by Paul Wing and Margaret H. Langelier
Profound change is coming to HIM. Leading organizations say HIM professionals must be willing to rethink their traditional jobs and acquire new skills in order to meet challenges and claim new roles.
HIM has been in transition for more than three decades, but the healthcare system is now poised for more change in the coming decade than it has experienced in the previous three combined. Expected to drive the change are developments in four key areas:
- Integrated, interconnected electronic systems
- More controlled access to patient data
- Sophisticated, coordinated HIM teams
- More analysis of data to support clinical and business decisions
These changes will transform what HIM professionals do and how they do it. What must HIM professionals know and do to position themselves for the transformations now on the horizon? Important insights can be gained from companies at the forefront of change in HIM.
New Tools, New Work
This article is based on a series of nine case studies on HIM employers (see “Participants in the Case Studies,” below). These employers are in one way or another leading the changes now under way in HIM. Interviews with more than 100 executives, managers, and HIM professionals from these firms give perhaps the best insights now available into what the future holds for HIM. Each case study involved as many as 26 interviews with different managers and HIM professionals.
| Participants in the Case Studies |
Care Communications, Inc., Chicago, IL
Cerner Corp., Kansas City, MO
Group Health Cooperative of Puget Sound, Seattle, WA
Hospital Corporation of America, Inc., Nashville, TN
Maimonides Medical Center, Brooklyn, NY
Partners HealthCare, Boston, MA
Pfizer, Inc., New York, NY
Rockford Health System, Rockford, IL
Department of Veterans Affairs, VISN 2 Network, Albany, NY
Despite the diversity of their organizations and their individual jobs, participants in the study had remarkably consistent messages about the future of HIM. They discussed deep technological changes that will redefine the medical record and challenge HIM professionals to reconceptualize their work and grow into newly influential roles. Participants identified the following issues:
- Health records will be increasingly automated and will eventually be fully digitized. Paper records will be replaced by electronic records. The pace of change will accelerate.
- Information will become increasingly important for more purposes as it becomes easier to collect and share.
- Healthcare organizations are changing, and the roles of health information managers are expanding. These changes will be driven by a number of factors including greater concern about clinical outcomes, new technologies and automation, and greater concern about privacy.
- Many HIM professionals will need new skills to survive in the workplace of the future. To succeed, HIM professionals must embrace change, enhance their technical skills, and increase their understanding of data content, structures, analysis, and applications.
- HIM education programs must adapt their curricula to the changing healthcare environment, for both new and existing practitioners.
- Teams and networks will form and evolve as progress is made toward a fully functional electronic HIM environment.
In the newly emerging patient-centric environments, the electronic health record (EHR) will be fundamental to clinical decision making, to determinations about therapeutic interventions, to business processes, and most importantly, to quality outcomes. As information grows in importance, and as more and better information is linked to quality decision making, the EHR will become increasingly important for both clinical effectiveness and administrative efficiency. It is around the EHR that the most visible and most profound changes are occurring. The EHR will redefine HIM practice and HIM roles.
Historically, the paper record has been a consolidated, comprehensive tool that guides providers in patient care. Case-study participants in all nine organizations cautioned against thinking that the electronic record will be essentially the same as the paper record. Several changes were mentioned consistently:
- Patients and healthcare professionals will interface with this new record in new ways, and access will be on a need-to-know basis.
- Patient records will transition from a record residing in a single location to patient information distributed across interconnected machines and networks.
- Change will affect many clinical and administrative processes. Ports into the patient information systems will be located in clinical facilities, administrative offices, research labs, and oversight organizations.
- Electronic records will promote quality in both clinical and business processes not possible in a paper-record world.
- The transition to date has focused primarily on creating new tools to do old work. Attention must now shift to performing new work made possible by the new systems.
New Work, New Skills
The changing nature of HIM work will present new challenges and new opportunities for HIM professionals. It will also require new skills. Participants in the study identified significant changes to HIM practice and the HIM workplace and the influence these will have on the HIM professional’s role. The commonality among their viewpoints was a significant finding of the study and adds strength to their observations and recommendations.
Changing with Organizations
Increasingly, healthcare organizations are moving from silos of practice to continuums of care. They are structured as matrices, teams, and project-oriented work groups. As organizations change, the professional roles within them also change. Health information managers increasingly are found in a variety of organizational units in a variety of roles as HIM becomes less centralized and less departmentalized. Changes of this magnitude can create tremendous stress for a profession, but it is also reassuring to know that the profession can accept many roles and functions within organizations.
Some HIM departments are becoming virtual units as electronic tools permit HIM professionals to work in remote settings and further allow work to be outsourced. The process of care will continue to be redesigned in a patient-centric model, changing the way in which care is delivered and information is managed, stored, and distributed.
Claiming New Roles
Health information managers are moving from surveillance and archival functions to prospective functions and process intervention. One case-study participant described this change as work by exception rather than by checklist. HIM professionals will be challenged to be strategic thinkers who exhibit leadership and project management skills.
HIM must continue to be expert in clinical content and vocabularies. Coding languages and typologies will persist as efficient and uniform languages that limit the size of the record while permitting extensive data abstraction to enhance clinical decision making. Participants cautioned that many health professions are poised to assume new HIM roles. It will be important for HIM professionals to be vigilant, visible, and vital to the process of change in their healthcare organizations so that they maintain important roles in the new systems.
HIM professionals will be required to communicate effectively with stakeholders across their organizations both in written communication and in oral presentations to executive management. HIM professionals will increasingly work in matrix and team structures rather than in segregated, departmentalized ones.
A new role for HIM professionals will emerge as patients gain increased access to their personal health information and as they become more proactive in managing its content. HIM professionals are well positioned to provide expert advocacy and education services to patients.
Managing Information as a Resource
The potential to improve the quality of patient care is a major impetus for electronic information systems. The amount of information currently available is beyond the capacity of clinical providers to access and absorb. Electronic systems will help clinicians synthesize and use the information to improve outcomes and quality.
More and more, health information managers will be required to manage data content and to create content libraries for their organizations. Privacy and security of the information will be a continuing concern of HIM professionals.
Leveraging Digital Records
The nine participating organizations are at different points in planning and implementing the EHR. Without exception, however, they indicate that health information will be fully digitized in the future.
Capable coding systems, voice recognition technology, and electronic signature applications will perform some functions currently belonging to HIM. New functions will evolve at higher levels to replace these functions. HIM professionals will continue to be data managers, and they must maintain their knowledge of healthcare processes. HIM professionals will be responsible for abstracting data from health records and converting it into useful clinical and business information in the organizations in which they work.
Enhancing Technical Skills
Implementation of an EHR requires a broad knowledge of both electronic architecture and information applications. HIM professionals must embrace change and upgrade their technical skills. They must understand the way in which information systems are structured and linked. HIM professionals must understand database applications and be familiar with data analysis and presentation tools.
By understanding computer systems and information technology, HIM professionals will enhance their functionality. Professionals who understand the value of information, who can collaborate with other professionals, who understand the clinical or administrative context of HIM, and who can use the EHR effectively will be highly valued in the future.
Expanding Education and Experience
Participants identified a number of important skills and competencies for the ideal future HIM professional. These include a command of coded languages and standard nomenclature, data mining and analysis skills, statistical analysis, accounting and finance skills, anatomy and physiology, legal and regulatory standards, pharmacology, disease process, and relational databases. Senior HIM professionals should also master strategic planning and project management, leadership skills, oral and written communication, and process management. Formal education programs are fundamental in conveying these skills to HIM professionals.
The importance of experience in the field was an ongoing theme when discussing recruitment and hiring with employers. This stress on hands-on experience underscores the importance of the professional practice experience during the formal educational process. These programs provide experience to students new to the field as well as introduce new professionals to potential employers.
The Next 10 Years in HIM
Case-study participants were optimistic about the future of the HIM profession, which was widely viewed as a bridge between the clinical and business functions of healthcare organizations. They saw important opportunities for the HIM profession to understand patient information, the clinical processes that create it, the clinical and management uses for the information, the confidential nature of the information, the regulations that affect its use, and its implications for clinicians and provider organizations.
Several participants stressed that to succeed in the future, HIM must maintain a professional identity based on patient information. The HIM profession must not permit the EHR to be appropriated by other stakeholders. To accomplish this, HIM can no longer simply be the policeman directing traffic into and out of the record, performing mainly surveillance functions. HIM professionals must be among the designers of the traffic systems to ensure that information moves smoothly but safely through the grid. They must also understand the location and content of patient data in that system and help manage, abstract, and refine it into useful information.
The importance of HIM professional participation in the change processes within organizations cannot be overstated. HIM professionals must actively present themselves and their competencies to their organizations and ensure that they are involved in both the planning and implementation of all aspects of the EHR.
It’s a promising future that will demand high-level skills, produce challenging and satisfying work, provide professional visibility, and create important new roles for HIM in healthcare organizations.
| HIM Professionals: Diverse Jobs in a Changing Environment |
The employer case studies reported here are part of a larger HIM work force research project sponsored by the Foundation of Research and Education and conducted by the Center for Health Workforce Studies at the University at Albany. Earlier phases of the project surveyed AHIMA members, graduating students, and program directors, documenting the changing HIM landscape and providing valuable perspectives for practitioners, policy makers, educators, and other HIM stakeholders on who HIM professionals are, where they work, and what they do.
The surveys captured a profession working in diverse settings and a rapidly changing environment. Among the key findings:
- HIM is a remarkably diverse profession, practiced in an equally diverse set of organizations. The 2002 AHIMA member survey showed that members held dozens of different job titles in more than 30 different types of organizations.
- The pace of change in HIM will accelerate in the future. The changes in the coming decade will be greater than those of the past three decades combined. Many HIM positions will change dramatically as the electronic health record becomes the norm.
- Important roles for HIM professionals in designing and managing HIM systems are not guaranteed in the future. They must be earned or else other types of professionals will be given these responsibilities, even if they are not best suited or qualified.
- HIM is just one of several components of the team needed to manage information. Teams dealing with HIM include clinicians, HIM professionals, IT professionals, administrators, and a host of support staff.
- Many HIM education programs are at risk because of their small size. Many also must be redesigned and reoriented to help HIM professionals meet the changing demands of the workplace.
- There is great variation in the penetration of AHIMA across the 50 states. Low penetration in some states limits the ability of healthcare administrators and policy makers to see the advantages of having AHIMA-credentialed workers on the job.
Full results of the research may be read in the reports and articles listed in “References” at the end of this article. Results of the member, student, and program director surveys are also available online at www.ahima.org. A report based on the employer study is also available online.
Mackenzie, Scott. “Coders Today: Where They Work, What They Earn.” Journal of AHIMA 74, no. 7 (2003): 20–27.
Wing, Paul, and Margaret Langelier. “Employment of HIM Professionals in the US: Current Patterns and Future Prospects.” Rensselaer, NY: Center for Health Workforce Studies. School of Public Health, University at Albany.
Wing, Paul, and David Armstrong. “Penetration of HIM Professionals in the Fifty States, An Examination of Geographic Patterns of AHIMA Members.” Rensselaer, NY: Center for Health Workforce Studies. School of Public Health, University at Albany.
Wing, Paul, and Tracey Continelli. “Professionalism in Health Information Management, An Examination of Attitudes of AHIMA Members.” Rensselaer, NY: Center for Health Workforce Studies. School of Public Health, University at Albany.
Wing, Paul, and Margaret Langelier. “AHIMA 2002 Member Survey Report.” Rensselaer, NY: Center for Health Workforce Studies. School of Public Health, University at Albany.
Wing, Paul, and Margaret Langelier. “Salaries of HIM Professionals.” Rensselaer, NY: Center for Health Workforce Studies. School of Public Health, University at Albany.
Wing, Paul, et al. “Who We Are: Findings from the 2002 Member Survey.” Journal of AHIMA 74, no. 5 (2003): 22–30.
Wing, Paul, and Margaret Langelier. “HIM 2002 Student Exit Survey Report.” Rensselaer, NY: Center for Health Workforce Studies. School of Public Health, University at Albany.
Wing, Paul, and Margaret Langelier. “HIM 2002 Education Program Director Report.” Rensselaer, NY: Center for Health Workforce Studies. School of Public Health, University at Albany.
Wing, Paul, and Edward S. Salsberg. “How Trends Shape the Work Force Today and Tomorrow.” Journal of AHIMA 73, no. 4 (2002): 38–45.
The work force research study was funded in part by AHIMA's Foundation of Research and Education (FORE) with a leadership grant from 3M Health Information Systems, with additional support from MedQuist, Inc., and contributions to the Fast FOREward Campaign from AHIMA's component state associations and member gifts.
Paul Wing (firstname.lastname@example.org) is deputy director and Margaret H. Langelier (email@example.com) is senior research associate at the Center for Health Workforce Studies, School of Public Health, University of Albany.
Wing, Paul, and Margaret H. Langelier. "The Future of HIM: Employer Insights into the Coming Decade of Rapid Change." Journal of AHIMA 75, no.6 (June 2004): 28-32.