Laurie A. Rinehart-Thompson, JD, RHIA, CHP, FAHIMA
Health information management (HIM) education sets the stage for a variety of career trajectories that provide nearly limitless professional opportunities. As members of educational cohorts, HIM baccalaureate-degree students can confidently surmise that, although all of them will graduate armed with the same degree in HIM, their work settings and roles will be as diverse as the number of students in the cohort.
With the HIM profession’s origins in the hospital, the hospital setting remains restrictively deemed the “traditional” environment. However, there are myriad departments and opportunities within hospitals for which the HIM skill set is well suited. For example, licensure and accreditation, information systems, data analytics, revenue and reimbursement, quality improvement, privacy and compliance, and, of course, HIM. Within these areas, job titles can include licensing and accreditation specialist, systems analyst, project manager, data analytics specialist, revenue and reimbursement analyst, quality data manager, compliance analyst, business system analyst, and EMPI data analyst, among others.
In addition to the many opportunities a hospital or other healthcare provider affords HIM graduates, a unique benefit of this profession—contrasted with direct-care health professions—is the opportunity to immediately pursue career paths in the non-provider realm, such as electronic health record (EHR) software developers; technology-enabled healthcare providers; healthcare benefits technology companies; healthcare technology companies delivering cloud-based software in the areas of financial planning, analytics, and performance; software platforms that deliver artificial intelligence (AI) solutions and communications, workflow, and information management software; consulting companies; government agencies; and law firms. Job titles can include implementation specialist; project manager; sales development and operations specialist; client systems analyst; billing operations associate; application analyst; and data integration consultant.
While HIM programs strive to meet the needs of all students, regardless of where they ultimately work, the ever-present question is: What are the essential skills that new and relatively new HIM professionals deem critical to their success?
To answer these questions, I emailed HIM professionals from New England to California and locations in between and asked them if they would informally answer some open-ended questions in hopes that they would share their professional experiences, as well as the knowledge and skills required for their success. Understanding what these professionals have found they need to be successful—in terms of technical skills and soft/professional skills—is instructive in helping educators build a curriculum that advances their needs. The young professionals that provided feedback all had fewer than four years of post-graduate experience, including those who graduated in the past year.
What emerged from their experiences and collective insights was a snapshot that, while not unexpected, gave greater clarity about the essential elements for success among HIM professionals engaged in the business of healthcare.
Technical Skills and Tools
Technical skills and proficiency with multiple technology-based tools are imperative. There are technical tools that all workforce members should be able familiar with and proficient in using—regardless of the setting they work in. The technical skill set required of HIM professionals working for hospitals and other healthcare providers is not vastly different from that required in other settings. While this is reflected in part by the fact that HIM professionals work in diverse roles within a hospital, it should also cause us to question any assertion that “traditional” HIM careers are less technically rigorous.
Proficiency with spreadsheets, databases, and EHR software frameworks and navigation is crucial for HIM professionals, whether they work in a hospital or other type of setting. Whether they use these tools as end users, support staff, or in a vendor capacity, they should be well versed in implementation and troubleshooting.
Other technical skills include knowledge of commonly used computer terminology; understanding of the basic structure of computers and servers; the ability to ask intuitive questions; data mining, analysis, and presentation; an understanding of the basic language and structure of HL7 messages; and knowing what specific information to look for in interface messages. For HIM professionals involved in clinical information system design: development and implementation, and an understanding of current and new applications and software is integral to the success of clinical operations.
Excel and SQL/SSMS were the most frequently cited technological tools used, followed closely by Tableau, Power BI, Epic, and other EHRs including legacy EHR systems, Outlook, and Microsoft Office Suite (with an emphasis on PowerPoint and Access). Other tools included Zoom and Microsoft Teams, Google Drive, computer assisted coding (CAC) software, Microsoft Visual Studio, Crystal Reports, REDCap, Smartsheet, Compliance360, Service Now, OnBase, Jira, Workday, SaaS, Zendesk, Salesforce, Definitive Healthcare, Outreach io, and customized software developed by and for the individual employers.
What does the future hold, and what technical skills and tools do HIM professionals expect they will eventually need to learn or become more proficient in? This, of course, depends on their roles. However, professionals employed both within the healthcare provider realm and outside of it stated that the ability to write programming language and to work with software such as R, RStudio, Python, and SAS for data analysis is expected to become more prevalent. The ability to perform advanced SQL scripting and a more sophisticated understanding of cloud computing and AI are also important as they continue to consume a larger portion of the healthcare space. Those who are not already using Tableau, Power BI, or other reporting tools expect usage and mastery to become more necessary and, eventually, an employer expectation.
Professional and Soft Skills
Several themes emerged from the feedback I received from HIM professionals from diverse professional experiences. Customer service skills were mentioned frequently. This came up in expected areas such as consulting, but it also was apparent in areas such as hospital information systems, where the definition of “customer” can encompass a variety of stakeholders. Working HIM professionals also emphasized time management and prioritization, stress management, organization, ability to multitask, attention to detail, critical thinking, problem solving, troubleshooting, and the ability to take action following fast-paced conversations.
Communication, while a known important soft skill, is multifaceted. It includes public speaking and strong presentation skills, as well as unstructured and spontaneous speaking during business conversations, projecting confidence, and making sure that one’s voice is heard at the table. It further includes setting agendas and preparing meeting materials that provide clarity to others, and finessing written communications so the end product is both professional and personable.
Less apparent, perhaps, is having difficult but essential conversations, and admitting when one doesn’t know the answer but promises to find it—and the ability to follow through on that promise.
Also stressed were personal characteristics—of which many are hallmarks of emotional intelligence—such as positivity, motivation, curiosity, adaptability, openness to learning new things, understanding others’ work preferences, developing a thick skin so as not to take negative feedback personally, and empathy.
All of the characteristics highlighted are well recognized as necessary in order to work well with others. What was noted, however, was, as remote communication became more prevalent pre-pandemic and has burgeoned out of necessity during the pandemic, soft skills will need to be finessed to meet the expanded remote working environment that will certainly continue to exist post-pandemic.
Understanding the Healthcare System
We must be careful not to underestimate the value to HIM graduates of entering the workforce with a solid understanding of the healthcare system. New graduates are hired from many disciplines and for many reasons, including the aforementioned technical skills and soft skills. However, HIM graduates have an advantage over new graduates with degrees in non-health-related disciplines or generalized health studies who, although hired for their critical thinking skills, come into their positions lacking the important context of a generalized knowledge of the healthcare system as well as more specific industry concepts.
It was reported, by those working for healthcare providers and non-providers alike, that an understanding of certain healthcare topics is more difficult if one hasn’t learned about them in an educational setting. That can include lack of familiarity with health record content, HIM-related vocabulary and health terminology—such as knowing what an ambulatory patient is; the difference between Medicare and Medicaid; and the basic concept and structure of an HL7 message. All can be difficult for those without a focused healthcare/HIM education. Knowledge of these concepts and industry knowledge, in contrast, allow HIM professionals to keep pace with conversations that those without an HIM background cannot.
It’s All About the Data
Data management has always been a central component of the HIM profession. However, the profession has made a profound shift from not only managing data, but also understanding types of healthcare data and utilizing specific data elements in order to make significant contributions to business decision-making. The HIM professionals I heard from concluded that the ability to harness and appropriately use data cannot be overvalued. To be successful, HIM professionals also must understand the vast amount and different types of health data, how quickly they are created and exchanged, their degree of accuracy, and their value.1
Large databases that enable data aggregation help with decision making, but optimizing these databases through appropriate use and reporting requires skill and training. HIM professionals must have a keen understanding of how data are gathered, structured, categorized, and manipulated, and then must be able convert raw data into meaningful information to identify trends and translate those trends into deliverables for key stakeholders. In other words, what story is that data telling? Or, as one HIM professional aptly stated: “What is the ‘so what?’”
It is only with a sophisticated knowledge about data that their significance can be discerned and, subsequently, insightful decisions can be made. Just as data elements within the primary source—the medical record—are the building blocks for individualized patient care, so too are aggregated data elements the building blocks for important purposes such as improved health outcomes, strategic planning, and successful public health initiatives.
- Ishwarappa and J. Anuradha. “A Brief Introduction on BigData 5Vs Characteristics and Hadoop Technology.” Procedia Computer Science. 2015. https://doi.org/10.1016/j.procs.2015.04.188.
Laurie A. Rinehart-Thompson (firstname.lastname@example.org) is a professor and the program director of the health information management and systems program at The Ohio State University.