Eligibility requirements for advanced health informatics certification

Abstract

AMIA is leading the effort to strengthen the health informatics profession by creating an advanced health informatics certification (AHIC) for individuals whose informatics work directly impacts the practice of health care, public health, or personal health. The AMIA Board of Directors has endorsed a set of proposed AHIC eligibility requirements that will be presented to the future AHIC certifying entity for adoption. These requirements specifically establish who will be eligible to sit for the AHIC examination and more generally signal the depth and breadth of knowledge and experience expected from certified individuals. They also inform the development of the accreditation process and provide guidance to graduate health informatics programs as well as individuals interested in pursuing AHIC. AHIC eligibility will be determined by practice focus, education in primary field and health informatics, and significant health informatics experience.

INTRODUCTION

In November 2015, the AMIA Board of Directors endorsed advanced health informatics certification (AHIC) eligibility requirements. These proposed requirements constitute 1 of 3 components needed to establish AHIC and will be presented to the future AHIC certifying entity for adoption.¹ Eligibility requirements are a pivotal piece of a certification process. They help define the scope of certification, enable individuals to assess their readiness for certification, set a standard for younger professionals who seek professional development, and provide information to employers about the knowledge, experience, and commitment that certified individuals can be expected to bring to an organization. They also inform accreditation requirements for education programs and shape curricula. This paper describes the process AMIA used to develop the proposed eligibility requirements, outlines the rationale for requirements that were selected, and presents the requirements so the informatics community can begin to prepare for the forthcoming establishment of AHIC.

DEVELOPMENT OF AHIC ELIGIBILITY REQUIREMENTS

Early in 2014, AMIA began a series of conversations with thought leaders in key national clinical and public health professional education organizations on the concept of AHIC and how it might be achieved. These interactions led the AMIA board to convene a Work Group in November 2014 whose charge included developing recommended AHIC eligibility requirements for consideration by the future AHIC certifying entity. This group included representatives from clinical informatics research, dentistry, nutrition, nursing, osteopathy, pharmacy, public health, and radiology.

Two AMIA Academic Forum task force reports informed the Work Group’s deliberations. First, the 2012 AMIA Academic Forum Advanced Interprofessional Informatics Certification Task Force Report recommended that the AHIC eligibility requirements should result in a certification that is equivalent in rigor to that of the American Board of Medical Specialties (ABMS) Clinical Informatics Subspecialty (CIS).² Thus, the Work Group used ABMS CIS as a model for how to approach AHIC eligibility requirements. Second, the 2012 AMIA Academic Forum Roles and Functions Task Force determined that the AHIC eligibility requirements should focus on informatics practitioners whose role involves applying knowledge to operational aspects of information and knowledge problems that directly affect the practice of health care, public health, and biomedicine (adapted by the Work Group to personal health).³ In addition, the Work Group set a goal of developing AHIC eligibility requirements that would be appropriate for all health professions rather than create different requirements for each discipline.

To ensure that the certification would achieve the desired level of rigor and be workable for all disciplines, the Work Group based its framework for AHIC eligibility requirements on the ABMS CIS eligibility requirements.⁴ Work Group members asked 72 thought leaders and representative individuals across 8 disciplines to use the framework to provide data on education pathways and feedback on the draft requirements; 66 individuals responded. The Work Group used the resulting data to inform the development of AHIC eligibility requirements. Work Group members unanimously approved the proposed requirements that were subsequently endorsed by the AMIA Board of Directors in November 2015.

ELIGIBILITY REQUIREMENTS

The Work Group developed the proposed eligibility requirements before key related activities were completed (ie, AHIC core content that formally defines the knowledge and skills associated with advanced health informatics practice, AHIC certifying entity that administers the exam, accreditation of graduate health informatics programs).¹ Eligibility requirements for certification are generally linked to graduation from an accredited education program. To address the fact that accreditation for graduate health informatics programs is under development, the proposed requirements include 2 phases (ie, before and after program accreditation is in place). The first phase is called the “experience period,” a parallel construct to the ABMS CIS practice pathway.⁴

The AHIC eligibility requirements comprise 3 elements: practice focus, education in primary health field and health informatics, and health informatics experience. Practice focus defines the kinds of professionals who are likely to seek AHIC. The latter 2 elements establish the “advanced” level of this certification. The high-level requirements are presented below, followed by details in each of 3 respective sections.

To be eligible for AHIC, an individual must:

1. Practice health informatics with an operational focus on information and knowledge problems that directly impacts the practice of health care, public health, and personal health;

and

2. Have earned:

1. A master’s degree or higher in a primary health profession and a master’s degree or higher in health informatics^aor

2. A doctoral degree in a field characterized as having its primary focus in clinical or health informatics;

and

3. Have:

1. Qualifying health informatics experience in the United States or Canada and

2. 18 months of health informatics experience over a 3-year period that has been completed within the past 5 years.^b

^a,b Note: Prior to accreditation of sufficient numbers of graduate health informatics programs, the graduate degree requirement can be offset by additional health informatics experience. Specifically, individuals who have not earned a health informatics graduate degree may qualify if they have 36 months of health informatics experience over a 5-year period that has been completed within the past 10 years.

Practice focus

AHIC is intended for individuals whose informatics work directly impacts the practice of health care, public health, and personal health. Examples of the types of activities that qualify an individual for AHIC include the following:

• Assess and develop effective responses to meet the information and knowledge needs of health care and public health professionals, patients, and citizens in general.

• Implement effective systems to support health and health care decision-making and manage personal health.

• Characterize, develop, evaluate, and refine health and health care processes that support effective, efficient, safe, timely, equitable, and patient-centered care.

• Develop effective practice improvements, process and workflow redesign, or automation.

• Utilize informatics approaches to improve system design, implementation, evaluation, and evolution.

• Ensure the legal, ethical, and effective use of health and health care data and information.

• Lead procurement, customization, development, integration, implementation, management, evaluation, and continuous improvement of health and health care informatics systems.

• Align system priorities with clinical/health care and health needs.

• Utilize the rapidly expanding amounts of data becoming available in various health and health care organizations (eg, payers, providers, pharmaceuticals) to derive insights for improving care delivery and population health.

This certification distinguishes individuals who practice advanced health informatics from those whose focus is primarily teaching or research. However, individuals who teach in health informatics programs or conduct research, but whose primary focus is the practice of health informatics, may also pursue AHIC.

Education

The eligibility requirements address 2 types of applicant education: primary field and health informatics. The Work Group determined that to be considered “advanced,” this certification should require individuals to have earned graduate degrees in their primary health field and in health informatics. During a limited “experience period,” individuals may offset the requirement for a master’s or higher degree in health informatics through more experience.

Table 1 presents the specific AHIC education and experience requirements organized by 2 phases and 2 possible paths for eligibility. Phase 1 refers to the unspecified period of time before there is a sufficient number of accredited programs to meet the demand for education from individuals who seek to practice health informatics at an advanced level. Phase 2 refers to the time period that begins once all individuals seeking AHIC must graduate from an accredited health informatics program. Path 1 applies to individuals trained in a health profession. Path 2 applies to individuals whose primary field focuses on clinical or health informatics.

Table 1.

Proposed AHIC education and experience eligibility requirements

Path	Primary Health Profession or Graduate Educationa	Health Informatics Education	Health Informatics Experienceb
Phase 1: Before a sufficient number of accredited health informatics programs exists
1A	Master’s or higher degree in primary health field	Master’s or higher degree from health, biomedical, or clinical informatics program that is accredited or deemed satisfactory to the AHIC certifying entity	18 months over a 3-year period; this 3-year period must have been completed within the past 5 years
1B		None	36 months over a 5-year period; this 5-year period must have been completed within the past 10 years
2	Doctoral degree in a field characterized as having its primary focus on clinical or health informatics		18 months over a 3-year period; this 3-year period must have been completed within the past 5 years
Phase 2: Once a sufficient number of accredited health informatics programs exist
1	Master’s or higher degree in primary health field	Master’s or higher degree from accredited health, biomedical, or clinical informatics program	18 months over a 3-year period; this 3-year period must have been completed within the past 5 years
2	Doctoral degree in a field characterized as having its primary focus on clinical or health informatics		18 months over a 3-year period; this 3-year period must have been completed within the past 5 years

^aHealth profession or graduate degree must be earned from a school or university in the United States that at the time of the applicant’s graduation was a nationally or regionally accredited institution, or a school deemed satisfactory to the AHIC certifying entity. Degrees that meet requirements:

Path 1: Master’s (eg, MPH, MSN, NP, PA) or higher (eg, DDS, DNP, DPH, DO, MD, PharmD). Limited exceptions (eg, BS in pharmacy prior to 2005) will be considered.

Path 2: PhD in biomedical or health informatics, or DNP with nursing informatics focus.

^bQualifying health informatics experience should have occurred in the United States or Canada and includes focused informatics activity (as demonstrated by informatics core qualifications) for a concentrated and sustained period of time.

Table 1 includes examples of the types of degrees that would qualify individuals to take the AHIC exam; the certification is not limited to the professions listed. The AHIC certifying entity will be responsible for maintaining a public list of specific health professional degrees that qualify.

The Work Group emphasized the need for accredited master’s health informatics programs to include mentored experiences in health informatics to mirror the experience focus of CIS fellowships. Purely didactic programs are not sufficient to develop the skills needed for the advanced practice of health informatics.

Informatics experience

The Work Group limited its focus to individuals with qualifying health informatics experience in the United States or Canada. Once AHIC is established, the certifying entity could choose to investigate opportunities for expansion or recognition of individuals practicing in other countries.

The Work Group concluded that the health informatics experience requirement should be significant and recent for 2 reasons. First, mastery that would be associated with “advanced” certification requires a range of concentrated experiences completed over a sustained period of time within the recent professional life of the individual. Second, faced with the diversity of education/training experiences that will be presented to AHIC, rigor equivalent to CIS can be achieved by emphasizing the experience of AHIC applicants. These experiences may accrue in educational or employment settings and will be evaluated as outlined below.

To capture the breadth and depth of AHIC applicants’ experiences and to manage the diverse range of experiences that will arise due to the multiple professions seeking AHIC, the Work Group proposed the use of informatics core qualifications, or ICQs. The ICQ framework is based on the US government’s Senior Executive Service core qualifications⁵ and was informed by the 2012 AMIA Academic Forum Roles and Functions Task Force Report.³ ICQs comprise 4 domains in which an advanced practitioner is expected to have made an impact and will be used to organize the experiences that individuals report as part of their application for the AHIC examination. Specifically, as part of the application to sit for the AHIC examination, individuals will need to document that they have impacted:

1. Patients or individuals through informatics initiatives designed to enhance health care, population health, or personal health;

2. Health systems and/or organizations through informatics initiatives designed to enhance performance and learning;

3. Technology that promotes better health and health care; and

4. System or team effectiveness by leading and managing health informatics change.

Applicants may use multiple projects, or, if a single large project provided experience in each of the 4 domains, that project can be used to illustrate how experience was gained. Descriptions of the activities within each domain must demonstrate the application of informatics knowledge and skills to the operational aspects of information and knowledge problems that directly affect the practice of health care, public health, and personal health. In addition to describing relevant activities, applicants will need to describe their role, the context for the experience (eg, part of educational program vs employment, mentored vs independent), and the results achieved.

NEXT STEPS

The development of proposed AHIC eligibility requirements constitutes an important step on the path to AHIC. AMIA is actively working to move forward on the remaining steps: developing the AHIC core content, establishing the certifying entity, and launching graduate health informatics program accreditation.¹ Once established, the future AHIC certifying entity will need to adopt the proposed eligibility requirements and the forthcoming core content, determine how to host the examination, develop an application process that outlines how the applicant experience will be assessed, and create the examination. The certifying entity will also determine the length of Phase 1, which will depend on the availability of accredited graduate health informatics programs.

The proposed AHIC eligibility requirements and forthcoming core content raise issues to be addressed by the health informatics accreditation process so that alignment is achieved between what accredited programs are expected to offer and what programs need to do to prepare their students for AHIC. The anticipated launch of AHIC provides an opportunity for graduate health informatics programs to consider how to include mentored informatics experiences in their curricula and to collaborate with other programs to identify ways that they can help their students prepare for AHIC. For example, the AMIA InSpire Annual Conference of informatics educators will provide opportunities for AMIA Academic Forum members, program directors, program coordinators, and faculty to convene around this issue. Combined with the forthcoming AHIC core content, the proposed eligibility requirements will provide individuals with an understanding of what is being certified and how they can prepare for AHIC. Specifically, they can use the proposed eligibility requirements to assess their readiness for AHIC and, if gaps exist, identify educational opportunities and experiences that will position them to be eligible.

CONCLUSION

Creating rigorous, fair eligibility requirements for individuals who come from diverse professional backgrounds was an ambitious task. Its completion is a pivotal achievement for the field of health informatics. The fact that a multidisciplinary group could reach consensus on these requirements indicates that the informatics community has a shared understanding of what constitutes the scope of health informatics practice. The resulting eligibility requirements may also clarify for the public the role of health informatics professionals in the health ecosystem.

By developing AHIC eligibility requirements that emphasize advanced education and a range of meaningful experiences, AMIA promotes high expectations for current and future practitioners. Further, these eligibility requirements reflect some of the health informatics community’s aspirations for advancement of the profession. Going forward, AMIA will continue to be the authoritative steward of the scope of the health informatics field, strengthen the health informatics profession, and support individual health informatics professionals at every stage of their career.⁶