UBC Faculty Research and Publications

Health record personnel in British Columbia Barer, Morris Lionel, 1951-; Ross, Susan E.; Brothers, Kent; Jansen, Sharon; McCashin, Brian; Stark, A. J. (Annette J.) Sep 30, 1982

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.. • • HEALTH RECORD PERSONNEL IN BRITISH COLUMBIA Report S:l3 The Division of Health Services Research and Development Office of the Coordinator of Health Sciences The John F. McCreary Health Sciences Centre The University of British Columbia Vancouver, British Columbia Prepared by: Morris L. Barer Susan E. Ross Kent Brothers Sharon Jansen Brian McCashin Annette J. Stark September, 1982 .. • HEAL TH MANPOWER RESEARCH UNIT C/O OFFICE OF THE COORDINATOR HEALTH SCIENCES CENTRE PHONE: (604) 228-4810 Mr. Chris Lovelace, Chai nnan, Health Manpower Working Group, Ministry of Health, 1515 Blanshard Street, Victoria, B.C. Dear Mr. Lovelace, 4th FLOOR l.R.C. BUILDING THE UNIVERSITY OF BRITISH COLUMBIA VANCOUVER, B.C., CANADA V6T IWS It gives me great pleasure to transmit to you and to the members of the Health Manpower Working Group, the final report from the Health Record Personnel Project. This report provides, we believe, the first comprehensive look at this profession in Canada, and certainly in B.C. The analyses raise a number of issues of importance to the personnel, to the Ministry of Health, and to the ministries responsible for higher education in this province. This report is one of a series examining the supply, distribution and requirements for health manpower and other health care resources in this province. We look forward with anticipation to receiving comments, suggestions and questions for further study. /slm Sincerely yours, ~ Morris L. Barer, Ph.D., Associate Director, Division of Health Services Research and Development. A Research Unit for the Health Manpower Working Group, Ministry of Health, British Columbia ... , ' r ,, .. • TABLE OF CONTENTS :· AbbreviatiOns List of Tables List of Figures I. . Introduction II • . Previous Research III. Methods IV. Results . . . A. Employer .Questionnaire B. Employee Questionnaires B~I With Formal Health Record :Training B.II With Formal Health Record Training - Job iii iv vii 1 4 6 13 13 32 33 Satisfaction 60 B.III Health Record Clerks/Medical Stenographers 70 c. Earlier Literature 78 V. Education - History, Issues and Opportunities 80 Current Educational Opportunities -·United States 82 Current Educational Opportunities - Rest of Canada 83 Education of Health Record Personnel in British Columbia 83 VI. Health Information Technology and Health Record Personnel Futures 86 VII. Summary and Policy Implications Summary of Questionnaire Responses Implications for Public Policy 95 95 99 Appendices -ii-TABLE OF CONTENTS (continued) A Criteria Used for Selecting Employers Within Agency Categories 102 B Questionnaire Sent to Employers of Health Record Personnel l 04 C Employee Questionnaires 113 D Regional Hospital Districts of B.C. - Map 130 E Full-time-equivalent Health Record Personnel in and outside Health Record Departments, by Employer Group by HMRU Region 132 F Educational Programs for Health Record Personnel -United States 138 Bibliography 154 .. r AMRA ART BCIT CAMRL CCHRA CRT EDP f.t.e. · HOT HEU HMRI HMRU HMWG HR HRA HRABC HRT ' HSA MRA MRL PAS RRA RRL UBC VDT VGH WCB -iii-ABBREVIATIONS American Medical Record Association Accredited Record Technician British Columbia Institute of Technology Canadian Association of Medical Record Librarians .Canada College of Health Record Administration Cathode Ray Tube Electronic Data Processing Full-Time-Equivalent Health Data Technologist Hospital Employees' Union Hospital Medical Records Institute Health Manpower Research Unit, UBC Health Manpower Working Group, B.C. Ministry of Health Health Record Heal th Record Admi ni"strator Health Record Association of British Columbia Health Record Technician Health Sciences Association of B.C. Medical Record Administrator .Medical Record Librarian Professional Activity Study Registered Record Administrator (U.S.) Registered Record Librarian University of British Columbia Video Display Terminal Vancouver General Hospital Workers' Compensation Board -iv-LIST OF TABLES Table l 2 3 4 5 6 7 8 9 Page Employer Mailing List by Broad Categories ............................. 8 Survey Response Rates by Employer Category .............. . ............. 17 Health Record Personnel (Full-time-equivalents) in and outside Health Record Departments by Employer Group ...•...•.................. 20 Distribution of Health Record Personnel (Full-time-equivalents} in and outside Health Record Departments, by Employer Group ........... 21 Distribution of Health Record Personnel by Job Classification ......... 22 Employer Category Distribution of Health Record Personnel by Job Classification •................•.................................. 23 Full-Time Equivalent Health Record Personnel in Health Record Departments, per 100 Beds by HMRU Region ... ; .......................... 25 Full-Time Equivalent Health Record Personnel Employed in Health Record Departments in the Hos pi ta l Sector ............................. 26 Use of Alternate Job Titles by Health Record Personnel Category . ............................................................. 28 10 Employment Functions and Tasks by Personnel Type ...................... 29 11 Respondent Comments on Training of Health Record Personnel ............ 31 12 Number of Vacancies for Health Record Personnel by Type of Vacancy . .............................................................. 31 13 Frequency of Reported Reasons for Difficulty in Recruiting, by Type of Health Record Personnel ........•.............................. 31 14 Health Record Trained Respondents Grouped by Age, Marital Status and Full-time/Part-time Employment Status ...................... 34 15 Respondents with Formal Health Record Training Classified by Current Work Status and by Qualification for Health Record-Related Employment ................................................ : .... 34 16 Current Employment Status of Health Record Trained Personnel ...•....... 36 17 Future Employment Plans of Health Record Trained Personnel not Currently Employed, Classified According to Their Qualification Status ......................... , ....................................... 36 18 Length of Time Since Last Health Record-Related Position Held by Currently Unemployed Health Record Trained Personnel, Classified According to Their Plans for Future Employment ............... 37 ' J ·' r • .. -v-Table 19 Highest Education Attained by Currently Employed Health Record Trained Respondents Classified According to their· Qualification Status ........•...........•..........•.......•...•..... 40 Highest Education Attatned by Health Record Trained Respon-dents Unemployed at Time of Survey, Classified According to their Qualification Status .......................................... 41 21 Highest Health Record-Related Education, by Current Work Status, for Respondents Employed in Health Records .................. 42 22 Highest Health Record-Related Education, by Qualification Status, fnr Currently Employed Health Record Trained · Respondents •..... ~ ................................................... 43 23 Educational Preparation by Highest Level of Health Record-Related Education .................................................... 43 24 Field of Specialization of Correspon.dence Courses Taken by Health Record Trained Respondents Classified According to Their Current Work Status ................................................ . 47 25 Frequency of Participation in Continuing Education/Professional ·Activities as Reported by all Health Record Trained Respondents ...... 47 26 Nature of the Continuing Education Program, and Frequency of Participation in Each Type of Program Taken in the Past Two Years by Health Record Trained Respondents, Classified According to Their Current Work Status ...•......................•.........•...... 48 27 Natu.re of Further Education Desired by Health Record Trained Responden~s Classified According to Their Qualification Status .....• 50 28 -Nature of Further Education Desired by Health Record Trained Respondents, Classified by Highest Health Record Education Attained ............................ ~ .............................. . 50 29 Total Length of Time Employed in the Health Record Field, Health Record Trained Respondents, Classified by Current Work Status and by Qualification Status ..... ; ................................... 52 30 Length of Time Employed by Current Employer, by Total Length of Ti me in the He'a Tth Re co rd Fie 1 d, as Reported by Hea 1 th Record Trained Respondents •..••......••. ~ ..... . .•..•..•....•.....••... •.... 54 31 ·Allocation of Work Time to Broad Task Categories, by Qualification Status ............. ~ ................................................. 57 32 Allocation of Work Time to Broad Task Categories, by Current Emp 1 oyment Status .............•..................................... 58 -vi-Table Page 33 Respondents to Job Satisfaction Questionnaire, Current Work Status by Qualification Status .....•...................•............. 61 34 Attitude Toward Current Position as Reported by Health Record Trained Respondents-., Clas.s-ifi-ed Acc0-rding to Current Wo.rk Status .............................................................. . 61 35 Future Intentions Re Health Record Employment ••..•.•................. 63 36 Plans to Leave Present Employer, But Remain in Health Record Field ............................................................... . 64 37 Reasons for Feeling That Current Health Record Position Will Not Provide Experience Required for Career Advancement in the Health Records Field, by Current Work Status and Attitude Toward Current Job .................................................. . 65 38 Number of Health Record Trained Respondents Reporting Diffi-culty in Securing Employment in the Health Record Field, and the Nature of the Difficulty for Types of Positions Sought as Reported by Respondents .............................................. 67 39 Clerk/Steno Health Record-Related Personnel: Age/Sex by Full-Time/Part-Time and Marital Status .................................... 71 40 Work Status, Qualifications, and Employment Title; Health Record Clerks and Medical Stenographers .............................. 72 41 Health Record Clerks/Medical Stenographers: Length of Time Employed in the Health Record Field .................................. 73 42 Highest Education Attained by Sample of Currently Employed Health Record Clerk/Medical Steno Personnel, Classified Ac-cording to Qualification and Work.Status. .............................. 73 43 Task/Function Profiles for Medical Stenographers and Health 'Record Cl er ks ......... , .............................................. 77 44 Locations, Institutions, Numbers of Graduates and Lengths of Programs Training Health Record Administrators in Canada, Outside B.C., 1981-2 ............................................... . 84 45 Locations, Institutions, Numbers of Graduates and Lengths of Programs Training Health Record Technicians in Canada, Outside B.C., 1981-2 ....................................................... . 85 46 Institutions, Programs and Enrolment for Medical Stenographers/ Health Record Clerk Programs ........................................ 87 ' -vii-LIST OF FIGURES Figure Page I Health Record Personnel Project 5 II Flow and Tasks Associated with a Hospital Inpatient Record 14 III Vancouver General Hospital, Chart of Services Following Processing of Records 15 IV Distribution of Health Record Trained Personnel by Years of Post-Secondary and Health Record - Related Education 38 v Allocation of Work Time to Broad Task Categories, By Qualification Status 57 VI Allocation of Work Time to Broad Task Categories, by Current Employment Status 58 -1-I. INTRODUCTION Background The i-nitiative fo~ a study ~ Health Reeo~ Personnel in Br""-itish Columbia can be traced to events surrounding the closure of Notre Dame University in 1977. 1 At the time, Notre Dame offered the only four year baccalaureate program for Health Record Administrators in the province. A feelina that the program could and should be transferred elsewhere rather than be abandoned led to an attempt to establish the program at The University of British Columbia (U.B.C.) After two years of considerable involvement by the Universities' Council, the Health . Record Association of B.C. (H.R.A.B.C.) and per.sons at U.B.C., in developing a potential program, it was rejected by its proposed sponsor, the U.B.C. Faculty of Medicine (U.C.B.C. (1976), U.B.C. (1977)). The U.B.C. rejection did not quell the interest in and discussion of health record personnel and their training opportunities. Since then, the Health Man-power Working Group (H.M.W.G.) has been asked to consider proposals from the University of Victoria to provide a four year baccalaureate program in Health Information Systems (now in place, with the first intake of students scheduled for September 1982), from the College of New Caledonia to provide a one year training program for Medical Record Technicians (or Certified Medical Record Clerks), and from the British Columbia Institute of Technology (B.C.I.T.) to provide a one year training program for Health Record Technicians. There have also been requests from individuals and groups (including the H.R.A.B.C.) to assess the general need for various types of health record personnel and to under-take a survey of personnel involved in health data management in B.C. Attempts by the Health Manpower Working Group to make specific decisions in response to these proposals and requests have heretofore been frustrated by the lack of cur-rent information on mix, numbers, job content, and future requirements for health record personnel. In addition, there seemed to be many divergent views regarding the future form of provincial health information systems. As a result, the H.M.W.G. requested the H.M.R.U. to undertake a study of health record personnel in B.C. and decided to delay college-based program-specific decisions pending completion of the study. 1 Brief elaboration on the history of the Notre Dame University program may be found in section V of this report. -2-Project Team Personnel directly involved in the project fall into two groups: the research team and the steering conmittee. The research team was comprised of Morris L. Barer, project manager and co-principal investigator; Susan E. _Ross, co-principal investigator; Sharon Jansen, responsible for data and information collection, coding and inputting; and Brian McCashin, systems analyst responsible for programming and statistical analyses. Annette J. Stark assisted with project conceptualization, question-naire design and policy issues, while Kent Brothers and Ned Glick provided statistical consultation. In addition, other staff members within the Division of Health Services Research and Development provided varied assistance and suggestions at numerous junctures, and Susan Moloney put up admirably with our acute case of revisionitis. The Health Manpower Research Unit, in consultation with the Health Manpower Working Group, determined that a Steering Committee would best provide the neces-sary mix of external expertise for this project. It was set up early in 1980, composed of representation from the Ministry of Health, employers and educators of health record personnel and health record employees. Composition of the steering committee (.which changed somewhat duri"ng the life of the project), .was as follows: Ministry of Health Ministry of Health Ministry of Health Ministry of Health Ministry of Health Ministry of Health Ministry of Health B.C. Health Association B.C.I.T. University of Victoria H.R.A.B.C. e.c.M.A. Long Tenn Care Health Surveillance Registry Data Processing Hospital Programs Vital Statistics Home Care Mental Health Terms of Reference - Health Record Personnel Project Mrs. Pat Davis Mrs. Helen Colls Or. Walter Dietiker Mr. Ray Goodacre Mr. Len Hole Ms. Diane Duston Ms. Bethi a Yuen (resigned-surrmer 1980) Mr. Charles Grierson Mrs. Betty Nelson Dr. R. N. Payne/ Prof. Denis Protti Ms. Laurie Smvth Dr. H. Stansfield l. To formulate a working definition of 'health records'. 2. To categorize and quantify those records in terms of source, frequency of production, content and current uses. • -3-Terms of Reference (continued) 3. To attempt to ascertain the future form and composition of health records in B.C . 4. To iden-tlfy and des-G-ri-be -Real th- r-ec-o-rd tasks , as be-1 ng tilose t-asks- req1:1i-ri ng manipulation or utilization of health records. 5. To identify those personnel currently undertaking health record tasks, as to their education, experience and current employment. 6. To ascertain from present and potential employers of health record personnel their current and future personnel needs, given alternative health informa-tion system futures. 7. To estimate optimal numbers and mix of health record personnel to satisfy B.C. 1s health records requirements over the next five years. 8. To make policy reconmendations regarding training programs, based on the analysis in the above sections. Terms of Reference - Steering Committee 1. To provide information and sources of information on, and to help identify: i. types of health system and patient data currently generated and utilized in the various service provision, administrative, and funding sectors of the health care delivery system in this pro-vince; ii. likely futures for health information systems in the province - structure and form, scope and proposed uses; iii. current and future health data needs of the sectors identified in ( i ) . 2. To assist in identifying: i. types and locations of personnel currently performing health data tasks; ii. specific descriptions of those tasks. 3. To ass·ist in formulating specific questions/areas relating to (1) and (2) which need to be addressed in this project and to advise as to methodology for best answering those questions. -4-Terms of Reference - Steering Committee (continued) 4. To advise on survey questionnaire content and form; to assist with interpretation of results where doing so requires field expertise; to. comment and provide suggestfons on preliminary drafts of the study report. Project Framework Development The Steering Co11111ittee met formally three times in early 1980, as part of the process of delineating a set of answerable questions for the project and clarifying definitional boundaries. A decision was made at the first meeting (March 1980) to limit the scope of study to 'patient' records (the traditional usage of health or medical records) since health-specific exper-tise 1s required for much of their processing. This meant excluding from examination in this project other health care system-related data such ~s non-heal th-record-related staffing, facilities, utilization and financial informa-tion. These areas were considered peripheral to a focus on health record personnel requirements, although the co11111ittee recognized that this focus might be restrictive in light of potential future health information technology of a highly integrated system-wide nature (see e.g., Ad Hoc Conmittee on Health Information (1979)). The second meeting of the Steering Conmittee (April 1980) served to identify types of health record data currently in use in the health sector, and establish the project terms of reference. The project framework (Figure I) was approved at the third meeting in June, 1980. At the same time, a protocol for committee review of questionnaires, mailing lists and personnel category definitions was approved, in order to eliminate the need for further meetings. In addition, both interim and final reports were circulated to the members of the Steering Committee for conments and suggestions for revisions. This re-port reflects the improving contribution of the committee. II. PREVIOUS RESEARCH The terms of reference of this project suggest four potential areas of attention in the literature -- health records, health record personnel, the implications of advances in technology on the first two, and educational pro-grammes/curricula. The third area (technology· and health information systems) receives attention in section VI of this report. Educational programs are considered in section V. Here our focus is primarily on past research directed at rationalizing the roles of and estimating requirements for, health record personnel. Figure I: Health Record Personnel Project Health Records-Definition I Employee Health Records I Ambulatory Patient I Health Records I Personnel Services of I Public/Private Sector ,11 Acute Care inpatient Aggregated Records ~ • re: government reporting + , (Vital Statistics. Hospital Programs • etc. ) I~ • ' "' Current & Potential Emp 1 oyers of Health Record Personnel J, Survey of Emp 1 oyers re: mix, numbers. require-ments 1 etc. ·~ Routine medical examination History. diagnostic relating to employment. on- records, assessments 1 · going assessment. counsel- prognosis. treatment, ling. follow-up follow-up !Health Record Tasks: ~ .. ' If Education/Experience Requirements for Health Record Personnel · ~ Survey of Employees re: tasks. educatioR, experience. etc. r I Institutional Patient I Health Record$ I Other Institution$1 Outpatient & inpatient Emergency t 11\ t ·~ •If Initial diagnosis. diag~osis test records (lab, radiology. sono-graphy. etc.). prescrib~d treat-ment services, diagnosis on dis-charge, length of stay. (for inpatient) Future Potential Health Infonnation System Impacts 'I Policy Reco11111endations and Conclusions re: ( i) educational progr~ms (ii) personnel requi reo1ents I U1 I -6-A large amount of literature, primarily of an instructional nature, describes the format, content, processing, and uses of health records in various settings (e.g. Huffman (1972), American Hospital Association (1972), Waters and Murphy (1979), Ontario (1978), Sullivan (1979)). Of more direct interest to this project is the literature relating to the validity of medical records in various settings (e.g. Romm & Putnam (1981), Tufo and Speidel (1971) 1 Corn (1980), Demlo et al. (.1978), Studney and Hakstian (1981)). This literature is pertinent on two counts. First, we found interest, expressed in various quarters, in an expanded future role for health record administrators -- this role would involve more extensive involvement in evaluation activities (,quality assurance, peer review, medical audit, program evaluation, etc.). The validity and reli-ability of records has the potential to make or break such activities, suggesting that health record personnel may be key actors in a wide variety of activities extending beyond the narrow confines of record generation. Much of this litera-ture questions the reliability of data abstracted from complete medical records, and Romm and Putnam (1981) even raise concerns about the 'completeness' of the information contained in complete records. The second area of relevance for this literature relates to the impact of .. medical information systems. The literature has served to raise flags regarding comprehensiveness, reliability and validity of records, and these are concerns which should be carried forward and examined in the context of new information systems. Such systems have the potential of rectifying many of these problems. They also have the potential of exacerbating them. The literature most directly pertinent to our focus is that relating specifically to health record personnel. It is comprised of two broad categories -- examinations of professional and educational advancement opportunities, and empirical descriptions of the health record sector in terms of size, mix and requirements (e.g. Davenport (1980), Von Kuster et al. (1976), Waters and Hanken (1977), Stumpfhauser (1976), Reding (1981), Johnson and Cave (.1979), Mattix (1980), Johnson (1981), Szabo (1980) and Bloomrosen (.1980)). Since a discussion of this literature requires some clarification of personnel categories, it is left to be considered in the context of our results in section IV. III. METHODS The collection of data on health record personnel was a complex undertaking because of the diversity of their employment settings and jpb classifications-. No existing roster of employers or employees was available since licensure/certifica-tion/membershi·p are not compulsory for any of the categories of personnel. This meant a three-stage process of data collection: i. establis.hment of an employer roster; ii. survey of employers to determine number and mix of personnel, as well as other information; iii. follow-up survey of employees, distributed with the assistance of employers. .. -7-Target Group of Potential Employers Due to the absence of any comprehensive registration list of health record personnel, successful contact with all agencies thought to employ such personnel was crucial to the success of the data gathering stages of the project. We were dependent upon the location/mix/numbers information provided by employers for establishing a 'roster' of employees by category. For this reason, considerable time and effort was spent in developing an employer mailing list and in follow-ing up both respondents and particularly non-respondents to ensure the informa-tion at hand was as reliable and comprehensive as possible. In a following sec-tion of this report we discuss the employer response rate and examine the implica-tions of non-response by employer category. Questionnaires were first sent to targeted employment settings in the fall of 1980 with second mailings to non-respondents in January 1981. In agencies where specific health record-related contacts were unknown, senior administrators were asked to direct the questionnaire to appropri"ate staff /departments. An overview of the employers targeted for participation in the health record personnel project is provided in Table l. The crjteria used for selec-ting specific employers within certain agency categories are detailed in Appendix A. Target Group of Employees Employer questionnaire responses provided relatively comprehensive informa-tion on the number of employed health record personnel, by type of personnel and location. This information represented the potential target list for the surveys of emeloyees. A number of steps were required in paring this to a workable tar-get list. First, consideration of absolute numbers and the cost/feasibility of a full survey versus sampling was required. Second, if sampling were thought neces-sary, it was clear that without a unique identification roster of personnel, cluster s-ampllng would be necessary (i.e. sampling of employers rather than emplo.yees} and an appropriate stratification would be required (Lansing and Morgan (1971)}. The procedure chosen involved three parts. All health record personnel who were formally trained in the health record area2 or were working in positions normally desi'gnated .for health record'-trained personnel were to be sent question-naires. This left the group of personnel designated as medical stenographers and health record clerks. The number of personnel involved in these two groups was too large to make a blanket survey feasible. In addition, it was felt that there would likely be.less variability in job specifications and education/experience background within these groups. In addition, many of these personnel spent less than a full working day on health record-related functions. Accordingly, a 2 This included accredited record technicians, health record technicians, health data technologists, health record analysts, medical record librarians and health record administrators. See below for definitions and descriptions. • -3-Table 1: Employer Mailing List by Broad Categories* Provincial Ministry of Health Professional and Institutional Services -(includes Medical Services Co11111ission, Medical Services Plan of B.C., large medical clintcs-; acute, l'ehab-., end -ex-t-ended care hosp1-t-als, diagnos-t-1.c and treatment centres-. outposts, private hospitals; Emergency Health Services Conmission; Medical Consulta-tion Division). C011111unity Health Services -(includes Vancouver Bureau, care services (and facilities), mental health institutions, perventive services, health district offices/services; Alcohol and Drug C011mission). Planning, Policy and Legislation, Vital Statistics, Health Promotion and Infonnation, Ministry Support Services. Other Provincial Government Ministries - relating to health service provision Ministry of Human Resources -(includes Family and Children's Services, Health Care Division, Phannacare, human resource and health centres). Ministry of Attorney General -(includes correctional institutions, coroner services). Ministry of Labour -(includes Workers' Compensation Board). Ministry of Universities, Science and Communications -(includes university health services and clinics). Ministry of Education -(includes health services at co11111unity colleges and educational institutions). Voluntary Associations - relating to health care Federal Government - relating to employee health or health provision (includes Health and Welfare Canada - regional health services, Veterans Services, Pension Services, Income Security Programs, Transport, Employment and Immigration, Solicitor General, R.C.M.P., National Defense). Private Sector - large companies that might offer employee health services (includes transportation/c011111Unication corporations, banks, department stores and industrial companies with 500 or more employees). Detailed mailing list available on request • .. -9-decision was taken to develop a sampling frame for health record clerks and medical stenographers. The final step involved surveying known members of the Health Record Association of B.C. (HRABC) and graduates of B.C.I.T.'s health data technology program as a cross-check and as a potential means of collecting information from a small number of health record personnel who were unemployed at the time. Each stage is described in more detail below. (i) health record trained employees all employers who provided information on health record-trained personnel were asked to distribute two questionnaires to each such employee.3 Because the numbers reported by employers were full-time-equivalents, extra questionnaires were made available to those employer contacts assisting with distribution, so as to ensure that all individuals working in the designated positions were given an opportunity to respond. The first .mailing was undertaken in April 1981. Where we received no responses from personnel associated with a given employer, a reminder note was sent to the employer late in May 1981. (ii) health record clerks and medical stenographers as the employer-reported size of the steno/clerk population was in excess of 1,200, a sampling strategy was followed. Without a roster of those personnel, a random sample was precluded. In-stead cluster sampling was employed for the hospital sector, where-in employers were stratified by size and location, and all stenos/ clerks within chosen employment settings received questionnaires (again distributed by their employers). The two major employment settings for stenos/clerks were hospitals and health units (provincial and municipal). On the advice of J. Turner. Clerical Consultant, Ministry of Health, five of the 22 health unit {_then health districts) areas were selected as being representative of health unit settings in B.C. in terms of size, location and 'type of program' criteria. The health units selected were South Okanagan, Upper Fraser Valley, Boundary, Upper Island and Northern Interior. The Workers' Compensation Board (W.C.B.) and Vancouver General Hospital (V.G.H.) were major employers of clerks/stenos in their own right. Because of their size as employers and a suspected wide internal functional variability, these institutions were isolated for special attention. The personnel who had responded to the original employer questionnaire were asked to distribute questionnaires to the 25% of stenos/clerks who, in their opinion, best represented a cross-section of the institution's steno/clerk population. Vancouver General Hospital cooperated fully. However, 3 The questionnaires are described in a subsequent section, and may be found in Appendix C. Briefly, one questionnaire covered personal identification and education/experience/employment information, while the focus of the other (which requested no personal information) was job satisfaction and potential employment mobility. -10-a W.C.B. policy of not distributing ques.tionnaires to employees unless they originated internally or were of potential use to the Board, undennined attempts to collect any information fran W.C.B. employees. The sampling procedure for the clerk/steno group employed within the (broadly defined4) hospital sector involved a stratification of hospitals in two dimensions -- size and region. These were felt to be the t>nly eharaeteristies likely to undE!'rly significant variability in task mix or experience/education mix among these categories of personnel. Size categories were: less than 100 beds, 100 - 400 beds, more than 400 beds. Health Manpower Research Unit regionsS were aggregated into tour cells: Greater Vancouver, Capital and Island Coast, North Central and Central and North, South-east and Okanagan and Fraser Valley. This yielded 12 cells, and 25% of the hospitals within each cell were selected randomly. For selected institutions, the employer-designate was asked to distribute questionnaires to all clerks/stenos. Finally, all other institutions or agencies which had reported employing clerk/stenos were asked to distribute questionnaires to those personnel. The clerk/steno questionnaires were mailed for distribution in early April 1981. Non-respondent employers were second-prompted in late May, 1981. SURVEY DESIGN Various sets of questionnaires ,were prepared by the H.M.R.U. staff and refined in consultation with the Steering Corrmittee. The result of this process was one questionnaire for employers of health record personnel, and three ques-tionnaires to be directed to various groups of employees. The employer question-naire forms Appendix B of this report. The employee questionnaires are contained in Appendix C. The questions asked in each questionnaire were determined in general by the guidelines laid out in the terms of reference for the project and more specifically by an information priority list developed for the project. The information requested in the employer survey included identification of the institu-tion or agency, health record-related activities of the agency, mix and number of currently employed health record personnel, on-the-job training offered or required by the agency, and current vacancies and projected future requirements for health record personnel. 5 The 'population' included all acute care, rehabilitation or extended care and psychiatric hospitals, with the exception of V.G.H., from whom we had received an employer response. See map in Appendix D. -11-As noted earlier, two of the three employee questionnaires were directed to health record positions normally requiring persons with specialized health record training. One of the two questionnaires solicited information which could be linked to specific personal identification (age/sex, etc.), while the second was fielded as a confidential questionnaire. The information requested in the fi·rst questionnaire included: personal identification, history of formal .education and on-the-j.ah training. c..antinuing education/professional activities. health record-related certification, interest in further education, current qualifications and employment status, history of employment in the health record field, current employment and mix of current employment tasks. The second (con-fidential) questionnaire linked respondent attitude to current position, future employment plans and general feelings about working in the health record-related field, to qualification/work status identification. Although the two question-naires were distributed together, separate return envelopes were provided to ensure confidentiality and encourage the completion of the second questionnaire. The third employee questionnaire was a shortened version of the first, designed specifically for persons employed as health record clerks or medical stenographers. In particular, the task mix question was much less detailed. Definitions and Personnel Categories Since health record personnel can be and are hired under a diverse range of job titles, the steering conmittee and H.M.R.U. project staff agreed that the following health record definition and personnel classifications would accom-pany the employer survey for clarification. 1. A Health Record has been defined for the purposes of this study as: 11 any set of data generated as a result of an encounter of a clearly identified individual with the health care delivery system; items include data pertaining to health status, his-tory, treatment and prognosis, and relevant socioeconomic and demographic characteristics" 2. Health Record Personnel: (a) Medical Stenographer (b) Health Record Clerk major responsibility is transcription of health records; skills usually include typing, dictaphone and some knowledge of medical terminology. usually responsible for filing, admissions and discharges. (c) Accredited Record Technician (d) Health ·Record Technician (e) Health Data Technologist (f) Health Record Analyst ( g) Hea 1th Record Administrator -12-a graduate of an approved technician train-ing program until 1973 (Canadian Association of Medical Record Librarians (C.A.M.R.L.) correspondence cours-e-, commun i ty -co 11 ege , or institute of technology with the exception of B.C.I.T.), who passed the C.A.M.R.L. accreditation exam for technicians. 'Associate• status with Canadian College of Health Record Administration (C.C.H.R.A.). a Post-1973 graduate of an approved techni-cian training program, except in B.C. (no C.A.M.R.L. accreditation exam in existence post-1973). 'Associate• status with C.C.H.R.A. graduate of the Health Data Technology (H.D.T.) program at B.C.I.T., prior to 1980. 1 Associate' C. C.H. R.A. status. usually employed as quality assurance officer. may be an 'Associate' or 1 Certificant 1 of the C.C.H.R.A. 1Certificant 1 of the C.C.H.R.A.; includes all graduates of B.C.I.T. 1 ~ H.D.T. program from 1980 on. formerly titled 'Medical Record Librarians'. In general, health record personnel were determined to be those people ·who are hired because of the existence of health records in their employment setting. This means that many handlers/users/recorders are excluded from the health record personnel category. This particularly applies to the health professionals such as physicians, nurses, psychiatrists, social workers, dietitians, etc. There is no question of their some-time-involvement with health records. It is equally clear that the vast majority of these personnel do not require, or possess, specialized health record training. -13-Site Visits To facilitate a working familiarity with the flow and handling of infor-mation through different cype.s of hospital medical record departments~ the p.r°"' ject staff undertook four site visits - to Delta· Hospital, Vancouver General Hospital, the Acute Care Unit of U.B.C.'s Health Sciences Centre Hospital, and Sunny Hill Hospital for Children. These visits revealed considerable commonality of function despite wide variation in size (number of records, number of personnel employed} and sophistication (technology vintage}. Figure II represents a schema of some of the more common information channels associated with hospital medi-. cal records for inpatients. Figure III reproduces a V.G.H •. schema representing external requests to that hospital's medical records department. IV. RESULTS A. Employer Questionnaire Response Rates Precise determination of response rates is hindered by the absence of a clearly delineated denominator. The original mailing list to (known and likely} employers of health record personnel was comprised of two sets of contacts total-ling 310 mailing addresses. The majority of these (287 employers} were considered to be contacts capable of answering the questionnaire on behalf of their agency. The remaining 23 were senior government administrators whose assistance was sought in distributing the questionnaires within their jurisdictions. We did not expect completed questionnaires directly from these 23 contacts, but were well aware that they might generate considerably more than 23 responses. As responses were received and related back to these 23 original contacts, the 310-element roster was expanded. In addition, within the set of 287 contacts were a ~umber of large agencies which were actually 'multiple employers' of health record personnel. These con-siderations, too, led to an expansion of the 310, and both phenomena resulted in a total list of 351. While recognizing that this may result in slightly upward biased response rates, we have adopted it as our denominator. This discussion serves to point out that where a survey instrument is not only being used to collect information but also to determine the sources of that information (because of the absence of a well-defined roster), response rates must be interpreted -with some caution. FIGURE II: FLOW AND TASKS ASSOCIATED WITH A HOSPITAL INPATIENT RECORD ---'M admi ss1on I I : patient 1 to ward pull record start new record --~ I I I I internal reporting, finance. administration. etc. Medical Record Department assembling quantitative analysis abstracting transcription I I I ___ ga_!i_!n!_ d!s~h~g_!:d _____ 1 I [l abOra i<>-;:;1 ,-nur5il19 repo!ii) physician reports-----I radiology I etc. ------~provincial goverrunent legal qualitative analysis staiistics quality assurance I __, ~ I Ii llli s:• ' Fjgure: III Abstracts • Group & life Insurance .JUNE:. l91Jr ~"'-~ p .C'\ ~ .• ·~ ~ 0 '). ... a v-'NcouvER GE:N£R"L HosPrt-'l CHART OF S£RVIC£s FOLLo .. ,IVG P11oc£ss1NG OF ll£co11os Birth Notices; Death Certificates I -(J'l I -16-The 351 mailings generated 286 direct or indirect 6 responses, for an overa 11 response rate of 81.5%. The 65 non-responding contacts may, of course, represent more than 65 potential employers. Of the 263 employers who answered directly on behalf of their agency, 216 indicated some involvement with health records. A deta1led breakdown of response rates by employer category is presented in Table 2. This allows us to examine the extent to which missing information (non-response) might affect survey results. The notes to that table provide detailed employer-group-specific convnents. Since the non-respondents are scattered fairly evenly throughout the dif-ferent employer categories, it is likely that the following information is re-presentative of the mix of the health record personnel in the province, although it should be recognized that the actual numbers are almost certainly a conserva-tive estimate. Scope of Health Record Activities As the crudest indicator of the scope of health record activity in the pro-vince employers were asked to designate their agencies as involved or not involved with health records/health data. Of the 216 employers who reported collecting; recording, analyzing or reporting health records (according to the project defini-tion), 17 did not hire special personnel for the task, 125 hired health record (HR) employees to work within a designated health record department, 85 hired HR employees but had no designated health record department, and 11 of the 125 hired HR employees for both health record and 'other' (non-health record) departments within their agency. The most frequently cited 'other' departments and associated staff were: laboratory (medical stenos), medical services (medical stenos), radiology (_medical stenos} and admitting (health record clerks). In many cases the respondents did not identify the 'other' department by name - this was partic-ularly true for the community health ·responses - and thus tnis set of information (.site of health record activities} should not be considered to be comprehensive. Current Staffing (a) Number by Type of Personnel 6 Information was requested regarding the type and number (in full-time-equivalents) of health record personnel currently employed by each agency and whether the personnel were attached to a formal health records depart-ment or some 'other' department. Indirect responses would have come via the 23 senior government administrators serving as internal distributors. • Table 2: Survey Response Rates by Employer Category Number of Employer Category Known Contacts 1. Provincial Ministry of Health (a) Large medical clinics 15 (b) Hospitals (by rated bed capacity) 129 (i) ~ 400 beds 11 (ii) 300-399 beds 8 (iii) 200-299 beds 12 (iv) 100-199 beds 19 (v) 50- 99 beds 23 (vi) < 50 beds 42 (vii) holding beds only/no rated bed 14 capacity (c) CO!lllllnity Care Facilities 9 (d) Mental Health Institutions 10 (e) Health District Offices 22 2. Other Provincial Government Ministrl ServtcesZVo1untarl ~genc1es (a) Human Resource and Health Centres 5 (b) U.B.C. health-related clinics 5 (c) University/College/Educational Institutions• Health Services 22 (d) Denture clinics 5 (e) Voluntary Associations 8 3. Federal Government Services 26 4. Private Sector: Large Companies 49 Number of Respondents 6 108 11 8 12 19 16 31 11 7 9 15 4 4 17 2 6 22 41 Response Rate 40S 84S lOOS -lOOS lOOS lOOS 70S 74S 79S 78S 90S 68S sos sos 77S 40S 75S 85S 84S CollJnents see note l see note 2 see note 3 see note 4 see note 5 see note 6 see note 7 see note 8 see note 9 see note 10 see note 11 see note 12 I __. ...... I -18-NOTES TO TABLE 2 1. Only clinics with 10 or more physicians in residence were included in the survey. The average number of health record personnel per responding clinic is 1.6 FTE medical stenographers plus 0.9 FTE health record clerks with a range of 0-5 personnel reported. If the non-responding clinics fit the average, an additional 14.4 FTE medical stenographers and 8.1 FTE health record clerks should be included in the estimate of current health record manpower. 2. Since hospitals are major employers of health record-related personnel, a high or representative re-£ROllSl! rate ts critic.a.I to the estimate of heal th record manpmoter in B~C~ Al I hospitals with a rated bed capacity of 100 beds or greater responded to the survey. Responding hospitals of 50-99 bed size (excluding the Cancer Control Agency) average 0.5 ART/HRT + 0.3 HOT+ 0.5 HRA + 2.1 med. stenos+ 1.0 HR clerk per hospital. Responding hospitals with less than 50 beds average 0.4 ART/HRT + 0.1 HOT+ 0.2 HRA + 0.5 med. steno per hospital. Responding agencies with holding beds only reported no health record personnel. If the non-responding hospitals have similar health record employment characteristics to the responding hospitals, an additional 7.9 ART/HRTs + 3.2 HOTs + 5.7 HRAs + 20.2 med. stenos + 7 clerks should be in-cluded in the estimate of current health record manpower. 3. Only community care facilities with 200 or more beds were included in this survey. None of the respon-ding facilities currently employs health record personnel and most did not use/keep formal health records. It is unlikely that non-responding facilities employ significant numbers of health record manpower. 4. The responding agencies average 1.0 ART/HRT/HOT + 0.8 HRA + 1.5 med. steno+ 2.7 clerks per agency. The one non-respondent is unlikely to fit the 'average' and unlikely to be a major employer of health record personnel. 5. Health districts vary in size and population covered, and therefore, in numbers/frequency of programs offered and in numbers of personnel staffing the programs - using a response average to build an estimate of missing numbers is not appropriate. Total staffing information was available for 6 of the 7 non-re-sponding districts. Only 'health record clerk' personnel are currently hired in health districts. On the recommendation of J. Turner, Clerical Consultant to the Ministry of Health, a 40-50% range of total FTE clerical staff was used as a best estimate of the numbers of FTE clerk positions involved with health records. This suggests approximately 95 health record clerks (range 84-107) should be added to the com-munity health roster. An independent study of clerical manpower is presently being conducted by the Ministry of Health and should provide more detailed information for the final report on health record manpower. Reported numbers of FTE health record clerk (or medical stenographer) positions cannot be assumed as positions in which 100% time is spent handling health records; merely positions in which some portion of time is spent at this task. 6. The average health record staffing per centre was 0.6 med. steno + 0.3 HR clerk. Two of the four respon-dents did not hire health record personnel. 7. The clinics vary greatly in activities. Two of the four respondents employed no health record personnel - the remaining two respondents employed 2.5 and 3 medical stenographers. The one non-respondent is un-1 ikely to have more than 3 medical stenographers and more likely to employ less than 2 such staff. 8. Of the 17 respondents, seven reported they were not involved with health records. Of the ten reporting the use of health records, only three hired health record personnel (medical stenographers only). The estimate of current health record manpower could be adjusted by adding up to two medical stenographers (average of 0.4 per service). 9. The two responding clinics reported no health record personnel and this is probably a representative response for most dental/denture clinics. 10. Of the six responding voluntary associations, two stated no involvement with health records, four used health records in providing service but only one of the four hired health record personnel (0.5 med. steno). Missing information in this category is not likely to significantly alter the current health record manpower figures. 11. Of the 22 respondents, 12 reported involvement with health records, 6 reported no involvement and 4 represented senior management contacts from whom no direct answer was expected. Those handling health records are confined to divisions providing medical services. A total of 17 medical stenographers, 4 health record clerks and 1 health-record-trained person were reported for the 12 agencies and this averages 1.4 med. steno, 0.3 HR clerk and 0.1 HR-trained personnel per agency. Of the 4 non-respondents, 2 are likely to be involved with health records and 2 are unlikely to have health record personnel. The current manpower estimate could be adjusted by adding 2.8-5.6 med. stenos, 0.6-1.2 HR clerk and 0.2-0.4 HR trained personnel. 12. Of the 41 respondents in the private sector, 44% (18) reported an involvement with health records and less than half of those (7) employed health record personnel. The average per company involved with health records is 0.5 med. steno and 0.1 HR clerk. This would suggest an additional 1.5 med. steno and 0.3 HR clerks among the non-respondents. • -19-Current Staffing (continued) The personnel categories were: (i) medical stenog.raphers~ (ii) health record clerks (HR clerks), (iii) accredited record technicians/health record technicians (ART/HRT), (iv) health data technologists (HDT), (v) medical record librarians/health record analysts/health record administrators (HRA), and (vi) 'other' personnel as specified by the respondent. Table 3 shows the reported total and distribution of health record personnel in the province. Of the 1,400 full-time-equivalents, 54% were employed in formal health record departments. The majority of those .not employed in formal depart-ments are health record clerks and medical stenographers. Only ten full-time-equivalents formally trained health record personnel were found outside such de-partments. Not surprisingly, 77% of health record department personnel were found in the hospital sector, and hospitals represented 60% of the total reported health record work force. The vast majority (ninety-one percent) of health record personnel are funded by the Ministry of Health, broadly defined to include agencies and institutions such as hospitals which are the fiscal responsibility of the Ministry. The Professional and Institutional Services branch of the ministry currently 'employs' sixty-seven per cent of the reported personnel. A breakdown of personnel by broad employer group and HMRU region may be found in Appendix E. Tables 4-6 are more detailed representations of segments of Table 3. Table 4 shows the relative proportions of health record personnel currently employed by each category of employer, again split into health record and other departments. In the hospital sector in particular, the data on personnel in health record departments are somewhat more reliable than those reporting personnel in other departments, because of an unknown severity of uneven reporting. For example, hospitals in the over 400 bed category reported 152.5 full-time~equivalent person-nel in other departments, most of them in the clerk and steno categories. In contrast, the 300-399 bed group reported a total of only five (5) clerks and stenos involved in health records outside formal departments. Our best interpre-tation of the data received was that there was wide variation in the effort expended by respondents (who were most often employed in health record depart-ments) by way of determining the numbers and extent to which ward clerks and others were involved, definitionally, with health records. Caution is advised, then, in the use, in particular, of the steno/clerk numbers for non-health-record departments in the hospital sector. Subject to the same cautions, Table 5 shows the distribution of f.t.e. person-nel by type of personnel, within and outside health record departments. Of the six -20-Table 3: Health Record Personnel (Full-tfme-egufvalents) fn and outside Health Record Departments, by Employer Group 1,2 Per•OR""""I in "-•Ith R..,ord n-ts Total Per•onnel in Other DBDt• Total• f;!!!2 I !i!ller1 ART/ .. ART/ Other l!!!!2! Clerk• ....!!!lL ..!!!!L. ....l:!!!!L Other ll!l!lL Steno• Clerk• ....l:!!ll!... ..!!UL. ....l:!!!!L Other Q!e.!.!_ .....!!!!!L Mtni•try of Heslth/Sarv MSC, MSP, EHSC • Mod1cal Con•ul. Div o.o 0.0 o.o o.o o.o 0.0 o.o o.o 67.0 o.o o.o t.O 10.0 78.0 78.0 Med. Cl1nic11 • Diag. Treat C•ntre• 7.11 7.11 o.o o.o 0.0 0.0 111.0 7.0 2.0 o.o 0.0 0.0 0.0 1.0 24.0 Acute Car• Ho•pttal• 1110re than 400 b•d• H .11 70.0 31.!I 8.0 32.0 o.o 213.0 60.0 77.!I 3.0 • t.O t.O 10.0 152.5 36!1.!I 300 to 388 i8.!I 14.0 1.0 2.0 7.0 o.o 47.!I !1.0 0.0 o.o 0.0 o.o o.o !1.0 !12.!I 200 to 288 37.0 2t.ll 17.0 4.!I 13.0 t. !I 84.!I 7.0 o.o o.o o.o o.o o.o 7.0 101.!I 100 to 188 30.0 1 t.O 1 t.O !1.0 14.0 o.o 7t.0 8.0 !1.0 o.o o.o o.o o.o 14.0 8!1.0 !10 to 89 33.11 llt.O 8.!I t.O 10.!I t.!I 106.0 2!1.!I 44.0 1.0 o.o o.o 0.0 70.5 176.5 le11• th•n !10 13.5 0.11 10.11 2.!I !I.II o.o 32.11 t.!I o.o t.O o.o 0.0 t.O 3 . !I 36.0 Rehab, ECUs a Pr1v. Ho•P• > 200 bedll 4.5 O.!I 2.0 O.!I 4.0 0.5 12.0 0.0 0.5 0.0 0.0 0.0 0.0 0.5 12.!I 100 to 188 t.O 2.0 t.0 0.0 2.0 o.o 6.0 4.5 o.o o.o 0.0 o.o t.O !1.5 tt.!I le•• than 100 o.o 0 .0 0.0 0.0 t.O o.o 1.0 1.0 0.0 o.o o.o 0.0 0.0 t.O 2.0 Mtn. of H./COftllll. Health 41.5 74.0 8.0 3.0 8.0 0.0 134.5 62.0 116.0 1.0 o.o o.o 2.0 181.0 315.5 M1ntstry of Health/Other o.o o.o o.o o.o o.o o.o o.o 1.0 8.0 o.o 1.0 o.o 3.0 13.0 13.0 Provtncal Gov . /Other t.O o.o o.o o.o 0.0 !1.0 6.0 46.0 29.!I 0.0 0.0 0.0 3.0 78.5 84 . !I Fad•ral Gov•r,....nt 8.0 &.~ o.o o.o 1.0 o.o 13.0 5.0 4.0 o.o o.o o.o 10.0 19.0 32.0 Prtvate Conopan1e• 11.0 t.O 0.0 o.o o.o t.O 7.0 4.!I 0.0 0.0 o.o o.o o.o 4.!I 1 t.!I Column Totals 264.5 259.0 too !I 27 5 98.0 9.5 759.0 :Z38.0 353.!I 6.0 2.0 2.0 40.0 642.5 t 401.!I F'repared by: Health Manpower Research Unit The Untver11tty of Br1t111h ColUIOlbia • Table 4: Distribution of Health Record Personnel Full-time e uivalents in and outside Health Record De arbnents b Emp oyer Group Health Record Personnel in Health Record Personnel Total Health Record Personnel Employers Health Record Departments in Other Departments I i of total I i of total I i of total Ministry of Health/Services MSC. MSP. EHSC & Medical Consul. Division 0 o.o 78.0 5.6 78.0 5.6 Medical Clinics & Diag. Treat Centres 15 1.1 9.0 0.6 24.0 1.7 Acute Care Hospitals more than 400 6eds 213 15.2 152.5 10.9 365.5 26.1 300 to 399 47.5 3.4 5.0 0.4 52.5 3.7 200 to 299 94.5 6.7 7.0 0.5 101.5 7.2 100 to 199 71.0 5.1 14.0 o.o 85.0 6.1 50 to 99 106.0 7.6 70.5 5.0 176.5 12.6 less than 50 32.5 23.2 3.5 0.2 36.0 2.6 Rehab. ECUs. and Private Hosps > 200 beds 12.0 0.9 0.5 ' O.Q 12.5 0.9 100 to 199 6.0 0.4 5.5 . 0.4 11.5 0.8 -less than 100 1.0 0.0 - 1.0 0.0 2.0 0.1 Min. of H./Comn. Health 134.5 9:6 181.~ 12.9 315.5 22.5 Ministry of Health/Other 0.0 o.o 13.0 o.o 13.0 0.9 Provincal Gov./Other 6.0 0.4 78.5 5.6 84.5 6.0 Federal Government 13.0 0.0 19.0 1.4 32.0 2.3 Private Companies 7.0 0.5 4.5 0.3 11.5 0.8 Column Totals 759.0 54.2 642.5 45.8 1401.5 100.0 I I".,) -I -22-Table 5: Distribution of Health Record Personnel by Job Classification HR Job HR Personnel Within HR Personnel in Other Total HR Classification HR Departments DepartJnents Personnel # S of Total * S of Total # S of Total Stenos 264.5 34.9 239.0 37.2 503.5 35.9 Clerks 259.0 34.1. 353.5 55.0 612.5 43.7 ARTs/HRTs 100.5 13.2 6.0 0.9 106.5 7.6 HDTs 27.5 3.6 2.0 0.3 29.5 2. 1 HRAs 98.0 12.9 2.0 0.3 100.0 7 .1 Others 9.5 1.3 40.0 6.2 49.5 3.5 • Total 759.0 100.0 642.5 100.0 1401.5 100.0 • Table 6: Employer Category Distribution of Health Record Personnel by Job Classification Health Record Personnel Job Classification EMPLOYER CATEGORY Stenos Clerksl ART/HRT HDT HRA Other Total ! ! ! ! ! ! ! Min. of Health, Professional & Institutional 65.8 61. l 91.6 86.4 91.0 51.5 67.4 Min. of Health, Conmmity Health 20.6 31.0 8.5 10.2 8.0 4.0 22.5 Min. of Health. Other 0.2 1.3 0.0 3.4 0.0 6.1 0.9 Other Provincial Ministries 9.3 4.8 o.o 0.0 o.o 16.2 6.0 Federal Government 2.2 1.6 0.0 0.0 1.0 20.2 2.3 Private Companies 1.9 0.2 0.0 o.o o.o 2.0 0.8 Total S 100.0 100.0 100.0 100.0 100.0 100.0 100.0 n • 503.5 612.5 106.5 29.5 100.0 49.5 11401.5 l A revised estimate of HR clerks (usfng infon111tion about non•respondents) is likely to change the proportion to approxfutely SOS Ministry of Health. Professional and Institutional Services and 40S Ministry of Health, ea.unity. See Table 1. note 5. I N w I -24-different job classifications. for health record personnel, the accredited record technician/health record technician, health data technologist and health record administrator classifications are likely to require pers·onnel formally trained in aspects of health records or to require full-time (exclusive) involvement in health record-related tasks. These three classifications (trained health record personnel) represent only 17% of all f.t.e. health record personnel reported in the survey and approximately 30% of health record personnel reported for health record departments. Wlth one exception, the trained health record personnel are employed directly or funded indi'rectly by the Ministry of Health. Table 6 reports the proportions of each class of health record personnel employed in various- settings, and is again simply an aggregation of the data in Table 4. In Tables 7 and 8 we refocus on the hospital sector, and specifically on health record personnel employed in (more-or-less) formal health record depart-ments. Table 7 shows personnel per 100 beds by HMRU region. For GVRD, bracketed figures are ex the Cancer Control Agency of B.C. Because the Agency serves in a province-wide monitoring and service capacity in addition to providing beds through the A. Maxwell Evans Clinic, its placement in the 50-99 bed category is misleading in terms of bed-linked personnel deployment. North Central hospitals utilize more personnel than those in the remainder of the province, and hospitals in the Capital region less. In the former case the explanation lies in the re-latively liberal deployment of stenos and clerks, while the low figure for Capital region hospitals seems a result of generally low utilization across all personnel categories. The North region hospitals reported substantially more HRAs per 100 beds than all other regions. Table 8 shows personnel per bed and per institution, by hospital size class. In this table the bracketed figures in the 50-99 bed category are ex the CCABC, and it is in this table that the dramatic impact of that Agency shows most clearly. Generally one might expect personnel per institution to decline with bed size. In fact, when the CCABC is included, a marked steno and clerk anomaly in the 50-99 bed category carries through to the aggregate personnel per institution figures. When the CCABC is removed, the per institution series roughly decline with bed size. The personnel per 100 bed figures generally show the reverse pattern; that is, f.t.e. personnel per bed increases with declining bed size (with the exception of the clerk category). Here again there are marked differences in the figures with and without the CCABC. Alternate Job Titles While employers were asked to report numbers of current health record staff within the categories of personnel delineated for this project, these categories were often not in strict accord with institutional job classifications. Accord-ingly, respondents were asked to report actual titles used when there was a dis-crepancy. These alternate job titles may reflect differences in job classifica-tion (for similar sets of tasks) because of agency or union differences; varia-tion in regional hiring practices; or true variation in matching of qualifications and job tasks. The latter source of variation is examined in more detail later in this report. • • • ... Table 7: Full-Time Equivalent Health Record Personnel in Health Record Departments, per 100 Bedsl by HHRU Region HHRU REGIONS Stenos Clerks ART/HRT HDTs HRAs Other G.V.R.D.* 0.89 1.20 0.41 0.14 0.47 0.01 (0.72) (0.77) (0.41) (0.14) (0.43) (0.01) Capital 1.08 0.59 0.37 0.04 0.39 0.0 Fraser Valley 1.28 0.91 0.64 . 0.41 0.37 0.0 Okanagan 1.40 0.72 0.85 0.0 0.59 0.08 South-East 1.11 0.31 0.93 0.31 0.50 o.o Island Coast l. 71 0.68 0.78 0.21 0.53 0.11 Central 1.75 1.12 0.49 o.o 0.91 o.o North Central 2.14 1.29 0.70 0.20 0.60 0.0 North 1.17 0.39 0.98 0.0 1.56 0.0 * Figures in parentheses exclude the Cancer Control Agency of B.C. Total 3.11 (2.48) 2.48 3.61 3.64 3.16 4.03 4.27 4.93 4.10 • I N (J'I I -26-Table 8: Full-Time E~uivalent Health Record Personnel Employed in Health Record Departments in the Hospita Sector I. Per 100 Beds Bed Size Stenos Clerks ART/HRT HDT HRA Other Total > 400 0.87 0.91 0.46 0.11 0.41 o.o 2.75 300 - 399 0.71 0.46 0.22 0.12 0.39 0.02 1.92 200 - 299 1.16 0.64 0.57 0.13 0.42 0.04 2.96 100 - 199 1.33 0.56 0.52 0.21 0.69 0.0 3.31 50 - 99* 3.44 5.08 0.92 0.19 1.21 0.15 10.99 (2.10) Cl.54) C0.97) (0.20) (0.87) C0.15) (5.83) < 50 1.94 0.07 1.51 0.36 0.79 0.0 4.67 II. Per Institution Bed Size Stenos Clerks ART/HRT HOT HRA Other Total ? 400 6.00 6.25 3.17 0.75 2.83 0.0 19.00 300 - 399 2.42 1.58 0.75 0.42 1.33 0.08 6.58 200 - 299 2.79 1.54 1.36 0.32 1.00 0.11 7.11 100 - 199 1.82 0.76 0.71 0.29 0.94 o.o 4.53 50 - 99* 2.37 3.50 0.63 0.13 0.83 0.10 7.57 ( 1. 46) ( 1.07) (0.68) (0. 14) (0.61) (0.11) (4.07) < 50 0.59 0.02 0.46 o. 11 0.24 0.0 1.41 * Figures in parentheses exclude the Cancer Control Agency of B.C. .. -27-The relative frequency of use of specific alternate job titles by respon-dents to the questions for each personnel category is outlined in Table 9. Only those ~itles that were reported by at least five agencies are included. The major point suggested by this table is that the 'boundary• separating medical stenographers from health record clerks is subJective at best (although later we find distinct differences in average task mixes). Job Task Description Employers were asked to provide a general description of the tasks per-formed by each type of health record personnel in their agency. These tasks were coded and categorized into five major functions associated with health record departments and are reported in Table 10 in order of frequency of re-sponse for each personnel type. Only those tasks that were reported at least 15 times are included. The data show a distinct separation of tasks assigned to each personnel type and a general separation of function in the sense that management and qualitative tasks are associated with the health record admini-strators category onlv. The quality of response to this question varied con-siderably, although overall these responses are consistent with the findings from the more detailed examination of employee-reported job tas.ks. Adequacy of Training Employers were asked to indicate areas of inadequacy where they considered the training of any health record personnel to be inadequate. They were also asked to mention particular strengths provided by the education/training of any of the personnel. The question was designed to elicit response only from the very satisfied or the dissatisfied. Employers could make any number of conments about the training of one or more of the personnel so that the aggregate frequency of conments could exceed the number of respondents. Table 11 surmnarizes the frequency of responses re-ported more "than once, by general comment area. Thus, for example, "medical terminology (3) 11 under the adequacy column for medical stenographers indicates three agencies conunented positively about the medical terminology training of their medical stenographer(s). On-the-Job Training Eighty-five employer~ reported that their agency provided on-the-job training programs for one or more types of health record personnel. Table 9: Use of Alternate Job Titles by Health Record Personnel Category (a) (b) (c) (d) (e) (f) l 2 3 Alternate Job Titlesl Pe~onnel Category in Health Record Departments Other Departments Medical Stenographers clerk-steno/secretary2 clerk (other)3 c 1 erk (other )3 steno/secretary steno/secretary clerk-steno/secretary2 office assistant office assistant Health Record Clerks clerk (other)3 clerk (other)3 office assistant office assistant clerk-steno/secretary AAT/HRT health data technician N/A health record administrator HOT N/A N/A Health Record Administrator director of medical records assistant director of medical N/A records Other clerk (other)3 Listed 1n order of frequency of mention. Only those alternate job titles reported by at least five respondents are included in this table. 40 different descriptive titles reported. 7 different descriptive titles reported. I N ti) I Table 10: Employment Functions and Tasks by Personnel Type Specific Tasks Reported Personne 1 Type Function Category ( 2o+reported) (15-2b reported) (a) Medical Stenographers quantitative only - transcribing (shorthand, dfctaphone) generial filing - typing . - other clerical tasks (such as photocopying, Dlilil duties, etc.) (b) Health Record Clerks quantitative only - admissions reception duties - genera 1 fi 11 ng - discharges - chart retrieval and filing - other clerical tasks - assembling (c) ART/HRT quantitative only - coding - abstracting - completing Ministry of Hea 1th forms - 1uantitatfve analysis checking accuracy and completeness of records) (d) HDT quantitative only N/Al N/A1 (e) Health Record Administrator management - planning, organizing and managing health record department functions qualitative Rartijipation in quality o care comnittees quantitative -codi~ - abstracting 1 Similar to tasks reported for HRT but numbers are too small for inclusion. I I'\) ~ I -30-Formal tratning programs for medical stenographers were provided by four agencies, for ARTs by two employers, for HRTs· by three agencies, for HDTs by 15 agencies and for health record administrators by one agency. The length of the training programs varied from a few days to as long as 50 weeks. No con-sistent pattern for length of formal training within personnel categories was evf dent. Tflfs may be due to the fact tftat responses did not necessarily report full-time training (.e.g. a 30-week training program may refer to one day per week for 30 weeks, or one half-an-hour per day every day for 30 weeks, etc.). In addition, there will be wide variation in types of training, even within a given personnel category. Some of this training likely represents clerkship/ apprenticeship 'clerical' components of formal educational programs. On-the-job (.but not formal} training was reported by 17 agencies for medical stenographers, by 25 agencies for health record clerks, by one agency each for ARTs and HRAs. Other (unspecified length and type) training programs were reported by 14 agencies for medi'cal stenographers, by 15 agencies for health record clerks, by two agencies each for ARTs, HRTs and HDTs·. The number of agencies reporting training programs for medical stenographers and health record clerks is consistent with the problem of inadequate training previously reported for these two personnel categories. Recruiting - Current and Recent Vacancies The employers were asked if they had any vacancies for health record-related personnel in their institution at the time of the survey. Of the 216 survey re-spondents, four did not answer, 178 reported no current vacancies and 34 (15.7%) reported vacancies for health record personnel as illustrated in Table 12. In answer to the question, "Have you had difficulty in recruiting staff for vacant health record-related positions over the last two years?", 65 either did not answer the question or stated they had had no experience with vacancies, 77 reported no difficulty, and 74 reported vacancy difficulties. The reasons given for these difficulties are tabulated in Table 13. Future Personnel Requirements The respondents were asked to indicate if they could foresee either an increased or a decreased need for health record-related personnel within the next two years. Seventy-three agencies forecast a need for additional personnel, citing the following reasons: increased workload (37), expansion of facility (23), increased detail /change in workload (15), change of health record system (8), presently understaffed for workload (5) and reallocation of workload (4). -31-T1ble 11: l!ppond!nS £ :ta ., Tnt111M If llltltl! !1!c!r4 ,,,,,_1 c-nts re: '9rs011Ml C.tevo1'1 ~of C-nts re: lne!!!gu.c..: of Tr11tntng i!I lllldtcal Stenognptien ge1Wr1l tr1tntng (I) requtrecl on-the-iob tr1tntng [not fo1Wlly tr1tned] 16) mdtCll tel'lltnoloV (3) mdtc1l tenatnol:t{ (8) progrlll/coun1 content -C1n1dt1n Hosp. Assoc. (2) tr1tntng not ,.,d ly 1v1t11ble (2) V1ncouver Voe1tt-1 report wrtttng/l1yaut sktlls (2) lnstttute (2) blckgrouncl expertence (2) tllllth bcWd Clerks ..,.r1l tr1tntng (3) requtrecl on-the-job tr1tntng (14) •dtc1l termtnoloV (10) blckground expertence (2) Accredited Record Techntct1n (MT)/ ve•r•l tr1tnfng (2) progr..,courH content He1lth Record Techntct111 ltllT) - C1111dt1n Hosp. Assoc. (4) ...ttcal tel'lttnology (3) codtn11 sktlls (3) blckground expert.nee (2) H11lth Oita Technologtst (Hor) 11ner1l tr1tntng (8) b1ckgrouncl expert1111Ce (3) proqr..,coune content- progr111/coune content-l.C.l.T. (3) B.C.l.T. (3) Hell th Record Adllltntstr1ton (HM) g1111el'll tr1tntng (4) I/A Tlblt 12: llulllbtr of V1canctes for lllllth Record Personnel !w Tm of ¥1t111cr• VICl!lq Type Stenos Clerks AJJs/ HDTs llRAs Other HRTs Fu11-t1• 11.0 12.0 1.0 o.o 13.0 5.112 P1rt-tt• 4.5 0.5 o.o 0.5 o.o o.o C.SUll 3.0 o.o o.o o.o 1.0 o.o I Res119nses ,,. blsed on a stngle potnt tn tt• for 11cll ,.spondlnt, but ,.sponses .. ,. ,.cttved over the pertod Novlilber 1980 - Mlrch 1981. I 3 Oita Proctsstng Stiff Z lles11rch Offtcert Tlbl• 13: Fmuen2 of Rerrted Reasons for Otfftcultr tn Recrutttng, v Tm of Heelth Record nonne Reason for Stenos Cltrks ARTs/HRTs HOTS HRAs Other I Dtfftcul\1 tn Recrutttng lot enough tr1 t ned/1xpert1nced personnel IV1t11bl1 36 14 13 3 12 3 ' &eogr1plltc 1oe1tton 5 2 4 3 5 1 L11vt of Absence - ~ VICl!lq 6 1 2 4 3 0 .Job clllrectertsttcs (shtft-work, extended ca,. or LTC setttn,, requtres z 0 0 1 3 0 cons t dtreb 1 treve 1 ) 51111'1 2 2 0 0 0 0 Other l"lllOlll 3 1 0 0 0 0 • l11eludl ld:lfnt1tr11tt• 111t1t1nt, dltl ,.....11n11 stiff Ind r1111rch offtcer. -32-Six agencies predicted a decreased need for personnel as a result of pro-posed computerization or simplification of their health record information systems. The aggregate number of additional required FTE health record-related person-nel fg.recast b;Y respondents was 68- medi-eal s.tenog.rapl'u!-rs, 6-5 health rec0-rd clerks, 40 accredited health record technicians, six health data technologists, 16 health record administrators and five others (three unknown, one research officer, one statistician). B. Employee Questionnaires Response Rate Meaningful response rates based on the employee questionnaires are even more elusive than was the case with the employer questionnaires. Two denominator uncer-tainties plague response rate calculations. First, the employers reported full-time-equivalents, whereas an attempt was made to distribute the employee question-naires to individuals. The actual number of target individuals was not precisely known. Second, questionnaires were distributed to members of the HRABC. The degree of duplication was unknown. Responses to questionnaires directed at this membership list could fall into three categories: (i) duplications (personnel also receiving a questionnaire through their employer); (ii) employed personnel whose employer did not respond to the initial survey; (iii) personnel not employed in health records at the time of the questionnaire distribution. While each actual response could be correctly categorized after the fact, only those falling into category (i) could allow a relatively accurate response rate adjustment. Given these rather extensive qualifications, our best estimates were a 50% response rate for the ART/ HRT group, 55% for the HDTs and just over 50% for the HRAs. The aggregate steno/ clerk response rate for the seleeted samples was approximately 36%. These relatively low rates of response may raise questions regarding repre-sentation. To get some sense of potential bias, respondents were first classified according to their work status and regional district (HMRU region) of employment. These figures were compared to the FTE personnel reported by employers. With one exception (ART/HRT under-representation in the Capital region) the respondent per-sonnel mix in each region was similar to the employer-reported mix. A second check specific to the hospital sector involved a comparison of response rates for health-record-trained employees within each bed size category, with the overall hospital sector response rates for each class of personnel. The HOT category appears to be under-represented within the largest hospitals (>400 beds), while ART/HRTs had relatively low response rates within the >400 bed and <100 bed classes. With respect to the latter, 14 per cent of the ART/HRT respondents working in hospi-tals did not identify their institution of employment and are classified under 'un-known bed size' unless other information permitted the size class of the hospital to be identified. • -33-The remainder of this section is partitioned along the lines of the three employee questionnaires. Thus, we discuss first the information from the question-naire t I) distributed to employees with some fonnal health record training, then the confidential job satisfaction questionnaire (II) sent to the same employees, and finally the questionnaire distributed to the sample of stenos and clerks (III). B.I With Formal Health Record Training Age/Marital Status/Employment Status/Qualifications Respondents were asked to complete questions regarding their sex, age, marital status, current employment (full-time or part-time, type of position) and HR-related qualifications. Table 14 provides information about marital status and FT/PT employment status for the respondents classified by 10 year age groupings. All the respondents are female, and this appears repres.entattve of the formally trained health record sector in British Columbia. Table 14 also indicates that health records employs a relatively young cohort (.47 per cent of respondents were under 30, over 70 per cent were 1 ess than 40 years of age). In addition, respondents were predominantly married (62 per cent), and most worked full-time. The 17 part-time workers were asked whether they were seeking full-time status and, if so, whether this was for the same or a different position. Most respondents ( 88 per cent) did not wish a change to full-time status. Table 15 compares the information provided by respondents about their current work (employment) status with the information they provided about their qualifica-tions for HR-related employment. Although data reported in this section describes HR personnel with formal HR training, there were 5 respondents working as ART/HRTs who did not have the expected qualifications. These are individuals who are either in the process of completing their formal qualifications or who have attained their positions through on-the-job experience. They are included in this section by reason of their work status since section B.III deals only with clerk-steno posi-tions held by indtviduals who have not completed formal HR education. The 11 clerk-steno positions included in this section are held by respondents who have completed formal HR education and are qualified to hold ART/HRT, HOT or HRA positions . -34-Table 14: Health Record Trained Respondents Grouped by Age, Marital Status and Full-time/Part-time Employment Status Unknown Other Age Groups Marital Status Single Married Marital Status Row Totals P/T PIT fil ~ PIT F/T NIA fil NIA ! ! N/A 1 1 (0.5) 21-30 years - 1 32 7 2 31 16 3 - 92 (46.7) 31-40 years - - 4 1 9 23 5 6 1 49 (24.9) 41-50 years - - 2 1 3 13 2 1 1 23 (11.7) 51-60 years - - 4 - 1 11 2 4 - 22 (11.2) 60+ - - 2 1 - 3 1 3 - 10 (5.1) 1 1 44 10 15 81 26 17 2 197 (100.1) (0.5) (0.5)(22.3) (5.1) (7.6)(41.1)(13.2 (8.6) (1.0) 100.0 Table 15: Respondents with Fonnal Health Record Trainin9 Classified by Current Work Status and by Qua11f1cat1on for Health· Record-Relate Employment Current QUALIFICATION STAJUS Employment Status Not Answered Clerk/Steno ART/HRT HOT HRA Not Answered 2 3 16 12 Clerk/Steno 7 3 1 ART/HRT 5 34 11 5 HOT 4 12 3 HRA 7 3 52 Other 1 8 5 3 Column Total 3 5 63 50 76 .Row Total 33 11 55 19 62 17 197 • • -35-As one might expect, the majority of personnel fall in the 'diagonal' cells ~ that is, 62 per cent of ART/HRTs, 63 per cent of HDTs and 84 per cent of HRAs were employed in positions commensurate with their qualifications. A number of those with HOT qualifications were employed as ART/HRTs, but this may simp-ly reflect a lack of formally designated HfrT positi-ons. Table 16 shows the relationship between the current (employment) status of HR-trained personnel and their age groupings. A considerable proportion (25.8%) of responding health record administrators are within the 6J,-60+ years age group. The 21-30 age group dominates the HDTs, but these were the only two distinguishing features in the age/employment status mix. Unemployed Personnel Thirty-nine respondents were not employed at the time they answered the survey. Seven respondents provided information about their most recent employ-ment status which is included in the reported data about current work status. The remaining 32 unemployed personnel can be identified within the group of respondents providing "no answer" for current employment status in the previous tables. The unemployed respondents included 15 HRAs, 18 HDTs, 5 ART/HRTs and l unidentified personnel type. Table 17 describes the plans for future employment of this group. It is worth noting that of the 25 unemployed who provided this information, only two indicated involvement in an active health record related job search. An additional eleven were not currently seeking such employment, but at least some of these may actually have had a position to which to return. The plans for future employment did not appear to be related to the length of time out of the work force, as can be seen in Table 18. Just over half (51.3%) of the unemployed respondents had been out of the work force for over l year and 45% of this group had definite plans to return to the HR field. The two persons who were seeking health record employment had both been unemployed for less than 6 months. ' Formal Education Respondents were asked to provide details of their formal education, starting with high s·chool and including community college, hospital or institute of techno-logy, univers·ity undergraduate, university post-graduate, and other formal educa-tion such as· correspondence courses. Information requested for each level was: name and location of institution, number of years in attendance, program or field of specialization, degree/diploma/certificate received, and year of graduation. Figure IV shows the total years of post-secondary education and total years of health record-related education reported by ART/HRT, HOT and HRA respondents classified according to their <XJrrent work status. Table 16: Current Employment Status of Health Record Trained Personnel Age Group Not Answered Clerk/Steno* ART/HRT HOT HRA Other N/A - - 1 (9.1} - - - - - -21-30 years 20 (60.6) 5 (45.4) 23 (41.8) 12 (63.1) 25 (40.3) 7 (41.2) 31-40 years 6 (18.2) 3 (27.3) 17 (30.9) 5 (26.3) 15 (24.2) 3 (17.6) 41-50 years 3 (9.1} 1 (9. 1} 9 (16.4) l (5.3) 6 (9.7} 3 (17.6) Sl-60 years 1 (3.0) 1 (9. l} 4 (7.3} 1 (5.3) 12 (19.4) 3 (17.6) 60+ 3 (9. 1} - 2 (3.6) - 4 (6.4} 1 (5.9) Column Total 33 (100.0) 11 (100.0) 55 (100.0) 19 (100.0) 62 (100.0) 17 (100.0) * With Health Record Training Table 17: Future Employment Plans of Health Record Trained Personnel not Currentl Employed, Classified According to Their Qualification Status Future Employment QUALIFICATION STATUS ROW TOTAL ---Plans N/A ART/HRT HOT HRA ' % -· plan to return to health records l 1 5 4 11 (28.2) seeking other field - l 6 5 12 (30.8) seeking Health Record field position - - 2 - 2 (5. 1} not answered - 3 5 6 14 (35.9) -Column Total 1 5 18 15 39 (100.0) ~ Total 1 (0.5) 9e (46.7} 49 (24.9) 23 ( 11. 7) 21Z ( 11.2) 1D (5. l} 1917 ( 100.0} I w O'I I Table 18: Time Lapse Since PLANS FOR FUTURE EMPLOYMENT Last Employment N/A Plans to Return Seeking to Health Records Other Field N/A 7 - -Never Previously Employed - - 2 < 6 months - 2 3 6 months - l year 2 - l l year+ - 3 years l 4 l > 3 years 4 5 5 Colwnn Total 14 11 12 Currentl ans tor Seeking Health Record Field --2 ---2 Row Total I s - -7 (17.9) 2 (5. l) 7 (17.~) 3 (7.7) 6 (15.4) 14 (35.9) 39 (99.9) I w ....., -38-Figure IV: DISIBIBUIICH CE HEALIH BECCBD IBAIHED l'!EBSCHHEL D~ ~E6BS CE easI-SECCHD6B~ 6HD HE6LIH BECCBD-RELAIEP £DUCATIQH, 80 80 ABIIHBI ABIIHBI 70 70 "' 60 60 I-z LU "' Q "' 5. z ... 50 0 "' ... ..."' "' LU 40 "" .... 40 .. I- 0 "" J: :r: 30 ..... ... 30 I- c "" .. ct .. .. 20 ... "' 20 0 u ... 10 10 (} 3 4 5 6 (1 I 1 2 I 3 4 5+ TOTAL YEARS OF POST-SECONDARY EDUCATION TOTAL YEARS OF HR-RELATED EDUCATION 80 70 60 6 "' "' I- "' z ... .... "' 50 5 Q ... z "' 0 ... .... "' .. 40 4 .... 0 "" J: I- ... Q c 30 3 :r: .. .. ... .. 0 "' u 20 2 ... 10 <l 1 2 3 4 5 6 7 8+ (1 I 1 2 3 4 5+ I TOTAL YEARS OF POST-SECONDARY EDUCATION TOTAL YEARS OF HR-RELATED EDUCATION 80 8 70 7 "' "' 60 6 I- "' z ... .... "' Q ... 50 5 z "' 0 ... .... "' .. .... 0 40 4 "" J: ct ... "" c :r: .. 30 3 .. ... .. 0 "' u ... 20 2 10 Cl 7 8+ <.1 I 1 2 3 4 5+ I TOTAL YEARS OF POST-SECONDARY EDUCATION TOTAL YEARS OF HR-RELATED EDUCATION -39-In general, the number of years of post-secondary education increases as current employment moves from the ART/HRT level through to personnel employed as HRAs. The years .of health record-related education shows spikes at two years, particularly for HOTs (since there was only one two year program train-ing- tfl-is elas-sifi-eati-en of personnel). HAAs ne-t Stwpris-hlgly s-how the large.st proportion of personnel with three or more years of health-record-related train-ing. This set of data provided a complex and diverse mix of education experiences, but also a mix from which it was often difficult to infer a 'highest level of education' designation. In Tables 19 and 20, personnel are reported by .our some-what arbitrary 'highest education' classification. Table 19 includes those health-record-trained respondents who were employed in health records at the time of the survey, while Table 20 provides comparable information on the 39 unemployed re-spondents. Note that the disaggregation in these tables is by qualification status rather than current employment status. These two tables clearly show that those with ART/HRT qualifications gained them largely through health records correspondence courses; all HOTs are college program graduates; and HRAs come from a diverse mix of educational backgrounds. While the highest level of education for most HRAs was college health records and/ or management programs, other relatively large concentrations come from hospital-based, correspondence, and university-based health records and/or management traini~g. Of course one must bear in mind that 'qualification status' was self-reported, and may not always have concurred with what might be generally regarded as HRA qualifications. These two tables show the most common educational preparation of the 197 health record-trained respondents to be health record or management specializa-tion at the college level (80, 40.6%),health record and/or management courses by correspondence (38, 19.3%h or college level non-HR-related education plus health record and/or management courses by correspondence (17, 8.6%). The greatest degree. of diversity in educational pr~paration is seen in the group of admini-strators and the least diversity, in the group of health data technologists. An alternative classification and aggregation yielded counts of highest levels of health record-related education within five groups: no health record-related training, correspondence only, hospital training only, college-level health record education, and university level health record education. Of the 197 respon-dents, eleven (5 ~ 6%) had no health record-related education (or had not reported the field of specialization in a manne·r that indicated any relationship to a health records discipline); 64 (32.5%) had completed health record and/or management courses by correspondence but had no other health record education; 88 (44.7%) had completed college-level education with health record/management specialization, and 10 (5.1%) had university degrees in health record/management-related fields.7 . This aggregation .is portrayed in Tables 21 (by current employment status) and 22 (by qualification status), for those employed in health records at the time the questionnaires were fielded. 7 Of course there may be wide variation in total education within each health record-related level. For example, those with no health record-related education may have only high school graduation, or be university graduates. Table 19: Highest Education Attained by Currently Employed Health Record Trafned Respondents Classified According to their Qualification Status HIGHEST EDUCATION QUALIFICATION STATUS Row Total No Answer Clerk/Steno ART/HRT HOT HRA I i High School Only 1 2 2 - 1 6 ca.a) Health Record and/or Management Correspondence Only - 1 27 - 8 36 (22.8) Hospital-Based Health Record and/or Management Only 9 9 (5.7) + Health Record and/or Manage-ment Correspondence 3 3 (1.9) Hospital Non-Health Record Only 1 1 (0.6) + Health Record Correspondence 1 1 2 Cl .3) College Health Record and/or Manage-(3$.4) ment Only 8 29 19 56 + Health Record and/or Manage-(1.9) ment Correspondence l 2 3 College Non-Health Record + Health Record and/or Manage-nient Correspondence l 14 2 17 ( H).8) + Hospital Health Record 3 3 Cl .9) + Hospital Non-Health Record 1 1 (Q.6) University Health Record and/or Manage-(3.2) ment Only 5 5 + Health Record and/or Management Correspondence 2 2 (1.3) + Hospital Health Record and College Non-Health Record 1 1 (0.6) University Non-Health Record + Health Record and/or Management Correspondence 4 4 (2.5) + Hospital Health Record 4 4 (2.5) + Hospital Non-Health Record 1 1 (0.6) + College Health Record and/or Management 3 3 (1.9) + College Non-Health Record 1 1 (Q.6} Column Total 2 5 58 32 61 158 (10()1.0) I ~ 0 I Table 20: Highest Education Attained by Health Record Trained Respondents Unemployed at Time pf Survey, Classified According to their Qualification Status · QUALIFICIATION STATUS Row Toltal HIGHEST EDUCATION No Answer ART/HRT HOT HRA I I Health Record and/or Management Correspondence Only 2 2 1(5. l) Hospital Health Record and/or . Management Only l l 1(2.6) + Health Record and/or Management Correspondence l l (2.6) Hospital Non-Health Record + Health Record and/or Management Correspondence l J (2.6) College Health Record and/or Management Only l l 16 6 24 (61.5) + Hospital Non-Health Record l l (2.6) College Non-Health Record Only l l (2.6) + Health Record and/or Management Correspondence 2 2 1(5. l) + Hospital Health Record and/or Management l l (2.6) University Health Record Only 3 3 1(7. 7) + Hospital Health Record l l 1(2.6) University Non-Health Record + College Health Record and/or Management l l 1(2.6) Column Total l 5 18 15 39 (1100.0) I .;:. ..... I Table 21: Highest Health Record-Related Education, by Current Work Status, for Respondents Employed in Health Records CURRENT EMPLOYMENT STATUS Highest Health Record-Related Education Not Answered Clerk/Steno ART/HRT HOT HRA Others ! % ! ! ! % ! % ! ! ! ! No health record-related education 1 (100.0) 6 (10.9) 1 (1. 7) 2 (15.9} Correspondence only 4 (40.0) 29 (52.7) 3 ( 15.8) 17 (28.3) 6 (46.2} Hospital only 1 (10.0) 2 (3.6) 2 (10.5) 13 (21. 7) 1 (7.7) College 5 (50.0) 18 (32.7) 14 (73.7) 22 (36.7) 3 (23.l} University 7 ( 11. 7) 1 (7.7) Column Total 1 (100.0) 10 (100.0) 55 (100.0) 19 (100.0) 60 (100.0) 13 (100.0) Row Total ! ! 10 (6.3) 59 (37.3) 19 (12.0) 62 (39.2) 8 (5.1) 158 (100.0) I ... N I Table 22: Highest Health Record-Related Education, by Qualification Status, for Currently Employed Health Record Trained Respondents Highest Level Health QUALIFICATION STATUS Row Total Record-Related Education Not Answered Clerk/Steno ART/HRT ··HOT HRA . I % I s I s I s # s I s No health record-related education 2 (100.D} 3 (60.0} 3 (5.2) , 2 (3.3} 10 (6.3) Correspondence only 2 (40.0} 46 (79.3) 11 (18.0) 59 (37.3) Hospital only 19 (31. 1} 19 (12.D} College 9 (15.5) 32 (100.0) 21 (34.4) 62 (39.2) University 8 (13. 1} 8 (5.1} Column Total 2 (100.0) 5 (100.0), 58 (100.0) 32 (100.0) 61 (100.0} 158 (100.0) Table 23: Educational Preparation by Highest Level of Health Record-Related Education Highest Education FEELING OF PREPAREDNESS RQw Health Record-Related Not Answered Adequately Prepared Inadequately Prepared To~l ! ! ! ! ! ! ! ! Non-health-record education 2 (18.2) 6 (54.5) 3 (27.3) 11 (1:00.0) Correspondence only 4 (6.3) 42 (65.6) 18 (28.l} 64 (1100.0) Hospital training 3 (12.5) 17 (70.8) 4 (16.7) 24 (liOO.O} College health records 6 (6.8) 65 (73.9) 17 (19.3) 88 (1!00.0) University health records - - 8 (80.0) 2 (20.0) 10 (100.0) Column Total 15 (7.6) 138 (70.1) 44 (22.3) 197 (100.0} I .i:i. w I -44-A comparison of Tables 21 and 22 makes clear that the diversity of educa-tional preparation in health record-related areas appears much greater when HR tra-1--ned- pe-rSGl'lRe l a.re Glass-i f i-ed by the tr employment s ta.tus (_Tab 1-e i l ) tha.n b-y their qualification status (Table 22). This is particularly noticeable for the health data technologists who had a well-defined training program (2 year college-level, graduates of B.C.I.T.) but report a variety of different work status and job titles. For example, for the 50 (employed and unemployed} HDT respondents, current job titles were reported as medical steno (.1), health record clerk (2), accredited record technician (3), health record technician (6), health data technologist (8, 16% of total/ 25% of employed HDT}, health record administrator (3), other varied titles (11) and no present title due to unemployed status (16). 8 In addition, 4 ART/HRTs and 3 health record administrators reported working under the job title of health data technologist. The match between work status/job title and education/ qualifications appears imprecise at best. The proportion of ART/HRT, HDT and HRA - qualified respondents working in positions generally requiring less or more formal training are: ART/HRT HDT HRA % of respondents in jobs generally 13.5% 48.3% 14.8% requiring less formal training % of respondents in jobs requiring 65.4% 41.4% 85.2% similar training to that attained % of respondents in jobs generally 21.2% 10.3% requiring more formal training This sort of pattern might arise because of (_a) institution-specific job class·ification rigidities, (b) specific personnel types not being available or not perceived to offer unique expertise, and/or (_c) personnel advancement being associated more with experience and perceived capability than with educational qualifications/criteria. The diversity of educationa.l preparation for HRAs regatd-less of whether they are classified by qualification or work status is most easily explained by the historical scarcity of HRA-specific education programs in the province. 8 Two of the 18 unemployed HDTs· provided a job ti.tle anyway. • -45-The most frequently mentioned fields of specializati.on for HR-related degrees/diplomas/certificates were medical records (191/277, 68.9%), commerce (28/2~7, 10.1%) and health care management (26/277, 9.4%). All other mentions of degrees (for example, statistics. data processing, international coding, medical termi"nology) represented less than 2% of the total. Adequacy of Formal Education In response to a question regarding adequacy of educational preparation for the duties of their current position, 138 of the 182 respondents (70.1%) who answered the question replied in the affirmative and 44 (22.3%) replied 'no'. A negative response to this question did not appear to be associated with any one personnel type or field of specialization. When respondents were classified accordinq to their highest HR-related education group there was an expected association between health-record-education and feelings of prepared-ness (Table 23). The respondents who felt their education had inadequately prepared them for their current job were queried regarding the areas of education which should receive more emphasis, and those which were not particularly relevant. The mpst frequently mentioned areas for more emphasis by the 43 respondents reply-ing to this section were:management (11 mentions) coding (11 mentions) pharmacology(lO mentions) statistics ( 6 mentions) budgeting ( 6 mentions) The education areas felt to be not particularly relevant to the respondents• current work were reported by only 15 respondents - the areas mentioned more than once included: psychology (3), computer application (2), building renovation and planning (2), genetics (2) and statistical methods (2). Of course both sets of figures are relatively unhelpful unless linked to particular employment positions. . Correspondence Courses Seventy-eight of the 197 health record trained respondents completed 90 correspondence courses as part of their educational preparation. The Canadian Hospital Association was cited by all who reported a sponsoring agency/institu-tion. Degrees/diplomas/certificates received were primarily those for ART/HRT (58/90 - 64.4%) and Hospital Departmental Management (17/90 - 18.9%). Other -46-degrees mentioned represent 3% or less of the total. The reported year of graduation from these correspondence courses ranged from 1955-81 in the following way: 8 graduates from 1955-65, 31 graduates from 1966-75, and 40 graduates from 1-916--81 (4 reee-ivt·ng degrees/ee·r-tifie-at-e-s/diploma-s -di-d not report yea·r e-f gradua-tion). Seven respondents were in the process of completing a correspondence course. Most of the courses were completed in one year or less. When the 78 respondents who had taken correspondence courses are classified by their qualification status. the majority were ART/HRT (51/78, 65.4%) or health record administrators (24/78, 31.6%). The courses taken were primarily in the fields of medical records (67/90, 74.4%) and health care management (18/90, 20%). When the respondents who had taken correspondence courses are classified by their current work status, the results, as seen in Table 24, are less clustered. Continuing Education Respondents were asked to report on their participation in continuing educa-tion or professional upgrading activities during the two years irrmediately pre-ceding the survey. Six specific examples were provided (see questionnaire in Appendix C), as well as the opportunity to report other non-specified activities. One hundred and sixty-two of the 197 respondents (82.2%) reported participating in at least one continuing education/professional ·activity. Table 25 shows this self-reported frequency of participation. The most frequent type of activity reported for those who participated in only one type was PAS/HMRI workshops. For those participating in 2 types of activities the most frequent combination was the PAS/HMRI workshops and an HRABC workshop. Table 26 shows the type of continuing education and corresponding partici-pation rates reported by the respondents, classified according to their cur-rent work status. Health record administrators showed the highest participation rates in contin-uing education generally, and in HRABC workshops. Quality assurance workshops, and multidisciplinary conferences/seminars specifically. Of course, caution must be exercised in interpreting these figures, since opportunities to avail oneself of continuing education may often be a function of one's work status, rather than the reverse causality. • • Table 24: Health Record Trained Respondents Correspondence CURRENT EMPLOYMENT STATUS Row Total Course Content . No Answer Clerk/Steno ART/HRT HOT HRA Other ' Not Specified - - - - 1 - 1 Medi ca 1 Records 3 5 26 3 16 6 59 Health Care Management 1 - 1 - 8 - 10 Health Record and Health ca re Managemn t - - 3 - 3 2 8 Column Total 4 5 30 3 28 8 78 Table 25: F~uency of Participation 1n Continu1n9 Educat1on,Profess1onal Act1v1t1es as Reported by all Health Record Traine Responden s Nud>er of Cont1nu1ng Education Number of Respondents Activities Reported ' s No part1c1pat1on answer 36 18.3 One Act1v1'ty Only 62 31.5 T.a Act1v1t1es 37 18.8 Three Act1v1t1es 26 13.2 Four Act1vi.ties 23 11.7 Five Act1v1t1es 4 2.0 Six Act1v1ties 9 4.6 Column Total 197 (100.0) s 1.3 15.6 12.8 10.3 100.0 I ~ ........ I Table 26: Nature of the Continuing Education Programa and Freguency of Particilation in Each ~ipe of Program Taken in the Past Two Years by Health Record Tra1ne Respondents. Classified ccording to The r Currentlliork Status PARTICIPATION BY RESPONDENT CLASSIFIED BY CURRENT WORK STATUS Type No Current of Work Status Clerk/Steno ART/HRT HOT HRA Other . TOTAL P.ARTICifATION Per Cent of ~er of Tptal Continuing Education n•33 n=ll n=55 n=l9 n=62 n=17 Pafticipants Respondents s s s s s s n=l97 PAS/HMRI Workshops 15 45.5 3 27.3 37 67.3 17 89.5 53 85.5 9 52.9 134 68.0 HRABC Workshops 7 21.2 l 9.1 18 48.6 8 42. l 38 61.3 5 29.4 77 39.l . Quality Assurance Workshops 6 18.2 - - 5 9.1 l 5.3 23 37. l 5 29.4 40 20.3 CCHRA Annual Conference 2 6.1 - - 3 5.5 l 5.3 11 17.7 3 17.6 20 10.2 HRABC Annual Convention 11 33.3 l 9.1 11 20.0 6 31.6 33 53.2 8 47. l 70 35.5 Multidisciplinary Conference/Seminars 4 12. l - - 3 5.5 2 10.5 21 33.9 2 11.8 32 16.2 Other Continuing Education/ Professional Activities l 3.0 l 9.1 5 9.1 - - 6 9.7 4 23.5 17 8.6 N~nmer of Respondents and S of total resoondentsl 20 (60.6) 4 (36.4) 44 (80.0) 18 (94.7) 62 (100.0) 14 (82.4) -I ~ CX> I .. .. • -49-Future Educational Plans/Desires · Interest in pursuing further formal education was expressed by 142 (72.1%) respondents. Those who irulicated an interest in further ~tion were asked to specify their field of interest -- whether this was a health record-related area, a health but non-health records area or a non-health science field. Eighty-two per cent (117 respondents) of those wishing more education indicated a single field of interest -- 77 indicated health records, 22 .a health science non-HR field, and 18 a non-health sciences field. Of the 23 respondents who selected more than one field of interest, half chose the combination of health record and a non-health science field. In total, 97 respondents (68.3%) wished some further education in the health record field and the most frequently cited reasons were education in the health record administration .or management area, educa-tion to. update their knowledge, and education for attainment ~f certificant status. Tables 27 and 28 examine the relationship between the type of further educa-tion desired by the 142 respondents expressing an interest, and their previous education ~r training. The 164 responses reflect multiple interests for some respondents. Most of the health-record-trained respondents were interested in further ' health record-related education, although a relatively high proportion of the HDTs expressed an interest in non-health record education. Part of this reflects multiple interests, but the size of this non-health-records response within this group could also reflect career dissatisfaction. The ART/HRT group, in contrast, seemed bent on upgrading their health re.cord careers. Reasons for interest in further education in the health record field varied roughly with qualification status -- .knowledge update (HRAs), upgrade to certi-ficant level (HDTs), health records administration (ART/HRT). Those qualified as ART/HRT with correspondence training only were the most likely to desire further health record education. On the Job Training Respondents were asked to report any HR-related on the job training they had ever received. Forty-four (22.3%) of the 197 respondents reported receiving some on the job training -- this represented 18 per cent of the group having no current work status, .. 18 per cent of the clerk/stenos, 29 per cent of the ART/HRT group, 5 per cent of the HDTs, 16 per cent of the HRAs and 53 per cent of those classified as 'others~ . The nature of the reported training varied widely. General categories included: medical terminology, coding, statistics, supervision-management, disease/diagnosis classificatfons. No associ.ation was apparent between reported training and work status of respondents. The 'coding' category of training was reported by 30 per cent of those receiving on the job training. Table 27: Nature of Further Education Desired by Health Record Trained Respondents Classified According to Their Qualification Status Area Chosen- llllAI It- I 1111,. !)tATllC: for No Answer Clerk/Steno ART/HRT HOT Further Education n=2 n=5 n=46 n=39 Health Records 2 (100.0) 4 (80.0) 36 (78.2) 19 (48.7) Health, Non-Health Records - - 1 (20.0) 6 (13.0) 15 (38.5) Non-Health Science - - - - 8 (17.4) 9 (23.l) Not Specified - - - - 2 (4.3) - -Proportion of Group 66.7S 100.0S 73.0S 78.0S Wanting any Further Education Table 28: Nature of Further Education Desired by Health Record Trained Respondents, Classified by Highest Health Record Education Attained Area Chosen HIGHEST HEAL TH RECORD t'.DUCAI J Jn •~n:.L for No Health Record Correspondence Hospital College Further Education Related Education Only Training Health Record n=6 n=46 n=15 n=67 Heal th Records 4 (66.7) 41 (89.l) 11 (73.3) 37 (55.2) Health, Non-Health Records l (16. 7) l (2. l) 2 (13.3) 26 (38.8) Non-Health Science l (16.7) 7 (15.2) 4 (26.7) 16 (23.9) Not Specified - - 2 (4.3) 2 (13.3) - -Proportion of Group Wanting Further 54.5S 71.9S 62.51 76.11 Education • HRA n;:;SO 36 (72.0) 10 (20.0) 14 (28.0) 2 (4.0) 65.8S University Degree Health Record n=8 4 (50.0) 2 (25.0) . 3 (37.5) - -80.0S .. (.Tl 0 I .. • • -51-All but three of the 27 employers offering on-the-job training were hospitals. The length of training varied from less than l week to 1 year, but information was not solicited on total time spent in the actual training process. A larger pro-portion of on-the-job training was reported for the years 1976-81 than prior to 1976 . . In general, the information about on-the-job training was difficult to in-terpret - the differences between fonnal training, orientation to a new job and continuing education workshops/seminars held at the respondents' institutions were .not easily distinguishable. In addition, a question asking for 'any' train-ing ever received is bound to be subject to recall problems. Length of Employment in the HR Field Information was requested on the total length of time respondents had been employed in the health record field. Their responses are categorized according to their qualification status and current employment status 'in Table 29. Seventy-seven (3~%) of the HR trained personnel had spent less than 5 years in health records. Over half (56%) of the respondents who had spent more than 15 years in the field were health record administrators. Considerable differences in field times are .evident between the group of qualified HOT personnel and the groups of ART/HRT and HRA qualified personnel -- the majority (78.0%) of the former being in health records f9r less than 5 years, while the majority (81.0% and 67.1% respectively) of the latter groups have worked in the field for more than 5 years • This is not unexpected, of course since the B.C.I .. T. course for· health data techn-ologists is relatively new (.first graduates, 1973) . ·Forty-five (23%) of the 197 respondents stated that they had worked in health records outside British Columbia. The largest contingent of outside B.C. personnel were the health record administrators (34% of those with HRA qualifications). The majority (79%) of those indicating out-of-B.C. health record employment had left their most recent such position within the past year. Eighty per cent of these positions were in other parts of Canada, the remainder being primarily in the United States or Great Britain . . Respondents were also asked to report the total length of time they had been employed by their present employer. Of the 157 HR trained personnel who provided this information, 17 (11%) had been with their present employer for less than 6 months, 20 (.13%) for 6 months to l year, 28 (18%) for 1-2 years, 16 (10%) for 2-3 years1 . l~ (12%} for 3-5 years, 26 (17%) for 5-10 years, 13 (8%) for 10-15 years and 19 (12%) for more than 15 years . .. • Table 29: Total Length of Time Employed in the Health Record Field, Health Record Trained Respondents, Classified by Current Work Status and by Qualification Status I. Qualification Status Length of Time in No Answer Clerk/Steno ART/HRT HOT HRA Health Record Field Not Specified 1 (33.3) - 1 (1.6) 1 (2.0) - -< 1 year - - 1 (20.0) 1. (1.6) 5. (10.0) 6. (7.9} 1 - 2 years 1 (33.3) 1 (20.0) 2 (3.2) 7 (14.0) 3 (3.9) 2 - 5 years - - - - 8 (12.7) 26 (52.0) 16 (21.1) 5 -15 years - - 1 (20.0) 42 (66.7) 11 (22.0) 29 (38.2) > 15 years 1 (33.3) 2 (40.0) 9 (14. 3) - - 22 (28.9) Tcl>tal # 'l 3 1.5 13 6.6 14 7.1 50 25.4 83 42.1 34 17.3 Column Total 3 (100.0) 5 (100.0) 63(100.0) 50(100.0) 76 (100.0) 197 (100.0} II. Current Work Status Len~th of Time in No Answer Clerk/Steno ART/HRT HOT HRA Other Total Heal h Record Field ' 'l Not Specified 2 (6.1) - - 1 (1.8) - - - - - - 3 (1.5) < 1 year 2 (6.1) - - 4 (7.3) 3 (15.8) 4 (6.5) - - 13 (6.6) 1 - 2 years 3 (9.1} - - 4 (7.3) 2 (10.5) 3 (4.8) 2 (11.8) 14 (7 .1) 2 - 5 years 14 (42.4) 3 (27.3) 12 (21. 9) 4 (21.1) 14 (22.6) 3 (17 .6) 150 (25.4) 5 -15 years 9 (27.3) 7 (63.6} 28 (50.9) 10 (52.6) 22 (35. 5) 7 (41.2) 83 (42. l) > 15 years 3 (9.1) 1 (9.1) 6 (10.9) - - 19 (30.6) 5 (29.4) 34 (17.3) Column Total 33 (100.0) 11 (100.0} 55 (100.0) 19 (100.0) 62 (100.0) 17 (100.0) 1197 (100.0) .. I U1 N I -53-The relationship between the length of time employed in the health record field and the length of time employed by the present employer can be seen in Table 30. Persons who fall above the 'box diagonal' have held more than one health record position over the1r health record careers, while those falling below the 'diagonal' have worked in health records for only part of their work time with their current employer. In other words, those below the 'diagonal 1 have held more than one position with the same employer. The diagonal elements are not true diagonal elements because the time categorizations in the vertical and horizontal directions are not identical. However, the figures seem to in-dicate that a large proportion of. the respondents (at least 41 per cent) have held health record positions with more than one employer over their health record careers. In contrast, very few respondents had moved into health records from other areas with their then current employers. Of course this does not allow one to determine the scope for upward mobility within health records in any given employment setting. Those who may have progressed through the health record ranks with one employer would fall into the diagonal cells. One cannot differ-entiate them, however, from others who have held a single health record position with one employer for their entire health ·record career. This latter phenomenon is, of course, more likely in the upper left cells of the diagonal than in the lower right. Job Task Mix One of the major purposes of this questionnaire was to attempt to establish the degree of association between current employment qualification status and the average mix of tasks entailed in particular employment settings. The job task mix question (see questionnaire in Appendix C) requested information on the fre-quency with which a long list of tasks was undertaken in connection with each respondent's normal activities. Tasks were grouped into five broad categories -- quantitative, management qualitative, health information and liaison. In-cluded in the quantitative category were such functions as admissions and dis-charges, typing, filing, abstracting and transcribing; management embodied plan-ning and admfoistrative functions, involvement in quality assurance or research studies were examples of qualitative functions; development of statistical reports or aggregation of data, or information systems work fell within the health informa-tion rubric; and liaison included a number of functions involving interaction with peer professionals. There were nineteen functional categories in the quantitative group, twelve management items, seven qualitative functions, eight health informa-tion-related duties, and four ~iaison categories. Respondents were asked to designate each task according to the normal fre-quency with which it was undertaken -- daily(D), weekly but not daily(W), at least once a month but not as often as once a week(M), or occassionally (less than once a month)(O). In addition, space was provided for respondents to in-dicate the number of hours spent on each task, per day, week or month (depending on the earlier D, W, M or 0 designation). Table 30: Length of Time Emploied by Current Employera by Total Length of Time in the Health Record Field, as Reported by Healt Record Trained Respon ents Length of Time TOTAL LENGTH OF TIME IN HEALTH RECORD FIELD with Current Employer Not Answered < 6 months 6 mo. - 12 mo. 1 up to 2 yr. 2 up to 5 yr. 5 up to 15 yr •. < 6 months 1 4 2 1 3 6 6 up to 12 months - - 4 2 7 6 l up to 2 years - - - 6 11 11 2 up to 3 years l - - - 7 7 3 up to 5 years - - - - 5 12 5 up to 10 years - - - l l 21 10 up to 15 years - - - - l 6 > 15 years - - - - - 3 Not answered l 3 - 4 15 11 Column Total 3 7 6 14 50 83 s (1.5) (3.6) (3.0) (7.1) (25.4) {42.ll ... > 15 yr. -1 -1 1 3 6 16 6 34 (17 .3) Total 17 20 28 16 18 26 13 19 40 197 (100.0) I U1 ~ I -55-Our initial objective had .been to develop average task mix profiles by task group and type of personnel. With accurate hours of work infonnation this would have been relatively straightforward. However, the hours of work responses were plagued by internal incons1Stenc1es and low response rates. It became readily apparent that any task mix profiles would have to be proxies based on the less precise daily/weekly/monthly information. The latter was completed much more frequently and comprehensively by respondents than was the 'hours' information. Thus, the analysis presented here is that undertaken at a rather aggregated level -- we report no task-specific trends, nor detailed hours of work infonnation, although both may be made available in response to indivi-dual requests. Using only the D/W/M information, we attempted to develop a variable which would (more or less accurately) portray the proportions of monthly work time that respondents spent on each of the five broad task categories. Let Dij denote the number of specific tasks of broad category j (j=l, ... 5; quantitative, liaison, etc.).·done on a daily(D) basis by the ;th respondent. Similarly, let Wij and Mij take on the corresponding weekly(W) and monthly(M) designations. If we assume that tasks done on a daily basis are, on average, undertaken 21.75 times per month, those marked W -- 4.33 times per month, and those marked M -- once a month, then we may define o .. x 21.75 + W .. x 4.33 + M .. s lJ lJ lJ ij= o. x 21.75 + W. x 4.33 + M. ,. l• l• o. = I:D •. l• j lJ W. = l:W .. l • j lJ M. = l:M .. l• j lJ as the share of total work time spent by the ;th person on broad j-category tasks. As an example we might construct two hypothetical personnel - one work-ing as a health records clerk, the other as an HRA. Assume the clerk's question-naire responses indicate 13 quantitative tasks done on a daily basis, an addi-tional 4 quantitative tasks done on a weekly basis, and one health infonnation task done on a monthly basis. Assume further that the HRA's response indicates the f?llowin.g mix of tas-ks: D w M Quantitative 1 Managerial 3 7 1 . Qualitative 3 2 Health Infonnation 1 2 4 Liaison with other 3 Professi ona 1 s -56-Then the time shares for the two personnel would be as follows: sj Clerk HRA Quantitative .997 .028 Managerial .00 .630 Qualitative .00 .098 Health Information .003 .224 Liaison with other .00 .020 Professionals The statistical analysis was designed to identify significant task mix differences across qualification status, current employment status and, within the hospital sector, across bed size categories. In addition, we were able to generate 'average' task mix proportions by qualification status and current work status. Interpretation of these profiles and of the statistical analysis must be guided by cognizance of the assumptions built into the construction of the Sij variable. In particular, we make the clearly unrealistic assumption that every task done on a daily basis consumes the same amount of time. If an HRA spends one hour each day doing 15 quantitative tasks, and the rest of each day involved in one management task, the quantitative vs management Sij values for that person would grossly misrepresent his/her task time allocation. In the absence of hours of work information, however, we can do nothing more than highlight the potential biases built into this variable and pray that aggregation across individuals will even out some of the discrepancies. Some follow-up sensitivity analysis may be undertaken in the near future. lt seel118d. reasDoable to suppose that the mix of tasks for ~ny type of personnel would vary within the hospital sector by size of hospital. For example, one might expect an ART/HRT level person to take on many more manage-ment functions in a small than in a large hospital. On the other hand, if an HRA happens to be employed in a small hospital, he/she may end up spending much more time on quantitative tasks than his/her counterpart in a large urban hospi-tal. To test this proposition, we undertook two two-way analyses of variance (one each using qualification status and current employment status) incorporating both status and bed size. These analyses examined the variance in S· for each of j = 1, .•• ,5). Once differences in qualification status or employment status were taken into account, there were no differences statistically attributable to hospi-tal s. i ze in any of the broad functional categories ( p>. 05). With bed size showing no statistical role in explaining variance in the Sj for the three personnel classifications, we followed up with a one way analysis of variance focusing only on status (qualification or employment). Table 31 and Figure V show the estimated time profiles based on qualification status, and Table 32 and Figure VI are the corresponding pair based on current employment status. Statistically significant differences between types of -57-Table 31: Allocation of Work Time to Broad Task Categories, by Qualification Status QUALIFICATION STATUS ART/HRT HDT HRA UICI ... .. .. .... .... .... ·~:: ... .. ..... ..... ·:.· ..... :: ·'° :: .... ·:·: ·.·: ·:.· ·:: ... ·:·:· •• ..... ·:: ::::: ::·: :: II! :: .... ;:: ~~~ .. .IO I ·:::: l!i ::::: ! :: i :: AO ::::: ~ ·.·.· .. .::::: ·:·:· .IO ~:~:~ :::: ~}~ ·:·:· .ID :·:·: ::·: ~~~~~ ... ~~~ •:: ::::: :: :: 0 ::::: CIMl'ITllmE Quantitative 0.14 0.85 0.50 IWWill8ll' TASK CATEGORY Management Qualitative 0.01 0.07 0.24 Figure V 0.02 o.os 0.07 I ART/HRT HllT HllA Health Infonnation 0.08 0.02 0.10 IBL.lH llFllMTllll UAllDI Liaison 0.09 0.01 0.08 -58-Table 32: Allocation of Work Time to Broad Task Categories, by Current Eltplo1!!nt Status CURRENT EMPLOYMENT STATUS Clerk/Steno ART/HRT HOT HRA II! ;: ... ... .... ... ... ... ••• Quantitative 0.91 0.86 0.87 0.45 Management 0.01 0.02 0.05 0.27 figure VI TASK CATEGORY Qualitative Health Infonnatton 0.02 0.03 0.04 0.06 i CLIRUITDID ART/HllT HDT lfRA UAID 0.03 0.04 0.03 0.12 Liaison 0.03 0.05 0.01 0.10 .. • -59-personnel classified by qualification status were evident for quantitative and management tasks (p<.001), and for health information tasks (p<.05). When cur-rent employment status was used to classify personnel, a similar pattern emerged -- statistically significant differences in time proportions for quantitative and management tasks (p<.001) and for health information tasks (p<.01). A number of interesting trends emerge from this analysis. Those qualified or working as ART/HRTs or HDTs spent the vast majority of their work time on quantitative tasks. Surprisingly, those qualified as ART/HRTs spent, on average, the same share of time on management functions as did HDTs. When viewed from the employment status perspective, however, HDTs spent more 'management' time. The significant differences in proportions in these two functional areas are clearly attributable to the HRAs, who spend significantly less and more time, respectively on quantitative and management tasks. Health data technologists, whether by qualification or employment, spent virtually no time undertaking liaison functions. In general, quantitative tasks appear to dominate the work-ing day of all health record personnel, and thereappear to be few differences in time profiles of ART/HRTs on the one hand, and HDTs on the other . -60-B.II With Formal Health Record Training - Job Satisfaction A second confidential questionnaire was distributed to all health record-trained personnel, requesting information rel ating to job satisfaction. Respon-dents were asked to provide information about their highest health record related qualifications and their employment status but were not asked for personal infor-mation that could identify them. These questionnaires were returned in separate envelopes. Table 33 describes the respondents to the job satisfaction questionnaire by qualification status and by current work status. Although the same number of HR trained personnel (.197) responded to the job satisfaction questionnaire as to the HR-trained employee questionnaire, the personnel categories reported represent a slightly altered group. Since the questionnaire was designed to ensure confidentiality, there is no way of knowing whether this is a somewhat different group of respon-dents or the same group reporting their qualifications/work status differently. It seems reasonable to assume that the majority of respondents returned both questionnaires. Attitude Toward Current Position Respondents were asked to describe their attitude toward their current position as dissatisfied, indifferent, satisfied or extremely pleased, and to indicate briefly the reasons for their attitude. This information is summarized in Table 34. The majority (70.6%) of HR trained personnel expressed satisfaction with their current job -- those working as clerk/stenos, HDTs and ART/HRTs were less frequently satisfied than those working as HRAs. The reasons given for a positive attitude toward their current position were, in order of frequency: the job provided a challenge, stimulation or variety (23); there were good staff relations (17); the work was enjoyable (10); there was ·good management/administration (7); physical working conditions were good (6); there was opportunity to take responsibility/be independent (5), or to use acquired skills/training (5); ahd the working hours were good (5). Seven respondents qualified their positive comments with comments about their low salary. The reasons given for a negative or indifferent attitude toward their job were, in order of frequency: the job . provided no challenge or stimulation, laeked variety, was boring (13); the job either did not use acquired skills or did not acknowledge skills (13); there were problems regarding management/administration (10); salary was inadequate (8); the job description was inappropriate/inaccurate (7); the job did not provide enough opportunity to take responsibility or be in-dependent (4). Other reasons given for either positive or negative attitudes toward work were mentioned by less than 4 respondents. Table 33: Respondents to Job -Satisfaction Questionnaire, Current Work Status by Qualification Status Respondents by Current RESPONDENTS BY ~UIJ.. FICATION STATUS Row Total Work Status Not Specified Clerk/Steno ART/HRT HDT HRA Other ' s ' . Not Specified - - 6 13 12 l 32 (16.2) Clerk/Steno - - 6 5 l l 13 (6.6) ART/HRT 2 5 26 10 5 - 48 (24.4) - l 12 3 - 17 (8.6) HDT l -HRA 3 - 9 2 52 1 Other 2 - 7 3 7 l Column Total 8 5 55 45 80 4 s (4.1\ (2.5) (27.9) (22.8) (40.6) (2.0) Table 34: Attitude Toward Current Position as Re orted b Health Record Trained Res ondents Classified Accordin t Current Wor Status Attitude Toward CURRENT WORK STATUS 67 (34.0) 20 (10.2) 197 (100.0) - . Current Position Not Specified Clerk/Steno ART/HRT HDT HRA Other Row Total s s s s I j s Not Answered 1 (3.1) - - - - l (5.9) - - - ... 2 (l .O) Extremely Pleased 4 (12.5) l (7.7) 6 (12.5) 2 (ll.8) 14 (20.9) 6 (30.0) 33 (16.8) Satisfied 12 (37.5) 8 (61.5) 26 (54.2) 10 (58.8) 40 (59.7) 10 (50.0) 106 (53.8) Indifferent ' 3 (9.4) - - 7 (14.6) l (5.9) 3 (4.5) l (5.0) 15 (7.6) Dissatisfied 12 (37.5) 4 (30.8) 9 (18.7) 3 (17.6) 10 (14.9) 3 (15 .0) 41 (20.8) Column Total 32 (100.0) 13 (100.0) 48 (100.0) 17 (100.0) 67 (100.0) 20 (100.0) 197 ( 100.0) I m _, I -62-Future Employment Plans Currently employed respondents were asked whether they were considering leaving the health record-related work force and, if so, whether permanently or temporarily and for what reasons. Thirty-six (18.3%) health record trained personnel reported they were considering leaving the field. Table 35 summarizes their responses. The largest proportion expressing intent to leave were the HDT's (all of whom indicated a desire to switch careers), although absolute numbers were small. Over ten per cent of all HRAs, HDTs and A~T/HRTs responding to this questionnaire complained of insufficient job challenge, and an equal proportion intended to switch careers. Salary complaints were relatively in-frequent, except within the 'other' personnel category. Respondents who were not considering leaving the health record-related work force were asked to indicate whether they were considering leaving their present employer and if so, (or if they had resigned from a HR-related position in the past two years), to give their reasons. Table 36 summarizes this infor-mation, with multiple reasons again permitted in the responses. Less than expected challenge, and desire for career progression were the most frequent reasons given for leaving or intent to leave an employer. The career progre-ssion aspect was followed up in another question. Potential for Career Advancement Reasons were solicited relating to whether or not current or most recent health record related positions provided experience which would allow career advance-ment in the health records discipline. This information is summarized in Table 37. The most oft-cited impediment to career advancement was that such advance-ment required turther formal education. This was particularly evident for the ART/HRT category, where 24 per cent of all respondents (13/55) noted this as a problem. Experience expectations were not fulfilled by positions held by 14 (7 per cent) respondents. Those filling clerk/steno and ART/HRT positions were not likely to indicate that the current job, educational requirements or both were impeding career progress. Also of some interest is the fact that of those indicating that insufficient education blocked career advancement, almost 70 per cent had a generally positive attitude toward their current employment. In contrast, over 70 per cent of those indicating that unsatisfactory job experience blocked career advancement, were dis-satisfied with their current jobs. All (four) of those noting both education blocks and current job experience deficits, were "dissatisfied" with their current positions. Table 35: Future Intentions Re Health Record Enploent CURRENT WORK STATUS. 'l Not Specified (32) Clerk/Steno (13) ART/HRT (48) HOT (17) HRA (.67) Other (20) Column Total (197) * Pennanently - Teq>orarfly Number & Per Cent of Respondents Considering Leaving the HR Related Wor.k Force # (S Respondents} 3 (9.4} 2 (15.4) 9 (18.8) 4 (23.5) 11 (16.4} 7 (35.0) 36 (18.3) Intended Duration of Absence From HR Work Force ' f.*- 1- N/A l - 2 - l l ' 4 2 3 2 - 2 3 3 5 - 2 5 10 8 18 *** Each respondent could provide more than one reason REASONS GIVEN FOR INTENT TO LEAVE HR WORK FORCE*** Less Than Salary Moving to Return to To Switch Personal Expected Lower Than Another Fe>nnal Reasons Careers Challenge Expected Area - Ed$.lcation 2 l l - - l l l l l - -4 5 4 l - l 4 2 - - 2 -5 7 l - 3 2 l 2 4 l 2 l 17 18 . 11 3 7 5 Other Reasons -l -l 3 -5 I en w I -64-Table 36: Plans to Leave Present Employer, But Remain in Health Record Field REASONS GIVEN FOR CONSIDERING LEAVING PRESENT (or irrmediate east} EMPLOYER 5 .s::. ~ 11 ... ... QI .... .... 0.. .... QI uu "' .... "i ... ;:., I ";;j u ~ is 5!ii c 3: ~ QI cu 0 ~·P"" u Q.OI .., .... ~ :2 "' "' "' ... "'0 o~ .... 0 )( c Ulll Ill c Nl.lllber & Per Cent of UGI QI 111· .... c Ill .... lo.I QI Ill <111 ~ 0 :z~ ........ lil8~ u ... ... QI QI "' Health Record Trained Respondents Considering ,:! i: Ill c.- 0 ... sa: Ill ...... .... a. .... Ill Ill .._ OI ... QI ~! :I cu "'~ Ill .s::..s::. 0 .... Ill a: Respondents Classffied Leaving Their Present u a. .... c :z 1-U QI ... OI 0 c .... :I ........ "' ... 0.. c 0 ... by Current Work Status Employer .... .... in "'"""' c Ill Ill .... _.., f QI .... .... "' ... 0 Ill "' Ill > f! 5 ' (S Respondents) iS ... co..- c QI ~ i< QI Cl =>3 .... :::> .... a.. 0 Not Specified - 3 - 3 5 3 2 5 2 Cl erk/Steno 4 (30.8) - - - - 1 4 3 - -ART/HRT 11 (22.9) 2 2 2 1 3 4 5 1 -HOT 1 (5.9) - - - - - - 2 - -HRA g (13.4) 2 2 1 2 5 7 - - 2 Other 1 (4.8) - - - - - 1 1 1 -Collnn Total 26 (13.2) 4 7 3 6 14 19 13 7 4 Table 37: Reasons for Feeling That Current Health Record Position Will Not Provide Experience Required For Career Advancenent in the Health Records Field, by Current Work Status and Attitude Toward Current Job REASON FOR JOB PROVIDING INSUFFICIENT EXPERIENCE FOR CAREER ADVANCEMENT CURRENT WORK STATUS (a) (b) (c) (d) (e) No Reason Not Seeking Career Advancement Requires Job has not fulfilled (c) and (d) Given Advancement Fonnal Education experience expectations Not Specified - 2 4 5 3 Clerk/Steno - 2 2 l -ART/HRT 1 3 13 4 -HDT - - 3 - -HRA - 3 4 4 l Other - - - - -Total 1 10 26 14 4 Attitude Toward indifferent BOS positive 69.2S positive 7l.4S negative lOOS neJative Current Job (1/1) (8/10) (18/26) ( 10/14) (4/4 (f) Other l --1 1 l 4 5oi positive (2/4) Total NLB!lber and Proportion of Respondents in · Work Status Group , s 15 46.9 5 38.5 21 38.2 4 21.1 13 21.0 . 1 5.0 59 29.9 I O'I tn I -66-Along the same lines, respondents were queried regarding the manner in which current and past health record positions had shaped their health record careers. In particular, information was sought on the role of past positions in career advancement. In addition, the respondents were asked to indicate how their jobs had suppo·rted career advancement or, on the other hand, why they had not, and if this restriction was important. A total of 139 respondents (70.6%) answered this question - 101 felt their jobs had provided career advancement opportunity, while the remaining_ JB did ®t. There we.re no o.utstaruliog anomalies or patterns in the positive responses. Six of the eleven HRAs noting restricted career progress cited limited experience provided by the tasks and responsibilities assigned to them. However fourteen of the 42 affinnative response HRAs cited exactly the opposite traits as stengths in their past positions. Clearly there is considerable variation in the range of tasks and responsibilities embodied in apparently equivalent posi-tions in different settings. Among other reasons offered by those indicating restricted advancement opportunities were 'advanced positions not available' -- these included those at the top of the ladder having nowhere to advance, no vacancies within area where respondent lives or has moved, or no senior positions required/classified for area; and 'restricted job classification·s.', which incorporated reasons describ-ing jobs that over time had grown in complexity and responsibility but had not been reclassified to match job description/title to job reality. For example, a clerk job at one institution might include a range of tasks generally seen for a technician level job at most other institutions. Difficulties in Securing Employment Respondents were asked if they had ever had difficulty in securing employment, and if so, to report the type of position being sought and the nature of the dif-ficulty. Thirty-six (18.2%) of the 197 respondents reported such difficulties. Table 38 classifies their responses by the nature of the difficulty and respon-dents' qualification status. Specific reasons grouped under the heading of 'desired position not available in location of residence' include no HR positions existing in the area, no advanced position existing in the area, desired positions exist but not available {vacancy related) or the suitable position was not available on a part time basis. Respon-dents citing lack of experience as a reason for having difficulty in securing employment were most likely to be referring to their first job and to employers' general lack of support for new graduates. Of particular note is the 18 per cent of HDTs who had at some time been unable to find HOT-level positions in their areas. Other Conments Space was provided on both questionnaires administered to personnel with formal health record training, for supplementary conunents expanding on points addressed in the questionnaires or covering additional issues. Eighty-one respondents {41 per cent) added conunents to the employee questionnaire and fifty-three {27 per cent) to the job satisfaction questionnaire. -67-QUALIFICATION STATUS QUALIFICATION STATUS Not s8;Bified ART/HRT HOT HRA Total n=55 n=45 n-=80 n•l97 I. Desired Positions· Not Avatlable ln [ocatlon of Reslaence . Position Sought N/A - 1 1 - 2 ART/HRT - 2 - - 2 ' HOT - 1 8 - 9 HRA 2 - - 3 5 Director of Medical Records - 1 - - 1 Anything in Health Records - 1 1 1 3 II. Positions So~ht Reguired More Ex~erience ig~er gua1ification Position Sought ART/HRT - 2 1 - 3 HOT - - 1 - 1 HRA 1 1 1 3 6 Director of Medical Records - - - 1 1 Anything in Health Records - 1 1 - 2 lll. No Reason 1 1 Total 3 11 14 8 36 (S of personnel group) (37.5) (20.0) ( 31. 1) (10.0) (18.3) -68-The majority (75 per cent) of corrments made reference to the lack of stand-dardization (training/qualifications, titles/job descriptions, professional status, remuneration/salary) within the HR field in B.C. and across Canada, and to the lack of opportunity for both updating and upgrading of qualifications. It should be emphasized that these are comments offered by respondents, and do not reflect -ei tlle--r '6GR-Se-ll5-US -Gi}i--A-i--EmS- eff.er~ in t"eS-poo-s-e- te- -s--peei fie -questions, o-r necessa-ri ly the views of the project team. Specific comments re standardization are best summarized as follows: 1. the different terminologies for HR trained personnel are too numerous and confusing - distinction between, for example, ART/HRT, HOT, HRA, MRL (usually differentiated by diploma, associate or certificant status within professional body) is blurred by hospital-specific and union-specific variations in funding/job classification; by the history of training opportunities; by the size and individual needs of the employer and by the experience/capabilities of the individual employers. 2. many viewed the professionally determined distinctions in qualifications as arbitrary and artificial with the result that employers did not have a clear understanding of how best to classify and utilize the talents of HR personnel: Suggested solutions included licensure based on strict educa-tional guidelines on the one hand and criteria for performance appraisal on the other. 3. particular mention was made of the health data technologists (B.C.I.T. graduates) position within the field, e.g., they are classified at the same level as the ART/HRT but have more formal training (2 years vs 9 months to l year); the opportunity to advance is restricted by the associate level status but their broader training leads to discontent within a job level that does not challenge all their skills; new gradu-ates from B.C.I.T. with the same length of training will have certificant status, opportunity to hold HRA positions and access to the HSA rather than HEU resulting in a 'significantly' higher salary scale. Major points raised relating to education included: 1. the opportunity to upgrade one's qualification status to certificant level should be available to all HR personnel regardless of location in the province and should be compatible with full time work status. A laddering system was frequently suggested. 2. those who feel they have attained certificant level proficiency by virtue of past training, work experience, continuing education and individual motivation should be allowed to challenge the certificant level examination without being required to take a specific set of academic credit courses. 3. support for upgrading and/or updating and opportunity for subsequent advancement or reclassification should be provided for HR personnel by administration. ,. -69-4. baccalaureate level programs/training are required for HR administration in large hospitals. In addition, mention was made more than once of the following: - job mobility is a problem - community based health services and provincial government health programs are under-employing HR-trained personnel - on-the-job training should be more-readily available Questions were asked about the rationale behind changes in training emphasis from the technician to the administrator. Comments about the survey itself in-cluded the difficulty of accurately distinguishing/categorizing the HR personnel types, the difficulty of assessing time expenditure on specific tasks, and the feel~ng that the questions/task lists were oriented more to HR departments in hospitals than to any other work situation. This latter comment appeared despite the flexibility built into the questionnaires ·for 'write-in' additional tasks . . Comments provided for the job satisfaction questionnaire were primarily concerned with the same issues of standardization and educational opportunities, but were less general, tending to reflect personal experiences. Few respondents commente.d on areas. of job satisfaction -- most cooments were about problem areas or job dis~atisfaction. Typical examples of such corrments are: because of the lack of standardization, two people doing the same job with the same qualifications are paid different salaries under different unions in different hospitals ..• proposals for establishing some consi-stency in criteria used for remuneration varied considerably but included type of training, licensure, level of responsibility, and experience/ performance appraisal standards some respondents felt administration/personnel had little or no under-standing/appreciation of the training/skills of HR personnel and this resulted in any of the following: inappropriate job descriptions/classi-fications, poor physical working conditions, limited delegation of .authority/responsibility leading to overly routine boring jobs, lack of support for participation in continuing education, a poorer salary with 1-2 years. training than some unskilled workers in the same 'institution, formal upgrading not rewarded by improved salary/reclassification, a lack of HR trained personnel in some employment sectors, and a lack of change/ modernization in HR department operations; many respondents who commented o~ the need for upgrading opportunities made reference to the need for improved/equal access to courses even though they lived in remote areas or had to keep working full time. College courses were preferred to correspondence courses by some. A number of respondents noted frustration at inappropriate restrictions or prerequisites to courses and/or exams. -70-B.111 Health Record Clerks/Medical Stenographers A single questionnaire covering much the same area as the non-confidential questionnaire to health record-trained personnel, was administered to a large sample of clerk/steno personnel whose job responsibilities fell within the health reeo-rds bailiwic.k. Age/Sex/Marital Status/Employment Status Table 39 provides a snapshot of respondents' work and marital status, age and sex. Of the 162 respondents to this questionnaire, 159 (98.1%) were female. Close to half (47 per cent) of the respondents were married full time employ-ees, and 137 (85 per cent) worked on a full time basis. All but three of the respondents working part time preferred their part time status and were not seeking full time employment. One-third (35 per cent) of the respondents were 30 years old or less, with two-thirds being 40 years old or less, and female. · Table 40 compares the information provided by the respondents about their current work status, their health record-related qualifications and their cur-rent job title. Seventy-three (.45%) of the respondents reported their current work status as medical stenographer, and 64 (39.5%) as health record clerk. Work status for the remaining 25 (.14.8%) took on a variety of descriptions. This work status distribution was similar for each age group. Employment in the HR Field Respondents were asked to report the total length of time they had been employed in the health record field. Their responses are presented in Table 41, by current work status. The medical stenographers were more likely than the clerks to have been in the field for more than 15 years (15 per cent vs. 5 per cent), and for more than 5 years (.49 per cent vs. 36 per cent). Each group had similar short dura-tion proportions. In general, both 'disciplines' tend to be currently populated by a stable workforce of relatively young personnel. Formal Education Details of formal education were requested, conmencing with high school and including colTITlunity college, hospital or institute of technology, university or correspondence. Information included the name and location of the institution, the number of years in attendance, the program or field of specialization, any Table 39: Clerk/Steno Health Record-Related Personnel: Age/Sex by Full-Ticne/Part-Time and Marital Status AGE/SEX Unknown Marital Status Single Married Other Marital Status FIT PIT F/T P/T F/T P/T FIT P/T 21 - 30 yr. Female ·· - - 26 2 21 3 2 2 31 - 40 yr. Female I 9 28 9 4 l - - -41 - 50 yr. Female - - 4 - 10 6 4 -Male - - l - - - l -51 - 60 yr. Female l - 2 - 15 l 5 -Male - - - - l - - -1io+ yr. Female l l l - l - - -Column Total 2 l 43 2 76 19 66 3 (1.2) (0.6) (26.5) (1.2) (46.9) ( 11. 7) (9.9) (1.9) Row Total I s 56 34.5 51 31.5 24 14.8 2 1.2 24 14.8 l 0.6 4 2.5 162 100.0 ( 100.0) I ....... _, I Table 40: Work Status, Qualifications, and Employment Title; Health Record Clerks and Medical Stenographers Job Title HEALTH RECORD CLERK MEDlCAl STENO . CLERK-STENO CURRENT WORK STATUS Medical Health Other Medical Health Medical Health Other Steno Record Clerk Work Status Steno Record Clerk Steno Record Clerk Work Status gyalifj~ation Status Not Specified l 5 1 6 - 3 2 6 Medical Steno l 2 - 36 l l l -Health Record Clerk - 21 - - - - l -Other - 1 - 1 - - - . 1 ColUllVI Total 2 29 l 43 l 4 4 7 s 32 (19.7) 44 (27.2) 15 (9.3) l continued) Job Title OFFICE ASSISTANT SENIOR SECRETARY OTHER TITLE CURRENT WORK STATUS Medical Health Other Medical Other Medical Health Otherll Steno ·Record Clerk Work Status · Steno Work Status Steno Record Clerk Work Status Qualification Status Not Specified 4 2 1 1 1 2 7 3 Medical Steno . 11 2 l l 1 3 2 2 Health Record Clerk l 10 l - - - 7 l Other l - 3 - - - - 3 ColUllVI Total 17 14 6 2 2 5 16 9 s 37 (22.8) 4 (2.5) 30 (18.5) I 45 65 42 10 162 162 Total s (27.8) (40.1) (25.9) (6.2) (100.0) (100.0) I ...... N I Table 41: Health Record Clerks/Medical Stenographers: Length of Time Employed in the Health Record Field .. TOTAL LENGTH OF TIME EMPLOYED IN THE HEAL.TH RECORD FIELD , . s.. "' cu "' "' "' c!i cu "' "' "'"' ~ ...Is.. "'"' cu"' cu s.. cu "' cu i.. ...Is.. ...... ~ ... '° 0 cu .... .. .. cu c .... +>>- cu · . 0 cu O>- "' ... . C 111 O>- +>>- ... CURRENT WORK STATUS . u ia.c 111.- ... on Ill 8. .c+> .c s.."' ~on 111.- s.. .... c +>C s.. "' "' 0 c .. .. c .. c "' c cu "'::E it=. - cu "' cu "' cu .a >-... "' >-.c >-.C >-.C 0 cu .... ..... .... on z ...I '° ..- N on ..-· Medical Stenographers 12 8 2 5 10 25 11 Health Record Clerks 13 7 1 7 13 20 3 ·Other 4 7 l 3 1 8 1 Column Total . 29 22 4 15 24 53 15 s (17.9) (13.6) (2.4) (9.3) (14.8) (32.7) (9.3) Table 42: Highest Education Attained by Sample of Currently Employed Health Record Clerk/Medical Steno Personnel, Classified According to Qualification and WOrk Status - QUALIFICATION STATUS. WORK STATUS Highest Education Health Record Other Medical Health Record Grouping Not Speeified Medical Steno Clerk Qualification Steno Clerk -High Schoo1 -:0n1y 29 31 32 8 . 39 48 (64.4) (47.7) (76.2} (80.0) (53.4) (75.0) High School and Correspondence - 5 2 4 1 (7.7) (4.7} - (5.5) (1.6) Hospital Training 1 (2.2) - - - - -College-Level 14 27 7 2 27 14 (31.1) (41.5) (16.7) (.20.0) (37.0) (21.9) Universtty-Level 1 2 1 - 3 . l (2.2) (3.1) (2.4) (4.1) (l .6) Coluai Total 45 65 42 10 73 64 (100.0) (100.0) (100.0) (100.0) (100.0) ( 100.0) . Row Total 73 64 25 162 (100.0) Other WC>rtt Status 13 (52.0} 2 (8.0) 1 (4.0) 9 (36.0) -25 (100.0) -Total I s 100 (61. 7) 7 (4.3) 1 (0.6) 50 (30.8) 4 (2.5) 16Z (100.0) I ....., w I -74-degree/diploma or certificate received and the year of graduation. These data were aggregated into specific groupings of 'highest education' in a semi-hierach-ical mutually exclusive fashion as follows: those who completed l. high school but received no further formal education 2. high school plus some formal education by .correspondence 3. hospital training 4. college level education 5. university level education The entire sample of clerk/stenos had completed high school. The year of graduation from high school ranged from 1936 to 1980 and in general reflected the age mix of the respondents. Of those providing the information, 61 per cent completed their high school education in British Columbia, 23 per cent in other Canadian provinces and 16 per cent in other countries (primarily Great Britain and the United States). Table 42 outlines the highest education attained by the sample of currently employed clerk/steno personnel classified according to their reported qualifica-tion status and work status. While the majority completed only high school, a signi.ficant number qualified and working as medical stenographers had some college training. The most frequently mentioned fields of specialization were commerce or busi-ness (which could represent a commercial/secretarial/accounting stream in high school or similar specialty areas at the college level), medical secretary/recep-tionist/office assistant and medical terminology. These specialties accounted for 73 per cent of those mentioned. The most 'popular' correspondence courses were 'conunercial' (16), (e.9., busi-ness education, accounting, secretarial, convnercial), medical terminology (6) and medical records (4). Similar proportions o·f the medical stenographers, HR clerks and 'other' groups of persGnnel reported taking correspondence courses (close to l out of 5 individuals). Seventy-eight per cent of these courses were less than l year in duration, the remainder being l year in length. Continuing Education -Respondents were asked to report their participation in work-related con-tinuing education or professional activities during the· past two years. The types of programs identified by respondents were computer courses (including word processing), pre-supervision for management support staff, medical termino-logy, organizational behaviour, communications,. typing/shorthand, first aide, time management seminars, receptionist training, 'women in the work force', supervision fundamentals, management, clerk/steno seminars/courses, secretarial development, ICD, motivation, and anatomy/physiology. -75-Thirty-two clerk/stenos in the sample (20 per cent) reported participating in at least one continui'ng education program and some specified up to three different programs. For the most part, the programs were aimed at enhancing wr-k sk111 s of a technlcal nature (the most rrequently reported be1ng computer programs/word processing), or of a management/supervisory nature (the most frequently reported being 'fundamentals of supervision'). Of the 32 participants in continuing education, 12 were medical stenos and 14 were health record clerks, by current work status. Future Education Plans Interest in pursuing further formal education, whether in a health record-related area, in a non-health record-related area but in another health sciences discipline, or in a non-health sciences field, was indicated by 95 (59 per cent) of the respondents. Areas of interest were distributed as follows: 40 expressed interest in a health record-related area; 33, in a non-health record-related but health science area; and 41 in a non-health sciences field. Of those choosing further education in a health record-related area, the most frequent fields of specialization reported were HDT/HRA training (12), supervision (3), and an up-date of present knowledge (3). (Other fields of specialization mentioned by less than 3 people included medical terminology, coding and abstracting, ART training, and data processing.) On-the-Job Training Respondents were asked to report any HR related on-the-job training they had ever received. Fifty-seven (35.7%) of the 162 respondents reported receiving some on-the-job training -- this included 27 medical stenos, 24 health record clerks and 6 classified as 'other' work status. In total, 71 mentions of on-the-job training were reported. The nature of this reported training varied widely and is summarized in order of frequency of mention as follows: medical terminology (25), unspecified training (21), coding {_8), and other training mentioned 3 times or less -- statistics, computer use, medical stenography, international classification of diseases, record keeping/ billing, microfiche, research, charting, and administration/supervision. All but 5 of the 19 employers offering on-the-job training were hospitals. Of those per-sonnel who reported the location of their training (32 out of 57), 23 stated either the Greater Vancouver Regional District or the Capital Region. The length of time taken up by on-the-job training programs ranged from less than 1 week (60 per cent of programs mentioned) to 18 weeks. -76-In general, it was difficult to draw a definitive line between on-the-job training, some continuing education courses and orientation to a new job. The interpretation of the respondent was taken at face value as the best means of classification, and care was taken to avoid having courses/training included in more than one category. Job Task Mix Included in the steno/clerk questionnaire was an abridged task/function list which keyed on the quantitative component of the larger task roster developed for the health record trained personnel questionnaire. Respondents were also given space to write-in other tasks. Again, the hours of work information was unreli-able, necessitating sole use of the 'daily', 'weekly' and 'monthly' designations (see questionnaire in Appendix C). SevP.nteen supplementary tasks were written-in by respondents, yielding a total classification of 32 tasks/functions. For clarity of presentation and because some of the categories suggested natural groupings, this set was aggre-gated into thirteen broader task groups. Using the same methodology as that applied to the other personnel task information, we estimated average time allocation profiles for each of stenos and clerks. These appear in Table 43. The results are, of course, subject to the same biases as described in section IV (B.I.). However, there are some quite plausible differences in the two profiles. As one might expect, medical stenographers spend the largest single share of their time (close to 30 per cent) on transcription. Other typing and word proces-sing tasks comprised an additional quarter of the 'average' stenographer's working time. Chart and report retrieval or filing, and varied other clerical tasks ac-counted for close to thirty per cent of work time. This leaves approximately 15 -20 per cent for a11 other tasks. The health record c1erk profile differed most dramatically in the expected places -- much less (almost no) time transcribing, less time typing, and more time on chart/report manipulation, quantitative analysis, coding, admissions/discharges and other clerical tasks. Clerks spent the largest share of their time on chart and report retrieval and filing. Neither group was involved with non-quantitative tasks (less than l~ of time on management/liaison). General Comments As with the formally health record-trained personnel, the clerks/stenos were given an opportunity to add comments about their field of work. Fifty-eight (36 per cent) of the sample group of HR clerk/stenos provided comments that fell within five broad categories -- opportunity for continuing education, employment opportuni-ties, working conditions, training adequacy and general comments about health records. -77-Table 113"! Tnk/Funct1on PY'ofites for Medical -stenographers amt Health Record Clem AVERAGE ALLOCATION OF WORK TIME Task/Function Medical Stenographers Health Record Clerks Admissions/Discharges 0.02 0.08 Assembling 0.03 0.05 Quantitative Analysis 0.01 0.06 Coding 0.01 0.06 Completing Claims Fonns and Other Ministry of 0.01 0.05 Hea 1th Fonns , . Abstracting 0.01 0.02 Transcribing 0.29 0.02 Typing and Word Processing 0.25 0.14 Chart/Report Retrieval Filing 0.15 0.22 Reception 0.08 0.10 Census/Statistics 0.01 0.02 Other Clerical* 0.13 0.18 Management/Liaison 0.01 0.01 Total 1.00 1.00 * Otherclerical includes: microfilm, purging of records, medical library tasks, preparing and processing income reporting fonns, preparing client reports, etc. -78-The most frequently mentioned issue was the lack of opportunity or restricted access to continuing education for both new information and updating. Thirty-eight per cent of those providing comments cited this as their main concern. A variety of types of education were mentioned: supervisory skills, abstracting, word processing, legal issues, medical terminology, health records and general updating of previous training.. Reasons for limited access to education inclwied lack of support from employer, location (usually a small community) and position in the institutional hierarchy. Nine respondents noted little opportunity for advancement or for finding work appropriate to their training -- often location was reported as a reason. Many mentioned as well, their feeling that their skills were being underutilized because their job was unsuitable or their employer did not recognize their po-tential. Six respondents reported poor physical working conditions and/or excessive workload and stress. Cormients were also made about the lack· of finan-cial incentive to improve skills or take on added responsibility. Ten respondents felt their prerequisite training had been most suitable for the job they held, or stated their work required no special training that could not be acquired on-the-job. General comments about health records included the need for standardization in handling health records in the community setting, and criticism about the waste of time, space and effort by current methods of handling health records when computerized systems are feasible and more effective and efficient. C. Earlier Literature The ground covered by the empirical thrust of this project appears to have been given scant previous attention. As noted in the introduction, the literature relating specifically to health record personnel (.as opposed to information systems, for example) has two components -- one dealing with employment, the other with education. This literature is, unfortunately, exclusively set in the U.S. context. Below the border, Registered Record Administrators tRRA) appear to be a close equivalent to our HRAs. Johnson (1981) reports that the American Medical Record Association had over 23,000 members ·in 1979. Johnson and Cave (.1979)_ attempted to distin~uish between technician level and administrator tasks by fielding a questionnaire to close to 1,500 entry level RRAs, or ARTs. Of the respondents, 23 per cent were self-reported administrators, 21 per cent supervisors, 15 per cent assistant administrators and 33 per cent technicians. As in our results by current employment status, they reported a small number (8 per cent) of these health record-trained personnel to be working as clerk/stenos. Ninety-six per cent of their respondents were female, and the average age was 27 years for RRAs, mid-30s for ARTs. Almost ·three-quartersof their respondents work within the acute care hospital sector. The major intent of this study was to examine roles. Since the authors' focus was on assigned roles for entry-level personnel (i.e., generally with less· than one year's post-RRA or post-ART work experience), the -79-results are likely to be somewhat different from those in the present study. In particular, one would expect new RRA-level personnel to have less liaison and ~ement r8Sf)cmsiDi 1 itias than tllose with same years at that level with a particular employer. The study approach was to classify functional areas by increasing levels of complexity of action verbs. For example, such verbs as "apply", "maintain", "retrieve", "code", etc. were identified far more frequently with ART-level than with RRA-level personnel. Similarly, the highest complexity level verbs, such as "evaluate", "monitor" and "interpret" appeared only (and even then seldom) coupled to RRA's, while the second highest verb-group ("super-vise", "develop", "establish", 11 advise 11 , "recommend", etc.) was found to charac-terize RRAs far more frequently than ARTs. This approach was similar to ours in that different types of personnel were asked about similar tasks. But whereas our project requested extent of in-volvement infonnation, Johnson and Cave sought 'type' of involvement data. It is therefore difficult to compare the two sets of results. However, at a general level, both analyses identified significant differences in types of function mix between technician- and administrator-level personnel. Mattix (1980) sought information similar to that solicited through our questions regarding satisfaction/dissatisfaction with educational preparation, and future career plans. The author fielded questionnaires to all graduates of a specific record administration program. Results are based on a relatively small sample -- 37 respondents out of 72 questionnaires. Ninety-four per cent of those employed at the time of the survey were employed by hospitals. Most of the respondents (80 per cent) were directors or assistant directors in medical record departments. Close to three-quarters of the respondents were happy with their jobs, because of "the challenge of the profession, good working conditions and benefits, the ability to use one's knowledge and having admini-strative respons·ibilities in other areas of the institution in addition to the medical record department" (p. 93). Around 20 per cent of those working were dissatisfied, for the oppqsite sorts of reasons -- lack of opportunity to apply knowledge and capabilities, lack of challenge, etc. Nine respondents felt there was room for further advancement in their field, 15 indicated at least a per-ceived opportunity to expand their scope of responsibilities, while 8 indicated no opportunity for advancement with their current employers. Eighteen of the respondents ·indicated a desire to earn an additional degree, with MBA, public health and . health information systems being the most desired options. A similar follow-up of ART-level graduates was reported by Von Kuster et al. (1976). Again, around a 50 per cent response rate was achieved, with ninety-four responses. Exactly half the respondents were, at the time of the survey, still employed in their first job. Fifteen per cent of respondents had never been employed as record technicians, and an additional nine per cent had in the past, but were no longer. Of those employed, 78 per cent were in hospitals. This s·tudy also questioned those to whom the technicians reported in their employment settings. Eighty per cent of the supervisors were satisfied (or very satisfied) with the capabilities of the formally trained technicians, and almost -80-two-thirds felt that similar expertise could not be garnered on-the-job. Forty-two per cent of supervisors "reported that by employing MRTs, their facility could defer hiring a medical record administrator" (p. 26). Reporting on the American Medical Record Association's 1974 Task Force on the future Role of the Medical Record Ad__ministrator~ Stumpfhauser (1976) noted that 87 per cent of ARTs held jobs requiring ART accreditation, but the other 13 per cent held RRA-level jobs. Ninety-two per cent of RRAs held corresponding jobs, while the other 8 per cent held jobs not requiring 'registration' (the apparent equivalent of CCHRA certificant status). This is quite consistent with our finding of relatively few 'off-diagonal' personnel in our qualification status by employment status matrix. Over three-quarters of the ARTs and over half of the RRAs surveyed by this task force desired a return to further formal education. Most ARTs were interested in obtaining a B.Sc. degree and registration, while many RRAs were interested in obtaining masters degrees. Health information and management were the most frequently mentioned areas of specialization. \~hile this literature concurs in general with the results of the present study, the educational, employment and registration/certification characteristics of the different settings limit the usefulness of the American evidence to the current B.C. situation. Davenport (1980) reports a relatively crude approach to estimating require-ments for health record personnel. Based on per bed "technical standards". the method attempts to incorporate "demand shift" factors peculiar to an area over the period of projection. It is, of course, defining those "demand shift" factors which makes or breaks any manpower projection model. With respect to Canadian information, the U.B.C. (1977) report of the Health Record Administration Committee estimated 10 - 12 HRA level positions available by 1982. V. EDUCATION - HISTORY, ISSUES AND OPPORTUNITIES The health record specialist (whether technician or administrator) has had a chequered past, not only in B.C. but in the rest of the country and the U.S. This has been a result of a constant, yet changing search for a professional niche. The absence of well-established professional roles has inevitably spilled over and manifested itself in lack of clear direction from health record · associa-tions, and confusion within the education sector. The corresponding problems in the employment sector seem to have been uneven and inconsistent educational re-quirements and hiring policies. It is difficult to determine, of. course, the direction of causality. Current educational is·sues may be classified into two types -- general and specific. At a general level are issues related to personnel classification --what types of persons should a program train, and .how best can one ensure a viable profession (i.e. opportunities for professional advancement). Specific issues would then relate to curriculum content and optimal program-specific size. But .. -81-the two levels are clearly interdependent -- optimal program size depends on supply and demand which depends, in turn, on personnel classification and qualifications. While the situation in B.C. is particularly muddy, these issues are not unique to the province. Nor are they issues likely to be resolved easily. In B.C. we wrestle with the need for technician- and administrator-level programs, and beyond, and with ensuring sufficient laddering to create attractive careers. It is not surprising, then, to find the progression or laddering issue of inter-est as well in the United States (Waters and Hanken, 1977; Johnson, 1981) or to find that the Task Force on the .Future Role of the Medical Record Administrator (-Task Force, 1974) focused most of its energy on defining a professional hierarchy (technician/administrator/health information coordinator). The professional identity crisis also appears widespread in the U.S. "There is particular concern because MRA functions are being assumed by systems and/or computer specialists who are not MRAs ..• 11 (Johnson, 1981, 34). The fact that such problems continue to plague the 'profession' in a country boasting numerous baccalaureate-level health record administrator programs makes all the less sur-prising the fact that similar issues are areas of concern and contention among CCHRA and HRABC members on this side of the border. Szabo (1980) has done a commendable job of documenting the unique and peculiar professional and educational situation in Canada and particularly in B.C. For that reason, only a skeleton is reproduced here. The year 1942 marks the formal begin-ning of a national body representing health record personnel. The Canadian Associa-tion of Medical Record Librarians, however, represented "only three RRLs in B.C. at that time" (Szabo, 1980, 36). Education in health records, such as it was, was hospital-based. Throughout the 1950s, a 2 year correspondence course was offered jointly by the CAMRL and the Canadian Hospital Association, to persons working in hospital medical record departments. Graduates were called medical record librar-ians (MRLs), and under changing terms and conditions were usually ultimately eligible to write registration exams (to upgrade to registered librarians (RRLs). In 1960 the correspondence course was changed to one year technician-level training, again for those already working in hospital medical record departments. With the shift of health education programs to community colleges, two-year technician programs were initiated at Niagara College and B.C. I. T. "With the ending of the correspondence course for the training of Medical Record Librarians, the phasing out of some hospital-schools, and the reduced output of some of those remaining hospital-schools, the percentage of Registered Record Librarians was decreasing within the association ..•. This imbalance prompted the association to grant the right to train medical record librarians (who [would] be eligible to write their registration examination) to newly opening two-year college programs; concurrently, one-year programs were started at other community colleges to gradu-ate Record Technicians. Consequently, serious inconsistencies exist within the assodation's educational patterns" (ibid., ·39). · -82-In 1976 the CAMRL became the Canadian Health Record Association, (Canada, (19Bla), which in turn assigned accreditation and standard-setting to its rcollege' -- the Canadian College of Health Record Administrators. Concurrently, there were a number of changes in titles. Registered record librarians became health record administrators and Certificants of the CCHRA. Technicians became or were eligible to become Associates of the College. A 'Fellow' designation was also made available to distinguished Certificants with years of experience and con-tributions through publication/teaching, etc. Szabo (1981, 41) indicates that as of recently, no one had been made a Fellow. While the concept of three levels -- technician, administrator, and senior-level personnel; or associate, certificant and fellow -- seems straightforward and not inconsistent with the American situation, operational simplicity has been elusive. Since accreditation developments were not planned in concert with educational progression and grandfathering provisions, one finds now a quite remarkable mix of personnel and educational possibilities. As Szabo (1980, 41) notes, "The progression from the lowest to the highest status is not yet clearly established. This progression is based partly on further education, partly on the accumulation of credits for attendance at associational events, partly on work experience". Of course, behind all this confusion still lies the major underlying problem -- an ill-defined role or set of roles based on health care sector needs, which has resulted in inconsistent educational content requirements. Current Educational Opportunities - United States Two levels of program are available. Four year baccalaureate programs in medical record administration train persons who are then eligible to sit a national registration exam. Successful completion of this exam permits one to become a registered (with the AMRA) record librarian. In fact the health record-related content of these baccalaureate programs is generally confined to the senior two years. Those with an undergraduate degree may generally complete requirements in twelve month postgraduate programs. Medical Record Technician training programs are of one or two years' duration. There is also a national accreditation examination for this level, leading to an accredited membership in the AMRA as an accredited record technician. Appendix F contains additional information on educational opportunities and accreditation requirements in the U.S. -83-Current Educational Opportunities - Rest of Canada Canada Health Manpower Inventor~l980 (.Canada, 198la) provides information on pregrams trai-nifig perS'Ons t-OWard t · Ce-rtifiea-n-t l-eve-1 of the CCHAA. In 1981 this totaled six programs outside B.C. Locations, institutions and lengths of programs appear in Table 44. The only French language program, in Montreal, graduates over 40 administrators each year. The non-B.C. English language pro-grams graduate just over 50 per year, although the St. Michael's hospital pro-gram is slated to move from 8 to 20 graduates in 1983. With the exception of the CEGEP program, the duration of all these programs is approximately two aca-demic years including practica. Programs outside B.C. training persons at the technician level are listed in Canada (198la). Table 45 provides the information on location, institution, program length and number of graduates. Approximately 70 graduates are trained each year. While most of the programs range from nine to eleven months in length (one academic year), the Niagara College program is of two years' duration. Education of Health Record Personnel in British Columbia Until 1963, the only training of health record personnel in British Columbia came via the Canadian Hospital Assoication correspondence courses. Shortly after the correspondence course shift to technician-level training, Notre Dame University in Nelson initiated its Medical Record Librarian program. This was a four year baccalaureate program. In 1973, the program was informed that it no longer met the accreditation standards of the Canadian Association of Medical Record Librarians, and as a result Notre Dame hired a new program director with a mandate to rectify the deficiencies. In 1975, the HRABC presented a proposal to the B.C. Medical Centre and Universities Council of B.C. for developing a new 4 year Health Record Admini-strators program. The Joint Advisory Committee established to examine this proposal first conducted a review of the updated NDU program and, in doing so, precipitated their re-accreditation in 1976. In the meantime, however, a decision had been taken to close NDU by June 1977, with the intention of investigating alternate sites for the program. Efforts were made to relocate the Medical Record Librarian program at a coastal university, with UBC being recommended. A program proposal was devel-oped for, and eventually rejected by, the UBC Faculty of Medicine. The Universities Council then approached the University of Victoria, which proceeded with development of a health information science program described in greater detail below. In the meantime, a 'technician-level' program commenced at B.C.I.T. in 1971, with annual graduation of approximately fifteen students. The program was more comprehensive than comparable programs training health record technicians. In fact it was more clearly patterned after two year HRA programs elsewhere in Canada. Yet its graduates were not eligible to sit the certificant-level exam -84-Table 44: Location~ Institutions, Nunt>ers of Graduates and Lengths of Programs Training Health Record A 1n1strators in Canada, Outside 8.C., 1981-2 Location & Institution Alberta Northern Alberta Institute of Technology, Edmonton Saskatchewan Wascana Institute of Applied Arts & Sciences, Regina Ontario Algonquin College of Applied Arts & Technology, Ottawa St. Michael's Hospital, Toronto Quebec CEGEP d'Ahuntsic, Montreal Nova Scotia Halifax Infinnary, Halifax Length* Two years Two years Two years Two years Three years Two years * Approximate lengths only. Infonnation obtained from B. Nelson, B.C.I.T. ** PRODUCTION '81 Estimated Yearly Graduates** 16 10 15 8 42 6 -85-Table 45: Loat1ons. lns.titu.ti.ons. Numbers .. of Graduates .and Lengths .o.f Prpsrams Ir-Unipg Hea.ltb. .Re.co.r.d Technicians in Canada, Outside, B.C., 1981-2 * ** Location & Institution Alberta Southern Alberta Institute of Technology, Calgary Saskatchewan Wascana Institute of Applied Arts and Sciences, Regina Manitoba Red River C01111111nity College, Winnipeg Ontario Niagara College of Applied Arts & Technology, Welland Fanshawe College of Applied Arts & Technology, London Nova Scotia Halifax Infirmary, Halifax Canadian Hospital Association and CCHRA Length* one year one year one year two years] one year one year Correspondence, one year Approximate lengths only. Information obtained from B. Nelson, B.C.I.T. PRODUCTION '81 Estimated Yearly Graduates** 25 5 12 33 6 must be working in a hospital to be eligible to take program -86-of the CCHRA. In short, the program was deemed to fall somewhere between train-ing technicians and administrators. For this reason, it was named the Health Data Technology program. Consistent with its peculiar and unique status, some of its graduates have taken up administrator-level positions while some employers seek-iTllJ to hire ttAAs have re fused to consi-der Hfffs. The status of the B.C.I.T. program has recently undergone significant change. Commencing with the September, 1978 intake, the new Health Information Technology {HIT) program began training HRAs eligible to sit the CCHRA certificant-level exam. In addition, B.C.I.T. now offers {as of September 1981) an evening continuing education program allowing former HOT ·graduates to upgrade to a level equivalent to that of the new HRA graduates. This allows past HOT program graduates to sit the certificant-level exam as well. Finally, the Ministry of Education has most recently approved but not funded a proposal for a one year health record techni-cian program at B.C.I.T. Colillllencing in September 1982, the University of Victoria {UVIC) will offer a four year baccalaureate program in Health Information Science. Initial intake will be 30 students per year. This is not intended as a health records training program. It will not produce health record technicians or health record admini-strators. Nor has the relationship of graduates of this program with the CCHRA been articulated. (While certificant level has been mentioned, the problem of distinguishing between these persons and traditional HRAs has not been addressed). The curriculum in the latter years of the program is not yet well developed, but presumably students would be able to select {through electives) a specialization stream emphasizing health data and information processing. However, the intent of the program seems to be the generation of graduates with a much broader expo-sure to information technology in the context of health care delivery. Graduates are likely to have less exposure to the technical and practical every-day aspects of health record processing in the health care delivery system, and more expertise in the theoretical and planning aspects of information systems, program evaluation and the like. As such, the program creates a potential upward educational step in a career ladder for health record administrators. In British Columbia, formal laddering arrangements with B.C.I.T. would be necessary if gradu-ates of the HIT program were to be granted admission to the third year of the UVIC program, and/or graduates of a future HRT {one-year) program granted admis-sion to the second year. It is not clear at this time that such laddering is feasible, and the feasibility of this coordination is a curriculum/education issue beyond the scope of this project. 9 As we will discuss in later sections of this report, however, such integration would be highly desirable for health record admihistrators and, given likely technological trends, perhaps essential to their continued employment. g An essential first step would be the development of a course transfer guide covering the B.C.I.T. Health Information Technology program, similar college courses, and the courses required by the new University of Victoria program. -87-There are, finally, numerous courses in medical stenography offered throughout B.C. Table 46 provides infonnation on location, institution, enrol-ment and type of course. VI. HEALTH INFORMATION TECHNOLOGY AND HEALTH RECORD PERSONNEL FUTURES Perhaps the single most important factor in determining future health record personnel requirements is the likely state of information technology as applied to health records. Because future scenarios depend so critically not only on the technological state of the art but also on political pressures, finances, the training of available personnel, etc., it is impossible to develop with confidence, realistic projections of requirements based on 'what will be' x years down the read. In addition, an in-depth discussion of the current and po-tential form and role of health infonnation systems is clearly a project in it-self, and not one to which the Health Manpower Research Unit could bring any particularly special expertise. This section of the report, then, has a somewhat more modest goal. We provide a relatively brief and very selective synopsis of the literature on both medical information systems and future roles for health record personnel. We then contemplate the types of systems one might find in B.C. 's future, and discuss some possible health record personnel scenarios. Electronic data processing (EDP) has had some role in health care for at least a quarter of a century. Giebink and Hurst (1975) cover some of the early developments. It is interesting to note that approximately fifteen years ago, computers were being touted as the solution to myriad paper, cost and person-nel problems, as well as playing significant clinical roles in diagnosis and interpretation: 11The computer was hailed as an eventual replacement for the physician, an efficient manager of medical records, and an instrument which would soon dominate the human element in data acquisition, processing, and interpretation. Computers in hospitals were to handle communications among all departments, assist in the acquisition and interpretation of medical, social, and financial information, and act as an integrator of the data. The computer was to perfonn the mechanical, repetitive, time-consuming chores of recording and placing orders for medications and procedures and was to be used as a major daily operational tool in ancillary departments of the hospital'~. (ibid., 5}. Most of that promise did not (and in fact has not yet) come to fruition, and blind faith cost many an institution dearly. Remarkably, one hears much the same claims and promises today, with a few major differences. The technological advances over that fifteen year period have been nothing short of astounding. Even those advances will pale in contrast to the advances over the next fifteen years. Furthennore, there are some 'successfully' operating systems now in place (Lindberg, 1979). But the major issues -- ultimate impact on patient health outcomes, and the finan-cial costs and benefits -- remain largely unevaluated (see Dragen and Metzger (1981), Coffey (1980), Rogers et al. (1982), and Rogers and Haring (1979), for examples of cost and patient impact studies). -88-Table 4~: Institutions. Programs and Enrolment for Medical Stenographers/Health Record Clerk Pro!lrams Institutions Types of Programs V.C.C. - V.V.I. Medical Stenographer Transcriptionist Hospital Clerical Worker Medical Office Assistant Dental Receptionist Capilano College Medical Office Assistant Douglas College Medical Secretarial Malaspina College Medical Office Assistant Pacific Vocational Institute Medical Transcriptionist Okanagan College Medical Secretary Northwest C0111Tiunity College Medical Stenographer Camosun College Medical Office Assistant Medical Terminology Cariboo College Medical Dictaphone/Typing College of New Caledonia Medical Tenninology Medical Receptionist East Kootenal Communitl College Medical Terminology * ** Medical Secretarial - continuous intake, individual program Medical Stenographer - continuous intake *** Medical Dictaphone/Typing - on-going. part of word processing program Enrolment JO 16 36 varies 25 varies* 18 8 29 varies** 35 28 5*** 20 20 15 (part time) .. • • -89-One might think of computer applications in health care as being of two broad types -- administrative/management/planning, and clinical. Examples of the former might include financial and cost accounting systems, billing systems, resource and utilization systems and the like. Among the latter would be compu-terized monitoring laboratory, pharmacy and radiology systems and d1agnost1c and therapeutic aides. The health record, of course, spans both, being a major input into most functions falling within each broad category. The process of computer-izing medical records has traditionally been one of reducing a large quantity of hard copy to a machine readable synopsis (abstracting and coding), and then in-putting it into some pre-determined computer file structure. The future may see a bypassing altogether of large components of the paper record, if direct inter-active entering of data through VDTs becomes widespread. In any case, such records have a role in both administration/planning, and in the prospective or retrospective practice of medicine (diagnosis, quality assurance, etc.). Descriptions of existing systems may be found in a number of sources (e.g., Giebink and Hurst, 1975; Lindberg, 1979; United States, 1977). The speed of technological change may, however, already have dated such sources as description of state of the art systems. In a comprehensive look at twenty-nine computerized systems, Giebink and Hurst (1975) found a 'medical records' application mentioned in twenty-five (the single most frequent application). The most oft-mentioned objective (but in only 13 of the 29 projects) was "improve quality of patient care", while "improve efficiency" and "improve cost control" were reported by representatives of only eight and three of the projects respectively. Three of the best-known systems currently (or as recently as three years ago) in operation, are PROMIS, TMIS and COSTAR. All three are documented in Giebink and Hurst (1975), Lindberg (1979), and United States (1977). In addition, Dragen and Metzger (1981) review a number of cost evaluations of the TMIS system. Brief descriptions of each, with an emphasis on medical record applications are offered below: PROMIS (Problem-Oriented Medical Information System) (University of Vermont) As its name suggests, this system is primarily patient-medical-record-oriented, and emphasizes the use of 'problem' information in concert with diagnostic and treatment information, to enhance the process of patient care. It "is designed to store all pertinent medical infor-mation concerning any patient. It is not designed for a particular medical specialty setting. Furthermore, it is designed to preserve within its records of patient care the linkages necessary to relate all items to one or more explicitly stated problems of the patient in question" (Lindberg, 1979, 43-4). The computer terminal plays a central role in this system. A variety of informational formats may be requested, and viewed on a CRT screen, so as to reduce or eliminate reliance on paper records. "During a four-year demonstration period there were no written records maintained in parallel" (ibid., 44). Terminals for accessing or updating patient records are located on the wards as well as in laboratory and radiology, pharmacy and the operating room. "All contents of the system are organized -90-around the scheme that patient management must be divided into four phases .... acquisition of a data base (information concerning the patient); a state-ment of the problem list; development of a plan of action for each problem; and the -keeping of progress notes on each prob 1em 11 (op.cit. ) This system was designed as a physician-aide. It has built-in prompting and feedback re diagnoses and treatment procedures, is linked to current literature on specified procedures or diagnoses, and in general serves to introduce a more structured, methodical discipline to the practice of medicine. In addition, of course, it provides a record of the logic of approach to a presenting problem, thus facilitating medical audit/quality assurance function. On a process-basis, there is little doubt about the benefits of the system. Cost/effectiveness justification on an outcome basis has, however, failed yet to materialize. For example, Giebink and Hurst (1975, 201) note that "there were no personnel replacements as a result of system implementation, but there were significant role changes for both physicians and nursing staff. The system is used most by medical professionals, nurses, and paramedics, rather than by clerical and management personnel". Of primary importance to the focus of the present project is that the medical record is generated and updated by those providing service, and by the patients themselves. COSTAR (Computer Stored Ambulatory Record System} (Harvard Community Health Plan) This system encompasses both clinical and administrative/managerial functional areas for a prepaid group practice '(HCHP) with approxi-mately 50,000 members. Unlike PROMIS, data are not entered into the system directly by providers. Instead, physicians, nurses and others involved in direct care complete encounter forms by checking off specified items appropriate to each encounter or procedure. These forms are pre-coded, so that no abstracting is necessary. The data are entered into the system by clerical staff with no training other than minimal systems operation. The medical record department of the HCHP interacts with providers by ensuring that all pertinent status information is provided in hardcopy format at the time of scheduled appointments. In addition to batch inputting and batch hardcopy report production, however, interactive query capability is built in. The system, like PROMIS, is used in quality and treatment regimen control. Unlike PROMIS, COSTAR incorporates management information functions relating to group practice enrolment, appointments, budgeting and planning. TMIS (Technicon Medical Information System) This is the only one of the three systems reviewed in this report which was not designed specifically for a particular institutional setting. Rather, it is a commercially offered system, described here in the con-text of perhaps its best known site -- El Camino Hospital in California. -91-Data are entered directly by physicians, nurses, etc., as well as by admitting clerks, at VDTs spread throughout the hospital, including nursing stations. Tests and other orders may be entered by physicians using light-pens to mark designated spots on the VDT screens, and the system has built-in completeness-prompts. "Clerical personnel type in dictated radiologist reports in the X-ray department", while "results of high volume laboratory tests are entered by linking automated labora-tory instruments dfrectl y to the nus computer". ( u-. s. ' 1977' 22}. Both interactive VDT and hardcopy information retrieval are possible. TMIS also builds in some of the medical knowledge library features of PROMIS. In addition, the system perfonns a number of business and administrative functions such as patient billing, payroll, inventory, etc. This system generates only part of each patient's medical record. A hardcopy of the computerized segment of the record sits alongside supplementary progress notes, patient history, etc., in a manual medi-cal record. As s·uch, the medical record department is still the final repository for complete records, computerized and manual segments must be coordinated, and functions such as abstracting are still an integral part of the system. Of the three systems described briefly here, this seems to be the only one on which special attempts have been made to undertake economic evaluations (Giebink and Hurst, 1975; Dragen and Metzger, 1981; Coffey, 1980). In a multivariate analysis of the effects of the TMIS on hospi-tal operating costs (ex direct TMIS operating costs), the largest cost saving impact appeared for nursing department costs (Coffey, 1980, 7). · 11TMIS reduced the amaiint of time that nurses spent on paperwork. A concerted management effort took advantage of the lessened workload and reorganized the nursing staff. It was a reduction in the nursing work force which ultimately caused the decline in departmental costs". Average lengths of stay were also significantly reduced by the system's ability to enhance test turnaround time. However, it is important to note that the lowered average lengths of stay did not reduce total days more patients were admitted per month. Thus, nursing costs per patient fell significantly, but there was no significant impact on nursin9 costs per patient day, and nursing costs per month rose significantly. {Of course, so did revenues, and in the U.S. context the bottom line still reigns supreme!) All other significant changes in costs (whether per pati-ent, per patient day, or per month) were increases! Of course once the operating costs of the TMIS were included in hospital operating costs, any reductions in costs vanished. Since labour (.and particularly nursing labour) costs comprise approximately 70 - 75% of hospital operating costs, any cost savings through implementation of infonnation systems must come through reductions in personnel employment. Such reductions. would be partly in nursing personnel (through reduced paperwork for nurses), and partly in support staff (.administration and medical records). It is. not sufficient to identify theoretical time saving impacts of MISs through -92-such methods as task analysis or job content analysis. Time savings can be con-verted to cost savings only through reductions in wage bills. Dragen and Metzger {1981) note a number of other potential pitfalls in moving from estimated labour savings to operationa·1 cost savings. On the other side, of course, are the rather substantial operating costs of the systems themselves. For example, Giebink and Hurst {1975, 49-50) report annual operating costs of $300,000 for COSTAR, $996..,ilQQ fo.r TM1S~ and $919,DOO f~r PR!lMlS. and one might assume significant increases since those data were assembled in the early 1970s. Of course, operating and developmental costs may be expected to fall over time as the technology advances and the bugs are ironed out of some of the pilot systems. If one is able to draw any conclusions from the limited literature on information systems as they currently exist, those conclusions would be: { i) {ii) {iii) evidence is still scarce on the patient outcomes effects of these systems {see Rogers et al., 1982 for a recent example); in the absence of positive impacts on outcomes, such systems would still be justifiable if significant cost savings could be realized in conjunction with no health outcomes impact; while there is scattered evidence of the potential to reduce selected task times and rationalize labour deployment, one cannot make the leap from there to operational cost savings on faith. Cost reduction must come through labour cost sav-ings, and the .evidence that such cost saving rationalization takes place in concert with system implementation has yet to be produced in any consistent manner; one may conjure up visions of information systems along a broad spectrum ranging from administrative {payroll, inventory, billing) system aides, to sophisticated interactive medical record and diagnostic/therapeutic aide systems with linkages to national or provincial medical information libraries. The latter address the ever-increasing problem of individual physi-cians {even within sub-specialties) staying abreast of research developments in their areas, and allow decision-analytic methods to be applied to the practice of medicine. Where does all this leave the future of health record personnel? This discussion has, if nothing else, made clear that the mix and skills of person-nel needed in this province five and ten years from now will depend critically on the systems of health care information-handling put in place in the interim. Those involved with health record administration training are increasingly advo-cating training geared to computerization. Thus, for example, the AMRA Ad Hoc Committee on Graduate Education recently recommended that graduate programs appropriate for educational advancement of experienced health record admini-strators include a content area in "management of computer-based information systems for health care facilities" {Journal of AMRA, 1980). The AMRA Task Force on the Future Role of the Medical Record Administrator reported that the most frequently mentioned subject area for further education desired by ARTs and RRAs in the U.S. was "health information coordination"; the third most frequently mentioned area was "computers and systems analysis" (Stump~hauser, 1976). Ball and Shannon,(1980, 109), suggest that "as the field of medical record science continues to grow and unfold, it is inconceivable that medical record scientists can be fully effective designers, administrators or imple-mentors without specific skill in medical computer sciences and without the -93-art necessary to integrate the specialties in a· way that sharpens focus on the whole patient". Szabo (.1980) undertook a delphi survey aimed at estab-lishing experts' views of the future role of health record administrators in Canada. While there appears to have been an overly-heavy weighting on medical f)ractltiGRe-rS in the saffif}ley and wnile the i)Glicy d-iscussi-OR in tnis thesis seems, at times, somewhat distant from the data analysis on which it is pre-sumably based, a number of the findings are of some interest. Many of the roles suggested for future HRAs were based on an assumption of availability of quite different HRAs than presently function in the field. In particular, HRA involvement in areas of quality of care assessment, research, health information systems, computerized records, and health information linkage were among the most often-mentioned future roles. HRAs as currently trained would be often ill-equipped to function in participatory, organizational, integrative or advisory capacities in some of these areas. Along with alternative scenarios for health information systems, then, are alternative scenarios for health record personnel. A number of alternatives are offered .here: (a) status quo - some computerization and record linkage in larger and more modern hospitals, but widespr.ead continued reliance on paper records, and purchased services such as PAS and HMRI. Implications are continued need for record technicians and administrators in com-plements not unlike those seen in current deployment patterns. (b) more widespread computerization, but no direct input by practitioners -- this type of 'future', such as the COSTAR system, might still mean some need for the abstracting and coding tasks of technician-level health record personnel. Since medical record departments as now organized would still have a role, health record administrators would also still be required. (c) fully computerized medical record, administrative and clinical aide systems with linked records from multiple care sites, and direct in-put by practitioners and technicians -- this type of system would eliminate the need for the technician-level health record person. There would still be a need for clerk/steno level personnel to in-put admission information, standardized histories, etc. The health record administrator as currently trained could be obsolete, as there would be no need for medical records departments as now envisioned. Instead, health information specialists with expertise in systems design for the health care setting and health information linkage might play a planning/facilitation/liaison role. It is unclear whether such personnel would serve in management capacities, or only as technical/research consultants. Even in robust economic times, it would probably be safe to say that we are a fair distance from a fully integrated system in B.C. which would link all 'parts' of care, at least regionally, and which would see all component systems linked, in -94-turn, to a provincial or national medical information data bank. In view of our climate of fiscal restraint, and the economic uncertainty which may linger for a number of years, the operati.onal advance of technology may be considerably slower in the next five years than it has been in the past five. Since cost effectiveness for information systems depends on labQW' cost savings. or yet to be demonstrated significant positive impacts on health care outcomes, and since issues of cost effectiveness become more important in times of recession and tight public budgets, we are unlikely to see rapid widescale strides over the next five years .. One might expect exceptions in the case of new institutions, where the need to rationalize existing personnel employment is circumvented. Therefore, it is our view that the status quo, slightly modified to incorporate slow 'computer-creep' , . is the most likely health record personnel scenario. The implications of this are taken up in the final section of this report. .. -95-VII. SUMMARY AND POLICY IMPLICATIONS The principal objectives of this project were to attempt to develop a provincial picture of health record handling in terms of the personnel involved in the collection, storage, manipulation ana transmission of health records; to gather together information which would allow an assessment of the relation-ships between personnel education and experience, and health record-related responsibilities; and to attempt to develop personnel and education require-ments, taking into account the potential impact of changing technology on health information collection and exchange. In this final section of the report we sunmarize the major findings from the data collection and analysis, and then reflect on the apparent policy implica-tions of the information gathered here. Summary of Questionnaire Responses Three hundred fifty-one agencies, identified by project staff as potential employers of health record personnel in B.C., were surveyed in 1980-1. Two hundred eighty-six agencies completed the questionnaire (just over an 80 per cent response rate). This response rate must be interpreted with caution since the survey instrument was used both to collect information and to ascertain potential sources of that information. Non-responses were relatively evenly distributed across types of employers. Two hundred sixteen institutions/agencies involved with health records were identified, and of those, 210 hired personnel specifically because of that involve-ment. One hundred twenty-five employers hired health record personnel for for.mal health record 'departments'. Four broad categories of personnel were identified: medical stenographers and health record clerks, accredited or health record technicians (ART/HRTJ, health data technologists (HOT), and health record administrators (HRA}. With the general exception of the first category, these personnel require some formal health record-related training for their job clas~ifications. Respondents in-dicated employed f.t.e. totals of approximately 1,100 clerks/stenos, 105 ART/HRTs, 30 HDTs and 100 HRAs. When adjustments based on 'average' employment patterns are made to account for non-responses, the size of the current health record sector (in f.t.e.} is as follows: medical stenographers health record clerks .accredited/health record technicians health data technologists health record administrators other health record-related personnel ~sso ~740 ~115 30-35 100-110 ~so -96-Fifty-four per cent of employed health record personnel (as reported by employers) were linked to formal health record departments. Almost all non-health-record-department employees were clerks and stenos. Thirty per cent of the personnel in the health record departments of respondents were those falling into categories indicating formal health record training (ART/HRT, HOT, & HRA). Hospitals employed over three-quarters of formal health record department per-sonnel. Ninety-one per cent of health record personnel were employed directly, or their positions funded indirectly, by the provincial Ministry of Health. With-in the hospital sector, health record personnel employed per 100 beds tended to descrease with increasing hospital size, while personnel per hospital increased with hospital size. Employers provided a general description of tasks performed by each type of health record personnel. Responses suggested that, in general, stenographers were primarily involved with transcription and other typing, clerks with admis-sions, discharges and file-related tasks, ART/HRTs and HOTs with coding, abstract-ing and checking for record completeness, and HRAs with planning and management/ organizational activities. The more detailed task mix information provided by employees was highly consistent with the employer responses. In particular, the ART/HRTs and HOTs all reported spending the major portion of their work time on quantitative tasks, while HRAs reported spending about 50 per cent of their time on quantitative tasks and the other half on management, liaison and qualitative functions. Perhaps the most interesting finding from the task mix analyses was that HOTs, while receiving education arguably equivalent to that of many HRAs, more closely resembled technician-level personnel in the work functions actually performed. This may have been a result of institutional/employer hiring policy rigidities, but may also have reflected the types of positions sought by the graduates of the HOT program. Also interesting was the finding that hospital bed size was not a significant factor in determining task mix for those employees within the hospital sector. · Three types of information regarding recruitment were solicited from employers. These are each and together of consi'derable policy importance. First, employers assessed the adequacy of training of their health record personnel. The most oft-reported 'complaints' regarding medical stenographers and health record clerks related to the need to train on-the-job li.e. hiring persons with little or no training), and the difficulty of recruiting personnel with medical terminology training. However, given the large number of medical stenographers, the frequency of mention of these inadequacies was not unduly alarming. For technician-level personnel, inadequate medical terminology background, and com-plaints about the content of the CHA correspondence course were the most fre-quent. Employers of health data technologists seemed equally divided on the strengths and weaknesses of the B.C.I.T. program, often praised the general training of the HOTs, and occasionally questioned their background experience. Second, employers were queried regarding vacancies at the time of the questionnaire, and past ltwo years) difficulties in recruiting. The largest number of vacancies, both in absolute numbers and as a proportion of f.t.e. positions, was reported for HRAs (about 13 per cent). The next largest vacancy rate was for technicians {about 9 per cent). No vacancies were reported for HOTs, probably because very few positions would have been designated as 'HOT positions'. • -97.-The most frequently mentioned reason for past and current recruiting difficulties was the unavailability of sufficient trained/experienced person-nel. This problem was most frequently mentioned with respect to medical steno-graphers, but as a proportion off .t.e. positions, frequency of mention was approximately equal for all three formally trained categories (ART/HRT, HOT and HRA), and above that for the stenos and clerks. Vacancy rates for positions which can be filled by training 'on-the-job' must, of course, be treated with some caution. While the implied vacancy rate for stenos/clerks was 2% - 3%~ many more vacancies may be filled with persons lacking desired qualifications or experience, and then trained on the job. This phenomenon becomes less import-ant of course, as one moves to designated positions requiring increasing amounts of formal education. The HMRU 'Difficult-To-Fill' survey provides supplementary information on vacancies of at least 30 days duration. Difficult-to-fill (DTF) positions are defined as those remaining vacant, and for which the employer is actively recruit-ing, for thirty days or more. The survey cov~rs 127 hospitals and other institutions in British Columbia. Over the period January 1980 through April 1982 a total of nineteen HRA positions were reported as difficult to fill (an average of two every three months). Each such position remained vacant for an avera9e of three and one-half months. There were fewer HRT/ART DTF vacancies (fourteen), but their average duration (four and one-half months) was longer. Thirty-seven per cent of the HRA vacancies and one-half of the technician vacancies were in the Greater Vancouver Regional Hospital District. This information suggests that there are, in general, relatively few DTF vacancies across health records positions in the hospital sector and that,· while the DTF vacancy rate is slightly higher for HRA positions, technician positions {once becoming DTF) are harder to fi 11. Third, employers were queried regarding additional personnel requirements over a two year period. For reasons primarily of increased workload, expansion, or changes in type of function or system, a need for 12 per cent more stenos/ clerks, 38 per cent more technicians, 20 per cent more health data technologists, and 16 per cent more health record administrators was forecast. Given the self-reported complementary task roles of ART/HRTs and HDTs, this suggests a major requirement for additional technician-level personnel, even if one takes into account potential wish-list bias of employer respondents. As for the surveys of the health-record-trained employees themselves, our best estimate was an approximate 50 per cent response rate. Here the major in-tent was to solicit information sufficient to sketch in an impression of the relationships between education/qualifications, employment status, and employ-ment tasks/functions. In addition, information on age profiles was sought for use in projecting requirements resulting from retirements. Health record-trained personnel may best be described as a relatively young, female cohort, predominantly married and working full-time, and working in posi-tions conunensurate with their qualifications. Perhaps the one distinguishing exception is the 26 per cent of responding HRAs who were in the 51-60 year age group. This, of course, has potentially serious manpower implications ten years down the road, which may or may not be mitigated by the influence of technology on health information personnel requirements. -98-Education information was as confusing as it was informative. In general, however, ART/HRT qualifications had been gained largely through correspondence courses (CHA); all HDTs were, of course, B.C.I.T. graduates; and HRAs came from a very diverse mix of educational backgrounds (hospital-based, correspondence, college and university-based health records and/or management training programs). Just under 6 per cent of respondents had reported no health record-related educa-tion, and an additional 33 per cent had comp1eted only correspondence courses in management and/or health records. Almost fourteen per cent of ART/HRTs were employed in positions generally requiring less than formal technician-level train-ing; close to 50 per cent of HDTs were in positions requiring less-than-HOT-level training (a phenomenon reflected in the task/function information as well); while 15 per cent of (self-reported) HRA-qualified personnel were employed in technician, HDT, or steno/clerk positions. On the other hand, 21 per cent of ART/HRT respon-dents were employed in HDT or HRA-level positions, and 10 per cent of HDTs were in HRA positions. A large proportion of formally trained personnel (68 per cent) indicated an interest in further formal education. Among the questions in the confidential questionnaire administered to formally trained health record personnel, was one regarding career advancement. Almost one-quarter of technician-level respondents indicated further formal education as an impediment to career advancement. Whether this means further education was not readily available, or just that it was required for advancement, was not always clear. If the former, however, it suggests the need for an accessible educa-tional ladder for technician-trained personnel. The 'other side' of the employer vacancy question was addressed in an employ-ment search question directed at employees. Close to twenty per cent of all re-spondents indicated having had difficulty finding health record employment at some time. Of course this reflects a combination of factors - location, education, time preference -- in addition to lack of vacancies. A large number of additional 'write-in' comments were offered by health record-trained personnel, and the majority of these related to lack of standardiza-tion and unavailability of educational upgrading access. They merit reemphasis in this summary because of their frequency and commonality. Concerns falling within a 'standardization' rubric included lack of consistency in qualification-determined designations (e.g., ART/HRT, HRA, HDT), and between these designations and job classifications/titles. Those of an 'educational' nature related primarily to up-grading opportunities (lack of access, and lack of a laddered structure). A sample of stenos/clerks was surveyed in an attempt to gather representative information similar to that requested of the formally trained personnel. Again, respondents were predominantly female, married and employed full-time. All had completed high school, and some had college training. Over one-half of the re-spondents indicated an interest in further education, and many voiced their concern over lack of access to same. As expected, stenos and clerks were involved almost exclusively with quanti-tative tasks, and the task mixes concurred closely with those reported by employers. .. -99-Implications for Public Policy The extent to which manpower and training implications may be inferred from the data gathered and analyzed in this report is limited by the critical and cen-tral role of technology advancement in governing both personnel number and mix requirements. Any policy recommendations must be set firmly and explicitly with-i ·n a teehnologtcal eontext. Thus, the data and analyses in p-revi-ous s-eettens suggest a number of policy directions based on a technology status quo, but such an assumption is clearly inconsistent with the reality of technological momentum. While it is not our feeling that we will see rapid development and widespread deployment of computerized health information systems in this province over the next five, or even ten years, some such development is all but inevitable and it cannot help but change some work environments surrounding the generation, assembly, updating, reporting, analyzing and utilization of health records. It is not inconceivable that by the year 2000, health record departments as now constructed will be obsolete, and with them the need for health record techni-ci'ans and administrators. Most of the technology (.both hardware and software) necessary to supplant both that departmental structure {particularly, of course, i"n hospital organi'zations) and the personnel traditionally employed therein, appears to exist. If there is any policy message in that, it must be that tradi-tional health record-related educational programs {both new and existing) must be both flexible {able to increase or reduce enrolment or, in the extreme, disappear) and adaptable (able to alter curricula relatively rapidly in response to changing work environments). One should not find oneself tied to lengthy, inflexible pro-grams which would be politically or practically difficult to phase out or dis-assemble. But the move from efficacy of technological innovation to practical every-day effectiveness in non-experimental environments is large, rocky and often ponderous. Gradual transition is likely to characterize health information system development in B.C. How gradual is gradual? Clearly this will be a function not only of the physical availability of appropriate systems, but of their cost-effectiveness, and of political and financial pressures. Two factors likely to hold back these developments at the present time are the general eco-nomic slowdown in this province, and the lack of convincing and consistent cost-effectiveness evidence. If systems are not shown to be cost-effective, they cannot easily be justified in difficult economic times. But the catch-22 is that if they are shown to be cost-effective, this result will almost certainly be in-tegrally linked to labour cost savings, implying the need for the politically unpleas· ant task of phasing out jobs. Within a scenario of slow evolution of health record management and communica-tion from paper- to computer-based, then, the major implications appear to be: {a) a need for the development of a laddered educational structure for health record personnel. The objective should be to provide career advancement opportunities through educational advancement, where warranted by manpower requirements. While it is most likely impossible to make all steps of such an educational ladder accessible to all, recognition should be given to the sex/marital mix of this group of personnel, and to the significant numbers of those personnel for whom the lower mainland is inaccessible from an educational stand-point. The skeleton structure of such a ladder appears already -100-to exist in B.C., but the coordination necessary to ensure that it is a widely accessible ladder rather than an ad hoc mix of programs, does not. One possible ladder structure would have, as a bottom rung, one or more technician-level training programs of approximately one year's duration. This rung would not only provide sufficient education to enable graduates to function at the technician level (qw-n-titativ-e taSoks~T -but wo,u_la -also µroviae sufficient prerequisites for direct (or almost direct) entry into the second year of a two-year HRA program. Thus, the first year of an HRA program would very closely resemble a one-year HRT program. In a similar manner, career advancement opportunities might be made available to HRAs in the form of a four year bachelor's level pro-gram. This program would take off from the HRA technical and prac-tical management/administrative training, to broaden the HRA's conceptual knowledge base and provide more systems, research and computer expertise. Some filling of prerequisites might be necessary in order to prepare HRAs for entry into the third year of such a bachelor's program, but to the extent possible the two year HRA pro-gram content should provide a sufficient basis for third year entry. Finally, the bachelor's level program would provide entry level require-ments into a number of post-graduate programs leading to upper-middle management positions possibly with responsibilities for health informa-tion functions. Such existing programs as MBAs and master's degrees in health services planning or health administration, or even a new master's level degree emphasizing, for example, 11management of computer-based information systems, for health care facilities 11 , 11 the ... health care delivery system11 , and 11 health care financing" (AMRA, 1980), are all possibilities. This laddered structure would ideally have two compon-ents~ on-site, and a correspondence/distance education option, with common examination structures at each rung. (b) at the present time the major educational need in British Columbia would appear to be for a one-year technician-level program which would, as noted above, also provide entry into the second year of an HRA program. It would appear that with the former HOT program now producing HRAs, and B.C.I.T. 's formal continuing education option allowing HOTs to upgrade to CCHRA certificant status, re-quirements for HRAs are taken care of for the foreseeable future. Conversion of HOTs to HRA level will take care of any need backlog, and we found no evidence of a need for more thar. the 15-16 HRA gradu-ates per year implicit in the existing program. The largest need, as suggested by employers, was for persons at the technician-level. Furthermore, any HOT upgrading to HRA level will deplete the technician function ranks further, and complaints about CHA correspondence training for technicians were among the most oft-cited problems. All these factors suggest that a one-year HRT pro-gram would be highly desirable. • (c) (d) (e) -101-the one year and two year programs should, as noted earlier, . be kept as flexible as possible, since our view is that some time down the road, quHe different graduates wi 11 be required, or the programs will no longer be necessary. we noted in (a) above the desirability of a third rung on the ladder. The proposed University of Victoria program is far more, and really not, a health record program. While there is .no doubt that this pro-gram will produce graduates who will become more and more desirable and necessary over timeto we have two concerns. First, this program could, among other things, provide that third rung on the health records/information ladder •. This would require a concerted, coordina-ted and cooperative effort between B.C.I.T. and University of Victoria to ensure that the 'prerequisite gap' for HRA graduates to enter the third year of the University of Victoria program were minimized. Our second concern is with the size of the University of Victoria program. We found no evidence justifying a program which, commencing in 1986 will graduate over 30 bachelor's level health information experts. Such numbers seem justifiable only if one has a very different view of the speed with which health information systems should or will be implemented in B.C., or if B.C. taxpayers are to provide training for a much wider mar~et. the HRABC, in concert with the CCHRA, must ensure the availability of some certification differentiation for graduates of any bachelor's level program training persons who will be involved with health records at relatively senior levels. 10 In fact, some information has been gathered in correspondence with the program director, indicating considerable interest in the future graduates of the program. A survey to ascertain the interest of employers in serv-ing as practicum sites yielded a large percent of positive responses. By the summer of 1982, about 45% of the responses had been positive, with another 25% "possible". Of the 45% positive responses, over 50% were extremely interested. Of course this may or may not imply anything about post-graduation employment opportunities. -102-APPENDIX A Criteria Used for Selecting Employers Within Agency Categories -103-APPENDIX A Criteria Used for Selec~ing Employers Within Agency Categories Provincial Ministry of Health a) Large Medical · Clinics - includes only those clinics with 10 or more physicians in residence. b) Hospitals - includes all hospitals in the acute care, rehabilitation, extended care, outpost and diagnostic and treatment centre categories. Special treatment centres are also included. c) Community Care Facilities - includes only those facilities that are larger than 200-bed size. d) Mental Health Institutions - includes all provincial facilities and clinics with the exception of health district-related services/ programs. e) Health District Offices - includes all provincial and municipal health districts in B.C. and specific programs offered within the districts (e.g. nursing/public health, home care, long term care, mental health). Private Sector - includes only those B.C. companies with 500 or more employees. Note: for other employer groups itemized on the mailing list (see Table 1) known employers/agencies within each group were contacted. -104-APPENDIX B Questionnaire Sent to Employers of Health Record Personnel I -105-EMPLOYERS OF HEALTH RECORD PERSONNEL (I) I DEN TI Fl CA TI ON 1. Name of Institution/Agency: ---------------------------2. Address: ~------------------------------------3. Name of Respondent:--------------------------------Position of Respondent: -----------------------------------------------· Phone:~---------HEALTH RECORD ACTIVITIES 4. Is your institution/agency involved in any way with health records/health data (e.g. collecting. recording. aggregating. analyzing. reporting)? YES D If NO: llOU hll.ve completed this questioMaire. f'hll.nk 11ou for .11our •••i•tanc:e. Ple.ue. return it in the stamped self-addressed envelope provided. If !§!: please continue with question S. CURRENT STAFFING S. Does your institution/agency have a formal Health Records Department? If!!£: If!§!: (a) YES D NOD please 90 on to question 6. Please tndicate the current number of funded full-time equivalent (FTE) positions (i.e. filled and vacant) of each type in your Medical Records. Department and answer the questions concerning the adequacy of personnel training. Part-time positions shOuld be counted IS ,. Medical Stenographers: Number of FTE Positions ----Alternate Job T1 tle(s )_*--------------------~.e •• if not called 'Medical Stenographers' in your setting. but performing tasks of the type specified on definition sheet. General Responsib.ilities: ( ••.••• continued) -106-CURRENT STAFFING (continued) S. Health Records Department personnel (continued) (b) (c) (d) (e) (f) Health Record Clerks: Number of FTE Posftfons ----Alternate Job Title(s) ---------------------General Responsibilities:--------------------Accredited Record Technicians/Health Record Technicians: Number of FTE Positions __ _ Alternate Job Title(s) ---------------------General Responsibilities: --------------------Health Data Technologists; (B.C.I.T. Graduates): Number of FTE Positions ----Alternate Job Title(s) ---------------------General ~esponsibilities: --------------------Medical Record Librarians/Health Record Analysts/ Health Record Administrators: Number of FTE Positions ----Alternate Job Title(s) ---------------------General Responsibilities: --------------------Other; (please specify} Number of FTE Positions----~lternate Job Title(s) ----------------------General Responsibilities:--------------------( ...•.. continued) .. -107-CURRENT STAFFING (continued) 5. Health Records Department personnel (continued) (g) If, in your opinion, the training of any of these personnel is inadequate for the position they ·hold, please specify (i) the type of employee; (ii) the areas(s) of inadequacy in the training. Other C0111llents: (e.g., partjcular strengths provjded by the educatjon/training of particular groups of e~ployees): 6. Do health record-related personnel of types a) through f) of question 5 currently serve in other departments/centres within your institution/agency? If YES: (a) YES D NOD Please indicate the number of full-time equivalent health record-related positions (i.e. filled and vacant) for personn.el who serve in departments or capacities other than a fonnal health record department, within your i'nstitution/agency? Medical Stenographers: Number of FTE Positions ___ _ Alternate Job Title( s >*----------------------*i.e., if not called 'Medical Stenographers' in your setting, but performing task of the type specified on definition sheet. Employed in What Oepartment(s) ---------------------General Responsibilities: ( .•.••. continued) -108-CURRENT STAFFING (continued) 6. Other departments/centres (continued) (b) (c) (d) (e) Health Record Clerks: Number of FTE Positions ----Alternate Job Title(s) ---------------------Employed i'l What Department(s) ------------------General Responsibilities: Accredited Record Technicians/ Health Record Technicians: Number of FTE Positions ___ _ Alternate Job Title(s) ---------------------Employed in What Department(s) ------------------General Responsibilities: Health Data Technolo ists: (B.C.!.T. Graduates Number of FTE Positions ___ _ Alternate Job Title(s) ---------------------Employed in What Department(s) ------------------General Responsibilities: Medical Record Librarians/Health Record Anal~sts/Health Record Administrators: Number of FTE Positions ----Al~ernate Job Title(s) ---------------------Employed in What Department(s) -----------,.---------General Responsibilities: ( ...•.. continued) " ti • -109-CURRtNT STAFFING (continued) 6. Other departments/centres (continued) (f) Other; (please specify) Number of FTE Positions ----Alternate Job T1tle(s) --------------------Employe~ in What Depa'rtment(s) -----------------General Responsibi~ities: (g) If, in your opinion, the training of any of these per~onnel is inadequate for the position they hold, please specify (i) the type of employee; (ii) the area(s) of inadequacy in the training. Other Conments: (e.g., particular strengths provided by the education/training of particular groups of employees): 7. Are there health record-related projects which you would like to see undertaken and for which you have the necessary funding, but which are not undertaken because of lack of adequately trained personnel? YES 0 If YES: Please specify nature of projects and necessary personnel qualifications: ( •••••• continued) CORRENT STAFFING (continued) -110-B. Does your institution/ftgenty provide on-the-job training for any of t,~ personnel groups (1) to (f) of questionl S and 6 (or has it done so in the past two years)? YES D If ~: Please indicate for which personnel category training was provided, the length of the training and the number of your then-existing staff who were involved in the training process, both as students and instructors. ( i) Personnel categories: Length of training: Number of students involved: . Number of staff involved as instructors: ' (ff) Personnel categories: length of training: Number of students involved: Number of staff involved as instructors: (iii ) Per.sonnel categories: length of training:· Number of students involved: Number of staff involved as instructors: CURREHT VACANCIES AND FUTURE REQUIREMENTS 9. Do you currently (i.e., at present and over the past 30 days) have any vacancies (i.e., funded but not filled} for health record-related personnel in your institution? YES D If YES: Please indicate the number of vacancies for each of these personnel, for full-time, part-time and ~asual positions: Medical Stenographers Health Record Clerks Accredited Record Technicians/ Health Record Technicians Health Data Technologists Medical Record librarians/Health Record Analysts/Health Record Adm n fs t re to rs Other (please specifg) Number of Vacancies Full-time Part-time Casual 10. Have you had any difficulty in recruiting staff for vacant health record-related positions over the last two years? YES D No Experience with Vacancies [:::J ( •••••• continued) • • • -111-CURRENT VACANCIES AND FUTURE REQUIREMENTS (continued) 10. Have you had any difficulty in recruiting staff for vacant health record-related positions over the last two years? (continued) 11. If YES: Please indicate for which recruiting is difficult and suggested reasons for the difficulty: (/) If Difficult Medi ca 1 Stenographe.rs 0 Health Record Clerks 0 Accredited Record Technicians/ 0 Health Record Technicians Health Data Technologists D Medical Record librarians/ D Health Record Analysts/Health Record Administrators Other (please •pecify) D Reason(s) for Difficulty In addition to current staff and/or vacancies (if any), do you foresee a need for any additional health record-related personnel within the next two years? YES D If NO: (please proceed to question 12) If YES: 1) Please indicate how many additional health record-related personnel you foresee 1 need for (do not include replacements for staff who may leave): Medical Stenographers Health Record Clerks Accredited Record _Technicians/Health Record Technicians Health Data Technologists Medical Record Librarians/Health Record Analysts/Health Record Administrators Number of Additional Personnel b~ Why will there be a need for these additional personnel? ( •••••• continued) -112-CURRENT VACANCIES AND FUTURE REQUIREMENTS (continued) · 12. IF YOU CURRENTLY EMPLOY OR HAVE VACANCIES FOR HEALTH RECORD RELATED PERSONNEL: Do you foresee a declining need for any of these personnel wfthfn the next two years and ff ve yea rs? YES D NOD If YES: a) Please indicate how many health record-related positions of each type you foresee n betnv eliminated (du not tncivcle 2- ym projections tn 5- ynr ftgures): CONFIDENTIALITY Medical Stenographers Health Record Clerks Accredited Record Technicians/ Health Record Technicians Health Data Technologists Medical Record Librarians/ Health Record Analysts/ Health Record Administrators Other (p~ease specify) b) Why will you require fewer such personnel? Number of Potential Eliminated Positions In 2 Years In 3 to 5 Years 13. Please describe any policies or systems used by your institution or agency to ensure that access to patient health records fs restricted to authorized personnel. COHMENTS: Please indicate other areas of eoncern, or ••ti•f•ction reg•rding 11our health record-rel•ted •Uffing r~nk 5'0U for 510ur cooper•tion in c:ompleting this que•tionnaire .. -113-.. . APPENDIX C EMPLOYEE QUESTIONNAIRES .. -114-SURVEY OF HEALTH RECORD PERSONNEL Medical Stenographers A Health Record Clerks I. PERSONAL INFORMATION l. (Surname) (First Name) (lliddle Name) (a) Position Title : (b) Institution/Agency: Address: -------------------- Phone No: ------Full-time 0 Part-time 0 Hours per two-week period ____ _ Are you seeking fu11 time employment : YES D NO D (c) How long have you been employed by this eqiloyer? _____ years and ___ months. 2. Sex: Male D Female D 3. Marital Status: Single D Married D Other D 4. Year of Birth: .. I I. EDUCATION 5. Please provide details of your formal education in the appropriate spaces below: (Do not include on-the-job traini!!9_ in health-record-related disciplines). Type Location of No . of Program Degree, Diploma, of Institution Years or Field of Certificate Year Education (City/Prov./Country) Attended Specialization Received Rec'd High School Corrmunity College, Hospital or Institute of Technology Unhersity Other (e.g . correspondence course) •.•••• continued .. I I. 6. -115-EDUCATION continued Please provide details of any on-t~e-1ob health record related training you have received during the course of your regular employment e.g. coding, abstracting, medical tennfnology). (Do NO'r' include correspondence courses noted under question SJ. Please continue ' on back of sheet ff you have been involved in more than one program. Training received in program------------------------Diploma or certificate received (ff any): -------------------Duration of training _____ weeks. Year Completed--------Name of Agency where training was received:--------------------Location: -------------------------------------~---------<citgJ (Province) 7. Have you participated in any work-related continuing education in the past 2 years? YES D NO D .. Please Specify: 8. Are you interested in pursuing further formal education? YES D NO D If YES: please check appropriate box D in health record-related area Please specify: D in non-health record-related area, discipline 0 in non-health sciences field but in another health sciences ...••..• continued -116-Ill. HEALTH RECORDS EMPLOYMENT continued 9. Which of the following titles most closely represents (a) your health reco.rd-related qualifications and, (b) your employment status? 10. (a) Qualifications (b) Current Employment Status D D ·o D D D ••••••••••••• Medtal Stenographer ••••••••••••• ..•.••.•••••• Health Record Clerk •••••••.••.•.• ...•••..•• Accredited Record Technician •••••••• ••••.••..•••. Health Record Technician ••.•.•••• •..•..•...•.. Health Data Technologist •.•••• · ••• •.....•••.•.••.••••• Other ••••••••••••••••••••• Please Specif!/ D D D D D D What is the total length of time you have been employed in the health record field? ____ year(s) 11. Hea 1th Record. Job Task Mix: The following chart outlines a list of job tasks that may or may not .be part of your own work duties. Using the time share code, please indicate how often, if ever, you perform the tasks and how much of your work time you spend on each: Code for Time Share (Column 1) N/A s not part of work duties D = task is regularly done on a dai-ly basis W = task is a regular component of each week's work but not necessarily an "every day" task M task is undertaken at least once a month, but not as often as once a week 0 • task done occasionally, i.e. less frequently than monthly In column (2) please indicate the approximate number of hours spent on each task - per!!!! if you answered Qin Column (1), or per~ if you answered Win Column (1) or per !!!2!!1!! if you answered .f:1. in Column (1). • ...•.. continued ... 111. HEAL TH RECORDS EHPLOYHEtlT continued -117-11. continued (1) (2) HOURS SPENT ON .. TASK PER DAY OR TASKS/FUNCTIONS TIME SHARE WEEK OR MONTH Admissions (other than typing) Discharges (other than typing) Auemhlt.ng Quantitative Analysi~ (checking charts for deficiencies) Coding Completing Ministry of Health Reporting Forms (e.g., HIA's, Home Care , Mental Health Ser-vices) Abstracting Transcribing (D1ctatyping) Typing . Word Processing Chart Retrieval and Filing Loose Report Filing Microfilm Census Reception Purging of Records Preparing Billings Information Medical Library Tasks Other Clerical Tasks Additional health record tasks not listed above (please specify): All other tasks not related to health records (please specify general categories): •...••. continued -118-III. HEALTH RECORDS EMPLOYMENT continued 12. SUPPLEMENTARY INFORMATION Please corrment briefly on any problem5 which affect you directly or about which you are aware, con-cerning the relationships between your employment duties and your health record training (if any), opportunities for training, emplo,Yment opportunities, this questionnaire, etc. THANK YOU FOR YOUR COOPERATION IN COMPLETING THIS QUESTIONNAIRE If you wish to receive a copy of tabulated results from this survey (which would be available only after the study is· completed), please check (J) the box: · D -119-SURVEY OF HEALTH RECORD PERSONNEL (I) I. PERSONAL INFORMATION 1. 2. ~ome Address: 3. Sex: 4. Marital Status: 5. Year of Birth: 11. EDUCATION (Surname} (First Name} (Middle Name} {Apt. or BOK No.} (Street No. and Name} (City} Male 0 Single 0 -----(Province/State} (Postal/Zip Code} Female 0 Harried O Other 0 6. Please provide details of your formal education in the appropriate spaces below: training in health-record-related disciplines}: Type Location of No. of Program or of Name of Institution Years Field of Education Institution (City/Prov./Country} Attended Special-ization High School Community College, Hospital or Institute of Technology University Undergraduate Graduate Other ( e.g. correspondence course) (do not include on-the-job Degree, Diploma, Certificate Year Received Rec'd ••••...• continued -120-II. EDUCATION (continued) 7. Please indicate by checking the appropriate box, any fonnal health record-related certification you currently hold: Certificant, CCHRA 0 Associate, CCHRA 0 Other 0 Please Specify-------8. Please provide details of any on-the-iob health record-related training you have received.* (Please continue on back of sheet if you have been involved in more than two such training programs). • (i) Nature of training:----------------------------Diploma or certificate received (if any):---------------------Duration of training (in weeks): .----------- Year Completed: -------Name of Employer where training was received:-------------------Location: (City) (.Province) (Country) (ii) Nature of training: ------------------------------Diploma or certificate received (if any): ---------------------Duration of training (in weeks): -----------Year Completed: -------Name of Employer where training was received:-------------------Location: (City) (Province) (Country} On-the-job training does not include correspondence courses taken concurrently with employment, nor the practicum component of college or university training programs. Please report only training received during the course of regular employment (e.g. coding, abstracting, medical terminology, statistics, etc.) at your place of employ. . .... . . continued -121 -II. EDUCATION continued 9. Have you participated in any of the following Continuing Education or Professional activities in the past two years? Please check (J) boxes as appropriate: PAS and HMRI Workshops D CCHRA Annual Conference D HRABC Workshops D HRABC Annual Convention D Quality Assurance D Multidfscfplfnary Conferences/ D Seminars Seminars Other Pl8llse specify: (do not include education activities described in previous questions): 10. Are you interested in pursuing further fonnal education? YES D If YES: please check appropriate box D in health record-related area Please specify: D D in non-health record-related area, but in another health sciences discipline in non-health sciences ffeld III. HEALTH RECORDS EMPLOYMENT 11. Which of the following titles most closely represents (a) your health record-related qualifications and, (b) if currently employed fn the field, your employment status? (a) Qualifications Current Employment Status ff (b) CURRENTLY EMPLOYED fn Health Records Ffeld 0 · ...... · ...... · · · · · · · · · Medical St~nographer · • • • · • .... ·: .. · .. · · • • • • · ·D D · · · · · · ·· · · · · ·· · · · · · · · · · Health Record Clerk························ D 0 .... · .......... · .. · · Accredited Record Technfcfan · ...... · .. · · .... • • .. D 0 ...... · .............. · Health Record Technician ............ •• .. •• .... D 0 ...... · · .... · .. · .. · .. · Health Data Technologist .... • ...... • .. • .... • .. 0 0 ..................... ·Medical Record Librarian ..... · ................ D D · · · · · · · · · · · · · · · · • ·-· · · · · • Health Record Analyst······•··············· D D .... · .. · · · · .. · .. · · · • Health Record Admfnfstrator · · .. • • • • · • • .. • .. • • • • ·D D Other D IF YOU ~ CURREN'l'LY EllPLOYBD IN A HEAL'l'H RECORD-RELA'l'ED POSI'l'ION, PLEASE PRCX:EED 'l'O OUES'l'ION l3. IF NOT, PLEASE ANSWBR OUES'l'ION l2, AND 'l'HEN PROCBED 'l'O OUES'l'ION l3. • ••••.. continued -122-III. HEALTH RECORDS EMPLOYMENT continued 12. (a) Please check (/) the most appropriate descrfptfons of the reasons why you are .!!2! currently employed fn a health recor4s-related posftfon: 13. D working fn another occupation, but seeking posftfon related to health records Please specify other occupation: D D D D D D working f n another occupation! and not seeking health-record-related posftfon taking further education and planning to enter a non-health record-related field taking further education and planning to return to health records unemployed, seeking health record-related posftfon unemployed, seeking employment fn some other field out of labour force but planning to return to health records specify year likely to return: ------D out of labour force and not planning to return to health records (b) How long has ft been since you left your last health record posftfon? O never previously employed fn such a posftfon 0 less than 6 months 0 6 months to a year 0 between one and three years 0 more than three years If you include time in all health-record~ related posftfons you have held, what fs the total length of time you have been employed in the health record field? (Please check (JJ one only). 0 under sfx months 0 six months to under one year 0 one year to under two years 0 two years to under five years D ffve years to under fifteen years c=J fifteen years or more 14. Hav~ you ever worked fn a health-record-related job outside of British Columbia? YES D If YES, how long ago did you le·ave your last such position? ___ years In which of the following general regions was your last such position? 0 Other Canadian Provinces (please specify) --------0 United States 0 Great Brftian D Other country ....... continued .. -12~-III. HEALTH RECORD EMPLOYMENT CONTINUED: PLEASE PROCEED 2'0 QUESTION 17 IF rou ARE JJJ!l CURRBN'l'LY EllPLOYED IN A HBAL'l'H-RBCORD-REIA'l'ED POSITION. O'l'HERWISE, CON'l'INUE WI'l'H QUES'l'ION lS. 15. What fs your current employment status? (a) Posftfon Tftle: (b) Instf tutfon/Agency: ----------------------------Address: Full-tfme D Part-tfme 0 Hours per two-week perf od -----Weeks per year -----( c) How long have you been employed by thfs employer? years and months. (d) If employed on a part-tfme basfs. please check (./) the appropriate descrfptfon(s) of your desired status: 16. Job Task Mfx D D currently seeking full-tfme posftfon wfthfn the same job classfffcatfon as you checked (./) fn question llb. currently seeking full-tfme posftfon wfth a different job classfffcatfon than that fndfcated fn question llb. (please specify) 0 currently not seeking full-tfme employment The following chart outlines a list of job tasks that may or may not be part of your present work duties. Using the time share code. please check (JJ how often, ff ever. rou personally perform each task. Code for Time Share N/A = not part of work duties D = task fs regularly done on a daily basis W = task fs a regular component of each week's work but not necessarily an "every day" task M = task fs undertaken at least once a month, but not as often as once a week 0 =task done occasionally f.e., less frequently than monthly In the column headed HOURS please indicate the approximate number of hours spent on each task - per day ff you {./) column D, per week ff column W fs (,A or per month ff M is (/) • •..••..•. continued III. HEALTH RECORD EMPLOYMENT (continued) 16. continued TIME SHARE TASKS/FUNCTIONS I. Quantitative N/A D w M 0 Admissions (other than typing) . Discharges (other than typing) Assembling Quantitative Analysis (_checking charts for deficienctes) Coding Completing Ministry of Health Reporti ng Forms (e.g., HIA's, Home Care, Mental Health Ser-vices) Abstracti ng Transcribing (Dictatyping) Typing Word-processing Chart Retrieval & Filing Loose Report Filing Microfilm Census Reception Purgi ng of Records Preparing Billings Information Medical Library Tasks Other Clerical Tasks TASKS/FUNCTIONS -- - -HOURS II. Management Planning, Organizing & Managing Health Record Department Fune-tions Development, Implementing & Monitoring Health aecord Department Policies & Procedures Directing/Managing other Departments (e.g. admit-ting) Coordinating Interdepartmental Activities Budgeting Preparing Departmental Operating Statistics Staffing Developing, Executing & Utilizing Performance Standards & Evaluation Administering Collective Agree-men ts Professional Development Supervision of Health Record Students Supervision of Other Students N/A ; I ' I I I I I i I TIME SHARE D w M 0 HOURS . ..... continued I __. N ~ I III. HEALTH RECORD EMPLOYMENT (continued} 16. continued TASKS/FUNCTIONS TIME SKARE Ill. Qualitative N/A D w M D HOURS Accreditation Quality Assurance Programs Retrospective & Prospective Audits Participation in Quality of Care Corrmittees Clinical Research Studies Health Legislation, Health Law Cost-effectiveness Studies TIME SHARE IV. Health Infonnation N/A D w M 0 HOURS Develop, Compile or Analyze monthly/quarterly/annual clinical data; monitor PAS/ HMRI reports Develop, Coordinate, Manage Information Systems of Health Records Department Fonnulate Policy re Clinical Data Develop, Coordinate, Manage Information Systems of Other Record-Keeping Departments (e.g. emergency, anmulatory & home care programs) Development of Institutional Linkage of Clinical Infonna-tion through Corrmon Patient Identifier Government Reporting (e.g. Vital Statistics/Health Surveillance Registry, Cancer Control Ayency) Develop Policies re Confidenti-ality (Medical/Legal) and Re-lease of lnfonnation Data Processing TASKS/FUNCTIOllS I v. Liaison with other Health Profess fona 1s Advise and Educate re: documen-tation requirements, policy and law lnterprofessional Audits Interdisciplinary Problem Solving and Decfsfon Making Inter-Institution/Agency lnfonna-tion Exchange VI. Addftfonal Tasks not listed above (Please Specif"IJ) N/A D TD(E SHARE w M 0 HOURS I ' I I I ...... continued I ..... N U"I I -126-III. HEALTH RECORD EMPLOYMENT (continued) 17. Do you feel that your education oulined in earlier questions of this survey, has adequately prepared you for the duties in your current position? YES [:J NO (:J If NO: Please indicate, (a) areas where you feel more emphasis might have been placed (e.g. coding, statistics, medical terminology, pharmacology, etc.), (b) areas which in retrospect you find not particularly relevant to your work situation. IV. SUPPLEMENTARY INFORMATION 18. Please comment briefly on any problems which affect you directly or about which you are aware, concerning certification or licensure, task allocation in relation to training, job and employment mobility, this questionnaire, etc. THANK YOU FOR YOUR COOPERATION IN COMPLETING THIS ()UESTIONNAIRE If you wish to receive a copy of tabulated results from this survey (which would be available only after the study is completed), please .check (J) the box: . D 1. -127-SURVEY or HEALTH RECORD PERSONNEL JOB SATISFACTION (II) Which of the following titles most closely represent, (a) your health record-related qualifica-tions and, (b) if currently employed in the field, your employment status? (a) Qualifications (b) Current Employment Status 1f CURRENTLY EMPLOYED in Health Records Field D D D D D D D D D •••••••••••••••••••.• Medical Stenographer • • • • • • • • • • • • • • • • • • • • • • • 0 ••••••••••••••••••••• Heal th Record Cl erk • • • • • • • • • • • • • • • • • • • • · • • • D .................. Accredited Record Technician • • • • • • • • • · • • • • • • • • D • • • • • • • • · • • • • ·······Health Record Technician • • ... • • • • • • • • • • • • • • • D •• • • •• • • • • ··········Health Data Technologist.····_··············· D ····················Medical Record Librarian ····················D • • • • • • • • · • · • • • • ·······Health Record Analyst • • • • • • • • • • • • • • • • • • • • • D ...... • · •• ••••••·• .. Health Record Administrator • • • • • • • • • • • • • • · • • • D _____________ Other D (Please Specify) 2. Would you describe your attitude toward your current position (or if not currently employed in health record-related position, in your most recent such position) as: D Dissatisfied D Indifferent D Satisfied D Extremely pleased Would you briefly indicate the reasons for this attitude? 3. If you are currently employed in a health record-related position, ere you presently considering leaving THE HEALTH RECORD-RELATED WORK FORCE. YES D If YES: (check appropriate boxes) permanently I temporarily to switch careers because of less than expected challenge and/or stimulation because of salary lower than expectations moving to another area of residence return to formal education persona 1 reasons D D D D D D D D D other, (Plflllse Specify:-----------------------' ( ••••• continued) -128-HEALTH RECORD PERSONNEL JOB SATISFACTION (continued) 4. If you are currently employed in a health record-related position and are not considering leaving the health record-related work force (i.e. answered NO in question 3), are you considering leaving YOUR PRESENT EMPLOYER? YES D 5. If you answered yes to questfon (, or flllve reslgned from a ~eal!h record-related posltlon durlng tfie last two years, please indicate the appropriate reason(s). If you answered NO to question 4, please proceed to the next question. D D 0 D D D D D D D difficulties with employer difficulties with immediate supervisor unsatisfactory physical working conditions unsatisfactory pay less than expected challenge and stimulation desire for career progression more than expected challenge and stimulation moving to another area of residence personal reasons other: (please specif'fl: -------------' 6.(a) Do you _feel your current (or most recent) health record-related position has provided you with experi-ence which will allow career advancement in a health records-discipline? YES D If NO: is this because: D D D D you are not seeking career advancement advancement requires formal education rather than (or in addition to) work experience current position has not fulfilled experience expectations other: (please specify-------------(b) If you have held more than one health-record-related position, have your past such positions, in general, provided you with opportunities for career advancement in the health records discipline? YES D If YES, please describe how. If NO, please give reasons and indicate whether this restriction was important to you. ( ••••• continued) -129-HEALTH RECORD PERSONNEL JOB SATISFACTION (continued) 7. Have you at any time found difficulty in securing employment in the health records discipline? YES 0 If YES, for what type(s) of position were you searching? Please describe briefly the nature of the difficulty (e.g. inappropriate training, location, pay, hours or experience). COMMENTS 'J"HANK 1'0U 1'0R YOUR COOPERA'J"ION IN COllPLE'J"ING 'J"HIS QUES'J"IONNAIRE -130-APPENDIX D ·REGIONAL HOSPITAL DISTRICTS OF BRITISH COLUMBIA .. lwl MnplUll Dhlrlct1 I All•nl-Cl•1-t ~ ~!~~r-u 4 CorllNID 5 Centrol Coon a Centro! frHtf' V•l106 1 c ... tr•I -'°""' I C...trol Dt.,..goo I Col-to-SIMl-P ID c-a-StrotllC-11 C°"icMo Wol ltJ IZ lleodney-Al-lUI 13 Ent -toMt 14 Fruer-CM9 15 Fruer-Fort GIGrte 16 &noter ,..,,. .... .,. 11 Kltt .. t-SUUM II -lOMy-ry 11 -·l-... -ZD .... ,., ZI lorlll OlonogOR ZZ Okonoy•o-Si•tlk-Zl Puce lhor·Ll•rd Z4 , .... 11 ..... ZS Sbeno·Qlonn CMrloUe Z6 Squ•hll-LI 11-t ZJ Stlk1rw ZI s..n.~trw tout Zt ,.....,._•tcol• Atl Ull • 1--- - - ----------21 • fort .. h .. 23 • D~on tr11ll. (fRAS!RVALLH] • Regional Hospital Disl1icts of Britisll Columbia !!!!!....!!!!:. TH IEGIOllS* I Gt;Rll Z ~ITAL l ~I WALLEY ·~ S SIJuT~Wl ' I~ CDAST 7 WTIAL I $TKWTIAI. 9 llj)llTK "11q,onol MIPIUll Dhtrlcu .... llOejl orottrorllt '"'""" tlr u. KtolP llon- ileseorcb U.ll I• orc14tr to prll'flde 1ufflcleot INS• far """''''' of -Iler -I~- )> ., 1 • -0 ~ l'TI w :z ~ c ...... >< c • Division of Health Services Research & Development -132-APPENDIX E Full-Time-Equivalent Health Record Personnel in and outside Health Record Departments by Employer Group by HMRU region Appendix E Employers HMRU Region GVRD Ministry of Health/Services Ministry of Health/Conm. Hlth Ministry of Health/Other Provincal Government/Other Federal Government Private Companies Region Column Totals HMRU Region Capital Ministry of Health/Services Ministry of Health/Conm. Hlth Ministry of Health/Other Provincal Government/Other Federal Government Private Companies Region Column Totals Full-Time-Equivalent Health Record Personnel 1n and outside Health Record Departments 1.~ 2 by Employer Group by HMRU region Personnel in Health Record Depts Total Personnel 1n Other Depts ART/s ART/s HR .> • Totals other Stenos Clerks HRTs HDTs HRAs Other Depts Stenos Clerks HRTs HDTs HRAs ~ Depts ~ 75.50 103.00 35.50 11.50 40.00 1.00 266.50 87.00 103.00 0.00 0.00 o.oo U>.OO 200.00 466.50 14.00 37.50 6.00 3.00 7.00 o.oo 67.50 15.00 74.00 1.00 0.00 o.oo e.oo 92.00 159.50 o.oo 0.00 0.00 0.00 0.00 o.oo 0.00 1.00 4.00 o.oo 1.00 0.00 $.00 9.00 9.00 1.00 0.00 o.oo o.oo o.oo 5.00 6.00 43.00 29.00 o.oo 0.00 0.00 3.00 75.00 81.00 2.00 4.00 0.00 0.00 o.oo o.oo 6.00 1.00 o.oo 0.00 o.oo o.oo b.00 1.00 7.00 5.00 1.00 0.00 0.00 o.oo 1.00 7.00 3.50 0.00 0.00 o.oo 0.00 o.oo 3.50 10.50 97.SO us.so .,I.SO 14.So 47 .00 7.oo 3S3.oo lso.so 210.IJIJ l.IJIJ I.IJIJ 0 .IJIJ 1~.IJIJ 380.so 733.so ,,. 27.50 15.00 a.so 1.00 10.00 0.00 62.00 3.00 89.50 3.00 1.00 2.00 10.00 108.50 170.50 2.00 0.00 1.00 0.00 1.00 0.00 4.00 35.00 0.00 o.oo 0.00 0.00 0.00 35.00 39.00 0.00 0.00 o.oo 0.00 0.00 o.oo o.oo 0.00 4.00 o.oo o.oo 0.00 D.00 4.00 4.00 o.oo o.oo 0.00 0.00 0.00 0.00 0.00 2.00 o.oo 0.00 0.00 o.oo D.00 2.00 2.00 4.00 2.00 o.oo 0.00 1.00 0.00 7 .00 4.00 o.oo o.oo o.oo 0.00 0.00 4.00 11.00 0.00 0.00 o.oo 0.00 o.oo 0.00 0.00 0.00 o.oo 0.00 0.00 o.oo o.oo o.oo 0.00 33.SO 17.IJIJ 9.50 1.00 12.00 o.oo 73.oo 44.oo 93.50 3.00 1.00 2.00 10.00 153.so 226.so I .... w w I Appendix E (Cont'd) Employers lfilRU Region Fraser Valley Ministry of Health/Services Ministry of Health/Comm. Health Ministry of Health/Other Provincal Government/Other Federal Government Private Companies Reg!!!.n Column Totals lfilRU Region Okana9an Ministry of Health/Services Ministry of Health/Comm. Health Ministry of Health/Other Provincal Government/Other Federal Government Private Companies Region Column Totals Full-Time Equivalent Health Record Personnel in and outside Health Record Departments 1•l by Employer Group by HMRU region Personnel in Health Record Depts Total Personnel in Other Depts ART/s ART/s HR Totals Other Stenos Clerks HRTs HDTs HRAs Other Depts Stenos Clerks HRTs HDTs HRAs Other ~~ 14.00 10.00 7.00 4.50 4.00 0.00 39.50 5.00 o.oo 0.00 0.00 0.00 o.ro 5.00 44.50 10.50 0.50 0.00 0.00 0.00 0.00 11.00 3.00 16.50 0.00 0.00 0.00 0.00 19.50 30.50 o.oo 0.00 0.00 . 0.00 0.00 0.00 0.00 0.00 o.oo 0.00 0.00 0.00 o.oo 0.00 o.oo o.oo 0.00 o.oo 0.00 0.00 0.00 0.00 0.00 o.oo 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4.00 0.00 0.00 0.00 3.00 7.00 7.00 0.00 0.00 o.oo 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 24.SO 10.50 1.00 4.50 4.00 0.00 50.50 8.00 20.50 0.00 0.00 0.00 3.00 31.50 82.00 19.00 12.00 10.00 o.oo 7.00 1.00 49.00 6.50 0.00 0.00 0.00 0.00 o.oo 6.50 55.50 4.50 9.50 0.00 o.oo 0.00 0.00 14.00 5.00 13.00 0.00 0.00 0.00 0.00 18.00 32.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 o.oo 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 o.oo o.oo 0.00 0.00 o.oo 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 o.oo 0.00 0.00 0.00 0.00 o.oo 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 23.50 21.50 10.00 0.00 7.00 1.oo 63.00 11.50 13.00 0.00 0.00 0.00 0.00 24.50 87.50 I __. w ~ I Appendix E (Cont'd) Employers Hll'RU Region South-East Ministry of Health/Services Ministry of Health/CORIR. Health Ministry of Health/Other Provincal Government/Other Federal Government Private Companies Region Column Totals HMRU R~ion Island oast Ministry of Health/Services Ministry of Health/COlllll. Health Ministry of Health/Other Provincal Government/Other Federal Government Private Companies Region Column Totals ~ Full-Time Equivalent Health Record Personnel in and outside Health Record Departments 1 •2 by Employer Group by HMRU region Personnel in Health Record Depts Total Personnel in Other Depts ART/s ART/S HR • Totals Other Stenos Clerks tl{Ts HDTs HRAs Other Depts Stenos Clerks HRTs HDTs HRAs other Depts ~ 12.00 4.50 7.50 2.50 4.00 o.oo 30.50 3.00 o.oo 1.00 o.oo 0.00 0.00 4.00 34.50 1.00 11.50 0.00 0.00 o.oo o.oo 12.50 0.00 3.00 o.oo 0.00 0.00 o.oo 3.00 15.50 o.oo 0.00 0.00 0.00 o.oo o.oo o.oo o.oo o.oo o.oo o.oo 0.00 0.00 o.oo 0.00 o.oo 0.00 0.00 0.00 0.00 0.00 o.oo o.oo o.oo 0.00 0.00 0.00 0.00 o.oo 0.00 0.00 0.00 0.00 0.00 0.00 0.00 o.oo o.oo o.oo o.oo 0.00 0.00 o.oo 0.00 0.00 0.00 0.00 0.00 0.00 o.oo o.oo 0.00 0.00 o.oo o.oo o.oo o.oo 0.00 0.00 0.00 13.00 16.00 . 7 .so 2.50 4.00 o.oo 43.00 3.00 3.00 1.00 o.oo 0.00 0.00 7.00 50.00 24.00 9.50 11.00 3.00 7.50 1.50 56.50 4.50 0.00 o.oo 0.00 0.00 1.00 5.50 62.00 4.00 6.00 0.00 o.oo 0.00 o.oo 10.00 1.00 7.50 o.oo 0.00 o.oo 0.00 a.so 18.50 o.oo 0.00 0.00 o.oo 0.00 0.00 0.00 o.oo 0.00 0.00 0.00 0.00 o.oo 0.00 o.oo 0.00 0.00 o.oo o.oo 0.00 0.00 0.00 o.oo 0.00 o.oo o.oo o.oo o.oo 0.00 o.oo 0.00 0.00 0.00 0.00 0.00 0.00 0.00 o.oo 0.00 0.00 0.00 o.oo 4.00 4.00 4.00 0.00 0.00 0.00 o.oo o.oo o.oo 0.00 0.00 o.oo o.oo 0.00 0.00 0.00 o.oo o.oo 28.00 15.So 11.00 3.oo 7.50 1.50 66.50 - 5.50 7.50 0.00 0.00 0.00 5.00 1a.oo 84.50 I ~ w U1 I Appendix E (Cont'd) Employers HMRU Region Central Ministry of Health/Services Ministry of Health/Conni. Health Ministry of Health/Other Provincal Government/Other Federal Government Private Companies R~ion Column Totals HMRU Region North Central Ministry of Health/Services Ministry of Health/Comn. Health Ministry of Health/Other Provincal Government/Other Federal Government Private tompanies Region Column Totals Full-Time Equivalent Health Record Personnel in and outside Health Record Departments 1 •2 by Employer Group by HMRU region Personnel in Health Record Depts Total Personnel in Other Depts ART/s ART/s HR Totals Other Stenos Clerks HRTs HDTs HRAs Other Depts Stenos Clerks HRTs HDTs HRAs Other Depts ~ 12.50 8.00 3.50 0.00 6.50 o.oo 30.50 3.50 o.oo o.oo o.oo 0.00 1.00 4.50 35.00 1.00 0.00 1.00 o.oo 0.00 0.00 2.00 0.00 0.00 0.00 0.00 o.oo 0.00 0.00 2.00 0.00 0.00 o.oo o.oo o.oo 0.00 0.00 0.00 0.00 0.00 o.oo o.oo 0.00 o.oo o.oo 0.00 0.00 o.oo 0.00 0.00 0.00 0.00 0.00 0.00 o.oo o.oo 0.00 0.00 0.00 o.oo 0.00 o.oo o.oo 0.00 0.00 0.00 0.00 0.00 o.oo o.oo 0.00 0.00 o.oo 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13.50 8.00 4.50 O.oo 6.50 O.oo 32.50 3.50 O.oo O.oo O.oo 0.00 Loo 4.50 37.00 21.50 13.00 7.00 2.00 6.00 0.00 49.50 6.50 3.50 1.00 0.00 0.00 0.00 11.00 60.50 3.50 9.00 0.00 0.00 0.00 0.00 12.50 1.50 0.00 0.00 0.00 0.00 0.00 1.50 14.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 o.oo 0.00 0.00 o.oo 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.00 a.so 0.00 0.00 0.00 0.00 1.50 1.50 0.00 0.00 0.00 o.oo 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.00 3.00 3.00 0.00 0.00 0.00 0.00 o.oo 0.00 0.00 1.00 0.00 0.00 0.00 0.00 0.00 1.00 1.00 25.00 22.00 7.00 2.00 6.oo 0.00 62.oo rn.oo 4.00 t.oo O.oo O.oo 1.00 te.oo 80.00 I _, w C'I I Appendix E (Cont'd) Enployers • Full-Time Equivalent Health Record Personnel in and outside Health Record Departments 1 •2 by Employer Group by HMRU region Personnel in Health Record Depts Total Personnel in Other Depts ARf/s ARt/s HR • Totals Other Stenos Clerks HRTs .J!!ITL HRAs Other ~ ~ Clerks HRTs HDTs HRAs Other Depts ~ HMRU Region North Ministry of Health/Services 5.00 3.00 2.50 0.00 4.00 0.00 14.50 1.50 o.oo 0.00 o.oo o.oo 0.00 1.50 16.00 Ministry of Health/COlllR. Health 1.00 o.oo 0.00 o.oo 0.00 o.oo 1.00 1.50 2.00 0.00 o.oo 0.00 D.00 3.50 4.50 Ministry of Health/Other 0.00 o.oo o.oo 0.00 0.00 o.oo 0.00 0.00 0.00 0.00 0.00 0.00 10.00 0.00 0.00 Prov1ncal Government/Other 0.00 o.oo 0.00 o.oo o.oo 0.00 o.oo 0.00 o.oo 0.00 0.00 0.00 0.00 o.oo o.oo Federal Government 0.00 o.oo 0.00 0.00 0.00 0.00 o.oo 0.00 o.oo 0.00 0.00 o.oo o.oo 0.00 0.00 Private Companies 0.00 0.00 0.00 0.00 0.00 o.oo 0.00 o.oo 0.00 0.00 0.00 o.oo 0.00 0.00 0.00 Region Column Totals 6.00 3.00 2.50 0.00 4.00 o.oo 15.50 3.00 2.00 o.oo o.oo o.oo o.oo 5.00 20.50 1 These figures underestimate total full-time equivalent positions because of lower than lOOS response rate. See notes to Table 2. 2 Particularly for medical stenographers and health record clerks {but also to a lesser extent for the 'other' classification), the figures · represent full-time-equivalent positions and do not necessarily represent manpower devoted exclusively to health record tasks. Prepared by: The Health Manpower Research Unit The University of British Columbia I _, w ...... I -138-APPENDIX F Educational Programs for Health Record Personnel -United States • • • MEDICAL RECORDS -139-AMERICAN MEDICAL RECORD ASSOCIATION FACT SHEET MEDICAL RECORD ADMINISTRATORS • MEDICAL RECORD TECHNICIANS A medical record is a permanent document of the history and progress of one person's illness or Injury, made to pre1erve information of medical, scientific. legal and planning value. It is a compilation of observations and flndlnp recorded by the patient's physician and other professional members of the medical team. These entries and reports originate at vario\11 points throughout the hospital. clinic, nursing home. health center or other health care facility. Through a network of communications systems they are entered in the individual patient's record. X-ray and laboratory reports, cardiopam tracings, diet orders and pulmonary function tests are examples of pertinent data Included. This vital medical prome constitutes the patient's own unique medical history. Vital Information in the medical records is needed by: 1. The Patient. Medical records help safeguard the individual patient. Recorded information is essential to lCcUrlte diagnosis and rapid treatment of present and future illness. This material is needed to verify insurance claima and authenticate legal forms. 2. The Community. Medical records are used to inform public health officials and the community of health conditions and disease trends. This information is essential to effective public health programs, and planning for community health needs. 3. Holpit.81 Adminittraton and Profeaior111I Mamben of 1he Medical S11ff. Medical records help hospital penonnel lhow they have discharged their responsibilities to the patient and the community. Records provide a basis for 10und hospital planning. They constitute the factual data on which hospital accreditation and licensure are based. 4. Medic.t A-rchen. Medical records provide data for evaluating new methods of treatment and comparing the effectiveness of different medications. Much medical research depends on these medical data. THE MEDICAL RECORD ADMINISTRATOR The medical record administrator is the professional responsible for the management of health information systems consistent with the medical, administrative, ethical and legal requirements of the health care delivery system. I. ,..nning and developing: MedicaJ record systems which meet standards of accrediting and resulatory agencies; inservic:e educational materials and instruction of health care personnel; departmental budgets; institutional policies and procedures Including medical-legal; 2. 0.igning: H~alth information systems appropriate for various sizes and types of health care facilities; health record abstracting systems; facilities in which medical record services may be offered efficiently . 3. Directing: A total health record program appropriate to the health facility; preparation of indexes; collection and analysis of patient care data; the management of human resources; 4. Participating and Coordinnng:Committee functions relating to medical records and patient information systems; medical staff activities in the evaluation of patient care and utilization review; basic and applied research in the health care field; the services of the medical record department with other departments within the facility. AMERICAN MEDICAL RECORD ASSOCIATION - 111 N. Mldlltmn Awnue - ..... 11110, Ol'-lo, llllnoil IOl11 - 3121787·2172 A7-AS/FS-MRA:MRT/275 11 ·2) -140-To qualify for designation u a professional Registered Record Adininistrator {RRA) a candidate must succeafully complete an approved medical record administration educational program and pass a national registration examination. Entrance requirements and coune tltle1 vary from school to achool. Approved programs fall into two main groups: I. For th1 high 1ohool •IClu1t1: Colleae or unlvenity underaraduate proaram1 lead to a bachelor'• degree with a major in medical record administration. Student• may take the ftnt two years of colleae study in liberal arts and aclencea at any reaionally approved collep or junior college, ind transfer to the junior and senior yean of a baccalaureate program in medical record administration in one of the lcllooh approved by lhe American Medical Aaoclation. 2. For the coll1111 greduat1: Individuals who have already earned a bachelor's degree In another related academic area, and have taken specific required counes In the biological aclence1, may enter postgraduate programs, 12 months In length, which off er a certificate In medical record administration. THE MEDICAL RECORD TECHNICIAN Hospitals and other health facilities also employ medical record technicians. High school graduation, plus one or two years of junior coJJege and hospital training in the technical aspects of functions performed in the medical record department are required for Accreditation as a Medical Record Technician. Many junior colleges offer Medical Record Technician associate degree programs, and a few hospital schools offer one year programs. · Following comple~ion of an approved educational program, the graduate is eligible to take a national accreditation examination for designation as an Accredited Record Technician {ART). Medical Record Technicians serve u specially trained assistants to the Registered Medical Record Administrator, carryin8 out the many technical activities within a medical record department - typing medical records, preparing statistical reports on patients treated, supervising clerical personnel, reviewing medical records for completeness, working with doctors, nurses and other health professionals on medical records and medical research projects. In addition, ARTs often are employed as directors of medical record departments in small hospitals and nursing homes. AMERICAN MEDICAL RECORD ASSOCIATION Founded in 1928, AMRA is the national organization of professional medical record administrators and technicians. lta goals are to improve standards, promote the teaching of medical record administration, supervise a professional registry, recruit qualified students into the field, and interpret the profe•ion to other medically-related groups and to the general public. The staff of the Association works from headquarters at 875 N. Michigan Avenue - Suite 1850, Chicago, Illinois 60611. SOME STATISTICS ABOUT OPPORTUNITIES AND NEEDS Number of U.S. hospitals and other medical installations which need one or more medical record personnel: Approximately 60,C.:CO. - Number of Registered Record Administrators available: Approximately S,000. Salary ranaes RRA $10,000 - $30,000. Number of Accredited Record Technicians available: Approximately 8,500. Salary ranges: ART $7,SOO - $15,000. Job opportunities other than in hospitals: Outpatient chnic1, health centen, medical reaearch organizations, consulting firms, nursing homes, insurance companies, private and governmental health agencies, colleges and univenities which have educational programs for medical record administrators or medical record technicians. Number of colleges and hospitals offering approved courses: For Medical Record Administration: 40. For Medical Record Technicians: 60. - Tuition: Regular college or university tuition rates apply in most cases. Student loans ue available from th1 Foundation of Record Education, 875 N. Michigan Avenue - Suite 1850, Chicago, Illinoil 60611 and some state medical record associations. Recommended high school courses: general college preparatory; including mathematics, biology, chemistry, Latin, English, typing. A7-AS/FS-MRA:MRT/27& 12·21 • • ,. • AMERICAN MEDICAL RECORD ASSOCIATION -141-875 North Michigan Avenue Chicago. Illinois 60611 312/787-2672 QUALIFICATIONS FOR REGISTRATION OF MEDICAL RECORD ADMINISTRATORS (RRA) APPLICANTS MUST MEET REQUIREMENTS I and J, or 2 and J 1. Be a graduate of an educational program for medical record administrators approved by the designated accrediting authority, provided that the qualifications of such program at the time of the candidate's graduation meet the requirements of the current designated accrediting authority for approved programs. Note: All medical record administration educational programs are at the baccalaureate level, either incorporated in four-year programs leading to a baccalaureate degree, or in programs of post-baccalaurcate study. Specific information on school admission requirements should be obtained directly from the educational institutions which off er the programs. A list of accredited medical record administration programs may be obtained from the AMRA Executive Office. 2. Be a graduate of a program for medical record administrators approved by a foreign association with which there is an agreement of reciprocity, providing that the graduate meets the current educational requirements of the AMRA. Note: The Canadian Health Record Association is the only Association with which the AMRA now has an agreement of reciprocity. The agreement of reciprocity with the Canadian Health Record Association states: "The American Medical Record Association and the Canadian Association of Medical Record Librarians shall permit a graduate of a program in medical record administration approved by the designated accrediting agency of the respective associations to write the registration examination given independently by the two associations provided that the graduate meets the educational requirements for registration established by the Association to which the application is made. 3. Pass the examination provided by the Education and Registration Committee. REGISTRATION EXAMINATIONS ARE GIVEN TWICE EACH YEAR, IN MAY AND OCTOBER, APPLICATIONS MUST BE RECEIVED IN THE AMRA EXECUTIVE OFFICE NINETY DAYS PRIOR TO THE DATE OF THE EXAMINATION • Application I orms may be secured from Examinations Office AMERICAN MEDICAL RECORD ASSOCIATION 175 North Michi1an Avenue-Suite 1850, Chica10, Illinois 60611 A27·AS, Quals l 1079 (l·ll AMERICAN MEDICAL RECORD ASSOCIATION -142-875 North Michigan Avenue Chicago. Illinois 60611 312/787-2672 QUALIFICATIONS FOR MEMBERSHIP - 1980 I. ACTIVE MEMBER: Any registered medical record administrator is eligible for Active Registered membership. Any accredited medical record technician is eligible for Active Accn:dited membership. 2. ASSOCIATE MEMBER: Any person intetated in the purposes of the Association who does not meet the qualifications for Active membership is elipble for As-sociate membership. J. STUDENT MEMBER: Any student enrolled full time in an approved educational program for medical record personnel is eligible for Student membership. Students enrolled in the AMRA Correspondence Course for Medical Record Personnel, or the Independent Study (modules) Program, arc only eligible for Associate membership. The Student class of membership may be continued only until the first Qualifying Examination after the student has graduated. After that time he shall be transferred to Active or Associate membership, based on the results of the examinations. ~. INACTIVE MEMBER: Any member who is no lonaer employed may retain Active or Associate membership or shall be granted Inactive membership upon application. Inactive membership is granted ONLY to current mem-ben who as;e no longer working in any field, part time or full time. APPUCATION: All applications for membership 1ball be ia writing in the form prc1eribcd by the Board of Dirccto,n and shall be accompanied by the payment of annual d11e1: $80 for Active Rep1tered, S60 for Active Accredited, S30 for Auociate, Sl.S for Inactive, and $10 for Student membership. New members joinin1 for the first""" alter July 1 shall pay only one-half the annual duc1 for the current • year. Application forms arc -available from AMRA, Attn: Membenlaip Section. DUES: Due11 shaU be paid on a calendar year bui1and1haU be due on January I. Dues shall 0e paid by the applicant or member directly to the American Medical Record As-sociation. Dues include subscriptions for the Qfficial journal and newsletter of the Association as well u membership in the appropriate Component State Association. ASSESSMENT FOR CONTINUING EDUCATION: S5 annually for each Active Registered or Active Accredited member. Payment is mandatory and membership is not complete unless it is paid with dues. The full amount i1duc for a membership covering part of a calendar year. QUALIFICATIONS FOR ACCREDITATION OF MEDICAL RECORD TECHNICIANS (ART) APPLICANTS MUST MEET REQUIREMENTS I and J, or 2 and J 1. Be a graduate of an educational program for medical record technicians approved by the designating accrediting authority. 2. Have successfully completed the American Medical Record Association•s Correspondence Course for Medical Record Personnel. (AMRA Bylaws amended 10/77 require successful completion of the AMRA Correspondence Course for Medical Record Personnel and a minimum of 30 semester hours of academic credit effective for candidates taking the Accreditation examination after April, 1980). 3. Pass an examination provided by the Education & Registration Committee. ACCREDITATION EXAMINATIONS ARE GIVEN TWICE EACH \'EAR, IN APRIL AND SEPTEMBER. A PPL/CA TJONS MUST BE RECEIVED IN THE AMRA EXECUTIVE OFFICE NINETY DA VS PRIOR TO THE DA TE OF EXAMINATION. Application forms may be secured from the Examinations Office AMERICAN MEDICAL RECORD ASSOCIATION 875 North Michigan Avenue-Suite 1850, Chicago, Illinois 60611 A27-AS.' Qumb: 1079C1·21 • • • .. • • -143-ACCREDITED EDUCATIONAL PROGRAMS JN MEDICAL RECORD TECHNOLOGY Apierican Medical Record Association 875 North Michigan Avenue Chicago, Illinois 60611 Reviled to January 1981 All of the following usociate degree propams for medical record technicians have been accredited by the Committee on Allied Health Education and Accreditation of the American Medical Association, 535 North Dearborn Street, Chicago, Illinois 60610 in collaboration with the CouncU on Education or the American 'Medical Record Auociation. Tuition costs for medical record technol0ty prosrams generally are the same as tuition for the college/univcnity. For more information about a specific medic:al record technology program, contact the c~llege/univenity. ALABAMA University of Alabama in Birminaham Resional Technical Institute University Station Birmin1ham. AL 3.5294 Director: Lenore A. Cou1hlin, RRA Prereq: High School Length: 2 yn. Begins: Sept. Wallace State Community College P. 0. Box 250 Hanceville, Al. 35077 Director: Lucille P. Nicholson, RRA Prcreq: High School Length: 2 yn. Beains: Sept. ARIZONA Phoenix College 1202 West Thomas Road Phoenix, AZ 8.5013 Director: Vivian Hauaen, RRA Prereq: High School Length: 2 yn. Begins: Aug. CALIFORNIA Cypress College 9200 Valley View Cypress, CA 90630 Director: Ola Faye Pearson, RRA Prereq: High School Length: 2 yrs. Begins: Sept. Chabot College 2.SSSS Hesperian Blvd. Hayward, CA 94.54.5 Director: Phoebe Corte11is, RRA Prcreq: High School Length: 2 yrs . Begins: Sept. CAUFORNI~ (Coat.) East Los Angeles College 1301 Brooklyn Avenue Monterey Park, CA 91754 Director: Lea David10n, RRA Prereq: High School Length: 2 yn. Begins: Sept. San Diego Mesa College 7250 Mesa College Drive San Die10. CA 92111 Director: Yvonne BeraJand, RRA Prcreq: High School Length: 2 yn. Begins: Sept. City College of San Francisco .SO Phelan Avenue San Francisco, CA 94112 Director: Betty Biles, RRA Prereq: High School Length: 2 yrs. Begins: Sept. West Valley College 14000 Fruitvale Avenue Saratoga, CA 95070 Director: Ruth Fogiato, RRA Prcreq: High School Length: 2 yn. Begins: Sept. COLORADO Arapahoe Community College 5900 South Santa Fe Littleton, CO 80120 Director: Kaarcn Hardenbrook, RRA Prereq: High School Length: 2 yrs. Bea!ns: Sept . FLORIDA Miami-Dade Community College 950 N. W. 20th Street Miami, FL 33127 Director: William Worley, RRA Prereq: High School Length: 2 yrs. Begins: ·sept. IDAHO Boise State University 1910 Univenity Boise, ID 83725 Director: Elaine Rockne, RRA Prereq: High School Length: 2 yrs. Begins: Sept. ILLINOIS Bcllcv.illc Arca College 2SOO Carlyle Road Belleville, IL 62221 Director: Paula E. Allen, RRA Prereq: High School Length: 2 yrs. Begins: Sept. Central YMCA Community College 211 West Wacker Drive Chicago, IL 60606 Director: Dorothy Tyler, RRA Prereq: High School Length: 2 yrs. Begins: Sept. College of Lake County 1935 I West Washington Street Grayslake, IL 60030 Director: Sister Susan Plevak, RRA Prereq: High School Length: 2 yrs. Begins: Sept. Oakton Community College 7900 Nagle Avenue Morton Grove, IL 60053 Director: Mildred R. Marx, RRA Prereq: High School Length: 2 yrs. Begins: Sept. Moraine Valley Community Colle1e 10900 South 88th Avenue Palos Hills, IL 60465 Director: Charlotte Razor, RRA Prereq: High School Length: 2 yrs. Begins: Sept. INDIANA Indiana University Northwest 3400 Broadway Gary, JN 46408 Director: Margaret A. Skurka, RRA Prereq: High School Length: 2 yrs. Begins: Aug. IOWA Kirkwood Community College 6301 Kirkwood Blvd. Cedar Rapids, IA S2406 Director: Terese A. Claeys, RRA Prereq: High School Length: 2 yrs. Begins: Sept. -144-IOWA (Cont.) Indian Hills Community College Ottumwa Hci1hts Campus Ottumwa, IA 52501 Director: Nancy Thomas, RRA Prereq: High School Length: 2 yrs. Begins: Aug. KANSAS Hutehin1en C-ommunity C-olleae 1300 North Plum Hutchinson, KS 67'01 Director: Diana Callen, RRA Prereq: High School Lenght: 2 yrs. Begins: Aug. Johnson County Community Collese/ Baptist Memorial Hospital College Blvd. at Quivira Road Overland Park, KS 66204 Director: Carol Sustrick, RRA Prereq: High School Length: 2 yrs. Begins: Aug. KENTUCKY Western Kentucky University Bowling Green, KY 42101 Director: Leigh Palmer, RRA Prereq: High School Length: 2 yrs. Begins: Sept. Eastern Kentucky University Richmond, KY 4041S Director: Prereq: High School Length: 2 yrs. Begins: Sept. MARYLAND Community College of Baltimore 2901 Liberty Heights Avenue Baltimore, MD 21215 Director: Ernani B. Morgan, RRA Prereq: High School Length: 2 yrs. Begins: Feb. and Sept. Prince George's Community College 301 Largo Road Largo, MD 20870 Director: Conchita T. Felter, RRA Prereq: High School Lentth: 2 yrs. Begins: Sept. • • • .. • MASSACHUSETTS Northern Essex Community College 100 Elliot Street Haverhill, MA 01830 Director: Patricia Taalianetti, RRA Prereq: High School Length: 2 yrs. Beains: Sept. Holyoke Community College 303 Homestead Avenue Holyoff, -MA~ Director: Jane Chalmen, RRA Prereq: High School Length: 2 yrs. Begins: Sept. Massachusetts Bay Community Colle,c 50 Oakland Street Wellesley, MA 02081 Director: Geraldine Berenholz, RRA Prereq: High School Length: 2 yrs. Begins: Sept. MICHIGAN Ferris State College Big Rapids, Ml 49307 Director: Margaret Neterer, RRA Prereq: High School Length: 2 yrs. Begins: Sept. Henry Ford Community College 22,86 Ann Arbor Trail Dearborn Heiahts, M 1 4812'7 Director: Bette Reynolds, RRA Prereq: High School Length: 2 yrs. Begins: Sept. Mercy College of Detroit 8200 West Outer Drive Detroit, Ml 48219 Director: Catherine F. Wrobel, RRA Prereq: High School Length: 2 yrs. Begins: Sept. Wayne County Community College• 1001 Fort Street Detroit, Ml 48226 Director: Prcreq: High School Length: 2 yrs. Begins: Aug. •Not accepting students 1981-82 school year. Schoolcraft College 6701 Harrison Street Garden City, Ml 4813S Director: Patricia A. Rubio, RRA Prereq: High School Length: 2 yrs . Begins: Aug. -145-MINNESOTA Anoka Area Vocational Technical Institute P. 0. Box 191 Anoka, MN 'S303 Director: Betty McLean, RRA Prereq: High School Length: 2 yn. Begins: Sept. St. Mary's Junior CoUeae 2SOO South Sixth Street Minneapolis, MN 55454 Director: Joanne Odepard, RRA Prereq: High School Length: 2 yn. Begins: Sept. Moorhead Area Vocational Technical Institute Moorhead, MN S6S60 Director: Helen Schuster, RRA Prereq: High School Length: 2 yrs. Begins: Sept. MISSISSIPPI Meridian Junior College SSOO Highway 19 North Meridian, MS 39301 Director: Prereq: High School Length: 2 yn. Begins: Sept. Hinds Junior College P. 0. Box 428 Raymond, MS 391S4 Director: Gwendolyn Green, RRA Prereq: High School Length: 2 yrs. Begins: Aug. MISSOURI Avila College 11901 Womall Road Kansas City, MO 6414S Director: M. Ann Fcndenon, RRA Prereq: High School Length: 2 yn. Begins: Aug. Penn Valley Community College Kansas City, MO See listing under Kansas, Overland Park, Johnson County Community College/Baptist Memorial Hospital NEW HAMPSHIRE New Hampshire Vocational Tecbnical Collqe Hano\ler Ellen11on Oaremont, NH 03743 Director: Patricia A. Sorento, RRA Prcrcq: High School Length: 2 yrs. Begins: Sept. NEW .JERSEY Union County Technical Institute 1776 Raritan Road Scotch Plains, NJ 07076 Director: Marpret Grace Hayes, RllA Prereq: High School Lenath: 2 yrs. Begins: Sept. NEW YORK Smte Univenity of New York Asricultural and Technical Collep Alfred, NY 14802 Director: Merida L. Johns, RRA Prereq: High School Lensth: 2 yrs. Begins: Sept. Broome Community College Upper Front Street Binghamton, NY 13902 Director: Mary L. Rosato, RRA Prereq: High School Lensth: 2 yrs. Begins: Sept. -146-Borough of Manhattan Community College 1633 Broadway New York, NY 10019 Director: Camille Layne, RRA Prereq: High School Length: 2 yrs. Begins: Sept. Monroe Community College 1000 East Henrietta Road Rochester. NY 14623 Director: Elimbeth Robinson, RRA Prereq: High School Length: 2 yrs. Begins: Sept. National Technical Institute for the Deaf One Lomb Memorial Drive Rochester, NY 14623 Director: Marilyn G. Fowler, RRA Prereq: High School and Special Requirements Length: 2 yrs. Begins: July NORTH CAROLINA Central Piedmont Community College P. 0. Box 4009 Charlotte, NC 28204 Director: Linda K. Porter, RRA Prereq: High School Length: 2 yrs. Begins: Sept. OHIO Stark Technical College 6200 Frank Avenue, N.W. Canton, OH 44720 Director: Louise Ann Weber, RRA Prercq: High School · Lensth: 2 yrs. Begins: Sept. Cincinnati Technical Colleae 3520 Central Parkway Cincinnati, OH 45222 Director: Rosemary Clark, RRA Prereq: High School Lenath: 2 yrs. Begins: Sept. Cuyahoga Community College 2900 Community Colleae Avenue Cleveland, OH 4' 115 Director: Carolyn LindbelJ, RRA Pmeq: ·Hish School Lenatb: 2 yrs. Besim: Sept. Sinclair Community Colle• 444 Wm Third Street Dayton, OH 4M>2 Director: Robin L. Wright, RRA Prereq: Hi1h School Length: 2 yrs. Begins: Sept. Bowling Green State Univenity 901 Rye Beach Road Huron, OH 44839 Director: Ellen Wachs, RRA Prereq: High School Lensth: 2 yrs. Begins: Sept. Hock.ins Technical Colleae• Route I Nelaonville, OH 45764 Director: Prereq: High School Length: 2 yrs. Begins: Sept. •Not acceptina students 1980-81 1ebool J,Dr. OREGON Central Oregon Community College Colleae Way Bend, OR 97701 Director: Ellen Hemley, RRA Prereq: Hiah School Length: 2 yrs. Begil)I: Sept. Portland Community Colleae 12000 S.W. 49th Avenue Portland, OR 97219 Director: Beverly Hooten, RRA Prereq: Hiah School Lensth: 2 yrs. Begins: Sept. • • • .. • • PENNSYLVANIA Gwynedd-Mercy Colleae Gwynedd Valley, PA 19437 Director: Kathleen Lynch, RRA Prereq: Hiah School Lenath: 2 yrs. Beain1: Sept. Community College of Philadelphia 34 South 11th Street Philadelphia, PA 19107 Director: Jluth B. Daniela, RRA Prereq: High School Lenath: 2 yn. Beain1: Sept. Community College of Allegheny Countr 808 Ridge Avenue Pittsburgh, PA 1.5212 Director: Jo Ann Avoli, RRA Prereq: High School Lenath: 2 yrs. Begins: Sept. PUERTO RICO Puerto Rico Junior College P. 0. Box AE Rio Piedras. PR 00928 Director: Ada Lily Torres, RRA Prereq: High School Length: 2 yrs. Begins: Aug. SOUTH DAKOTA Dakota State College Madison, SD .57402 Director: Loretta Metz1er, RRA Prereq: Hi1h School Length: 2 yrs. Begins: Aug. TENNESSEE Chattanooga State Technical Community Colle1e 4.501 Amnicola Hi1hway Chattanooga, TN 37066 Director: Carolyn Herrin1, RRA Prereq: Hi1h School Lenath: 2 yrs. Be1ins: Sept. Volunteer State Community Colleae Gallatin, TN 37066 Director: Lois Ann Knobeloch, RRA Prereq: Hi1h School Length: 2 yrs . Begins: Sept. Roane State Community Colle1e Harriman, TN 37748 Director: Alice Moore, RRA Prereq: High School Lenath: 2 yrs. Be1ins: Sept. -147-TEXAS Amarillo College P. 0. Box447 Amarillo, TX 79178 Director: Vivian Fidler, RRA Prereq: High School Lensth: 2 yrs. Beaim: Aua. Tarrant County Junior Collep . 128 Harwood Road Hunt, TX 76053 Director: Delores J. McDonald, RllA Prereq: Hiah School Lenath: 2 yrs. Begins: Sept. St. Philip's Colleae 2111 Nevada Street San Antonio, TX 78203 Director: Delores B. C. ViUarreal. RllA Prereq: Hi1h School Length: 2 yn. Begins: Sept. Temple Junior Colleae 2600 South Finl Street Temple, TX 76501 Director: A. D. Courtney, llllA Prereq: High School Lenath: 2 yrs. Begim: Sept. Wharton County Junior Collep 911 Boling Highway Wharton, TX 77488 Director: Mary King, RRA Prereq: High School Length: 2 yrs. Begins: Sept. VIRGINIA Northern Virginia Community College · 8333 Little River Turnpike Annandale, VA 22003 Director: Sandra Bailey, RRA Prereq: High School Length: 2 yrs. Begins: Sept. Central Virginia Community CoUeae P. 0. Box 4098, Fort Hill Station Lynchburg, VA 24502 Director: Mildred P. St. Leger, RRA Prereq: High School Length: 2 yrs. Begins: Sept. J. Sargeant Reynolds Community ColleSC-108 E .. Grace Street Richmond, VA 23241 Director: Lena Ann Fekete, RRA Prereq: High School Lenath: 2 yrs. Begins: Sept. •Not accepting 1tudent1 198~1 scbool year WASHINGTON Shoreline Community Collese 16101 Greenwood Avenue North Seattle, WA 98133 Director: Roslyn Regudon, RRA Prereq: High School Length: 2 yrs. Begins: Sept. Spokane Community College N 1810 Greene Street Spokane, WA 99207 Director: Beverli Reding, RRA Prereq: High School Length: 2 yrs. Begins: Sept. Tacoma Community Collese 5900 S. 12th Street. Bldg. 19 Tacoma. WA 98465 Director: Prereq: High School Length: 2 yrs. Begins: Sept. WEST VIRGINIA Fairmont State Collese Fairmont, WV 265S4 -148-Director: Sister Marie Hor\'ath, RSM, RRA Prereq: High School Length: 2 yrs. Begins: Sept. West Virginia Institute of Technology• Montgomery, W\' 25136 Director: Marilyn Wells, RRA Prereq: High School Length: 2 yrs . Begins: Sept. •Not accepting students 1980-81 school year. WISCONSIN District One Technical Institute 620 West Clairmont Avenue Eau Claire. WJ S4701 Director: Sister Nora Purtell, RRA Prereq: High School Length: 2 yrs. Begins: Sept. Moraine Park Technical Institute 235 North National Avenue Fond du Lac, WI S4935 Director: Ruth H. King, RRA Prereq: High School Length: 2 yrs. Begins: Sept. Western Wisconsin Technical Institute 6th and Vine Streets La Crosse, WI .5460 I Director: Carol Kowal, RRA Prereq: High School Length: 2 yrs. Begins: Sept. .. • • • • • • -149-ACCREDITED EDUCATIONAL PROGRAMS IN MEDICAL RECORD ADMINISTRATION American Medical Record Association 875 North Michigan Avenue Chicaao, Illinois 60611 Revised to January 1981 All of the following baccalaureate and post-baccalaureate degree programs for medical record administrators have been accredited by the Committee on Allied Health Education and Accreditation of the American Medical Association, .53.S North Dearborn Street, Chica101 Jllinois 60610 in collaboration with the Council on Education of the American Medical Record Association. Tuition costs for medical record administration programs generally are the same as tuition for the college/university. For more information about a specific medical record administration program, contact the college/ university. ALABAMA University of Alabama in Birmingham University Station Birmingham, AL 3.5294 Director: Sara Grostick. RRA Prereq: 2 yrs. college Length: 2 yrs. Degree: Bachelor of Science Begins: Sept. ARKANSAS Arkansas Tech University Russellville, AR 7280 I Director. Susan Parker, RRA Prereq: 2 yrs. college Length: 2 yrs. Degree: Bachelor of Science Begins: Sept. CALIFORNIA Loma Linda University 1932 Nichol Hall Loma Linda, CA 923.54 Director: Marpret C. Jackson, RRA Prereq: 2 yrs. college Length: 2 yrs. Degree: Bachelor of Science Begins: Sept. University of California School of Public Health Los Angeles, CA 90024 Director: Olive Johnson, RRA Prereq: Degree Length: 2 yrs. Degree: Masters of Public Health Begins: Varies Golden Uate University .536 Mission Street San Francisco, CA 9410.S Director: Joan Ludwia. RRA Prereq: 2 yn. college Length: 2 yrs. Degree: Bachelor of Science Begins: Sept. COLORADO Regis College CoUeae Denver, CO 80221 Director: Carolyn Samuels. RRA Prereq: 2 yrs. college Length: 2 yrs. Degree: Bachelor of Science Besins: Sept. CONNECTICUT University of Bridgeport Room 7 B Bridgeport, CT 06602 Director. Rose T. Manes. RRA Prereq: 2 yn. college Lensth: 2 yn. Degree: Bachelor of Science Begins: Aq. FLORIDA Florida International University North Miami Campus Miami, FL 33181 Director: Florence Amato, RRA Prereq: 2 yn. colleae Lensth: 2 yn. Degree: Bachelor of Science Besins: Sept. University of Central Florida Orlando, FL 32802 Director. Prereq: 2 yn. coUqe Length: 2 yrs. Degree: Bachelor of Science Begins: Sept. GEORGIA Emory University 1364 Clifton Road, N.E. Atlanta, GA 30322 Director. Betty Ramsden. RRA Prereq: 3 yn. college or dearee Length: 11 months Degree: Bachelor of Medical Science Begins: Sept. GEORGIA (Cont.) Medical College of GeorJia School of Allied Health Scienc:a Augusta, GA 30902 Director: Sara Davenport, RRA Prereq: 2 yrs. college Length: 2 yrs. Degree: Bachelor of Science Belina: Sept. ILLINOIS University of lllinois Medical Center 808 South Wood Street Chicago, IL 60612 Director: Rita Finnepn, RRA Prereq: 3 yrs. college or degree Length: 12 months Degree: Bachelor of Science Begins: June Illinois State University JOB C Moulto"l Hall Normal, lL 61761 Director: Elizabeth Gruber. RRA Prereq: 2 yrs. college Length: 2 yrs. Degree: Bachelor of Science Begins: Sept. INDIANA Indiana Univen.ity llOO West Michigan Street Indianapolis, IN 46202 Director Mary L. McKenzie, RRA Prereq: High School Length: 4 yn . Degree: Bachelor of Science Begins: Aug. KANSAS University of Kansas Medical Center 39th and Rainbow Blvd. Kansas City, KS 66133 Director: Susan Malone, RRA Prereq: 3 yrs. college or degree Length: I J months Degree: Bachelor of Science Begins · Sept. KENTUCKY Eastern Kentucky University Richmond, KY 40475 Director. Elaine Caldwell, RRA Prcreq: 2 yrs. college Length: 2 yrs. Degree: Bachelor of Science Begins: Sept. -150-LOUISIANA University of Southwestern Louisiana P. 0. Boll 4-!JC7 U. S. L. Lafayette, LA 70~01 Director: Carol A. Venable, RRA Prereq: High Sc'lliool Length: 4 y~. Degree: Bachelor of Scieace Belin•: Sept. Louisiana Tech Univenlty Collt&~ of Am and Scienms Ruston, LA 72170 Director: Lou Stebbins, RRA Prerect: 2 yrs. coUeae Length: 2 ,;:rs. Degree: Bachelor of Science Begins: ~pt. MAR\'LAND V. S. Public Hea&lth Service Hospital 3100 Wyman Park Drive Baltimore, MD 21211 Director: Jobnell Branch, RRA Prereq: DeJ.RC Length: 11 months Dep-ee: A warded by affiliated collepa olSly. Colby-Sawyer College New London, NH 032'7 Towson State Universitv Baltimore, MD · Begins: July MASSA CHU SITTS Northeastern University Huntington Avenue Boston, MA 02130 Director: Judith WciJcntein, RRA Pre1eq: High School Lensth: 4 yn. Degree: Bachelor of Science Bcains: Sept. MICHIGAN Mercy College of Detroit 8200 W. Outer Drive Detroit, MI 48219 Director: Diane E. O'Neil, RRA Prenq: Hip School Length: 4 yrs. Degree: Bachelor of Science ~gins: Sept. Ferris State College Big Rapids, MI 49307 Director: Joan Beltowski, RRA Prereq: 2 yrs. college · · Length: 2 yrs. Degree: Bachelor of Science Begins: Sept. .. .. ,. • -151-MINNESOTA NEW YORK Colleae of St. Scbolastica Daemen Collese 1200 Kenwood Avenue 4380 Main Street Duluth, MN 55811 Amherst, NY 14226 • Director: Patricia J. Pien:ic, RRA Director: Joanne Muller, RRA Prereq: Hip School Prereq: 2 yrs. colleae Length: 4 yn. Length: 2 yn. Degree: Bachelor of Science Degree: Bachelor of Science Begins: Sept . Begins: Sept. .. MISSISSIPPI Downstate Medical Center, SU'NY University-of Miaiuippi Medical Center ~ C1arUon A¥cnuc Brooklyn, NY 11203 2SOO North State Street Director: Jaaac Topor, RRA Jackson, MS 39216 Prereq: 2 yn. collep Director: E. Jacquelin Whitmore, RRA Length: 2 yn. Prereq: 2 yrs. college Desree: Bachelor of Science Length: 2 yrs. Begins: Sept. Degree: Bachelor of Science Begins: Sept. NORTH CAROLINA MISSOUIRI Western Carolina University Stephens College Without Walls School of Health Sciences P. 0. Box 2083 Cullowhee, NC 28723 Columbia, MO 6S21S Director: Mary J. Neill, RRA Director: John Berkbuegler, RRA Prereq: 2 yn. college Prereq: ART Length: 2 yrs. Length: Varies Degree: Bachelor of Science Degree: Bachelor of Arts or a Certificate Begins: Sept. Begins: Varies East Carolina University Avila College Greenville, NC 27834 11901 W omall Road Director: Peay H. Wood, RRA Kansas City, MO 6'1S6 Prereq: 2 yrs. college .. Director: Walter Aoreani, RRA Length: 2 yrs . Prereq: Hiah School Degree: Bachelor of Science Length: 4 yrs. Begins: Sept. Degree: Bachelor of Science .. Begins: Sept. St. Louis University OHIO 1 S04 South Grand Blvd. The Ohio State University St. Louis, MO 63104 1S83 Perry Street Director: Shirley Anderson, RRA Columbus, OH 43210 Prereq: High School Director: Melanie Pariser, RRA Length: 4 yrs. Prereq: 2 yrs. college Dep-ee: Bachelor of Science Length: 2 yrs. Begins: Jan. and Sept. Degree: Bachelor of Science MONTANA Begins: Sept. Carroll College Faculty Box 8-394 OKLAHOMA Helena, MT 59601 East Central Oklahoma University Director: Sister Rose Agnes Louk, RRA Ada, OK 74820 Prereq: High School Director: Lorraine Hooker, RRA Length: 4 yrs. Prereq: 2 yrs. college Degree: Bachelor of Arts Length: 2 yrs. Begins: Sept. Degree: Bachelor of Science I NEBRASKA BeP,,.s: Aug. College of Saint Mary University of Tulsa 1901 South 72nd Street 600 South College Omaha, NE 68124 Tulsa, OK 74104 .. Director: Ellen Jaco))&, RRA Director: Helen T. Epstein, RRA Prereq: High School Prereq: 2 yrs. college Length: 4 yn. Length: 2 yrs. Degree: Bachelor of Science Degree: Bachelor of Science Begins: Sept. Begins: Sept. OKLAHOMA (Cont.) Southwestern Oklahoma Sbite Urdversity Weatherford, OK 73096 Director: Marion S. Prichard, RRA Prereq: 2 yrs. college Length: 2 yrs. Degree: Bachelor of Science Begins: Aug. PENNSYLVANIA T~ University 3307 Nonh Broad Street Philadelphia, PA 19140 Director: Elaine 0. Patrikas, RRA Prereq: 2 yrs. college Length: 2 yrs. Degree: Bachelor of Science·· Begins: Sept. University of Pittsburgh 307 Pennsylvania Hall Pittsburgh, PA 15261 Director: Elisabeth Anderson, RRA Prereq: 2 yrs. college Length: 2 yrs. Degree: Bachelor of Science Begins: Sept. York College/ Hospital 1001 South George Street Yorl, PA 17403 -Director: Prereq: 2 yrs. college Length: 2 yrs. Degree: Bachelor of Science Begins: Sept. SOUTH CAROLINA Medical University of Sopth Carolina 171 Ashley Avenue Charleston, SC 29403 Director: Mildred S. Cash, RRA Prereq: 2 yrs. college Leng!h: 2 yrs. Degree: Bachelor of Science Begins: Sept. TENNESSEE University of Tennessee 956 Court, Suite JAi I Memphis, TN 38163 Director: Mary C. McCain, RRA Prereq: 3 yrs. college Length: 12 months Degree: Bachelor of Science Begins: Sept. -152-Tennessee State University-Meharry Medical College 3500 Centennial Blvd. Nashville. TS 37203 Director: Lois Jenkins, RRA Prercq: 2 yn. college Length: 2 yrs. Degree: Bachelor of Science Begins: Aug. TEXAS Texas Woman's University, Dallas Campus 1810 Inwood Road Da:las, TX 75235 Director: Barbara James, R RA Prcrrq: 2 )n. collqe Length: 2 yrs. Degri:c: Bachelor of Science Begins: Sept. University of Texas Medical Bnnch Schoo! of Allied Health S~ienm Galveston, TX 77550 · Dirrctor: Kathryn E. Howard, JlR,\ Prereq: 2 yrs. college i Length: 2 yrs. Degree: Bachelor of Science Begins: Sept. lncar!late Word College 430l Broadway San Antonio, TX 77003 Director: Vincent Elequin, R RA Prerrq: High School Lcngt h: 4 yn. Degree: Bachelor of Science Begini.: Aug. Southwest Texas State Univenity School of Health Professions San Marco!-, TX 78666 Director: Adolph Ramon, RRA Prereq: 2 yrs. college Length: 2 yrs. Degree: Bachelor of Science Begins: Aug. VIRGINIA Virginia Common\\oealth University Medical College of Virginia MCV Station Richmond, VA 23298 Director: Dwight Dixon, RRA Prcreq: 2 yrs. college Length: 2 yrs. Degree: Bachelor of Science Begins: Aug. WASHINGTON Seattle University I 108 E. Columbia Street Seattle, WA 98122 Director: Kathleen Waters, RRA Prereq: 3 yrs. college or degree Length: 9 months Dcgr~e: Bachelor of Science Begins: Sept. WEST VIRGINIA Alderson-Broaddhus College Philippi, WV 26416 Director: Anna Kraus, RRA Prereq: High School Length: 4 yrs. Degree: Bachelor of Science Begins: Sept. 'W ... & • • & • .. WISCONSIN Viterbo College 818 South 9th Street La Crosse, WI 54601 Director: Lois Hess, RRA Prereq: High School Length: 4 yrs. Degree: Bachelor of Science Begins: Sept. University of Wisconsin-Milwaukee Sc1ioot of Allied Healfh Professions Milwaukee, WI 53201 Director: John Lynch, RRA Prereq: 2 yrs. college Length: 2 yrs. Degree: Bachelor of Science Begins: Sept . -153-PUERTO RICO Umversity of Puerto Rico G.P.O. Box 5067 San Juan, PR 00936 Director: Ana de Hestres, RRA Prereq: Degree Length: 11 months Degree: Post-baccalaureate diploma Begins: Aug. Scholarshipr. available. -154-BIBLIOGRAPHY Ad Hoc Committee on Health Information. "Report of Sub Group on Hospital Institutions." 1979. Aldrich, Robert F., and Turner, Judith A. Dilemma: A Report of the National Conference on the Health Records Dilemma, Washington, D.c., October 12-13, 1977. Washington, D.r..: National Commission on Confidentiality of Health Records, 1918. American Hospital Association. Hospital Medical Records: Guide-lines for Their Use and the Release of Medical Information. Chicago, Illinois: American Hospital Assoc1at1on, 1972. American Hospital Association. Medical Record Departments in Hospitals: Guide to Organization. Chicago, Illinois: Ameri-can Hospital Association, 1972. AMRA Ad Hoc Committee on Graduate Education. "AMRA Ad Hoc Com-mittee on Graduate Education Outlines Three Recommended Content Areas for Advanced Degree Programs." Journal of the American Medical Record Association (August 1980): 64-70. ' Ball, Marion J., and Shannon, Roger H. "The Medical Record Scientist as a Health Care Computer User: An Emerging Role for the Future." Journal of the American Medical Record Assoc-iation 15:3 (June 1980):12,108-111. Bloomrosen, Meryl. "The Development of a Quality Control Program: Activity Reporting and Performance Standards." Journal of the American Medical Record Association 51:4 (August 1980): 57-63. Canada. Canada Health Manpower Inventory 1980. Health and Welfare Canada. ISSN-0381-2561. 1981a. Canada. Health Manpower Training Programs in Canada. Health and Welfare Canada. 1981b. Canadian Organization for Advancement of Computers in Health. Guidelines to Promote the Confidentiality and Security of Automated Health Records. June 1979. Coffey, R.How a Medical Information System Affects Hospital Costs: The El Camino Hospital Experience. DHEW Publication No. (PHS) 80-3265. March 1980. Corn, Richard F. "Quality Control of Hospital Discharge Data." Medical Care XVIII:4 (April 1980):416-426. Davenport, Sara R. "A Pre-empirical Approach to Assessing the Need for a Medical Record Administration Education Program." Journal of the American Medical Record Association 51:2 (April 1980):53-56. Demlo, Linda K.; Campbell, ·Paul M.; and Spaght Brown, Sarah. "Reliability of Information Abstracted from Patients' Medical Records." Medical Care XVI:12 (December 1978):995-1005. II It • • Q ' ' fl -15:>-Drazen, E., and Metzger, J. Methods for Evaluating Costs of Automated Hospital Information Systems. DHHS Publication No. (PHS) 81-3283. July 1981 • Giebink, Gerald A., and Hurst, Leonard L. Computer Projects in Health Care. Ann Arbor: Health Administration Press, 1975 • Gordis, Leon, and Gold, Ellen. "Privacy, Confidentiality, and the Use of Medical Records in Research." Science 207 (11 January 1980} !153-156. Hayt, Emanuel. Medicolegal Aspects of Hospital Records. Berwyn, Illinois: Physicians' Record Company, 1977. Horn, Susan Dadakis, and Pozen, Michael w. Implicit Judgments in Chart Review." Health 2:4 (Summer 1977):251-258. "An Interpretation of Journal of Community Huffman, Edna K. Medical Record Management. Berwyn, Illinois: Physicians' Record Company, 1972. International Federation of Medical Records Organizations. Proceedings of the Seventh International Congress on Medical Records. Toronto, Ontario: 1976. Johnson, Olive G., and Cave, Carolyn. "Review and Verification of Roles and Functions of Medical Record Personnel." Journal of the American Medical Record Association (June 1979):25-35. Johnson, Olive G. "We've Come a Long Way." Journal of the Ameri-can Medical Record Association (October 1981):33-38. Lansing, J.B., and Morgan, J.N. Economic Survey Methods. Ann Arbor, Michigan: Survey Research Center of the Institute for Social Research, 1 971 • Lindberg, Donald A.B. The Growth of Medical Information Systems in the United States. Toronto: Lexington Books, 1979. Mattix, Sandra K. "MRA Graduates Respond to Survey: Careers and College Preparation." Journal of the American Medical Record Association 15:5 (October 1980):92-95. Ontario. Medical Record Keeping. Toronto, Ontario: The Ontario Council of Health, 1978. Peterson, Lynn L., and Reisch, Joan S. "Update on the Status of Medical Computer Science Programs in the U.S. - 1979." Dallas: The University of Texas. Reding, Beverli H. "Accredited Record Technicians with a Baccal-aureate Degree - An Examination of Education, Health Record Work Experience and Motivation Factors as Predictors of Entry-Level Registered Record Administrators' Occupational Readiness." Journal of the American Medical Record Associa-tion 52:3 (June 1981):26-35. - l .;J-Rogers, James L., and Haring, Olga M. "The Impact of a Computerized Medical Record Summary System on Incide~ce and Length of .Hospi-talization." Medical Care XVII:6 (June 1979):618-630. Rogers, James L. et al. "Medical Information Systems: Assessing Impact in· the Areas of Hypertension, Obesity and Renal Disease." Medical Care XX: 1 (January 1982) :63-74. Romm, Fredric J., and Putnam, Samuel M. "The Validity of the Medical Ree-o-rd." Medical Care- XIXtJ. (March 1981):310-315 .. Shires, David B. "A Standardized Curriculum Design for the Educa-tion of Technician Level, Health Record Personnel in Canada." Report of a Study Commissioned by the Canadian College of Health Record Administrators. Halifax: Dalhousie University, 1980. Smith, Martha E. Record Linkage of Hospital Admission-Separation Records. Chalk River, Ontario: Atomic Energy of Canada Limited, 1973. Starfield, Barbara et al. "Concordance Between Medical Records and Observations Regarding Information on Coordination of Care." Medical Care XVII:7 (July 1979):758-766. Studney, D.R., and Hakstian, A.R. "A Comparison of Medical Record with Billing Diagnostic Information Associated With Ambulatory Medical Care." American Journal of Public Health 71 :2, 145-149. Stumpfhauser, Laszlo. "Educational and Professional Mobility, Change, and the Medical Record Practitioner." Journal of the American Medical Record Association (August 1976):50-55. Sullivan, Robert J. Medical Record and Index Systems for Community Practice. Cambridge, Massachusetts: Ballinger Publishing Company, 1979. Szabo, Irma. "The Future Role of the Health Record Administrator: A Delphi-Survey." M.Sc. thesis, The University of British Columbia, 1980. Task Force on the Future Role of the Medical Record Administrator. "Conclusion and Recommendations of the Task Force on the Future Role of the Medical Record Administrator: Final Report April 9, 1974." Journal of the American Medical Record Association 45:6 (December 1974):83-85. Troman, Linda, and Gruber, Elizabeth. "Assessing the Educational Needs of Medical Record Personnel." Journal of the American Medical Record Association 51:2 (April 1980):42-44. Tufo, Henry M., and Speidel, Joseph J. "Problems with Medical Records." Medical Care IX:6 (November-December 1971):509-517. U.S. Congress. Office of Technology Assessment. Policy Implica-tions of Medical Information Systems. Washington, D.C.: November 1977. " " ' • • r • Q ~l -157-U.S. Department of Commerce. Computers, Health Records, and Citizen Rights, by Alan F. Westin. PB-262 497. December 1976. Universities Council of British Columbia. "A Proposal Concerning the Health Records Administration Program at Notre Dame University of Nelson." mimeo, Ad Hoc Committee on Health Records Administration, 1976 . University of British Columbia. "Minutes." U.B.C. Committee on Health Record Administration, meetings 1 through 5, 1977. University of British Columbia. PRODUCTION 81. Division of Health Services Research and Development, Office of the Coordinator of Health Sciences. Report P:5. 1982. University of British Columbia. "Report of the Health. Sciences Centre Committee Concerning a Health Record Administration Program at U.B.C." mimeo, 1977. Von Kuster, Thomas w., Jr.; Appel, Gary L.; and Sippel, Curtis L. "Exploring Curriculum Relevance & Labor Market Conditions for MRTs." Journal of the American Medical Record Association (October 1976):22-29. Waters, Kathleen, and Hanken, Mary Alice. "Progression Update -ART to RRA." Journal of the American Medical Record Associa-tion (June 1977):20-23 . Waters, Kathleen A., and Murphy, Gretchen Frederick. Medical Reco rds in Health Information. Germantown, Maryland: Aspen Systems Corporation, 1979. Whiting-O'Keefe, Quinn E.; Simborg, Donald W.; and Epstein, Wallace V. "A Controlled Experiment to Evaluate the Use of a Time-Oriented Summary Medical Record." Medical Care XVIII:8 (August 1980):842-852. v & ' " • • 

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