This article is the second 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 first installment.
The first installment of this two-part article series exploring how AHIMA and the health information management (HIM) profession has evolved over the last 90 years explored how the association and its members worked to innovate and evolve their profession and standing within the healthcare industry—from the first meeting of the association in the late 1920s to the first time the association participated in an international meeting in the 1950s. From the 1960s to present day, the association and profession continued to evolve as the landscape of the healthcare industry changed more and more rapidly.
1960s: A Growing Field of Opportunity
As opportunities continued to grow for the promising profession of “medical record librarian” in the 1960s, the healthcare industry was undergoing significant changes. Medicare and Medicaid (and a corresponding new load of paperwork) were established when President Lyndon B. Johnson signed the Social Security Amendments, which amended the Social Security Act, in 1965. Computers also made their way into hospitals in this era, bringing with them all the promise and challenge inherent with new technology. As noted in “Highlights From the Fourth International Congress on Medical Records” by Rosetta Hickman, RRL, in 1964:
The trend is to automation, but much difficulty is encountered in deficient records, namely doctors’ entries, nurses notes, incomplete diagnosis, and lack of uniformity in data on a national basis as well as on an international basis…
Twenty-seven hospitals in the country having computers were surveyed. Nine of the 27 are utilizing the machine. Eighteen are only receiving marginal benefits from the computer. Most machines are obsolete in a short time after installation. One speaker suggested the Medical Record Librarian request a good adding machine, lined paper, and pencils—the cost would be minimal.
Opportunities for those interested in pursuing the profession continued to grow. The 1963-1964 Occupational Outlook Handbook from the US Department of Labor noted: “Opportunities for qualified medical record librarians are expected to be excellent during the rest of the 1960s… The increasing number of hospitals and the volume and complexity of hospital records will contribute to a growing demand for medical record librarians over the long run.” Tuition for educational programs around the country ranged from $125 for 12 months at Viterbo College/St. Francis Hospital in Wisconsin to $500 a year for the four-year program at the College of St. Scholastica in Minnesota. The association also launched a correspondence course in 1962 and incorporated the Foundation of Record Education.
Following a poll that reflected overwhelming support for a name change, the association changed its name to the American Medical Record Association (AMRA) in 1969. Members felt the new name more accurately represented the association and their work. The name became official on January 1, 1970.
1970s: New Name, New Code Set
The association embarked upon the new decade with its new name and a mission to understand and meet the needs of its members. From legislative developments to offering a standard for best practices across the country, AMRA continued to break ground with medical records in the 1970s. As the transition to ICD-9-CM approached, the association conducted over 200 training workshops for almost 12,000 professionals. Even as the profession faced this latest challenge, interest and opportunity continued to grow. An article in Woman’s Day magazine mentioned medical record management in 1976 as an occupation where the growth rate was unlikely to keep up with demand. A day after the issue with the article was released, the association had received 742 requests for information about careers in medical records. By the end of the decade, the association had surpassed 23,000 members.
Already, the role of HIM professionals as people who could bridge the gap between care providers, such as physicians, and system experts, such as computer specialists, was beginning to emerge. Patricia J. Pierce, RRA, contemplated the future of the profession in her article “The Medical Record Profession of 1985—To Lead, To Follow, To Perish?” in the December 1973 issue of the association’s magazine Medical Record News:
There is one person who should be able to communicate with both members of the healthcare delivery team and the systems analyst/computer specialist. You guessed it—the person is the medical record practitioner. If he or she is familiar with the data needs of the healthcare system—the what, where, and when needed—and at the same time knows the basic workings of computer hardware and software and what kinds of processing and analysis should be performed by the system, he or she is the perfect link between the other two… This means we must be able to talk both languages—medicine-healthcare and technology. We don’t need to know how to write mathematical algorithms any more than we now need to know how to diagnose. But we do need to understand the needs of the computer people just as we need to understand the needs of the health worker.
1980s: Strategic Planning for an Evolving Future
As the profession continued to grow in the 1980s, the association focused on strategic planning for the future, working to ensure the organization was governed in a manner that would most effectively serve its members. “AMRA must be decisive in discarding what has served us in the past but is no longer relevant to our practice,” said Mildred St. Leger, RRA, AMRA president in her incoming message at the 1982 annual meeting in Los Angeles, CA. As a result of this initiative, the association developed a new format for the annual meeting and House of Delegates and revised the association’s bylaws to better facilitate change. The association continued to use this model for future strategic planning.
New ground was covered in the healthcare industry as diagnosis related groups (DRGs) made their first appearance in this era. AMRA stepped up to offer practice guidance for members on DRGs with the publication of Data Quality and DRGs. “Without doubt, medical record professionals are the most appropriate individuals in hospitals to provide the necessary interpretation of DRG data,” said Geoffrey Jackson in his Journal of AMRA article titled “The New DRGs—ICD-9-CM.” Data quality and prospective payment initiatives also made their first appearance in the 1980s. Indeed, qualified medical record professionals were more important and needed than ever before.
Association members found themselves working in a variety of settings as demand for their skills and expertise grew, and in recognition of the evolving needs of their membership, AMRA established several specialty groups within the association. The Long Term Care section, the Assembly on Education, and the Physical Medicine and Rehabilitation Sections were formed in 1988, offering specialized workshops, networking opportunities, and newsletters with content specific to the section’s needs.
1990s: New Technology and a Changing Profession
The association kicked off the 1990s by holding its first-ever Technology Summit, gathering representatives from the healthcare information technology industry and AMRA leaders to discuss the future of the medical record profession and its role in managing health information. A 1991 position statement from the association, “Computer-Based Patient Record: An Essential Technology for Healthcare,” voiced early support for the idea of a computer-based record:
AMRA believes that a computer-based patient record is essential to quality care in today’s environment, is necessary to meet the needs of a growing number of users, and is possible to achieve in this decade.
Later in 1991, the association underwent another name change, becoming the American Health Information Management Association, reflecting the changes in the profession as members were taking charge in managing important and increasingly complex health information. As AHIMA’s 1992 Annual Report noted:
The health information management professional collects, analyzes, and manages the information that steers the healthcare industry. At the heart of the profession’s information responsibilities are records, both computer-based and paper, of individuals’ healthcare. The professional orchestrates the collection of many kinds of documentation from a variety of sources, monitors the integrity of the information, and ensures appropriate access to the individual record.
Other highlights from this decade include the US Congress passing the Health Insurance Portability and Accountability Act (HIPAA) in 1996, though the HIPAA Privacy Rule would not be finalized until several years later. By the end of the 1990s, association membership had passed 38,000 and would continue to climb.
2000s and 2010s: Technology Driving the Evolving Healthcare Landscape
The HIM profession and healthcare industry in general has been witness to momentous changes in the past 18 years. The HIPAA Privacy Rule became effective in 2003 and the HIPAA Security Rule in 2005, soon to be followed by the HIPAA Enforcement Rule and the Breach Notification Rule. Even now—a decade and a half later—this mammoth piece of legislation is a frequent source of confusion for industry professionals. Designed in a time when paper medical records were the norm, HIPAA has had to adapt over the years. As Joy Pritts, chief privacy officer at the Office of the National Coordinator for Health IT, told Journal of AHIMA for its “HIPAA Turns 10” article in 2013:
“People sometimes ask of HHS—‘So are you finished changing the rules now?’ There is no ending point. Technology is constantly changing, and there are always new challenges. Protecting the privacy and security of health information is a continuous process. HIPAA must be reassessed all the time to make sure it is working optimally.”
Electronic health records (EHRs), with the aid of various initiatives, became commonplace for healthcare providers in the late 2000s. The Centers for Medicare and Medicaid Services’ “meaningful use” EHR Incentive Program began in 2009, bringing with it what some would call a breakneck pace of EHR implementation. Despite widespread adoption, many challenges continue to face EHR users and inhibit providers’ ability to utilize the technology to the full extent of its potential. From barriers to interoperability to patient matching conundrums, HIM professionals remain a vital voice in the ongoing discussion to identify and resolve these issues and many other problems.
After years of delays and uncertainty, the United States officially made the transition to the ICD-10-CM/PCS code sets on October 1, 2015. Much of the 2000s and 2010s were characterized by efforts to educate and prepare healthcare professionals for the transition. Originally scheduled for implementation on October 1, 2011, multiple delays pushed the implementation to 2015. HIM professionals were on the front lines of the transition, and AHIMA advocated against any further delays in ICD-10 implementation.
When asked to consider what the next five to 10 years might hold for HIM, Rebecca Reynolds, EdD, RHIA, CHPS, chair and professor, Department of Health Informatics and Information Management College of Health Professions, University of Tennessee Health Science Center, told the Journal’s Mary Butler in 2018 that she looked ahead with enthusiasm:
“I think the future is very exciting, similar to when we started in the late 1990s and 2000 when it was the idea of HIM without walls. We’re even moving further from that now that we have all this data… We’re seeing a greater demand for graduates that have those data analytics skills to move into those roles to manage the data those plans have, manage their healthcare.”
As of 2018, association membership has doubled since the late 1990s, surpassing 79,000 and still growing. With change ever on the horizon for the healthcare industry, the association and its members are gearing up for what’s next.
Wylecia Wiggs Harris, PhD, CAE, chief executive officer of AHIMA, spoke to the current position of the association in her “Inside Look” column in the November-December 2018 issue of Journal of AHIMA:
We stand at an important crossroads where there are great opportunities for the profession and for AHIMA. To fully embrace the possibilities… and our potential… we must ask ourselves: in what ways must we let go of what was in order to not miss what is or what can be?
With a nearly 100-year history that has embraced and driven change in the industry, AHIMA is paving the way ahead for health information’s vital place in modern healthcare. There’s no doubt that both the association and its members are up to the task.
Sarah Sheber is assistant editor/web editor at Journal of AHIMA.