Flying Below the Radar

By Rachel Vilsack and Dru Frykberg 
December 2010

PDF of article

Health information management specialists might not be as visible as doctors and nurses, but their behind-the-scenes work is an important part of the medical field and offers plenty of career opportunities.

Chances are when you go in for a checkup, your doctor is looking at a computer screen rather than a clipboard to update your medical chart. Taking medical information from the printed page to digital records is a big job. In fact, there is an entire career pathway around the management of health information, including entering and coding data, maintaining computer software programs and protecting your private information. 

Unlike nurses and physicians, health information professionals work under the radar.

But what they do helps ensure providers get paid, patient records are accurate and safeguarded, the reputations of doctors and institutions are fairly presented, and health data are tracked to support medical research and funding.

Lisa Kampa, manager of health information services and privacy for Gillette Children’s Specialty Healthcare in St. Paul, admits her own mother, a nurse practitioner, doesn’t fully understand what her daughter does at work. And Kampa is concerned young people don’t realize the opportunities health information careers afford, especially as the federal government pushes the health care industry to digitize medical records.

Health information encompasses a wide range of job functions and settings, including medical records management, privacy, risk management, medical coding, corporate compliance, and data analysis and reporting. Health information professionals said they were attracted to the fast-paced health industry but didn’t necessarily want to work directly with patients. They also mentioned the work appeals to their sense of order and attention to detail.[1]

“It’s an amazing career, and it’s taking off with lots of opportunities in the field,” said Jodi Hermann, who has worked in coding for 29 years at HealthEast Care System in St. Paul.

Hermann has been the coding and compliance coordinator for 12 years after beginning her career as a clinical coder, working with outpatient records. She received a two-year medical records degree from Anoka-Ramsey Community College.

Medical records and health information technicians are responsible for compiling, processing and maintaining the medical resources consistent with administrative requirements of the health care system and for reporting patient information for health requirements and standards. There were about 3,700 medical records and health information technicians employed in Minnesota in 2009, with an average wage of $18.32 per hour. Most technicians are employed in the health services field at hospitals, clinics, nursing care facilities, outpatient care centers and home health care services. An associate degree is common for entry-level openings in this field, and many employers prefer to hire a credentialed technician.

Coders are important because they describe what services are provided so health care facilities can be reimbursed by insurance companies and Medicare. Codes are also the basis for statistics as well as doctor and institutional ratings and reviews. (Table 1 includes a list of typical tasks for medical records and health information technicians.)

“If facilities want to grow, they need to show through codes what services are being rendered,” Hermann said.

With increased use of medical records by health care systems, the projected employment growth in this field is excellent, especially for those with a strong understanding of technology and computer software. Hermann, who also teaches an introductory coding course at Century College, encourages students to research coding careers to make sure they know what they are getting into because the job isn’t just a way to work from home and it isn’t medical transcription. (Table 2 includes a list of key skills for medical records and health information technicians.)

Coding careers demand people who are driven, precise, adaptable and independent workers who can keep up with ever-changing Medicare regulations, coding systems and technologies. Coders have to understand medical terminology, procedures and diagnoses to tell the story using medical codes.

“You have to like putting puzzle pieces together,” Hermann said. “If you’re not adaptable to change, get out.”

Health information professionals can find work in venues outside of health care facilities. Some work for law firms, computer software developers and insurance companies. (Table 3 includes a list of industries that employ medical records and health information technicians.)

Ilene Estabrook, health information and coding manager for Sanford Medical Center in Thief River Falls, started out as a coder and now manages a staff of about 25, including medical secretaries, medical records clerks and coders. In December, she’ll receive a bachelor’s degree in organizational management from Ashford University in Clinton, Iowa, after first receiving an associate degree in health information technology from what’s now called Northland Community and Technical College.

Estabrook and her staff are coordinating the move to electronic medical records, purging and scanning old patient records that were on paper. “The driver for this is we are building a new hospital and we do not want to bring old records,” she said.

“You can’t get by and succeed without computer skills and the ability to work and adapt because paper [records] are going bye-bye,” she said, noting how the career has changed.

The career will continue to change, too. The American Recovery and Reinvestment Act (ARRA) of 2009 included a significant boost to the health care industry and its use of technology with the Health Information Technology for Economic and Clinical Health Act (HITECH). HITECH is aimed at expanding electronic health record technology so every U.S. citizen has an electronic health record by 2014. Clinics, hospitals and nursing homes that comply would be eligible to receive incentives through Medicare and Medicaid reimbursements. The act also created an Office of the National Coordinator to oversee health IT policies and standards.

The goal of increasing medical record usage is no small task. The National Center for Health Statistics estimates that only 41.5 percent of physicians used all or part of electronic medical records systems in 2008.[2]  To meet the demand for qualified and certified workers in health information management, money was allocated to educational institutions to expand training capabilities, attract new entrants to the field or enhance the skill set of existing health care workers. Four Minnesota colleges received grants to train workers to meet the demand starting in fall 2010.

Kampa found plenty of management opportunities pursuing a health information career.

She started her medical career as a medical transcriptionist, and while working for the former Chisago Lakes Medical Center in Wyoming, Minn., took notice of the role of the director of medical records. “I felt like I had found something I could go back to school for,” she said.

At age 42 and with three kids, Kampa said she wasn’t interested in going back to school but liked how the health information management degree programs were structured in increments and that she could attend school and continue to work. Kampa attended the then College of St. Catherine in St. Paul, earning a two-year associate degree in the health information specialist program.

Upon graduation, she landed a job as a chart room manager for Regions Hospital in St. Paul, where she managed a 50-member staff and was responsible for creating new patient records and delivering patient information to the emergency room. While at Regions, Kampa earned a bachelor’s in health information management from the College of St. Catherine.

Now that she’s at Gillette Children’s Specialty Healthcare—managing a 35-member staff and medical information and patient privacy issues—Kampa is pursuing a master’s in organizational leadership from St. Catherine University.

Health information practitioners said health information management education also provides a safety net because the coursework and work experience is good preparation for other medical jobs. As Kampa’s experience proves, there are many credentials people can pursue after they complete programs from accredited institutions. (Table 4 includes a list of the common health information technology credentials and accredited Minnesota schools.)

Kampa said she believes the demand for health information workers will not subside once the industry completely transitions to electronic health records. The desire to collect and track health information will continue to grow, she said, citing the expanding interest in specialized databases, such as trauma and cancer/tumor registries, that are developed to assist medical research.

Training in health information technology careers has accelerated in 2010, as four Minnesota post-secondary institutions received national grants to train workers in these fields. Normandale Community College in Bloomington is one of a group of Midwestern community colleges set to boost the skills of both new and incumbent workers in the integration of health record information systems. Over the next 18 months, an estimated 300 students will receive training for roles as practice workflow and information management redesign specialists, clinician and practitioner consultants, implementation support specialists and electronic health records trainers.

With an aging population projected to drive the demand for health care services in the coming years, it’s no surprise the health care industry will be one of the fastest-growing employment segments of Minnesota’s economy.

Meet DEED’s Health Care Industry Specialist   Susan Speetzen is DEED’s health care industry specialist. Speetzen is a statewide liaison between DEED and other agencies, health care providers, industry groups, educators and the WorkForce Center system. She is on the workforce advisory councils of the Minnesota Hospital Association, Aging Services of Minnesota and the International Institute of Minnesota and a member of the Minnesota State Colleges and Universities system Health Education and Industry Partnership (HEIP). We sat down with Speetzen to get her insights on trends in Minnesota’s health care industry and what employers are looking for in job candidates. What is the major trend(s) in health care that you see? Nurses are expected to work at the top of their scope of practice. Facilities are aware that it costs less to have nursing aides and LPNs do the work that requires less critical thinking and a lower level of skills, while assigning RNs the work that only they are licensed to do. The greatest need for nurses in the next decade will probably be in elder services, like skilled nursing facilities, home health and assisted living facilities. Acute care (hospitals) used to be where a nurse was expected to get his or her “real” experience, but more recently it seems that gerontological training and experience is being added to nurse education programs by schools that are keeping abreast of the changes. Community health appears to be another area that will see a greater demand for nurses. This would be connected to the trend to keep the elderly in their homes longer. It also looks as though the scope of practice of advanced practice nurses and physician assistants is being expanded so that they may be enabled to work a little more independently without lessening the quality of care that they have been allowed to do in the past. As we see a shortage of primary care doctors in rural areas, it appears these care providers will fill in some of the gaps. Occupational and physical therapy assistants are being utilized more because of the shortage of advanced degree professionals. They also offer employers a more economical alternative. With greater access to care coming through health care reform as well as changes in reimbursement rates, it’s more economical for a facility to hire fewer physical therapists with doctoral degrees and have them oversee one or two physical therapy assistants without reducing the quality of care. You talk to health care employers. What do they look for in a prospective employee? They are looking for a better match than they have in the past. Prior to the recession they were willing to give someone a chance even if they didn’t quite meet all the qualifications if they had all the required credentials, certifications and licenses. Now, given the greater pool of applicants, that’s less likely. They are able to find perfect matches. Of course, they still look for someone with a strong or stable job history.  When considering someone who has gone through a layoff, they also look at what the person has been doing during that time. If the applicant seemed to have a proactive, strong job search going, went back to school or did volunteer work during their time off, they are viewed as a better candidate than someone who wasn’t as active.  What is the best way for a job seeker or student to learn about health care careers? I recommend informational interviews whenever possible. Informational interviews are a great way to ask someone how they got interested in their career, what they like and dislike about their job. In addition, use a website like ISEEK (www.iseek.org) to learn more about careers.  Another online resource is the Health Careers Center at the University of Minnesota (www.healthcareers.umn.edu). This tool is for people at all levels and will help users take into consideration transferable skills, self-exploration, feasibility and the logistics of a health care career and training. It encompasses careers beyond those offered by the University of Minnesota.  ISEEK - www.iseek.org Health Careers Center, University of Minnesota - www.healthcareers.umn.edu

[1]Health Information Careers, www.hicareers.com .
[2]National Center for Health Statistics, www.cdc.gov/nchs/data/hestat/emr_ehr/emr_ehr.htm .

Top