Careers in health information technology: medical records specialists

CAREERS IN

HEALTH INFORMATION TECHNOLOGY

Institute Research Number 200 ISBN 1-58511-200-3 DOT Number 079.167-014, 079.362-014, O*Net SOC Code 29-2071.00

CAREERS IN

HEALTH INFORMATION TECHNOLOGY MEDICAL RECORDS SPECIALISTS ARE YOU SEARCHING FOR A ROCK SOLID CAREER WITH TREMENDOUS POTENTIAL?

Does medicine interest you, but you’re not looking forward to the rigors and expense of medical school? One of the best ways to participate in the fast-paced world of healthcare is behind the scenes, in the health information technology field. It’s one of the few jobs in healthcare that doesn’t involve direct patient care. We have all glimpsed the drama of modern medicine either on television or through personal experience. On ER, we see highly skilled hands frantically working to keep up with the fast pace of an urban emergency room. While not all healthcare is delivered in such intense surroundings, one thing is certain: providing quality medicine requires teamwork. There are no nonessential jobs in healthcare. There is plenty of drama, challenge and satisfaction to go around. There are two giant industries that are huge and still growing: healthcare and information technology. Put them together and you’ve got the ingredients for a career with loads of opportunity. Consider this: every time a healthcare professional treats a patient, there is a paper trail. From admission to a doctor’s office to payment from an insurance company, every detail of that patient’s medical history must be documented. In order to provide the highest level of patient care, doctors, nurses, and other healthcare providers will rely on you, the professional health information technician, to provide them with accurate and complete information.

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Your duties while performing your job will vary depending on where you work. But in general, health information is collected electronically and on paper, transcribed into reports, coded so it can be uniformly understood, cross-indexed so it can be accessed in various ways, organized, and maintained. If you think that’s a lot of work, you’re right. It actually takes a team of several people to pull it all together. Last year Americans spent one trillion dollars on healthcare, and that incredible amount is predicted to continue growing. That translates into tremendous opportunity for health information professionals who will continue to be in demand for the foreseeable future. In fact, experts predict health information technology as one of the 20 fastest growing occupations in the US today. There are a variety of job specialties within this field including medical coders, health information technicians, and health information administrators. They work in a variety of medical settings including hospitals, clinics, insurance companies, and doctors’ offices. Medical coders assign codes to medical treatments and then post those codes to records. The coded records are then passed on to insurance companies for proper reimbursement. Health information technicians make sure that medical records are accurate and complete. They may also coordinate reimbursement. Sometimes they specialize in maintaining disease registries for research. Administrators supervise teams of technicians and coders within larger healthcare settings. Sometimes they are responsible for the hiring and training of health information workers within their departments. Every year Americans are becoming more concerned about their health. The growing demand for quality healthcare leads to increased need for health information specialists. If you choose a career as a health information specialist, you will become a part of this movement towards better health. If you think you’d like the satisfaction of playing a significant role in helping to keep people well, take a closer look at this career.

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HOW TO START YOUR EXPLORATION THIS IS A CAREER THAT CAN BE STARTED WITHOUT A COLLEGE DEGREE, BUT HAS

definite advantages for those who choose to obtain formal training and certification. Either way, your education should start in high school. You’ll improve your chances of landing that first job or gain acceptance into a good training program by taking the right courses in high school. You should get a good foundation in business, general science, math, English (particularly composition), and computer courses. Studies in anatomy, physiology, biology, medical terminology, business administration, and information management courses would enhance your knowledge. A foreign language would also be a good idea. Ask your guidance counselor to help you get information and applications for college level courses in health information management. There are over 200 accredited colleges and universities with good programs. There is a complete listing at this website, which is searchable by area: http://www.ahima.org/careers/college_search/ Your high school counselor may also know about possible part-time job openings with doctors, or even a local hospital. If you’re a good student with strong keyboarding skills, you might just be the trainee they’re looking for.

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HISTORY OF THE CAREER HEALTHCARE HAS BEEN AROUND AS LONG AS HUMANS HAVE BEEN ON THE

planet. The roots of the modern healthcare systems were established over 7000 years ago. In those ancient times, injured and sick members of tribes depended on the local medicine man. Back then, the source of healing was cloaked in mystery and mysticism. The medicine man, or shaman as he was sometimes known, was revered for having supernatural powers – powers that could not be transferred, taught, or explained. Healing sessions were lengthy, often lasting days, and usually involved the family or even the entire tribe depending on the seriousness of the malady and the status of the patient. The medicine man led ceremonies that involved dancing, drumming, chanting, and praying while he applied presumably magic potions and herbal formulas. As primitive as this may sound, the medicine men were often successful in their treatments. They might accidentally happen upon an herb or process that did actually improve the patient’s condition. When the patient died, it was determined that it was the will of the gods. No one dared question the knowledge and skill of the shaman. When the time came for the medicine man to retire, he would choose an apprentice and pass on the secrets of his practice only to this chosen successor. No written records were kept of treatments or techniques. The information was oral and training was one-on-one. Written records of healthcare first appeared about 2700 BC. The Egyptians wrote about physicians and even rated them according to their successes. Reviews of prominent physicians appeared. They wrote about dentists, too, but not surprisingly, no one seemed to like dentists very much. Medical records in ancient Egypt were kept on papyri, a paper-like material made from the papyrus plant. One such document known as the Edwin Smith Papyrus, documents the practice of medicine more than 5000 years ago. It shows their methods were still primitive, but physicians had developed a case approach much like that which is used today. Physicians examined patients in set routines, noted symptoms, and issued a diagnosis. The treatments, however, still revolved around magic formulas and prayers. Even though thousands of years had passed, medicine continued to be based in religion. Like their tribal predecessors, ancient Egyptian physicians were credited with supernatural powers. And although there were now medical schools, the teachers were all priests. They 5

taught that evil spirits and demons caused illness and therefore, only gods could eradicate disease. There was a favorite god for healing known as Imhotep who, after numerous reported medical miracles, emerged as the God of Medicine. Healthcare moved beyond religion and into rational science about 2500 years ago. It was the ancient Greeks who rejected the idea of depending on supernatural powers and magic to treat disease and laid the groundwork for modern medicine. Today’s medical terminology reflects the strong Greek influence; much of it is derived from the Greek language. The Greeks gave us Hippocrates, known as the father of medicine, the greatest of the ancient physicians. He died in 379 BC at the age of 61. During his lifetime, he wrote more than 50 books on medical techniques and procedures derived from countless case studies. It is interesting to note that Hippocrates believed in the holistic approach to medicine; treating the whole person, not just the diseased part. It would take over 2000 years for the medical community to return to that philosophy. In the meantime, doctors the world over have taken the Hippocratic oath before embarking on their medical careers. Until the Middle Ages, physicians provided their services by making house calls. In the fifth century, the Christians took on the responsibility of caring for the sick and built the first hospitals. These early institutions were called hospices meaning places of rest in Latin. It is no coincidence that they were built along the route used by pilgrims to the Holy Land. Churches built and managed the hospices as part of their effort to support the Crusades. As it happened, all this traveling back and forth created a health hazard. Returning pilgrims brought an epidemic of leprosy to England. Over 200 hospitals were converted into lazar houses, buildings meant to isolate lepers from the public. On the North American continent, the first permanent hospital was established by Cortez in Mexico. Built in 1554, the Jesus of Nazareth Hospital is still in operation today. But it wasn’t until the early 1800s that the hospitals started to pop up in America. Much like the lazar houses of England, the American hospitals were intended to isolate patients who had contagious diseases. There were serious epidemics spreading: typhus, scurvy, smallpox, tuberculosis, and typhoid fever. Since there were no cures, the hospitals had morbidly 6

high death rates. At that time, an American hospital was where one went to die. It was nearly the 20th century before hospitals emerged as places to get well. The first American medical school was founded in Philadelphia in 1765. Apprenticeship was no longer a viable option for training doctors since there simply weren’t enough to go around. The country was growing rapidly and with it, the demand for healthcare. The number of new medical schools grew to 400 by 1840, but there were no set standards and most were of questionable quality. To correct this, a group of well-known physicians formed the American Medical Association (AMA) in 1847. Its original purpose was to establish guidelines for quality in medical education and a code of ethics for practicing physicians. Managed care emerged in the mid-1800s, when companies that employed large numbers of workers tried to attract good employees by offering medical care. There were no HMOs yet; the companies contracted independently with local doctors and hospitals. A few large plantation owners and mining companies built their own clinics and hospitals. The medical community frowned upon the system, and doctors were sometimes threatened with the revocation of their licenses. It was the American College of Surgeons (ACS), founded in 1913 that first realized the need for documentation in hospitals. In an effort to raise standards and improve quality of care, the ACS began collecting data from hospital health records. It soon became clear that the documentation was wholly inadequate. The organization’s landmark report, Minimum Standards, released in 1917, included specifications for writing a health record for every patient. The standards set down in that report – that patients’ records be complete, accurate, and accessible – are still used today. Shortly after setting the standards for medical records, the ACS established the Association of Record Librarians of North America to maintain and elevate those standards. The importance of medical record quality to patient care and research was clear. The organization’s name has changed several times over the years, but under its current label, the American Health Information Management Association, it remains the leader in standardizing quality medical record management. Medical technology in the 20th century produced many medical miracles. It was a boon to healthcare for millions, but it also came 7

with a price. The costs of healthcare skyrocketed. The public demanded access to quality healthcare, but many were turned away because they were uninsured or underinsured. The federal government’s answer to the problem was Medicare, implemented in 1965. This public health insurance program was a huge undertaking that resulted in a mountain of paperwork. The only way to handle it was to institute a coding system that standardized payment. Medical records technicians began to play a critical role in the administration of Medicare, linking providers with the federal program. In the 1980s, when HMOs took hold of the nation’s healthcare system, even more paperwork was generated. Today, American healthcare is a complex system made up of facilities, providers, payers, and regulators. The level of sophistication in medical technology is matched by the need for comprehensive information management.

Health information management

professionals today fill a variety of roles from record coders to information security analysts. Wherever they work, from managed care facility to community clinic, health information workers share a common goal: to apply modern technology to health information management. Their role is an essential one: to help provide the best possible care to patients.

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WHERE YOU WILL WORK ONE OF THE GREAT ADVANTAGES OF THIS CAREER IS THE WIDE VARIETY OF

possible work settings. Wherever health information is created, there is an employment opportunity. And wherever you choose to work you can be sure it will be in a pleasant and comfortable office complete with the latest technology. The most common job locations for health information specialists are in hospitals, clinics, nursing and personal care facilities, physician offices, but they work in just about any other medical setting you can think of. The majority of medical record technicians work in hospitals, either in admissions or the medical records department, but only after they’ve worked in less demanding situations for at least a year or two. Most start out in private clinics, in the offices of physicians, and in group practices. With some experience, technicians move into positions in long-term healthcare facilities, industrial clinics, state and federal health agencies, medical research organizations, health maintenance organizations, and insurance companies. You’ll even find them working aboard ships. Some other organizations that hire health information specialists include: Behavioral health facilities Law firms Consulting firms Information system vendors Ambulatory care facilities Rehabilitation centers Home care providers Pharmaceutical companies Those who advance into management positions usually do so in hospitals, long term care facilities and nursing homes, or wherever the facility is large enough to employ a staff of technicians. Sometimes health information managers are self-employed consultants. This works well for facilities that have multiple workers requiring some leadership and guidance, but not enough to pay for a full-time supervisor.

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Health information specialists holding master’s degrees or higher can choose to become teachers, taking positions at colleges. Medical coders work in three main areas: hospitals, doctors’ offices, and insurance companies that specialize in health and property-liability. Occasionally, medical coders are self-employed and contract their services out. These independent contractors work in their own offices, sometimes working at home.

THE WORK YOU WILL DO EVERY TIME A PATIENT IS GIVEN MEDICAL CARE, A RECORD IS CREATED THAT

documents that treatment. Considering the millions of people who receive healthcare each day, that’s a lot of information to keep track of! Medical records are permanent documents that will be used throughout a person’s life by doctors, nurses, and other healthcare providers. It’s the job of health information managers to gather and maintain these records, making sure that they are well organized, complete, and accurate. Each patient’s record contains many pieces of information, any of which are potentially significant. To properly diagnose a patient, for example, the attending physician needs to know what medications are being taken, when, and how much. What were the results of that medication or any other treatments? How much fluid does the patient take in each day and what is the typical diet? Blood pressure, temperature, and blood count must be noted. The family’s medical history needs to be considered. If lab tests or x-rays have been taken, what do they show? Does the patient have any allergies? Was there any surgery performed? How many stitches were required? What kind of anesthesia was used? How was it tolerated? With each step through the healthcare process, more details are added to the record. Healthcare providers depend on medical records being complete, clear, objective, and readily available. High quality health information is vital to providing high quality healthcare. Health information managers play an important and indispensable role as trained members of the medical team.

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There are numerous stages that health information must go through to be properly processed. First, the information is recorded by doctors and nurses on audiotape, on paper, or on computer. It is then transcribed into reports, numerically coded according to an established system, cross-indexed for easy access, organized, and stored where it can be quickly retrieved as needed. If you are working in a small facility, you may be performing all of these tasks yourself. In a larger facility such as a hospital, it usually takes a team of half a dozen job titles to make it all work. And if the hospital is a research facility or a teaching hospital, there are even more specialists involved. There are a number of job titles within this field, but three are certified professionals: Medical Coding Specialists, Health Information Technicians, and Health Information Administrators. Coding specialists assign and post the correct numerical codes to records and are often responsible for reporting that information to insurance companies. Health information technicians organize and maintain medical records and are responsible for their accuracy and thoroughness. Health information administrators are in charge of medical records departments and supervise technicians and coding specialists.

Medical Transcriptionists Every time a doctor sees a patient, the physician makes an audiotape detailing the event. It is simply a verbal description of observations, diagnosis, treatment, and prognosis. The audiotapes must then be transcribed so the information can be easily accessed. Medical transcriptionists are trained to transcribe what they hear on doctors’ tapes using a transcribing machine and a computer. They must have a thorough working knowledge of medical terminology, including correct spelling of medical terms. The proper procedure and medical terminology can be learned through training programs that are available at community colleges, vocational schools and through correspondence courses. Most take about six to nine months. Medical transcriptionists work in hospitals. Others work for service bureaus that act as agency go-betweens. Many are self-employed, hiring out their services to a number of doctor’s offices that are too small to require full-time transcriptionists. If a medical transcriptionist doesn’t work in a hospital, chances are the work is done at home, usually exchanging files electronically.

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Healthcare is a vast subject; therefore, most medical transcriptionists usually specialize in a particular area of medicine such as acute care or oncology.

Medical Records Clerks Medical records clerks and health information technicians perform similar duties. The main difference is clerks are not as highly trained and are not certified. Therefore, they cannot do work that requires specialized knowledge. Medical records clerks work mostly in small settings such as doctors’ offices. They also work in clinics and hospitals, primarily in admissions and record departments. In large hospitals, clerks work under the supervision of health information administrators. In smaller settings, their supervisor is likely to be a highly experienced technician. Medical records clerks keep track of patients’ medical histories, charts, and hospital reports. They are responsible for making sure that all the information is correct and is easily accessible for use by doctors and nurses. Clerks also check each patient’s chart before the patient is discharged from the hospital, ensuring all the necessary information regarding treatment has been included. This is important not only for insurance purposes, but also in case the patient needs to return for further treatment. In some cases, clerks collect statistical information such as the types of diseases being treated in the hospital where they work. The information gathered is used primarily for research.

Tumor Registrars Tumor registrars are medical records specialists who compile and maintain records of cancer patients. Their job is to identify, compile and analyze patient data and provide information to doctors and other medical staff for use in cancer management. Some tumor registrars work for cancer research facilities. Tumor registrars review cancer patient health records, then summarize and code data such as demographics, history and progression of the disease, diagnostic methods, and treatments. Often, they deal directly with patients and their families for the purpose of gathering as much information as possible. Under the guidance of physicians, they evaluate and record follow-up information about the quality of life and length of survival.

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All information gathered is presented in statistical, graphic, and text reports that are maintained in the registry.

Medical Coders Medical coding is at the heart of health information management. Anyone working in this field must have a working knowledge of medical coding systems. Those who specialize in this task are experts who have received special training and passed a written exam. They are Certified Coding Specialists (CCS), and they generally work in the hospital setting. Medical coders analyze the medical records of discharged patients, and then classify medical data into numerical categories. Each bit of data has a numerical code assigned to it, representing each step in a patient’s treatment from diagnosis to lab tests to pharmaceuticals and surgeries. The result is a comprehensive medical database. The codes are used to compare and track diseases, for clinical research, market data, insurance payment, and statistical reporting of all kinds. This is very precise work. It requires alertness, good vision, manual dexterity, keyboarding skills, problem solving, analytical skills, written and verbal communication skills, and above all, the ability to work well under pressure. Mistakes are not tolerated. Any code entered erroneously could cost the hospital thousands of dollars or worse – jeopardize the proper treatment of a patient. There is an official classification system that coders must follow to ensure compliance with federal regulation and insurance requirements. In order to properly classify data, they must have expertise in the primary coding systems along with a working knowledge of medical terminology, diseases, therapies, and pharmacology. There are thousands of codes. And although experienced coders have memorized the most commonly used codes, they do rely heavily on handbooks and databases. Using a computer, the first step in the coding process is to assign the patient to a DRG – Diagnosis Related Groupings. There are several hundred possibilities, but it’s important that the coder make the right choice. It’s the DRG that determines the amount the insurance company will pay to cover treatment. Medicare and most large insurance companies use the DRG system, but unless the coder is working exclusively in billing, they’ll be working with other systems as 13

well. The other main coding systems are the International Classification of Disease System (ICD) used for statistical reporting, and Current Procedural Terminology (CPT) for describing treatments. There are now over 9,000 codes within the CPT system alone. Not all medical coders work in hospitals. There is a special designation for those who work in physician-based settings such as doctors’ offices, group practices, clinics, and specialty treatment centers. This medical coder is a Certified Coding Specialist-Physician-based (CCS-P). A physician-based coder must have particular expertise of the ICD and CPT coding systems and be highly skilled in documentation, data management, and information quality control.

Health Information Technicians Health information technicians (HITs) form the backbone of the health information management system. There are several duty positions in the system, and HITs not only possess the skills to perform each one, in many cases the same employee will do them all. On a typical workday, a health information technician might: Enter data onto computers Review records for completeness and correct code data Abstract records and write summary reports Cross-index medical information Compile statistics for insurance reports Analyze records for quality and cost control Prepare graphic presentations. In a hospital setting, health information technicians check patient charts before discharge. Every detail about the patient’s stay must be properly documented for the hospital to be reimbursed by insurance companies and to continue the patient’s care in the future. HITs must be proficient at medical coding. Medical code is like a special language of health information managers. Coding consists of assigning predetermined numerical values to the various pieces of information in medical records. It’s designed to make it easier to use the information in the files. It also makes it much easier to cross-index the files – a big part of the technician’s job. Cross-indexing allows anyone handling the records to access the particular information they need in a number of ways. For instance, information on the use of a particular medication could be found under the name of the patient, 14

the name of the illness, the pharmaceutical name, or under any of the names of the attending physicians. Health information technicians deal with data in a variety of forms including on paper, on audiotapes, and in computers. HITs almost always use computer software programs to store and maintain that data. The software helps them quickly and efficiently tabulate and analyze information so it can be used to improve patient care and control costs. Most health information technicians work in hospitals, but anywhere that health information or patient data is being created, there are HITs working there. Just a few examples are doctors’ offices, nursing homes, home health agencies, mental health facilities, and public health agencies. They also work for employers who do not provide patient care. HITs have a unique understanding of the health information process including how to interpret it and how to keep it secure. Experienced health information technicians will find that their special knowledge is valuable to employers such as pharmaceutical companies, law firms, insurance companies, software companies, consulting firms, and medical product vendors. The actual job description of a health information technician can vary a lot depending on the size of the facility. In small facilities, the HIT may perform all aspects of health information management. In a medium facility, duties may include managing the medical records department. In large settings, there may be a number of technicians on staff with each one specializing in one particular aspect of health information. In large hospitals, health information technicians often serve as assistants to health information administrators. In this capacity, their responsibilities include overseeing some or all of the day-to-day functions of their department. They often supervise other health information employees within their department, such as medical records clerks, medical transcriptionists, and coding specialists. They also are called upon to perform the more demanding technical functions that medical records clerks aren’t qualified to do.

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Technicians may be asked to help administrators collect specific data for research or statistical reports. In some cases, they manage special departments such as tumor registries. Like health information administrators, they may be called upon to testify in court, utilizing their knowledge and expertise to translate medical records. Most health information technicians choose to advance by moving into management positions. In many cases, especially when working in a small community hospital or clinic, experience alone may qualify an HIT for a management position. But to be promoted to health information administrator in a large hospital, the HIT must hold a bachelor’s degree and pass the certification exam administered by the American Health Information Management Association.

Health Information Administrators Health information administrators perform many of the same functions as health information technicians. In fact, they are required to have spent a number of years in that position, gaining knowledge and experience. Like HITs, they manage, analyze, and distribute patients’ medical records and make sure they are accessible to healthcare providers when needed. But health information administrators take on much greater responsibilities, as well. The health information administrator is an administrator as well as an expert technician. They plan, develop, and coordinate entire systems for managing health information. The health information systems they set up must meet numerous medical, administrative, ethical and legal requirements. An HIA typically acts as a hospital’s medical records department executive manager. In that capacity, the HIA sets health information policies, plans budgets and allocates resources, and consults with others on the medical staff and ancillary committees. Because there is no part of healthcare that can operate effectively without quality health information, HIAs interact with all departments – clinical, financial, administrative – on a daily basis. It is the HIA who is ultimately responsible for quality assurance throughout the organization. The HIA’s primary focus is to train, supervise, and evaluate health information employees within the department. They also work closely with other staff administrators, advising them on procedures for handling medical records in a way that will ensure compliance with state and federal regulations. 16

In addition to being experts in the care and handling of medical records, HIAs must be well versed in the legal aspects of managing such information. Health information is confidential and highly sensitive. Information security has become a serious issue among consumers. It’s the administrator’s job to decide when, where, and to whom medical information will be released. They might even have to defend their information management practices in court. HIAs often become more involved in research and other special studies and are called upon to assist in those studies because of their experience in analyzing medical data. They oversee the collection and management of medical data that documents certain types of conditions and treatments. They may also collect census data for statistical reports on diseases treated, surgeries performed, and the use of hospital beds. Most HIAs work in hospitals or other large healthcare facilities, such as group practices, nursing homes, home health agencies, HMOs, PPOs, mental health facilities, quality review agencies, and public health agencies. Some choose to work as independent consultants, offering their services to skilled nursing facilities and other small medical providers that do not need full-time administrators. HIAs with graduate degrees in business or health administration find numerous opportunities to work for accounting firms, insurance companies, or computer service bureaus that specialize in health information systems. HIAs who hold doctoral degrees sometimes choose to advance their careers by teaching health information technology in colleges.

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HEALTH INFORMATION PROFESSIONALS TELL ABOUT THEIR CAREERS I Manage Medical Records for a Cancer Treatment Center “I’ve always been interested in medicine and there was no question that I’d have a career in healthcare. I thought seriously about getting involved in some sort of hands-on profession and looked into the possibility of becoming a nurse or EMT, something like that. What I wasn’t so sure about was the stress involved in those jobs. I’m very sensitive to people’s needs and although I want to help, I was afraid I’d be too overwhelmed with emotion to do my best under pressure. Fortunately, I learned about medical records management. When I was in college, I came home on break and ran into my cousin whom I hadn’t seen for at least a year. She told me about her new job and she was very excited. I didn’t know anything about medical records management. I don’t think I’d even heard of it, but when she told me about it, right away it seemed like the perfect fit for me. That was over 20 years ago. I’ve enjoyed two decades of working in a job that has provided me with financial stability as well as personal satisfaction. It’s been a very rewarding career. I think one of the best aspects of this career is that there is such a broad scope of opportunities available. I started out working in a clinic. As a way to advance in my career, I made a lateral move to a nursing home, though I didn’t stay there very long. I personally found it a little depressing. Eventually I found my favorite situation, which is the cancer treatment facility where I still work today. I find this job particularly fascinating because they do research here and I get to be a part of cutting-edge medical work. Anywhere medicine is practiced, there is a need for people like me. Every step of the medical process has to be documented, analyzed and interpreted in order for patients to receive the best possible healthcare.

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I spend my days in a bright, modern office that I share with three others doing essentially the same work. Even though I spend most of my days with my nose to the computer monitor, I feel comforted by the camaraderie. We’re a team. We often socialize, going out to lunch together and sometimes getting together on weekends. I enjoy that feeling of being a part of something. I know that it’s a small part that I play, but I really feel that it’s an important one. Even the most highly trained doctors rely on me to do my job well. In order for them to provide proper diagnosis and treatment to their patients, I have to manage their patient’s information with utter accuracy and efficiency. I keep track of every tiny detail, making sure everything is coded properly and cross-indexed in every possible way. This is one job where it pays to be a perfectionist! Medical records management is a good choice for anyone who is interested in some sort of career in healthcare, but is more suited to the administrative side of the industry. It’s particularly good for someone who enjoys working with computers. And there’s always room for advancement if you’re ambitious. I’d highly recommend this career to anyone who wants to help people and work in a job where you can make a difference. If you have basic people skills and have an organized mind, you’ll always have plenty of opportunities to choose from no matter where you go.”

I Am a Hospital Health Information Administrator “It may sound silly, but I’m in this career because I loved St. Elsewhere. I grew up on that TV show and still can’t help watching any good hospital drama that comes on television. I admired the doctors, the nurses, even the orderlies. I wanted to be just like them. It all seemed so exciting, so important. Just one problem: I faint at the sight of blood – really. But lucky for me, that didn’t deter me from my desire to work in a hospital. It was my high school guidance counselor who told me to check out the possibilities in health information management. It seemed there was a whole lot of work to be done 19

in a hospital besides working directly with patients. I got the idea and ran with it. Of course, my counselor was right. There are massive amounts of information collected and maintained in hospital files. Not so much on paper anymore, but it’s all in there, in the computers. When a patient comes in, every single thing that happens to that patient is documented, coded, and analyzed. It’s a lot of work, and that means a lot of opportunity for someone like me. I got my associate’s degree in medical record technology from a state college and had no trouble getting a job in the medical records department of a hospital in my hometown. I started out coding and abstracting medical records. Because this was not a huge facility, I spent a good deal of time talking to medical staff and sometimes to patients about their records. That was nice because the job could be a little isolating. And I have to confess; sitting at a terminal in a cubicle could get tedious, too. I soon discovered that I had a knack for computers beyond data entry. With the backing of my employer, I was able to earn a bachelor’s degree in systems analysis. That was a big boost to my career. Although I stayed with my hometown hospital for several more years – partly out of loyalty and partly because I was very comfortable there – I eventually moved to a large university medical center in Chicago where I could fully utilize my education and experience. In my present position, I am responsible for implementing the hospital’s information management functions and strategies. The work is challenging and that’s great. It keeps me interested and I look forward to work every single day. I could have gone in a lot of different directions with my career; there are so many opportunities. I developed a particular interest in patient privacy issues, which led me to specializing in computer security. In addition to earning a very good living, I am rewarded with the sense that I am performing an important function within the system. I am fully immersed in the hospital setting that drew me to this career to begin with. It’s everything I thought it would be but so much more. It’s hard work for sure. But it’s work I love.” 20

PERSONAL QUALIFICATIONS NEEDED SUCCESSFUL HEALTH INFORMATION WORKERS ARE PEOPLE WHO ENJOY WORKING

in a progressive office environment. They possess a keen interest in medical and health matters and feel they are contributing to the well being of the public. To do well in this career, you should like working with data and be able to follow set procedures and routines right down to the minutest detail. To do the job correctly the first time requires active listening skills. This work involves a lot of reading and writing. Reading comprehension, particularly with attention to details, is important. So is the ability to gather and organize information and present it in clear written reports that others will be able to understand. This kind of work requires mental acuity and an analytical mind. You should naturally strive for accuracy and be able to concentrate for long periods of time. Most of your work will be done on computers so an interest in using computers and other office machines would be very helpful. Basic keyboarding skills are required along with the manual dexterity to perform keyboarding functions all day long. The constant reading of materials, both on paper and on computer monitors, makes good vision a necessity, particularly in the close-up range. You’ll be working within a structured environment. To succeed, you’ll need to be able to accept direction and work well with others. Getting along with co-workers and managers is important for job satisfaction and longevity. There’s no room for mavericks or independent thinkers in this career. This work requires a high level of maturity and trustworthiness. You’ll be dealing with information of a highly sensitive and private nature. You need to understand that and treat the records in your care with the utmost respect.

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ATTRACTIVE FEATURES THE ADVANTAGES OF WORKING IN THIS CAREER ARE CLEAR. FOR STARTERS, THE PAY

is good and so are the fringe benefits. There is plenty of opportunity for upward mobility. There are several ways you can advance in this career, whether it is into management or a specialized area. Or if you prefer, you can simply stay in whatever job position suits you best and watch your earnings grow as you receive pay raises each year. This is a very stable job, ideally suited for anyone who is concerned with long-term job security. Healthcare is one of the fastest growing industries in the US, and job opportunities abound. This career does not require a four-year college degree, so you can get started fairly quickly. You never have to be bored. There are many directions you can go with this career. If your present working situation doesn’t appeal to you, you can move into another. Wherever you go, you will enjoy good working conditions in nice, modern offices. Hours are predictable. Most medical records technicians work a regular 40-hour workweek. There is some part-time work available; usually in hospitals at night and on weekends. There are intrinsic rewards to this career, too. You’ll have the chance to work on challenging assignments, working independently and as part of a team, with access to the latest in technology and modern office equipment. You’ll also be providing a valuable service while working with others in a friendly non-competitive environment. You can expect supportive management that will stand behind you as you move through your career.

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UNATTRACTIVE FEATURES THIS IS A CONVENTIONAL CAREER WHERE YOU’LL BE EXPECTED TO BE PROPERLY

attired, keep a regular schedule, and follow instructions to the letter. It can be fast paced, even stressful at times. There can be a lot of pressure associated with efficiently running a vast and growing health information system that requires quick data retrieval on demand. There is little room for creativity. You’ll be dealing with data and details, not original ideas. This work follows very strict procedures and guidelines, and there is a clear line of authority to follow. If you don’t like being told what to do and how to do it, this is not the job for you. Technicians work at computers for long periods of time. Most medical environments have the latest in ergonomically designed furniture and equipment. But still there is risk of eyestrain, headaches, carpal tunnel syndrome, and back problems.

EDUCATION AND TRAINING STRICTLY SPEAKING, THERE ARE NO EDUCATIONAL REQUIREMENTS TO GET STARTED

in this career beyond a high school diploma or GED. With basic office skills, you are qualified to hire on as a medical record clerk and learn the basics of your new job with about one month of on-the-job training. This is a more common practice among doctors’ offices than large institutional employers. To get started this way, your chances will be much greater if you complete a course in medical transcription. There are courses available at most community colleges and there are excellent correspondence courses available that you can take in your spare time even before you graduate from high school. Some hospitals offer in-house training programs for medical record clerks who demonstrate exceptional aptitude. With two to five years of job experience and completion of the hospital’s training program, you could advance to health information technician without going to college. Many employers in the industry, however, do prefer health information workers with education credentials and many hospitals require it – especially for promotion to more responsible positions. There are three types of certification available: Registered Health Information Technicians (RHIT), Registered Health Information 23

Administrator (RHIA), and Credentialed Coding Specialist (CCS). The American Health Information Management Association (AHIMA) administers certification. Each type of certification has educational and/or training requirements. There are currently more than 200 accredited college programs in Health Information Administration (bachelor’s degree) or Health Information Technology (associate’s degree). A few programs also offer master’s degrees in Health Information Management, a degree that is required primarily for teaching.

Medical Record and Health Information Technicians To become a RHIT, you must pass a written examination offered by AHIMA. But in order to sit for the examination, you must first graduate from a two-year associate degree program accredited by the Committee on Allied Health Education and Accreditation, a division of the American Medical Association. There are no exceptions, and there is no substitute for the educational requirement. On-the-job training does not make you eligible to take the examination, no matter how extensive your knowledge, skill, or experience. Aspiring RHITs earn their degrees at community colleges or vocational/technical schools. There are also a few accredited independent study programs for those who need a nonresidential, correspondence course. Applicants will need a high school diploma or its equivalent, and preference is given to those who have taken courses in the sciences, computers, and business administration while in high school. Course work in medical record technology includes the biological sciences, medical terminology, anatomy and physiology, medical record science, business management, legal aspects of health information, data coding and abstraction, hospital procedures, database management, statistics, quality control, and computer data processing. In addition to classroom instruction, practical hospital experience is required for graduation. Upon graduation, you will be eligible to take the national accredited health information technician examination. It is only offered once a year. Successfully passing the written test entitles you to use the letters RHIT after your name. Those four letters can mean greater career opportunities and higher starting salaries.

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Medical Coders Coding specialists must have a high school diploma or GED certificate, but most coders also have at least an associate’s degree. Training is usually conducted on the job, but classes are offered at technical schools and community colleges, at coding education workshops and seminars, and coding within health information technology programs offered by AHIMA. There are one-year programs in medical coding available through community colleges, adult education, Regional Occupation Programs (ROP), and vocational schools. In addition to courses in medical terminology, anatomy and physiology, students gain a working knowledge of HCPC, ICD, and CPT codes. Upon completion, they are able to efficiently and correctly analyze medical records and then to assign and sequence numerical classification codes to diagnoses and procedures. There is also a 12-week course available. Upon completion, you can call yourself a professional coder and use the letters CPC after your name. While it is worthwhile for the entry-level coder, it does not carry the same weight as certification from the AHIMA. To earn recognized credentials, coding specialists must pass an examination administered by the AHIMA. Most coding specialists have a combination of experience and education before becoming certified. Certification for this specialty is considered voluntary. Upon successful completion of the examination, you can use the designation CCS after your name.

Health Information Administrator This credential, Registered Health Information Administrator (RHIA), is required by most hospitals to advance into managerial or supervisory roles in medical records departments. To earn the RHIA designation, you must earn a four-year bachelor’s degree and pass the AHIMA’s written examination. Health information administrators have proven that they can collect, interpret, and analyze patient data accurately and completely. But assuming a managerial position poses additional challenges and responsibilities. To prepare you to meet these challenges successfully, the undergraduate college education will teach you how to interact with all levels of a large medical organization including clinical, financial, and administrative. By the time you’re certified, you should be well prepared to make decisions based on patient data, incorporating your knowledge and experience throughout the day in a variety of operations. 25

EARNINGS EARNINGS FOR MEDICAL RECORDS and health information technicians are

very stable and quite competitive. There is some variation, however, that depends upon where you live, your level of experience, and where you work. You’ll find the highest salaries in the Northeast and the Southwest, in hospitals (rather than private medical practices), and in big cities. As a health information technician with an associate’s degree, you can expect to start out earning about $25,000 a year working in a hospital. With some experience, that starting salary average will rise to about $35,000 annually. In a large city hospital, salaries can go as high as $40,000 with a few years of experience. The average income is similar in private nursing and personal care facilities. Working directly for doctors in their offices or clinics lowers the average to just over $20,000. Choosing to work for the federal government would lower that income a bit more. Medical coders tend to earn the least in this field. On average, medical coding pays $20,000 to $25,000 a year. However, this is a job where getting certified really pays off. Certified Coding Specialists (CCS) with at least five years of proven experience can earn as much as $25 an hour. Naturally, working in a supervisory position pays more. For instance, Registered Health Information Administrators earn an average salary of over $50,000 a year. Recent graduates with a bachelor’s degree start in the $35,000 to $50,000 range. With a few years of experience, that upper end can go as high as $75,000. According to the American Health Information Management Association, education is key to earning higher salaries in this field. According to a recent survey of members earning $50,000 to $75,000, about seven percent have associate’s degrees, while over 20 percent have baccalaureate degrees. A whopping 40 percent in this income bracket hold master’s degrees. The same survey noted that as little as one to four years of experience can boost average earnings to well over $30,000. Ten years of experience can almost insure a leap into the $50,000 bracket. This field typically offers regular 40-hour work weeks with full benefits. Included in most benefit packages are paid vacations, holidays, sick leave, and employer-paid health insurance and pension plans. 26

OPPORTUNITIES IF YOU’RE LOOKING FOR JOB STABILITY, YOU COULDN’T ASK FOR A BETTER CAREER.

Health information technicians are part of one of the fastest growing occupations with many opportunities for diversification and advancement. There are several reasons why growth in this field is going to continue for years to come. First, there is a growing population who are living longer than ever. Particularly with so many elderly, more and more people will be using medical services. The more medical services used, the more data needs to be processed. There are daily advancements in medicine creating more tests, therapies, treatments, and procedures – all of which generate information that needs to be tracked. There is also a growing demand for documentation from insurance companies, government agencies, researchers, disease registries, and accrediting agencies. All of this is good news for health information workers. As the volume of medical information grows, more trained specialists will be needed to keep records up to date. This field is expected to grow twice as fast as all other occupations on average. Experts list health information technology among the top 20 fastest growing occupations in the US. Demand will be particularly strong for coding specialists. Opportunities should be excellent for those who have completed a formal training program, especially those who are certified. Newly trained workers, especially those willing to relocate, should easily find a job. More medical record technicians work in hospitals than any other setting and that will continue to be the case. But actual job growth will be faster in doctors’ offices, clinics, long term care facilities, and home health agencies. There are also opportunities with insurance companies, tabulating and analyzing health information. This career is great for ambitious people – those who are motivated to improve their income and their professional standing. Opportunities for advancement in this career are plentiful. If you have an eye for upward mobility, you can expect to work your way into a position that pays three times your starting salary. Experienced medical records and health information technicians usually advance in one of two ways – by specializing or promotion to management. 27

The two main areas of specialization are Medicare coding and tumor registry. There are also opportunities to specialize in research, collecting information from research facilities and analyzing the data. Management opportunities are most plentiful in large organizations, where you can aim for a supervisory position by working first as assistant administrator in the medical records department. From there you can move up to section supervisor, overseeing the work in a single section. In a smaller facility, with enough experience, you can advance to the position of health information director. To qualify as a medical records administrator in large hospitals you’ll need a bachelor’s degree in health information administration. Fortunately, with the demand for qualified workers so great, many hospitals encourage their technicians to continue their education by giving them time off from work to attend classes.

GETTING STARTED IF YOU CHOOSE TO START YOUR CAREER WITH FORMAL TRAINING, THE SCHOOL YOU

attend will have a placement office that can help you find your first job. There is a strong demand in this field, especially for certified workers. Major employers commonly notify schools of job openings in the hopes of finding properly trained and qualified applicants. Networking is a good way to find opportunities not advertised to the general public. Check with professional associations, and if you’re in school, be sure to ask your instructors for recommendations and help with job placement before graduation. Make a list of doctors, hospitals, clinics and medical centers in your area. Apply to them directly by sending a résumé, and follow up with a phone call, asking for an interview. Other places you can apply to directly include health research firms, insurance and accounting companies specializing in health information, and any government or private agency that deals with managing Medicare. Employment agencies and your state employment office are likely to have opportunities for you to check out. In most cities, there are job search firms that specialize in the health industry. Look for listings in your local newspaper help wanted ads and on the Internet. Just as there are job placement firms that specialize in health industry jobs, there are also Internet job search sites that specialize in this area. One of the best is AHIMA’s job bank, but it is available only to members. 28

ASSOCIATIONS n Medical Records Institute http://www.medrecinst.com/ n American Association for Medical Transcription http://www.aamt.org n American Academy of Professional Coders http://www.aapcnatl.org/ n American Health Information Management Association http://www.ahima.org n National Cancer Registrars Association http://www.ncra-usa.org/

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WEBSITES n AHIMA Job and Resume Bank http://www.ahimanet.org/JobBank/Login.cfm n The Health Information Management Supersite http://HIMinfo.com n Medical Records Briefing Newsletter www.hcmarketplace.com n Health Information Management Job Search http://www.hipjobs.net/ n Hospital Jobs Online http://hospitaljobsonline.com/ n Health Jobsite http://healthjobsite.com n Health Management Jobs http://healthmanagementjobs.com/ n Medical Records Jobs http://medicalrecordsjobs.com/ n Hospital Soup http://hospitalsoup.com/

COPYRIGHT 2007 Institute For Career Research CHICAGO CAREERS INTERNET DATABASE www.careers-internet.org

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