The health information management (HIM) profession is nothing if not resilient. With every change in the process of health data collection, maintenance, and use, HIM professionals have adapted to industry transitions to ensure health information quality for effective decision-making.
The most recent changes—triggered by the rapid implementation and use of electronic health record (EHR) systems and associated technologies—is yet another transition that requires the HIM profession to adapt. This most recent change is unique because of its pace. Major changes related to health information have historically been adopted somewhat gradually. But EHR adoption, initially spurred by the Centers for Medicare and Medicaid Services (CMS) “meaningful use” EHR Incentive Program and continuing with the CMS Quality Payment Program, fundamentally and rapidly transformed the work of health information professionals. Moreover, advances in technology related to electronic health information, such as computer-assisted coding (CAC), which uses natural language processing (NLP), will continue to have a major impact on HIM roles.
HIM is at a critical moment in its history and requires new strategies to ensure the continued relevance of the profession. HIM professionals must have the body of knowledge and practice to ensure the completeness, availability, accuracy, and integrity of health information to facilitate real-time healthcare delivery and critical health-related decision-making for multiple purposes across diverse organizations, settings, and disciplines.
The American Health Information Management Association’s (AHIMA’s) HIM Reimagined (HIMR) initiative is designed to advance the HIM profession and professional. HIMR offers immediate and long-term implementation strategies to ensure the profession is equipped academically and professionally to advance individuals and HIM to greater levels of relevance, while keeping pace with changes in the HIM industry and the broader healthcare ecosystem. Details about the history of HIMR, members of AHIMA’s HIMR committee, and deliverables are available on the HIMR website at www.ahima.org/about/him-reimagined.
HIMR Market Research Study Gages Industry’s Needs
Since the healthcare industry is necessitating an increased level of specialization and related skills that require education, one specific recommendation of HIMR is to develop more specialized HIM credentials. As part of the HIMR committee’s work, AHIMA initiated a market research study to determine specific job skills, competencies, and specialties that align with healthcare organizations’ future needs. This work was done with a purpose of aligning industry needs and potential academic-based credentials. The market research was conducted to complement other AHIMA efforts, such as the 2015 AHIMA Workforce Study, and the aim was to assess the perceptions of HIM professionals, clinicians, employers, and other related areas.
Between May and June 2017, Vault Consulting (the research vendor selected for this project) sent a survey to 274 senior-level professionals within clinical (e.g., hospitals and clinics) and non-clinical (e.g., vendors and consulting firms) organizations. AHIMA membership was not required for participation. The respondents who participated in the survey were included if they met three criteria:
- Held a senior-level title, such as chief information officer or chief technology officer
- Reported being “extremely” or “very” familiar with the specific job skills or competencies required of the individual in their organization who is primarily responsible for managing electronically collected patient information
- Reported being highly involved in hiring decisions for senior-level HIM staff
The results of the study are significant, and the full executive summary of the report is posted for review in the AHIMA HIM Body of Knowledge at http://bok.ahima.org/PdfView?oid=302482. Overall, a majority of respondents from both clinical and non-clinical organizations reported that today’s HIM professionals are extremely or very well prepared for future organizational needs. However, 41 percent of clinical respondents and 18 percent of non-clinical respondents reported that their current HIM workforce is somewhat or not very well prepared for future needs. Of note is that IT vendors and research companies were most likely to report their current workforce is prepared for the future. Among clinical segment participants, 55 percent are extremely/very concerned about soft skills, and 45 percent are similarly concerned about hard skills. Some examples of soft skills desired in the HIM industry include teamwork, problem solving, work ethic, creativity, and verbal and written communication. Examples of hard skills include science, statistics, technology, and health science education. Among the non-clinical segment, the level of concern is greater. Approximately 64 percent of respondents are concerned about soft skills, while 75 percent reported concern about hard skills. In short, non-clinical respondents have a greater level of concern regarding hard skills among their HIM workforce than clinical respondents.
The study also examined perception of changes related to the diagnostic and procedural coding function within organizations during the next five to 10 years. Fifty percent of clinical respondents reported over 70 percent of the coding function will be computerized. Moreover, 72 percent of clinical respondents reported over half of all the coding function would be computerized within the next five to 10 years.
Respondents were also asked to identify the skills and competencies most relevant for future HIM employee requirements. Clinical respondents reported the following as areas most critical to future HIM roles:
- Computing/technology proficiency
- Electronic management of health information/EHR expertise
- Information privacy/security
- Coding proficiency (accuracy, speed, clinical familiarity, real-time EHR documentation)
- Revenue cycle management/clinical documentation improvement
Non-clinical respondents also view new data-driven technology as the biggest change to prepare for and—like the clinical segment—they also prioritize computer/technology proficiency, electronic management of health information, privacy and security, and leadership. In contrast to the clinical segment, however, they place relatively less importance on coding itself, and more on data analysis, data mining, informatics, and specialized clinical knowledge. Additionally, non-clinical respondents place relatively greater importance on consumer-centric care and reimbursement. Both groups place significant value on individuals who are cross-trained and able to work in inpatient and outpatient environments.
Based upon these results, the specialty areas for associate degree curricular tracks have been identified as focusing on revenue cycle management as well as healthcare data and technology management, although the specific names for each track have not yet been assigned.
Regarding educational level of the future HIM workforce, respondents—particularly those from non-clinical organizations (and driven by IT vendors and research firms)—generally feel that at least a baccalaureate degree, if not a master’s degree, is preferable for most areas of inquiry (see Figure 1 on page 22). Clinical respondents indicated that informatics, data analytics, and IT skills should preferably be accompanied by a relatively higher level of education (master’s to PhD); revenue cycle management, information privacy/security/compliance, and population/public health might be satisfied with a baccalaureate/master’s degree; and data standards, coding, and patient engagement can be met/obtained with an associate or baccalaureate degree, the study shows. The results demonstrate the necessity to build pathways from one academic pathway to another and to structure opportunities that allow students to move in and out of education as needed.
Primary Study Findings
In summary, there are three primary findings from this study. First, healthcare executives have validated the HIMR recommendation for specialization and educational advancement within the HIM workforce. With a clear understanding of health information roles and responsibilities, job functions, and experience in hiring HIM professionals, the study’s respondents noted a shift in skills necessary for working with health information within their organizations. The area of focus for respondents from clinical and non-clinical organizations was the need for professionals with these skills to adopt, use, advance, and adapt to technologies at a rapid pace.
This finding illustrates how recent developments in information technology have impacted healthcare organizations. The CMS “meaningful use” EHR Incentive Program, for example, resulted in the rapid implementation of EHRs across inpatient and outpatient clinical settings. That policy completely transformed how health information is collected, used, exchanged, and leveraged across the healthcare continuum. It also resulted in a shift regarding the competencies required to successfully work within an electronic health information environment. Influenced by the many technological changes being introduced into the landscape, respondents from both clinical and non-clinical organizations noted leadership as a top priority, including the interpersonal skills necessary to interact with clinicians, manage projects and teams, and lead organizations. The complexity of healthcare and health information has resulted in healthcare executives’ perceived need for more specialized and more educated HIM professionals.
The second key takeaway is related to diagnostic and procedural coding. One of the tenets of HIMR is that advances in CAC will significantly impact the number of HIM professionals employed to manually code medical records. According to estimates from AHIMA, nearly half of all HIM professionals enter the profession in a coding-related role. The majority of AHIMA members are currently employed in coding-related roles. The HIMR Task Force has identified this area as a major concern because of the risk for automation due to CAC and other technology. Respondents to this survey have validated previous findings related to the potential impact of CAC on coding roles. A higher proportion of records will be coded through CAC. It is critical to identify opportunities for current HIM practitioners to obtain additional training, academic education, and professional certifications now in order to transition HIM practitioners into roles where their advanced knowledge of health information can be leveraged. The value of coding and the importance of coded information is not in question. The HIMR white paper, which outlines the objectives of HIMR and is available at www.ahima.org/about/him-reimagined/himr?tabid=whitepaper, clearly supports coded data. The power of natural language processing, the quality of voice to text translation, and the sophistication of algorithms to extract meaning from unstructured data will revolutionize this industry.
The final takeaway may be the most important. Study respondents working for non-clinical organizations stressed the advanced need to develop “hard skills” for future HIM workforce roles. Those “hard skills” align with the types of roles AHIMA has identified as a result of its most recent strategic planning, which places a priority on leading in data analytics and informatics. This is an important finding because it demonstrates that these organizations understand the capability of the HIM workforce and have potentially identified transitional pathways for the workforce within their organizations. On the other hand, respondents from clinical organizations were not as concerned about these hard skills for their future HIM employees. This can be interpreted to mean that these executives do not see HIM professionals filling these roles within their organizations.
Does this mean that HIM professionals should accept the misperception of executives working within clinical organizations? Absolutely not. What this does mean is that there is a lack of understanding about HIM practice today. This also means that if the perception of HIM is going to change in the minds of most healthcare executives within clinical settings, it is critical for HIM professionals to continue to pursue roles outside of their comfort zone and the HIM department.
Figure 1: What HIM Skills, Competencies are Most Important for the Future?
THE FOLLOWING QUESTION was posed to market research participants: “Next you will see 2 short lists of HIM skills and competencies that some have identified as necessary to align with their future healthcare information management needs. For each skill, please indicate the education level you feel would best prepare a hiring candidate with that particular skill.”
HIM Must ‘Get Comfortable with Being Uncomfortable’
The current environment requires HIM professionals to get comfortable with being uncomfortable. In order to get comfortable once again, it will be more critical today than ever before for HIM professionals to advance their knowledge through training, professional development, education, and certification.
The beauty of health information management lies in its diversity, yet the scope of practice has resulted in a lack of understanding about core competencies among key industry stakeholders (e.g., executives within clinical and non-clinical healthcare organizations). There is now an opportunity for HIM to alter the narrative. This will take time.
In the immediate and long-term time frame, change will be promoted by education and the higher-level skills of graduates as well as specialized credentials. AHIMA will continue to focus on raising awareness of HIM within healthcare through grassroots efforts and by leveraging HIM’s skills. There is an opportunity now for professionals to explore options to advance careers within and outside of organizations, identify training and professional development opportunities to obtain skills that align with emerging trends, and to demonstrate these skills with certifications and credentials.
Ryan Sandefer, PhD, (firstname.lastname@example.org), associate professor and chair, Department of Health Informatics and Information Management, The College of St. Scholastica
Norbert Belz, PhD, RHIA, chair and clinical assistant professor, Department of Health Information Management, KU Medical Center
Sandra Brightwell, MEd, RHIA, FAHIMA, director, health information program, Central Arizona College
Michelle Green, RHIA, CPC, FAHIMA, SUNY distinguished teaching professor, Mohawk Valley Community College
Corinne Jarvis, RHIA, CHDA, instructor, health information technology, Tacoma Community College
Neisa Jenkins, EdD, RHIA, full professor, Devry University
JoAnn Jordan, MPH, RHIA, CCS, CCS-P, CPHI, CHTS-TR, program chair, HIM, Franklin University
Desla Mancilla, DHA, RHIA, vice president, academic affairs and certification, AHIMA
Kathryn McMillan, RHIA, manager, health information and facility privacy official, University Surgical Associates
Michelle Millen, MSCPM, RHIA, director, health information management, Collin College
Diana Warner, MS, RHIA, CHPS, CHPI, FAHIMA, director, informatics, information governance, and standards, AHIMA
Greg Zobel, RHIA, CRC, CCA, CHPS, CHTS-CP, RT(CT), business manager, specialty service lines, Major Health Partners