career oportunities

Paradigm Shifts in Health Information Management

By Leah Grebner, MS, RHIA, CCS, FAHIMA; Director, Health Information Technology, Midstate College
n 1928, the medical record librarian profession was born. It was composed of individuals having interests similar to todays students preparing to enter the health care field in an area that doesnt involve direct patient care, as opposed to clinical-focused health care professions. Over the years, this profession evolved to become medical records management in order to reflect that professionals did more than simply file charts, but rather managed the record documents. Advances in technology further evolved the profession to introduce management of the information within those documents. This led to another name change for the profession, which is now known as health information management (HIM). Introduction of the electronic health record (EHR) has enabled storage of patient data in a manner that facilitates processes involving processing patient data through database queries to create simple statistical reports and complex data analysis. This evolution has not only changed the basic functions of HIM professionals, but has also changed job titles, roles, training, education, credentials, specializations, reporting relationships, and work settings. File clerks transitioned to scanning specialists and quality assurance for electronic document management. Physician record assistants, who used to pull hard copy charts for physicians to complete, now assist physicians with navigation of the EHR and verifying completion of documentation deficiencies by the physicians. EHR evolution has also created new roles for HIM professionals in the information systems departments of health care organizations, as there is a need for expertise in record management principles during the implementation process and through continued maintenance of the EHR functions. Transcriptionists have experienced significant role changes as outsourcing and voice recognition software have become more commonly used in health care. Now, HIM professionals trained for transcription are no longer listening to the recorded provider dictation to type notes, but rather work as editors, performing quality review and corrections on documents produced by outsourcing vendors and voice recognition software. Another evolving function performed by HIM professionals with transcription training is working in the role of a scribe. A scribe follows the provider through patient care and enters information into the EHR that is dictated by the provider. Coders have experienced significant changes over the years. Coding systems have been revised. Encoder software has been developed. An increased amount of information is abstracted from the records. Prospective payment systems have been implemented. Most recently, coders have assumed roles as auditors and documentation improvement specialists. Natural language processing (NLP) and computer assisted coding (CAC) are developing technologies that are presenting new roles for coders. It is important to note that NLP and CAC are not intended to replace coders, but rather to facilitate the coding process. It is becoming increasingly common for hospitals and other providers to eliminate the walls that previously contained the HIM department. This does not mean an elimination of HIM staff members, but rather a shift in reporting relationships and physical
Page 18 Healthy Cells Magazine Peoria September 2013

location of the employees in the facility. This is partially a result of a nationwide shortage of qualified HIM professionals, leading to difficulties finding HIM Directors. Another significant contributor to this change is the increased diversity in education that HIM students are receiving. HIM professionals are urged by leaders in the career field to pursue higher degrees and more diverse education, the HIM professionals are seeking more prestigious, interesting, and higher paying positions outside of the traditional setting. HIM students are now well prepared to cover roles that had previously only been held by nurses, such as utilization review, performance improvement, and other administrative positions. New developments in technology and education have made this an exciting time to work in the HIM career field. HIM offers diverse options for professionals already working in other areas of health care, along with those who have an interest in entering the health care arena in non-patient care positions. The American Health Information Management Association (AHIMA) has a career map for exploration of not only the entry-level positions, but also the opportunities for career growth from each position. This is located at hicareers.com. Are you interested in learning more about these and other options for starting a career in the Health Information Management career field? Midstate College offers courses to meet schedules requiring day, night, or online needs. Call Leah Grebner, Director of the Health Information Technology department at 309-692-4092 or visit mdstate.edu for more information.