Medical records technicians are the health-care industry's best-kept secret, says Darrell King. He is the program director of the health information technology program at Vincennes University in Indiana.
King finds it disturbing that so many people do not understand the health information management field. "That is why there is a shortage of qualified job applications. People don't understand what an attractive career this is," he says. "It's a career for life."
The medical records profession interested him because it was in a health-care field, but it didn't require hands-on work with patients.
After graduating from a training program, King went to work as an assistant records technician at a hospital in Kentucky. Initially, his job did not pay well. It was the 1970s, and female-dominated jobs were typically poorly paid. "They were eager to attract men to the field because it would drive the wages up," he says.
The job gave King the opportunity to deal with all kinds of people working in the health-care field. After a few months, the director retired and King was offered the job.
"It was scary at the time," he recalls. "I knew what I was doing, but it was a different type of thing for me."
King hired new employees for his department and trained them personally. He discovered that he enjoyed teaching. In time, he was spending more time training than doing anything else.
"I had good staff and the department almost ran on its own," he says.
But after 12 years, the work was no longer challenging. King left the hospital and came to Vincennes University to begin teaching the profession to others. "I don't think I would change a thing," he says. "This has been a good career for me."
King explains that health information technologists play a critical role in the operation of a hospital or other health-care facility. Without proper records, hospitals cannot claim reimbursement from insurance companies and other funders.
"We are the hospital's lifeblood," he says.
Medical records technicians are trained to perform various functions. However, the two main functions are transcriptions and coding. Many people specialize in one or the other.
Coders assign codes to every disease, condition, treatment or test that is noted in a patient's chart. A coder might go through a patient's file and try to understand which codes to use.
There are approximately 50,000 codes to choose from. The coders have to understand biology and anatomy. They also have to understand the lingo that physicians and other health-care professionals use.
Suppose a patient had suffered a heart attack. Coders have to understand the details of the heart attack. They will have to code whether it is left ventricle, right ventricle or related to a valve. They determine whether there was a compilation of factors and if so, how it affected this and that.
Perhaps the coder notices that the patient had a complication or a pre-existing disease such as diabetes. This would affect the diagnosis. Therefore, the hospital might be able to bill the insurance companies for some extra funding because of the complication -- but only if it is coded properly.
It is a fast-paced atmosphere. The work never ends. When technicians come to work on Monday morning, they often find a collection of files that piled up over the weekend. This means they are already behind at the start of the workweek.
"There's no such thing as saying you finished your work so you can leave early on a Friday," says King.
Sometimes physicians and other health professionals do not complete their charts promptly. There might be 45 or 100 uncompleted charts. They could be worth millions of dollars in reimbursements to the hospital. Therefore, the hospital's administration wants the coder to hurry up so they can claim for reimbursement.
"Trying to get the doctors to come in and complete their charts can be stressful," adds King.
Transcribers listen to voice recordings and type the information into a medical record. They must be able to understand what the physician is saying in the dictation. They must recognize complex medical terms and know how to enter them correctly.
King adds that coders and transcriptionists spend most of their day working at a computer. However, some health information professionals specialize in other areas, such as legal aspects. People who do this type of work are more likely to be moving around, talking to lawyers and so on.
This is the best profession if you don't want to work with patients directly, says King. "You work in a clean environment, you're well thought of, you're in a high-tech environment, and you will be the last one to be laid off if there are cutbacks."
Laurie Kenward thinks it is a great career.
When she was in Grade 12, Kenward was interested in the health field, but she didn't want to be a nurse. Then a counselor directed her to take a one-year program studying medical records technology.
"I thought, 'If I don't like it, it's only one year.' But I did like it," she says.
After graduating, Kenward worked on a short-term project at a small hospital. The project involved implementing a new system of keeping records. "It was fun for a new grad. There was lots of interaction with staff people."
After that project ended, Kenward went to work as a coder at a hospital.
After a patient is discharged, the nursing unit sends the file to the health record department. It lands on the coder's desk. Coders like Kenward use an international classification system to assign a code number to all of the diseases, interventions and procedures that apply to a patient.
The database is used to generate reports that help physicians with research or help administration make decisions about health-care resources. "Data classification is one of the unique roles of our profession," adds Kenward.
Sometimes Kenward attended committee meetings with other members of the health-care team. However, most of her day was spent at the computer.
On a typical day, Kenward would go through the chart and pick out the pertinent information. She needed a good understanding of medical terminology as well as an understanding of the coding itself. "Coders need to have good attention to detail," she says. "The ability to decipher handwriting is also an asset."
Kenward also did work called "abstracting." Abstracting means taking demographic information from a chart and entering it in a computer. This could include information such as age, gender, location, length of stay in hospital, whether or not the patient was seen by a social worker, name of treating physician and so on.
Sometimes, reports in the file could be amusing. Kenward recalls a report written by a physician. It read, "Patient thinks he has hemorrhoids. He does."
After a year, Kenward moved to another hospital as director of medical records. This was a management position. Five years later, she moved into teaching.
Now, she is the coordinator of the health information services program at a college.
Kenward enjoys health records management because she likes being part of health care without being directly involved with patients. She also likes using technology. And she likes the interaction with other staff within a hospital setting.
The workload can be stressful. Productivity is a big issue. "Your desk is never clear," she says. "It's important to be able to produce and still maintain high quality."