Health Information (Medical Records) Technicians
A new entry is made in patients' medical records each time they receive care. In an inpatient setting such as a hospital or long-term care facility the records will be separate from those maintained in practitioners' offices or other outpatient ambulatory care settings. Each record will contain information about the patient's complaint and symptoms, the diagnostics (test and x-ray results and reports), the diagnosis, treatments, and outcomes.
Duties, Activities, and Scope of Practice
The medical records or health information technician assembles the patient's information and ensures that all portions of the chart are complete and signed by the appropriate team member, such as the physician, nurse, or therapist. If the records are computerized, the technician ensures that all information is entered correctly and is complete.
They make sure that each portion of the chart is correctly identified and that all forms are complete and signed appropriately. In some instances the technician may participate in the tabulation and analysis of patient data to ensure quality is maintained, to improve patient care delivery, or to control costs. Technicians then follow procedures and systems established by the RHIA (Registered Health Information Administrator) to ensure the records are maintained, secure, and easily accessible.
Education and Training
Employers prefer to hire health information technicians who are registered. This requires a minimum of an associate's degree in health information from an accredited program. The Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM) accredits these programs.
The curriculum includes general-education courses plus medical terminology, anatomy and physiology, computer science, the legal aspects of health information, coding, quality improvement, database management, statistics, and abstraction of data.
Licensure/Certification
Graduates of accredited programs can sit for the certification examination given by AHIMA. Those who pass may use the credentials RHIT (registered health information technician). Recertification is done every two years and requires continuing education.
Work Settings and Salaries
Medical records technicians usually work forty hours per week. Some overtime may be required occasionally. In hospitals, the medical records department must be accessible twenty-four hours a day, and therefore technicians may work day, evening, or night shifts, and some weekends and holidays.
Health information technicians also work in ambulatory care settings, long-term care facilities, and public health departments.
Fact
According to the U.S. Department of Labor, the median income in 2004 for health information medical records technicians was $25,590. Salaries ranged from $17,720 to over $40,000 and largely depended on education, credentials, and settings. Those working in hospitals tended to make more money.
Career Potential and Additional Information
There is expected to be an enormous amount of medical records produced in the next decade due to an aging and growing population that is expected to require much more medical care and services. Therefore the U.S. Department of Labor expects this profession to grow faster than the average for all occupations over the next decade.
To find out more about becoming a medical records health information technician, contact the American Health Information Management Association (AHIMA). Their Web site is
