By: Ramona Kyabaggu, Assistant Professor and MHA-HIIM Coordinator, Johnson Shoyama Graduate School of Public Policy_­

We have reached a new digital health era. Following the institutionalization of eHealth services across Canada over the last two decades, there has been renewed interest among health system decision-makers in the strategic importance of health data and information for Canada’s economic future. The COVID-19 pandemic has further exposed the need for real-time access to rich and reliable health information, and the current gaps in and need for health data governance and health information management (HIM) systems within a robust, interoperable digital infrastructure.

The work of HIM leaders is essential in addressing longstanding health care challenges. Depending on its responsiveness to change and readiness to evolve, the HIM profession has a significant opportunity to increase its visibility and influence. In realizing the enormous potential of health data and information, key stakeholders (e.g., governments, industry, professional associations, or post-secondary institutions) must collaborate to identify the needs of the sector and invest in human resource planning and development, not the least of which involves educating a critical mass of HIM professional leaders to support Canada’s digital and data transformation plans.

Understanding Canada’s need for HIM leadership

The importance of HIM leaders must not be underestimated. HIM professionals (HIMs) are individuals who have graduated from a recognized HIM program of study, and are data stewards who know the nature, sources, quality, and context-specific interpretation and uses of health data and information. As champions of the profession, HIM leaders help decision-makers understand the role and functions of the HIM professional and their downstream effect on the quality of decisions about care performance, patient safety, healthcare costs, and overall population health. 

However important their role, HIM leaders in high-level, senior, decision-making roles are scarce. The health sector will be under further strain as the profession undergoes significant demographical changes in the next decade[i]. The large number of forecasted retirements will exasperate the current shortage in qualified, experienced HIMs who can lead change in the new digital and data ecosystem. Shortages in HIM leaders also exacerbate inequities – for example, rural, remote, and northern communities, with fewer services and supports than their urban counterparts, are most at risk of high turnover and shortages of HIM professionals.

Changing industry demands, regionalization and amalgamation, and increasing professional overlap impose an additional burden on the HIM profession, as hiring managers are desperate to fill labour and skills gaps. This trend is evident, as many advanced roles (per the CHIMA career matrix[ii]) require graduate trained professionals or those with a bachelor’s degree with many years of experience. As fewer than 5% of HIM professionals possess a master’s degree, individuals with business administration, nursing, and other graduate degrees are considered for leadership roles in place of HIM professionals without graduate education.

The lack of HIM professionals in these leadership roles can have perilous effects on the profession and health systems globally. HIMs are critical to protecting the integrity of health systems and possess specific content expertise. The risks inherent in decision-making by those without pertinent HIM education or experience can be illustrated by incidents where senior leaders – lacking a concrete understanding of how health information governance principles and attendant legal, regulatory, fiscal, operational, and risk management standards affect day-to-day transactions – unintentionally cause financial and/or operational harm to organizations[iii]^{,[iv],[v],[vi],[vii]}.

Emergence of specialized HIM graduate programs

The health ecosystem is rapidly changing – it is more complex, there is constant advancement in knowledge and technology, and decision-makers have a greater need and reliance on quality health data and information. Increasing HIM recognition and acceptance in advanced roles is needed to maintain and sustain the integrity of Canada’s health data.

A strong base of HIM professionals must move forward from the comfort of traditional technical and consultative roles toward less familiar spaces to promote and champion a unique skill set at a decision-making level.  

The HIM profession has professional practice models designed around specialty graduate degrees ─ a condensed foundational core of HIM courses with specialization in specific disciplines, such as health administration, at the program level. This educational framework has been endorsed by Canadian academics involved in curriculum development for leading accrediting bodies and the American Health Information Management Association[viii]^,[ix].

(Interactive graphic: https://h5p.org/node/1047791) 

Dr. Kelly Abrams, JSGS adjunct professor in the MHA-HIIM program and Standards Council of Canada representative to ISO Health Informatics TC215 Working Group 3, stated that “an advanced specialty degree with condensed HIM modules should be developed for senior health leaders. Health leaders consider the incorporation of HIM educational content into other programs (e.g., Masters of Health Administration, Masters of Business Administration) as important for future health leaders to support an increased understanding and use of clinical and administrative data. There is an urgency of addressing this education gap as the need for senior HIM expertise has long-term implications for health practice and policy related to electronic health information systems and technological advancement, funding and resource allocation, and the relevance of the HIM profession itself.”[x]

Saskatchewan: A place of health policy innovation

The product of an innovative and successful partnership between the University of Regina and the University of Saskatchewan, the Johnson Shoyama Graduate School of Public Policy (JSGS) is one of Canada’s leading policy schools.

Since 2012, JSGS has offered an online Master of Health Administration (MHA) program that attracts a diverse and highly skilled group of professional students (e.g., emergency medical physicians, chief of emergency and trauma services, managers of population health units, mental health counsellors, registered nurses, pharmacists, health policy and regulation consultants, and health program managers) from across Canada. In 2019-2020, the school launched the Health Informatics and Information Management (HIIM) major as an advanced-practice professional program aimed at educating HIMs about the capture, quality, protection, and use of health information to support the Canadian health care system. The fully online master’s degree is also unique because of its strong emphasis on health system leadership.

The MHA-HIIM curriculum is based on traditional HIM subject matter (e.g., privacy, coding and classification, health data standards) while integrating newer areas of critical core competency (e.g., informatics, data science and analytics, information governance) in order to be responsive to future health information needs[xi]. Informed by Gibson, Dixon, and Abrams’ HIIM framework[xii], the major was also designed with the health informatics competencies (Figure 1) in mind. For this reason, the MHA-HIIM program is evidence-based in conceptualization and design.

Students in the MHA-HIIM program learn in an interdisciplinary environment. The interdisciplinary approach supports MHAs and MHA-HIIMs to understand and develop their capacity to apply knowledge in different situations. By the end of the program, students understand the intricate interdependencies between health information management, health care administration, governance and policy, particularly as it relates to Canada’s most complex and pressing healthcare issues, thereby providing the necessary foundation for HIM leadership advancement.

Featuring online asynchronous coursework and the opportunity to pursue a work-study placement with a partner organization, the MHA-HIIM program also requires students to complete two three-day residencies held in-person in Regina (virtually during the pandemic). The online format and mature entry options—for applicants without an undergraduate degree but substantial professional experience—offer new and accessible pathways for graduate education.

“The JSGS MHA-HIIM program is geared specifically to meet identified needs of HIM professionals and health leaders, and promotes digital healthcare solutions in Canada,” says Dr. Kelly Abrams. “The program allows an individual to tailor the coursework to their own specific needs, introduces HIM content to current and future health leaders, and provides for important interaction between professionals. The Residency portion of the program should be of particular interest to HIM professionals as the connections made over the intensive, interactive weekend will carry forward into the work environment.”   

With flexible options to complete the program on either a part-time or a full-time basis and two program start dates (September and January), the MHA-HIIM program is for working professionals with busy lives.

For more information on MHA-HIIM course offerings, application requirements for the May 1 and October 1 deadlines, or to register for an upcoming program information webinar, visit us online.

Ramona Kyabaggu, MSc, is a Certified Health Information Management (CHIM) professional who graduated from the University of Western Ontario’s honours specialization program in health information management in 2009. Since then, she has worked in public health as a program evaluator and knowledge broker and taught Public Health Informatics at the University of Lusaka, Zambia. Currently, Ramona is a 4th year doctoral candidate in Health Information Science (Western University) and an assistant professor at Johnson Shoyama Graduate School of Public Policy at the University of Regina, where she coordinates the Master of Health Administration major in Health Informatics and Information Management (MHA-HIIM). Ramona is an applied researcher whose primary research goal is to strengthen health system readiness for learning health systems. Her current research addresses how we can improve health information systems implementation through the better use of theory and evaluation.  

[i] Canadian Institute for Health Information (CIHI). Health Workforce Database, 2017 — Data Tables. Ottawa, ON: CIHI; 2018.

[ii] Canadian Health Information Management Association. CHIMA Career Matrix. Available at https://www.echima.ca/public/CareerMatrix/index.html

[iii] Landi, Heather. (2016) “Physicians at Canadian Hospital Petition to Suspend EHR System Roll Out Due to Patient Safety Concerns.” Healthcare Innovation. https://www.hcinnovationgroup.com/interoperability-hie/news/13026996/physicians-at-canadian-hospital-petition-to-suspend-ehr-system-roll-out-due-to-patient-safety-concerns

[iv] Monica, Kate. (2018) “Investigators Deem Canadian Cerner Implementation Poorly Executed.” HER Intelligence. https://ehrintelligence.com/news/investigators-deem-canadian-cerner-implementation-poorly-executed

[v] Adeleke IT, Suleiman-Abdul QB, Aliyu A, Ishaq IA, Adio RA. (2019). Deploying unqualified personnel in health records practice: Role substitution or quackery? Implications for health services delivery in Nigeria. Health Information Management Journal. 2019;48(3):152-156.

[vi] Monica, K. (2018, January 16). Investigators Deem Canadian Cerner Implementation Poorly Executed. EHR Intelligence. Retrieved January 13, 2021, from https://ehrintelligence.com/news/investigators-deem-canadian-cerner-implementation-poorly-executed

[vii] Wissmann, S. (2015). Addressing Challenges to the Health Information Management Profession: An Australian Perspective. Perspectives in Health Information Management (International issue, May 2015).

[viii] Gibson, C. J., Dixon, B. E., & Abrams, K. (2015). Convergent evolution of health information management and health informatics: a perspective on the future of information professionals in health care. Applied clinical informatics, 6(1), 163–184.

[ix] American Health Information Management Association (AHIMA). (2017). HIM Reimagined: Transformation starts with you – White paper. Available at: https://www.ahima.org/about/him-reimagined/himr?tabid=whitepaper

[ix]Gibson, C. J., Dixon, B. E., & Abrams, K. (2015). Convergent evolution of health information management and health informatics: a perspective on the future of information professionals in health care. Applied clinical informatics, 6(1), 163–184.

[x] Abrams, K.J. (2016). Leadership and Health Information Management in Canada (unpublished doctoral dissertation). Regina, Saskatchewan: oURspace University of Regina Institutional Repository. Copyright 2016 by K. J. Abrams

[xi] Butler, Mary. (2017). Teaching the ‘New’ HIM: Educators Integrating Informatics, Data Analytics, and Information Governance Into HIM Programs. Journal of AHIMA 88, no.5: 16-19.