International Journal of Medical Informatics 50 (1998) 43–47

HMI education for HIMs1

Rosemary Roberts a,*, Jennifer Mitchell b

a National Centre for Classification in Health, Uni6ersity of Sydney, PO Box 170, Lidcombe, NSW, 2141, Australiab Education Ser6ices, Health Information Management Association of Australia, Australia

Abstract

This paper analyses the curricula of the four Australian university programs for health information managers(HIMs) in relation to their coverage of health and medical informatics (HMI). The overlap between HIMs and HMIsshould be increased through exchange of information at conferences such as this as well as communication andco-operation between the Schools of HIM and those offering health informatics related training at other Australianuniversities. © 1998 Elsevier Science Ireland Ltd. All rights reserved.

Keywords: Health information managers; Health and medical informatics; Education

1. Introduction

Several key changes to health care deliveryin Australia have made it imperative thateducators responsible for health and medicalinformatics (HMI) education communicateeffectively. These changes include the intro-duction of casemix funding in a number ofAustralian states, the trials of co-ordinatedcare, restructuring of health services in a waythat requires linking of health information,the need for accountability for cost effective

health services and the development of elec-tronic health records. Educators and practi-tioners must provide mutual support indeveloping a core group of experts in healthinformatics and health information manage-ment and an understanding between theseexperts and those delivering and fundinghealth care-clinicians, bureaucrats, adminis-trators, insurers and politicians.

2. Some misconceptions

Brittain [1], writing in ‘Topics in HealthInformation Management’, November 1996,stated that ‘‘British universities (and also

* Corresponding author.1 Paper for presentation at the 6th International Conference

on Health and Medical Informatics Education, Newcastle,Australia, August 14–16, 1997.

1386-5056/98/$19.00 © 1998 Elsevier Science Ireland Ltd. All rights reserved.

PII S1386-5056(98)00049-5

R. Roberts, J. Mitchell / International Journal of Medical Informatics 50 (1998) 43–4744

Australian and New Zealand universities)have been slow to respond to the increasinglyobvious and substantial educational needs ofthe health services for informational profes-sionals’’ and ‘‘As yet, there are no undergrad-uate degrees in the United Kingdom orAustralia in health informatics…’’. Despitehis appointment to the University of SouthAustralia, Brittain continues to demonstratehis ignorance of the Australian situation bycommenting on the lack of ‘‘refinement andapplication’’ of coding systems such as Read,SNOMED and ICD-10 in Australia. He says‘‘The Australian position has been to waitand see the developments in other countries’’!This is two years after the National CodingCentre was developed [2] and the NationalCentre for Classification in Health recom-mended the adoption of an Australian Mod-ification of ICD-10 [3] and development of anAustralian procedure classification, both ofwhich have now been completed and are dueto be published in 1998.

Ritchie [4], in deploring the numbers of‘‘capable practitioners with an effective un-derstanding of the three discrete bodies ofknowledge required to ensure effective per-formance in the area of health informationsystems (comprising health services manage-ment, clinical sciences and information tech-nology)’’ completely ignores the healthinformation management programs estab-lished in Australian universities over the lasttwo decades [5–10].

The authors will attempt in this paper toportray a brief outline picture of the fourprograms and their course content relating toHMIs.

3. Health information management inAustralia

Australian health information managers

(HIMs) gain their qualification and eligibilityfor membership of the Health InformationManagement Association of Australia (HI-MAA) following successful completion of anundergraduate or postgraduate program inHealth Information Management. These pro-grams are available at University of Sydney,Queensland University of Technology(QUT), La Trobe University in Victoria andCurtin University in Western Australia. TheUniversity of Sydney also offers a GraduateDiploma in HIM as well as Graduate Certifi-cates in Casemix and in Clinical Data Man-agement. Each year, the four undergraduateprograms produce over 100 graduates.

The graduates take up a variety of posi-tions dealing with patient information includ-ing management of medical record services,clinical classification and research data man-agement. The subjects in the programs covera wide range of topics relating to manage-ment, health and health information systems,biological and behavioural sciences, clinicalclassification, health care evaluation, casemixmeasurement, health law and ethics, epidemi-ology, research methods and computing.More specifically, subjects most relevant toHealth Informatics are those in health infor-mation systems, programming, systems anal-ysis, health computer applications anddatabase systems. Graduates of the HIMprograms are considered as HIMs ratherthan health informaticians because the healthinformatics subjects form only one compo-nent of their broad based education.

4. Health informatics in HIM curricula

Universities seeking accreditation from theHIMAA for their HIM programs at under-graduate and postgraduate levels mustdemonstrate that students cover all the fields

R. Roberts, J. Mitchell / International Journal of Medical Informatics 50 (1998) 43–47 45

Fig. 1. Mandatory fields of study for health information management programs.

of study shown in Fig. 1. These fields ofstudy are linked to a set of minimum compe-tencies for new HIM graduates. This list ofsubject areas and the competencies were ap-proved in 1991 and are currently beingupdated.

Table 1 shows an estimate of the percent-age of course hours spent in each universityHIM course on exclusively ‘informatics’ re-lated formal subjects covering areas such asinformation technology, computer applica-tions, programming logic and systems analy-sis and design, health informationsystems/science and health informatics. It

does not include the professional experiencehours which would also include applicationof informatics knowledge in the healthservices.

Table 1Percentage of HIM course time in health informatics

University HIM course % Informatics

Curtin 21La Trobe 23

26QUTSydney 24

24Total

R. Roberts, J. Mitchell / International Journal of Medical Informatics 50 (1998) 43–4746

These estimates are extremely conservativeand integration of health informatics withother subjects in all curricula makes the anal-ysis difficult. For example, the design and useof computerised patient administration sys-tems, including patient master indexes, ad-mission, transfer and separation systems, bedallocation and patient appointment systems,are studied in subjects dealing with hospitalmedical record systems. Medico-legal subjectsinclude material on the security, accessibilityand authorisation of electronically stored andtransmitted data. Clinical classification andcasemix subjects include hands-on use ofcomputer assisted encoders, disease indexesand the electronic submission of statisticaldata to health authorities. La Trobe, for ex-ample estimates that between 50 and 85% ofthe HIM course relates to health informatics.

Not included in the percentage estimatesare the subjects covering clinical classificationand casemix classification. There would be anargument for ‘classifying’ these topics in med-ical informatics. In terms of Ritchie’s descrip-tion of the bodies of knowledge required(health services management, clinical sciencesand information technology) [4], 100% of allcourses would qualify.

5. Western Australia, Curtin University ofTechnology

The School of Public Health, Curtin Uni-versity of Technology, has approximately 20student places per year and utilises unitstaught by other Schools and Divisions withinthe university. The School of Computing andCurtin Business School as well as the Schoolof Public Health teach information systemsand informatics to students enrolled withinthe BSc (Health Information Management)program. Medical informatics was first intro-duced as a specific study module 4–5 years

ago to build on patient information systemsalready covered in other units. Medical prac-titioners involved in the Medical InformaticsSociety have been teaching the medical infor-matics module, although plans are under wayto involve a wider range of professions togive the module greater depth and scope.

Curtin program includes courses in Infor-mation Technology, Information Systemsand Health Information Systems and HealthRecord Systems.

6. Victoria, La Trobe University

The Victorian undergraduate programwithin the School of Public Health at LaTrobe University leads to a Bachelor ofHealth Information Management. It includescourses explicitly called ‘Health Informatics’as well as courses in Health Information Sci-ence, Management of Health InformationSystems and Computer System Specificationin Health Care. The health informaticscourses aim to develop student skills in usingcomputers, computer systems and computertechnology in the health industry. Studentsdevelop skills in health data manipulationand retrieval. As well, they develop an under-standing of the roles and areas of expertise ofhealth personnel involved with computing(including HIMs) and how each is involvedin developing information technologystrategies.

7. Queensland, QUT

The QUT course, also within the School ofPublic Health at that university, has as partof its HIM program courses in BusinessTechnology and Information, Health Com-puter Systems and Health Information Man-agement. Graduates are awarded a Bachelor

R. Roberts, J. Mitchell / International Journal of Medical Informatics 50 (1998) 43–47 47

of Business-Health Information Manage-ment.

8. NSW, University of Sydney

The University of Sydney School of HealthInformation Management teaches studentsMicrocomputer Applications, ProgrammingLogic and Systems Analysis and Design,Database Systems, Computer Applications inHealth Care as well as staple courses inHealth-Information Systems. It accepts ap-proximately 50 students each year in its un-dergraduate program and offers postgraduateprograms in Health Information Manage-ment, Casemix and Clinical Data Manage-ment. Graduates of the undergraduateprogram are awarded a Bachelor of AppliedScience (Health Information Management).

9. Conclusion

HMIs education has been part of educa-tion for HIM since the bachelor degree pro-grams were introduced in the mid-1980s. Inturn, education of Health Information Man-agers is part of HMI education. While thatmay seem an impossible concept, it representsthe intertwined relationship of the two pro-fessional groups. While diversity in healthand medical informatics education is essentialfor the health and dynamism of its products,there is also the need to keep in mind theshared goal of educators in this area. Thefuture of health services is dependent on sup-port from health information managers andhealth and medical informaticians. We mustbring to health professionals the knowledge,skill and expertise to allow health services tobe delivered efficiently and effectively.

An increase in numbers of HIMs trained inhealth informatics is vitally important in sup-porting the need for health service adminis-trators and clinicians for informatics support.By combining the efforts through conferencessuch as this, the expertise will be pooled andstrengthened. Not only is this essential at theundergraduate and postgraduate levels, butin continuing education.

References

[1] J.M. Brittain, Commentary: Where has health in-formatics come from? Where is it going?, Top.Health Inf. Manage. 17 (2) (1996) 63–71.

[2] P.J. Watson, The National Coding Centre—anoverview, Aust. Med. Rec. J. 23 (4) (1993) 123–128.

[3] R. Roberts, Options Research Paper on FutureLong Term Suitability of Using the ICD-9-CM inAustralian Hospitals, 1994.

[4] D. Ritchie, Managing the gap: balancing advancesin technology with advances in management prac-tice, Aust. Health Rev. 20 (1) (1997) 53–63.

[5] P. Watson, HIMAA—from 1949 to 1995. Six-teenth Conference of the Health Information Man-agement Association of Australia. ConferenceProceedings. 31 October–3 November 1995, pp.92–103.

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