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September 18, 2006
Next month’s annual AHIMA conference could mark the beginnings of a new era in the organization’s history. Opponents are just fine with the status quo. In October, the AHIMA House of Delegates will vote on a controversial proposal that would amend the organization’s bylaws to eliminate associate membership status and bestow upon noncredentialed members the right to vote and hold office. AHIMA leadership and proposal backers contend that if the organization does not move to redefine HIM and expand eligibility for active membership to include noncredentialed professionals, the influence it currently wields will erode as professionals coming into the profession from nontraditional HIM backgrounds and roles bypass the AHIMA for other organizations that do provide them with the rights of full membership or start new groups. “We’re starting to see a lot of people who are getting very interested in what I would call health information management-related jobs. The jobs are broader; they’re not the traditional HIM department management,” says AHIMA President Jill Callahan Dennis. “The problem is we can’t fill all those positions with credentialed folks, so we’re starting to see lateral entrance into the field. The question is, do we want them to be part of the association with the opportunity to influence the application of HIM practice standards, etc, or do we want them not to be part of our field? “The board of directors and others who support this change believe there are real advantages to a broad definition of the HIM field at this time of great change and new opportunity. We’d rather have them be part of us and claim that space for HIM professionals,” she adds. “It exposes second career professionals to HIM, it opens doors down the road for graduates of our programs, and it expands the definition of HIM rather than trying to draw an artificial line around what an HIM professional can do.” Opponents, however, contend that should the proposal pass, it will do exactly the opposite of what the leadership intends—rather than increase AHIMA’s size and influence, it will devalue the association and its credentials. “Having an AHIMA-granted credential is what makes you active. That’s what we’re trying to preserve here,” says Darice Grzybowski, MA, RHIA, FAHIMA, president of HIMentors, LLC, former Illinois Component State Association (CSA) president, fellow, and Triumph Award winner. “When you disassociate the two, you devalue the formal educational process that supports those credentials because now you’re giving someone equal vote who doesn’t have them; it devalues and dilutes the pool of who you say are active members.” The Right Time? Today, there is a much greater emphasis on electronic health records and electronic information exchange. Also, the types of work within HIM have expanded to the point where the AHIMA’s member database contains more than 120 job titles and more than 40 different types of employers. In fact, fewer than one half of the HIM jobs within the AHIMA’s databases are in acute care compared with 90% 10 years ago. “Increased demand for that skill set is the key difference between 10 years ago and now,” says Dennis. “It’s also why there is a timing imperative in making this decision. This is an opportunity to consolidate and expand our reach. Five years from now, that horse will have left the barn.” The decision involves amending the bylaws to create an inclusive membership. Specifically, the House of Delegates is being asked to vote on the following changes (while the information was current at press time, changes are likely before the October vote): • Alter the membership composition from four categories to three: active, student, and honorary. • Open active membership to “individuals interested in the AHIMA purpose and willing to abide by the Code of Ethics.” • Change the composition of the board of directors to require that a majority of board members be AHIMA-approved credential holders. The rationale behind the changes are that they streamline AHIMA membership—which is currently at approximately 50,000, 10% of which fall within the associate class—and address key issues facing the profession, such as increased demand in part due to the change from HIM to eHIM, a shortage of credentialed professionals, and the aging workforce. According to the AHIMA, the ability to influence direction and standards is key to the future of the association and profession; therefore, AHIMA membership must encompass all who engage in HIM by establishing an open membership, which will foster inclusiveness, flexibility, and potential growth in membership. “Health information has changed dramatically from what most of us grew up with,” says AHIMA President-elect Bryon Pickard. “HIM has moved to the forefront and there are a whole heck of a lot of other people out there who are doing health information. We’re kidding ourselves if we think we’re the only one doing health information management.… That’s why the timing of this is so important. If we don’t bring these folks into the AHIMA fold, they could very well join other associations where they can be active, voting members, and that puts us at risk.” Debating the Issue “I’m concerned that the credential will get watered down,” says Stanley P. Greenberg, BA, RHIT, president of Greenberg & Associates, Inc., former Ohio CSA president-elect, and Illinois CSA board member. “The board of directors at AHIMA establishes the curriculum used by HIM programs throughout the country. Furthermore, through the Council on Accreditation of the AHIMA, graduates of accredited programs are eligible to take the national examinations for certification as RHIA or RHIT. So one of the major concerns I have is that if you don’t have HIM-educated and -credentialed people sitting on the board, or you bring in individuals who don’t have that background in HIM and recognize the coursework you need to have, it’s going to be slanted. In other words, in the clinical sense, these changes will place a greater emphasis on IT instead of information management.” Greenberg, along with Grzybowski and six other AHIMA members—most former office holders—issued a counterpoint to the AHIMA-issued frequently asked questions on the membership bylaw proposals, and have undertaken a grassroots campaign to educate fellow members about the proposed changes and their concerns about the future of the AHIMA under an open membership. For example, they point out that an AHIMA survey found that employers value credentials more than 80% of the time and question whether that will still be true if active membership no longer requires a credential. “The whole thing is about balance; you’ve worked for something and you’ve achieved something so you get rewarded for it,” says Grzybowski. “Filling the workforce with people who aren’t credentialed, how does that meet the needs? Aren’t employers looking for people with that education and those credentials?” The AHIMA’s leadership discounts the idea that credentials will be devalued simply because it is no longer a requirement for active membership. “The value of the credential comes from the employer’s view of it, from the market demand for it when making hiring decisions,” says Dennis. “If anything, drawing new people into the association will feed the growth of people who seek those credentials.” A second key concern voiced by detractors is that eliminating the credential requirement for members who will then be able to shape policy will result in a loss of influence by the association because the AHIMA will be ceding some control over its standards—something other professional associations have refused to do, yet have maintained both their size and power. For example, the American Bar Association is unyielding in its degree and/or credential requirements for the legal nurse consultant certification program, to the point where Greenberg says he was denied entry into an introductory course for legal nurse consultants because he was not a registered nurse (RN)—although his background appeared to qualify him for entry. Greenberg was eventually allowed to take the class, but it was made clear that he could not become involved as a student in the certificate program without being an RN. “Why is my national organization pushing to water down our credential requirements when I can’t take a class because the American Bar Association restricts me from even getting into the profession?” he asks. “AHIMA has always been in the forefront of trying to make a political statement in regards to making changes in our environment, yet there are other national organizations that have just refused to bend their position” and have remained powerful players in setting the standards for their respective industries. Influence comes not from the credential itself, but from the work the AHIMA has done to develop standards, the caliber of people within the organization, and the focus the organization has placed on outreach and building bridges, says AHIMA leadership. “The extent that we close ranks and don’t allow those kinds of interactions to occur, we’ll have less influence in the field,” says Dennis. “One of the important things any association does for its members is advocate for member interests in Washington and represent HIM practice in a number of standards and collaborative venues. You can do that better if you are more dominant and a stronger force in the industry. This is not numbers for the sake of numbers. It is broadening the reach and the influence of the profession by maintaining our position as the No. 1 HIM association in the United States. That’s an important benefit.” Adds Pickard: “It’s going to make AHIMA stronger and I really do believe there is strength in numbers. It adds to our influence, it makes us stronger, and that comes back as a benefit to all members.” A Lack of Communication? But that’s not enough, say some, who take particular issue with an earlier aborted attempt to pass the amendment via an electronic vote. “That didn’t allow for the dialogue to take place that needed to take place,” says Greenberg. “A lot of people are still not informed on this issue and their state delegates have not done a good enough job of educating their membership. So we feel that there are still a lot of members out there who don’t understand the ramifications of this, either pro or con, because they’re still in the dark.” Adds Grzybowski: “It’s worrisome. [Education] has been a grassroots effort for sure.… It’s been a very condensed public debate time on this, which is not right.” The leadership counters that there has been ample debate over the issue and that changes have already been made to the proposal to account for feedback delegates have received from their membership, including changing the proposal from any interested individual to interested individuals who are willing to abide by the Code of Ethics, as well as the credential requirement for the board. “This is something members should stay tuned to because between now and October, there will be some additional changes,” says Dennis. Despite those concessions, Grzybowski, Greenberg, and others who oppose the change say not enough attention has been paid to possible alternatives that have been presented. Among those are the following: • allowing interested members to sit for the RHIT or RHIA certification exam after one year of associate membership, allowing them to move into active status if they pass; • continuing business partnerships and joint activities such as cohosting educational activities, teaming up to lead initiatives such as the Certification Commission for Healthcare Information Technology with the National Alliance for Health Information Technology and HIMSS, and welcoming other professionals as associate members as well as AHIMA members participating in other associations’ activities; • dedicating research dollars to encourage recruitment for schools and exploring why individuals with other types of credentials have not been pursuing additional education with the desire to pass the national exams and obtain certification; • pursuing “national” licensure to become a “health information practitioner,” defined as having graduated from an accredited HIM educational program and receiving a certification by passing a national examination, thus strengthening the credential and separating the membership issue from the credential; and • continuing to look at ways associate members can obtain other possible certification and education so they can work their way toward and be encouraged to receive an HIM credential and become an active member. “AHIMA executives and the board are not responding to any of these alternatives and that’s what is frustrating,” says Grzybowski. “Our whole point is that there are other ways to accommodate these things. You can partner with an association or even become one association; you can have different sections and societies in which you have voting and office privileges for those particular areas of interest but not in other areas where perhaps you’re not as expert. That’s one way to do it; there are others as well.” Adds Greenberg: “Don’t get me wrong; I don’t want to keep people from participating. I think there is definitely an opportunity to participate. I just don’t think they need to be on our board of directors and influence our educational requirements. I don’t have any problem with anyone who wants to participate as an associate member. Let them get a credential. Open the door to let people sit for the examination because if they’ve got the educational knowledge and experience, they’re going to pass. That’s what it boils down to.” An October Decision “Instead of pushing this down the throats of the delegates at the meetings, they should withdraw the motion and hold an open forum at the conference, line up a number of us on one side and a number of us on the other, and actually have a debate,” says Grzybowski. “Let the people decide for themselves. “Some thoughtful consideration, evaluation of the alternatives and empirical data, that’s all people are asking for,” she adds. “We’re an association that values that.” The membership absolutely should continue to weigh in through discussions with their delegates, who are ultimately responsible for taking into account the direction set by the members they represent, says Dennis, adding that if delegates have not been reaching out to their membership, then members need to get proactive about communications. The decision, she says, “is not one you make lightly. There has been a lot of thought, a lot of debate, and a lot of talking with individual members about it. And we know that not everyone will agree with the strategy, but what we have to do in the House is look at what is best in the long term for the association and try to plow forward in that direction. The risk of doing nothing—and doing nothing is also making a decision—is to turn your back on an opportunity that would be a great one for expanding the HIM profession in the near future.” — Elizabeth S. Roop is a Tampa, Fla.-based
freelance writer specializing in healthcare and HIT.
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