By David T. Marc, PhD, CHDA; Janet Robertson, RHIA; Leslie Gordon, MS, RHIA, FAHIMA; Zakevia D. Green-Lawson, PhD, MSHA, RHIA, LHRM, FAHIMA; David Gibbs, PhD, CHPS, CPHIMS, CISSP; Kayce Dover, MSHI, RHIA; and Michelle Dougherty, PhD, RHIA
In 2015 a workforce study was conducted using a survey instrument to define how health information management (HIM) is shifting to meet future needs and what knowledge, skills, education, and credentials will be necessary to perform successfully as an HIM practitioner.1 This study discovered that HIM professionals anticipate they will spend a lower percentage of their time on diagnosis and procedural coding in the future while leadership, teaching, and informatics were identified as tasks that will increase the most significantly. Since this study, AHIMA has aligned their strategic objectives around supporting informatics/analytics, information governance, creating pathways for HIM professionals in emerging roles, and consumer engagement.2 Many in the industry have anticipated that the HIM workforce will make a shift towards more technical careers with greater emphasis on advanced education.
In an effort to evaluate this anticipated shift in the workforce towards more technical careers with advanced degrees, the authors of this paper conducted an analysis of HIM job postings on Indeed.com and determined the most common phrases that occur in the job requirements and the specific requirements for educational degrees and credentials. This analysis was conducted in February 2017 and included a total of 456 unique active job postings from around the United States. The job postings were queried based on the presence of the phrase “health information management.” Any job posting that included this phrase in the title, description, or any related metadata were returned in the query. Using a method to parse out the noun and noun phrases from the job descriptions, a word cloud was generated to find the most frequently used words in the postings (see Figure 1). Additionally, the frequency of the job titles from the postings were summarized based on the six categories and skill levels specified in the AHIMA Career Map (see Table 1).3 The proportion of job postings that included a requirement for specific education levels were summarized (see Figure 2). Finally, an analysis was conducted to summarize the shifting need for more technical credentials over the past five years (see Figure 3).
Figure 1 shows that the terms related to the healthcare domain (i.e., “health” and “medical”) and medical records (i.e., “records,” “information,” and “management”) occurred frequently and were related broadly to HIM. Next, researchers saw use of technical terms such as “data,” “privacy,” “tech,” and “computer” occur frequently in the job postings. Collectively, the 100 most frequent terms revealed that many job postings appeared to focus on documentation, standards, data, health information technology, and analytics. Given the information derived from the word cloud, the authors queried the same job posting for the most frequently occurring job titles broken down by categories.
Figure 1: Word Cloud of Frequently Occurring Words in HIM Job Postings
|The word cloud displays the 100 most frequently occurring noun and noun phrases from job postings queried from Indeed.com in February 2017. The size of the word indicates the frequency of occurrence, with larger words occurring more frequently than smaller words.
Table 1 displays that the majority of the job postings were in alignment with roles related to operations and medical records administration careers, and required mid-level skills. The majority of the job postings that were categorized as related to informatics/data analytics and education/communication largely required advanced skills, while those in alignment with IT/infrastructure and revenue cycle management coding and billing required mid-level skills. Privacy and security roles are represented in multiple categories including compliance/risk management and IT/infrastructure.
Table 1: Percentage of Job Postings by Category and Skill Level
|This table displays the percentage of job postings that meet the criteria of the six job categories and skill levels specified in the AHIMA Career Map.
||Job Category Total
|Operations Medical Records Administration
|Revenue Cycle Management Coding and Billing
|Skill Level Total
To determine if the job categories and skill levels are aligned with a specific level of education, the job postings were summarized based on the percentage of job postings that listed a preferred education level of an associate’s degree, baccalaureate degree, or master’s degree. Figure 2 displays that the majority of the jobs required a bachelor’s degree with a similar percentage requiring an associate’s or master’s degree.
Figure 2: Education Requirements for HIM-Related Job Postings
|The percentage of job postings that specify the following education categories as preferred. The analysis was limited to only the job postings where a preferred education was listed (n= 272). If the job posting listed two education levels in the requirement, the highest preferred education level was selected.
Finally, according to the Indeed.com job trends tool, the percentage of job postings mentioning healthcare privacy and security credentials increased significantly in 2016. In 2012, the percentage of job postings on Indeed.com mentioning CHPS reached only 0.00031. In 2014, a spike in job postings temporarily raised the percentage to .0019, an increase of over 1,400 percent. An even more meaningful indicator is the rapid increase that occurred in 2016 raising the percentage to .00469, which represents more than double the previous peak percentage in 2014. Not surprisingly, the corresponding chart for the related Healthcare Information Security and Privacy Practitioner (HCISPP) credential was very similar with almost the same order of magnitude spike in 2016 (the HCISPP credential was launched in 2013). Figure 3 depicts these numbers graphically. Both the CHPS and HCISPP levels have remained high as 2017 began. The authors interpret these numbers to indicate a sharp increase in industry demand for healthcare professionals with credentials in privacy and security.4
Collectively, the findings from this analysis are in alignment with previous studies suggesting HIM-related careers are moving toward more advanced positions, including those that require mid-level, advanced, and master skills with a baccalaureate or master’s degree. However, there are currently a large percentage of jobs that still require a minimum of an associate’s degree with either entry or mid-level skills.
Figure 3: Trends in Job Postings for Healthcare Privacy and Security Credentials
CSAs Must Work to Meet Future Industry Needs
The role of preparing future professionals and the offering of continuing education opportunities is a responsibility that also extends to AHIMA and its component state associations (CSAs). CSAs have a unique position/role as the gateway to connecting members with the industry and the national professional association. This connection is demonstrated through various means such as volunteerism (service), education, training, scholarships, advocacy, and industry promotion and awareness. This type of “frontline” response is evidence of the important role of each CSA within the fifty represented states, the District of Columbia, and Puerto Rico, to answer the call in the education of current and future health information and informatics professionals.
The opportunity has arrived for CSAs to think outside the box and reach beyond the boundaries of tradition and normalcy, to increase their involvement more so than ever in the training and education of AHIMA members, students, employers, educational institutions, and the community in which it serves. The matter of relevancy, when determining the best education and training strategies, can be addressed with the following questions: What are the trends and directives of AHIMA and other external forces, such as the overall healthcare industry (local, national, and global) and the climate of influence of the federal government?; What is the best method of delivering quality education and training?; Does the educational agenda align with both the strategic plan and mission of the CSA?
The inauguration of the new presidential administration presents a number of unknowns and uncertainties, particularly in the US healthcare industry. At the same time, this change lends itself as an excellent teaching tool as a “real-time” example when it comes to the effects of the climate and the force politics and government has on the state of the healthcare industry. Thus, the appointed/elected role of the individual(s) to oversee the efforts of advocacy within the CSA, more so now than ever, must establish and maintain a high level of engagement in order to ensure its members remain abreast. Delivering quality education and training in a society that is highly technology-dependent and technology-driven opens the door of opportunity, creativity, and innovation.
The District of Columbia Health Information Management Association (DCHIMA) provides a great example of how to exercise true creativity and innovation in the midst of change. In the last four years, members of DCHIMA integrated virtual guest speakers and hands-on interactive group lessons/activities into their traditional educational and quarterly business meetings (QBMs), focusing on topics such as strategic planning and professional goal setting. In addition, DCHIMA has worked diligently to create and foster collaborative partnerships with local colleges and universities such as Montgomery College and the University of Maryland University College. This has led to DCHIMA co-hosting of a number of successful educational and training events, such as the two-day ICD-10-CM/PCS workshop, a data analytics workshop, and a three-day RHIA and RHIT Prep Review marketed to both DCHIMA members and students within the health IT and HIM programs at both institutions. DCHIMA is also planning its first-ever virtual annual meeting that has both the members and executive board very excited.
In order to keep pace with a rapidly transforming industry and profession, other CSAs are strongly encouraged to follow suit, while at the same time not losing focus on individual members and the local community. This is an excellent time for CSAs to revisit their strategic plans and mission statements to ensure they continue to serve as a beacon of the HIM industry in 2017 and beyond.
One effort underway to shape and strengthen the long-term future of HIM is HIM Reimagined (HIMR), an initiative developed by AHIMA to steer workforce skills toward in-demand and emerging roles like informatics, data analytics, and information governance. Among the recommendations outlined in the draft HIMR white paper is to increase specialization across all levels of HIM education. Specifically mentioned are the CHDA and CHPS credentials along with condensing the core curriculum at the graduate level to allow for more skill specialization.5
The range of specialty certifications available through AHIMA continues to grow with the Certified Professional in Health Informatics (CPHI) becoming available in 2017. The CPHI credential was created in response to advancements in technology and increasing demand for health informatics professionals.6 AHIMA’s certifications are overseen by the Commission on Certification for Health Informatics and Information Management (CCHIIM), which establishes, implements, and enforces standards for certifying and ensuring competency of HIM professionals.7
What Led Up to and Why this Study was Conducted
The changes in HIM have been happening rapidly in this age of technological development. Implementation of the electronic health record (EHR) has been the largest contributor to the changes. The EHR has changed the way health information is managed, resulting in the need to train future HIM professionals in new educational competencies that align with evolving career opportunities.
The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 was enacted as part of the American Recovery and Reinvestment Act (ARRA). This act included a provision to ensure the workforce is properly trained in the use of EHRs. Many HIM programs received grants as part of this workforce training to educate professionals in six months or less. Part of the funding was used to support a set of health IT competency examinations that are now maintained and supported by AHIMA.
To meet the specialization trends in the healthcare industry, AHIMA has also created HIM-related credentials—such as the Certified Health Data Analyst (CHDA) credential. In 2006, a HIM job analysis conducted by AHIMA prompted the Commission on Certification for Health Informatics and Information Management (CCHIIM) to formally develop a certification promoting competence in data analytics. Further surveys and analysis continued through 2008. A needs study was conducted with 834 respondents in the healthcare management field. When asked, 86 percent of the respondents felt that there was a growing need for health data analytics. Data by setting showed that 82 percent of the respondents from integrated healthcare delivery systems and 77 percent from a hospital would support the need for competent individuals in healthcare data analytics. Indications from these studies helped validate the need for the CHDA credential.8
Another example is the Certified in Healthcare Privacy and Security (CHPS) credential, which demonstrates commitment to and competence with advanced privacy and security practices in healthcare. According to the HIM Reimagined white paper, developed by AHIMA as part of the association’s ongoing effort to help HIM professionals transition into emerging roles, only 280 individuals currently hold the CHDA credential and 487 hold the CHPS.9 These numbers are expected to increase as health IT programs develop specialty tracks driven by growing need from the industry. Experts report that 2016 was the year “cybercrime went mainstream” and specifically targeted healthcare data.10 The HIM specialty areas of data analytics, along with privacy and security, are expected to show increased demand in the coming years.
Revising HIM educational competencies to meet workforce demand has always been a “catch up” process. The challenge is due to the rapid changes in the industry, as compared to the ever-slow process of changing curricula in formal education. How can educators and HIM industry professionals come together to solve this dilemma? This article will not provide that answer; however, even awareness of this issue is important.
Health information administration and health IT programs are charged with implementing new curricula approximately every five years. Most recently, a new curriculum (2014 Curriculum) is required to be in place by August 2017. This curriculum is more focused on data analysis, information governance, and leadership. The 2014 Curriculum is based on competencies versus the previous curricula, which were more knowledge-based. The process for implementing a new curriculum into educational programs takes many years. The curriculum is developed with input from industry and educators and then passed to the accreditation board. Because it can take an entire academic year for a program to change curriculum, the accreditation board allows programs three years to incorporate the new competencies.
“A significant change in approach is noted with this release of the curricula. The emphasis and measurement of success is with attainment of the Bloom’s taxonomy level associated with the Student Learning Outcomes rather than the curricular considerations (which are examples of topics to be considered). When specific content is required it is part of the student learning outcome. With the pace of change in healthcare and HIM today, the curricular considerations may change with great frequency, but the student learning outcomes would remain consistent over longer periods of time,” states AHIMA’s curriculum development toolkit on the curriculum changes.11
AHIMA created the Council for Excellence in Education (CEE), formerly the Education Strategy Committee (ESC), to assist the HIM profession in advancing the career through education. The CEE develops the HIM curriculum at all educational levels with input from industry experts and academic and workforce stakeholders. The CEE passes the curricula to the Commission on Accreditation of Health Informatics and Information Management Education (CAHIIM) who in turn use the curricula as one of its accreditation standards. HIM educational programs are able to take advantage of the many tools and opportunities developed and supported by the CEE.
The need for specialty tracks at the associate degree level is being further investigated by AHIMA’s CEE. More research is being done at the national level so component state associations (CSAs) have the necessary information to support specialty certificates by HIM educational programs that will meet workforce demands. Some states are also gathering data within the state to determine the workforce needs. At least one state is considering collaboration among HIM educational programs to strategically offer specialty tracks. This would eliminate the redundancy of certificate programs within the same component local associations (CLAs) and throughout the state.
Another important initiative is the proposal to modify existing US Bureau of Labor and Statistics standard occupational classifications (SOC) and develop a new SOC for Health Informatics Practitioner. SOC is used by the government to collect and analyze occupational data, used by employers to set organizational leadership structure and salary scales, and used by job seekers and students considering career training. The proposal to modify the existing SOCs was due to a desire to reflect healthcare industry changes, and due to the AHIMA Career Map accounting for the more technical demands of the careers based on shifting responsibilities related to the EHR. AHIMA, the AHIMA Foundation, and 16 collaborative organizations joined together to propose a new SOC for a new health informatics practitioner role. The proposal resulted in a new SOC for Health Informatics Specialists and Analysts, which is currently undergoing a regulatory and public comment process.
Regarding the SOC proposal, AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA, was quoted in a press release saying, “Employers increasingly need health information management (HIM) professionals that are technologically skilled and specially trained and educated. The recognition of the health informatics practitioner position—which was supported by researched data from our first of a kind career map—will help organizations establish leadership structures to manage and govern health data and electronic health records (EHRs) to deliver quality healthcare.”12 Collectively, these efforts demonstrate the need to continue to evolve given the changing technical landscape that has required HIM professionals to take on new roles and responsibilities.
The Future is in Our Hands
The fact that HIM is changing is not a new story for HIM professionals. But the pages of this story will continue to be written as researchers use historical and current data to look for trends and try to predict what changes are needed in order to be prepared for tomorrow. National efforts have been made to redefine what it means to be an HIM professional, such as the creation of new, technically-oriented credentials. Job postings with a demand for mid-level and above skills, like the ones examined in this study, also provide evidence of change, and appear to be in alignment with a need for higher education. CSAs should be driven to provide training and support for their members to meet this change head-on. Finally, AHIMA, with the support of the educational committees, knew to anticipate and react to these changes to ensure the association is pushing future HIM professionals in the right direction. Collectively, the current chapter of HIM’s story focuses on evolution of the HIM profession—as evident by posted job listings. How the HIM industry writes the next chapter, and if it embraces this change, is in HIM professionals’ hands.
Government Updates HIM Related Occupational Classifications
|In 2014, the US Bureau of Labor Statistics began the multi-year process to formulate changes to the standard occupational classifications (SOCs) and make recommendations to the Office of Management and Budget. The final changes will be published in the Federal Register this summer and go into effect in 2018. The SOCs group occupations primarily by work performed regardless of background, and only in special cases take skills, education, and training into consideration.13 There were two changes in the SOCs that are reflective of changes in work performed in HIM and other informatics occupations. These include specifically:
- The SOC for Medical Records and Health Information Technicians will change to Medical Registrar and Records Specialists in 2018. A description of the work performed in this SOC includes “compiling, processing, and maintaining medical records of hospital and clinic patients in a manner consistent with medical, administrative, ethical, legal, and regulatory requirements of the healthcare system. Process, maintain, compile, and report patient information for health requirements and standards in a manner consistent with the healthcare industry’s numerical coding system.” This SOC includes medical coders.14
- A new broad category and detailed SOC will be added in 2018 for Health Information Technology, Health Information Management, and Health Informatics Specialists and Analysts. A description of the work performed in this SOC includes “to apply knowledge of healthcare and information systems to assist in the design, development, and continued modification of computerized health care systems. Design, develop, select, test, implement, and evaluate new or modified informatics solutions, data structures, and decision support mechanisms to support patients, healthcare professionals, and their information management and human-computer and human-technology interactions within health care contexts. May educate staff and assist in problem solving to promote the implementation of the healthcare information system.”15
These are not the only SOCs that reflect HIM occupations. For example, there are classifications related to directors/managers, various IT roles, educators, and others found in the AHIMA Career Map. However, the new SOC for Health Information Technology, Health Information Management, and Health Informatics Specialists and Analysts reflects confirmed changes in work performed in healthcare settings today.
 Sandefer, Ryan et al. “Survey Predicts Future HIM Workforce Shifts: HIM Industry Estimates the Job Roles, Skills Needed in the Near Future.” Journal of AHIMA 86, no. 7 (July 2015): 32-35.
 AHIMA. “Strategic Objectives.” 2017.
 AHIMA. “Health Information Careers—Career Mapping.” 2017.
 Indeed.com. “Job Trends.” 2017.
 AHIMA and Haugen Consulting Group. “Draft Whitepaper: HIM Reimagined: Transformation starts with you.” 2016.
 AHIMA. “Certified Professional in Health Informatics (CPHI).”
 AHIMA. “CCHIIM—About the Commission.”
 AHIMA House of Delegates. “Proposed New Credential—Certified Health Data Analyst.” 2008.
 AHIMA and Haugen Consulting Group. “Draft Whitepaper: HIM Reimagined: Transformation starts with you.”
 Butler, Mary. “Three HIM Stories to Watch for in 2017”. Journal of AHIMA website. January 1, 2017.
 AHIMA. “CEE Courseshare: Curriculum Development Toolkit: Side-by-side Crosswalk (Mapping of 2012 to 2014 curriculum) PDF and RTF.” 2015.
 AHIMA. “Changing With the Times: AHIMA provides recommendations on job classifications to the US Bureau of Labor Statistics.” Press release. August 6, 2014.
 US Bureau of Labor Statistics. “SOCPC Responses on Public Comments Regarding Changes for 2018.” July 22, 2016.
 US Bureau of Labor Statistics. “Preliminary 2018 SOC Detailed Definitions.” July 2016.
David Marc (firstname.lastname@example.org) is an assistant professor and the health informatics graduate program director in the department of health informatics and information management at the College of St. Scholastica in Duluth, MN. Janet Robertson (email@example.com) is the HIT program director at Santa Barbara City College, based in Santa Barbara, CA. Leslie Gordon (firstname.lastname@example.org) is associate professor of HIM at the University of Alaska, based in Sitka, AK. Zakevia Green-Lawson (email@example.com) is the master of science in health informatics graduate program chair at the University of Maryland University College, based in Adelphi, MD. David Gibbs (firstname.lastname@example.org) is an assistant professor in the department of health information management at Texas State University, based in San Marcos, TX. Kayce Dover (email@example.com) is the president and CEO of HIM Connections, based in Birmingham, AL. Michelle Dougherty (firstname.lastname@example.org) is a senior health informatics research scientist for RTI International, based in Research Triangle Park, NC.
Marc, David; Robertson, Janet; Gordon, Leslie; Green-Lawson, Zakevia D; Gibbs, David; Dover, Kayce; Dougherty, Michelle.
"What the Data Say About HIM Professional Trends"
Journal of AHIMA