SAQA

All qualifications and part qualifications registered on the National Qualifications Framework are public property. Thus the only payment that can be made for them is for service and reproduction. It is illegal to sell this material for profit. If the material is reproduced or quoted, the South African Qualifications Authority (SAQA) should be acknowledged as the source.

SOUTH AFRICAN QUALIFICATIONS AUTHORITY

REGISTERED QUALIFICATION:

Occupational Certificate: Health Information Manager

SAQA QUAL ID	QUALIFICATION TITLE
101838	Occupational Certificate: Health Information Manager
ORIGINATOR
Development Quality Partner - HWSETA
PRIMARY OR DELEGATED QUALITY ASSURANCE FUNCTIONARY			NQF SUB-FRAMEWORK
-			OQSF - Occupational Qualifications Sub-framework
QUALIFICATION TYPE	FIELD		SUBFIELD
Occupational Certificate	Field 09 - Health Sciences and Social Services		Promotive Health and Developmental Services
ABET BAND	MINIMUM CREDITS	PRE-2009 NQF LEVEL	NQF LEVEL	QUAL CLASS
Undefined	454	Not Applicable	NQF Level 07	Regular-ELOAC
REGISTRATION STATUS		SAQA DECISION NUMBER	REGISTRATION START DATE	REGISTRATION END DATE
Reregistered		EXCO 0425/24	2018-07-01	2025-12-30
LAST DATE FOR ENROLMENT		LAST DATE FOR ACHIEVEMENT
2026-12-30		2029-12-30

In all of the tables in this document, both the pre-2009 NQF Level and the NQF Level is shown. In the text (purpose statements, qualification rules, etc), any references to NQF Levels are to the pre-2009 levels unless specifically stated otherwise.

This qualification does not replace any other qualification and is not replaced by any other qualification.

PURPOSE AND RATIONALE OF THE QUALIFICATION

Purpose:
The purpose of this qualification is to prepare a learner to operate as a Health Information Manager. A Health Information Managers effectively manage all the non-clinical components within a healthcare environment in order to support the business elements of the clinical practice and manage the relevant risks associated with the administration of the healthcare facility and service.

A qualified learner will be able to:

Compile and maintain patient files and records and ensure the safekeeping and controlled use of the patient information in order to facilitate effective treatment, care and utilisation of medical benefits within legislative requirements.

Coordinate and manage the patients and health care facilities in order to optimise patient well-being and reduce operational risks.

Coordinate healthcare facility and service operations in order to ensure smooth and efficient daily operations.

Prepare budgets and basic accounts in order to manage the cash flow for the healthcare facility.

Coordinate and manage the human and other resources of the healthcare facility in order to optimise efficiency and sustainability of the healthcare facility.

Facilitate the development and implementation of strategies in order to sustain and enhance an organisation in the healthcare environment.

Rationale:
One of the core enabling milestones of the South African National Development Plan 2030 is to provide affordable access to quality healthcare whilst promoting health and wellbeing at all levels in our society. Chapter 10 of the National Development Plan is devoted to the promotion of health. Two of the key focus points in that chapter refer to ensuring effective governance within the health sector and collaboration for the phased introduction of the National Health Insurance scheme.

Healthcare, worldwide, is evolving at a significant pace, the demand for healthcare is increasing as technology enables more healthcare options and as people gain access to information that raises their expectations and needs for healthcare. In developing societies this is exasperated by the fact that development cannot take place if the total population does not have access to quality healthcare. South Africa is also situated strategically within Africa and more and more do we see that healthcare is becoming an export product for the country. A major challenge in the South African and global context, is the collaboration between public and private sector healthcare providers.

Traditionally, the administrative roles within the private healthcare system have been executed by healthcare professionals on a part time basis or by general administrative workers under the direct supervision of healthcare professionals. The organisational and legal environment is making this increasingly difficult. All healthcare services are subject to regulatory review and the administrative burden is growing significantly. The healthcare funding landscape has also evolved to a level where dedicated experts are required to facilitate access to the various funders and to ensure that the correct billing and coding practices are applied. Patients have become clients, and the host of related stakeholders involved in the healthcare environment is making it an extreme administrative challenge.

In order to deal with the demands as stated above it is an opportune time that we, in South Africa establish appropriate qualifications that will offer opportunities for learners to enter this dynamic career field. The qualifications should enable healthcare professionals to grow into the healthcare administration field and it should also enable non-professionals to take up this career option.

The Occupational Certificate: Health Information Manager is tailor made to meet the needs of the evolving healthcare industry in South Africa. It is totally aligned to global leading practices and it will serve as a basis for job creation and career progression. It is anticipated that a significant number of new jobs will be created in this field over the next five years.

There are currently at least 200 000 healthcare professionals registered with the Health Professions Council of South Africa (HPCSA) alone, not to mention medical scheme administrators, public and private healthcare facilities, billing houses and other third party payers and funders. The need for healthcare services in South Africa, and globally is growing continuously and with this the related need for proficient healthcare administration support. The successful implementation of the National Health Insurance initiative will require increased healthcare administration. This qualification will also be used by staff who are in current positions in the various healthcare facilities. The target groups to take up this qualification would be people within the private sector and public sector.

LEARNING ASSUMED TO BE IN PLACE AND RECOGNITION OF PRIOR LEARNING

Recognition of Prior Learning (RPL):
RPL for access to the external integrated summative assessment: Accredited providers and approved workplaces must apply the internal assessment criteria specified in the related curriculum document to establish and confirm prior learning. Accredited providers and workplaces must confirm prior learning by issuing a statement of result or certifying a work experience record.

RPL for access to the qualification: Accredited providers and approved workplaces may recognise prior learning against the relevant access requirements.

Entry Requirements:

Level 4 with Communication and Mathematical Literacy.

RECOGNISE PREVIOUS LEARNING?

QUALIFICATION RULES

This qualification is made up of the compulsory Knowledge, Practical Skill Modules and Work Experience Modules:
Knowledge Modules, 188 Credits:

325201000-KM-01, Healthcare administration and legislative requirements, Level 5, 44 Credits.

325201000-KM-02, Fundamentals of Communication within healthcare facilities, Level 5, 11 Credits.

325201000-KM-03, Supervision of healthcare facilities, Level 6, 8 Credits.

325201000-KM-04, Coding and Billing within the healthcare environment, Level 6, 48 Credits.

325201000-KM-05, Operations Management in healthcare facilities, Level 6, 37 Credits.

325201000-KM-06, Healthcare Organisation Management, Level 7, 40 Credits.

Practical Skill Modules, 88 Credits:

325201000-PM-01, Compile and safe-keep patient files/records (Digitally and manually), Level 5, 8 Credits.

325201000-PM-02, Liaise with medical schemes regarding treatment, care plans and benefits, Level 5, 8 Credits.

325201000-PM-03, Ensure the well-being of patients as they move through the care processes in the healthcare facility, Level 5, 6 Credits.

325201000-PM-04, Prepare and monitor budgets, Level 5, 16 Credits.

325201000-PM-05, Manage the patient billing process, Level 6, 6 Credits.

325201000-PM-06, Execute debtor management, Level 6, 6 Credits.

325201000-PM-07, Prepare the trial balance and preliminary financial statements, Level 6, 8 Credits.

325201000-PM-08, Participate in the development of a dynamic healthcare organisational strategy, Level 7, 16 Credits.

325201000-PM-09, Facilitate total compliance with all legislative requirements, Level 7, 8 Credits.

325201000-PM-10, Implement appropriate risk management strategies and processes, Level 7, 6 Credits.

Work Experience Modules, 178 Credits:

325201000-WM-01, Work as an administrator within a recognised healthcare environment for one month, Level 5, 20 Credits.

325201000-WM-02, Coordinate the administrative activities in a healthcare facility for a two-month period, Level 5, 14 Credits.

325201000-WM-03, Supervise the operational management of the facility for a period of two months, Level 6, 8 Credits.

325201000-WM-04, Coordinate and manage the coding processes within a healthcare facility for a period of three months, Level 6, 48 Credits.

325201000-WM-05, Manage the billing and financial aspects of a healthcare facility for a period of four months, Level 6, 24 Credits.

325201000-WM-06, Exposure to the coordination and Management of all resources within the healthcare facility, Level 7, 32 Credits.

325201000-WM-07, Exposure to the processes of facilitating organisational development within healthcare facilities, Level 7, 32 Credits.

EXIT LEVEL OUTCOMES

1. Compile and maintain patient files and records and ensure the safekeeping and controlled use of the patient information in order to facilitate effective treatment, care and utilisation of medical benefits within legislative requirements.
2. Coordinate and manage the patients and health care facilities in order to optimise patient well-being and reduce operational risks.
3. Coordinate and manage the coding processes within a healthcare facility.
4. Prepare budgets and basic accounts in order to manage the cash flow for the healthcare facility.
5. Coordinate and manage the human and other resources of the healthcare facility in order to optimise efficiency and sustainability of the healthcare facility.
6. Facilitate the development and implementation of strategies in order to sustain and enhance an organisation in the healthcare environment.

ASSOCIATED ASSESSMENT CRITERIA

Associated Assessment Criteria for Exit Level Outcome 1:

The ability to communicate with clients, patients and related stakeholders within a healthcare environment will be demonstrated by:
> Evaluating the interactions and identifying areas where good and poor communication principles are applied.
> Describing how to improve the levels of communication and optimise the client experience.
> Describing the consequences of the negative communication for all stakeholders in the given situations.

The ability to behave ethically within a healthcare administrative context will be demonstrated by:
> Identifying breaches of confidentiality and describe the short medium and long term consequences of these breaches.
> Identifying the legislative requirements that will guide the ethical behaviour within the given situations and reflect on the extent to which the specific requirements have been applied.
> Identifying where high standards of ethical conduct were applied within the given scenarios.
> Giving examples for personal work experience where high standards of ethical conduct were exhibited.

The ability to interpret different sources of healthcare information and collate it into integrated healthcare records will be demonstrated by:
> Interpreting given information and reports and indicating the processes for handling and routing the information in order to take appropriate action.
> Describing the security requirements for maintaining and storing all healthcare records.

The ability to apply the healthcare regulatory principles in order to execute the duties of an administrator in a healthcare facility will be demonstrated by:
> Identifying the clinical legislation relevant to various scenarios and reflecting on the purpose of the legislation and the extent to which it is complied with.
> Identifying the organisational legislation relevant to the scenarios and reflecting on the purpose of the legislation and the extent to which it is complied with.
> Describing the processes and role of the Administrator in applying the legislation and the actions that must be taken to ensure compliance with the legislation.

Associated Assessment Criteria for Exit Level Outcome 2:

Demonstrate the ability to Schedule, organise and coordinate daily activities and processes within a healthcare facility by, given scenarios illustrating the operational dynamics within various healthcare facilities:
> Developing and motivate a priority list of what must be done (who must do what by when).
> Developing a time management plan to ensure that all the required activities are completed in time and indicate what actions will be taken to prevent deviations from the plan.

Demonstrate the ability to Identify and solve problems and make decisions within the daily operations of a healthcare facility by, given scenarios illustrating the operational dynamics within various healthcare facilities:
> Identifying and classify all the issues that requires attention.
> Using analytical processes to identify the root causes of problems.
> Anticipating future problems and plan preventative and contingency actions to deal with them.

Demonstrate the ability to Identify and mitigate operational risks within the administrative component of a healthcare facility and plan accordingly by, given scenarios illustrating the operational dynamic within various healthcare facilities:
> Conducting an operational risk assessment.
> Indicating what actions are required to mitigate the risks.

Associated Assessment Criteria for Exit Level Outcome 3:

Demonstrate the ability to Identify coding errors and assess billing queries and rejections by, given various clinical case scenarios (Simulated patient records) where coding was already allocated:
> Identifying all the coding errors.
> Reflecting on the implications of these errors on the various stakeholders.
> Describing the required corrective actions.

Demonstrate the ability to apply coding rules and guidelines for simple and complex situations by, patient records):
> Identifying the coding rules and guidelines applicable to the given situations.
> Finding the correct codes and insert it correctly into the account using the appropriate coding rules and guideline.

Demonstrate the ability to apply the coders code of conduct within a range of practical work situations by, given various clinical scenarios:
> Identifying and describe the relevant conduct that impacts on the scenario.
> Describing the implications of the required conduct.
> Evaluating the implications of the code of conduct on the overall role of a healthcare coder and give practical examples of the application of the code of conduct.

Associated Assessment Criteria for Exit Level Outcome 4:

Demonstrate the ability to prepare and monitor budgets for a healthcare facility by, given the requirements for various healthcare facilities, previous budgets and expenditure statements as well as the organisational strategy and objectives:
> Compiling relevant and practical budgets.
> Compiling revenue forecasts.
> Develop cash flow statements.

Associated Assessment Criteria for Exit Level Outcome 5:

Demonstrate the ability to co-ordinate and manage the total human resource life cycle within a healthcare facility by, given the dynamics of various healthcare facilities within the private and public healthcare space and Human resources structures, policies and procedures:
> Evaluating the level of legal compliance of the policies, procedures and structures.
> Describing the processes required to manage and coordinate all the activities.
> Identifying and describe the role of external agencies and regulators relevant to the various situations.
> Describing the impact of the policies and procedures on productivity, efficiency and sustainability of the organisation.

Demonstrate the ability to assess and implement information technology policies and procedures within a healthcare facility by, given the dynamics of various healthcare facilities within the private and public healthcare space and Information Technology structures, policies and procedures:
> Evaluating the level of legal compliance of the policies, procedures and structures.
> Describing the processes required to manage and coordinate all the activities.
> Identifying and describe the role of external agencies and regulators relevant to the various situations.
> Describing the impact of the policies and procedures on productivity, efficiency and sustainability of the organisation.

Demonstrate the ability to assess and implement financial policies and procedures within a healthcare facility by, given the dynamics of various healthcare facilities within the private and public healthcare space and financial structures, policies and procedures:
> Evaluating the level of legal compliance of the policies, procedures and structures.
> Describing the processes required to manage and coordinate all the activities.
> Identifying and describe the role of external agencies and regulators relevant to the various situations.
> Describing the impact of the policies and procedures on productivity, efficiency and sustainability of the organisation.

Demonstrate the ability to assess and implement operational policies and procedures to manage and safeguard the physical assets within a healthcare facility by, given the dynamics of various healthcare facilities within the private and public healthcare space and operational structures, policies and procedures:
> Evaluating the level of legal compliance of the policies, procedures and structures.
> Describing the processes required to manage and coordinate all the activities.
> Identifying and describe the role of external agencies and regulators relevant to the various situations.
> Describing the impact of the policies and procedures on productivity, efficiency and sustainability of the organisation.

Associated Assessment Criteria for Exit Level Outcome 6:

Demonstrate the ability to assess the organisational strategy for various healthcare facilities and identify strategic areas that could lead to risks or opportunities by, given various healthcare facility scenarios and related organisational strategies:
> Determining the feasibility and relevance of the strategies.
> Identify organisational strengths, weaknesses and threats.
> Recommending changes to strategy that will mitigate risks and lead to future organisational growth.

Demonstrate the ability to evaluate the marketing strategies for various healthcare facilities and identify areas of improvement in line with the overall organisational strategy by, given various healthcare facility scenarios and related Marketing strategies:
> Determining the feasibility and relevance of the strategies.
> Identify marketing strengths, weaknesses and threats.
> Recommending changes to strategy that will mitigate risks and lead to future organisational growth.

Integrated Assessment:
Integrated Formative Assessment:
The skills development provider will use the curriculum to guide them on the stipulated internal assessment criteria and weighting. They will also apply the scope of practical skills and applied knowledge as stipulated by the internal assessment criteria. This formative assessment leads to entrance into the integrated external summative assessment.

INTERNATIONAL COMPARABILITY

For the purposes of aligning the qualifications with international leading practices, a comparison was made between these qualifications provided in the United States of America (USA) and Australia.

The practices in both these countries are very similar as far as these occupations are concerned.

Australia:
In Australia, a Certificate III in Health Administration (HLT37315) is offered. This qualification is viewed as a major opportunity for advancement. They have created a range of certificates which are registered on the Australian Qualifications Framework.

This qualification reflects the role of administrative workers in the health industry. These workers follow known routines and procedures, taking responsibility for their own work under general supervision. They combine communication, customer service and technical skills, and use discretion and judgment to adapt and transfer their skills to different situations. The South African version includes work exposure and will be completed in plus minus eight months.

Diploma of Practice Management (HLT57715):
This qualification reflects the role of business or practice managers who manage the operation of small to medium sized health practices. The content of this qualification is similar to the remaining content of the South African Occupational Certificate. However, in the Occupational Certificate the focus is pitched at a higher level including all elements of Operations Management, Information Technology, Finance and Human Resources Management. The Australian Diploma can be completed in approximately one year, finalizing the Occupational Certificate will take an additional fourteen months.

This occupational qualification goes beyond that of the Australian qualification in that it caters for the additional strategic focus areas relating to strategic healthcare administration management aspects within both the Public and Private sector. The South African Qualification also focuses on a wider range of coding systems such as: International Classification of diseases 10th revision (ICD-10 WHO), Referenced Price List (RPL), Clinical Coding South Africa (CCSA) and Uniform Patient Fee schedule (UPFS).

United States of America (USA), a number of institutes conduct online training in this area and there are a number of graduate and Postgraduate qualifications for Healthcare administrators. There are also a number of specialised qualifications for healthcare coders.

Conclusion:
Healthcare Administration is an evolving and growing study field throughout the world. Comparatively the qualification relates favourably with the international offerings in terms of the objectives and content.

The Occupational Certificates cater specifically for the South African healthcare context and addresses the needs within a developing society. These qualifications are closely aligned to and support the healthcare strategies that will drive healthcare in our continent over the next 30 years.

ARTICULATION OPTIONS

Horizontal Articulation:

National Certificate: Governance and Administration Level 7.

Vertical articulation:

Postgraduate Diploma: Business Management and Administration, Level 8.

MODERATION OPTIONS

N/A

CRITERIA FOR THE REGISTRATION OF ASSESSORS

N/A

NOTES

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LEARNING PROGRAMMES RECORDED AGAINST THIS QUALIFICATION:

NONE

PROVIDERS CURRENTLY ACCREDITED TO OFFER THIS QUALIFICATION:

This information shows the current accreditations (i.e. those not past their accreditation end dates), and is the most complete record available to SAQA as of today. Some Primary or Delegated Quality Assurance Functionaries have a lag in their recording systems for provider accreditation, in turn leading to a lag in notifying SAQA of all the providers that they have accredited to offer qualifications and unit standards, as well as any extensions to accreditation end dates. The relevant Primary or Delegated Quality Assurance Functionary should be notified if a record appears to be missing from here.

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