Update for a Standard Occupational Classification (SOC) Code for Informatics: Likely to Happen But Needing Revision

For years, many in the informatics field have lamented our invisibility when it comes to US government labor statistics. As I and others have been writing for years, there is no Standard Occupational Classification (SOC) code for those who work professionally in informatics [1]. As the SOC is updated by the Bureau of Labor Statistics about once a decade, I was pleased to be appointed to a group led by the Office of National Coordinator for Health IT (ONC) to submit a proposed revision to the 2018 SOC to include a code for health informatics in July 2014.

Like many classifications, the SOC is organized hierarchically. Its hierarchy goes to a depth of four levels, with the levels called Major Group, Minor Group, Broad Group, and Detailed Occupation. The Major Group. Most healthcare occupations are in the Major Group 29-0000, which is subdivided into three Minor Groups, which are in turn broken down into Broad Groups and Detailed Occupations for many health professionals from physicians to phlebotomists. In the last (2010) SOC, there was only one Broad Group and Detailed Occupation pertaining to health IT, namely 29-2070 Medical Records and Health Information Technicians, which mainly referred to those with the Registered Health Information Technologist (RHIT) certification from the health information management (HIM) field. The list below shows the three Minor Groups in the health professions and then more detail for the 29-2070/22-2071 code:
29-0000 Healthcare Practitioners and Technical Occupations
  29-1000 Health Diagnosing and Treating Practitioners
  29-2000 Health Technologists and Technicians
    29-2070 Medical Records and Health Information Technicians
      29-2071 Medical Records and Health Information Technicians
  29-9000 Other Healthcare Practitioners and Technical Occupations
Those from HIM with the Registered Health Information Administrator (RHIA) certification were among those included in the 11-9111 Medical and Health Services Managers category. (The Broad Group 11-0000 serves for Management Occupations.)

Earlier this year, the BLS released its first proposed revisions for the 2018 SOC for public comment. In particular, they released Docket Number 1-0148 -- Health Informatics Practitioners (Multiple), which included the following:
Multiple dockets requested new detailed occupations and improved coverage of occupations related to Health Information Technology such as Health Informatics Practitioners, Medical Records Specialists, and Medical Registrars. The SOCPC partially accepted these recommendations and proposed revising the title for 29-2071 Medical Records and Health Information Technicians to 29-2071 Medical Registrar and Records Specialists, adding Medical Bill Coder as an illustrative example, and adding "Includes medical coders" to the definition. The SOCPC also proposes a new broad and detailed occupations (29-9020 and 29-9021) for Health Information Technology, Health Information Management, and Health Informatics Specialists and Analysts. Finally, the SOCPC proposes adding illustrative examples to the existing 11-9111 Medical and Health Services Managers to include: Clinical Informatics Director, Health Information Services Manager, and Chief Medical Information Officer.

While I was pleased to see that our recommendation for the addition of a code for health informatics practitioners was accepted, myself and others were disappointed that the code lumped together three distinct groups who work professionally with IT in healthcare, namely health informatics, health information management, and health IT. A number of leading health IT organizations support the view that these are distinct. I was pleased to have the opportunities to work with my colleagues from the American Medical Informatics Association (AMIA) and a number of other organizations to draft a letter endorsing the view the there should be three Detailed Occupation codes for these three areas.

In particular, the letter led by AMIA advocates modification to the final 2018 SOC that will be released in 2017 that will split the new 29-9021 code into three new Detailed Occupations defined as follows:

• Health Informatics professionals: Design, develop, select, test, implement, and evaluate new or modified informatics solutions, data structures, and clinical decision support mechanisms to support patients, healthcare professionals, and improved usability of such systems for patient safety within healthcare contexts.
• HIM professionals: acquire, analyze, and protect digital and traditional medical information vital to the daily operations management of health information and electronic health records (EHRs).
• Health IT professionals: Apply knowledge of healthcare and information systems to assist in the design, development, and continued modification of computerized health care systems.

The letter also suggests that, SOCPC for 11-9111 Medical and Health Services Managers to include: Clinical Informatics Director, Health Information Services Manager, and Chief Medical Information Officer. We suggest the addition of “Chief Nursing Informatics Officer” to this list to add further clarity. Experience among our constituencies indicate a proliferation of senior executives and other management-level job titles within and across these distinct occupations, all of which need to be captured under this detailed code.

I agree with AMIA and others that the occupations of health informatics, health information management, and health IT are each important yet unique within healthcare. Having them represented in the SOC separately will hopefully allow further delineation of the contributions each makes to advancing the use of information and technology in healthcare.

References

1. Hersh, W (2010). The health information technology workforce: estimations of demands and a framework for requirements. Applied Clinical Informatics. 1: 197-212.