By Sandra Nunn, MA, RHIA, CHP
For The Record
Vol. 26 No. 10 P. 28
I was seven months pregnant the first time I heard about medical records management, unaware that I soon would be a single mom. An article in one of the women’s magazines prevalent at the time explained how the profession was suitable for wives and mothers who wanted both a career and a home life. Nevertheless, the details describing the profession that would eventually become my own for more than 30 years quickly escaped my thoughts.
I was an English and French teacher but following my divorce I needed skills that would generate enough of an income to adequately raise my son. I spent a year studying accounting, thinking it would be a stable field. It didn’t work out, but I’m still grateful for that knowledge.
While setting my sights on becoming an accountant, another opportunity arose. I began to work pro re nata in the evenings at a hospital two doors away from my parents’ home while my mother took care of my son. I happened to be assigned to work in the medical records department, where two terrific information management professionals took me under their wing. Director Kathy Vaughn, who encouraged me to change careers, said a sense of humor was essential, especially when it came to dealing with older physicians. Assistant director Pat Wellbrock, a pioneer in information management who already was studying data processing, influenced my decision to move into more IT-related roles later in my career.
Memories of those early days were revived recently while watching Charlie Rose interview author-filmmaker Tom Friedman (“Years of Living Dangerously”). The chat touched on population growth, the desire to join the middle class, and future employment opportunities. “It’s the biggest question. When I go around the country—around the world—there’s a paramount foreign policy question and that is, ‘How’s my kid going to get a job?’” Friedman said. “Truly regardless of what country, and what is striking me is that we are in the middle of a really big disruption here.”
The conversation reinforced how fortunate I was back in 1976. I entered the HIM field when a bachelor’s degree and an RHIA credential guaranteed a management position in a traditional department. I began as a coding supervisor, moved through assistant and associate director positions, and eventually became director of HIM for a large health care system. During that time, neither the HIM department nor the health care system itself changed much. The same functions (filing, chart assembly, chart completion, coding, etc) provided jobs with good benefits to a female-dominated staff of 75 to 100.
To become system director, it was necessary to obtain a master’s degree, typically a master of business administration. However, a fascination with computers and a timely chat led me to take another route. A young intern working toward her master’s degree in library science who occasionally helped me research topics for committee meetings recommended I consider a computer systems degree. “Management of documents, books, and records will all soon be electronic,” she opined.
The rest, as they say, is history; I’m now working on a second master’s degree in information architecture and knowledge management.
IT Is Where It’s At
As the move to EHRs began in earnest, I left traditional HIM behind and moved to the IT department to manage data administration. Subsequently, HIM departments became a branch of finance as coding became paramount. The records management component of HIM did not transition to its core electronic records management competency in an information governance environment, but instead moved to a clerical status involving the scanning of hard copy records and completing physician deficiencies in the EHR. Managing these functions didn’t require much training or education and produced positions unlikely to generate high salaries or promising career paths.
These changes in HIM have far-reaching effects. As tasks are automated and computerized, low-skilled work (such as filing) disappears and more advanced skills, like transcribing, are threatened. Technologies such as natural language processing lead to more outsourcing of the functions typically seen in the “old” HIM world. As a result, there may be fewer HIM managers and less staff under their guidance.
“It is now all about data and the management of data, including the management of concurrent data as it is generated,” Mervat Abdelhak, PhD, RHIA, FAHIMA, department chair and an associate professor at the University of Pittsburgh, told me at AHIMA’s recent Assembly on Education. In other words, HIM is no longer a field in which information is managed retrospectively, but rather one in which data must be constantly monitored to generate the necessary health intelligence.
HIM professionals will probably follow the Google model that emphasizes technically inclined leaders managing a highly skilled staff. Even coding will become more computerized. HIM professionals who evolve with the changes likely will move into less traditional environments such as research, pharmaceutical product development, enterprise electronic records management, content management, and information governance. A myriad of different roles awaits the ambitious.
“Lifetime employment is gone,” Reid Hoffman, cofounder and executive chairman of LinkedIn and author of The Alliance: Managing Talent in the Networked Age, recently told Charlie Rose. In other words, working at one company performing one function is an outmoded model.
A Choice of Tours
Hoffman envisions an employment model in which employers and employees agree on a contract that allows both parties to be invested in a “mission” or a “tour of duty.” He argues that companies will need to offer three types of tours. There’s the foundational tour, in which employees invest themselves in the company, potentially for a lifetime. For continuity purposes, this group is essential to any company’s success, but it can’t survive in an evolving environment if this is the only type of employee on hand.
Employees, particularly those starting out or starting over, may want to consider a transformational tour, which features a two- to five-year project with the potential to transform a career and move the company into a better market position. Lastly, there are rotational tours, in which employers can either scale up or down. Here, staff members may occupy temporary or pro re nata (as needed) positions or work as part of an outsourcing team.
Get on the Bus
With Big Data projects ballooning, the sky could be the limit for future HIM professionals. However, there will not be the predefined, secure jobs I found when I emerged from school with my RHIA credential. Days of uncertainty are at hand, but those who innovate and grow—either within health care systems or elsewhere—can expect to thrive if they commit to lifelong learning and change.
To paraphrase Susan Fenton, PhD, RHIA, assistant dean for academic affairs at UTHealth, HIM professionals must get on the bus or they’ll wind up under it.
— Sandra Nunn, MA, RHIA, CHP, is a contributing editor at For The Record and principal of KAMC Consulting in Albuquerque, New Mexico.