Australasian College of Health Informatics

Application to Join the Australasian College of Health Informatics

Use this application form to apply to join ACHI as a:

·  Student Member

·  Graduate Member*

·  Full Member

·  Fellow

Prepare:

·  Decide which membership category describes you (see next page for eligibility requirements).

·  Check that your CV is consistent with details you give in this application about Health Informatics activities in: education completed; paid and honorary positions held; research and development activities; community contributions. Please use text highlighter to give prominence to the items in your CV that you include in this application.

·  Assemble transcripts of your Health Informatics educational qualifications.

·  Arrange two referees who will provide a written account of what they know of your Health Informatics activities; and who will verify that you meet standards of professional behaviour as described in ACHI's Code of Conduct. Neither referee can be your current employer or employee.

·  If you have a question about completing your application, e-mail ACHI's mentoring program at (see www.ACHI.org.au/Membership.htm#Mentors)

Proceed:

·  Download and complete this application form. Your CV and education transcripts must accompany your application.

·  Place all documents in a zipped folder named "ACHI-application-YourSurname-YourFirstname". E-mail your folder to . (If you are applying for joint membership of ACHI and HISA, apply through the HISA website and follow instructions there for lodging your documents.)

·  The ACHI membership subcommittee reviews and verifies your application, seeks clarification and referee reports as required, and makes a recommendation to the ACHI Council. The ACHI Council makes a decision on your application, and you receive an email from the Secretary advising you of the outcome.

·  If your application is approved, you receive an invoice for annual membership (except student members). Once paid, you are welcomed into the ACHI community, with information on how to access the members-only area of the website, participate in email discussion forums, and contribute to project working groups.

·  You receive acknowledgement of receipt when you upload your application on the website. Please allow up to six weeks for notification of your application outcome. Direct any queries regarding application processing to .


Eligibility Requirements

All applicants must:

·  meet standards of professional behaviour as described in ACHI's Code of Conduct at www.ACHI.org.au/Governance.htm

·  agree to abide by ACHI's Constitution at www.ACHI.org.au/Governance.htm

·  meet minimum criteria for a combination of educational qualifications, paid and honorary positions, achievements and innovations, research and development, as shown on this page.

A Student Member (points not required; referees not required):

·  must be enrolled currently in a Health Informatics-related subject or study program

AND

·  must aim to build capacity for contribution to the field of Health Informatics, through continuing learning and development in the profession

A Graduate Member (formerly known as "Associate", minimum of 1 point, for Education):

·  must have been an ACHI Student member in the 12 months prior to their application

AND

·  must have completed a Health Informatics-related subject or study program

AND

·  must aim to build capacity for contribution to the field of Health Informatics, so as to be eligible for ACHI full Membership within a period of five years under normal circumstances

A full Member (minimum of 60 points; compulsory to have points for both Education and Position; optional to have points for Community Achievement or R&D):

·  must have completed a degree in Health Informatics or equivalent; OR

·  must have held a position of practical experience in Health Informatics for a minimum of three years (excluding work done for credit as an enrolled student in a program of study);

AND

·  have capacity for contribution to the field of Health Informatics; OR

·  have made a measurable contribution to the field of Health Informatics

A Fellow (minimum of 100 points; compulsory to have points for Education, Position and Community Achievement; optional to have points for R&D):

·  must have completed a degree in Health Informatics or equivalent; OR

·  must have held a position of practical experience in Health Informatics for a minimum of eight years (excluding work done for credit as an enrolled student in a program of study);

AND

·  must have been in a position for at least five of these years, from which their actions resulted in outcomes which constitute a distinguished contribution to the field

AND

·  must have made a distinguished contribution to the field of Health Informatics - that is, a notable, recognised and positive influence within the community, above and beyond normal expectations.

1.  Applicant Contact Details

Full Name
Address
Phone / Fax / Mobile
Email address

2.  Referee Contact Details (Not required for Student membership)

Name / Email address

3.  Applicant Statement & Signed Declaration

In 200 words or less, please state:
·  the ACHI membership category for which you are applying, and your estimated total points scored
·  a summary of your aim to build capacity for contribution or your actual contribution to the Health Informatics field, as appropriate to the membership category.
·  factors not addressed elsewhere in this application form, that ACHI should consider when reviewing your application

By lodging this application with ACHI, you agree that:

a)  ACHI is not under any obligation to accept the applicant even if all of the criteria for eligibility of admission are met.

b)  No representation has been made by or on behalf of ACHI indicating that the application will be successful.

c)  The outcome when it is notified by ACHI to the applicant is final and the ACHI is not obliged to provide reasons for the outcome.

d)  ACHI does not accept any liability for any loss suffered by the applicant as a result of or in connection with the processing or the outcome of the application.

e)  The applicant has read and understood ACHI's privacy policy at www.ACHI.org.au/Privacy-Policy.htm

Applicant's Signature ______Date ______

4.  Educational qualifications (you may claim a maximum of 50 points in this category)

Give details of the awarding institution & year completed, as shown in your transcript / ACHI points value / Your estimated score*
Unit of Study, Certificate or Diploma in Health Informatics **
(or equivalent)
(maximum of 3, or 3 points) / 1 each
Bachelor Degree in Health Informatics (or equivalent) / 3
Post Graduate Certificate in Health Informatics (or equivalent) / 5
Post Graduate Diploma in any Health discipline OR
Post Graduate Diploma in IM/IS/IT ** * or any other relevant field / 10
Post Graduate Diploma in Health Informatics (or equivalent) / 20
Masters Degree in any Health discipline OR
Masters Degree in IM/IS/IT or any other relevant field / 20
Masters Degree in Health Informatics (or equivalent) / 30
Doctorate in any Health Discipline OR
Doctorate in IM/IS/IT or any other relevant field / 40
Doctorate in Health Informatics (or equivalent) / 50

* In estimating your score, select the highest level/s achieved.

** Awarded by a technical, vocational or industry association relevant to Health Informatics

*** IM/IS/IT = information management, information systems, information technology

5.  Paid and Honorary Positions (you may claim a maximum of 50 points in this category)

Give details of each organisation, position title & period served, sufficient for ACHI to verify / ACHI points value / Your estimated score
Completed year in a Health Informatics paid position in an organisation.
(Do not count periods less than 1 continuous year.)
(Maximum of 10 years, and 50 points) / 5 per year
Completed year as an honorary office bearer of a Health Informatics professional organisation or incorporated association.
(Maximum of three years, and 15 points) / 5 per year

6.  Community Achievements (you may claim a maximum of 80 points in this category)

Give details and evidence of each claim, including your specific role, sufficient for ACHI to verify*

/ ACHI points value / Your estimated score
Being directly responsible for a major and successful Health Informatics project, which impacts on the Health or IT industry as a whole or on other areas outside the applicant's immediate working environment
(maximum of 4 projects, and 80 points) / 20
For outstanding innovations in the advancement of Health Informatics within the Health or IT industries, Governments or Non- Government Organisations, or the Community.
(maximum of 3 contributions, and 30 points) / 10

*Evidence could be, for example, a project report accepted by a funding agency; an industry prize or community citation awarded; or a report done by an independent auditor or evaluator.

7.  Research and Development (you may claim a maximum of 60 points in this category)

Give details of each, sufficient for ACHI to verify *

/ ACHI points value / Your estimated score
Publication of a refereed research paper or book chapter on Health Informatics or a recognised sub-discipline
(maximum of 4 papers/chapters, and 40 points) / 10 each
Authorship or editorship of a published book on Health Informatics or a recognised sub-discipline
(maximum of 3 books, and 60 points) / 20 each
Awarding of a significant competitive Health Informatics grant, where the applicant is a chief or principal investigator
(maximum of 3 grants, and 60 points) / 20 each
Development, presentation or organisation of a new Health Informatics professional development seminar of one full day or more
(maximum of 3 seminars, and 30 points) / 10 each
Presentation (but not publication) of an invited or refereed paper on Health Informatics or a recognised sub-discipline at a national or international conference
(maximum of 3 presentations, and 15 points) / 5 each

* Use AHRQ modified Vancouver style http://www.ahrq.gov/funding/grant-mgmt/refstyle.html

ACHI Application Form Page 8 of 8 June 2015