Medical Records and Health Information Technicians

• Employment is expected to grow much faster than average.
• Job prospects should be very good; technicians with a strong background in medical coding will be in particularly high demand.
• Entrants usually have an associate degree; courses include anatomy, physiology, medical terminology, statistics, and computer science.
• This is one of the few health occupations in which there is little or no direct contact with patients.

Every time a patient receives health care, a record is maintained of the observations, medical or surgical interventions, and treatment outcomes. This record includes information that the patient provides concerning his or her symptoms and medical history, the results of examinations, reports of x rays and laboratory tests, diagnoses, and treatment plans. Medical records and health information technicians organize and evaluate these records for completeness and accuracy.

Technicians assemble patients’ health information. They make sure that patients’ initial medical charts are complete, that all forms are completed and properly identified and signed, and that all necessary information is in the computer. They regularly communicate with physicians and other health care professionals to clarify diagnoses or to obtain additional information.

Some medical records and health information technicians specialize in coding patients’ medical information for insurance purposes. Technicians who specialize in coding are called health information coders, medical record coders, coder/abstractors, or coding specialists. These technicians assign a code to each diagnosis and procedure. They consult classification manuals and also rely on their knowledge of disease processes. Technicians then use computer software to assign the patient to one of several hundred “diagnosis-related groups,” or DRGs. The DRG determines the amount for which the hospital will be reimbursed if the patient is covered by Medicare or other insurance programs using the DRG system. In addition to the DRG system, coders use other coding systems, such as those geared toward ambulatory settings or long-term care.

Some technicians also use computer programs to tabulate and analyze data to improve patient care, control costs, provide documentation for use in legal actions, respond to surveys, or use in research studies. For example, cancer (or tumor) registrars maintain facility, regional, and national databases of cancer patients. Registrars review patient records and pathology reports, assign codes for the diagnosis and treatment of different cancers and selected benign tumors. Registrars conduct annual followups on all patients in the registry to track their treatment, survival, and recovery. Physicians and public health organizations then use this information to calculate survivor rates and success rates of various types of treatment, locate geographic areas with high incidences of certain cancers, and identify potential participants for clinical drug trials. Cancer registry data also is used by public health officials to target areas for the allocation of resources to provide intervention and screening.

Medical records and health information technicians’ duties vary with the size of the facility where they work. In large to medium-sized facilities, technicians might specialize in one aspect of health information or might supervise health information clerks and transcriptionists while a medical records and health information administrator manages the department. In small facilities, a credentialed medical records and health information technician sometimes manages the department.

Medical records and health information technicians usually work a 40-hour week. Some overtime may be required. In hospitals—where health information departments often are open 24 hours a day, 7 days a week—technicians may work day, evening, and night shifts.

Medical records and health information technicians work in pleasant and comfortable offices. This is one of the few health occupations in which there is little or no direct contact with patients. Because accuracy is essential in their jobs, technicians must pay close attention to detail. Technicians who work at computer monitors for prolonged periods must guard against eyestrain and muscle pain.

Medical records and health information technicians entering the field usually have an associate degree from a community or junior college. In addition to general education, coursework includes medical terminology, anatomy and physiology, legal aspects of health information, coding and abstraction of data, statistics, database management, quality improvement methods, and computer science. Applicants can improve their chances of admission into a program by taking biology, chemistry, health, and computer science courses in high school.

Hospitals sometimes advance promising health information clerks to jobs as medical records and health information technicians, although this practice may be less common in the future. Advancement usually requires 2 to 4 years of job experience and completion of a hospital’s in-house training program.

Most employers prefer to hire Registered Health Information Technicians (RHIT), who must pass a written examination offered by the American Health Information Management Association (AHIMA). To take the examination, a person must graduate from a 2-year associate degree program accredited by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM). Technicians trained in non-CAHIIM-accredited programs or trained on the job are not eligible to take the examination. In 2005, CAHIIM accredited 184 programs for health information technicians.

Experienced medical records and health information technicians usually advance in one of two ways—by specializing or managing. Many senior technicians specialize in coding, particularly Medicare coding, or in cancer registry. Most coding and registry skills are learned on the job. Some schools offer certificates in coding as part of the associate degree program for health information technicians, although there are no formal degree programs in coding. For cancer registry, there were 11 formal 2-year certificate programs in 2005 approved by the National Cancer Registrars Association (NCRA). Some schools and employers offer intensive 1- to 2-week training programs in either coding or cancer registry. Once coders and registrars gain some on-the-job experience, many choose to become certified. Certifications in coding are available either from AHIMA or from the American Academy of Professional Coders. Certification in cancer registry is available from the NCRA.

In large medical records and health information departments, experienced technicians may advance to section supervisor, overseeing the work of the coding, correspondence, or discharge sections, for example. Senior technicians with RHIT credentials may become director or assistant director of a medical records and health information department in a small facility. However, in larger institutions, the director usually is an administrator with a bachelor’s degree in medical records and health information administration.

Medical records and health information technicians held about 159,000 jobs in 2004. About 2 out of 5 jobs were in hospitals. The rest were mostly in offices of physicians, nursing care facilities, outpatient care centers, and home health care services. Insurance firms that deal in health matters employ a small number of health information technicians to tabulate and analyze health information. Public health departments also hire technicians to supervise data collection from health care institutions and to assist in research.

Job prospects should be very good. Employment of medical records and health information technicians is expected to grow much faster than average for all occupations through 2014 because of rapid growth in the number of medical tests, treatments, and procedures that will be increasingly scrutinized by health insurance companies, regulators, courts, and consumers. Also, technicians will be needed to enter patient information into computer databases to comply with Federal legislation mandating the use of electronic patient records.

Although employment growth in hospitals will not keep pace with growth in other health care industries, many new jobs will, nevertheless, be created. The majority of new jobs is expected in offices of physicians as a result of increasing demand for detailed records, especially in large group practices. Rapid growth also is expected in home health care services, outpatient care centers, and nursing and residential care facilities. Additional job openings will result from the need to replace technicians who retire or leave the occupation permanently.

Technicians with a strong background in medical coding will be in particularly high demand. Changing government regulations and the growth of managed care have increased the amount of paperwork involved in filing insurance claims. Additionally, health care facilities are having difficulty attracting qualified workers, primarily because of the lack of both formal training programs and sufficient resources to provide on-the-job training for coders. Job opportunities may be especially good for coders employed through temporary help agencies or by professional services firms.

Some cancer registrars may have difficulty finding open positions in their geographic area because of a limited number of registrars employed by health care facilities and low job turnover. However, when a position does become vacant, qualified cancer registrars have excellent prospects because of the limited number of trained registrars available for employment.

Median annual earnings of medical records and health information technicians were $25,590 in 2004. The middle 50 percent earned between $20,650 and $32,990. The lowest 10 percent earned less than $17,720, and the highest 10 percent earned more than $41,760. Median annual earnings in the industries employing the largest numbers of medical records and health information technicians in 2004 were as follows:

Medical records and health information technicians need a strong clinical background to analyze the contents of medical records. Other workers who need knowledge of medical terminology, anatomy, and physiology but have little or no direct contact with patients include medical secretaries and medical transcriptionists.

Information on careers in medical records and health information technology, including a list of programs accredited by CAHIIM, is available from:

• American Health Information Management Association, 233 N. Michigan Ave., Suite 2150, Chicago, IL 60601-5800. Internet: http://www.ahima.org/

Information on training and certification for medical coders is available from:

• American Academy of Professional Coders, P.O. Box 45855, Salt Lake City, UT 84145-0855.

Information on a career as a cancer registrar is available from:

• National Cancer Registrars Association, 1340 Braddock Pl., #203, Alexandria, VA 22314. Internet: http://www.ncra-usa.org/

Source: Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2006-07 Edition