September-October 2020

Evolving Education: HIM’s Role in Interprofessional Education
By Pam Oachs, MA, RHIA, CHDA, FAHIMA, and David Gibbs, PhD, CPHIMS, CPHI, CHPS, CISSP, FHIMSS
For The Record
Vol. 32 No. 5 P. 5

Working together as a team is difficult. Teamwork requires patience, an open mind, clear communication, commitment, and respect. Competent, compassionate, and effective care can be provided only by a team of professionals who are knowledgeable and supportive of each other. Ineffective collaboration among care team members can lead to medical error, one of the leading causes of death in the United States. Therefore, it is critical to provide students and practitioners with interdisciplinary knowledge and opportunities to collaborate across professions.

Faculty, students, and practitioners alike may not be aware of all the disciplines involved in the care continuum. For example, HIM is an often overlooked and misunderstood element of the team. To have an effective team, it is important to understand and respect the individuals responsible for each aspect of the patient experience.

Traditionally, educators in health-related academic programs focus on their discipline’s content, which can be highly detailed and technical. Educators have a mountain of content to cover to ensure graduates are competent and capable of earning the licenses and/or credentials required to earn a position in their field.

However, gaining employment is only the beginning. Practitioners must be able to perform in a profession that increasingly involves collaborating across professions. In fact, interdisciplinary collaboration is explicitly required in the AHIMA Code of Ethics.

Despite a growing knowledge of the benefits of working with a collaborative health care team, there is often no room in the health-related major’s schedule for electives such as an interprofessional health care course. Students who do have room for an elective often choose to take a lighter load rather than a relevant nonrequired course.

Faculty also have full teaching loads to consider. In addition, health care practitioners mentoring students in internships and practical experiences may not have the time—or experience—to share the importance of interprofessional collaboration.

Interprofessional education (IPE) is not a new concept. Faculty have incorporated awareness and knowledge of various disciplines for years. The challenge is to solidify IPE as a consistent priority in workplace and academic settings so that interprofessional collaboration can best serve patient needs.

HIM educators in all settings have a heightened responsibility to not only participate in IPE opportunities but also raise the awareness of the importance of HIM in collaborative care. Two institutions offer different approaches to incorporating IPE into their HIM curriculum.

Make It an HIM Requirement
Here’s how an IPE course that held little appeal to HIM students at one institution eventually became a requirement. The initial IPE course, which was offered in a classroom format and included social work and nursing students, drew few HIM students for several reasons, including being scheduled for an inconvenient day and time and being inaccessible to online HIM students. Also, many HIM students had full credit loads and/or part-time jobs.

Because IPE was important to the HIM profession and other majors with online programs, nursing, social work, and HIM faculty developed an online section. The HIM faculty agreed that the course needed to be a required part of the HIM curriculum.

The course’s learning activities centered on interprofessional engagement among student teams of four to six with at least one student from each profession represented. Content focused on incorporating the following Interprofessional Education Collaborative core competencies in the context of health care, specifically in the veteran population:

• roles and responsibilities;
• values and ethics;
• interprofessional communication; and
• teams and teamwork.

Each competency was the focus of a three- to four-week module in which students in their assigned groups completed activities and assignments. Each module had a final project consisting of a group paper or a presentation. Each group activity resulted in a team peer review based on participation. For a well-rounded evaluation, individual assignments were also included.

The course began with the team developing a set of ground rules, including plans for communication and handling conflict. Individual students submitted a video describing their profession, including the scope of practice and academic preparation. The group reviewed a case study and identified their profession’s role.

In the Values and Ethics module, students shared their profession’s Code of Ethics, applied an ethical framework to a case study, and reviewed each profession’s perspective. In the Communication module, the team analyzed a patient interview conducted via telehealth and discussed the value of a thorough patient handoff.

Lastly, in the Teams and Teamwork module, each group used an agreed-upon assessment tool to analyze a video of an interprofessional health care team in action. They then researched their individual personalities in terms of working in a team environment. A video of the team solving a problem was analyzed for individual and team attributes.

Benefits
In both the traditional classroom setting and online programs, HIM students incorporated their knowledge of coding and billing, referrals, release of information, patient privacy and confidentiality, compliance, risk management, telehealth, patient portals, and EHRs into practical course activities and case studies. They had the opportunity to not only share the many aspects of the HIM profession with nursing and social work students but also better understand their own roles on the health care team.

The HIM students were able to learn about other disciplines—in this case, social work and nursing—and practice their HIM, research, communication, interpersonal, and team-building skills.

Challenges
To make the course successful, both students and faculty had to be diligent to overcome hurdles. Technical material related to the learning management system and audio/video recording tools proved challenging, as did group work, especially online. (However, the point of the course was collaboration, so practice and improvement in this area was a planned learning outcome.)

It was critical to be open minded, curious, and flexible. When developing the course, disciplinary differences made it necessary for faculty to truly listen to each other’s perspectives. The same was true of grading.

Lastly, gaining the approval to make the course required for the HIM curriculum proved to be a challenge.

Required Assignments in Existing Courses
This example describes how HIM majors participated in IPE activities incorporated into existing courses that were already part of the accredited curriculum. This approach has been successfully implemented multiple times by an HIM faculty member collaborating separately with colleagues in the radiation therapy and physical therapy disciplines. The HIM/radiation therapy collaboration occurred for campus-based undergraduate students, while the HIM/physical therapy collaboration involved online HIM graduate students engaging with campus-based physical therapy students.

The EHR was used as a tool of common interest to clinicians as well as HIM professionals. Students were assigned to teams with members drawn from both participating disciplines. The teams were then assigned homework projects with due dates throughout the term that focused on the four Interprofessional Education Collaborative core competencies. For example, HIM and radiation therapy undergraduate students met in small groups at campus computer labs to demonstrate and explore different EHR systems used for training in their respective programs. Similarly, HIM and physical therapy graduate students met online in small groups to explore and discuss EHR systems, including one designed for physical therapists.

These activities provided HIM students with exposure to additional real-world EHR systems while also facilitating discussions about roles and responsibilities, teamwork, communication, and ethics.

At the graduate level, an additional assignment involved physical therapy students submitting progress notes to the HIM students to complete a documentation audit. This activity was surprisingly successful because many of the HIM students were experienced coders or otherwise had significant HIM experience. As a result, they provided detailed feedback beyond what was assigned and expected.

These collaborative sessions also enabled the HIM students to raise awareness among their future clinical teammates about the expanding roles of the HIM profession. Students were encouraged to use AHIMA’s online HIM career map as a visual aid during discussions.

Benefits
This approach was implemented within existing courses, without the need for new course approvals. Students from HIM and the other disciplines gained exposure to additional EHR systems and to a variety of perspectives in general. The students learned about each other’s disciplines, often dispelling common misconceptions about roles, responsibilities, and scopes of practice.

HIM students developed skills to raise awareness about the expanding roles of the HIM profession. All students became more cognizant of how they are part of a health care team and will be working with other disciplines to improve patient outcomes.

Challenges
Clear communication about schedules and expectations is essential between faculty members as well as with students. Assumptions about availability and progress, especially across disciplines, must be verified. Frequent status checks and open collaboration between faculty members will help streamline execution.

Lessons Learned
There are always areas to improve as educators prepare HIM students for the workplace. Lessons learned from the two cases presented in this article include the following:

• Interprofessional health care education is important. If IPE activities are not a required part of the curriculum, they may be difficult to incorporate consistently.

• Student behaviors in small groups can be challenging, especially for less mature students.

• Unsupervised competition between disciplines can develop into unproductive behaviors; ground rules for teams can help.

• Availability of online communication tools for the students’ interactions is critical. Clearly state when a particular online tool or software is required.

• Faculty must learn about other professions and their mission or purpose.

• Faculty must have clear and open communication with each other and with students.

• Assignment and case study content needs to include aspects from each profession so all students can see their role.

• Students should be far enough along in the program to represent their profession knowledgably.

• IPE can occur in various ways; be creative.

• Workplace IPE activities are great opportunities to raise awareness of the expanding roles of the HIM profession.

Future Considerations
Within reason, it’s important to consider and include all health care professions in IPE. Many disciplines, such as computer science and health care administration, feature students who can add value into an IPE activity beyond the health science professions. However, do not become overwhelmed by including more disciplines than can be reasonably handled. IPE can be effective with as few as two disciplines. Start small and grow as your capabilities permit.

Research related to IPE’s effectiveness is valuable. Questions to consider include the following:

• Does the HIM student feel knowledgeable about other professions?
• Is the student confident enough to collaborate with a health care team?
• Is the student confident in his or her role on an interprofessional team?

Because the HIM profession is a critical part of the overall patient experience, HIM students must be comfortable interacting with an interdisciplinary team. Therefore, integrating IPE within an HIM curriculum—which can be accomplished in a variety of ways—is an essential component of any education program. Educators are encouraged to explore options that work best for both their programs and their students.

— Pam Oachs, MA, RHIA, CHDA, FAHIMA, is an assistant professor in the Department of Health Informatics and Information Management at the College of St. Scholastica. She teaches in the areas of management, quality improvement, and interprofessional health care.

— David Gibbs, PhD, CPHIMS, CPHI, CHPS, CISSP, FHIMSS, is an assistant professor in the Department of Health Information Management at Texas State University. His teaching and research focus on the interrelated areas of health informatics, cybersecurity, and interprofessional education.