CHAPEL HILL -- National statistics show that a combination
of population growth and an increase in health-care visits to
hospitals, out-patient facilities and physician practices is
dramatically increasing the number of medical records that must
becoded and the amount of health-care information that must
be managed in health-care sites.
Yet little is known about the workforce largely responsible
for collecting, organizing, coding, reporting, securing and
analyzing health information. To provide insight into North
Carolina’s health information management workforce, the University
of North Carolina at Chapel Hill’s Cecil G. Sheps Center for
Health Services Research has released a new study.
"The Health Information Management Workforce in North
Carolina: Current Trends, Future Directions" seeks to predict
the short- to medium-term outlook for health information management
practitioners statewide, officials said. The report is sponsored
by the Council for Allied Health in North Carolina and the UNC-Chapel
Hill-based N.C. Area Health Education Centersprogram.
The health information management (HIM) workforce is not licensed
in North Carolina, nor are individuals required to hold a credential
from a certifying entity. Nearly 30 percent of hospital-based
health information management staff members in North Carolina
do not hold credentials related to the field from either the
American Health Information Management Association or the American
Academy of Professional Coders, the report said.
"The percentage of HIM staff without a credential in other
employment settings – physician practices for example – is likely
much higher," said Susan Dyson, report co-author and research
associate at the Sheps Center. Adequately cataloging the non-credentialed
HIM workforce was problematic because this workforce did not
show up in data received from AHIMA or AAPC, Dyson added.
Most hospital-based health information management vacancies
occur in coding positions, and anecdotal evidence of a shortage
of coders, technicians and administrators is abundant.
"Employers have utilized a combination of solutions to
deal with vacancies, specifically coding vacancies," said
Erin Fraher, report co-author and assistant director of the
Sheps Center. "Some have resorted to hiring contract coding
staff or uncertified individuals. Still other employers have
elected to train coding staff from within their organization."
The consequences for reimbursement, patient care and outcomes
from the use of unqualified or under-qualified coding staff
can be significant, Fraher added.
Also, the scope of health information management responsibilities
has changed tremendously during the last 50 years, the report
said. For example, before the increased use of technology, the
profession had been limited to medical record management. The
profession is now closely linked to information technology,
security and privacy issues.
The number of coding programs statewide has increased, yet
lack of a minimum standard for entrance into the coding profession
has resulted in programs of varying length and quality, the
report said. Yet the existing bachelor’s and associate’s degree
programs in health information management are operating at less
than full capacity and do not graduate all enrolled students.
While the current health information management workforce is
not representative of North Carolina’s population in terms of
racial-ethnic or gender ratios, recent enrollment patterns in
college and university health information management programs
offer optimism that the demographic makeup is changing, said
Dyson.
The Technical Panel on the Health Information Management Workforce,
a cooperative effort among health information
management employers, educators and practitioners, also issued
recommendations based on the information included in the report,
including:
- Increasing the marketing of the profession to clarify scope
of practice, and the skills, abilities and
responsibilities of the health information management workforce.
- Improving recruitment and retention efforts in health information
management university and college
programs.
- Defining minimum competencies, skills, knowledge and abilities
necessary for coding in different
employment settings, to alleviate existing discrepancies between
programs.
- Investigating the feasibility of establishing an entity
responsible for the registration of all health
information management practitioners, both credentialed and
non-credentialed.
Data came from a number of sources including certifying entities
such as the American Health Information Management Association
and the American Academy of Professional Coders; professional
associations such as the N.C. Health Information Management
Association; educational programs, including bachelor’s degree
programs from the 16-campus University of North Carolina and
associate’s degree programs from the N.C. Community College
System; a hospital health information management director survey;
and information supplied from literature, World Wide Web research
and interviews with key stakeholders.
The report was funded by a grant from The Duke Endowment. Fraher
oversaw the study. In addition to Dyson and Fraher, Laura M.
Smith served as a principal author.
For a copy of the full report, click on www.shepscenter.unc.edu/hp.
Sheps Center contact: Susan Dyson, (919) 966-7922
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