HIM’s Evolving Workforce: Preparing for the Electronic Age’s HIM Profession Shake-up

By Julie A. Jacob

When Sebrina Campbell started her health information management degree program at Saint Louis University, she knew she wanted to follow a non-traditional career path. To help her figure out her route, she turned to the HIM Career Map. The interactive online tool, available on the AHIMA-sponsored website www.hicareers.com, visually illustrates the myriad career paths that HIM professionals can take. Campbell used the tool to find the right career route for her goals.

“I am more interested in doing hospital administration. I am also very interested in information technology and health information exchanges,” says Campbell, who graduated last spring and has started her master’s degree program in health administration, also at Saint Louis University. “I’ve used it [the Career Map] to see what potential pathways are out there for me because I have a unique background and a master’s degree.”

In an era when the HIM profession is experiencing great change, the HIM Career Map, which formally debuted in July at the Assembly on Education Symposium and Faculty Development Institute, is a valuable career tool for both new and experienced HIM professionals. The HIM profession, which once seemed as serene and quiet as a garden pond, is now rapidly moving and branching out into new directions much like a fast-flowing river with many tributaries. Computer-assisted coding, electronic health records, ICD-10-CM/PCS, and the increased emphasis on using comprehensive data to optimize healthcare for patients and improve payment precision are all factors shaping the future of the profession. During this time of change, as the role of the HIM professional evolves from that of an administrator of paper records to an analyst of digital healthcare information, the Career Map can help HIM professionals smoothly navigate their careers.

Moving Beyond Paper Records

There’s no question that the days of a HIM professional managing shelves of paper records stored in cardboard folders are over. Nowadays, HIM professionals are expected to know how to manage digital databases of information.

“Information used to be sitting in a paper-based format and now it is moving into a digitized format… we have to make sure that information is being properly managed, is secure and protected, as we have always done, but the way we are doing it is changing,” says Carole Okamoto, MBA, RHIA, CHPS, FAHIMA, principal of her own consulting firm, C.O. Concepts, Inc., based in Seattle, WA. Okamoto serves on AHIMA’s Council for Excellence in Education and helped create AHIMA’s Vision 2016 document detailing the preferred future of the profession. That document established goals of transforming HIM into a graduate-level profession, aligning associate degree HIM programs with employer needs and preparing HIM educators to effectively teach students.

Kayce Dover, MSHI, RHIA, president and CEO of HIM Connections, a staffing firm in Birmingham, AL, also has observed a shift in both the skill set that employers are looking for in HIM professionals and the opportunities available to HIM professionals.

“Years ago we managed records that were physically in our possession,” Dover says. “As more and more [healthcare systems] have adopted the electronic health record, it has changed how we document and access records. The role hasn’t necessarily changed, but how we do it is certainly different.”

The healthcare industry’s rapid shift from paper medical records to electronic health records (EHR) has been hastened by the 2009 American Recovery and Reinvestment Act, which gives eligible healthcare systems and physician offices financial incentives to adopt EHRs through the “meaningful use” EHR Incentive Program. This transformation of medical records from paper to electronic files means that HIM professionals need to be savvier about using the tools of the digital age. They need to have much more than just a basic knowledge of common office software programs, and instead must understand how to access, manage, and analyze digital healthcare data, according to HIM career experts. They also need to understand the principles of digital healthcare data privacy and security.

Education Moving Students Forward

The types of courses offered in health information management degree programs reflect this change. HIM programs now include more courses on data analysis and research skills. For example, Arkansas Technical College in Russellville, AR, changed a computer skills course into a data analytics course where students now use computer-generated data to solve business problems, according to Melinda Wilkins, PhD, RHIA, the college’s professor and program director of the health information management and health informatics programs and past chair of the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM). Wilkins has also added more research courses to the program.

Campbell said her health information management program at St. Louis University also included several courses on using computer software programs to manage databases and analyze data, and added research courses to the program.

The increasing need for HIM professionals to analyze data is influencing the educational requirements for the profession. According to 2013 AHIMA membership statistics, about 12 percent of members have high school diplomas, 32 percent of members have associate degrees, 29 percent of members have bachelor’s degrees, 10 percent have master’s degrees, and the rest have other degrees or certificates. The percentage of AHIMA members holding bachelor’s and master’s degrees will likely increase in the coming years as the HIM jobs require more education, according to HIM teachers and consultants.

“We are seeing a transition to a master’s degree-level profession,” Dover says. Although it can be challenging to return to school mid-career, many university programs offer online degree programs, Dover says, which makes it easier for HIM professionals with families and full-time jobs to continue with their education. She sees an increasing role for HIM project managers, data analysts, and clinical coordinators.

“We need people who can document and track the data for all the departments and develop the reporting tools to analyze and use the data to make better decisions,” Dover says. “We will see more HIM professionals take jobs in IT departments. You need people with our knowledge to work with clinicians.”

Use AQ to Embrace Change in HIM

Think of change as energizing instead of terrifying, strengthen your CORE, and boost your adversity quotient (AQ). That’s the advice of Paul G. Stoltz, PhD, founder of PEAK Learning, Inc., a research and consulting company based in San Luis Obispo, CA, and author of four bestselling books on managing change and handling adversity. Stoltz is also a global expert and lecturer on effectively managing changes in one’s professional or personal life—the type of changes many HIM professionals face as their job roles change and they head down new career paths.

Most programs designed to help people adjust to change—whether a change in job responsibilities or life circumstances—fail because the programs are based on the assumption that change is a wrenching process that one needs to endure in order to reap the benefits. That’s the wrong way to look at change, Stoltz says. The idea that going through a career or life transition is akin to walking barefoot across hot coals is “absolute hogwash,” says Stoltz, who has reviewed about 3,500 studies on change management. “When you equip people appropriately, it can be completely different,” Stoltz says. “For an individual and an organization, there is nothing in the universe preventing change from being like that.”

AQ: Face Frustration with Optimism

Handling change better doesn’t mean following some simplistic advice like thinking happy thoughts, stresses Stoltz, who HR Magazine named one of the top 10 influential thinkers in 2010. Instead, he has learned through his research that people who manage change successfully have a high adversity quotient (AQ), which he defines as the ability to handle frustrations and setbacks with optimism and resilience.

A person’s AQ consists of four components: control, ownership, reach, and endurance.

  • Control is defined as how well a person can take control of a stressful situation. For example, a person stranded at the airport who has a low sense of control may passively wait for more information from the gate attendant, while a person with a high sense of control may immediately start checking his or her smartphone for alternate flights or nearby hotels.
  • Ownership is how likely a person is to take action to address a stressful situation. In the cancelled flight situation, a person who has a high sense of ownership may book another flight, reserve a room, or stake out a comfortable spot in the waiting room instead of sitting still and thinking that there is nothing that he or she can do.
  • Reach is defined as how much a person allows a stressful situation to seep into other areas of his or her life. A person who doesn’t allow the stress of a cancelled flight to spill over into other areas of his or her life, for example, will still be able to enjoy a good book or a phone conversation with a loved one.
  • Endurance refers to how quickly that person can untangle themselves from stressful circumstances. In other words, how quickly a person can move on from having to endure a bad situation. For example, a person with a high endurance score who is stranded in an airport will move swiftly to make alternate travel plans.
At a time when the health information management field is rapidly changing, HIM professionals can apply these AQ skills to embrace the changes in their profession and benefit from them, Stoltz notes.

“It might include how well you network with others, what are the possibilities you explore early instead of late… what the emerging career opportunities might be,” Stoltz says.

A person with a high AQ might take courses to improve and expand his or her skill set, he says, and explore the types of jobs that are emerging in an environment of electronic health records and computer-assisted coding.

Traction also helps. Stoltz defined traction as “having the firm sense of grip that allows you to move forward confidently.” He compared it to having snow tires on a car that make it easier to drive on a slippery road.

Diversity is also helpful in dealing with adversity, he says. The more people a person knows from different walks of life and occupations, the stronger the position that person will be in if adversity strikes, such as a layoff or upheaval in one’s profession.

“The more diverse something is, the stronger it is... talk to people inside and outside your field, inside and outside your organization, and start to create interests, opportunities, and options,” Stoltz says.

It all comes down to four simple rules. “Shatter the conventional wisdom of change, strengthen your AQ and your CORE, and remember that traction and options generate hope and resilience… and diversify your options,” he says.

AQ for AHIMA Members

AHIMA has partnered with PEAK Learning to offer the AQ—Positive Change online professional development course. AHIMA members receive a discounted rate and CEU credits for the course, which aims to measure and improve HIM professionals’ performance, engagement, and mindset both on the job and in life. Visit aq.peaklearning.com/info/ahima for more information.

HIM Demographics Changing

As the parameters of the profession change, so, too, do the demographics. Health information management, like elementary school teaching and nursing, has traditionally been a female-dominated profession. But more men are pursuing careers in health information management. That may be a result of the increasing emphasis on information technology, which has been a field that has traditionally attracted men, or because HIM is a field that pays well and offers plenty of jobs. So much so, in fact, that a September 12, 2012 U.S. News and World Report article ranked health information management as fourth on its list of the most promising college majors. Dover is also seeing more HIM job candidates who have degrees in nursing or other clinical health areas, she says.

“Some clinical staff seem to be looking for a different challenge and others are looking for opportunities to use their clinical knowledge outside of direct patient care,” she says. “Clinical documentation improvement is an area where you will find HIM professionals, RNs, and other clinical staff working side-by-side. These roles require a strong clinical knowledge and thorough understanding of coding guidelines and compliance.”

The transition next year to ICD-10-CM/PCS is also affecting the profession. Surveys have shown that ICD-10 coding may increase coding time by 69 percent, Dover says, which means that more HIM professionals likely will need to be hired and, consequently, hospitals and physician offices may boost salaries and benefits to attract and retain them. However, healthcare systems have also been eyeing offshore coding as a solution to their staffing issues, she says. Although some have speculated that experienced health information management professionals will retire instead of learn the new system, many experienced HIM professionals are embracing ICD-10 and eagerly learning its details, Dover says.

Map to a New Career

The move toward electronic health records, ICD-10, and computer-assisted coding means both new and seasoned HIM professionals can’t be static, HIM profession experts emphasize. HIM professionals can’t stand still; they have to keep learning, keep adapting, and keep exploring new career paths.

Using the HIM Career Map, HIM professionals can virtually explore different career paths and learn what skills and experience they will need to get from point A to point B to point C in their careers. They can also investigate jobs they may not have even considered, and find out which jobs are considered emerging and which are considered established.

“We wanted one place to show the scope of the HIM profession and the opportunities in the field, and to educate people on what those were,” says Scott MacKenzie, AHIMA’s senior director of member engagement and strategy.

For example, a HIM professional interested in electronic health records can go to the HIM Career Map and click on “EHR implementation specialist,” which is listed as a mid-level career in the IT/infrastructure category. A yellow diamond represents this job because it is considered an emerging role for HIM professionals. When an HIM professional clicks on the yellow diamond for the EHR implementation specialist job, lines appear connecting that job to other jobs. Black lines represent links to jobs at a higher level, such as REC/HIE exchange director in the operations/medical records administration category—indicating that moving to that job is a promotional career pathway. Red lines link the role to data architect and data application or system analyst, indicating that those are transitional jobs that may help the HIM professional switch to another career path. In addition, the HIM professional using the HIM Career Map can click on a “learn more” button to research in-depth information about a particular job’s educational requirements, average salary, responsibilities, and skills needed.

Arkansas Technical College’s Wilkins uses the HIM Career Map as a recruitment tool to show potential students the various paths they can follow as HIM professionals. She sees it as a resource that HIM professionals can use throughout their careers. “I think each member needs to have his or her own personal career plan,” Wilkins says. “We can sit back and hope our jobs don’t go away or change very much, but that’s not very realistic. I see each person taking the Career Map and looking at his or her potential and making sure their future remains strong.”

A great deal of thought and research went into the creation of the HIM Career Map, MacKenzie says. AHIMA worked with the Council for Adult and Experiential Learning, which had created a career map for the telecommunications industry, to develop the HIM Career Map. The AHIMA team interviewed members to learn how they might want to use such a tool. They then analyzed more than 100 job titles for HIM professionals. Some job titles were added, some were discarded, and some were combined in the map, MacKenzie says. Next, the HIM Career Map team surveyed more than 2,000 AHIMA members to find out what kinds of jobs they currently held, what jobs they previously held, and what they were paid. Based on the survey data, the HIM Career Map team mapped likely career routes, job titles, and salaries. “We wanted to make sure it [the Career Map] was showing what the reality was,” MacKenzie says.

Whether a HIM Career Map user is a student, a new HIM professional, or an experienced professional, the online tool can help that professional figure out what the next step might be in his or her career. HIM professionals can choose to use it for a bird’s eye view of potential career paths or to hone in on the details of salary and projected job growth for one particular role.

As the HIM profession evolves, so will the HIM Career Map, MacKenzie says. “At some points those yellow diamonds [for emerging jobs] will change to circles. There will be times when we will need to add new emerging roles… we can add or take off jobs any time we need to.”

Envisioning HIM in 2023

Just as the HIM Career Map can show a route to the future for individual HIM professionals, the AHIMA Envisioning Collaborative hopes to show the route to the future of the HIM profession as a whole. The collaborative, comprising AHIMA delegates from each US state, is setting goals for the profession for the next 20 years, just as the Vision 2016 document did 10 years ago. The group uses a website to post and discuss information.

“We have one team looking at the two-to-five-year range and another team looking at the five-to-10-year-plus range,” explains Vickie Delgado, RHIT, CTR, manager of HIM at Kindred Hospital in Albuquerque, NM, and co-chair of the AHIMA Envisioning Collaborative.

Although the Envisioning Collaborative has just begun its work, some themes are already emerging. One idea being discussed is organizing the HIM profession like NASA’s Mission Control Center, where professionals from across the country and internationally work together and build on each other’s strengths by sharing HIM information and best practices. For example, some HIM professionals may have special expertise in computer-assisted coding, while others may have expertise in billing fraud or electronic health records. These experts could organize and share their collective knowledge. The Envisioning Collaborative has already determined that the HIM profession needs to keep striving for a higher level of education among its members. “The idea is that we push the education level higher so they include more informatics in the education,” Delgado says. As the HIM profession moves forward, just where it fits in within the organizational structure of a healthcare system will become an increasingly important issue, Okamato says. The traditional medical records department is disappearing and it is important that HIM professionals make themselves visible and educate senior leaders in their organizations about the important role they play in managing, analyzing, and protecting digital healthcare information. “We are the ones who understand how information is used within the organization,” Okamato says. “We have to be the ones who take the initiative. It will be critical to our profession.”

Okamato envisions information governance as an emerging role for HIM professionals. “Someone at the organization has to oversee this information. The IT guys handle the hardware and software. Where we bring value is understanding how the information is managed within the organization,” she says.

As jobs in the HIM profession merge, disappear, and emerge, no one can predict exactly what the specific job titles and responsibilities will be for HIM professionals 10 or 20 years from now. Experts in the HIM profession agree, however, that HIM professionals have to keep moving ahead in order to prevent getting stuck. “The traditional health record as we have come to know it is gone,” Okamato says. “We must redefine our value to the organizations in which we work as well as the entire healthcare industry if we are to remain relevant as a profession.

“Each and every one of us must be a definitive part of that. We do it one HIM professional at a time.”

Video Extra: Map Out Your Future
Take an in-depth tour of AHIMA’s interactive HIM Career Map. http://journal.ahima.org

Julie Jacob (julieajacob@aol.com) is a freelance writer based in Racine, WI.

Article citation:
Jacob, Julie A. "HIM’s Evolving Workforce: Preparing for the Electronic Age’s HIM Profession Shake-up" Journal of AHIMA 84, no.8 (August 2013): 18-22.