1
Competence in the Information Professions:
A Comparative Analysis & Environmental Scan
Prudence W. Dalrymple & Nancy K. Roderer
The prominence of knowledge and information in increasingly global, technological
societies are accompanied by challenges to the traditional spheres of professional
competence. Three related disciplines—health informatics, health sciences librarianship,
and health information management--share many of the same ideals and principles, yet
the educational pathways to these professions are controlled by different accreditations
and jurisdictions. As a result, students seeking to prepare for careers in these domains
find it difficult to select the program that best meets their needs, or even to understand
and distinguish among them. Both clarity and visibility are necessary for the information
professions to continue to inspire the trust of the publics they seek to serve. This paper
will report on a comparison of the competencies promulgated by professional groups in
North America within these three professions, which influence the curricula used in
educational programs that prepare entrants to these professions. It will further report on
initiatives currently being explored to clarify and strengthen the information professions.
Questions will be raised as to what further delineation and focus is required for health
sciences librarianship—should it align with other professions What can the North
American community learn from approaches taken elsewhere? As the answers to these
questions will affect the future direction and position of the profession, this paper will
conclude with reflections on approaches to optimizing the profession’s position in the
current climate.
Introduction
The prominence given to knowledge and information in increasingly global,
technological societies is accompanied by challenges to the traditional spheres of
professional competence. Three related disciplines—health informatics, health sciences
librarianship, and health information management--share many of the same ideals and
principles, yet the educational pathways to these professions are controlled by different
accreditations and jurisdictions. As a result, students seeking to prepare for careers in
these domains find it difficult to select the program that best meets their needs, and
employers and society are not given clear statements about what to expect graduates will
know and be able to do. In an earlier paper, [1] we argued that the disciplines of
information science and biomedical informatics share a common foundation, and though
their sociocultural origins are different, there are indications of a convergence between
the two disciplines. It is our purpose today to extend that line of thought to address
specifically the positioning of the profession of medical librarianship within the
constellation of health and information professions and their preparation and jurisdiction.
First we define the various fields and their degree of overlap, and then take a look at the
educational level required for entry into the field, followed by the statement of
competencies for successful professional practice.
2
Definitions and disciplinary foundation
We begin by identifying three related fields of practice that deal with health information:
medical or health sciences librarianship [2], biomedical or health informatics, health
information management. The field of medical librarianship is dedicated to promoting
access to the world's health sciences information, and working to ensure that the best
health information is available to all. Medical informatics is a scientific field that draws
upon the information sciences and related technology to enhance the use of the
knowledge base of the health sciences to improve health and healthcare, research
(biomedical, clinical and public health), education, management and policy. The field of
health information management focuses on the management of the records created during
the course of caring for a patient. It is an integral part of clinical patient management.
We can also view each of these fields as a professional practice within a larger
disciplinary base. Medical librarianship is the practice of librarianship in the specialized
domain of health and medicine; while its historical origins lie in library science, a strong
argument can be made for viewing its disciplinary base as information science. [3, 4]
Medical informatics is the professional practice within the larger field of informatics or
information science; though initial steps have been taken in the U.S. to make it a subspecialty of internal medicine, there is a commitment to address the status of informatics
within other branches of practice such as public health. Health information management
is the practice of managing the records that are created during the course of patient care.
Health information management resembles closely the practice of records management
which, it can be argued, is an information profession; however, health information
management and as such, considers itself first and foremost a health profession. In
contrast, the field of records management concerns itself with the management of records
and information without regard for a specific domain of practice. (It may be of interest to
note that the field of health information management, formerly known as medical
records, was initially embedded within medical librarianship and separated from it in
1928).
Over the past decade, the relationship between medical informatics and medical
librarianship has been the subject of several reports and opinion pieces, most of which
observe the apparent blurring of distinctions between the two fields and emphasize the
commonalities between them. Among the factors most often cited as contributing to this
phenomenon is the increased prevalence of digital libraries that remove the constraints of
time and place when providing access to a full range of digital materials. As this
transformation extends beyond bibliographic materials to digital health records, the
linkages between digital health records and digital knowledge (published literature)
become more obvious. In 2005, Perry et al. acknowledged this trend and proposed a new
definition of health sciences informatics.
Health sciences informatics is the science that deals with health-related
information, its structure, acquisition, and use. [5]
3
They further noted that health sciences librarianship and informatics are heavily
overlapping disciplines with strong conceptual links to the theoretical discipline of
information science.
From this brief definitional survey, we can observe that the disciplinary identity of these
three fields is evolving, and is doing so in a context where the boundaries between fields
are porous. Perhaps the greatest distinction among them is the degree to which it is tied
to the delivery and outcomes of patient care. That is, both health information
management and medical informatics are health professions, directly involved in patient
care, while health librarianship’s tie to patient care is less immediate, focusing primarily
on access to information per se. Despite these differences, each field has the potential to
be affected by the others, and all three are deeply affected by the overall environment of
healthcare, which is undergoing rapid and far-reaching evolution in health care,
especially in the sphere of information systems and technology.
Knowledge, skills competence
An increasingly technology driven healthcare environment has focused attention on
identifying the knowledge and skills needed to manage the transition to a fully electronic
record and the ancillary applications that accompany it. In the U.S., for example, it is
estimated that a 49% increase in trained individuals prepared to be administrators,
specialists, consultants, educators, and researchers is needed to facilitate this transition.
As a result, there have been several efforts to identify the requisite competencies for
individuals and core content areas for educational programs. [6] [AMIA website]
Competencies represent certain clusters of skills, abilities and knowledges needed to
perform certain jobs. In the professions, they are usually determined by members of the
professional association, often in conjunction with the relevant educational organizations.
Approaches to specifying these competencies can differ substantially, ranging from those
that are very specific such as those recently approved by the American Library
Association (ALA) [7] to those specified by the Chartered Institute of Library and
Information Professionals (CILIP) [8]. The ALA competences specify what graduates
from an educational program must demonstrate that they know, and are to be considered
when the ALA’s Committee on Accreditation considers an educational program for
accreditation, while CILIP addressed the body of knowledge needed for practice [8]. The
CILIP approach is noteworthy in its level of abstraction, its extensibility across contexts
of practice and its acknowledgement of the need to acquire fluency in both the subject
disciplines and the organizational needs or characteristics of collections. The
International Federation of Library Associations (IFLA) [9] guidelines for professional
programs and the American Society for Information Science and Technology (ASIST)
are aimed at providing guidance to educational programs.[10] In addition to
competencies identified in the overall field in library and information studies, specialized
professions have identified competencies for their particular aspect of librarianship, often
focused on the needs of specific user groups, institutional or organizational needs, or
characteristics of collections. Indeed, there are 16 educational policy statements listed
on the Committee on Accreditation website, and many more discussion of competencies
4
can be identified through a literature search.. For the past fifteen years, the Medical
Library Association in the U.S. has had in place its educational policy statement, now in
its second edition, that occupies a middle ground among these various approaches which
are outlined in Table 1. In contrast, medical librarians in the United Kingdom are
included in the National Health Service where they are classified as knowledge
management staff. [12]
Since its founding in 2007, the Academic Forum of the American Medical Informatics
Association has been working to establish core competencies and core content areas for
biomedical informatics and related areas. [13] As part of its effort to establish clinical
informatics as a medical sub-specialty, AMIA identified core content areas to provide
guidance to training programs and the establish criteria for admitting clinicians to the
sub-specialty. [14]
Similarly, the American Health Information Management Association, in conjunction
with the American Medical Informatics Association, recently undertook a major study of
competencies needed at several levels of practice. [15]The resulting document expresses
the competencies as educational outcomes, using the well-known Bloom taxonomy, and
is expected to guide the curriculum of any program seeking to prepare professionals in
the field.
Table 1 lists the competencies from selected library and information science
organizations. Although there is not exact equivalence, the body of knowledge is clearly
similar; the primary difference lies in the degree of specificity and emphasis, and in the
ways in which they guide the educational preparation for entry into the field. Table 2
lists the core content for the three health-related professions discussed in this paper.
While it is difficult to make a one-to-one comparison across three professions whose
educational levels vary significantly, there clearly are commonalities among them. The
most striking difference (beyond level) is the breadth of the informatics content compared
with either the health sciences librarianship or the health information management core
content. Another, more subtle but important difference in approaches is that some
documents are clearly aimed at individual performance for which the professional herself
is accountable, while others are aimed at the educational programs that are held
accountable for documenting student learning outcomes at the time of graduation.
Table 1 Competencies from selected library and information science organizations
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ALA Competences,
(2009)
IFLA Guidelines (2000)
ASIST Educational
Guidelines ( 2001)
MLA Platform for
Change
Foundations of the
profession
Information environment policy and
ethics, history of the field
Foundations of information
science
Health sciences
environment and
information policies
Information generation,
communication and use
Information processing
Assessing information needs and
designing responsive services
Information transfer process
Information use and users
Organization of recorded
knowledge and information
Organization, retrieval, preservation
and conservation of information
Information processing
Research
Research analysis and interpretation
of information
Methods of inquiry
Technological knowledge
and skills
Applications of information &
communication technologies to library
& information producs & services
Information resource management &
knowledge management
Management of information agencies
Information technology
Information systems and
technology
Information resource
provision and management
Information resource
provision and management
Management of
information services
Management of
information services
Quantitative & qualitative evaluation
of outcomes of information & library
use.
Methods of inquiry
Research, analysis and
interpretation
Reference and user
services
Information resources
Administration and
management
Health sciences
information services
Documentation, Knowledge,
Information
User/client
Knowledge,Information,
Documentation
Health sciences resource
management (includes
acquisition, organization,
and retrieval)
Research, analysis and
interpretation
Instructional support
systems
Continuing education and
lifelong learning
CILIP Body of Professional
Knowledge*
Knowledge
Conceptual structures
Regarded as generic &
transferable skill
Regarded as generic &
transferable skill
Collection/information resource
Regarded as generic &
transferable skill
Regarded as generic &
transferable skill
Regarded as generic &
transferable skill
Subject context
Professional context
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Table 2. Knowledge & Skills for Informatics, Health Sciences Librarianship & Health Information Management
AMIA Core Content for Subspecialty
of Clinical Informatics (2009)
MLA Platform for Change (2007)
1. Fundamentals
1. Health sciences environment and
information policies: the context in
which the need for biomedical and related
information emerges and the unique ways
of perceiving and interpreting those
environments. HS librarians should be
alert to the changing information and
health care environments and the major
program and policy sources.
Clinical informatics
The health system
2. Clinical decision-making,
care process improvement
Computer decision support
Evidence-based practice
Clinical workflow analysis,
2. Health sciences information services:
Knowledge of the content of information
resources and skills in using them. HS
Librarians must understand the principles
and practices related to providing
information to meet specific user needs
and to ensure convenient access to
information in all forms.
3. Health sciences resource
management: HS librarians must know
the theory of, as well as have skills in,
identifying, collecting, evaluation and
organizing resources and developing and
providing databases.
Information systems and technology
AHIMA /AMIA Core Competencies for
Individuals Working with Electronic Health
Records (2008)
1. Health information literacy & skills
Selected examples: data vs. information;
Structure, design, use of health information;
Apply standard data definitions, vocabularies
Adhere to requirements, policies, etc.
2. Health informatics skills using EHR and PHR
Selected examples:
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process re-design, quality improvement
3.Health information systems
IT systems
Human factors engineering
Health information systems and apps
Clinical data standards
Information life cycle
Developments in technology have
reshaped the goals and systems of hs
librarianship and changed the way
information professionals function. HS
librarians must be able to understand d
and use technology and systems to
manage all forms of information.
Create & update e-documents
Locate & retrieve information
Apply principles of data integrity
Use software to generate reports
Research, analysis and interpretation:
Few dispute the library’s responsibility to
explore the “fundamental nature of
biomedical information storage,
organization, utilization and application in
learning, patient care, and the generation
of new knowledge.” In order to conduct
and interpret research, the hs librarian is
called upon to apply knowledge, skills and
understandiing of [research and
evaluation methods].
Instructional support systems: Teaching 3. Privacy & confidentiality of health
ways to access, organize, and use
information skills
information to solve problems is an
essential and ever-widening responsibility
of the hs librarian. Effective instruction
entails not only knowledge of the
structure and content of specific courses
and technology but also an understanding
of and expertise [in educational methods.]
Selected examples:
Apply policies related to privacy &
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4. Leading and managing change
Leadership models, processes &
practices
Effective interdisciplinary teams
Effective communications
Project management
Strategic & financial planning for HIT
Change management
Management of information services:
Leadership in the application of LIS to the
handling of health sciences information
resources in complex institutional
environments requires specialized
knowledge, skill and understanding of
management
confidentiality
Follow security & privacy policy & procedures
Identify, evaluate, select & appropriately use
computer systems for documentation
Teach others concepts, laws, policies as
applicable
4. Health information/data technical security
skills
Selected examples:
Develop & implement security polices &
procedures
Implement training for security
5. Basic computer literacy skills
Selected examples reflect skills
Acquired through computer fluency courses
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Heusden of the Netherlands takes a different approach to information-related competencies by
focusing on individual performance, regardless of the specific field of practice, and emphasizing
the public accountability of individual performance. [16] In this view, competences are regarded
as "the ability to perform well in a professional situation that involves the accomplishment of a
certain task or the dealing with a problem, in a manner that can observed and judged by others.”
Four core tasks of information professionals--anticipation, production, learning and creation-invoke a cycle of individual behaviors--initiating, structuring, realization, evaluation—that
reflect on the individual’s presentation of professional expertise. Although this approach does
not specifically mention domain knowledge and skills that are context dependent, its emphasis
on the presentation of self implies significant importance is attached to flexibility and reflective
practice, which are similar to the generic and transferable skills included in the CILIP body of
professional knowledge. Unlike competency statements that specify a particular domain such as
a library or a patient record system, these approaches place the responsibility for acquiring
contextual knowledge on the individual professional. It also differs by emphasizing competence
as a characteristic of individual performance rather than a body of knowledge imparted through
an educational curriculum.
Entry into practice17
The educational preparation for the three professional fields under consideration continues to
evolve. For nearly half a century, in North America and in many other countries, a master’s
degree is required for entry into librarianship. There is no requirement to attain specific healthrelated content knowledge, but the MLA’s Academy of Health Information Professionals
provides individuals with an opportunity for post-master’s recognition and a framework for
lifelong learning. Entry into the Academy requires two years of practice as a health sciences
librarian. A recent and notable exception is the informationist which requires additional training
and experience. [18-23] Although informationist training is not formalized and represents only a
small fraction of health sciences librarians, it has many features in common with informatics, and
is often seen as boundary spanning professional practice between librarianship and informatics.
Unlike health sciences librarianship and health information management, there is no single set of
competencies or educational program that has been defined and accepted. That is, there have
been no recognized currently no standard definitions, no defined competencies and no
recognized curriculum, though de facto, most informaticians undertake graduate or post-graduate
study. In the U.S. for the past 20 years, the National Library of Medicine (NLM) has funded 20
training programs located in medical schools; these programs have had a significant impact on
biomedical informatics training. These programs admit students with varying educational and
professional backgrounds and award differing forms of recognition—from a certificate to a
doctoral degree. The majority of the trainees come from the health professions (frequently
physicians) and enter the fellowship after completing their medical degree, thus it is not
surprising that AMIA’s initial plans to formalize education and certification in informatics
focuses on physicians. As AMIA continues to move in this area, it will likely establish
accreditation for training programs and establish a post-graduate inter-professional informatics
certification to address the needs of non-physicians in the field. A trend toward graduate
informatics education, primarily master’s degrees, extends internationally as well [24] Most
programs are located in medical schools and called medical informatics, though increasingly,
informatics programs may be located in schools of information systems and information science,
and it appears that informatics education will take place in schools of nursing, public health, and
or as cross-disciplinary efforts among several academic programs. How and whether medical
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librarians might choose to participate in this initiative –and what the impact of such a move
might be are topics worthy of future investigation.
The educational preparation for health information management is currently a baccalaureate
degree, but in 2007, AHIMA released a comprehensive report addressing educational reform to
meet the workforce needs envisioned by the transition to electronic records. [25] The plan sets
out three key priorities to be accomplished by 2016: transform health information management
to a graduate level profession; realign the associate degree with work force needs; and prepare an
effective, qualified pool of health information management faculty. If successful, this
undertaking will result in identifying a body of knowledge at the graduate level, strengthening
informatics and leadership competencies, and provide a career track that includes associate,
baccalaureate and master’s levels. Accreditation, currently limited to associate and
baccalaureate degrees, would extend to master’s level educational programs.
Professional jurisdiction
In the U.S., standards for practice, like competencies, are set by the representative associations in
consultation with employers and subject to licensing and regulating bodies, if any. Compliance
with standards is ensured through the processes of accreditation and certification which are
carried out by non-governmental agencies affiliated with the professional associations. (Other
countries have similar processes, but they are more likely to be administered through
governmental ministries.) Like competencies, accreditation standards are generally defined in
consultation between the education community, the profession and the employer community and
exert differing degrees of influence over the curriculum taught in educational programs. That is,
the accreditation process assures that graduates from accredited programs possess the knowledge
and skills that employers expect when they hire them; accreditation takes place at the
programmatic level. In addition to accreditation of programs, some professional fields require
licensure and certification (including re-certification) which take place at the individual level.
Together, these activities are referred to as credentialing. Table 4 displays the professional
associations that represent the three fields under discussion and indicates both the individual and
programmatic levels at which credentialing takes place.
Table 4. Professional associations that conduct credentialing activities in health information fields
Field
Association
Members
Librarianship
4,000*
Information
Management
MLA
(1989)
AHIMA
(1928)
Individual-level
credentialing
(licensure, certification,
recognition)
AHIP
53,000
Through examination
Informatics
AMIA
4,000
Proposed
Requirements
Program
level credentialing
(accreditation)
Master’s + 2
years
Associate,
Baccalaureate
Master’s
(proposed)
Post-graduate
Yes, ALA**
Yes, CAHIM
ABMS***
Proposed
* The Medical Library Association administers the Academy of Health Information that credentials individuals.
**The American Library Association (63,000 members) administers the accreditation process for master’s degrees in library and
information studies.
***The American Board of Medical Specialties will be responsible for controlling fellowship programs in clinical informatics
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Throughout this discussion, the authors have described three professions-- health informatics,
health information management, and health sciences librarianship--whose focus lies in health
information, its creation, management and use. While each has its historical origins in separate,
“parent” professions—clinical medicine, records management and librarianship—they share a
focus on health, information and the technologies to facilitate its use in the delivery of health
care. At the same time, the regulation of educational preparation, and the professional and
cultural identities of each profession exert strong, differentiating influences. Nowhere is this
more true than in health sciences librarianship which will be the focus of the remainder of this
paper.
Health sciences librarianship: positioning the profession
We began this paper by re-visiting an earlier one in which we argued that biomedical informatics
and library and information science were converging disciplines because of their similar nature
and scope. In our discussion, we drew heavily upon the definitions of information science
which put less emphasis on the library context of professional practice. By de-coupling the
foundational discipline from a practice context, our argument supports a model of the body of
knowledge as described by CILIP, by ASIST, and, to a large extent by AMIA and MLA. Since
the core content of health information management was not fully developed or articulated at the
master’s degree level at the time of our paper, we did not include it in our consideration.
However, the AHIMA documents, developed in consultation with AMIA, have now been
completed, bringing all three professions into similar alignment and highlighting both their
commonalities and their differences. An area of future endeavor might be to bring the MLA into
closer dialogue with AMIA or, at the international level, to bring members of this Congress
together with the International Medical Informatics Association.
In addition to the activities undertaken by professional associations, the U.S. has also seen an
increase in activity among the educational institutions that prepare students for professional
practice, and more generally for positions within the “information society.” The “i-school
caucus,” a consortium of 22 higher educational institutions meeting specific criteria was
founded in 2004 to build awareness of, support for and involvement with the i-field among key
constituencies, principally the media, business community, those who fund research, student
prospects, and users of information.” [26] Intentionally inter-disciplinary, the caucus schools
focus on research on the use and users of information and the nature of information itself, as well
as information technology and their applications. The unifying theme of the i-school movement
is people, information and technology, a theme which they share in common with the health
information professions. Though they do not conceive of their mission as preparing graduates
for professional practice, many of the individual degree programs at the member schools are
accredited by various accrediting bodies such as the American Library Association, National
Council on the Accreditation of Teacher Education, and the American Board of Engineering and
Technology.
Following the publication of our previous paper, the Council on Library and Information
Resources (CLIR) and the American Society for Information Science & Technology sponsored a
meeting of representatives of associations with a self-described identity of an “information
profession.” [27] According to the environmental scan conducted as background for the
meeting, over 900 programs at the baccalaureate level and above were identified in the U.S.
alone. Although the reason for the meeting, held in September 2008, was to explore the
feasibility of establishing an accreditation process for programs preparing “information
professionals,” the attendees expressed concern over the lack of a systematic way of describing
12
these programs to their stakeholders (employers, prospective students, and the public,
professional associations and the academic community), and the resulting inability to link the
various information disciplines in a framework of common elements along an information
continuum. At the conclusion of the meeting, the attendees recommended placing energy and
resources on a recognition process that would promote the educational opportunities within the
information professions, attest to the societal value of the information professions and inform
stakeholders about the range and of information programs available. The effort might also yield a
more standardized terminology as well as guidance in providing a widely recognized basic
educational program.
Against this backdrop of ongoing activities, health sciences librarianship faces some interesting
opportunities and choices. As illustrated in Figures 1 and 2, our profession shares common cause
with each of the professions discussed here—all three professions are concerned with health as a
domain, and with information as a meta-field. Despite their differing historical origins, all three
professions stem from a common discipline— information science. By broadening its vision to
find common cause with other information based professions, health information professionals
can embrace the “widening panorama” described by Haux, president of the International Medical
Informatics Association (IMIA). [28] Describing informatics as a bridging organization,
informatics emphasizes the development of methods of processing data, information and
knowledge leading to research on acquisition, storage, access retrieval and quality assurance.
ASIST
4,000
SLA
11,000
Libraries &
librarianship
65,000 members
MLA
4,000
Informationist
Figure 1. Library & Information Related Associations
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All Medical/Health
Professions
Health
Informaticians
Health Information
Management
Professionals
Medical librarians/
Information
professionals
Figure 2 Health Professions and Health Information Professions
In his year as president of IMIA, Haux cited a growing importance of consumer information
services, interdisciplinary educational initiatives, application of health –enabling technologies for
ambient assisted living, and new kinds of patient “libraries” with patient-related health data and
new kinds of services in the context of e-health services. Collaborative research and education
aimed at understanding and improving methods of processing data, information and knowledge
will be necessary to achieve this goal. In order to address the need for an expanded workforce to
meet the needs of the increasingly technology-driven global health environment, professions
such as ours should consider broadening our identity to more closely affiliate with those groups
that are explicitly information professions. Much movement in this direction has already been
initiated through such efforts as the informationist movement, but more is needed.
As we consider positioning our profession at this international congress, we recognize our
profession as an information profession, one which believes that understanding information’s
fundamental character and behavior are essential to health. The trends and currents described in
this paper underscore the need to attend to the various stakeholders in the health information
domain. As a health information profession, we are in a strong position to engage in dialogue and
collaboration with our partners--the various professional associations, credentialing agencies and
academic programs. Engaging in strategic planning to identify those whose values and functions
are both similar and complementary to ours will enable us to form stronger coalitions to
accomplish our common goals—bringing access to high quality information of all types and in
all formats to people when and where they need it.
14
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