Learning Outcomes

• Describe the historical evolution and global development of the Health Information Management (HIM) profession.
• Analyse the current and emerging roles of HIM professionals within the Australian and international healthcare systems.
• Evaluate future challenges and opportunities for the HIM profession in the context of digital health, workforce trends, and leadership development.

Introduction

The health information management (HIM) profession has a history spanning more than a century, with the first peak body established in Australia more than 75 years ago (Health Information Management Association of Australia [HIMAA], 2024a). While the role title of the health information manager has changed over time, its primary function has remained the same—to oversee the governance of health data and information.

This chapter presents the history of the HIM profession and professional bodies, including their involvement in informing policy and systems in Australia and other countries, and international organisations. Next, the chapter draws on literature examining the roles of HIM professionals in Australia and other countries, much of which has been published by this authorship team. Lastly, the chapter explores the future of the profession and roles for the health information manager, including emerging roles and the evolution required of the profession in the evolving digital landscape. The chapter concludes with activities that allow the reader to test their knowledge of the topics covered in this chapter.

History of the Profession

Globally, the HIM profession has evolved significantly over the past century, driven by advancements in technology, changes in healthcare delivery, and the increasing importance of data in decision-making processes (Butler-Henderson, 2017). These changes have occurred at different rates across nations, often reflecting the maturity of a country’s healthcare system and digital innovations. The origins of the HIM profession can be traced back to the early 20th century, when the need for standardised medical records became apparent. The birth of the HIM profession and the professional associations occurred in quick succession.

The creation of documentation standards in 1919 by the American College of Surgeons led to establishing the HIM workforce as stewards of recordkeeping (Abdelhak, 2015). A dedicated workforce was required to manage, sort, and catalogue health records. Following the Clinical Congress of 1928, the American College of Surgeons and representatives of the health record workforce established the Association of Record Librarians of North America. This organisation played a crucial role in setting standards for medical record-keeping and the professionalisation of the discipline. In 1942, the association split into the American Association of Medical Record Librarians and the Canadian Association of Medical Record Librarians (Abdelhak, 2015; Canadian Health Information Management Association, 2019). The United Kingdom’s association, now called the Institute of Health Records and Information Management, was formed in 1948 (Institute of Health Records and Information Management, 2025).

In 1949, the Australian Hospital Association invited Edna Huffman, a health records consultant and lecturer from Chicago, to share her expertise on records management with Australia’s Medical Record Librarians (Watson, 2013). Huffman’s visit resulted in the creation of state-based professional associations in Victoria and New South Wales (Watson, 2013). As the profession grew, so did the professional association, with the formation of a national association, the Australian Federation of Medical Record Librarians in 1955 (Watson, 2008). Other Australian states were encouraged to form associations and join the Australian Federation. With the formation of the Australian Federation of Medical Record Librarians, Australia had a voice in global developments for the profession, becoming an inaugural member of the International Federation of Medical Record Organizations in 1968 (Watson, 2008).

As the years progressed and the profession grew, the role of Medical Record Librarian changed to Medical Records Administrator in Australia in 1977, reflecting the increasing knowledge and responsibilities of the role. The Australian Federation of Medical Record Librarians became the Medical Record Association of Australia around the same time (HIMAA, 2024b). These changes reflected the evolving role of the profession, and the change in training needs. The introduction during the 1980s of computerised systems, such as the patient master index system, changed how patient identification was captured and recorded (Watson, 2013). The introduction of casemix in the United States in the 1970s changed how data were collected and used. Introduced to Australia in the 1980s, the use of casemix data and activity-based management in Victoria in 1992 and Western Australia in the mid-1990s, with a national activity-based funding approach introduced in 2012, drove an increased need for qualified HIM professionals (Duckett & Willcox, 2015; Independent Health and Aged Care Pricing Authority, 2024, Watson, 2013). During the 1980s and 1990s, the qualifications required for a Medical Records Administrator changed from a diploma to a bachelor degree, as graduates required skills across health, information governance, data science, and informatics, requiring a university qualification to undertake the role. In 1991, the members of the Medical Record Association of Australia voted to change the professional title to HIM and to rename the peak body the Health Information Management Association of Australia (HIMAA) (Watson, 2013).

As healthcare systems around the world recognised the importance of accurate and accessible health information, the HIM profession began to expand internationally. The International Federation of Health Record Organizations (IFHRO) became the International Federation of Health Information Management Associations (IFHIMA), which has been instrumental in promoting global collaboration and standardisation in HIM practices (Watson, 2019). IFHIMA’s triennial congresses provide a platform for HIM professionals from different countries to share knowledge and best practices.

The digital transformation of health data has evolved the role of health information manager (Butler-Henderson, 2017). The transition from paper-based records to electronic health records has improved the efficiency, accuracy, and accessibility of health information. HIM professionals have had to adapt to new roles involving data management, clinical coding, and information governance (Butler-Henderson, 2017). The integration of health informatics and data analytics into HIM practices has further enhanced the ability to derive actionable insights from health data (Butler-Henderson, 2017). Professional organisations such as HIMAA and IFHIMA offer certifications that validate HIM professionals’ competencies in these areas. Continuous professional development is essential to keep pace with the rapidly changing healthcare landscape (HIMAA, 2025). Despite the progress made, the HIM profession faces several challenges. Data privacy and security remain critical concerns, especially with the increasing use of digital health technologies. Ensuring the interoperability of health information systems across different countries and healthcare settings is another significant challenge. However, these challenges also present opportunities for HIM professionals to innovate and lead efforts to improve health information management globally (Butler-Henderson, 2017).

The Role of the Modern Health Information Manager

The health information manager role is described as one that will “plan, develop, implement and manage health information services, such as patient information systems, and clinical and administrative data, to meet the medical, legal, ethical and administrative requirements of health care delivery” (Jobs and Skills Australia, 2025). This is a broad definition, as the HIM role is much more extensive. Simply put, where health data is captured, there is a need for a HIM professional.

The American Health Information Management Association career map (AHIMA, 2024) highlights current and emerging HIM roles within six domains. The six domains cover data quality (including coding and clinical documentation integrity), revenue cycle management, consumer health information, data analytics, informatics, privacy, and risk compliance. The career map supports HIM professionals in planning their career trajectory, understanding where their knowledge and expertise can be used across the breadth of HIM roles, and identifying where further education may be required.

These domains differ slightly in Australia, where roles usually fall within four categories:

1. Classification and casemix.
2. Health informatics, including digital health.
3. Management, governance, and quality.
4. Academia and research (Butler-Henderson, 2017).

Classification and casemix roles include clinical coding (coder, auditor, educator, trainer), casemix analysts, data analysis, and clinical documentation integrity. In comparison, individuals who manage health records, including privacy and access to information, work within the domain of management, governance, and quality. The domain of health informatics initially focused on data standards, system management, and business analysis, but as electronic health records increased, more digital health roles aligned with this domain (Butler-Henderson, 2017). The last Australian domain is academia and research, which includes roles that educate others to become qualified health information managers and those working to create new knowledge through research such as research assistants, data managers, epidemiologists, and clinical research associates (La Trobe University, 2024; Queensland University of Technology, 2024; University of Tasmania, 2024).

HIM professionals are part of the specialist digital health workforce, also known as the HIDDIN workforce, being those specialising in Health Informatics, Digital, Data, Information and kNowledge (Butler-Henderson, Day & Gray, 2021). As it has in the past, the profession will continue to adapt and evolve in line with the healthcare system while maintaining core positions of clinical coder and health information manager, continuing to manage health data, records privacy, information access, and data reporting (Wissmann et al., 2024).

Competency Frameworks and Education Pathways

Competency and capability frameworks are important as they underpin graduate training needs and set out the graduate entry role. The creation of competency frameworks ensures that the workforce receives the academic foundation to effectively meet healthcare system information management needs. Therefore, competency frameworks must continually be reviewed and updated as the industry evolves to ensure graduates are job-ready (Ritchie et al., 2021).

HIMAA develops and maintains the Australian competency standards for the HIM profession. The competency framework provides a mechanism for educators, the industry, and third parties to understand the functions performed by the profession, in addition to the knowledge and skills of individuals from graduate to experienced (HIMAA, 2023). The competencies comprise 10 domains (Table 1) and three learning levels. Table 1 highlights the breadth of knowledge of a HIM professional and aligns with the broad role areas identified in the previous section.

The Australasian Institute of Digital Health (AIDH, 2022) maintains the Australian Health Informatics Competency Framework developed for the health informatics workforce. Another occupational group in the specialist digital health workforce, many HIM professionals work in health informatics roles and undertake the Certified Health Informatics Australasia certification (McNeile McCormick et al., 2024). There are several similarities between the HIMAA and AIDH frameworks, as shown in Table 1. The overlap between health information management and health informatics is also reflected in the Global Academic Curricula Competencies for Health Information Professionals (Global Health Workforce Council, 2015).

Within Australia, two core education pathways can lead to a career in HIM. A health information manager is a university graduate with either a Bachelor or Master in HIM (HIMAA, 2025). A clinical coder has two options: vocational education and training with a Diploma in Clinical Coding, or a Bachelor of Health Information Management degree. Both options provide the education to be employed as a qualified clinical coder and work in roles requiring classifications and casemix knowledge. Obtaining a qualification in HIM provides a solid foundation for a career working as a generalist or specialist in any of the domains previously discussed. Once working in the field, a HIM professional can move throughout an organisation, working in roles with titles that include officer, analyst, manager, director, consultant, chief executive, lecturer, and professor. HIM professionals are committed to lifelong learning through self education, informal and formal education, mentoring and coaching, and educating others  (Kemp et al., 2021).

Workforce Trends

The Australian Specialist Digital Health Workforce Census collects data about the broader specialist digital health workforce, and specifically the HIM profession, including comprehensive data about current workforce roles, as well as data about the demographics, training, professional development, and future intentions of this workforce (Butler-Henderson et al., 2017). The 2023 census data provides a snapshot of the HIM professional in Australia (Butler-Henderson, Gray & Arabi, 2023). An analysis of this data was undertaken for this chapter to provide a comprehensive picture about the HIM workforce in Australia.

The demographic and professional profile of HIM professionals in Australia reveals important insights into the workforce composition. Based on a sample of 133 participants, the data shows the workforce is largely comprised of  older women, with 82.0% identifying as women and 66.9% aged 45  or older (average age 49.3 years). Most HIMs identify as non-Indigenous (97.0%), and those living with a disability is low (0.8%). Citizenship status demonstrates the predominance of Australian nationals in the field (93.2%), with 6.8% holding permanent resident status. This is reflective of the broader trend towards a locally-based workforce in health information management.

In terms of educational qualifications, most HIMs have attained a formal tertiary qualification (69.2%). Of those with tertiary qualifications, the majority hold a Bachelor’s degree (56.5%). A large proportion (77.4%) of the workforce do not possess a formal credential, suggesting that credentialing is not a widespread requirement in the field. Despite this, the data suggests that years of experience in the workforce is positively associated with higher remuneration. Most HIMs earn between $2,000-$2,499 per week before tax (25.0%), followed by $1,500-$1,999 (19.4%). All respondents who earn above $5,000 per week hold a Master qualification.

Approximately half (47.0%) of HIM professionals identified having undertaken professional development in the last year, highlighting commitment to ongoing skill development in the profession in half of the workforce, but not an organisational need for staff in HIM roles to undertake continuous professional development. While nearly a third (29.7%) of individuals plan to remain in the workforce for 15 years or more, most have shorter-term plans to leave the workforce, with 24.7% intending to stay for five years or less and 14.0% uncertain about their future in the profession. Notably, despite uncertainties around their future workforce intention, an overwhelming 88.6% of respondents would recommend a career in a digital health specialist role, indicating strong overall satisfaction and endorsement of the profession.

However, aspirations for senior leadership roles appear less common in HIM professionals than in other areas of the specialist digital health workforce, with 63.9% of respondents indicating they do not intend to pursue senior leadership positions. This presents a significant challenge for future leadership and strategic direction of the field, particularly in an era where the healthcare sector is rapidly evolving. If this leadership gap is not addressed, the HIM workforce may face difficulties in adapting to emerging challenges, influencing policy development, or leading innovation in digital health. This data highlights the need for younger graduates with a clearer pathway to senior leadership roles, and may also point to potential barriers preventing HIM professionals from pursuing leadership positions, such as a lack of mentorship opportunities, limited visibility of career advancement pathways, or inadequate support for developing leadership skills within the field.

Future Direction of the Profession

The HIM profession has evolved significantly over the decades, driven by advancements in technology, changes in healthcare delivery, and the increasing importance of data in decision-making processes (Butler-Henderson, 2017). The transition from paper-based records to electronic health records has revolutionised the HIM profession. The future of the HIM profession is likely to be shaped by several key trends. The increasing use of artificial intelligence and machine learning in healthcare will create new opportunities for HIM professionals to leverage these technologies for data science and decision support. The growing emphasis on person-centred care and population health management will also require HIM professionals to develop new capabilities. Moreover, the global HIM community will continue to benefit from international collaboration and knowledge sharing. Organisations like IFHIMA will play a crucial role in fostering these collaborations and promoting best practices in health information management worldwide.

While the role of the HIM professional today is clearly defined, the workforce data presented in this chapter shows an ageing workforce, and advances in technology will result in the automation of some operational functions. In order to maintain the sustainability of the workforce, HIM professionals need to evolve from information operationalists to information strategists (Butler-Henderson, 2017). HIM professionals must engage in lifelong learning to keep pace with technological advancements and evolving healthcare needs. This includes obtaining certifications in emerging areas such as AI, machine learning, and data analytics. A greater emphasis must be placed on collaboration with other healthcare professionals, information technology specialists, and policymakers to develop integrated solutions for health information governance. The profession must also embrace new technologies such as artificial intelligence and machine learning to improve data management, security, and interoperability (Kemp et al., 2021).

The transition from paper to digital assets does not diminish the importance of HIM professionals. Health information managers are responsible for information governance, regardless of the medium. Given the accelerated adoption of digital health tools, the HIM professional’s role has become increasingly vital to safeguarding data privacy and security (Kemp et al., 2021). It is therefore essential that they remain up to date with regulations and best practices to govern health data and undertake further continuous professional development. The HIM professional needs to lead efforts to standardise data structures in health information systems and ensure interoperability across different health and social care organisations, settings, and jurisdictions to facilitate the seamless exchange of health data and improve health care (Butler-Henderson, 2017).

In addition to lifelong learning, it is also imperative that the HIM professional is recognised in the national and international classifications of occupations (Butler-Henderson et al., 2024). Recent research conducted globally has shown that most national-level classification systems did not classify health information managers as a professional occupation, but rather, as a technical occupation, and research has also shown that none of the classification systems reviewed used the term “digital health” (Butler-Henderson et al., 2024).

No innovation can be complete without a wide range of ideas and perspectives, and HIM professional leadership must promote diversity and inclusion within its workforce around the world (Butler-Henderson et al., 2024). Additionally, HIM professionals can lead advocacy efforts to promote policies that support the effective use of health information, and should collaborate with regulatory bodies to shape the future of the profession. The HIM profession has come a long way from its origins in medical records to its current iteration and focus on digital health and data analytics (Kemp et al., 2021). As the profession continues to move forward, it must embrace new technologies, address emerging challenges, and continue to advocate for the importance of accurate and accessible health information.

Conclusion

Global evolution of the HIM profession illustrates the changing nature of healthcare and highlights the essential role that health information plays in improving patient outcomes. The HIM profession has continually evolved to meet the changing needs of healthcare systems. As the profession moves forward, HIM professionals will need to embrace new technologies, address emerging challenges, and continue to advocate for the importance of accurate and accessible health information.

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