Profile of select allied health professions health record

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					Health Human Resources Advisory Committee


            Next Steps Workshop



  Profile of Select Allied Health Professions:

         Health Record Professionals
(Health Record Technicians and Health Record
               Administrators)
                                     Table of Contents

BACKGROUND                                               3

PROFESSION KEY FEATURES                                  3
 Demand Factors                                          3
 Education Seats                                         4
 Entry to Practice                                       4


EDUCATION                                                5
 Entry to practice                                       5
 Practicum                                               5
 Supply of Instructors                                   6
 Career Advancement                                      6
 Other                                                   7


WORK ENVIRONMENT                                         7
 Roles and Responsibilities                              7
 Organizational Structure and Deployment                 7
 Working Conditions                                      8
 Workplace Issues                                        8
 Educational Support                                     8
 Salaries                                                8


RECRUITMENT                                              9

RETENTION                                                9




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                      HEALTH RECORD PROFESSIONALS
           (Health Record Technicians and Health Record Administrators)

BACKGROUND

Regulated: No

Union:    Health Record Technicians (HRTs)         - Health Employees Union (HEU)
          Health Record Administrators (HRAs)      - Health Science Association (HSA)
          Both                                     - B.C. Government Employees Union (BCGEU)

Professi onal Association: Health Record Association of British Columbia (HRABC)

Professional College: Canadian College of Health Record Administrators (CCHRA)

EDUCATION:
Institution                                      Douglas College
Length                                                2 years
Credential                             Health Information Services Diploma
Intake/year                          Intake of 30 students every second year
Fees                                            $4,000.00 (approx.)
Tuition and books
                1
Current supply :    359 Health Record Professionals
                    285 Active members


PROFESSION KEY FEATURES
Demand Factors

•   Employers in BC are indicating that they are having difficulties filling vacancies. In response,
    the Health Information Services Diploma Program conducted a survey within BC to ascertain
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    vacancies, at the request of their Program Advisory Committee. The survey provided evidence
    of a shortage of health record professionals in BC. As of March 1, 2001 there were 38
    vacancies (18 part-time/temporary and 20 full-time), and an estimated 35 positions will become
    vacant in the next 12 months (due to retirees and other anticipated vacancies). More recent
    informal survey data indicates the number of current vacancies for HRTs and HRAs total well
    over 50 positions provincially.
•   Many of the functions performed by health record professionals in hospitals fulfill requirements
    outlined in legislation. The Freedom of Information and Privacy Protection Act, for example,
    drives access to and disclosure of health information workload in a Health Records
    Department. The Hospital Act requires that hospitals report a discharge abstract on all
    hospitalized cases in the province, and this “coding and abstracting” activity, performed by
    Health Record Professionals, transforms health records into evaluative and policy-supporting
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    information . The Ministry of Health can apply sanctions to health authorities who do not
    comply with this reporting requirement.


1
  Health Record Association of BC, 2000 – 2001 Annual Report. Membership as of September 1,
2001. Membership in the HRABC is voluntary.
2
  There were 35 responses representing 42 sites. One hundred surveys were sent out, thus these
numbers are only reflective of approximately half the employers in BC.
3
  Letter CEOs from Dr. Alan Thomson, Executive Director, Information Support).


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•   The number of registries developed to track people with chronic conditions consuming
    significant amounts of health service continues to grow. The data collection and management
    of these registries is often performed by Health Record Administrators.
•   Regionalization and the transition from manual, paper-based systems to electronic health
    records has created more demand for people with a strong health record and record
    management background to participate in the planning ad implementation processes. While
    this is creating opportunities for experienced professionals (retention factors), it is increasing
    the drift away from the entry-level positions.
•   The increasing emphasis nationally, provincially, and regionally on performance measurement
    and monitoring as a key component of evidence based decision making and public
    accountability is, and will continue to be, one of the strong raison d’etres for the data collection
    and reporting function in health records (BC Government’s New Era Commitments).
•   Some rural areas in BC have no professional looking after health records. It is perceived that
    this is at least partially due to the shortage issue.
•   Douglas College is the only source of Health Record Administrator graduates in Western
    Canada (BC and Alberta).
•   The majority of health record professionals are women in their childbearing years.
•   At one time BC Cancer Agency had a difficult-t o-fill vacancy for a Health Record Technician,
    and eventually had to hire a non-health record professional. Among the respondents of a 2000
    Health Record Professionals employment needs national study conducted by the CHRA, 14%
    reported hiring a non-health record professional for a position which requires a qualified health
    record practitioner. More than half attributed this to the lack of qualified candidates.
•   The pool of health record professionals in BC is not large. It can be expected that the gaps
    between available positions and number of qualified applicants will widen in the future, as
    further demographic changes occur. Major changes to our health care system are creating
    career opportunities in the healthcare, insurance, high tech industry, and legal fields, in
    addition to provincial and federal governments. Health record professionals are one of the few
    professions trained to meet these new challenges. Without an adequate supply of qualified
    professionals to manage the health information of British Columbians, the quality, integrity and
    the timeliness of the information may be compromised.
•   As of the year 2000, the one-year Health Record Technician programs are no longer being
    recognized in Canada. The health record programs have been transitioned to one level of
    diploma graduate, the HRP (Health Record Practitioner). A diploma graduate may work as
    either a Health Record Technician (HRT) or a Health Record Administrator (HRA). HRTs are
    paid less than HRAs. HRTs are in greater demand and this demand will continue to increase
    as most diploma graduates opt for the higher paying class of record administrator.

Education Seats

•   The program at Douglas College has an intake of 30 students every second year. In order for
    the program to go back to an annual intake, a sustained waitlist for entry into the program as
    well as additional funding from the Ministry of Advanced Education (MAVED) would be
    required.

Entry to Practice

•   In order to prepare future health record professionals to work in an increasingly complex health
    care environment, the CHRA has been mandated to change the entry to practice requirement
    from a diploma in health records to a baccalaureate in health information management. The
    year 2010 is the target date at which time the CHRA expects to implement this change of entry
    requirement into the Canadian College of Health Record Administrators (CCHRA). This is
    being looked at quite vigorously at both national and provincial levels. This change is in
    keeping with the CHRA’s new professional role statement, which will require higher knowledge
    and skills that can be obtained in the current education structure. For example, database
    management, information analysis, research, information security, dissemination of



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    information, data quality, and more advanced skills in information technology. The reality today,
    however, is that the demand is for practitioners with entry level skills to the extent that CHRA is
    re-evaluating its mandate to change entry to practice at the degree level.

EDUCATION

Douglas College is the only institution in BC that trains health record professionals responsible for
managing health information in a broad range of health-related services, facilities and agencies.
Their two-year diploma in Health Information Services (HIS) is recognized by the Canadian Health
Record Association (CHRA) at the Health Record Practitioner (HRP) level. The CHRA sets
standards whereby health record academic programs are evaluated for their suitability to prepare
students to meet the national standards for becoming certified health record/health information
professionals.

The program at Douglas College has an intake of 30 students every second year. The next intake
will be September 2002. This program combines aspects of business, health, computer science
and research in a unique records and information management program. Admission requires grade
12, submission of a written essay and personal resume, verification that the applicant toured a
health record/health information services department in a health care facility and attendance at a
group information session.

Graduates of the program are qualified to work as either Health Record Technicians or Health
Record Practitioners.

Entry to practice

A diploma from a recognized program in Health Record Administration or Health Information
Services is the current entry to practice route to the profession. Although not a requirement, it is
currently the norm for most hiring facilities to employ those that are full members of the Canadian
College of Health Record Administrators (CCHRA). To become a member of the CCHRA, one
must have graduated from a CHRA -recognized program and must successfully challenge the
national certification examination within five years of graduation. This exam is called the health
record practitioner (HRP) examination, and the fee to write this exam is approximately $300. The
examination is held in October following graduation. Successful HRP examination candidates will
achieve certificant, CCHRA(C) certification. National certification provides practitioners with
professional recognition and portability of credentials across Canada. This national certification is
also a prerequisite to membership in the CHRA.

Practicum

Practicum placements within the HIS program are provided in each semester of the program.
There is a one-week practicum in Semester I and a two-week coding extramural at the end of
Semester II. There is an additional two-week coding extramural at the end of Semester IV. This is
followed by an individual six-week senior practicum. The six-week practicum can be broken up to
different sites. Students are responsible for all travel and accommodation costs for the practicum
sessions and may be placed throughout the province.

It is mandatory for a student to have access to a lap top computer during the course of the program
as most of their course/practicum work is done through various health record software/hardware
programs. Also during semester 3 and 4, students go to Royal Columbian Hospital on a weekly
basis to code and must bring their laptop with them to work on.

Douglas College arranges pacticums for their students. One of the growing challenges for HIS
educators is providing adequate opportunities for supervised clinical placements for their students.




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Based on student desire there are not enough adequate placements available. The challenge for
educators relates to the volume and variety of clinical placements.

Supply of Instructors

Within the Douglas college program there are 1.75 regular FTE faculty. The program contracts out
some positions for the coding extramurals and practicums, and one core course. There are two
instructors teaching the HIS courses who also help with the programs administrative and
recruitment activities. There are no anticipated retirements in the near future.

Career Advancement

•   There are a number of career pathways depending on individual career goals and willingness
    to pursue further studies. A new HIS diploma graduate starting in the field could find a position
    as a Health Record Technician, a Health Record Administrator, or a Clinical Information
    Analyst. Typically, the majority of job opportunities available in the early years of a health
    record professional’s career are for coding and abstracting. Depending on the individual, they
    may then move onto data analysis-type positions, or they may be more interested in pursuing
    leadership positions where they become responsible for a functional area within the Health
    Record or Admitting Departments. Through continuing education and experience, some may
    advance to other positions such as in information system support and development, assisting
    with clinical research, teaching, consulting, and managing organization or regional business
    processes.

•   Professionals interested in research may take clinical research specialist courses and become
    a clinical research assistant.

•   Health Record Technicians that have graduated from a one-year program who are already
    working in the field may upgrade to the two-year diploma by direct entry into second year in the
    HIS program at Douglas.

•   Graduates from the two-year diploma program will soon have the opportunity to achieve a
    baccalaureate outcome in the field of Health Information Management. This would require two
    extra years of study. Degree completion builds upon the knowledge in skills acquired in the
    diploma program. The CHRA is currently working with four Canadian universities in the
    development and implementation of a baccalaureate degree program in Health Information
    Management. The University of Victoria has put forward a proposal to be included, but to date
    the proposal has not been accepted by the BC Government. Primary reasons include: 1)
    Health record professionals are in short supply across BC, and extending the training period
    would exacerbate the shortage; 2) Once individuals receive their diploma, if they feel they want
    additional education they can pursue it though the University of Victoria’s Health Information
    Science program; and 3) Given the nature of the work performed by health records
    professionals, the real need is in the area of continuing education, rather than a one-time
    baccalaureate bolus.

•   The skills gained as a health record professional are portable and can be applied in a variety of
    roles, including:

         Information Analyst                    Chief Information Officer
         Data Quality Manager                   Research Associate
         Documentation Coordinator              Director of Information Services
         Client Service Manager                 Consultant
         Patient Advocate                       Utilization Manager
         Project Manager                        Decision Support Analyst




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Other

•   The Canadian Healthcare Association offers a distance course in Health Information Services.
    This two-year Health Information Services (formerly Health Record Technician) program
    concentrates on the technical aspects of maintaining health records and health information.
    The program requires that applicants be employed in a health organization, have Grade 12 or
    equivalent education, and be proficient in typing. The program includes a three-month
    internship. Graduates of the Health Information Services program are eligible to write the
    Health Record Practitioner certification examination set by the Canadian College of Health
    Record Administrators. Approximate tuition and book fees are $2910.

•   Douglas College provides Continuing Education to assist health Information practitioners to
    maintain currency in their chosen field. A Health Data Classification Refresher Program is
    available as a self-paced, distance education program and is designed for HRTs/HRAs who
    wish to update or review their coding knowledge and skills to keep current with industry
    changes.

WORK ENVIRONMENT
Roles and Responsibilities

Health record professionals are vital members of the health care team and are involved in the
many aspects of health information systems. They perform the technical duties involved in the
collection, management, protection, storage and provision of health care data within their
respective health-related service or agency. The main functions involved in health record work are:
• Record management – insures that patient information in the health record is accurate,
     complete, and available to providers who deliver care. Involves retrieving records for ongoing
     patient care, and ensuring that security and confidentiality is maintained.
• Access to and Disclosure of Information - responds to requests for patient information in
     health records, applying the requirements of legislation, such as the Freedom of Information
     and Privacy Protection Act, the Mental Health Act, etc.
• Data management – includes developing and using standard data definitions and standards to
     enable the collection of high quality health information. Most often includes the collection,
     classification (coding), submission, correction, retrieval, and presentation of clinical and
     administrative data to support decision-making.

Health record professionals work closely with all departments of the health service or facility and
with other health care professionals. They are responsible for maintaining the flow of information
and reports to and from other departments and health services.

The information involved in health record work is used to support critical decision-making in a wide
variety of practice settings with regard to patient care, health service management and resource
allocation.

Organizational Structure and Deployment

Health record professionals work in a variety of settings across the health industry such as acute,
specialized and long-term hospitals, community health centres, and provincial or federal health
care agencies, as well as the health care research field. A number of health record professionals
have gone on to careers in the information technology sector. Pharmaceutical companies also hire
HRA’s with data analysis skills.

Most health record professionals are generally employed in health record departments in acute
care facilities where they are organized and deployed under their respective unions. The facility




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follows the guidelines of their Collective Agreement as it outlines the wage reimbursement for
responsibilities, supervisory duties, shift differential, etc. within the hospital setting.

Working Conditions

Health record professionals generally work a standard work week (36-hour week). Where health
record departments are open longer hours, they may be required to work shifts.

A significant part of the day is spent working at a computer, which may pose some ergonomic
problems. Because this group of people tend to do much of its work in front of computer terminals,
there is a risk for repetitive strain injury and eye strain.

At times Health record professionals may carry heavy workloads and may often find themselves
struggling to keep up in a timely matter, all while paying close attention to detail. Because mistakes
could have a negative effect on patient care or hospital funding, there is considerable pressure to
be accurate as well as efficient. As a support service, Health Records must often try to absorb
workload created through changes made in other parts of the system.

Workplace Issues

Apart from ergonomic issues, health record professionals are faced with an increasing use of
technology on a daily basis.

Educational Support

Public funded institutions support continuing education activities through teleconferences,
reimbursement of correspondence program fees, as well as sponsoring attendance at provincial,
national and international workshops.

The 2001 Survey conducted by the Health Information Services Diploma Program at Douglas
College found various responses in each facility in regards to each facility’s willingness to support
the progression of their HRTs to the HRP level. Of the 35 responding facilities, only eight facilities
definitely would be willing to support the progression, while five probably would not, and 16 would
perhaps consider it. Six facilities did not give a response.

Salaries

HSA, HEU and BCGEU are the bargaining units for public sector BC health record professionals.
Health Record Administrators working in acute care facilities have their salaries negotiated
between HEABC and the Paramedical Professional Association of Unions. Health Record
Administrators enter as the lowest paid profession in the HSA bargaining unit. Based on the 2001-
2004 HEABC/Paramedical Professional Bargaining Association Wage Schedule, a grade 1 Health
Record Administrator who is in grid 5 receives between $21.18 - $26.41 per hour, depending on
year of service. Grade 6 Health Record Administrators, are in grid 12 at $27.38 – $34.15 per hour.

Health Employees’ Union (HEU) is the bargaining unit for public sector BC Medical Record
Technicians. Based on the 2001-2004 HEABC/Facilities Subsector Collective Agreement Wage
Schedule the starting salary of a medical records technician is $20.19 per hour. After 12 months
the wage increases to $20.65 per hour.

Health record professionals can also be represented by the B.C. Government Employees Union
(BCGEU). According to the collective agreement the starting salary for a Medical Records
Technician is $19.5801 per hour.




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In the public sector, employers contribute 100% to health and welfare benefits (Basic Medical,
Extended Medical, Dental Plan, LTD, and Group Life). BC is the only province in Canada that
offers all health and welfare benefits at 100%.

RECRUITMENT

There are three ways the profession recruits people into the field: 1) Douglas College recruits
students for seats in their HIS program, 2) the professional associations market the profession, and
3) the employer advertises the employment positions.

The faculty of the Douglas College program attends open houses at various High Schools in the
Lower Mainland. They take the opportunity to attend career fairs such as the Vancouver Sun
Career Expo, hold program Information Sessions at the College. Public funded health care facilities
recruit through various forms of multi-media advertising (CHRA website, HEABC website, CHRA
voice mail system, CHRA Quarterly publication, the Health Information Listserve). Most employers
prefer to hire experienced people as they take shorter time to train. It is felt that industry needs to
take a more pro-active roll in marketing the profession.

There is a general sense that the health record profession is a hidden career choice and students
are not aware of the opportunities in this area when they make their education choices after high
school. A significant proportion of students (80%) come into the program with some post-secondary
education. The majority are still female students.

RETENTION

It is generally perceived that the health record profession has a high retention rate, although the
actual retention rate is not known. It has been expressed that the retention rate is changing as
opportunities for HRA’s are taking them out of the health care environment into private sectors
where they are offered more perks, are able to negotiate wages and not be forced into a “quid
system”.




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