A Tale of Two Professions: Biomedical/Health Informatics and Health Information Management

The OHSU Biomedical and Health Informatics Program recently had a new track in its Graduate Certificate accredited by the Commission on the Accreditation of Health Informatics and Information Management (CAHIIM). This culminated a several-year effort to establish a track within the program devoted to health information management (HIM). It will allow those who complete the track to sit for the Registered Health Information Administration (RHIA) credential.

While we are very proud of this accomplishment, and our desire to integrate informatics and HIM, it has probably added more confusion to a field that is already bereft with misunderstandings about its name, scope, and many other things. Nonetheless, I believe that the positives vastly outweigh the negatives. Both fields started in a very different place, but are increasingly converging toward the same intellectual content and professional work. Both fields need to adapt if they wish to meet the agenda for health information technology in the 21st century health care system.

The informatics field began as an academic research discipline, housed mainly in medical schools. Most working in the field had doctoral degrees, either an MD or PhD, and sometimes both. Much of the early work was funded by federal research grants. The HIM field, on the other hand, has always been one of the "allied health" professions. Its education has been at the lower end of the higher education spectrum, with a great deal of programs in community colleges.

In recent years, however, the two fields have moved much closer. Informatics has had to adapt as its applications, mostly notably electronic health records, have become "mainstream," with the concomitant growing need for professionals who can lead and support their adoption in operational health care settings.

HIM has had to adapt as well. The skills associated with managing folders of paper and record rooms have become obsolete, requiring updating to focus on the other important aspects of HIM practice, such as compliance, legal issues, and use of coded data.

This naturally gives rise to the question of where one discipline ends and the other one begins. Or, in a more practical question being asked by students considering study at OHSU, who should pursue the HIM track and who should pursue the regular clinical informatics track?

This is unfortunately not a simple question to answer, which I am sure leads to some frustration among those considering education and/or careers in a program such as ours. Part of decision must rest on career goals and professional identity. Even though HIM work is expanding more broadly into areas historically covered by informatics, the reality is that most HIM professionals still focus somewhat narrowly on the health record. This is not a bad thing, as there are many important tasks for the electronic health record (EHR), and HIM professionals are highly skilled in leading those efforts. Certainly someone who wants their career to focus on classical HIM tasks in an electronic world ought to pursue the HIM track. Likewise, if one wishes to identify as an HIM professional, this track is essential.

For those with clinical and/or information technology (IT) backgrounds who want to pursue what is increasingly known as "clinical informatics," my recommendation would be to pursue the conventional informatics track. There is still plenty of opportunity to focus on EHRs, but general informatics also allows their broader application. Our program has seen a number of HIM professionals enroll and graduate in an attempt to broaden the breadth of their expertise. Of course, as informatics moves to add credentialing to its professionals, we may see a blurring or even a merging of credentials from the two fields.

One positive consequence of our new HIM track is that it provides expanded coursework in our larger informatics program. Indeed, many students in the conventional track have found these new HIM courses interesting and worthwhile. Another important value of having the track is letting the community know that our informatics program is "HIM-friendly."

Going forward, I see continued convergence of informatics and HIM. HIM shares the attributes to which I have ascribed in other writings to informatics, namely that we are focused more on information than technology, and that our work's main goal is to improve health, health care, and biomedical research.