McCormick, K., Gugerty, B. & Sensmeier, J. (Feb, 2017). A Comparison of Professional Informatics-Related Competencies and Certifications. Online Journal of Nursing Informatics (OJNI), 21(1), Available at http://www.himss.org/ojni
Purpose: This paper describes various types of professional informatics competencies that are measured by certification standards. Certification demonstrates that an individual meets the standards of a professional body of knowledge and has reached a milestone in professional development. By getting certified, nurses distinguish themselves in an increasingly competitive marketplace, expand career opportunities, validate their knowledge, competency and credibility, and gain skills and tools to help them make a difference in their organization and community of practice.
Organizing Construct: Nursing has a proud history of defining competencies and roles for nurses working in the specialty of informatics. The American Nurses Association established the American Nurses Credentialing Center (ANCC) which has successfully achieved ISO 9001:2008 certification in the design, development, and delivery of global credentialing services and support products for nurses and healthcare organizations. ISO 9001:2008 certification is the firmly established global standard for assuring stakeholders of an organization's ability to satisfy quality-related requirements. Many organizations require that hiring candidates have certification and encourage current employees to obtain certification.
Methods: The ANCC focuses on scholarship in nursing informatics competencies and its role-delineation studies to develop and maintain the certification exam. The ANCC maintains a content-expert panel with oversight responsibility into the content for this examination and in defining the test-item content. Eligibility for the exam requires a bachelor’s degree in nursing or a “relevant field, ” along with specified practice and educational experience in nursing and information technology.
Findings: Certification credentials indicate to patients, colleagues and hospital-leadership, that a nurse is committed to standards of excellence that translate into better quality and outcomes of care. It demonstrates that the nurse meets the standards of a professional body of knowledge and has reached a milestone in professional development. As of December 31, 2014, 1622 nurses have achieved ANCC Informatics Nursing certification.
Conclusions: There are many types of professional informatics competencies that are measured by certification standards. Each of the certifications described in this paper have different educational entry points and varying requirements for continuing education to renew certification. Certification credentials are being recognized by nurses, hiring managers and administrators as essential for professional roles in informatics and health information technology.
Clinical Relevance: Informatics competencies are essential requirements for equipping every nurse to deliver safer, higher-quality patient care. Certification demonstrates that the nurse meets the standards of a professional body of knowledge and has reached a milestone in professional development.
As the healthcare industry matures, increasing numbers of professionals are seeking certification to further demonstrate their competence. At the same time, the number of professional certification programs has multiplied. Certification indicates mastery or competency as measured against a set of requirements, and typically requires testing via an examination by a third-party, standard-setting organization. These certification requirements, or standards, are set through a defensible, industry-wide process that includes a job analysis or role delineation survey for the specialty, and resulting publication of a content outline of the required knowledge and skills. Once certified, a healthcare professional must demonstrate ongoing competency by completing specific continuing education requirements to maintain their credentials. Industry certification programs continue to evolve, and today credentials are available for nursing and clinical informatics, health information management, health information technology, privacy and security, and cybersecurity.
Nursing’s Proud National and International History in Competency Development
During the 1980s nursing informatics professional groups began developing competencies for the specialty. In a 1987 meeting in Stockholm, Sweden, the Nursing Informatics Education Task Force, a subgroup of IMIA-NI (formerly called Working Group 8), was convened by Dr. Ulla Gerdin-Jelger (Peterson & Gerdin-Jelger, 1987). The group included nursing informatics representatives from the United States, Canada, Australia, and Europe. Individuals representing the United States included Drs. Susan Grobe, Bill Holzemer, Kathleen McCormick, and Judith Ronald. The Task Force defined nursing informatics competencies by examining the tasks associated at that time with the role of the nurse in administration, practice, education, and research. The informatics competencies and roles were categorized into three levels. Level 1 roles could identify information system requirements for healthcare. Level II roles participated in systems analysis and evaluation, and Level III roles included innovators and/or developers of new tools and those that participated in enhancing integration of patient information systems.
Simultaneously in 1985, Dr. Susan Grobe and five other colleagues organized the National League for Nursing (NLN) First National Forum on Computers in Healthcare and Nursing. The NLN is the primary nursing organization to accredit undergraduate nursing programs in the United States. Since 1985, the NLN has supported the integration of information technology content in nursing curriculum. In 2006 the American Association of College of Nursing (AACN), which accredits nursing education programs, revised The Essentials for Doctoral Education for Advanced Nursing Practice and The Essentials of Baccalaureate Education for Professional Nursing Practice to require the use of computers and informatics for both baccalaureate and graduate education. The requirements for informatics competencies are defined to prepare nurses to successfully use healthcare information technology (IT), and to contribute to the ongoing design of technologies that support nursing (AACN, 2016).
It was not until 1992 that the American Nurses Association (ANA) Database Steering Committee, chaired by Dr. Norma Lang, developed a definition of nursing informatics that was subsequently approved by the ANA for the specialty. Three years later in 1995, the American Nurses Credentialing Center (ANCC) offered the first Informatics Nursing certification. (Hunter & Bickford, 2015) The chair of the first ANCC certification committee to focus on validating Informatics Nursing competencies was Ms. Rita Zielstorff. ANCC is the only nurse credentialing organization to successfully achieve ISO 9001:2008 certification in the design, development, and delivery of global credentialing services and support products for nurses and healthcare organizations. ISO 9001:2008 certification is the firmly established global standard for assuring stakeholders of an organization's ability to satisfy quality-related requirements.
At the same time, three nurse leaders began to host Weekend Immersions in Nursing Informatics (WINI) that were workshops to help prepare nurses interested in becoming certified. Those same leaders are still involved in leading WINI workshops (Dr. Carol Bickford and Dr. Kathleen Smith), and the subsequent NI Boot Camps (Dr. Susan Newbold). (Saba & McCormick, 2015).
In 2005, funded by the Robert Wood Johnson Foundation, the Quality and Safety Education for Nurses (QSEN) project began. This project was organized over three phases between 2005-2012 with the overall goal to address the challenges of preparing future nurses with the knowledge, skills and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems in which they work. Informatics, one of the core QSEN competencies, was defined as the ability to use information and technology to communicate, manage knowledge, mitigate error, and support decision making.
In May 2008, the National League for Nursing (NLN) released a Position Statement titled: Preparing the Next Generation of Nurses to Practice in a Technology-rich Environment: An Informatics Agenda. In this statement, the group recommended that faculty develop competency in informatics (NLN, 2008). In an effort to assist faculty, the Task Group on Faculty Development Related to Informatics Competencies was formed by the NLN Educational Technology and Information Management Advisory Council to create a web resource with information and links to materials that would assist faculty to develop informatics competencies.
The ANCC focuses on scholarship in nursing informatics competencies in the role-delineation studies that inform test content for the certification exam. (Hunter & Bickford, 2015) The ANCC maintains a content-expert panel responsible for defining the test content for this exam. The test content outline is available on the ANCC website. Eligibility for the exam requires a bachelor’s degree in nursing or a “relevant field”, along with specified years of practice and educational experience in nursing and information technology.
For the first time, in the sixth edition of the Essentials of Nursing Informatics edited by Saba and McCormick, mappings of the ANCC content outline to the first eighteen chapters of the book are included. In this new study guide, sample test questions for each chapter were designed to aid faculty and students in preparing for the exam, (Brixey, Brixey, Saba & McCormick, 2015). The ANCC informatics nurse competencies are recognized by vendors who are developing and implementing electronic health records (EHRs), informatics faculty working in academia, and healthcare administrators seeking nurses with competencies in working with information technology.
Certification credentials demonstrate to patients, colleagues and healthcare organization leadership that a nurse is committed to standards of excellence that translate into better quality and outcomes of care. Today, ANCC sponsors a program called Success Pays™. Organizations that participate in this program pay for a minimum of 20 staff to sit for ANCC certification exams. Thus, the organizations can increase their numbers of board certified nurses, with no financial risk. Nurses can retake an exam if they fail, and even if they don’t pass, the organization does not pay the fee. (ANCC, 2016).
As of December 31, 2014, 1622 nurses have achieved ANCC Informatics Nursing Certification. The ANCC Primary Care Certification Exam also now includes content in Information Technology. The ANCC Informatics Nursing board certification is a competency-based examination that provides a valid and reliable assessment of the entry-level clinical knowledge and skills of registered nurses in the information specialty after initial RN licensure. Once completed, the credential is valid for 5 years. There are substantive continuing education requirements for renewal. The National Commission for Certifying Agencies and the Accreditation Board of Specialty Nursing Certification accredits the ANCC certification.
Adoption and Perceived Value of Nursing Informatics Certification
Since 2004, the Healthcare Information and Management Systems Society (HIMSS) has surveyed the nursing informatics community to gain an understanding of the roles and responsibilities of the informatics nurse professional. In the HIMSS 2014 Nursing Informatics Workforce Survey, representing more than 1,000 informatics nurses, 23% of those surveyed had achieved ANCC certification. The number of respondents with any professional certification increased to 48 percent from 45 percent in the previous survey in 2011 (Figure 1). Seventeen percent of respondents had achieved other nursing specialty certifications, and six percent had achieved CPHIMS certification.
Figure 1: Nursing Informatics Certification
Job responsibilities of the respondents included: Systems implementation, system optimization/utilization, systems development, clinical analytics, quality initiatives/reporting, informatics education, liaison/communicator, and regulatory initiatives (Table 1). Systems application experience included: nursing clinical documentation, electronic medical records (EMR)/EHR, Computer-based Provider Order Entry (CPOE), non-nursing clinical documentation, Electronic Medication Administration Records (eMAR), clinical information systems, Bar Coded Medication Management, quality improvement/risk management, and Point-of-care Clinical Decision Support.
Table 1: Job Responsibilities of Informatics Nurses
For the first time, respondents in the 2014 survey who held certifications were asked to identify the perceived value in being certified. As shown in Figure 2, the most frequently reported values were personal satisfaction (41 percent) and enhanced credibility and marketability (40 percent). Over one-third (35 percent) of certification holders also found that certification validates specialized knowledge. At least one quarter of respondents reported that certification enhances confidence (28 percent), provides a competitive advantage (28 percent) and demonstrates attainment of practice/clinical standards (27 percent). (HIMSS, 2014).
Figure 2: Perceived Value in Holding Certification
What does certification demonstrate? It demonstrates that the nurse meets the standards for a a professional body of knowledge and has reached a milestone in professional development. Many organizations require hiring candidates that are certified, and encourage their current employees to obtain certification. By getting certified, nurses can distinguish themselves in an increasingly competitive marketplace, expand career opportunities, validate their knowledge, competency and credibility, and gain skills and tools to help them make a difference in their organization and community of practice.
Healthcare Information Technology Professional Certifications
HIMSS established the Certified Professional in Healthcare Information and Management Systems (CPHIMS) credential in 2002. CPHIMS is a credential for experienced healthcare information and management professionals. The purpose of CPHIMS is to promote healthcare information and management systems professionals through certification by formally recognizing qualified individuals who meet the eligibility requirements and pass the required examination. The program encourages continued personal and professional growth in the practice of healthcare information and management systems. It also provides an international standard of knowledge required for certification, thereby assisting employers, the public and members of the health professions in the assessment of a healthcare information and management systems professional (HIMSS, 2016)
The CPHIMS exam is designed to test the knowledge, experience and judgment of IT professionals in healthcare informatics practice. Content of the examination is defined by an international role-delineation study. The study involved surveying practitioners in the field to identify tasks that are performed routinely and considered important to competent practice. The exam is developed through a combined effort of qualified subject-matter experts and testing professionals who construct the exam in accordance with the CPHIMS Exam Content Outline.
HIMSS also administers a professional certification program for emerging professionals who may not have experience within the healthcare industry but seek a pathway for a career in health IT. This program is the Certified Associate in Healthcare Information and Management Systems (CAHIMS). This certification exam is designed for emerging professionals in the healthcare industry with five years or less experience. This certification can demonstrate professional knowledge in healthcare information and management systems to potential and current employers and help establish a solid foundation as the individual acquires more experience.
American Health Information Management Association Certifications
In 2011, the U.S. Office of the National Coordinator for Health IT developed competencies and launched a certification program for healthcare professionals called HIT Pro™ Certification. This program was retired in March 2013 and the American Health Information Management Association (AHIMA) now oversees the exams as the Certified Healthcare Technology Specialist Series (CHTS). These exams follow the same role-based content as the ONC HIT Pro categories. The health IT roles include: Physician/Practitioner Consultant, (CHTS-CP), Practice Workflow and Information Management Redesign Specialist (CHTS-PW), Implementation Manager, (CHTS-IM), Implementation Support Specialist (CHTS-IS), Technical/Software Support Staff (CHTS-TS), and Trainer (CHTS-TR). AHIMA members include health information management employees, companies and consultants, individuals, and academic institutions with health information management programs. These roles include a focus on privacy and security, diagnostic and treatment coding, electronic health records, reimbursement, regulatory compliance, healthcare information technology, and information governance.
Other Professional Association Certifications
There are several other professional associations that offer certifications to demonstrate the healthcare IT and informatics competencies of healthcare professionals. The American Medical Informatics Association (AMIA) has partnered with the American Board of Preventive Medicine (ABPM) to develop a clinical informatics subspecialty and enable their members to take a board certification examination that represents competency in clinical informatics. This exam is administered by Pearson VUE Professional Centers. The American Board of Pathology (ABP) also offers certification in clinical informatics (Reston & Pope, 2015).
In 2016, AMIA launched the Advanced Health Informatics Certification (AHIC) and defined eligibility requirements that are intended for informatics professionals representing the spectrum of primary disciplines, including the clinical informatics subspecialty for physicians. This effort will establish a board certification program for professionals who practice clinical/health informatics at an advanced level. The program will address core informatics content relevant to all professions including dentistry, pharmacy, nursing, nutrition, public health and radiology.
Industry Certifications in Healthcare Information Technology
CompTIA™ is a non-profit international trade association representing over 20,000 information technology companies that hosts industry-wide certification programs. The most popular certifications from CompTIA™ are focused on security and IT competencies. For example, in order to bid on Department of Defense (DoD) contracts, a U.S. company must assure security competency of their IT personnel that can be achieved through CompTIA™ certification. Skillsoft has web-based training and tools for professionals to study and take the exams on-the-job. This requirement is written as a directive (DoD Directive #8570) that the DoD contractors must fulfill. The directive requires any full or part-time military service member, contractor, or foreign employee with privileged access to a DoD information system, regardless of job or occupational series, to obtain a commercial information security credential accredited by ANSI or an equivalent accreditation body. DoD estimates this credential is required for approximately 100,000 individuals in the U.S.
There are six categories outlined in the DoD directive matrix with different roles and responsibilities for the certifications applicable for each category. For example, information assurance personnel must meet relevant criteria; managers must meet the certification requirements of managers, and technical personnel must meet the certification requirements of the technical categories. This directive can be viewed as a government endorsement of the effectiveness and cost-efficiency of commercial certification of competencies.
The CompTIA™ certification roadmap validates expertise dependent on career focus and number of years on the job. It includes beginner, intermediate, advanced, and expert exams in eight major categories: Information Security, Network and Cloud Technologies, Hardware, Services, and Infrastructure, IT Management and Strategy, Storage and Data, Web and Mobile, Software Development, and Training.
CompTIA™ has also established a Healthcare Information Technology (HIT001) certification to evaluate competencies of individuals working in healthcare IT. The categories of competence include: Healthcare Organizational Behavior, Healthcare Regulatory Requirements, Healthcare Business Operations, Healthcare IT Security, Privacy and Confidentiality, and Healthcare IT Operations. The target groups for this certification are computer scientists, engineers, IT professionals and other industries desirous of working in healthcare IT, individuals certifying for careers in IT, government agencies for employees, contractors and veterans requiring certification. A resource was published to help prepare healthcare practitioners, computer scientists and engineers for the CompTIA Healthcare IT exam (McCormick & Gugerty, 2013). Appendix A of this book mapped each chapter content with the objectives for the CompTIA™ Healthcare IT Technician Exam, and Appendix B mapped each chapter content to the AHIMA CHTS exams. The healthcare IT exams are available internationally through Pearson Vue. For faculty adopters and those studying for the exam, there are several sample practice exam questions and answers, PowerPoint slides, and lesson plans for each segment of the exam. The CompTIA™ Healthcare Information Technology exam will retire in 2017. A new edition of the Healthcare Information Technology Exam Guide will focus on mapping for both the CHTS & CAHIMS certifications (McCormick, Gugerty & Mattison, 2017).
Comparison of Professional Certifications
The certifications requiring formal specific professional education include nursing informatics (ANCC), health information technology (HIMSS), health information management (AHIMA), and medical specialties (ABPM). Of these, the nursing informatics certification is the only program that has achieved ISO certification. The nursing informatics certification focuses on quality and effectiveness in healthcare. The persons hiring for these credentials differ from those hiring for IT skills alone. Table 2 contains a comparison of major content areas for the certifications discussed in this manuscript. Table 2 also allows the reader to view the categories (Domains, Mid-Level Content Topics and Subdomains) of competencies, represented by programs of HIT certification, all in one view. Each of the categories of these certificate programs also includes lower level competencies. There are six CHTS exams that lead to the following CHTS certifications: Practice Workflow & Information Management Redesign Specialist; Clinician/Practitioner Consultant; Implementation Manager; Implementation Support Specialist; Technical/Software Support Staff; and Trainer. Each CHTS exam covers five to seven Domains that target the role of the particular certificate bearer the best from among the 18 CHTS Domains. CPHIMS & CAHIMS have essentially the same Mid-Level Content Topics. However, the Lower-Level Content Topics differ between the two exams.
Table 2: Comparison of content domains in certification programs discussed
The alignment of concepts across certification programs is approximate, as the four groups were not working from a common set of standard concepts and terms. Furthermore, it would be incorrect to assume that a blank cell--for example the intersection of the CTHS and ANCC columns and the Security row—means those columns’ programs do not cover that competency; CTHS and ANCC cover Security and Privacy, which is also included in various other competency terms. Many of the differences seen in this Table 2 reflect the primary purpose of the various certification programs. CPHIMS is targeted towards the professional HIT workforce and the CAHIMS is mostly technical with some professional level competencies. CHTS, unlike the other two programs, combines the categories of competencies in different ways to create six certifications for six different roles, some of which are technical and others professional. ANCC is a professional nursing certification.
Industry Certifications Focused on Privacy, Security and Cyber Threats
Formed in 1989 and celebrating its 25th anniversary, ISC2® is the largest not-for-profit membership body of certified information and software security professionals worldwide, with nearly 100,000 members in more than 135 countries. Globally recognized as the Gold Standard, ISC2® issues the Certified Information Systems Security Professional (CISSP®) and related concentrations, as well as the Certified Secure Software Lifecycle Professional (CSSLP®), the Certified Cyber Forensics Professional (CCFP), Certified Authorization Professional (CAP®), HealthCare Information Security and Privacy Practitioner (HCISPP), and Systems Security Certified Practitioner (SSCP®) credentials to qualifying candidates. ISC2®’s certifications are among the information technology credentials that meet the stringent requirements of ANSI/ISO/IEC Standard 17024, a global benchmark for assessing and certifying personnel. ISC2® also offers education programs and services based on its CBK®, a compendium of information and software security topics.
A discussion of the future would be incomplete without considering that soon, competencies in genetics and genomics will be required in healthcare IT certification programs. Competencies in this area are especially needed to strengthen clinical assessment to include detailed family health histories. It is also important to consider the need for competencies regarding assessments of pharmacogenetic and pharmacogenomics influences on drug administration, observations of adverse reactions, and documentation of changes in medications. Genomic and pharmacogenomics competencies for nurses have been defined, but are not yet inclusive of all relevant informatics implications. Guidelines, algorithms, and roadmaps for inclusion of such content into the EHR and clinical practice are just beginning to be developed.
The primary healthcare IT certifications that require formal professional education include informatics nursing (ANCC), health information management (AHIMA), health information technology (HIMSS) and clinical informatics for medical specialties (ABPM). The ANCC has successfully achieved ISO 9001:2008 certification in the design, development, and delivery of global credentialing services and support products for nurses and healthcare organizations. These professional certifications focus on ensuring quality and effectiveness in healthcare delivery. The individuals with these credentials have competencies in both healthcare IT and informatics.
Professional societies, such as AHIMA and HIMSS offer certification programs in order to demonstrate informatics competencies of healthcare professionals. These programs encourage personal and professional growth and assist employers, the public and members of the health professions in the assessment of these certified professionals. Other industry certifications are available focused on information technology, privacy and security, with a recent emphasis on cybersecurity. As the professional practice and the certification industry evolve new programs must address competencies in emerging areas such as genomics and pharmacogenetics.
American Association of Colleges of Nursing (2016). The Essentials for Doctoral Education for Advanced Nursing Practice. Retrieved from http://www.aacn.nche.edu/about-aacn
American Nurses Credentialing Center (2016). ANCC Informatics Nursing Certification Retrieved from http://nursecredentialing.org/Certification/SuccessPays/FAQs
Brixey, J.J., Brixey, J.E., Saba, V.K. & McCormick, K.A. (2015). Essentials of Nursing Informatics Study Guide. New York, McGraw-Hill Global Education, LLC.
HIMSS (2016). CPHIMS Certification. Retrieved from http://www.himss.org/health-it-certification/cphims
HIMSS (2014). 2014 Nursing Informatics Workforce Survey. Retrieved from http://www.himss.org/2014-nursing-informatics-workforce-survey-full-results
Hunter, K.M. & Bickford, C.J. (2015). The Practice Specialty of Nursing Informatics. In Saba and McCormick (Eds), Essentials of Nursing Informatics, 6th Edition. 229-248. New York, McGraw-Hill Global Education, LLC.
McCormick, K.A. & Gugerty, B. (2013). Healthcare Information Technology: Exam Guide for CompTIA Healthcare IT Technician and HIT Pro Certifications. New York: McGraw-Hill Global Education, LLC.
McCormick, K.A., Gugerty, B. & Mattison, J.E. (2017). In Press. Healthcare Information Technology Exam Guide for CHTS & CAHIMS Certifications 2nd Edition. New York: McGraw-Hill Global Education, LLC.
National League for Nursing (2008). Preparing the Next Generation of Nurses to Practice in a technology-rich environment: An Informatics Agenda. New York: NLN.
Peterson, H.E. & Gerdin-Jelger, U. (1987). Preparing Nurses for Using Information Systems. Recommended Informatics Competencies. Proceedings of the Working Group 8 Task Force on Education: 1987 June 10-13, Djuro, Sweden. New York: National League for Nursing, `988. ISBN 0-88737-416-6.
Reston, R. & Pope, C. (2015). Clinical Informatics Board Review: Pass the Exam the First Time. Retrieved from http://www.informaticspro.com.
Saba, V.K. & McCormick, K.A. (2015). Essentials of Nursing Informatics, 6th Ed. New York, McGraw-Hill Global Education, LLC.
Wood, D.A. (2015). Nursing credentials matter to patients, employers and nurses. Retrieved from https://www.nurse.com/blog/2015/01/23/nursing-credentials-matter-to-patients-employers-and-nurses/