Other (Non-Physician) Certifications in Informatics, Health Information Technology, and Related Areas

Although the physician subspecialty certification has received the lion's share of the attention when it comes to certification of professionals in informatics, there are actually a great deal of other certification options for other professionals who work in informatics, health information technology (HIT), and related areas. While I am playing a big role in several aspects of the physician certification process, I believe that appropriate professional recognition is important for all who work in informatics. This is demonstrated by the demographics of the enrollment in our informatics educational program at Oregon Health & Science University (OHSU), where only about 30% of the students are physicians.

A number of people, including students in our educational program, have written me lately to ask about these certifications. That has led me to do some research to try to come up with a list and analysis to make sense of it all. I will use this post to provide a list of all certifications in informatics and related areas of which I am aware, and provide some commentary on gaps and limitations.

This process also raises the issue of just how important certification is or should be in our field. In all honesty, I am not sure. It is likely that the real determination of its value will come from employers and others who "vote with their dollars" by making certification part of their hiring and/or promotion criteria. I am not aware that this has happened yet on any widespread basis. In the case of the physician subspecialty, I am certain it will be years before being "board-certified" in clinical informatics will really matter in getting hired or advancing in one's career. But I am equally certain that it eventually will matter a great deal.

From this perspective, let us review what I have learned about certifications in informatics and related disciplines. A first finding is that the certifications fall into two broad categories, which are those that require formal education or training to be eligible to take the certification exam and those that do not.

The certifications requiring formal specific education are in nursing informatics and in health information management (HIM). (And, in a few years, in the new medical subspecialty.) The certification in nursing informatics is provided by the American Nursing Association (ANA). Eligibility for the certification requires having a bachelor's degree in nursing or a "relevant field," along with specified practice and educational experience in both nursing and informatics.

The HIM field has two certifications that require formal education in programs certified by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM). These certifications, and the required minimum education, include:

• Registered Health Information Technician (RHIT) - completion of an associate degree in HIM in a CAHIIM-accredited program
• Registered Health Information Administrator (RHIA) - completion of a baccalaureate degree in HIM in a CAHIIM-accredited program

The HIM field also has other certifications that do not require specific education and are focused on specific job functions:

• Certified Coding Associate, Specialist, and Specialist Physician-Based (CCS, CCA, CCS-P) - the historical credential for those who code medical records in ICD-9, CPT-4, and other standard code sets
• Certified Health Data Analyst (CHDA) - those who "acquire, manage, analyze, interpret, and transform data into accurate, consistent, and timely information"
• Certified in Healthcare Privacy and Security (CHPS) - those who design, implement, and administer privacy and security protection programs in healthcare organizations
• Clinical Documentation Improvement Professional (CDIP) - those who "improve and maintain quality information for those involved in healthcare as well as support the integrity of the patient’s health record"

There are a number of other certifications that do not require specific formal education. These certifications are mostly in technical areas and use the "health information technology" moniker.

The Healthcare Information & Management Systems Society (HIMSS) has had a certification called the Certified Professional in Healthcare Information & Management Systems (CPHIMS) that has been in existence for about a decade. I actually took the CPHIMS exam (and passed!) when it first came out. It is billed as a professional certification program for healthcare information and management systems professionals.

HIMSS also has created a new Certified Associate in Healthcare Information & Management Systems (CAHIMS), which is designed for emerging professionals within the industry (i.e., with five or less years of experience). This certification is said to demonstrate knowledge of HIT and management systems, and aims to facilitate entry-level HIT careers. It is also designed to be a career pathway to the CPHIMS credential.

Another certification is the HITPro Program, which was developed as part of the Office of the National Coordinator for HIT (ONC) Workforce Development Program. There are six certifications based on the six HIT workforce roles designated by ONC, which has also funded short-term training programs in community colleges, although the HITPro exams can be taken by anyone. The six workforce roles covered by the exams include:

• Practice workflow and information management redesign specialists
• Clinician/practitioner consultants
• Implementation support specialists
• Implementation managers
• Technical/software support
• Trainers

The curriculum for the HITPro exams is based on another ONC-funded project, which is the ONC Curriculum Development Centers Project in which I have had substantial involvement. The curricular materials are freely available for download from the ONC National Training and Dissemination Center (NTDC). In addition, an exam guide for these exams (as well as the CompTIA exam described below) was recently published.

There are two companies that offer a combination of both training programs or materials, along with certification exams. The first of these is Health IT Certification, which offers certification in four areas, along with (optional) training for each:

• CPHIT - Certified Professional in Health Information Technology
• CPEHR - Certified Professional in Electronic Health Records
• CPHIE - Certified Professional in Health Information Exchange
• CPORA - Certified Professional in Operating Rules Administration

The second company offering both training materials and certification is CompTIA, which provides many IT-related certifications and has recently added the CompTIA Healthcare IT Technician among its certification offerings. This certification covers the knowledge and skills required to implement and support HIT systems in a variety of clinical settings. The CompTIA Web site states that the Healthcare IT Technician certification exam covers "regulatory requirements, organizational behavior, IT operations, medical business operations, and security." The "recommended experience" for the exam is the baseline CompTIA A+ certification or 500 hours of hands-on technical experience in HIT.

Of course, all of the certifications that have been developed, including the clinical informatics physician subspecialty, still leave out some major elements of the informatics workforce. One of these in particular is the group of advanced informatics professionals who have master's and doctoral degrees or other advanced training in informatics. This group includes physicians who are not eligible for the subspecialty, other healthcare professionals who work in informatics, and others who hold advanced degrees or have had advanced training in the field. I have noted in previous postings that AMIA has established a plan for advanced interprofessional informatics certification of other individuals with doctoral degrees, including healthcare doctorates as well as PhDs and other doctoral degrees. I am not aware of official plans of anyone to certify master's-level informaticians, but it would not surprise me to see CAHIIM or even AMIA take the lead on that at some point soon.

This posting has shown that there are clearly many certifications for informatics and related areas. While it is not clear how much employers value or require these certifications, we do know that employers do have a desperate need for skilled talent, perhaps best exemplified by the report last year from the College of Health Information Management Executives (CHIME). This report concluded that the shortage of people with appropriate skills and experience was one of the critical challenges hindering the successful implementation of HIT projects. However, a common complaint heard among new graduates of HIT educational programs is that most positions they desire require experience, which many do not have, since they are just entering the field. Whether formal certifications will hedge against lack of experience is not clear.

Another perspective is to share my own approach to making hiring decisions in my academic department, where I am involved in hiring both those who work in informatics and HIT as well as those who do not (e.g., administrative staff). For each job search, every candidate brings a set of attributes. One of those attributes is their formal education and training. Another is experience in the work and/or setting that the job will entail. There are other factors, such as interviews and recommendations. All hirers apply some sort of calculus, not necessarily a purely quantitative one, to choose the "best" candidate for a given position.

Why is this relevant to informatics certification? It is relevant because in the early days of certification, whether for physicians or others, certification will be one of many attributes considered by a hirer. Other attributes will include experience, and many HIT and informatics personnel bring substantial experience, even if they have little or no formal education or training or any type of certification.

A final perspective I can share is a common question I am asked, which is whether someone should seek formal training in informatics. As the head of an educational program in the field, I obviously have a bias in favor of education. But I do tell those who ask this question that their formal education will be one of those attributes in the calculus of people who may hire them. Everything else being equal (which in reality almost never happens), a job candidate with a credential in informatics (e.g., master's degree, certificate, even the 10x10 course) will have a leg up over someone who does not.

There are clearly many certifications for different people and skills levels in informatics and HIT. It is likely that certification will play a growing role in an individual maintaining competitiveness in the job market. Of course, like all "knowledge fields," informatics will continue to evolve, as we already see the focus shift from implementation to use of data. Therefore the real key for anyone working in informatics is to keep up with the changes and new directions for the field.