This article is the first installment of a two-part series exploring how health information management and AHIMA have evolved in the 90 years since the association’s inception. Click here to view the second installment.
The field of health information management (HIM) has evolved significantly over the last 90 years—and AHIMA has been there every step of the way. From name changes and new credentials to game-changing technology innovations, the world of HIM looks vastly different today than it did when the association—then called the Association of Record Librarians of North America—was first formed in 1928. In celebration of AHIMA’s 90th anniversary, the Journal staff took a look through the association’s archives. They tell the story of an industry that is constantly changing and growing—championed by passionate professionals. The decades from the 1920s to the 1950s saw the association and its members finding their footing in a newly expanding profession, as members organized and collaborated on the national, state, and regional level—working together to both define and strengthen the role medical record librarians played in healthcare.
In 1912, five women who worked as record clerks for Boston Hospital met as the “Club of Record Clerks” at Massachusetts General Hospital to discuss and study clinical records. There were no organizations offering formal guidance or standards for the keeping of records at this time, and many early medical librarians were eager to learn from each other. They continued to meet and share ideas for several years, until the Association of Record Librarians of North America (ARLNA) was founded in 1928. As Enna C. Black noted in a 1948 presentation at the Midwest Hospital Association meeting, they were inspired to organize more officially after a physician invited record clerks from all over the country to meet with the American College of Surgeons in Boston. At this meeting, Matthew Foley, editor of Hospital Management Journal, suggested, “If you do not organize now, you perhaps never will.”
Grace Whiting Myers, AHIMA’s first president in 1928 (and honorary life president) spoke to what the state of the profession and association was like at that time in her autobiography:
Groups of Medical Record Librarians continued to form in one place and another and to attract the attention of doctors who had become interested. …The records had become an integral part of the hospital. The fever was catching, and was in evidence all over the country. These precious papers, called “records” or “case histories,” were no longer tied together in bundles and consigned to some closet shelf, there to remain and collect dust, to say nothing of drying up and falling to pieces as they were allowed to do in some small institutions. First, they were an important contribution to medical history if they were well written; and next, their value as a source of study was increasing as they were more carefully written, catalogued, and filed.
1930s: A Decade of Growth
The 1930s saw several changes for both the association and its members as the industry continued to grow. Perhaps most significantly, in 1932 ARLNA decided to develop and implement a credentialing process for medical librarians and clerks. The association appointed a registrar and three members to examine credentials, create exams, and approve candidates. The exam fee was $1.50, and hospitals that provided training were required to submit their course curricula to the association for review to ensure educational goals were aligned.
The association’s first name change came in 1938—the same year they celebrated their 10th anniversary—when they changed from ARLNA to the American Association of Medical Record Librarians (AAMRL). In her October 17, 1938 opening address at the national convention, Myers reflected:
During our first five years we were growing, learning, discovering, studying; growing in numbers; learning new methods; discovering new opportunities, studying the big problems which faced us. During the past five years we have been growing in united strength, learning how to keep up with advancing medical science, discovering fresh fields of usefulness, studying how to pass on our gains that they may not be lost…
We have made some mistakes; that was inevitable, but those we may forget. Man must go over the rocks to the stars, and the stars always beckon onwards.
1940s: State Associations, House of Delegates Form
By 1940, the number of registered medical record librarians in North America has grown to 932 and groups continued to organize at the state and regional level. As state associations—affiliated with the national association—cropped up all over the United States, the House of Delegates was formed in 1946 in order to better govern the association’s membership. Several of the state associations held their own annual conventions, in addition to the national convention held annually by AAMRL. The March 1941, Vol. 1, No. 1 issue of Progress Notes, the annual news sheet of the Northern California Association of Medical Record Librarians, spoke to the success of these more local organizations:
Between 1938 and 1940 we made huge strides. We affiliated with the National Association and a school for medical record librarians was opened in our midst at [Samuel] Merritt Hospital in Oakland [CA], contributing enthusiastic, progressive members to our association … students and graduates … keeping us on our toes … inspiring us to do big things…
World War II affected the entire country during this decade, and healthcare and health information management was no exception. Healthcare facilities across the country focused on preparations for what to do in the event of air raids and other disasters, and for the care of war-related casualties as the wounded returned home. The association did not hold an annual meeting in 1942, and both state and national meetings featured sessions that focused on topics such as “Short Cuts to medical Records During the War Emergency,” “Approved vs. Unapproved Short Cuts as War-time Measures in Record Rooms,” and “Medical Records Administration in the Navy.”
1950s: The Association Expands National Influence, International Reach
With 2,374 members in 1950, AAMRL membership was already booming in comparison to 1940. By the end of the decade, that number had almost doubled as membership seemed to grow exponentially. With this expanding influence came opportunities to get involved at the international level. AAMRL representatives, making their first international meeting appearance, attended the first meeting of the International Congress on Medical Records in London, England. Several AAMRL members delivered presentations at this meeting, discussing topics such as disease classification for diagnostic indexing, filing and disposition of records, and research in medical training methods.
This decade also saw AAMRL send delegates to the National Health Council, the National Health Forum, the National Committee on Aging, and the National Conference on Nursing Homes, where they worked to increase awareness of issues affecting medical records and those who work with them.
The association commissioned a report from the Graduate School of Public Health at the University of Pittsburgh on the status of education and medical record personnel in 1957. The recommendations delivered as a result of this report included the development of a focused plan of academic study, and the association planned to develop a detailed sample curriculum to that effect. In her presentation at the First International Congress on Medical Records in 1952, Edna K. Huffman, RRL spoke to the importance of developing a high educational standard:
It is implicit in the spirit and tradition of professions that each is primarily responsible for setting the standards for those who seek to join its ranks in order to increase the quality of service its members individual and collectively render. Medical records librarians and medical records officers would therefore be failing to meet one of their primary responsibilities if they did not seek to maintain an effective programme for promoting high educational standards, in all phases of medical records library practice, commensurate with the service they must render.
Sarah Sheber is assistant editor/web editor at Journal of AHIMA.