In the 1920s and 1930s, the health information (HI) management profession was defined by the management of medical records and those working in this space were known as medical record librarians. This title remained prominent through the 1970s when medical record administrator emerged as the new professional title.
In 1973, Patricia J. Pierce, former chair of the medical records department at The College of St. Scholastica, in Duluth, Minnesota, wrote an article (“The Medical Record Profession of 1985 – To Lead, To Follow, To Perish?”) in the American Medical Record Association’s journal that outlined a vision for the evolution of the profession. In the article, Pierce challenged the profession, stating that the role was doomed to extinction if medical records professionals didn’t plan and prepare.
Here we are in 2023 and her predictions of what was to come for HI professionals have come to fruition.
The call to action was for the HI profession to evolve, to change with times, and to meet the demands of the workforce; otherwise, the profession is doomed to fail. This doomsday narrative for the profession still persists, and the need to evolve and change is constant.
Today, we find ourselves in a very similar position to where we were when Pierce wrote her article 50 years ago. There is a disconnect between the skills and responsibilities of HI professionals and how they are represented by job titles. In 1985, using computers and having the technical skills to work on a computer was just emerging as important. Pierce observed this change and stated that these technical skills will be required for HI professionals, and that assertion was spot on.
By the 1990s, people working in the profession were largely known as medical records professionals. Thirty years later, the title has shifted again to HI professionals. The work performed today by HI professionals looks very different from the work performed nearly a century earlier by medical record librarians. While it is an evolving task, this responsibility to constantly redefine professional titles is critical to the identity, legitimacy, and legacy of the occupation.
As Technology Evolves, So Do Skill Requirements
Currently, AHIMA defines HI professionals as follows:
“Health information (HI) professionals are highly trained in the latest information management technology applications. They understand the workflow process in healthcare provider organizations, from large hospital systems to private physician practices, and are vital to the daily operations management of health information and electronic health records (EHRs). They ensure a patient’s health information is complete, accurate, and protected.
HI professionals have an extraordinary impact. They are the link between clinicians, administrators, technology designers, operations, and information technology professionals.
These professionals affect the quality of patient information and patient care at every touch point in the healthcare delivery cycle. HI professionals work on the classification of diseases and treatments to ensure they are standardized for clinical, financial, and legal uses in healthcare. HI professionals care for patients by caring for their medical data and are responsible for the quality, integrity, security, and protection of patients’ health information.”
In addition to the shifting titles, modern day computing has significantly disrupted the professional identity of what is considered “health information management.” The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 promoted widespread adoption of the EHR. Presently, significant advancements are being made in analytics, automation, and record management.
The result is the work performed by HI professionals is changing. However, the specific technical skills needed today and needed for the near future are still being debated. Revisiting the article by Pierce, who in the 1970s would have guessed that we would be at such a place today where employer and industry needs demand such advanced technical skills?
The Evolution of the HI Skill Set
In 2015, a workforce study asked HI professionals which skills will emerge and which will wane in the next 10 years. The study found that HI professionals anticipated spending a lower percentage of time on diagnosis and procedural coding in the future, whereas leadership, teaching, and informatics responsibilities were expected to increase most significantly.
Two years later, a study utilizing job posting data discovered that the majority of HIM-related job postings required a bachelor’s degree or above, and many jobs aligned with medical records administration were growing in the areas of informatics/data analytics, and IT/infrastructure. A 2018 study evaluated AHIMA’s call to action on the HIM Reimagined initiative related to professional skills. The study established that hiring managers were predominantly looking for professionals with a bachelor’s degree or above particularly to fulfill duties related to analytics, IT, informatics, revenue cycle, and compliance.
Job posting data was reevaluated in 2019 to examine global workforce trends for HI professionals, in a study that discovered four main categories of jobs including those related to data and technology, patient delivery, business and project management, and safety. In 2022, job posting data was again reexamined and crosswalked to the AHIMA career map and related curricular competencies. The study discovered the greatest similarity of job postings with the informatics career map category. Of note, there was disagreement between job postings and the AHIMA curricular competencies.
Collectively, this research paints a clear picture of the most-desired skills for the HI professional. Professionals should have completed a degree in higher education, possess technical skills in data analytics, have knowledge of revenue cycle, compliance, and understand the flow of information in healthcare.
Aligning Job Titles and Roles
For further context, professions are classified in a number of ways. A recent publication reviewed occupational classification systems in over 180 countries and how the health information discipline is categorized. Internationally, many countries adopted the International Standard Classification of Occupations (ISCO) to classify occupations into categories, a standard last revised in 2008.
The ISCO-08 has three categories that relate to Health Information professionals including: health information technicians (ISCO-08: 3252); filing and copying clerks (ISCO-08: 4415), and librarians and related information professionals (ISCO-08: 2622).
In the United States, occupations are classified by the Bureau of Labor Statistics using the Standard Occupational Classification (SOC). The SOC system is a federal standard used by federal agencies to classify workers into 867 detailed occupations for the purpose of collecting, calculating, or disseminating workforce data. The last revision of the SOC standards happened in 2018. Here, health Information professionals are categorized into four main occupations:
- 11-9111- Medical and Health Services Managers
- Plan, direct, or coordinate medical and health services in hospitals, clinics, managed care organizations, public health agencies, or similar organizations. (BLS, 2021a)
- 29-2072- Medical Records Specialists
- Compile, process, and maintain medical records of hospital and clinic patients in a manner consistent with medical, administrative, ethical, legal, and regulatory requirements of the healthcare system. Classify medical and healthcare concepts, including diagnosis, procedures, medical services, and equipment, into the healthcare industry’s numerical coding system. Includes medical coders. (BLS, 2021a)
- 29-9021- Health Information Technologists and Medical Registrars
- Apply knowledge of healthcare and information systems to assist in the design, development, and continued modification and analysis of computerized healthcare systems. Abstract, collect, and analyze treatment and follow-up information of patients. May educate staff and assist in problem solving to promote the implementation of the healthcare information system. May design, develop, test, and implement databases with complete history, diagnosis, treatment, and health status to help monitor diseases. (BLS, 2021b)
- 31-9094- Medical Transcriptionists
- Transcribe medical reports recorded by physicians and other healthcare practitioners using various electronic devices, covering office visits, emergency room visits, diagnostic imaging studies, operations, chart reviews, and final summaries. Transcribe dictated reports and translate abbreviations into fully understandable form. Edit as necessary and return reports in either printed or electronic form for review and signature, or correction. (BLS, 2021c)
The occupational statistics in the US are published on a website developed and sponsored by the US Department of Labor called O*Net Online. It is periodically updated based on labor trends with the addition of new occupations that may not be represented in the SOC. O*Net does include additional occupations related to HI professionals:
- 15-1211.01 - Health Informatics Specialists
- Apply knowledge of nursing and informatics to assist in the design, development, and ongoing modification of computerized health care systems. May educate staff and assist in problem solving to promote the implementation of the healthcare system. (O*Net Online, 2022a)
- 15- 2051.02 - Clinical Data Managers
- Apply knowledge of health care and database management to analyze clinical data, and to identify and report trends. (O*Net Online, 2022b)
Clearly, the roles and responsibilities of HI professionals extend well beyond the standards described in the ISCO and SOC and are not fully represented with the information present in O*Net. For federal employees, the SOC is utilized for determining job titles and pay structures. This is a concern, as a job role that is not properly classified may not receive an appropriate salary.
Taking a further step back, the speed of change within the HI profession due to computing advances and the accompanying shift in responsibilities requires that professionals advance their skill sets to meet these needs, and ongoing advocacy is necessary to ensure that the profession is properly classified within workforce standards systems.
Collaboration between industry, professional organizations, and educational providers is key to the ongoing success of HI professionals in this ever-changing environment, and while planning and preparation is still needed to keep pace with the speed of change in healthcare, HI professionals also need to continue to advocate for their roles and responsibilities to be accurately described.
Eric Nordgren is director of education experiences and development in the Stender School of Leadership, Business and Professional Studies at the College of St. Scholastica.
Katie Kerr is an associate professor in the Department of Health Informatics and Information Management at the College of St. Scholastica.
David T Marc is associate professor and chair in the Department of Health Informatics and Information Management at the College of St. Scholastica.
By Eric Nordgren, Katie Kerr, EdD, RHIA, & David T Marc, PhD, CHDA
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