A Comparison of Professional Informatics -Related Competencies

and Certifications
Source:
OJNI Volume 21, Winter 2017
by Kathleen A. McCormickBrian GugertyJoyce Sensmeier

Citation
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

Abstract
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 bachelors 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.

Introduction
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.

Nursings 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 bachelors 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 Informaticsedited
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 dont 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 rowmeans 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. ISC2s
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.

Future Competencies
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.

Summary
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.

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