Transforming Nursing

AlignmentofAmericanAssociationofCollegesofNursingGraduate-LevelNursingInformaticsCompetenciesWithAmericanMedicalInformaticsAssociationHealthInformaticsCoreCompetencies.pdf

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FEATURE ARTICLE

Alignment of American Association of Colleges of Nursing Graduate-Level Nursing Informatics Competencies With American Medical Informatics Association Health Informatics Core Competencies Karen A. Monsen, PhD, RN, FAMIA, FAAN, Ruth A. Bush, PhD, MPH, FAMIA, Josette Jones, PhD, RN, E. LaVerne Manos, DNP, RN, FAMIA, Diane J. Skiba, PhD, FACMI, ANEF, FAAN, Stephen B. Johnson, PhD, FACMI

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This study yielded amap of the alignment of American Asso- ciation of Colleges of Nursing Graduate-Level Nursing Infor- matics Competencies with American Medical Informatics Association Health Informatics Core Competencies in an effort to understand graduate-level accreditation and cer- tification opportunities in nursing informatics. Nursing In- formatics Program Directors from the American Medical Informatics Association and a health informatics expert independently mapped the American Association of Col- leges of Nursing competencies to the American Medical In- formatics Association Health Informatics knowledge, skills, and attitudes. The Nursing Informatics Program Directors' map connected an average of 4.0 American Medical Infor- matics Association Core Competencies per American Asso- ciation of Colleges of Nursing competency, whereas the health informatics expert's map connected an average of 5.0 AmericanMedical Informatics Association Core Compe- tencies per American Association of Colleges of Nursing competency. Agreement across the two maps ranged from 14% to 60% per American Association of Colleges of Nursing competency, revealing alignment between the two groups' competencies according to knowledge, skills, and attitudes. These findings suggest that graduates of master's degree programs in nursing, especially those specializing in nursing informatics, will likely be prepared to sit for the proposed Advanced Health Informatics Certification in addition to the American Nurses Credentialing Center bachelor's-level Infor- matics Nursing Certification. This preliminary map sets the stage for further in-depth mapping of nursing informatics cur- ricula with American Medical Informatics Association Core

thor Affiliations: University of Minnesota School of Nursing, Minneapolis (Dr Monsen); Hahn hool of Nursing and Health Science, University of San Diego, California (Dr Bush); Indianapolis hool of Informatics and Computing, Indiana University (Dr Jones); Kansas University Medical nter (Dr Manos); University of Colorado College of Nursing, Aurora (Dr Skiba); and New York iversity Langone Health, New York (Dr Johnson).

e authors have disclosed that they have no significant relationships with, or financial interest , any commercial companies pertaining to this article.

rresponding author: Karen A. Monsen, PhD, RN, FAMIA, FAAN, University of Minnesota hool of Nursing, 5–140 Weaver-Densford Hall, 308 Harvard St SE, Minneapolis, MN 55455 [email protected]).

I: 10.1097/CIN.0000000000000537

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Competencies andwill enable interprofessional conversations around nursing informatics specialty program accreditation, nursing workforce preparation, and nursing informatics ad- vanced certification. Nursing informaticists should examine their need for credentials as key contributors who will address critical health informatics needs.

KEY WORDS: Accreditation, Certification, Competencies, Nursing informatics

T hemajority of nursing work involves technology and in- formationmanagement.1–4Thus, health system employers depend on the nursing workforce to possess robust in-

formatics knowledge and skills as well as positive attitudes.5–8

Increasing demands for qualified nurse informaticists is driv- ing credentialing of nurses who specialize in informatics, with AmericanNurses Credentialing Center (ANCC) board certifica- tion available at the BSN level (RN-BC).9 A proposed Advanced Health Informatics Certification (AHIC) is under develop- ment, based on related work in accrediting health informatics programs.10–14 In this article, we provide background on the critical, intertwined issues related to credentialing (certification) of advanced nursing informaticists and the accreditation of nursing informatics specialty programs in the context of inter- professional healthcare informatics credentialing and program accreditation. We also report the results of our study examin- ing the alignment of nursing informatics education and health informatics education. These steps are critical to lay the foun- dation for further policy conversations regarding nursing's ability to participate in future AHIC credentialing and the accreditation of nursing informatics specialty programs.

INFORMATICS CERTIFICATION FOR GRADUATES OF NURSING PROGRAMS Certification is a way for nurses and other clinicians to demon- strate informatics expertise to prospective or current employers.9

Nurses are eligible to sit for theANCCbachelor's-level Informatics

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mailto:[email protected]

Nursing Certification (RN-BC) examination when they hold a current, active RN license; hold a bachelor's or higher degree in nursing or a relevant field; and comply with practice and continuing education requirements.9 The ANCCmay consider the development of an advanced informatics specialist certifica- tion at some point; however, it is currently not available, and the ANCChas not announced plans to develop such certification. The RN-BC credential is especially valuable for bachelor's degree-prepared nurses who are recent graduates and have not attended a graduate-level nursing informatics program.

ADVANCED HEALTH INFORMATICS CERTIFICATION FOR GRADUATES OF HEALTH INFORMATICS PROGRAMS The AHIC credential, under development by the American Medical Informatics Association (AMIA), will demonstrate advancedpreparation in health informatics across professions.10–14

As a professional application area within health informatics, nursing/nurses are primary users and essential teammembers in diverse health informatics contexts (industry, practice, re- search).14 Thus, nurse informaticists with advanced infor- matics education are within the definition of those who should seek advanced health informatics certification through AHIC.12,13 This AHIC credential would be especially valu- able for nurse informaticists who have completed advanced nursing degrees with a specialty in informatics. However, bar- riers to nurse participation in AHIC may exist, as it is an AHIC requirement that only graduates of Commission on Accreditation for Health Informatics and Information Manage- ment Education (CAHIIM)–accredited informatics programs will be able to sit for the AHIC examination. Currently, no graduate-level nursing informatics specialty programs are CAHIIM accredited.

Another challenge for nurse informaticist participation is the AHIC requirement of a minimum of two master's degrees: one in a health profession and one in informatics. Apropos of nursing's critical role in informatics, nursing informatics education exists

not separate from, but within the fabric of, nursing degree programs.8,15,16

That is, while all nurses learn essential informatics content during their nursing education at all levels, nurses obtaining advanced nursing degrees may specialize in nursing informat- ics within their degree programs.3,5 This advanced nursing informatics specialty educational model differs from other professional informatics educational models (eg, medical train- ing), in whichmedical training (eg,MDorDO) is separate from specialized health informatics education (eg, MS or MHI).17

Thus, the AHIC requirement of a minimum of two master's degrees conflicts with the nursing informatics specialty educa- tion model, in which nurses specialize in informatics within their graduate/doctoral degree programs and earn one, not two, academic degree. To enable nursing's participation in AHIC, it is essential to establish the equivalence of nursing's educational model and the dual master's educational model.

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One way to do so would be to examine the alignment of core competencies across educational models, as accreditation for both nursing and health informatics programs relies on core competencies.11,15,18 These core competencies for master's- level nursing informatics degree programs (developed by the American Association of Colleges of Nursing [AACN]) and for health informatics master's degree programs (developed by AMIA) are available online.11,15

COMMISSION ON ACCREDITATION FOR HEALTH INFORMATICS AND INFORMATION MANAGEMENT EDUCATION ACCREDITATION AND AMERICAN MEDICAL INFORMATICS ASSOCIATION CORE COMPETENCIES The relationship between CAHIIM and AMIA has been long established.10 The decision for AMIA to join CAHIIM builds on the work of the interprofessional Blue RibbonHealth Informatics Work Group in 2008; AMIA became a valued stakeholder member of CAHIIM in January 2015. The AMIA Academic Forum championed this decision, and the AMIA and CAHIIM Board of Directors approved it in 2014. A Health Informatics Accreditation Council within CAHIIM focuses on maintaining health informatics education quality, recommending action on program reviews, revising accred- itation standards, approving and overseeing peer reviewers, and collaborating with AMIA on curriculum requirements.10

The AMIA Health Informatics Core Competencies were developed based on the AMIA white paper in 2012 by the AMIA Accreditation Committee.11 They are: (F1) Health; (F2) Information Science andTechnology; (F3) Social and Be- havioral Science; (F4) Health Information Science and Tech- nology; (F5) Human (Factors and Socio-technical Systems; (F6) Social and Behavioral Aspects of Health; (F7) Social, Be- havioral, and Information Science and Technology Applied to Health; (F8) Professionalism; (F9) Interprofessional Collab- orative Practice; and (F10) Leadership. Each is defined and further specified with statements of knowledge, skills, and atti- tudes. The AMIAHealth Informatics Core Competencies are intended for curriculum development and accreditation for graduate (master's level) education in applied health informatics as defined by andwithin the scope set forth byCAHIIM.10,11,18

The broadly defined AMIA Health Informatics Core Com- petencies enable the analysis of interprofessional informatics competencies across disciplines.

ACCREDITATION OF NURSING PROGRAMS The linkage between accreditation and nursing informatics board certification is not explicit for nursing programs as it is for CAHIIM and AHIC. Rather, a number of bodies accredit nursing programs across the continuum of nursing degrees, including the Accreditation Commission for Education in Nursing, Commission on Collegiate Nursing Education (CCNE),

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FEATURE ARTICLE

and National League for Nursing Commission for Nursing EducationAccreditation.19–21Nursing scholarship and practice experts have developed extensive resources around informatics competencies in nursing.5–8,15,16,22–24 These are used for var- ious purposes in education and accreditation. Professional nursing organizations have established standards for nursing informatics competencies for nursing program accreditation. These competencies also assist faculty as they integrate infor- matics into program curricula at prelicensure and graduate levels.5–8,15,16,22–24 Specifically, to assess fitness for accreditation of a master's program, the CCNE uses the core competencies defined by the AACN Essentials of Master's Education in Nursing.15 In this article, we focus on the master's-level nursing informatics core competencies as the equivalent level to the master's degree in health informatics core competencies, although graduate nursing degree programs offer specializations in nursing informatics at the master's (MS,MSN) and doctor of nursing practice (DNP), and PhD levels. Nursing students increasingly specialize in informatics and data science areas at all of these levels.3 Such nursing informatics specialty programs have proliferated in recent years in response to the need for advanced practice nursing informaticists in diverse roles throughout the healthcare system.25

NURSING PROGRAM ACCREDITATION AND NURSING INFORMATICS COMPETENCIES The AACN Informatics and Healthcare Technologies Essential V recognizes that the master's-prepared nurse uses patient-care technologies to deliver and enhance care and uses commu- nication technologies to integrate and coordinate care.15 The six competencies of Essential V are as follows:

1. Analyze current and emerging technologies to support safe practice environments and to optimize patient safety, cost-effectiveness, and health outcomes.

2. Evaluate outcome data using current communication technologies, information systems, and statistical prin- ciples to develop strategies to reduce risks and improve health outcomes.

3. Promote policies that incorporate ethical principles and standards for the use of health and information technologies.

4. Provide oversight and guidance in the integration of technologies to document patient care and improve patient outcomes.

5. Use information and communication technologies, resources, and principles of learning to teach patients and others.

6. Use current and emerging technologies in the care environ- ment to support lifelong learning for self and others.15

However, general nursing accreditation does not qualify students to sit for the AHIC examination. Therefore, in the case of graduate-level nursing informatics specialty programs,

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it may be of interest for the specialty program to be dual- accredited by a nursing accrediting body (eg, CCNE) as well as CAHIIM.10 Accrediting bodies rely on competencies documents as standards by which programs can be measured. As described above, the competencies CAHIIM employs for health informatics program accreditation have been developed and defined by the AMIA Accreditation Committee.11,18

To summarize, there are numerous unknowns regarding nurse informaticist participation in AHIC. First, it is not known whether there is alignment across nursing informatics competencies and health informatics core competencies, and thus it is not known whether graduates of nursing and health informatics master's-level programs can be expected to have equivalent or similar competencies. Second, AHIC require- ments include CAHIIM accreditation,12 and it is not known whether CAHIIM accreditation will be available for advanced nursing informatics specialty programs. Third, AHIC require- ment of a minimum of two master's degrees12 conflicts with the nursing informatics specialty education model, in which nurses specialize in informatics within their graduate/doctoral degree programs. This policy would need to be changed in order for MS- and DNP-prepared nurse informaticists who hold a single master's or doctoral degree in nursing with an informatics specialty to participate in AHIC. This study ad- dresses the first gap in knowledge: the alignment across nurs- ing informatics competencies and health informatics core competencies. The purpose of this study was to compare competencies of the AACN Informatics and Healthcare Technologies Essential V nursing informatics competencies for graduate nursing education and the AMIA Health Infor- matics Core Competencies from the perspectives of nursing informatics and health informatics experts (HIs). Our long- term goal was to inform discourse regarding future accredi- tation policy development for nursing informatics education that will support accreditation of nursing informatics specialty programs and enable participation of nursing informaticists in AHIC (Figure 1).

METHODS This competency mapping study compared AACN- and AMIA-published master's-level competencies that were devel- oped to support graduate-level accreditation. The documents for both sources were available on the Internet. There were no human subjects involved.

The executive committee of the nursing informatics pro- gram director (NIPD) community of the AMIA Academic Forum together with an HI familiar with the AMIA Core Competencies (authors) conducted the mapping procedure and analysis using standard information mapping methods.26

First, one NIPD executive committee member mapped the six AACN graduate-level Essential V Competencies to AMIA Health Informatics Core Competencies knowledge, skills,

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FIGURE 1. Nursing and interprofessional accreditation, competencies, programs, and certification opportunities.

and attitudes (KSAs) based on definitions and NIPD domain knowledge. Second, the NIPD executive committee reviewed and revised this mapping. Third, theHI expert with knowledge of the AMIA Core Competencies independently mapped the AACN Essential V Competencies and AMIA Core Compe- tencies based on levels of knowledge depicted inMiller's Prism of Clinical Competence.27 Fourth, the results of both NIPD and HI expert mappings were compared in a final meeting of the entire team. Finally, analysis of agreement based on counts of AMIA Core Competencies by AACN Competency (percent- age agreement of the counts across mappings) was calculated in Excel (Microsoft, Redmond, WA) (Figure 2).

An example of aligning mappings for AACN Essential V Competency 5 is shown below. Use information and commu- nication technologies, resources, and principles of learning to teach patients and others were mapped both by NIPD and by

FIGURE 2. Miller's levels of knowledge.

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HI to the AMIA F4. This was selected as a match by NIPD for the content of the F4: Health Information Science and Technology Knowledge KSA, Identify possible biomedical and

health information science and technology methods and tools for solv-

ing a specific biomedical and health information problem. Core health information technology tools may be dependent upon the application area of the training program. The same AMIA Foundational Domain was selected by HI with the notation “use information and communication technologies.” Full mappings are provided in Tables 1 and 2, and both source documents are freely available online with supporting explanations and references.11,15

RESULTS Two independently conducted NIPD and HI mappings found congruence between the six AACN Essential V Competencies

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Table 1. AMIA Knowledge, Skills, and Attitudes Competencies: Definitions

Core Competency Mapped Foundational Domain Definition

Knowledge KF1 Describe the history, goals, methods (including data and information used and produced), and current challenges of the major health science fields. These include biology, genomics, clinical and translational science, healthcare delivery, personal health, and population health (F1).

KF2 Identify concepts, methods, and tools related to managing data, information, and knowledge, the basic information and computer science terms and concepts, the principles of information security, as well as the methods of assessing users' information needs (F2).

KF3 Identify the effects of social, behavioral, legal, psychological, management, cognitive, and economic theories, methods, and models applicable to health informatics from multiple levels including individual, social group, and society (F3).

KF4 Identify possible biomedical and health information science and technology methods and tools for solving a specific biomedical and health information problem (F4).

KF5 Draw on sociotechnical knowledge regarding the social behavioral sciences and human factors engineering to apply to the design and implementation of information systems and technology (F5).

KF6 Identify theories or models that explain and modify patient or population behaviors related to health and health outcome (F6).

KF8 Define and discuss ethical principles and informaticist's responsibilities (F8). KF10 Articulate the methods, concepts, tools, and characteristics of leading and

leadership (F10). Skills SF4 Design a solution to a biomedical or health information problem by applying

computational and systems thinking, information science, and technology (F4). SF5 Apply social behavioral theories and human factors engineering to the design and

evaluation of information systems and technology (F5). SF6 Address social and behavioral problems related to health of individuals, populations,

and organizations (F6). SF8 Professional practices that incorporate ethical principles (F8). SF9 Relationship-building skills, interprofessional communication skills, complex

problem-solving skills (F9). SF10 Employ leadership and followershipmethods, concepts, and tools tomotivate others

toward accomplishing a health informatics vision (F10). Attitudes AF4 Demonstrate consideration of the advantages and limitations of using information

science and technology to solve biomedical and health information problems, as well as the needs of the different stakeholders and context (F4).

AF5 Demonstrate consideration and respect for the role of users in the design and application of information systems and technology (F5).

AF6 Acknowledge the importance of social and behavioral aspects of health and their contribution to the health of individuals and populations (F6).

AF7 Demonstrate an awareness of the interrelatedness of social, business, human factors, behavioral, and information sciences and technology in the design, implementation, and evaluation of health informatics solutions (F7).

AF8 Demonstrate awareness of the value of information literacy and lifelong learning (F8). AF10 Demonstrate leadership behaviors for achieving a vision for health informatics

solutions (F10).

FEATURE ARTICLE

and the 10 AMIA Health Informatics Core Competencies. There were a total of 39 of 60 possible matches (65%) be- tween AMIA Core Competencies and AACN competencies in at least one of the mappings (Figure 3). The greatest number of matches in both mappings was for Competency 1: Analyze current and emerging technologies to support safe practice environments,

and to optimize patient safety, cost-effectiveness, and health outcomes

(eight of 10 AMIA Core Competencies), and the least was for

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Competency 2: Evaluate outcome data using current communication technologies, information systems, and statistical principles to develop

strategies to reduce risks and improve health outcomes (five of 10). In the NIPDmapping, there was an average of 4.0 AMIA

Core Competencies mapped to each AACN competency by the NIPD experts (Table 1). Most AMIA Core Competen- cies (n = 5) related to the AACN Competency 1: Analyze cur- rent and emerging technologies to support safe practice environments, and

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Table 2. Nursing Informatics Program Directors' Mapping of AACN Graduate-Level Informatics Competencies With AMIA Health Informatics Core Competencies

AACN Master's-Level Informatics Competencies Mapped Foundational Domains

Subtotal by Category

Total by CompetencyKnowledge Skills Attitudes

1. Analyze current and emerging technologies to support safe practice environments and to optimize patient safety, cost-effectiveness, and health outcomes.

KF2, KF4, KF5, KF6, KF10 SF4, SF5, SF6, SF10 AF4, AF5, AF6, AF10

5 4 4 5

2. Evaluate outcome data using current communication technologies, information systems, and statistical principles to develop strategies to reduce risks and improve health outcomes.

KF2, KF4, KF5, KF6 SF4, SF5, SF6 AF6

4 3 1 4

3. Promote policies that incorporate ethical principles and standards for the use of health and information technologies.

KF3, KF8, KF10 SF8, SF10 AF5, AF10

3 2 2 4

4. Provide oversight and guidance in the integration of technologies to document patient care and improve patient outcomes.

KF4, KF6, KF10 SF4, SF6, SF10 AF4, AF6, AF7, AF10

3 3 4 4

5. Use information and communication technologies, resources, and principles of learning to teach patients and others.

KF1, KF4 SF9 AF5

2 1 1 4

6. Use current and emerging technologies in the care environment to support lifelong learning for self and others.

KF1, KF4 SF4 AF8

2 1 1 3

to optimize patient safety, cost-effectiveness, and health outcomes. Most AACN competencies per AMIA Foundational Domain (n = 4) related to Foundational Domain 4: Health Informa- tion Science and Technology.

In the HI expert mapping, there was an average of 5.0 AMIA Core Competencies mapped to each AACN compe- tency by the Health Informatics Education expert (Table 2). Most AMIA Core Competencies (n = 7) related to the AACN Competency 7: Use current and emerging technologies in

the care environment to support lifelong learning for self and others. Most AACN competencies per AMIA Foundational Domain (n = 6) related to Foundational Domain 2: Information Sci- ence and Technology and 4: Health Information Science and Technology.

Percentage of agreement across mappings ranged from 14% to 60% by AACN competency (Figure 3). Consensus was reached that analyses based on domain knowledge and knowledge levels both contributed to understanding a fuller picture of the alignment between AACN and AMIA.

DISCUSSION A mapping study evaluated the alignment of the AACN In- formatics and Healthcare Technologies Essential V nursing

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informatics competencies for graduate nursing education and AMIA Health Informatics Core Competencies from the perspectives of nursing informatics and HIs. Both mappings separately revealed alignment between AACNCompetencies and all 10 AMIA Core Competencies, and together they showed agreement across nursing informatics and health in- formatics perspectives. These findings suggest that the nursing informatics education model should be supported as a viable option for nurse informaticist participation in AHIC. Further interprofessional conversations are needed to extend this in- quiry and establish policy around graduate nursing workforce preparation in today's informatics-rich healthcare context, in- cluding nursing informatics specialty program accreditation and interprofessional AHIC.

The intent of AMIA Core Competencies was to support interprofessional alignment of KSAs across professions, and emphasis was expected to differ by profession.11,18 In the case of this nursing-specific mapping, some of the AMIA Core Competencies (eg, F1: Health; F6: Social and Behav- ioral Aspects of Health; F8: Professionalism; F9: Interprofes- sional Collaborative Practice; and F10: Leadership) would be extensively incorporated within graduate nursing educa- tion and would not be reflected in the AACN Essential V

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FIGURE 3. Heat map depicting agreement across NIPD mapping and HI mapping.

FEATURE ARTICLE

that is specific to informatics competencies. The AMIACore Competencies model was designed to include the health dis- ciplines (1–3) and leadership (8–10), which likely would be reflected in other AACNEssentials. To reflect fully the scope of graduate nursing education as compared to the AMIA Core Competencies, we discovered that we would need to incorporate all nine AACN essentials and their correspond- ing competencies for graduate nursing education in the next phase of the mapping project. Further research is needed to discover the scope of informatics information provided in graduate nursing curricula as well as nursing informatics spe- cialty program curricula. The similarities between nursing informatics competencies and AMIA Core Competencies demonstrate that AMIA Core Competencies are appropriate for the professional nurse entering informatics practice at the graduate level.

Nursing informatics educators at the graduate level should consider using AMIA Core Competencies, especially F2: Information Science and Technology; F5: Human Factors and Socio-technical Systems; and F7: Social, Behavioral, and Information Science and Technology Applied to Health; in addition to AACN competencies, in order to best prepare graduate students to participate in and contribute to improve- ments in health informatics and healthcare practice, policy, and outcomes. Such program content evaluation should be further evaluated by workforce leaders to ensure relevance of the content. We welcome further conversation with other application areas in health informatics relative to the unifying structure provided by the AMIA Core Competencies and the extensive scholarship and practice expertise in nursing informatics competencies.5–8,15,16,22–24

Given that the AMIA Core Competencies apply to Health Informatics Education at the master's level, it was deemed

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equivalent to evaluate graduate nursing informatics compe- tencies at the master's level.11,15 Although there was equiva- lency in terms of competencies, the depth and breadth of the informatics content to achieve these competencies may be at differing levels, given that the AACN applies to all MS grad- uates in nursing and the AMIA competencies to health infor- matics at the master's level. This aligns with the previous suggestion that rather than focusing internally on what pro- fessional disciplines know, it is important to look at common- alities based on ways that we interact with the world (patient, practice, population).13

Beyond the case we presented in this article, further discus- sion is needed regarding the practice doctorate in nursing (DNP). Similar to the AACNEssentials of Master's Education in Nursing, the AACN Essentials of Doctoral Education for Advanced Nursing Practice (DNP) include an informatics Es- sential IV: Information Systems/Technology and Patient Care Technology for the Improvement and Transformation of Health Care.15,16 Given that the DNP in nursing includes all MS-level competencies, it follows that DNP programs with informatics specialties may be accredited by CAHIIM using competencies defined at the master's level; CAHIIM has yet to make a statement that affirms or denies this assumption.

This project explored alignment between competencies, or lack thereof, and established a preliminary baseline of agree- ment by leaders in the field. The scope of health informatics as defined in the AMIA Core Competencies was quite broad; this study found that theAACNEssential V nursing informatics scope exists within the AMIA Core Competencies definitions. The structures that AMIA is forging with CAHIIM and AHIC encompass nursing informatics at the master's-level competen- cies within the AMIA definitions. Thus, accreditation in health informatics includes nursing informatics, nursing informatics

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programs should consider CAHIIM accreditation, and nurses who desire to do so should sit for the AHIC examination. Further research is needed to validate these findings broadly across other disciplines such as pharmacy and public health with educational models that incorporate informatics within their curricula.

As with all information mapping studies, there are threats to validity due to human interpretation of the true meaning found within complex text that constituted the data.26 Our methods addressed these threats by using existing definitions from the source documents and by comparingmultiple map- ping methods and disciplinary perspectives. Further, this mapping study did not examine the depth and breadth of how individual graduate nursing programs meet the ANCC Essential V, which may vary by program. Further research is needed to examine whether graduates of particular pro- grams may be prepared to sit for the AHIC examination. The research team has considerable experience and the content expertise to make informed judgments regarding alignment of the two sources from nursing informatics and health informatics perspectives. The study should be repli- cated to ensure validity and replicability.

Levels of certification as seen in the RN-BC and AHIC credentials will drive the need for core competencies/ program outcomes for each educational level; and specific to AHIC, the credential will drive the need for CAHIIM ac- creditation. Therefore, we recommend that nursing infor- matics specialty programs be dual-accredited by CAHIIM regardless of the level of the level (master's or doctorate) and by AACN at the appropriate level for the nursing degree. We further recommend that the AMIA Core Competencies be used as a unifying interprofessional core competencies document to enable further comparisons of similarities and differences in informatics competencies by profession. This research is needed to inform employers needed a trusted cre- dential for graduates possessing advanced health informatics competencies, and to substantiate the notion of shared in- formatics expertise across professions that is described by Fridsma.24 The implications of such shared expertise are substantial, given the urgent need to advance interprofessionality in healthcare and the potential for informaticists to provide such leadership.28

CONCLUSIONS This competencies mapping study revealed alignment of AACN Graduate-Level Nursing Informatics Essential V Competencies with AMIA Health Informatics Core Competencies. Thus, graduates of nursing and health informatics master's-level programs can be expected to have equivalent or similar competencies. This finding supports CAHIIM accreditation of graduate nursing programs with informatics specialties and provides the necessary documentation to inform AHIC

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requirements regarding two versus one master's degree. Spe- cifically, AHIC policy should be changed to allow MS- and DNP-prepared nurse informaticist graduates from a CAHIIM- accredited program who hold a single master's or doctoral degree in nursing with an informatics specialty to participate in AHIC.11,15 To be truly interprofessional, the AHIC cre- dential must be inclusive of nurse informaticists, who are key players in health informatics practice. This study provides the necessary details to support equivalence of the graduate nursing informatics specialty and master's degrees in health informatics based on the alignment of core competencies. We invite participation of all professional informaticists and scholars in this important policy discussion.

Acknowledgments The authors acknowledge the contributions of the AMIA Academic

Forum, AMIA Accreditation Committee, and the Accreditation Council

for Health Informatics under the Commission on Accreditation for Health

Informatics and InformationManagement for their efforts to promote inter-

professional informatics accreditation and certification.

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FEATURE ARTICLE

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404 CIN: Computers, Informatics, Nursing

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August 2019

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