By Genna Rollins
Everyone in healthcare can feel the ground shifting. The changes are driving demand for information management, and HIM professionals can find new opportunities by keeping engaged and acquiring new skills.
Health information management may be one of the hottest healthcare careers in the coming decade, with up to 50,000 new jobs anticipated in the field. This growth presents great opportunities for the profession, but it also means changes in roles, in-demand skill sets, and educational requirements. Individuals willing to take on new responsibilities and learn about emerging areas of HIM practice, however, will be well-positioned for this new environment, according to experts.
"We're in a big transition, but we've done this many times in the past," says Sue Biedermann, MSHP, RHIA, FAHIMA, associate professor and chair of HIM at Texas State University in San Marcos. "There's a fundamental change coming to the field involving the use of information and HIM being purveyors of information. The people who will be successful are the ones who step up to the plate and take advantage of it."
Building the Health IT Workforce
Many forces are converging to drive demand for HIM positions. A 2009 report conducted on behalf of AHIMA by the American Institutes for Research (AIR) identified more than a dozen influencing factors, ranging from the growth of electronic health records to changes in standard medical billing and charting practices (see sidebar).
The report recognized healthcare reform as an important influence, but it was completed prior to passage of the American Recovery and Reinvestment Act of 2009 and subsequently may understate the impact of the legislation's healthcare provisions, according to Alexander Alonso, PhD, senior research scientist at AIR.
The act's healthcare measures, largely contained in a section referred to as the HITECH Act, seek to improve healthcare delivery and patient care through an unprecedented investment in health IT.
"Prior to specification of the Obama administration's policies, there was uncertainty as to whether the HITECH Act would eat into HIM," he explains. "But once the priorities were specified, it became clear that the HIM profession will benefit from and be leaders of a health IT workforce."
The HITECH Act established an incentive program to encourage adoption and "meaningful use" of EHRs, funded 60 regional extension centers to help providers adopt and implement EHRs, and created training programs to boost the health IT workforce. HITECH also provided funding to expand state-based health information exchange efforts.
Each of these efforts will drive demand for a workforce that can assist in the selection, implementation, and management of health IT and the management of increasingly mobile protected health information.
The government has projected a shortfall over the next five years of approximately 50,000 qualified health IT workers to meet the needs of hospitals and physicians as they move to adopt EHRs. The HITECH workforce development provisions are intended to reduce this shortage by 85 percent.
New Needs a Fit for HIM
The workforce provisions include a community college training program, a competency examination program to evaluate trainee knowledge and skills acquired through nondegree training programs, and a university-based training program.
The programs are designed primarily to attract individuals from other disciplines and bring them quickly up to speed in health IT. However, the influx of individuals without classic HIM training will not diminish the need for or influence of the HIM profession, according to Biedermann.
"There are many people actively engaged in moving the IT infrastructure forward in healthcare, and we're an integral part of that team," she says. "A lot of people contribute to the health record, but no one else knows [everyone] who uses it and for what purposes. We're right in the middle of the conduit." HIM knowledge, Biedermann says, is important to those designing EHR systems so that they understand how an EHR is used throughout an entire facility or enterprise.
Alonso agrees with this assessment. "The Obama administration's priorities made clear that HIM professionals will be the leaders of the workforce making higher-order decisions, but there still will be a need to train other people to meet societal needs," he notes.
AIR's research indicated that even before HITECH was passed employers saw HIM as a central player in guiding health information policies and decision making. "Employers placed value on having a feel for the clinical impact of policies and an ability to support organizational agility-to move with changing circumstances and still accomplish things," Alonso explains. "When it came to setting organizational principals behind actions, they said [the] RHIA was the way to go."
Biedermann is witnessing the impact in the careers of her former students and colleagues. She shares the story of one person whose employer consolidated HIM across several facilities. The immediate-and understandable-reaction of the HIM staff was fear for their jobs. But it became apparent that they would have new roles managing data, operations, IT interfaces, and other functions, albeit at more than one facility.
"That organization has determined that HIM has a valuable skill set, but the HIM professionals will have to be willing to step into and learn newer roles," Biedermann explains.
With Change Comes a Demand for Information Management
The AIR report identified more than a dozen factors influencing the demand for HIM professionals or their skill set:
- Changes in standard medical billing practices
- Changes in standard medical charting practices
- Clinical terminology and classification systems
- American Recovery and Reinvestment Act of 2009
- Electronic health records
- Government reporting requirements and auditing
- Healthcare reform
- Information technology systems
- Increased focus on data breaches
- The patient safety movement
- Personal health records
- Telecommuting workplace arrangements
Growing Need for Data Analysis
As the ground shifts around the use of health information, both Biedermann and Alonso believe data analytics will be an increasingly important skill for HIM. For example, one way for medical practices to demonstrate meaningful use of an EHR system will be to conduct outcomes analysis on patient populations to show improvements in key quality indicators, such as measuring hemoglobin A1c levels over time in diabetic patients.
"When doctors hear 'electronic health record' they're thinking of billing and scheduling functions," Biedermann explains. "They aren't really realizing there's a need to track outcomes for patients, nor do they know how to do that."
Even outside of the analysis needed to meet HITECH meaningful use requirements, Biedermann is seeing more and more new HIM graduates going into nontraditional settings like pharmaceutical and cancer research companies in which data analytics are front and center.
"It all has to do with the data-where do you get it, how do you manage it, how and to whom do you report it," she observes. "Everything has to do with the data."
As EHRs and other IT capture and organize increasingly comprehensive information, the demand for data analytics will soar, according to Alonso. He expects increasing requests for detailed analyses and comparisons run against other databases.
Data analysis expands traditional information management skills. AHIMA's Certified Health Data Analyst credential, introduced in 2008, demonstrates the knowledge to "acquire, manage, analyze, interpret, and transform data into accurate, consistent, and timely information, while balancing the 'big picture' strategic vision with day-to-day details."
In concert with all things data, critical thinking and project management skills will come to the fore front over the next decade, according to Biedermann. "HIM has been just dealing with maintenance of the medical record, but given the demands of data and uses of health information, higher thinking skills will be crucial," she says.
Alonso sees another golden opportunity for HIM over the next decade in the area of quality improvement. "Something that gets lost in the overall selling of the profession is that as managers of data, HIM know foremost what can be done to improve quality. In looking at data, they can assess what happens in care, see trends, and understand how processes can be changed so that care is more consistent and suits customers better."
Emphasis on Education
The AIR survey also revealed a trend toward specialization in HIM and a growing emphasis on credentials and certifications to demonstrate competency.
When asked to consider certifications needed in the future, more than half of HIM practitioners who participated in the survey indicated that the RHIT, RHIA, and CCS credentials will be required to land an HIM job in 10 years.
By the same token, one-third of employers and search firms reported that a master's in HIM was more valuable than other graduate degrees such as a master's of business administration or health administration.
"That was a consistent finding, even for positions like director of information systems that are a little blurry in terms of the HIM component," Alonso says. Employers indicated a growing expectation of graduate-level ability in financials, hospital organization, and systems and policies, as well as management experience.
Biedermann is familiar with the growing emphasis on graduate-level skills. Texas State University is one of nine colleges and universities participating in the Program of Assistance for University-Based Training, a HITECH initiative to "rapidly and sustainably" increase a health IT workforce qualified for roles requiring university-level training.
The program targets six roles, defined by the Office of the National Coordinator for Health IT, which is administering the funding: clinician/public health leader, health information management and exchange specialist, health information privacy and security specialist, research and development scientist, programmers and software engineer, and health IT subspecialist.
Staying Engaged, Keeping Competitive
HIM practitioners who wish to position themselves for these changes need to keep an ear to the ground to learn how the field is evolving, advises Biedermann.
"There's not one place to learn what roles are going to be in the future, and I'm not sure we know what all they're going to be-they'll continue to evolve," she says. In addition to AHIMA and state HIM associations, she suggests that individuals would do well to participate in other IT-related interest groups and stay abreast of the professional literature.
Biedermann also recommends taking AHIMA career development self-assessments, a series of 17 interactive online programs that enable participants to assess their proficiencies in specific roles. Through a personalized gap analysis the e-assessments identify learning opportunities to improve skills, identify where growth is needed, and gain insights about how to plan a new career or make a career move. The modules cover a variety of positions from RAC specialist and inpatient coder to data quality manager and healthcare information security officer (see https://www.ahimastore.org).
Both Alonso and Biedermann suggest that individuals seek out opportunities at work to gain experience in emerging areas of practice whenever possible and take advantage of continuing education programs. "I suggest anyone seeking to improve their marketability make sure they have all appropriate credentials. They should reach for the highest-order credentials in their areas of interest," Alonso says.
HIM professionals seeking a vibrant, fulfilling career that tracks with the evolving landscape of health IT and information management must engage the field. "Read and learn all that you can so that you're keeping current and can anticipate new roles," says Biedermann. "Think about what direction you want to go in and what you need to be competitive."
Genna Rollins (firstname.lastname@example.org) is a freelance writer specializing in healthcare.
"Forces of Change: The Growth of Data Drives Demand for Data Management"
Journal of AHIMA