of the employers. Surveying the profession must be done in such a way to ensure maximum responses on the big-ticket items. It is better to get full coverage on a number of high impact questions and resurvey, than to over burden respondents with multiple surveys and therefore reduce the response rate. Identification of those to survey was considered a problem due to the diversity of roles occupied by the HIW, many of whom are not members of the stakeholder groups. Questions were raised in relation to data ownership and access by stakeholder groups for their own reporting purposes.It was considered as per the discussion in the morning that an evaluation framework would guide the industry and government, identify gaps and establish national priorities for workforce development. Having up to date information would have left us in a position to better argue our case at present. Understanding what attracts people to the profession was considered important and whether they were work ready when they graduated was identified as an immediate need. A graduate survey would assist in informing the education sector and industry on the changes needed in graduate positions both now and into the future.

SOLUTIONThe solution was for the stakeholder groups to campaign for the ongoing data collection and evaluation of this workforce, including the examination of the existing workforce, future workforce configuration, workforce shortfalls/demand, roles and functions, competencies and qualifications. No consensus was reached on the frequency of data capture however it was considered that data capture needed to be ongoing to monitor changes / trends. It was agreed that the data capture should cover both Australia and New Zealand.

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SUGGESTED ACTIONS Section 3.41. Key stakeholders, led by the peak professional organisations, need to work together, using agreed definitions, to campaign for an ongoing data collection and evaluation program for this workforce. a. Such data collection should include the examination of the existing

workforce, future workforce configuration, workforce shortfalls/demand, roles and functions, competencies and qualifications.

b. An evaluation framework based on professional competencies and qualifications, rather than position titles and job descriptions, would guide industry and government, identify gaps and establish national priorities for workforce development.

c. As the health information professions are not regulated by AHPRA, self-regulation against agreed competencies, as opposed to professional titles, will provide evidence to government and employers of the value of HIW configuration as this changes.

d. A minimum data set as part of an ongoing periodical census program is a viable option, but the frequency of the census needs to be manageable.

e. Competencies and professional standards are required data fields for evaluation over time, and revision of competencies to ensure the professions are meeting the needs of employers.

2. The scope of this program would include: y quantifying and qualifying the workforce to build a capabilities-driven HIW

development framework, y negotiating with industry future workforce configuration requirements and

trends, and identifying areas for role diversification and specialisation, y specific demand forecasting in Clinical Coding to determine the level of

demand met by existing actions since the release of the AIHW 2010 Clinical Coding Workforce report, and the future demand required

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4. HIW Supply Challenges

There are two sources of HIW supply treated in this section: education and training, and work-based.

4.1 Education and Training

This section focuses on the challenges influencing supply of health information workforce from an education and training perspective, including those facing HIM courses in Australia, HI tertiary offerings in Australia, HIMAA’s Clinical Coding courses, and a Small Group Discussion (SGD) on recruitment – one of six conducted in the afternoon session of the Summit.

4.1.1 The University Supply Challenge

Merilyn Riley (La Trobe University) and Maryann Wood (Queensland University of Tech-nology [QUT])

With input from Vicki Bennett (Western Sydney University), Kerryn Butler-Henderson (University of Tasmania) and Tim Nelson (Curtin University)HIMAA has been offering professional accreditation of HIM degree courses based on its Entry level HIM Competency Standards to complement the university’s academic governance since 1992. Three universities are currently accredited by HIMAA in Australia: La Trobe (Victoria), Curtin (WA) and Queensland University of Technology. The Higher Colleges of Technology HIM degree in the United Arab Emirates is also HIMAA accredited.

Servant of Too Many MastersGovernance is one of the many challenges faced by HIMs delivering HIM degree courses in universities, due to the competing demands of various governance bureaucracies, according to La Trobe University’s HIM Course Coordinator, Merilyn Riley. “The reality is,” Meredith told Conference delegates, “we serve too many masters.”

At the federal government level the Tertiary Education Qualification Standards Agency (TEQSA) is an independent statutory authority established in 2011, which audits universities against the Australian Qualifications Framework (AQF). The AQF is the national framework for regulating qualifications in education and training at all levels. According to Ms Riley, a TEQSA audit can burrow down to a level of detail that says: “If you provide a 15-credit-point-subject at an undergraduate level you should examine it between 3,750 words and 4,500 words. A 15-minute presentation is worth 800 words. A 2-hour exam is 2,000 words.” It is quite prescriptive for developers of curriculum and syllabus, as well as for those delivering these.

At the institutional level, each University has its own academic procedures, requiring approval at Dean and a Chancellery academic board levels for approval of new courses and significant changes to existing courses. “The dollar is a very big push,” Ms Riley told delegates, “along with University rankings.” In Ms Riley’s experience, changes to a course can take 2 years. Even a change to an assessment activity needs to be justified against compliance with AQF requirements and university graduate capabilities.

At the professional association level, there are professional accreditation requirements such as HIMAA’s HIM Competency Standards. “Everything that we teach is mapped against the

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HIMAA Competencies,” Ms Riley told Summit delegates.“ At the end of the final year we give our students what we now define as a HIMAA Competency Exam. Students cannot graduate if they do not pass that exam.”

Then there is the professional placement, and the requirements of different employers. Students are sent to a wide range of agencies at La Trobe, only half of these being hospitals. “There is only so much a student can learn in 4 years, especially when the first year is core to all health science students,” Ms Riley informed delegates, “But there are different employer expectations as to what the students can do and are able to do in work experience placements. And these expectations keep changing,” Ms Riley said. “Employers often want students to do things outside the HIMAA Competencies.” La Trobe find placements relatively easy to find for final year students, but in 2nd and 3rd year students are yet to attain the whole skill set, and it must be a ‘hospital-based’ placement so students must be supervised by a qualified HIM. While there are enough HIMs in some sectors to supervise, hospitals are beginning to require payment to take students.

The Next Challenge: Recruitment – or “How do we get numbers?”“We are a ‘behind the scenes profession’,” Ms Riley suggested to Summit delegates. “We are not attractive to students when we are competing with such occupations as physiotherapy and sports exercise. We’re just not the flavour of the month. “However, once you actually get people to realise what we do, how employable we are and how many jobs there are – mature students will sell the course very easily to parents.”Here Maryann Wood, Course Coordinator for QUT’s HIM degree, takes over. Ms Wood highlighted the challenges presented to recruitment of students by faculty or departmental restructure and subsequent cancellation of programs. Universities these days are in business, and new courses need to be justified in terms of market appeal. The HIM team at QUT spent several years in resurrecting their HIM degree, which saw its last students through in 2010. Maryann acknowledged the recruitment challenges outlined by Merilyn Riley, but pointed out that La Trobe have a track record and student numbers. QUT was effectively, from 2014, starting out afresh, and so continues to be under threat until enrolments build to a critical mass.Another recruitment threat Ms Wood highlighted is in teaching staff. Selling a career path into academia to HIMs is difficult as the pay is less, and job security dependent on course security. The HIM teacher recruitment threat is exacerbated by universities that do not see the qualified HIM as essential into the teaching program. The standard academic convention for PhD or, at minimum, Masters level attainment for lecturers overrules the need in the eyes of some in the hierarchy for, in HIM courses, HIM expertise25. One of the key attractions to academic life, a mix of research and teaching, is also difficult to achieve according to Ms Wood. This is because the teaching demand tends to dominate, especially with the added pressure of finding meaningful work placements for students. A further challenge with student placements is that many of the richer experiences, including opportunities for hands on activity, are in in rural and remote areas, whereas the universities are based in the cities. So there is accommodation to find and living away from home expenses to fund. The extra effort is essential, however, in attracting HIM graduates to rural and remote practice on graduation. Industry support for student placements is also vital to the educational success of the HIM degree program. Ms Wood told delegates the value of the link between industry and education cannot be underestimated.

25Editor’s Note: Interestingly this convention is endemically overlooked in Medicine, where doctors who supervise students on

placement are accorded honorary lecturer status and GPs regularly walk into lecturing positions as Associate Professor.

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Diverging DevelopmentsTwo new HIM tertiary courses have commenced in 2015.In NSW, the Western Sydney University is delivering an HIM degree course built around a Bachelor of Information and Communication Technology - a BICT (HIM). The emergence of this degree course highlights the increasing need for Health Information Managers to be not just familiar with ICT, but conversant with and competent in it. The University of Tasmania’s Australian Institute of Health Service Management, based in Launceston and at the University’s Rozelle campus in Sydney, are delivering a Master of HIM (MHIM) aimed at practising HIMs needing the higher level management, data and quality management and leadership skills to step into senior management and executive roles needed in NSW Health and in other jurisdictions. The University of Tasmania have applied to HIMAA for accreditation of their MHIM and Western Sydney are expected to apply in 2016

SUGGESTED ACTION Section 4.1.1 1. As per the Professions Australia and Universities Australia 2016

Joint Statement of Principles for Professional Accreditation*, HIMAA should work more closely with HIM universities to ensure professional accreditation does not duplicate information already generated by academic accreditation processes.

2. HIMAA and the Universities should work together to develop and promote the career path into academia, and the combination of teaching and research, to the HIM profession, and the value of a HIMAA-accredited qualification to the university staff recruitment decision-makers

3. Advocacy to industry of the value of student placements in achieving one channel of relationship between industry and education to ensure the responsiveness of curriculum to industry needs.

* Joint Statement of Principles for Professional Accreditation, 9 March 2016 – see www.Professions.com.au/advocacy/policies/item/joint-statement-of-principles-for-professional-accreditation

4.1.2 Health Informatician Supply

Adj Assoc Prof Klaus Veil, President ACHI

ISSUESThe Australian Health Informatics Workforce is influenced by the National Health Reform Program which was “re-booted” in the May 2015 Federal Budget. A Health Informatician has been included in the early governance of the Australian Digital Health Agency (AHDA) which is to oversee the next stages in the implementation of the My Health Record (formerly PCEHR). With program activity funding of $485.1million over 4 years, this continuation of our national EHR program is will fuels workforce need.Workforce data in Health Informatics is as out of date as it is in Health Information Management and while there are ample education programs for Health Informatics available, low enrolments subject course survival to the same threats as experienced in the HIM courses. There will be a lack of workforce a few years down the track. The struggle is very similar to the issues with HIMs.

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CONTEXTWith extra funding of the My Health Record program creating an increased need for Health Informaticians and HIMs, workforce issues need to be addressed. Australia has close economic relations with New Zealand and it is important that they are viewed as one area. Adjunct Associate Professor Veil has been appointed to the Board of Professions Australia, which represents ~340,000 professionals across Australia including engineers, certified practising accountants, healthcare professionals such as sonographers, speech pathologists, dieticians, etc. This appointment has made Adjunct Associate Professor Veil aware that the workforce issues identified are similar in other fast-moving professions and not specific to the health information industry.Professions Australia is also finalising with Universities Australia a Joint Statement of Principles for Professional Accreditation which will strengthen the complementary role of professional accreditation of qualifications alongside the institution’s academic accreditation. This can only provide additional security for profession accredited qualifications in workforce recruitment and retention.

CHALLENGESAccording to Adjunct Associate Professor Veil, there are plenty of tertiary education programs available but enrolments are too low! On the other hand, e-health technology is “main-streaming” and there is a question how long this disruptive phase will last and how this will affect the workforce needs.

SOLUTIONSAdjunct Associate Professor Veil believes an evidence-based approach is needed to support any market intervention. With e-health mainstreaming there does not need to be as much e-health knowledge as there was previously, for example what was needed for HL7.Ultimately, the common denominator for Health Informatics and HIM is to provide the necessary skills infrastructure, a healthy workforce and continuing our collective efforts to build a better healthcare system for all Australians.

SUGGESTED ACTION Section 4.1.2 1. Conduct research to obtain up to date data on current workforce issues

to provide the evidence base for increased funding and support for HIW supply and configuration.

2. The professions of Heath Informatics and HIMs need to work together to obtain the evidence. This is urgent and the foundation for all other action items.

4.1.3 HIMAA’s Clinical Coding Courses

Richard Lawrance, HIMAA CEO, for HIMAA Education Services Training Manager Lyn Williams

ISSUEHIMAA has been offering distance education in clinical coding at the Vocational Education & Training (VET) level since 1990, but even though total throughput since the 2010 AIHW clinical coding study26 is barely half of the need forecast by that study, employers are resistant to engaging with the training provider to ensure employability of graduates.

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CONTEXTHIMAA commenced clinical coder training by distance education in 1990. By 1992 the service was nationally available. Today, as a Registered Training Organisation (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.This entry level training can be delivered more quickly via an Accelerated Program – with recognition of prior learning (RPL) in CMT, a student can complete Introductory Clinical Coding in 6 months. Intermediate &Advanced Clinical Coding programs are aimed at existing workers, and HIMAA’s Refresher Clinical Coding is designed to assist qualified clinical coders return to work.A total of 726 Clinical Coders have graduated from HIMAA’s Introductory Clinical Coding course since 2011. This does not meet even half of minimum need of 1,757 FTE predicted by AIHW in 2010 (see section 4.2 above for more information on this study). The total graduates of HIMAA’s Intermediate and Advanced Clinical Coding courses over the same period, 327, contributed in retention through professional development barely 22% of the 1,476 FTE net gain projected by the 2010 AIHW report. Enrolments in HIMAA’s CMT& Introductory coding courses are also declining. HIMAA is not sure why this is occurring. It is known that industry demand is increasing. But so too are industry expectations.

CHALLENGES

Industry ExpectationsSome employers have unrealistic expectations of what an entry level coder should be able to do. In all other health professions, all new graduates are considered entry level and go through continuous on the job training – in medicine, for instance, in the form of internship - before they become autonomous professionals. So why hasn’t industry built sufficient support networks in the workplace to allow this same period of supervision in health information? The tendency instead has been for industry to complain about the non-work-readiness of HIMAA graduates27 and, in the public sector, work with state government to develop their own workplace-based training equivalents independent of the profession’s key expertise in education and training and competency standards in the sector28. Is it possible that there is a case for convincing hospital management that clinical coding is an occupation that is part of the health information management profession and therefore requires the same professional support in the workplace as other health professional graduates?Many hospitals have 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 on conjunction with

26Australian Institute of Health and Welfare 2010. The coding workforce shortfall. Cat. no. HWL 46. Canberra: AIHW 27See GippsTAFE, Human Capital Alliance & Pavilion Health. The Clinical Coder Capability Framework, Victorian Department of Health, 2013, p.728See GippsTAFE, Human Capital Alliance & Pavilion Health. The Clinical Coder Capability Framework, Victorian Department of Health, 2013, p.8

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training providers. A number of recent solutions along these lines are explored in Sections 6.1 and 6.2 below.

SOLUTIONS y Advocate to hospital management the occupation of clinical coding as part of

the health information management profession, requiring the same ‘internship’ approach as other health professions

y Advocate the role of clinical coding educators and auditors are germane to health information management staffing structure

y Work with employers to extend workplace experience opportunities to students of existing clinical coding training providers such as HIMAA

Access to medical recordsA 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. The more records they have, the more work it is to update the answers 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?

SOLUTIONS y What we really need is access to records in the workplace

Access to the workplaceIt’s known how important it is that students can access the real workplace to code in context, 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 find. This is a Catch 22.

SOLUTIONS y With the Certificate IV in Clinical Classification, accredited by the Victorian

Registration and Qualifications Authority in 2014, an RTO may be able to access some funding for traineeships which will allow students workplace experience whilst learning.

y There is also the option of collaborating with hospitals to train existing workers in clinical coding. HIMAA has collaborated with a number of health facilities where they have a ‘trainee’ position in clinical coding. The student is enrolled in HIMAA courses & the hospital works alongside HIMAA with a mentor to provide hands on experience in the topic they are currently studying. At the end of training the students are much further along in their level of knowledge and skills.

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Time expectationsIndustry is often frustrated at how long it takes to complete the training program (even though HIMAA’s Accelerated Program can be as short as 6 months). Employers do not seem to understand that as a foundation pre-requisite 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. Even the new Certificate IV in Clinical Classification requires the first four of six coding modules to be completed before a coder enters the live environment. 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 only offers the status of Certified Clinical Coder 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 1 and 4 years. HIMAA is currently working on bringing the Certificate IV in Clinical Classification onto its scope of registration with ASQA. With the Certificate IV there will be more knowledge and skills to acquire – half of the 12 modules in the course are non-clinical coding, for instance - so the course could take even longer. HIMAA intends to integrate new tools and software into its online delivery that may enable accelerated learning but, nevertheless, if industry values the career and employability advance of a full VET level qualification in clinical coding, then it will also have to become realistic about incorporating substantial workplace opportunities into what will be at least a two year course.

SUGGESTED ACTION Section 4.1.1 1. Advocate to hospital management the occupation of clinical coding as

part of the health information management profession, requiring the same ‘internship’ approach as other health professions.

2. Advocate the role of clinical coding educators and auditors in the hospital system as germane to health information management staffing structure, and in need of appropriate financial reward and seniority of status to promote recruitment and retention.

3. Work with employers to extend workplace experience opportunities to students of existing clinical coding training providers such as HIMAA, instead of ‘reinventing the wheel’ by developing their own training outside national competency standards.

4. Employers need to work with existing authorised providers of clinical coding education and training to provide students access to live records to code in the workplace

5. Employers should support authorised training providers of the Certificate IV in Clinical Classification in achieving traineeship funding for students.

6. Employers concerned with the time clinical coding education and training can currently take should consider supporting HIMAA’s Accelerated Program option, which can be delivered in as little as 6 months

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4.1.4 SGD3: Recruitment – how to attract entrants to the profession

Facilitator: Merilyn RileySmall Group Participants = 16±

ISSUESIn terms of workforce recruitment, this group observed that recruitment of Clinical Coders and HIM Coders was more of an issue than Health Information Managers. As noted in Section 4.1.3, even after a clinical coding students has graduated from an authorized course, they are not getting the jobs because they do not have the work experience. Most of the workplaces want workforce ready Graduates. Their issue is time and effort it takes to train new members. The group acknowledged that these are the industrial challenges faced by new HIM graduates also, even though they access work placements.

CHALLENGES

If clinical coding graduates do not find work, they are lost to the profession. Similarly if HIM graduates cannot find work in a HIM related profession they end up moving in other disciplines altogether. One group member was even aware of a HIM graduate who ended up in banking.

Another challenge noted by the group was that noted in Section 5.1.1: the greater attractiveness of ‘big ticket’ courses that lead to well-paid employment, such as IT.It was also noted that the lack of any national registration in the profession led to variations in awards to which HIMs and Clinical Coders were assigned, which tended to driver them into more stable and better paid occupations.

SOLUTIONSIn terms of the ‘big ticket’ attractors, at university level the HIM profession can be promoted as the perfect job for people interested in exposure to medical knowledge but who are not necessarily interested in frontline care delivery.Partnerships with private sector, with other professional associations, between universities, and with government were all seen as ways of strengthening recruitment, but it was worth starting with “people we know”. This was certainly one way of can be one of identifying potential employers who may assist with workplace placements for students, and employing HIM professionals with appropriate qualifications.

Creation of scholarships in HIM and Clinical Coding would attract enrolments, and liaison with careers advisers in schools to promote the career, as well as career advisers in universities, will provide greater understanding about HIW roles.

It was suggested that HIMAA and the HIM universities form a joint working group to promote the HIM profession’s career.It was also agreed that introducing national registration that could be used as a standards medium to address award disparities around the country would also make the profession more attractive.

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The group discussed nurses who wanted to become clinical coders because they love working in health industry but tire of shift work, back ailments from lifting, and patient abuse, and seek a change. For them the challenge is that the HIMAA courses are expensive and time consuming, and there is no incentive for them to make the transition in their workplace. Another source of potential recruits identified were non HIMs or Coders working in Medical Records Departments, such as scanning clerks. Unlike nurses, such occupations need the education in medical terminology as well as clinical classification and coding, so the course is even longer. An advantage is that HIMs and Coders in the department can support them in their studies. Another potential solution that is also challenged is international students. Although HIM and Clinical Coder are occupations on the Consolidated Skilled Occupations List for skilled migration, international students are faced with visa problems. They may have to actually leave Australia in order to seek re-entry as skilled migrants.

SUGGESTED ACTION Section 4.1.4ACTIONS Section 4.1.41. The Profession to develop a strategy to introduce: 1.1. Scholarships, Internships, Traineeships and the Certificate IV Clinical

Coding Course 1.2. Registration of Health Information Managers and realign and rename

industrial awards so that they clearly identify the profession and improve salary and conditions of existing staff

1.3. Incentives for profession retentionAnd to: 1.4. Re-engage trained non-working HIMs and Clinical Coders 1.5. Target professionals likely to enter to the health information profession,

such as nurses and occupational therapists 1.6. Expand HIM and Clinical Coder nomination on skills shortage lists 1.7. Identify and engage with potential employers who will support HIM

profession recruitment and retention 1.8. Advocate the profession to young people through carers advisers,

careers expos and university open days 1.9. Involve HIMAA branches in 1.82. To achieve this HIMAA needs to: 2.1. Partner with relevant professional associations 2.2. Work with Career Advisers’ associations in each state and territory 2.3. Become involved in award restructure at the state level

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4.2 Work-based HIW Supply Challenges

This section examines the complex range of work-based challenges influencing HIW supply once graduates enter the workplace. These range from the visibility of career pathways within the health system to role substitution and the negative influence of industrial awards and job classifications. The section begins with an analysis by HIMAA’s Workforce Working Group of 7 baseline avenues for HIM career development from graduation.

4.2.1 Health Information Management Profession – Career PathwaysJulie Brophy, Chair, HIMAA Workforce Working Group

ISSUESAnecdotally, the lack of career pathways is often cited as an impediment to workforce recruitment and retention in the health information management profession. It is mentioned often throughout this report. For young people considering a future career, the HIM profession barely appears in careers advisory information. Where it does, it is often a subset of curation and librarianship, rather than an essential health profession.

For Clinical Coders and HIMs entering the profession, lack of clear professional development options either sideways or upwards can lead to disillusionment and attrition.

CHALLENGESThe challenges are to articulate such a career pathway, and to disseminate this information to young people considering a career, to HIMS and Coders entering the profession, and to those already working in health who may consider a sideways step into a health information management occupation.

SOLUTIONThrough a mind-mapping exercise led by Chair Julie Brophy and member Jen Lee, HIMAA’s Workforce Working Group has identified career pathways from seven graduate entry points for one of the two main occupations populating the HIM profession, Health Information Manager.Ranging from the traditional workplace avenue of Health Service Health Information Services (HIS) through non-HIS information services in the health system, and the private hospital setting, to Research, Government and Education, The Working Group has identified the following occupational options for the HIM professional:

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Entry level HIM ► Senior HIM ► HIS Manager ► Executive Manager

Entry level Clinical Coder ► Senior Coder ► Coding Manager / Educator / Auditor

Project Officer ► Project Manager ► Health Informatics Leadership

Data Analyst ► HIM Specialist ► Contractor / consultant

Data Manager ► Clinical trial Coordinator ► Clinical Research Associate

Entry level government Policy Officer ► Policy Adviser ► Senior Adviser ► Manager/Director

Lecturer ► Senior Lecturer ► Professor ► Head of School/Faculty

Table 3: Seven career avenues for entry-level HIM graduatesThere are three lessons to be learnt by Summit delegates from these seven career avenues:a. HIMs already enter a broad profession, with 7 clear career avenuesb. A structure of career diversity already exists on which future workforce configuration can

be explored with confidence that diversification and specialisation are achievable. c. The HIM’s role is evolving.In presenting this information to the Summit, HIMAA Workforce Working Group Chair Julie Brophy shared a perspective on the developing role of the HIW by Dr Mervat Abdelhak from the University of Pittsburgh, at the 2012 HIMAA Conference, adapted slightly here to reflect an HIM perspective:

� HIMs are a strategic resource – bridge builders – between data and clinicians, between data and information.

� Their role is evolving – from technologist to strategist. � Credentialing in electronic environment may be required in future. � Future roles for HIW developing in the US and Canada which could easily fit HIMs here

include: � Director of Clinical Documentation, � Director of Quality Improvement � Director of Privacy and Security � Director of Compliance � Director of Revenue Cycle � Director of Risk Management � Knowledge Officer � Learning Officer

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SUGGESTED ACTION Section 4.2.1 1. Promote existing health information management professional career

pathways in core occupations, such as HIM and Clinical Coder, to young people considering a future career, to HIM and Clinical Coder graduates entering the workforce, and to others working in the health system who might consider a step sideways or upwards into HIM.

2. Promote the full ranges of career avenues for HIMs and Clinical Coders as the sound basis for further diversification and specialisation as the future configuration of HIW requires.

4.2.2 HIM Role Substitution –Case Studies

Cassandra Rupnik, President, HIMAA NSW Branch

ISSUEThe issue of HIM positions being awarded to non-HIM candidates emerged from the qualitative components of HIMAA’s extensive 2013 consultation with its membership, particularly the 9-group focus group program. The issue is referred to as a barrier to workforce recruitment and retention in a climate of workforce shortage in a number of sections of this report. The case studies in this section illustrate not only the extent of role substitution fostered in NSW Health by disparate and competing awards, but also how workforce shortage limits the career aspirations of HIMs themselves.

CONTEXTIn NSW, there are a number of awards under which HIMs are employed. One of these is the Health Services Manager Award, which is not specifically for HIMs. Another is the older Medical Records Manager award, which modern HIMs have outgrown, and which pays less. Employers and HIMS are moving away from the Medical Record Manager award, but not replacing it with a dedicated new HIM award.CASE ONE HIMAA NSW Branch President Cassandra Rupnik wanted to apply for a regrade and so looked at how much experience she had versus most new graduates. She found they and she would be paid the same regardless of her 25 years’ experience. She reviewed positions advertised by the NSW Ministry of Health on a single day to examine the requirement for HIM qualifications. Ms Rupnik found that of positions advertised on the NSW Ministry of Health Employment website on 23rd October 2015, there were only 20 positions advertised under the Administration – Medical Records heading. Of these, seven were HIM positions: three under the Medical Records Manager award, four under the Health Manager Award requiring ‘HIM equivalent’ qualifications, with one even mentioning TAFE qualifications as suitable. The remaining positions were Clinical Coders (6), one Medico-Legal Clerk and six Administrative Clerks.On the other hand, 96 positions were advertised under the Health Manager Award. Under this classification, employees are paid more. Of the 96, 13 were identified as traditional HIM roles. While some positions requiring HIM knowledge, such as ABF, Casemix, Patient Administration Systems and Benchmarking did acknowledge HIM qualifications as being desirable, positions HIMs are suitably qualified to undertake, such as Quality Managers and Data Managers, did not refer to HIM qualifications or experience at all. CASE TWO In another case, Ms Rupnik applied for a position advertised under the Health Manager award. A contract was advertised as the Information Manager of a Mental Health Unit. Ms Rupnik was successful in securing the role but not released from her current role in

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a 200 bed base hospital because there are no other HIMs in the region. A Finance Clerk was appointed to the Mental Health Unit Information Manager position.Further input on this issue was made by a Summit delegate who took the opportunity to utilise an online Subsequent Input facility for those who were unable to make sufficient contribution during the Summit proceedings.

CASE THREE: SUBSEQUENT INPUT – NSW INDUSTRIAL AWARDS

This input was submitted subsequent to the Summit by a Summit delegate.

ISSUEOne of the issues discussed on the Workforce Summit day was “Why are we not advertising for vacancies using our Medical Record Manager Award” ? Most advertising for vacancies now advertise under the Health Service Manager Award.

CONTEXTI believe the answer lies in our diversity of roles for HIMs and the fact that the Award is out dated and has not kept up to date with current practise and salary levels due to organisations competing for limited HIM resources. If the Medical Record Manager award was reviewed and rebranded to ensure that it covered all areas of work for HIMs - such as data, research, health funds, medico-legal, medical records, Information management and technology, project management - then we could possibly start using the award. Currently the Health Service Manager Award is quite broad and allows for us to remunerate at a better level and also diversify with our skills and roles.

CHALLENGESThe challenge to change an award from Medical Record Manager to a dedicated HIM award I assume will be quite complex due to the channels it needs to go through. I do feel that we don’t really fit under the HSM Award but really need to change the Medical Records Manager award.

SUGGESTED ACTION: This really needs to be supported by the Ministry of Health and relevant bodies.

CHALLENGESRemuneration is an issue and challenge in a sector with finite resources. Variation in award, job classification, and in qualificational and occupational experience /role requirements for positions that should list HIMs, and HIM qualifications as the primary requirement, undermine morale amongst health information professionals..This leads to attrition in the industry and a deterrent to recruitment.This structural deprofessionalisation of HIMs through state health department variation in awards and job classification can only lead to an erosion of professional practice standards at a time, of eHealth reform, that NSW Health needs HIM expertise most. HIM attrition will also exacerbate workforce shortage.

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SOLUTION

Employer support is required for upskilling and to allow HIM staff to specialise and diversify to meet future workforce configuration needs. Employers should require HIMAA-accredited qualifications and specify HIMs as preferred applicants for roles that are traditionally HIM roles, and specialisations into which HIMs are qualified to diversify.

SUGGESTED ACTION Section 4.2.2 1. Support provided to employer to be able to access HIM qualified staff

from other geographical areas. Encourage, for example through a bursary, HIM graduates to undertake rural and remote posts.

2. Employer support for upskilling and to allow HIM staff to specialise and diversify to meet future workforce configuration needs.

3. Employers to require HIMAA-accredited qualifications and specify HIMs as preferred applicants for roles that are traditionally HIM roles, and specialisations into which HIMs are qualified to diversify.

4.2.3 Open Forum - Industrial Awards

ISSUESSome discussion during Open Forum before lunch at the Summit highlighted the need to address the impact of discussion of industrial awards on HIW recruitment and retention. Delegates from New Zealand revealed that the role of HIM is not actually recognised by New Zealand job classification structures, and the clinical coding role is shrinking so fast action on award structures may take too long to have any impact. Subsequent Input from a Summit Delegate offers a Case Study of the impact of award structures in South Australia on Clinical Coder recruitment and retention.

CHALLENGESA Victorian delegate during the Open Forum took up a suggestion of a consistent award structure that differentiates pay structure relative to level of educational attainment. Inequity results from current State based industrial relations arrangements. “This is why people move away from the profession. In Victoria, VET level Cert IV students may end up getting paid the same salary as a fully qualified HIM degree graduate. Victoria had 54 final year placements in the La Trobe HIM course this year. Of these, as a result, 27 now have jobs even though still on the course; 15 of these are in clinical coding. Four students ended up in a non-clinical space like research and management, and come under different awards again,” the delegate saidA New Zealand delegate told the Summit that too much time and energy could be spent trying to define what a clinical coder is for industrial relations purposes. “In New Zealand our role in clinical coding is shrinking. Managers and leaders should be obligated to ensure the skills and knowledge requirements to ensure the profession is future proofed rather than defined.”A HIM based in New Zealand offered a detailed example of the extent to which the profession as Health Information Manager was simply not recognised.

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CASE STUDYA New Zealand HIM spoke to the diversifying capability of a HIM, and the lack of recognition of the professional occupation in New Zealand. She graduated from QUT as a HIM then moved to NZ. She started out clinical coding but within 12 months became a clinical coding manager, then a department manager. Her role then morphed to IT project management, but her job title was “Health Informatics Consultant” – she not allowed to use a HIM title. “Doctors in NZ don’t know what a HIM is,” the delegate told the Summit. In her current role she has learnt Six Sigma design, assists the CIO in updating board papers, and has become the lead IT person for the organisation, installing 3M Codefinder, responsible for automation of forms, ranking up to 400 IT projects, and working on the privacy steering committee. So her role has transformed, but if she didn’t have her coding or casemix background or her education as a heath information manager she would not have been able to achieve the degree of diversification and specialisation that she has.

SOLUTIONSThe New Zealand delegate suggested that the urgent need was to limit time on definitions and look at the roles. Coding workforce shortage was at a level requiring remedial action. “There are significant challenges which mean hard work for an imminent future. We need a 2-5 year timeframe to turn around the decline. This is the experience in NZ.”The Victorian delegate suggested the need to deal with the IR issues “to avoid HIMs being drowned out, and our profession minimised.” The issue of definition should address future workforce configuration, “where we should go”.

"HIM has evolved into a profession that is distinguished from other health managers. Research, quality, health insurance etc are all involved in what our profession represents. But we still have four core streams to the profession: Management, Analysis, Information, and Classification. We know who we are and have the ability to do better. IR awards are created on a state by state basis with local authority, but this needs to be with the involvement and endorsement of the profession.”

SA CASE STUDY – INDUSTRIAL AWARDS – SUBSEQUENT INPUTThis case study was provided by a Summit delegate subsequent to the Summit. CONTEXTThere is a lack of coding staff in South Australia. We have vacancies for coding staff in SA Health that remain unfilled for quite some time. The Coding Manager position at the Lyell McEwin Hospital has been not been filled even though it has been advertised for the last 4 months. The Head of the Medical Records Advisory Unit (MRAU) HIM left earlier this year, and has not been replaced. The MRAU Coding Auditor/Educator does not seem to be supported by management to visit sites and provide education and auditing to help the quality of the Data. There is no local training for HIM courses in SA, have to study via correspondence, and no local coder training through VET in SA schools and Colleges

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ISSUEThere is an increasingly aging workforce in SA with quite a few coding staff expected to retire within the next 5-10 years. This is going to impact on the timeliness of the coding data unless steps are taken now to prepare for this situation. The industrial award structure needs to change to support coder recruitment and retention. CHALLENGESThe pay rate of coding staff needs to reflect the study and workplace training involved to become a qualified clinical coder. At present, they are only at Administrative Services Officer level 3 (ASO3 ) in SA, and the trainee's are ASO2.The MRAU have regularly sponsored SA Health workers to do HIMAA’s Comprehensive Medical Terminology and Introduction to Clinical Coding courses, but these people do not get sufficient experience and therefore lose their skills gained. Likely recruits will often refuse to take on the training because it will involve a pay cut to take on the traineeship. Why more to an ASO2 level when they are paid as an ASO3 in most admin roles and ward clerk/reception roles.Auditors are paid ASO4 and Managers vary from ASO4 and ASO5 pay rate. Even the State Auditor is capped at ASO5.People such as myself have moved out of the coder/Coding Auditor/ Coding manager roles as you can not progress past an ASO5 in SA in the Coding Stream.The new RAH has estimated they will require an extra 9 coding staff to fulfil data requirements, and I do not know how we will be able to find them considering the current shortage in SA.Coding from home is becoming an employment preference for some coding staff.SOLUTIONSLook at increasing the ASO Classification for Clinical coding staff including auditors and Managers.From what I heard at the Summit, WA coders are an ASO4, Auditors ASO5 and Mangers from ASO6 and the State Auditor/Educator is an ASO8.Introduce a state government training program to increase coding staff in SA, where a Coding Auditor trains a group of trainees, using the same medical record (Electronic Record could make this possible), so they write the codes down and hand them in, so that the auditor/trainer only has to code the record once for the whole group and use this to bulk train a group, all at once, and discuss results with each trainee, so they are ready for transition into the workplace when competent

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SUGGESTED ACTION Section 4.2.3 1. In New Zealand, develop a rapid-implementation 2-5 workforce

development framework to turnaround the decline of clinical coder numbers and contraction of coder role and responsibilities by addressing roles and responsibilities rather than academic definition.

2. At the same time, develop a recognition in NZ of the role of the HIM to assist the comprehensive conflation of core HIM competency standards available in Australia that generate the adaptability of the HIM to workforce configuration demands within the auspice of a professional accreditation.

3. In Australia, the profession is to address with the states and territories industrial awards issues to minimise “HIMs being drowned out”.

4. Rationalise standard ASO levelling across states to prevent stigma attached to the lower rates that SA currently suffer as we are the lowest paid coding staff in Australia.

5. Increase awareness of the profession, and also of HIM roles, in SA. 6. Increasing pay rates for SA coding staff to reflect 2-3 years training

required to become a clinical coder, rather than as currently the same as other admin staff who only require on the job training.

7. Resource scholarships for undertaking coding courses for non-SA Health staff so that we can increase qualified people, who might enticed by the career if they didn't have to outlay the cost of the courses, and offering them a traineeship at the end of their study so they can become qualified.

8. Increase the knowledge at a Health Executive level in all States to ensure that they understand the importance of coding, not only for ABF funding but also for predicting future health care requirements.

4.2.4 SGD2: Career Pathways upwards and sideways – HIM specialisation and diversifi-cation

Facilitator: Christine GodkinSmall Group Participants = 16±

ISSUES and CONTEXTParticipants in this small group discussion identified several issues for HIMs in seeking to move upwards and sideways into HIM specialisation and diversification.To begin with HIMs and clinical coders tend to be typecast to work in hospitals. Moreover, because they stereotypically work in a facility’s basement, they are associated with that level of status in the organisation.

This perception can be exacerbated by an employer who does not understand the HIM role or skill set. HIMs who are underutilised by employers unaware of the extent of their skill can lead to HIM boredom and attrition

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Nevertheless entry level HIMs tend to occupy higher level positions quickly in their career. This is due to the lack of HIMs employed in vacant positions. It can lead to burnout for those younger managers with inadequate support.Issues can arise when young inexperienced HIMs are managing more experienced staff. Negative staff experience of an inexperienced HIM can lead to a negative impression of HIMs as a whole.Employers unable to allow HIMs time off to upskill and gain certifications can also add to a HIM’s boredom and frustration. A HIM upgrading their skill set can be more valuable to the organisation adapting to meet changing workforce. As a HIM progresses in their career they may start to ask themselves, “Where else can I go?”An issue in seeking other career options is the varied job titles that a HIM can be employed under and for some HIMs they may not know what those job titles can be. Searching Health Information Manager on a recruitment search may prove fruitless. In addition, with a workforce shortage of HIMs, there can be a lack of examples and mentors to follow. See section 5.2.1 for an analysis of at least 7 career avenues for entry level HIMs. Another issue that can be widespread is the availability of benefits in the public system. Ironically, the accrual of work benefits can hold HIMs back if the benefits are not portable. The non-transferability of Long Service Leave, for instance, can deter a HIM from moving out to other positions that may be more fulfilling for them and which may also meet expanding workforce configuration needs. There may be an issue in smaller hospitals for an individual if they are unable to move on and/or diversify. With a lack of HIMs available to fill roles, an employee may not be released to diversify or specialised even though they are qualified for the new role. See Cassandra Rupnik’s example of this in Section 4.2.2 (CASE STUDY 2).

This perception can be exacerbated by an employer who does not understand the HIM role or skill set. HIMs who are underutilised by employers unaware of the extent of their skill can lead to HIM boredom and attrition.

CHALLENGESRural and Remote - There are very different opportunities available in metropolitan areas versus remote. With more opportunities available in metropolitan areas, there is little to encourage HIMs to work in remote areas. While a staff member would “wear more hats” in a regional position, there are still difficulties in encouraging HIMs to work in rural areas.

Internal Competition - The majority of the workforce in hospitals is nurses. This can cause an issue for HIMs wishing to fill a non-HIM management role. They are competing with nurses for those management roles, possibly even for information management roles. HIMs need to prove themselves to senior management and show they are able to engage clinicians. Nurses may be seen as having better skills in this area and a HIM wanting to move into management will need to be prepared to back themselves. HIMs still are not well acknowledged and it will take a long time to lose the perception of the basement.

Curriculum – It is not easy for HIM curricula to keep up with changes in software technology and other aspects of eHealth development, given the time it can take to ferry changes to coursework through layers of academic governance (see Section 5.1.1 for more on this challenge).Current software in use today in health settings is unlikely to be covered in current courses. There may be even more of a lag between HIMAA Competency Standards and

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the current environment. A mechanism is needed for curricular responsiveness at both the university and HIMAA level.This case study from the Open Forum earlier in the Summit highlights the limitations a graduate HIM can experience on entering the workforce.

CASE STUDY: Male Entry into HIMFrom a male perspective one Summit delegate completed a QUT degree in 1997 and believed when he finished his degree that you could only go into coding. All 6 males he graduated with left the industry. It wasn’t until later that he learnt there was so much more to being a HIM. ISSUEGender imbalance in the professionSOLUTIONSWe need to show that there are other activities to get involved with outside coding – and encourage others to come in and to stay in. We should focus on how to get that message out. Address some of the positions that might attract males, such as the IT aspects. There has to be a greater mix of gender within the profession. Engineering and Medicine have achieved a much more balanced approach in workforce distribution between males and females. This helps in staff retention.

SOLUTIONSWe need to start at the education level and address how people “fall” into health information management.

Often people don’t know about the opportunities in health information management until they are involved with HIMs and then often find their perfect career.

There are workforce shortages in other careers. One example is the sign writers industry, which involved high school students in a program run to expose them to the industry. This can be used from a diversification perspective to show students different jobs available to a HIM (see Section 4.2.1 for 7 examples). A good recruitment strategy is needed to leverage off student familiarisation.Interdisciplinary training is a useful mechanism for generating understanding of the value of HIMs and Clinical Coders amongst other health professions at the university level. An excellent example of this is at Curtin Medical School, where interdisciplinary training (nurses, HIMs, allied health etc) is involved in the degree, so clinicians have better understanding of others they work with.For HIMs whose only immediate career horizon is the hospital setting, an informational mechanism is needed to increase their awareness of promotional opportunities upwards, diversification sideways, and specialisation and diversification available in their current roles. Such an informational mechanism would include job titles such as Privacy Officer, Research Officer, Data Analyst, Solution Architect and Project Manager. Diversification or specialisation within existing workforce configuration, or to meet new configuration demands, can retain and extend HIMs rather than leaving the profession.

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Support from an employer is vital in a HIM being able to progress and may help HIMs stay longer in their positions if there were progression opportunities available. Without employer support, the ability to diversify is decreased.Employers also need informational support to help them provide this assistance to their staff. They need to know what HIMs and Clinical Coders are capable of. Ways to encourage new graduates to work in rural areas would be beneficial. Examples could include a bursary to encourage graduates to learn all skills of a HIM and bed down those skills before transferring to a metropolitan area. A mandatory rural internship would be another strategy.

SUGGESTED ACTION Section 4.2.4 1. Need a “role model” for the HIM profession: someone who is inspirational,

really passionate about what they do and can be a champion for HIM. The champion could also spread the message that there are other avenues for HIMs (not just medical records in a basement).

2. Investigate the different paths HIMs have taken and have those HIMs write a paper or showcase their path to others in the profession, perhaps as a snapshot in a broader promotion of the profession (such as videos on websites).

3. Engage those members of the current workforce as a priority. 4. Promotion to students should be done in a way that is more attractive

and showing paths of HIMs who have diversified and followed other paths (such as IT, project management, data analysis in well-known organisations).

5. Buddy up with other health organisations to show a different side of health (as opposed to nursing, medical, allied health). Use passionate, current HIM students to showcase the profession to prospective students.

6. The provision of more diverse placements for HIM students so that they can be aware of possibilities for diversification (this is not unique to HIMs), for example into the private health insurance space.

7. Providing diverse field trips as part of courses can help show HIMs from an early stage the possibilities in their career.

8. Encourage mentoring by HIM specialists. Seek out those who have diversified to approach for mentoring if they have not volunteered.

9. Reinforce to employers as an ongoing program the constant need for on the job support programs to encourage HIMs to upskill to improve their value to the employer, both in meeting current workforce configuration but also future needs.

10. Support programs for young leaders who are HIM qualified to be act as role models for their generation, and the next generation.

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5. HIW Supply Solutions

This Section explores two solutions state governments, NSW and Victoria, have pursued to shortage in the Clinical Coding workforce in recent years, both in consultation with HIMAA, and an entry-level solution to Health Informatics developed by HISA, ACHI and HIMAA in partnership. An account of national health and information strategy in New Zealand shows ongoing neglect of the health information professional, but a synergy of reports and updates may provide an axis for change. Finally, a quick survey of some international HIW developments provides an indication of what might work in Australia.

5.1 NSW Health Clinical Coding Workforce Enhancement (CCWE) Program 2012-14

Maria Stephanou, Project Manager, Clinical Coding Training, NSW Ministry of Health

CONTEXTThe Clinical Coding Workforce Enhancement Initiative was a pilot program undertaken by NSW Ministry of Health Centre for Education & Workforce Development from 2012 – 2014, aimed at addressing the existing clinical coder shortfall in NSW, in consideration of increasing demand due to:

� Introduction of ABF � Projected increases in health separations � e-health developments

RESPONSEProgram strategies:

� Upskill existing coding workforce to a Certificate IV in Health Administration � Recruit and train new coders at the entry level Certificate III in Health Administration � Development pathway through scholarships for coders seeking to enter Health Information

Management through university courses (eg. Curtin University HIM) � Collaboration with HIMAA for first two - NSW Ministry of Health’s RTO was the training

provider in collaboration with HIMAA: � trainees at Certificate III level used and undertook the HIMAA Introductory Clinical

Coding coursework, � existing Clinical Coders seeking professional development undertook HIMAA’s

Intermediate and Advanced Clinical Coding courses. 101 existing NSW MoH Clinical Coding staff participated. Of these:

� 59 completed the HIMAA Intermediate Clinical Coding Course � 30 completed the HIMAA Advanced Clinical Coding Course � Tangible improvements were demonstrated in work performance and coding quality

� 76% reduction in coding errors � Clinical coders will engage in career development if they are provided with support from

the workplace

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It is thus clear that if the support is available, Clinical Coders will engage in professional career development. And tangible improvements in workplace performance can result.

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 � 29 are still engaged in the sector � This was a piloted state wide traineeship model, which looked at the value and achievability

of these kinds of traineeships at a state government level � The program was discontinued, but Sydney LHD elected to continue it and have done so.

SOLUTIONSCareer Path for Existing Clinical Coders

� Enrolments in HIMAA’s HTLCC401B Intermediate Clinical Coding coursework over the two year Clinical Coder Workforce Enhancement (CCWE) project (59 pax) almost exceeded HIMAA’s annual national average intake over the same period (65.5 pax).

� The same is true for HTLCC402B Advanced Clinical Coding (30 pax in NSW Health CCWE vs HIMAA’s national average equivalent intake of 34.5 pax).

� It is thus clear that if the support is available, the Clinical Coders will engage in professional career development. And tangible improvements in workplace performance can result.

Clinical Coder Traineeships � State government funded traineeships in conjunction with an RTO like HIMAA or NSW

Health can lead to the fulfilment of entry-level workforce needs.

SUGGESTED ACTION Section 5.1 1. HIMAA to work with State Governments to support a career pathway

for Clinical Coders by funding access to HIMAA’s Intermediate and Advanced Clinical Coding Courses, and the subsequent exam leading to the credential HIMAA Certified Clinical Coder.

2. HIMAA to work with State Governments to develop a funded traineeship approach to the education and training of entry-level Clinical Coders, via HIMAA’s Comprehensive Medical Terminology and Introduction to Clinical Coding course, with suitable workplace support to enable work-ready graduates and employment.

3. Advocated to State Health Departments the HIM workforce value of providing scholarships to Clinical Coders to undertake HIM university coursework, by distance education if unavailable locally, or the student’s preference.

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5.2 Victoria’s Health Information Workforce Strategy

Julie Brophy, Manager – Productivity & HIM Workforce, Victoria DHS

ISSUES/CONTEXTVictoria has a slightly different perspective to the HIM workforce management than other states because traditionally its clinical coding workforce has been drawn from the HIM occupation. It also introduced what has become ABF, Casemix, in 1994. By 2010 Victoria had many Clinical Coder vacancies, with the potential to extend coding beyond acute episodes of care. The state health department realized that to gain an appropriate clinical coding workforce, they needed to change the structure of the workforce from predominantly HIMs to a new career pathway for non HIM Clinical Coders.

RESPONSEIn 2010 the Victorian government’s Health Information Workforce Strategy commenced with a focus on Clinical Coder development.

Coding Workforce Initiatives: � 2010 – An industry advisory group determined an alumni strategy for clinical coding, and

commenced plans for a clinical coding certificate for non-HIM clinical coders. It recognized the need to understand not only clinical coding, but auditing, reporting and the other competencies which were not provided in other accredited courses.

� 2012 – Clinical Coding Educator training commenced � 2013 – A Certificate IV in Clinical Classification & Entry level training guidelines were

developed and accredited with the Victorian Registration and Qualifications Authority in 2014.

� 2015/16 - Cert IV Clinical Classification commenced delivery: � Victorian Department of Health Services are looking at the feasibility of a coding

simulator for training. � There is a definite need to look at the way coding training is delivered � Need to become smarter about the way we train � All training delivery needs to complement existing training � The industry must consider how this changes the entry level jobs for entry level HIMS

� 2015 - Health Information Workforce Strategy broadened scope (outside Clinical Coding)

SOLUTIONSSolutions identified as a result of the first five years of the Victorian government’s Health Information Workforce Strategy are:

� Appropriate training is needed for Clinical Coders � Right level has been found – Certificate IV � Content has been developed – 6 new coding subjects in the Certificate IV in Clinical

Classification, and entry level competency guidelines � Consistency of curriculum is essential – content and assessment � Method for delivery of education and training – mix of new and old methods � Recruitment – recruits need: � Realistic expectations and an understanding of the work they will undertake � Basic skills level – eg computer literacy,

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� Aptitude - attention to detail, independent worker, enquiring mind, etc. – has been found a key to on-the-job training29

� Professional experience/ work readiness will always be an issue due to local requirements and procedures, so coder educator support is essential.

� Employer role – to provide: � Workplace placements for students, traineeships in Clinical Coding, mentoring for students

and trainees � Professional development for existing Clinical Coders eg in coder education, auditing

SUGGESTED ACTION Section 5.2 1. Provide appropriate training for non-HIM clinical coders at the appropriate

level (Certificate IV in Clinical Classification). 2. Ensure recruits to Clinical Coder training have realistic expectations of

the training, understand the work they will undertake as a result, and have the appropriate aptitude for the role of Clinical Coder.

3. Employers should provide: 3.1. Workplace placements, traineeships, and mentoring for clinical

coding students 3.2. Professional development in clinical coding training for existing

Clinical Coders eg. Coder Educator, Coding Auditor Educator

5.3 The CHIA Solution

Dr Louise Schaper, HISA CEO

ISSUEPoor industry understanding and recognition of the profession.

RESPONSEThe Certified Health Informatician Australia is Australia’s first certification for health informatics/e-health. The certification was jointly developed and is now jointly governed by HIMAA, HISA and ACHI. It provides independent recognition of health informatics knowledge and skills. Launched in December 2013, it is part of a global movement to certify professionals in health informatics. CHIA was developed because the industry recognised that health informatics is fundamental to the delivery of healthcare. As such there is a need for highly skilled, knowledgeable & experienced individuals in order to successfully implement and maintain the wide range of e-health initiatives which are essential for delivering sustainable health reform in AustraliaEligibility for the credential is on the basis of qualifications and experience and passing an examination. Competency areas for the examination include: Information and Communication Technology, Health and Biomedical Sciences, Information Science, Management Science, Core Principles and Methods and Human and Social Contexts. The competencies were mapped to health informatics competencies previously developed for Australia and also to international standards.

29See Catterson P, Transitioning newly qualified coders to work readiness; HIM-Interchange,4(2):23-25

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The CHIA examination covers these six (6) competency areas, with their fifty two (52) competencies, with a selection of 104 multiple choice questions, and takes two and half (2 ½) hours to complete.With employers and funders wanting to know their employees have the requisite skills, and professionals wanting to be able to distinguish themselves as individuals with health informatics credibility, this credential is one key piece in raising the awareness of the health informatics workforce.For employers / funders, CHIA can be used as a tool to help workforce planning, service redesign and development and succession planning. Recruitment, workforce differentiation and a guarantee of effective performance are also benefits to employers, along with the quality assurance benefits the credential brings to the staff complement in health informatics There are many benefits to individuals including competitive job advantage, differentiation from your peers in vocational assessment and recruitment, an ability to transition effectively into a new health informatics role, effectiveness in the workforce, and access to an alumni network.. The benefits to the health profession are also great in being able to advance the profession’s visibility, recognition and credibility, provide greater clarity on the competencies possessed by health informaticians, consistency of education and training, and a clear basis to demonstrate competency.

CHALLENGESPromotion of CHIA is essential to its success. With 113 CHIA, 219 are registered to sit the exam. So supporting throughput from registration to examination is important. For instance, while 29 of registrants are health information management professionals (2nd only to IT professionals), only 7 of the 113 CHIA are HIMAA members. HISA provides an extensive preparation resource for examination candidates and this is recommended for all candidates. Another challenge is that the majority of CHIA from public and private hospitals. There is an identified lack in primary care, and this is an area that needs more work.

SOLUTIONSA credential like the Certified Health Informatician Australia (CHIA) provides multiple entry points for a range of occupations, including health information management professionals, clinicians, ICT professionals, and health informaticians themselves. It is ‘early days’ of discussions between Canada, New Zealand, Brazil and the US to create a global recognition of health informatics certification programs. This would mean if an individual was to move to another country and want to certify as a Health Informatician, they can take the local exam and not need to complete the whole credentialing course again.

SUGGESTED ACTION Section 5.3 1. Improve exposure of CHIA to relevant professionals, including an

understanding of personal and professional benefits. 2. Provide more information to employers on benefits for the organisation

in upskilling employees to undertake certifications such as CHIA. 3. Increase promotion of CHIA to professionals who work in primary care.

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5.4 Health Informatics - A National Health Information Strategy in New Zealand

Dr Karen Day, FACHI and University of Auckland

ISSUEThe development in NZ of a national health information strategy alongside a National Health Strategy should be a source of confidence for health information professionals. But sadly the focus is on technology and clinicians, with an assumption that somehow bringing these together will result in information management.

CONTEXTThere are a number of programs available for Health Informatics in New Zealand. There are undergraduate courses, a Master of Health Informatics (with a focus on technology) and an online postgraduate diploma/certificate in Health Sciences (available internationally).In October 2015, the National IT Board released an update a Health Information Strategy to cover the next 10 years. This has never been a mainstream approach but in the same month, the New Zealand Health Strategy Update has been released with a future direction and roadmap of actions. Of the four elements of the roadmap, one is a national ICT approach and the other is integrative care.Also October 2015, an Deloitte independent review of New Zealand’s electronic health records was released, which provided a refresh of the National Health IT Plan for EHR/EMR implementation. It is unlikely that the intensive focus of this “EHR Maturity Staircase” on information management can proceed without the central involvement of health information professionals.

CHALLENGESGovernment understands that clinical leadership is needed but there is no specific mention yet of health informatics skills. It is assumed that clinicians have health informatics skills but they usually do not. The current roadmap of actions is focused on technology and capability (not people and process) and it is preferable for it to be framed more to health information management. The deadline for consultation and feedback processes for NZ Health Strategy is 4 December 2015.

SOLUTIONSClinicians need to be provided with training in health informatics skills. A national health information strategy in concert with an ICT plan generates governance support from the top that can enable this capability to be developed, but the role of health information professionals needs to be strengthened. Ms Day closed with a Maori proverb: “It is the people, it is the people, it is the people - and they have been forgotten in all documents.”

SUGGESTED ACTION Section 5.4In conjunction with New Zealand’s Health Information Strategy, National Health Strategy and Deloittes’ EHR Maturity Staircase, there is an opportunity in New Zealand to achieve two important improvements to eHealth implementation nationally:• The training of clinicians in health informatics• The central involvement of health information professionals in implementation

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5.5 International Models

Richard Lawrance, HIMAA CEOThe 2015 HIMAA NCCH National Conference immediately preceding the HIMAA, ACHI and HISA HIW Summit was attended by members of the International Federation of Health Information Management Association (IFHIMA), who were holding their annual face-to-face meeting in conjunction with the conference. From a plenary on International Workforce Initiatives at the Conference, of particular interest for Summit delegates were two examples of workforce strategy from countries in the Asia Pacific region: Canada and Japan.

CanadaIn Canada the health information management profession has parallel workforce concerns to Australia, but with approximately 4.5 times the professional association membership. As IFHIMA President Elect Marci McDonald informed the 2015 HIMAA NCCH National Conference, amongst the Canadian Health Information Management Association (CHIMA) responses to industry needs have been to develop HIM Learning Outcomes, just as HIMAA have developed their own HIM Competency Standards. CHIMA have engaged in sector studies within their membership in order to find out what industry needs are. HIMAA similarly targeted membership segments in its 2013 membership research, leading to specific surveying on workforce issues in 2014.CHIMA have formed partnerships with the Canadian equivalent to HISA here, COACH, and with the Canadian Health Infoway, an oversight organisation for a series of change management projects in Health and eHealth. HIMAA and HISA have had a Memorandum of Understanding since 2012, and have, since the Summit, developed one with ACHI.Canada’s main problem is the ageing of the HIM population. CHIMA is forecasting a 6,200–12,200 FTE replacement need for its current population of 39,900 health informatics and information management professionals over the next five years, with age as a significant driver. HIMAA membership research in 2013 revealed the same issue.CHIMA are also, as we are, looking at advanced certifications, specialisation, diversification in the workforce, movement of HIMs out of hospitals, and risk mitigation for HIM professionals which is a growing concern for CHIM. These are all directions on which we might learn from them based on discussions at the Summit.HIMAA currently has an MoU with CHIMA to develop a reciprocal certification agreement.

JapanIn Japan, the main learning for Australia is that the certification of HIM professionals in Japan is driven by the hospitals themselves, which means that it’s driven by the employers. This means that certification is almost a mandatory requirement of employment.As the 2015 HIMAA NCCH National Conference learnt from the IFHIMA Council’s SE Asian representative, Yukiko Yokoboro, in Japan certification was first introduced in 2005 by 5 associations including the Japan Society of Health Information management and the Japan Hospital Association. The Japan Hospital Association has been offering a 2 year distance education course in medical records management since 1972. They currently have records of 45,607 graduates to date, so they have an almost comprehensive register of HIMs they continue to track either in or out of the hospital system. With the introduction of certification in 2005 (29,529 Certified HIMs to date), the potential for workforce supply and configuration analysis is impressive. But it takes buy in from the employers.

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SUGGESTED ACTION Section 5.5 1. HIMAA to collaborate with CHIMA on advanced certifications,

specialisation, diversification in the workforce, movement of HIMs out of hospitals, and risk mitigation for HIM professionals.

2. Peak HIW bodies to develop a coalition of hospital executives to support the credentialing of health information management professionals and health informaticians as a requirement of employment.

3. Peak HIW bodies to work in alliance with a hospital executives coalition to maintain an active database of credentialed HIW, which tracks their career history.

4. Feed data from this register into a national HIW monitoring and research program.

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6. HIW Configuration – Present and Future

The Summit’s afternoon session was focused on designing the future health information workforce configuration. Recommendation 4 in the HWA HIW Report 2013 was cited to set the context for the afternoon’s proceedings.

Recommendation 4 in the HWA HIW Report 2013 is:

Consider future configuration of the health information workforce. � Focus on future workforce investment in the clinical informatics workforce structure by

teams (AHIEC Level 1 and 2 workforce) whose purpose is to help answer critically important questions during the design, content development and implementation of e-health tools that relate to workflow, ease and speed of use. This may be achieved through organisational initiatives and team formation, and whose skills are obtained through undergraduate, postgraduate or workplace-based training.

� Consider future workforce structures that include clinical educators/trainers (Level 2 workforce), whose role is to train clinicians to use new systems. Their skills may be obtained through workplace-based training conducted by the Level 1 workforce, or through external continuing educational programs (such as workshops, online training modules).

� Determine whether the configuration of these workforces is optimal in productivity and training terms.

This section of the report collates Summit proceedings and comment on HIW configuration. It begins with an analysis of the HIM Gap in Recommendation 4 from HIMAA’s perspective. After examining Open Forum discussion on the curricular relationship between core competencies and specialisation, the Forum goes on to discuss the separation between the two occupations of HIM and Clinical Coder in HIM curriculum.Section 6.4 features the variation in workforce configuration already occurring as HIMs move into Primary and Community Care, and the structural capacity there for further development. The Summit then heard from three speakers on the movements of HIMs upward into leadership and executive roles. Finally, 2 out of the 6 small group discussions focus separately on the role of the HIS team in current and future workforce configuration, and the core skills the health information professional needs for future workforce fit, and a third small group examines the future workforce configuration of Health Informatics.

6.1 The HWA HIW Report (2013) on Workforce Configuration [Recommendation 4] – the HIM Gap

Richard Lawrance, HIMAA CEO

ISSUEThe major oversight in HWA HIW Report 2013 Recommendation 4 is that it fails to reference the HIM workforce identified earlier in the report’s account of the AHIEC Level 130 workforce cohort31. Health information management professionals seem quite absent from the outline

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of the future workforce configuration behind Recommendation 4. Other disciplines are also identified as part of the AHIEC Level 1 HIW such as clinical costing specialist, data analysts, decision support and health ICT, but these also seem to be absent from the future workforce configuration according to the section of the HWA report leading to Recommendation 4.There is therefore general confusion in the messaging of the Report, with omission of all identified disciplines except health informaticians from report considerations on future HIW configuration. This perpetuates counterproductive divisions between the health information workforce professions. A more inclusive and comprehensive approach to future HIW configuration will enable workforce planning relevant to future needs.

CONTEXTRecommendation 4 of the HWA HIW Report 2013 overlaps with Recommendation 6, advocating as the latter does future investment only in the clinical informatics workforce to support the design, content development and implementation of workflow e-health tools; and ensure clinical educator/trainers are incorporated to support the required workforce through workplace-based training and external continuing education programs.Health information management professionals were identified earlier in the report under the AHIEC 3-level workforce framework’s Level 1 as comprising 64% of the Health Information Workforce - 50% being Health Information Directors, Managers and Officers and 14% Clinical Coders (including Coding Educators), with the remaining 36% made up of data analysts, costing experts and health IT specialists . But when it comes to configuring the HIW in Recommendation 4, these professionals are nowhere to be found. The first level of the future HIW structure identified is the Chief Medical/Nursing/Clinical Informatics Officers (CMIO/CNIO/CCIO) and Chief Information Officer (CIO), who work in a team responsible for clinical implementation and best practice, budget and IT infrastructure. This group is key to collaboration between IT and the clinical community and is considered highly strategic to achieving the clinical objectives of the health system, with the CIO’s primary focus on operational issues, ensuring data transfer by technology and software.The second level underpinning Recommendation 4’s future HIW configuration involves a core, clinical informatics-focused team. This team would play a large part in defining and creating tools that can be successfully implemented and used in a meaningful way by clinicians. The team will answer critical questions during the design, content development and implementation phases to ensure smooth workflow, ease and speed of use.The third level would involve physician champions, super users and clinical representatives trained by level 2 team members.

CHALLENGESWhat role could HIM professionals play in the future HIW configuration if they are not even considered in the future configuration of the HIW workforce by the HWA HIW Report 2013? The voice of the broader health information workforce needs to be heard in any strategic initiatives to shape the future workforce.

SOLUTIONSThe role of the health information management profession in the health system data quality framework, form both a financial and clinical perspective, is vital to the healthcare system as a whole. IHPA suggest in a YouTube presentation on their National Hospital Cost Data Collection (NHCDC) cycle (https://www.youtube.com/watch?v=InTVzRggwJ4) that the clinical information abstracted and coded by health information management professionals can lead, through the

30Health Workforce Australia.[2013] Health Information Workforce Report:13,Figure 231Health Workforce Australia.[2013] Health Information Workforce Report:14

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ABF cycle, not just to activity-based costing and pricing but also to improvements in clinical care. HIMs and Clinical Coders are thus essential to improvements in patient care based on coded and costed data. HIMs should be involved in the full continuum of patient care (i.e. primary, community, acute, subacute, etc.) as models of care change and the health information management profession diversifies. With the many diverse and specialised paths in a health information management professional’s career, the influence of this workforce will be increasingly integral to the healthcare system. New workforce configurations are already happening, but not always for the best outcomes. Role substitution of HIMs by employees without HIMAA-accredited qualifications are considered elsewhere in this report. HIM and health informatician contribution to the adequacy of workforce supply is necessary, including how our roles are being changed and replaced by others. Collective mindfulness can lead to change for the better.

The flaws of the HWA HIW Report Recommendation 4 reinforce the call for a common voice to ensure any future initiatives and strategic directions reflect a whole-of-health information workforce perspective.

SUGGESTED ACTION Section 6.1 1. Promotion of the full view of health information management

professionals as a key component of the future configuration of the HIW workforce is needed now. HIMs and Clinical Coders are essential to any improvements in patient care based on coded and costed data.

2. The broader HIW needs to collaborate to develop advice to government that reflects strategic directions to support an appropriate HIW configuration now and for the future.

6.2 Open Forum: Curriculum – Core Competencies vs Specialisation and DiversificationDuring the Summit’s Open Form on Workforce Shortage just before lunch, the issue of the relationship between university HIM curriculum and core HIM competencies invoked strong discussion.

ISSUEShould HIM curriculum be based on the four core competency streams in the HIM degree, or should there be more flexibility to embrace specialisation and diversification?

Four Core HIM Competency Streams � Management � Health Informatics � Health data analysis (which includes research methodologies and all related activities) � Health classification (which includes all of the clinical subjects which underpin the ability

to code (eg. anatomy and physiology, pathophysiology, medical terminology and coding/classification subjects)

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CHALLENGESPerspective 1: To address the career pathway for future workforce configuration we first need to review the HIM competencies to ensure they reflect changes in industry into which the profession is moving. This should address all existing HIM competencies but also establish programs to support specialization within the university curriculum. For example, while clinical classification is a core HIM subject it may not be necessary to teach full competence in clinical coding in all university courses as not all HIMs want to become clinical coders.Perspective 2: All four core streams that are part of the traditional HIM competencies should be the mainstay in all courses so that HIMs can guarantee that unique centre of the profession to offer. Post-graduate studies can pick up specialisations.

SOLUTIONSA compromise solution suggested was that you have the core subjects and then others leading to specialisation at Bachelor level, perhaps leading to Honours. There was further discussion on what are the required core HIM skills, including soft skills such as communication skills and hard skills such as database design.It was suggested that we should move away from calling the role ‘administrative’ which many may interpret as ‘clerical’. It is a non-clinical health management role.

The HIM career pathway allows people who want to work in health, to be involved in supporting clinical practice, health planning, funding/forecasting, research and management, but not clinical care.

SUGGESTED ACTION Section 6.2 1. HIMAA to continue to review and accredit HIM courses based on the

agreed Entry Level HIM Competency Standards. 2. HIMAA to lead a curriculum review with universities on the retention

of core HIM competencies at the same time as increasing flexibility for diversification and specialisation.

3. Promotion of the Health Information Manager role as ‘non-clinical health management’ rather than ‘administrative’.

6.3 Open Forum – The Separation of Clinical Coders and HIMs in HIM cur-riculum

ISSUEDuring the Summit’s Open Form on Workforce Shortage, in contrast to an emphasis on the dominance of core HIM competencies, concern was expressed about the heavy focus on clinical coding for the profession to the exclusion of other HIM skills. Delegates commented that the need for clinical coding skills was a ‘double-edged’ sword as it has been the impetus for government to take notice of the profession due to the ABF linkage to funding. Many participants were passionate and protective of retaining the coding skill set as a core HIM skill as it underpins and distinguishes the HIM profession; others thought it could be a ‘specialisation’ of the core competency of Classification and Terminology.

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CHALLENGESThe emphasis on coding has been a double edged sword. When clinical coding was ‘discovered’ with the onset of Casemix, and now Activity Based Funding (ABF), it brought the profession ‘out of the basement’ and gave HIMs and Coders a higher profile. On one hand government is interested in the role of clinical coding in generating a clinically meaningful activity base for funding allocation. On the other hand, this leads to downward pressure on clinical coders to code for funding outcomes rather than for clinical accuracy. Conversely, this focus on the Clinical Coder role has meant that other HIM roles and skills have been a little lost in terms of perceptions about what HIMs can do. The separation of Clinical Coders from HIMs as two occupations has shown that if you do specialise, the profession allows you to. But the division between HIMs and Coders in terms of reporting lines, and the pressure on Coders to conform to funding pressures, threatens the value of both occupations in the eyes of employers. Strong views were expressed on how much coding underpins what is done elsewhere in the health system. ABF may need it, but so do epidemiologists and researchers. Hence many participants emphasised the need to not see it being taken away from any HIM degree. Others said that HIMs should become experts in ALL classifications and terminologies that are arising within the health system e.g. sub-acute, non-admitted, emergency, mental health classifications and terminologies such as SNOMED CT. Many non-HIMs working in non-acute activity sectors are making decisions about how to “classify” in areas for which there is no training in grounded classification techniques.

SOLUTIONSIt was suggested that the value of postgraduate qualifications in signifying specialisation as a post-nominal, in addition to the core HIM degree, should be promoted. The role of certification, such as the Certified Health Informatician Australasia (CHIA), should also be encouraged as this has potential to validate the professional skills and impact on hiring practices. HIMAA currently credentials graduates of its HIM-accredited degree courses who joined the Association as Certified Health Information Managers (CHIMs) and Clinical Coders who have completed HIMAA Approved Programs such as HIMAA’s Clinical Coding courses as Certified Health Information Practitioners. In addition, graduates of HIMAA’s Advanced Clinical Coding course can sit an exam to become recognised as HIMAA Certified Clinical Coders.

SUGGESTED ACTION Section 6.3The use of specialist post-nominals, both post graduate qualifications and certifications, should be actively encouraged amongst qualified HIMs and Clinical Coders.

6.4 HIW Role in Primary and Community Care

In this section, a number of examples from personal experience show how HIMs are already diversifying into primary and community care sectors, and transforming workforce configuration in these sectors as they ‘find their feet’ in a new specialisation. Two HIM researchers offer analysis of synergy between the Primary and Tertiary Health sectors that suggest structural and concrete roles for HIM in workforce configuration for the integration of health care.

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6.4.1 PCEHR from an HIM perspective

Lisa Quick, Consultant Information Innovation, Primary Health Care Ltd, presented by Richard Lawrance, Summit Facilitator

ISSUEWhat are the skills that Health Information Managers can offer Primary Care?

CONTEXTMs Lisa Quick is a HIM who was a lead product manager for a health software provider during their project to deliver to their clients, General Practitioners, Personally Controlled Electronic Health Record (PCEHR) (now My Health Record) interoperability at a level that would not only satisfy their patient information needs but also enable them to receive Australian Government Practice Incentive Program payments.

CHALLENGESA key challenge was the ability to have the PCEHR interact with various other software products in use by general practices, such as practice management systems and diagnostic support software.

SOLUTIONSMs Quick was able to use her core HIM skills in working for a health software company. The most important capability she identified that helped her was her management skills. Communication skills were also important to success in this role. Ms Quick recognised that she was fortunate to have had great early role models and mentors to help her in her career.As the lead product manager, Ms Quick would liaise regularly with all stakeholders and her ability to learn how to communicate effectively in different ways with a variety of stakeholders was key to success. From identifying the target audience to adapting the product to suit key stakeholders needs, the ability to always scout for issues, risks and resolutions was essential.Including people in the process was vital so that that issues and problems did not occur or were identified. Another lesson was to review designs so there were no complications to customers’ daily lives, and always deliver on time. Use of a clinical classification for data was stressed. While it can be difficult, it’s important for HIMs to understand classifications such as SNOMED to enable the software to interface correctly as it will lead to the best outcomes.An important factor is a fundamental, comprehensive view of the patient health record and the journey of the patient.This project showed that good managerial skills can be transferred skills to any role in health.

Ms Quick summarised, “Sitting in the middle of healthcare we are unlike other health professionals. It is our business to understand the patient, the service, the data and how it all comes together (both patient-facing and back office). A technical data integration professional may understand the data but not the patient and the patient services that come together to give us all the unique and integral parts of the electronic patient health record. That is where this profession is so unique and we could and should be capitalising on this.”

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6.4.2 Sub-acute Care in the Hospital System

Paula Love, Community-based Health Information Manager, QLD Health

ISSUEWhat do HIMs have to offer beyond the traditional workspace of the HIM, in hospital sub-acute care ?

CONTEXTHIMs are not traditionally experienced in primary/community care. In entering sub-acute care in the Queensland Health hospital system, however, service inconsistencies encountered by HIMs uncovered informational challenges.

CHALLENGESA major issue is that the Department’s corporate information system (HBCIS) does not cater for multiple records, nor enable linkage of records across multiple sites, creating challenges in how a record is tracked across non-acute settings.In addition, different identifiers for patients/clients with at each service provider across health settings, in the context of a lack of standards nationally, was also challenging; compounded by the prevalence of paper records. These could be shared where geographical proximity allowed, but not across greater distances. With community care largely beyond the funding model of ABF, it was difficult to show ‘value for money’ in terms of outputs.

SOLUTIONSIn 2009 the HIM Community Health Network was developed with community based HIM professionals around Queensland coming together and being instrumental as one voice. This group helped raise the profile of HIMs and the issues they face in primary care. The group helps its members cope with daily issues and struggles, brainstorming solutions to challenges and providing an avenue of communication upward to government agencies and bodies.The group enabled members to develop ‘workarounds’ to the shortcomings of the HBCIS which enabled staff to identify client contact with individual Community Health Centres, and drew upon a Subacute and Ambulatory Service information system developed by one Hospital and Health Service which links HBCIS records to develop a clinical activity reporting capability that may translate into ABF. Being educated on relevant new legislation is important so the group sought advice from Queensland State Archives. Legislation does not allow for the current model of care in community, so HIM involvement was needed to send a consistent message on the issues faced.

”It’s important to remain an idealist in non-acute settings or HIMs can be frustrated very quickly. Scale down and see where good wins can happen. Stay practical, flexible and realistic, and deliver a consistent message.Over time clinicians realise they need you and how much value HIMs can provide to the service.”

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6.4.4 Linking the PCEHR to Classification Systems ICPC and ICD-10-AM

Dr Julie Gordon, Research Fellow, Family Medicine Research Centre (FMRC), University of Sydney

ISSUEIt’s vital to improve the use of healthcare information in line with strategic objectives of the national PCEHR (now My Health Record (MHR). Patient health and wellbeing should always be the focus. The ideal scenario is that the patient is followed by their medical record wherever their health journey takes them. Communication, sharing and populating the MHR would occur as the patient moves from service to service. The most important part of this is sending and receiving information and being able to read and understand another service provider’s care.

CONTEXTCurrently there are multiple silos of health data, with many of limited value or not used to their full potential. One of the causes of this limited use is that each provider has their own way of entering and storing data, making it difficult to access and use the information. We collect vast amounts of data but lack the ability to change the data into meaningful health information.

CHALLENGESThe major challenge is interoperability, as different sectors code and classify data using different systems and there is limited ability to interface between the systems. Like different languages, translation is needed. While ICD-10-AM is the most commonly understood clinical classification in the hospital system, in primary care it is ICPC-2; and between tertiary and primary sectors, through the MHR, SNOMED-CT is the language of classification. While partial mapping has been done between SNOMED-CT and the other two systems, it is not complete. Local data management systems also often involve drop down selections with free text and no linkages available to other systems.

SOLUTIONThe vision is for all providers to use local terminologies at the data entry level. Then map all to SNOMED CT-AU as the interoperability level. Then the data can be aggregated using international classifications such as ICD-10-AM and ICPC-2.Semantic interoperability is the ultimate goal, where GPs, hospitals, medical specialists, allied health, community care and aged care can share information with the patient as the focus and centre of the care.Linking this information to improve the use for high risk patients is vital through integrated care programs, referrals, discharge summaries and data aggregation.

While HIMs are experts in the use ICD-10-AM, they are also best placed to understand all terminologies and classifications, data models and structures and clinical risks associated with poorly recorded information. Additionally, HIMs understand the implication if nothing is fixed.

HIMs need to participate in fixing this issue. While the ideal would be everyone speaking the same language, this would involve starting from scratch which is not very practical.

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6.4.4 Role of HIMs in General Practice

Dr Joan Henderson, Deputy Director, FMRC University of Sydney

ISSUEThere are silos of health data throughout the healthcare system and particularly in general practice.

CONTEXTWhile 85% of Australians visit GPs and generally visit once a year, and 98% of GPs have used computers since 2000, a large number do not use computers for diagnostic or medical record support. Good quality data is needed for clinical care. It’s important to recognise that health data has many uses, such as at a Primary Health Network level for chronic disease management, notifiable diseases, and monitoring adverse events.Health data is also needed for accreditation to gain access to Practice Incentive Programs and Clinical Practice Improvement Programs and to substantiate income claims. Data is also needed to plan for workforce provisions, support patient care and medico-legal requirements.

CHALLENGESThere are concerns with the quality of GP data and GP literacy has always been an issue. Many GPs are not computer savvy, have little formal training and have worked in the same practice for many years .In general practice, there are 12 different software programs with a lack of common standards. Coding and format of each program is different. If a GP moves practices, they may have to learn a whole new system. There is currently no incentive to increase their data skills, and no perceived benefit to them in improving their data knowledge and skills for ongoing clinical care information management.The volume of incoming results and correspondence in the general practice is large, with pathology results, discharge summaries and correspondence scanned and attached to records. This volume of scanning means that practices are employing staff just for that purpose. An interesting challenge for general practices engaging with the MHR will be the resulting increased workload, time constraints and how they deal with these challenges to its adoption. General practices are vital for the MHR dream and need investment in their engagement and support for the system. However in the longer term, scanning is not a solution for the essentially digital eHealth value of SNOMED-CT. Scanned data is easily lost to searchability in the clash of softwares, both on input and extraction.

SOLUTIONSWhile HIMs are generally hospital focussed in their tertiary qualifications, they are a great solution for general practices. With information and data currently not well managed, practice sizes are increasing and with the requirements of the MHR coming, practices are currently paying staff to scan. Practice managers are also employed with no health information management skills.

A HIM can provide all functions of a practice manager with the addition of medico-legal and data quality expertise. This skill set is vital for general practices. A HIM’s salary would be well covered by the currently missed revenue from Practice Incentive Program and Clinical Practice Improvement Program.

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Workforce planning is vital for general practices and HIMs are an excellent answer to provide more reliable data.The advent of Primary Health Networks means there is a huge opportunity for GPs to use classification as part of health data entry, and for HIMs to forge the regional planning link between PHNs and LHNs through quality information flow and data management.

SUGGESTED ACTION Section 6.4 1. Promote to General Practitioners through Primary Health Networks

y the skills that HIMs can offer to Primary Health Care in bringing clinical classification and information integrity to practice information management

y the general practice management and medico legal skills HIMs can also bring to a practice position

y the income the practice will gain in currently missed PIP and CPIP payments, and save on scanning

2. Advocate to Primary Health Networks how well placed HIMs and Clinical Coders are to assist in the process of classification of health data to ensure it is meaningful for information integration, particularly with local hospital/health districts.

3. Use the skills of HIMS to support a semantic interoperability role for SNOMED CT between ICD-10-AM, ICPC-2, and other software systems.

4. Support the development HIM and Clinical Coder local networks to assist HIM professionals support each other in adapting to practice in community health and general practice.

5. Raise the profile of HIM professionals and their skill sets with peak community health bodies.

6. Provide advice and support to HIMs (in recruitment phase and existing HIMs) for opportunities in general practice and community health.

6.5 The HIM Executive

In this section one senior HIM and two senior Health Informaticians speak of the current and future role for Health Information Managers in HIW configuration at the upper end of organisational hierarchy.

6.5.1 Alexandra Toth, A/Director Health Information Management Service, QLD Health, Sunshine Coast

ISSUEThere are not enough HIMs in leadership roles. With the need to manage information more broadly, the future is in moving into executive roles and the question is “Are HIMs up to it?”

CHALLENGESBeing a HIM executive is a great job. In a Director role, a broad range of issues are faced

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every day and a broad range of competencies is needed to deal with everyday issues. HIM competencies are drawn from consistently to address the quest for solutions. While a HIM executive may not have coded in some years, the understanding of clinical coding is critical to their position. Other HIM skills are also needed to take on senior management roles that often involve being an expert advisor on a range of topics. A Director with a HIM background brings knowledge across a range of areas from privacy, confidentiality, use of information and how it all works in a business context that allows them to play a pivotal to the role in the organisation. These unique HIM skills are essential for a Director of a Health Information Service. Evolving technology is always a challenge in the healthcare environment and the scope is larger with an electronic medical record involved. We are still keeping information forever and while it may seem to not be that useful, it has implications for information governance that HIMs need to be leading.

SOLUTIONSThe future is more HIMs in leadership roles. With evolving technology, issues relating to the use of information, data integrity and the life cycle of information management will create greater demand for HIM skills in leadership of healthcare. With knowledge of the patient journey, revenue, clinician accessed information, reporting, staff and research, a HIM is well placed to fulfil executive health information roles in an excellent manner.

HIMs’ training make them well placed for the future in roles in CIO/IM related executive positions.

7.5.2 Health Informatician - Philip Robinson, Treasurer HISAPhilip is a former Health Service CIO with responsibility for Health Information Management

ISSUEWhether the role is running a large project in a large hospital or implementing electronic medical records, a HIM is needed. Setting up and running a clinical data warehouse or managing privacy and health records, a HIM is needed. Even being involved in a major accreditation survey, a HIM is needed.

CHALLENGESHIMs are needed in a wide variety of roles, including in executive roles. The variety and ability of a HIM has been shown often. There are some great examples of how HIMs have been involved in large projects, including leading large and innovative electronic medical record implementations. Other examples are HIMs in roles such as Knowledge and Information Officer and Director of Information Management.While Casemix has been implemented in Victoria for over 20 years, new roles are still emerging such as documentation improvement specialists. Responsible for ensuring that documentation is correct and millions in revenue is not lost, this is a great example of what a health information manager can do working directly with clinicians. Clinical coding can bring HIMs into a high profile as dollars are vital to a CEO of an organisation.A HIM is key to all roles in workflow so HIMs need to understand this workflow. Post graduate qualifications are also needed to be employed in higher positions. CHIA

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(See Section 6.3) is an example of a postnominal created by a collaboration of HISA, ACHI and HIMAA that is recognised by hospital executives. A number of HIMs have attained this certification with relative ease. As a postnominal, CHIA adds value to a HIM’s career potential.HIMs morph into a variety of roles. It is important for the HIM profession not to neglect the very valuable skills that HIMs have.

SOLUTIONSWith revenue being vital to management and executives, we should be using HIM and Clinical Coding skills to gain recognition and profile for the profession in health care.

Encouraging diversification and specialisation will assist to lift the professional profile. Showcasing exemplar role models as examples would provide hard evidence and inspire others.

6.5.3 Adj Assoc Prof Klaus Veil, President, ACHI

ISSUEHIMs are necessary everywhere. If people don’t know how to manage privacy and data retention requirements, this spells trouble, especially in private health. Getting it wrong has big consequences.

CONTEXTQuestions of where to go in relation to workforce is relevant to the broader community and not just to HIMs.Some HIMs may not have formal qualifications but do have experience. Conversely, some integration architects have excellent information management skills.La Trobe University provides a common year with a good grounding in IT. At Western Sydney University, there are 800 ICT students and HIM is a subspecialty which provides a strong grounding in IT for future HIM graduates of this course.Because of the management angle HIM courses provide, HIMs are forward looking.

SOLUTIONSThere is a large number of qualifications available, from universities to HIMAA, including certifications. In Health Informatics, being a Certified Health Informatician Australasia (CHIA) provides a generally recognised credential.Talking to government is particularly important as they fund healthcare. An HIW accreditation and certification framework needs to be part of that.

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SUGGESTED ACTION Section 6.5 1. Promote continuing education for HIMs to take up leadership roles. This

may be in the form of credentials (CHIA, CHIM, CHIP, CCC), Continuing Professional Development workshops and conferences, or Masters courses.

2. Retain clinical coding as a component of every HIM course. Keep a wide range of competencies in courses to equip young leaders with the skills they will need for the future.

3. Use exemplars as role models to show HIMs and Clinical coders how they can project their roles into the spotlight.

4. Provide a budgeted proposal to government to create accreditation and certification frameworks in HIW, and ensure concepts and recommendations are easily understood by non-health information professionals.

6.6 SGD 1: Organisational Structure and the Role of the HIS Unit – HIMs and CCs, role

substitution, and other industrial issues

Facilitator: Cassandra RupnikSmall Group Participants = 16±

ISSUEThe group was asked to consider the following issues:

� What are the key functions and responsibilities of the HIS Unit today? � Where does the HIS Unit sit within the hospital structure? � What will the key functions and responsibilities of the HIS Unit look like in the future (5

years, 10 years)? � Who makes up the HIS Unit of the future, e.g. HIMs, CCs, health informaticians, data

analysts, privacy specialists? � What support is required to get from current state to future state?

CHALLENGESCurrent Key Functions & Responsibilities of HISHealth information services (HISs) have generally provided the same functions for the past 25 years. The general example of what HISs currently do in the hospital setting relates to the traditional operational functions and varies depending on the size of the organisation. The roles have expanded from the 1990’s to providing advice on how to manage health information, including:

� Business case development � Record Management � Electronic Medical/Health Record � Coding/ Classification Knowledge � System Management& Support

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� Data Quality � Process Management � Training – Coding , Clerical , Clinicians and Executive � Human Resource Management � Advisory – Policy interpretation and development � Health Fund negotiation ( Contracts) � Contract Negotiation

Current reporting responsibility in organisational structure includes:Organisational structures vary with no definitive organisational fit in the hospital setting that HIMs agree upon, with executives also having varying opinions. Of participants in the group discussion, three were reporting up through Finance. This reportedly works well for ABF/ Coding and Data Quality and is the result of ABF and a focus on revenue from coded data. The impact of this on the HIS unit in the long term was queried. Others reported under a broader Corporate/ Finance structure. One participant was a Director – Information Strategy (architecture/ strategy/ IT projects). Other reporting lines were to:

� Clinical Governance; � General Manager � Casemix; � Medical/ Clinical Services; � CIO; � Clinical; � HR

This range of reporting lines would indicate that consistency in HIW configuration within a health facility may be challenging to identify. Vacancies, poor response to job ads and inability to attract staff were cited as significant recruitment issues in identifying current workforce configuration.Issues currently exist with existing award structures that vary between jurisdictions and are not in line with what HIMs do nor reward experience and expertise. Award structure disparity will also influence variation in workforce configuration. This will be exacerbated in the future.

Adopt an enterprise wide service mentality. Who you report to doesn’t matter so long as you are understood for what you offer the business.

What will the future HIS look like?The view of the discussion group was that HIM expertise will still be required in the future for areas such as data governance, policy advice and data management. Information management and data governance will be core functions. Skills in classification (i.e. coding) will still be required, however the option to code from home will be extended.Health services will still be scanning documents, but there will be more eMRs, placing a greater focus on data quality and the challenges of managing a ‘Hybrid’ medical record.Continuing learning will be required. This will need to cover areas such as integrated care and a focus on managing a digital medical record. Post-nominal recognition of education and training

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was queried – what role will it play in future HIW configuration?Industrial awards will need to be reviewed and consideration of accreditation/credentialing of professionals.There will be greater need to work with external providers of health care such as GPs and find cost efficiencies.The concern however is that health services’ strategic plans do not address all these issues.

HIS In 5-10 Years?Smaller space but still dealing with paper!!! Not completely digital/electronic.There will be a need to move away from in-house to cloud based services with decreased costs. Technical IT skills in-house will then be less important. However the skill set needed to manage this future does not exist and there will be a need to buy in skill sets and increase the Health Informatics workforce as we move to an IM organisation. This will require more involvement with IT, management and clinicians and more focus on data governance, audits and reviews. HIMs will need to become part of a multi-disciplinary team implementing eHealth.The demand will be for a higher skilled workforce, with less lower skilled and HIMs with health informatics skills in demand. Barriers to this future are that HIMs are bogged down in implementing EMRs and many lack interest to move to new roles or develop new skills as they want to retain traditional roles. New graduates however want to change the career pathway with many not opting for traditional roles. Non-HIMs managing HISs may increase as others can manage staff. The skill set of a HIM needs to be broader than just staff management as these roles and the need to manage clerical staff will decrease.Coding will focus more an editing, data verifying and quality checking role, predominantly based on digital data and potentially automated components. Future areas of work demand include the MHR, eHealth and data analysis, including managing and gaining insights from big data. We should also be considering the Asian market as part of our space.

� Don’t stand still – gotta keep learning! � “Invisible qualifications” – provide career paths for transitioning to health

informatics. Putting your hand up and saying “I can manage this for you!”

� HIMs have an opportunity to work with data scientists to gain benefits from the wealth of health data.

� Create points of difference that you can offer.

SOLUTIONSThe future HIS will need to continue to evolve to provide services beyond traditional functions of medical record and staff management to cover supporting data governance, policy advice, data management, information management, digital record management and eHealth adoption. HIM management skills will need to evolve to work with a broader range of stakeholders in a multidisciplinary approach with a greater emphasis on health informatics skills. To survive and be beneficial to the organisation HIMs will need to CREATE POINTS OF DIFFERENCE!They will also need to advocate for change and be solution enablers who can develop business

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cases that show return on investment; for example, spending on coding and audits that can improve financial returns, or adopting eHealth solutions that provide better clinical outcomes. Strategic planning is required to realise these benefits.Award structures need to be reviewed to allow staff to ‘move up’ a level if they achieve certain competencies or certification. A requirement in HIW awards for certification should be investigated. This would assist in strengthening the professional standing of HIMs and provide some consistency and confidence in the qualifications. It would also strengthen HIMAA the profession’s association, but would come at a cost.Quantifying the importance and impact of the classification function would benefit EBA negotiations and future employment for clinical coders e.g. revenue impact to provide the value proposition for improving the clinical coder training and employment conditions. Similarly, quantifying the impact of HIMs in eHealth implementations would provide evidence of the need for their skills.

SUGGESTED ACTION Section 6.6 1. Prepare the health information management professional for:

y Coding from home y Coder focus on digital data - editing, integrity, quality y Managing the hybrid scanned/digital record y Integrated care with external providers eg GPs y Move from In-house to Cloud-based IT support y The IM rather than IT organisation y Increased Health Informatics demand on HIMs y MHR, eHealth, data analysis, big data, and the Asian market

2. HIM education and training in semantic interoperability, information security, data analytics and analysis.

3. HIMAA to champion review and alignment of awards to enable clear career milestones for HIW, and incorporating certification/credentialing of HIW professionals and accreditation of their qualifications.

4. Research the value proposition to create points of difference for the HIM profession.

6.7 SGD 4: Future Workforce Configuration and the Role of HIW – What core skills does the health information professional need for fit?

Facilitator: Julie BrophySmall Group Participants = 16±

IssuesThe group was asked to consider the following issues:

� What skills will employers be looking for in the future? � What are the new opportunities? � HIMAA has developed entry level competency standards for HIMs.

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� Are all these valid for the future? � Are there areas of competency that will be less/more important, not needed or the level

of knowledge required changed? � Are there any new competencies we will need to develop? � Specific areas of debate include:

y Coding y Health Informatics y Health Sciences

� Will all graduates need to cover all the competencies – or specialise?

CHALLENGES

What are the core skills of the future for HIM professionals?The group initially asked the question as to whether the current HIM competencies sufficiently equip our professionals, both currently and futuristically, across a broad range of industries and changing work environments. The flavour of the group discussion lingered with informatics, classification systems and data analytic roles.

Data ScientistA name change was proposed to “Data Scientists” or “Data Change Agents” with active discussion about the HIM’s role as an information specialist rather than pure data specialist. It was proposed that HIM skills should move in the direction of becoming specialists in ontology (i.e. specification of a conceptualisation, in this case related to data concepts) and greater involvement with Big Data, data science, modelling, governance, semantic interoperability and managing data integrity through the connectivity between systems. The title “Data Scientist” however implies a strong mathematical basis, hence some group members were concerned that this may not be an appropriate future direction.

Current RoleThe question was asked: how do these skills align with and evolve from the current recognised HIM skill set of Health Sciences, Management, Communication and IT?

The important role a HIM can play as a communication specialist between informatics specialists, executive stakeholders, clinical staff and frontline system operators was raised. It was recognised that HIMs have a good understanding of data and data definitions but do not consistently integrate this knowledge within the context of changing technology.

The need to move from technologist or technical specialist to strategist in HIM roles was acknowledged.

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Core skills identified for HIMs of the future included:

Existing Core Competencies New Directions

Classification (Coding) Ontology

Management Data Science

Financial Management Modelling (big data)

Research Method Management/Professional agility

Information Management Governance (IM)

Knowledge Management Semantic Interoperability (Data/Management Perspective) Communications

Health Science

EVOLUTION FROM:

Health Information Manager ► Health Data Scientist

Technologist ► Strategist

Manager of Staff ► Manager of Content

Health Data a Requirement ► Health Data an Asset

SUBSEQUENT INPUT”I wish to promote the importance of maintaining the four pillars of HIM competency - management, informatics, data analytics and classification as core to the HIM skill set. Erosion of even one of these skill sets reduces the uniqueness and capacity of the HIM to contribute as successfully to the health workforce as they currently do. Graduates must have mastery of all of these when they graduate, even if they choose to specialise in post-graduate education in later working life”. HIM delegate

Clinical CodingMuch discussion took place about the clinical coding function. The lack of value attributed to the coding profession was a concern. There was also comment that doctors code in some countries, although the quality is questionable. There was also the future possibility of automating some of the coding process.The introduction of clinical coder training through a Certificate IV level pathway was discussed. Concerns were that this level of training undermines the complexity of the coding skill or a “dumbing down” of a highly skilled workforce (especially in Victoria which is predominantly HIM trained). VET level workforce entry also threatens potential pay rates of tertiary qualified HIM graduates who obtain coding roles. For example, if a CEO has the choice between a cheaper certificate coder compared to a University graduate for a coding role, when the professional organisation is advocating Certificate IV training as appropriate, why would they pay for a more highly qualified professional? It was also noted though that current HIMAA training is below

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Certificate IV level and does not result in a recognised qualification. This is a very real issue that has many implications for the future workforce. It should be noted that, since the Summit, the introduction by HIMAA of a national 22274VIC Certificate IV in Clinical Classification by online learning substantially addresses this concern.

Vision NeededThe group discussed the limitations and barriers to working with an eMR implemented at a state level, rather than broader integration at a national level. Experience was cited from other countries that adopt a Clinical Document Model with data schema and interface standards that allow interoperability between systems. The group was clear that we will see the HIM role morphing over time into a new identity in response to the changing informatics landscape of industry and the broader needs and demands of the health sector. Further discussion, agreement and creation of that dream with ensuing visions are needed to guide that in a suitable direction.

We need a vision for the future HIM profession and evidence of the value proposition

SOLUTIONSRegistration was seen as one way of future proofing the exsting health information management profession - develop a system similar to nursing where different levels of qualified professionals are recognised according to their qualifications and experience (eg. Certificate coders equivalent to SENs, tertiary qualified HIMs equivalent to tertiary qualified nurses etc).Very clear outline of the benefits HIMAA provides for its members to encourage improved membership numbers.Marketing and advocacy from HIMAA to advance the HIM profession in the health sector through engagement with professional organisations, publications and active research on contributions of HIMs to the health workforce (in all of its many and varied forms).

SUGGESTED ACTION Section 6.7 1. Transition strategies from technologist to strategist, information

management to information specialist, data analyst to data change agent, management of staff to management of content – establish professional alliances and framework to facilitate transition.

2. Vision and value proposition – selling the value of the profession by raising its profile with Government, Corporate, University, Unions, Employer and Health Care System stakeholders.

3. Research to support the value proposition eg. research in the Nursing profession demonstrated better patient outcomes if the ratio of RNs to ENs was higher.

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6.8 SGD 6: Health Informatics

Facilitator: Adj Assoc Prof Klaus Veil, President, ACHI

Scribe: Karen Day, Uni Auckland

Defining future role/sDifferentiating between HIM and HI. The Group briefly discussed this, and concluded that there is much overlap of the workplace activities of both and the different naming of the roles can be confusing to the uninitiated. There is one significant point of difference between the two as HIM focuses on clinical coding, while HI has a much broader scope, which also includes the blending of clinical, computer and business sciences. Ultimately the career paths of the two may converge. What is this thing called the HIM/HI role? New people entering the HIM/HI workforce are faced with a heavy workload (not enough resources) and the demands of ‘wearing many hats’ to get the job done. There is a clinical demand for informatics. In contrast, not many understand how a HIM/HI role could meet that demand. There are transferrable skills from a number of other qualifications, but this in itself is not enough to fill a HIM/HI role. There appears to be a mismatch between the universities that educate and qualify HIM/HI people and many employers who do not necessarily see the need for tertiary qualifications as they see still it as a “learn-on-the-job” role that extends a basic qualification such as computer science or business degree).

CHALLENGES Communicating about HIM and Health Informatics is traditionally not done well. Who is not ‘promoting’ and who is not ‘getting it’ about HIM and HI? Employers are not yet expressing HIM and HI jobs using the language of these two groups, nor do they appear to value tertiary education about them. Employers are still looking for software developers, business analysts, clinicians (usually doctors or nurses) who are interested in the ‘geeky’ world of health IT. Tertiary education programmes are undersubscribed for HIM and HI qualifications, resulting in small classes, under-resourced teaching and employment and risking discontinuation of programs by university management. Although employers claim that HIM and HI trained people are highly valued, they do not advertise/recruit using these terms. So are they really aware of these qualifications and what they mean? There is the notion that people who work in HIM or HI roles are typically introverted and uncomfortable being ambassadors for the profession. Also, jargon is a barrier especially when managers and clinicians use their own terminologies and HIM/HI jargon is added to the mix. Many HIMs/HIs are not equipped in their training or work experience with skills to communicate what they are doing and how their training supports their work. The group concluded that many employers, recruiters, strategists, managers and other decision

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makers about healthcare resources and delivery do not know enough about HIM/HI to make sound judgements about the value of the HIM/HI contribution. Context. The complex context of healthcare is counter-intuitive for HIM and HI development in the health sector. It is expected that a multidisciplinary team delivers health and care services to populations and individuals, but HIM and HI professionals are not considered part of this team. In some cases HI/HIM is recognised as part of a clinical context, e.g. laboratories, but in most contexts it is separated. This causes problems with implementation of information systems resulting in failure. It also promotes traditional silos, with HIM/HI as a silo, and possibly even more on the periphery than other services, e.g. allied healthcare. It is too easy to separate IT from health, instead of integrating the two as a single mode of working. We believe HIM/HI should fit into the whole health system, as an integrated identity. National strategic activities that involve health IT appear to largely ignore trained HIM/HI resources. In Australia this is worse than in New Zealand, where consultation is more widely practiced. Money, resources and evaluation of initiatives is limited, raising the risk of failure to implement and use HIM/HI skills, resources and tools well. As a consequence, there is a poor history of implementation of information systems in health in both countries, and patchy development and use of HIM and HI skills. More contractors are likely to be used for their expertise but that expertise is not local, nor is it contextual, i.e. their understanding of the health system as a whole and in particular is not strong enough for successful implementations. This is further exacerbated by the lengthy and convoluted procurement processes used by government and private health services alike. Education. Nowhere, at the time of the Summit, was HIM/HI as a field being taught to undergraduate doctors, nurses or allied healthcare workers. Postgraduate programmes appear to be diminishing in scope and size in Australia and only growing slowly in New Zealand. There is inadequate provision of Continuing Professional Development education in both countries. This will become critical in the future.Training for other countries was raised as a form of lost resource. Universities recruit international students as part of their strategic reach while domestic graduates may leave the country looking for better opportunities elsewhere. Both compound the issues of an inadequate HIM/HI workforce.

SOLUTIONS Clarifying the HIM/HI role. A multi-faceted approach could be used.

� Integrate the basics of HIM and HI into undergraduate clinical training, at the very least introducing the roles and their contributions to clinical care.

� Develop a strong communications plan that � Outlines what HIM and HI are, and how they contribute to the healthcare sector � Equips employers to recruit personnel to their actual needs � Equips trained HIM and HI graduates to express what they are capable of and how HIM

and HI contribute to healthcare delivery as part of integrated health and care � Identifies role models.

� Universities to clarify what they teach, and form close collaborations with employers. � Universities and employers to explore internships in the broader sense (some are already

being done, but internships can be leveraged more strategically and usefully to meet mutual needs).

� Consider merging “Health Information Manager” and “Health Informaticist” into one title to enhance the clarity of description and purpose of the role. This was not discussed in depth but would merit future discussion.

Form a collaboration network. The aim of this would be to integrate HIM and HI into the multidisciplinary teams in services, to incorporate them into management teams, and to include

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them in planning and funding decisions. This would take the form of � Membership of senior HIM/HI personnel of clinical governance groups � Development of clinical and HIM/HI networks that leverage shared/transferrable and shared

skills/knowledge to address national and regional issues. This already exists to some degree but needs to aim for a well-balanced multidisciplinary mix when strategic decisions are made.

� Build HIM and HI personnel into the multi-disciplinary healthcare teams, i.e. we should have doctors, nurses, allied healthcare professionals, managers and HIM/HI members in the team. This is easier to achieve on the project level, but also needs to be achieved on the everyday level, e.g. ward grand rounds.

Broaden the scope and levels of HIM and HI education. Some universities are doing this well, e.g. La Trobe and Western Sydney teach a common year in computer science and HIM. Integrate the basics of HI and HIM into clinical programmes rather than offering computer science general education courses or how-to-use-software sessions in clinical placements.Lobby universities to provide more postgraduate programmes in HI and HIMLobby employers and the government to recognise HI and HIM as part of multi-disciplinary teams and integrate the HI and HIM roles into the health and care context (and remove any silo-related behaviours and policies).

SUGGESTED ACTION Section 6.8 (needs more detail) 1. Clarify the roles of Health Informatics and Health Information

Management. 2. Collaborate and Communicate – demonstrating the value of HI & HIM. 3. Integrate HI & HIM into Clinical Education and Training. 4. Provide a budgeted proposal to government to create accreditation

and certification frameworks in HIW, and ensure concepts and recommendations are easily understood by non-health information professionals.

The call to action from this breakout group was to ‘get out of our comfort zones’ and never forget that all that we do is ‘about the people we serve, patient outcomes and great health care for all’.

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7. Unified Voice – The Action Imperative

Two linked discussions emerged strongly from the Open Forum that concluded the Summit’s morning presentations on workforce shortage. One of these was a discussion on the need for a national capability framework to future proof existing roles in future workforce configuration. The other was the need for a unified HIW voice to ensure carriage of actions to future proof the health information professions.

7.1 Open Forum – Capability Framework

CONTEXTThe Open Forum began with a discussion about the need for workforce data to address workforce shortage. This led to the need for definitions of what would constitute the roles making up the workforce. After a strong ensuing exchange between delegates on the need to base workforce analysis on competencies, and to ensure core traditional HIM competencies versus the need to diversify and specialise within curriculum, discussion moved to the use of qualifications to form a capability framework instead of definitions.

ISSUEHow do we future-proof the existing health information professions so that we can depend upon them as the building blocks for future workforce configuration? Is a capability framework the answer?

DISCUSSIONDelegates argued that roles and functions will constantly change to meet the emerging needs of organisations in the age of eHealth and ICT growth. One delegate pointed to a successful framework of roles and functions that responds to workplace change and organisational requirements that had been used to define the nursing workforce. Linking the framework to industry accommodates differing levels of responsibility, evolving and existing job roles and varying organisational sizes and profiles. Other delegates argued for a capability framework based on core competencies and thus linked to qualifications. The aim should be to future proof the workforce by linking the qualifications to topic/content areas and responsibilities. The use of industrial awards was also considered to define positions as these are generally based on qualifications (professional competencies) and endorsed by professional bodies. However, awards differ from state to state.Delegates felt knowledge based in the current workforce and existing literature could be used to develop the framework, and existing roles could inform the content of the framework in addition to the competencies/qualifications axis. ACHI Member Dr Evelyn Hovenga spoke to delegates of an existing capability framework for an Information Age developed by the Skills Framework in an Information Age (SFIA). This framework identifies the roles and functions needed of individuals based on the actual requirements from an organisation-wide perspective. The SFIA framework has a knowledge base built on a literature review, and provides a very good overview for Health Informatics and Health Information Management. Use of a framework will identify the whole array of Job and Person Specifications (JPSs) for individual roles/ functions per size and type of organisation. She advised the health information professions could future proof workforce definitions by way

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of such a capability framework. If we work on a globally collaborative basis, then we can draw on global research as well as local. A framework like this can be used for performance and quality management. Position descriptions can be completed by the professional associations.

Future proof workforce definitions by way of a capability framework. If we work on a globally collaborative basis, then we can draw on global research as well as local.

CHALLENGES Challenges considered by Summit delegates were the low visibility of the profession, and the need for the three professional organisations presenting the Summit - HIMAA, HISA and ACHI - to reach agreement of the core skill set* shaping the HIM/HI identity as a starting point for any capability framework.

SUGGESTED ACTION Section 7.11. The Peak health information bodies to: 1.1. Affirm agreement on the core skill set shaping the HIM/HI professional

identity as a starting point for any capability framework 1.2. Work with the professions and stakeholders to determine the appropriate

capability framework needed to future proof the professions eg. one based on roles and responsibilities or on competencies and qualifications

*The three peak bodies are concerned point out that there are already core competencies established that shape the HI/HIM identity. The CHIA, for instance, is based on 52 competencies agreed by the partners, and HIMAA’s Entry Level HIM Competency Standards consist of 127 individual competency tasks in 9 domains of knowledge/skill. The latter have been responsive to changes in industry and education since their introduction in 1992.

7.2 Open Forum - Unified Voice

CONTEXTWhile the Forum was discussing the need for definitions of workforce roles in order to research the health information professions’ workforce needs, one delegate suggested ‘reaching out’ to other supportive professional groups such as the Australian College of Health Service Management (ACHSM) to form an alliance.

ISSUEThis suggestion was not pursued until another delegate followed discussion of a capability framework with the ‘left of field’ observation that there were three professional associations represented at the Summit, but there would be constant delineation between them, a sense of professional rivalry, of silos, unless the peak bodies worked more closely together.

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People like to label. We need to see blending of roles, an image change from HIM and HI to health information professionals with diversification. And create a council to present a strong, unified voice for the three organisations.

SOLUTIONA test for consensus in response to this suggestion occurred in two steps. The first test was for consensus on the idea of a unified voice. There was unanimous support in the room for this, and delegates were informed that MoUs already existed between HIMAA and HISA, and HISA and ACHI, and that a HIMAA~ACHI MoU was in negotiation. Moreover the three peak bodies had been issuing common media statements on PCEHR/My Health Record policy and governance for the past 2 years. The second test for consensus was on the idea of a Council of the three organisations, HIMAA, HISA and ACHI, and while there was strong support for this in the room, consensus was not unanimous.Anne Ritchie, Health Librarian and Convenor of the Health Libraries Australia (HLA), the national health group of the Australian Library and Information Association (ALIA), commented that we were all in the business of healthcare. All have a unique skill set. HLA have an MOU with HISA and are looking to make one with HIMAA. Workforce advocacy needs a co-operative approach to progress. HLA wants to be in the tent. ACHI President Klaus Veil also spoke in favour of an overarching body. He reiterated variety in role preferences amongst HIMs present, from those who valued their clinical coding education, to those who want to be able to specialise in HIM and lose the clinical coding part of classification as a mandatory subject. He highlighted the differences between pay scales and structures, differences between States and Territories that create a threat for the HIM profession. All of these conversations call for an overarching structure and a common approach, Adj Assoc Prof Veil told Summit delegates. He reiterated the HLA interest in a united voice, and recalled the mention of the ACHSM earlier in the discussion.

We can’t be divided by definitions. Don’t let’s be split up, because we will suffer. An overarching body can unite us in getting on with workforce building and not worry so much about state and territory differences. Work towards a common approach, and let the states and territories work out the details.

SUGGESTED ACTION Section 7.2The Peak health information bodies to work together with other allied bodies to form a unified voice for health information workforce

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7.3 Action is ImperativeOne of the last comments from the morning’s Open Forum came from Jill Burgoyne, a senior HIM working in the Northern Territory with NT Health. Jill has worked in the NT for many years. She believes it is important to get research happening, and at the coalface level information and research can go hand in hand. There is a small HIM workforce in the NT - about 20 people - who have learned to work together to move forward. Jill’s observation over the years is that HIM and clinical coding qualifications are recognised by NT Health, “but if we don’t have skilled people who are HIMs/ coder, the positions that we have traditionally held, that means others will move into them.”Jill reconfirmed the importance of Clinical Coding in HIM. “This is our specialist skill and with ABF means remuneration has improved. We can’t afford to let others take or roles. At the same time, we need to be responsive to the job market by having a broad array of skills across many facets of competencies.”

This is a remote perspective. The research can happen but it also needs to. Unless we move and stop talking our roles will be assumed by others. Don’t delay! The caravan will move on! – Jill Burgoyne, NT

The final comment of the morning came from ACHI’s Dr Karen Day, from the University of Auckland.

We need to be wary of stereotyping. We need our own Vision. Why not crowdsource a dream? Why don’t we create our own dream and vision of what we want to be, let us determine what this will look like – then tell others. Make it happen! – Dr Karen Day, NZ.

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APPENDICESAPPENDIX 1: HIW Summit Program, 30 October 2015.APPENDIX 2: Glossary

APPENDIX 1: Health Information Workforce Summit Program

30 October 2015, Docklands Cockle Bay Plenary Rooms, Darling Harbour

Morning Session 10.00 am – 12.45pm – Addressing the Health Information Workforce Shortage

10.00am Welcome and key findings from HIMAA NCCH conference Workforce stream.

R Lawrance (Facilitator)

10.10am Health Information Workforce – the Need for Data[HWA HIW Report Recommendations 2, 5 and 6]

J Gilder, CHIM and HIMAA Senior Vice President

10.20am Health Information Management Professional – Career Pathways

Julie Brophy, Chair, HIMAA Workforce Working Group

10.30am HIM Supply – the Universities’ Challenge Merilyn Riley, La Trobe UniversityMaryann Wood, Queensland University of Technology

10.40am Health Informatician Supply Adj Assoc Prof Klaus Veil, Chair, ACHIKaren Day, FACHI & University of Auckland

10.50am The CHIA Solution Dr Louise Schaper, CEO, HISA

10.55am Clinical Coding Workforce and Recruitment Vicki Bennett, HIM Consultant

11.05am Some recent Clinical Coding Recruitment Solutions

� HIMAA’s Clinical Coding courses � NSW Health CCWE program 2012-14 � VIC Health’s Health Information

Workforce Strategy 2010-15

Lyn Williams, HIMAA Education ServicesMaria Stephanou, NSW Health Centre for Education and Workforce DevelopmentJulie Brophy, Workforce Innovation & Reform Unit , Victorian Department of Health & Human Services

11.20am The Formation of the Health Workforce Principal Committee’s Health Information Workforce Working Group.

Dean Raven, Director of Heath Workforce, Victorian Department of Health & Human Services, Chair HIW Working Group of HWPC AHMAC

11.25am Refreshment Break

11.45am Forum – HIM, Clinical Coder and HI Workforce Solutions?

� Need for ongoing research on workforce need

� Industry basis for workforce supply � Capability-building in supply � Other?

Facilitator (R Lawrance)

12.45pm Lunch

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Afternoon Session 1.30pm – 4.00pm – Designing the future health information workforce configuration

1.30pm The HWA HIW Report (2013) on workforce configuration [Recommendation 4] – the HIM Gap

R Lawrance, CEO, HIMAA

1.40pm HIM role substitution Cassandra Rupnik, NSW Branch President, HIMAA

1.45pm HIM Role in Primary / Community Care

� PCEHR from an HIM perspective Lisa Quick, Consultant Information Innovation, Primary Health Care Ltd.

� Sub-Acute Care in the Hospital System Paula Love, Community-based Health Information Manager, QLD Health

� Linking PCEHR, ICPC and ICD-10-AM Dr Julie Gordon, Research Fellow, Family Medicine Research Centre (FMRC), University of Sydney

� Role of HIMs in General Practice Dr Joan Henderson, Deputy Director, FMRC University of Sydney

2.05pm The Future Configuration of the HIW

� HIM Executive Alexandra Toth, A/Director Health Information Management Service, QLD Health Sunshine Coast

� Health Informatician Philip Robinson, Treasurer, HISA

� Health Informatician Adj Assoc Prof Klaus Veil, President, ACHI

2.20pm

Afternoon tea served

during session at

3pm

Small Group Discussions – the evolving role of the health information professionals in HIW configuration

1. Organisational structure and the role of the HIS unit – HIMs and CCs Role Substitution and other industrial issues

Cassie Rupnik, NSW Branch President, HIMAARapporteur: Catherine Garvey

2. Career pathways upwards and sideways HIM specialisation and diversification

Christine Godkin, HIM Recoveries Specialist, Lorica HealthRapporteur: Kim Campradt

3. Recruitment – how to attract entrants to the profession

Merilyn Riley, Course Coordinator HIM, La Trobe UniversityRapporteur: Bhavna Sehgal

4. Future workforce configuration and the role of the HIW in managing and applying classifications and terminologies – what core skills does the health information management professional need for fit?

Julie Brophy, Chair, HIMAA Workforce Working GroupRapporteur: Jenn Lee

5. Workforce configuration - data gathering and monitoring

Dr Kerryn Butler Henderson, Course Coordinator, Master of Health Information Management, UTASRapporteur: Stella Rowlands

6. Health Informatics Adj Assoc Prof K Veil, ACHIScribe: Dr Karen Day, University of Auckland

3.20pm Whole Group Feedback Facilitator (R Lawrance)

3.50pm Summary Richard Lawrance, CEO, HIMAA

4.00pm Close

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Rappporteurs:Kim CampradtCatherine GarveyNina LeanJenn LeeStella RowlandsBhavna SehgalLinda Westbrook

APPENDIX 2: HIW Report Glossary ABF – Activity Based FundingACHSM – Australian College of Health Service ManagementADHA – Australian Digital Health Agency (formerly Australian Commission for eHealth)AHIEC – Australian Health Informatics Education CouncilAHMAC – Australian Health Ministers Advisory CommitteeAIHW – Australian Institute of Health & WelfareALIA – Australian Library and Information AssociationAQF – Australian Qualifications FrameworkASQA – Australian Skills Quality AuthorityCCC – HIMAA Certified Clinical CoderCHIA – Certified Health Informatician AustraliaCHIM – Certified Health Information Manager (HIMAA)CHIP – Certified Health Information Practitioner (HIMAA)EMR/EHR – Electronic Medical Record / Electronic Health RecordFTE – Full Time Equivalent – an employee who works the average working week requirement of 37.5 hoursGP – General PractitionerHIM – Health Information Management (a health information management issue is a HIM issue)HIMs – Health Information Managers (a Health Information Manager is a HIM)HIS – Health Information SystemHIW – Health Information WorkforceHIW WG – Health Information Workforce Working Group (of the HWPC)HLA – Health Libraries Australia (a special interest group of ALIA)HWA – Health Workforce AustraliaHWPC – Health Workforce Principal Committee (of AHMAC)ICD-10-AM – International Classification of Disease, Version 10, Australian ModificationICPC-2 – International Classification of Primary Care version 2IHPA – International Pricing AuthorityIM – Information ManagementIT – Information TechnologyLHD – Local Health District MHR - My Health Record (previously PCEHR)

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MoH – Ministry of HealthMoU – Memorandum of UnderstandingNCCH – National Centre for Classification in HealthPCEHR – Personally Controlled Health Record (obsolete)RPL – Recognition of Prior LearningRTO – Registered Training Organisation – registered with ASQASGD – Small Group DiscussionSNOMED-CT – Systematic Nomenclature of Medicine – Clinical TerminologyTEQSA – Tertiary Education Quality Skills AgencyVET – Vocational Education & Training – the level of education between secondary school and university, most commonly characterised by TAFEs and RTOs.

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