Health Information Management and Medical Records: United States Industry Report

Summary

This report covers health information management (HIM) and medical records work in the United States, based on a verified pack of federal statistics, peer-reviewed hospital studies, regulatory texts and secondary commentary. The Bureau of Labor Statistics projects employment of medical records specialists to grow 8 percent, faster than the average for all occupations, with about 14,000 openings a year ¹. Hospital electronic exchange is now widespread: 96 percent of hospitals electronically send information and 93 percent receive it ². Integration of outside information into records remains a gap, with 22 percent of hospitals not integrating electronic health information ³ and integration flat at 79 percent ². Adoption lags in the most deprived areas ⁴ and in rural hospitals ⁵. Key risks include AI coding tools that may reduce some demand ¹, privacy and safeguard duties ⁶, and missing verified data on cost, turnaround and staffing. The outlook favors continued growth in exchange and records work, conditional on closing equity gaps and improving data quality.

Key findings

1. 1

   Hospital exchange is near universal in sending and receiving

   96 percent of non-federal acute care hospitals electronically sent information and 93 percent received it in the latest data.

   Confidence: High
2. 2

   Integration of outside information has stalled

   22 percent of hospitals did not integrate electronic health information into their systems, and integration of outside information stayed at 79 percent with little change over time.

   Confidence: High
3. 3

   Adoption gaps track neighborhood deprivation

   Hospitals in the most deprived areas were significantly less likely to adopt health information technologies, although adoption rose over time at all deprivation levels.

   Confidence: Medium
4. 4

   Rural hospitals continue to lag urban hospitals

   Rural acute care hospitals trail urban hospitals in telehealth, patient engagement and health information exchange functions.

   Confidence: Medium
5. 5

   Employment projections point to continued demand for medical records workers

   Employment of medical records specialists is projected to grow 8 percent, with about 14,000 openings per year, while BLS notes AI coding tools may affect demand.

   Confidence: Medium
6. 6

   Information blocking scope has expanded to designated record sets

   Secondary commentary reports that information blocking rules now cover electronic information in a HIPAA designated record set, not only the legal medical record.

   Confidence: Qualitative

1Industry definition and scope

This report covers health information management (HIM) and medical records work in the United States. The geographic scope is national. The source pack contains no global comparison data, so no international claims are made. Each source reports its own latest available data, and the sources do not share one reporting period, so cross-source comparisons are indicative only.

The pack does not contain a formal industry definition. This report uses the boundaries implied by its sources: the occupation of medical records specialists ¹, electronic exchange of information by hospitals ²³, and the legal duties governing patient records ⁶⁷⁸¹⁰. Electronic health information (EHI) means the electronic patient data covered by interoperability rules. The designated record set is the group of records a covered entity uses to make decisions about individuals, and it includes billing records, not only the legal medical record ⁸.

Excluded from scope: ambulatory-only, payer and vendor market sizing, because the pack holds no verified figures for them. Hospital statistics cover non-federal acute care hospitals ², so federal hospitals and other facility types are outside the hospital data.

Scope follows the source pack only. No industry definition was taken from outside the pack.

2Market size, structure and value chain

The pack contains no verified market size, revenue or growth figure for HIM services or medical records software. Market-research compilations exist, but their figures could not be checked against primary data for the same period, so this report does not state a market value. The closest verified growth indicator is workforce: the Bureau of Labor Statistics projects employment of medical records specialists to grow 8 percent, faster than the average for all occupations ¹. This is a forecast of employment, not of revenue.

The value chain runs from clinical care to records and back. Hospitals and other providers create records. HIM staff code diagnoses and procedures, process records requests and prepare information for release. Electronic health information then moves through EHR systems, direct exchange and health information exchanges (HIEs). A market-research compilation reports that 61 percent of hospitals query outside patient information through state, regional or local HIEs ⁹. This is a secondary figure from a publisher that is not independently verified, so it is treated as indicative only. Federal rules set obligations at several steps ⁶⁷.

Key stakeholders include hospitals, ambulatory providers, post-acute and behavioral health providers, HIEs, patients and federal regulators. Revenue models are not documented in the pack. Data are not available on how providers, HIEs or software suppliers fund HIM functions or what they spend on them. Interpretation: because billing records fall within the designated record set ⁸, financial and clinical record handling are regulated together, which widens HIM work beyond the clinical chart.

• Projected employment growth, medical records specialists 8percent change in employment Forecast United States, Latest BLS projection period [1]

Figures are taken directly from the pack. The market-research figure is labeled as secondary and not verified.

3Customers, demand and adoption

Patients are a central end-user group. Individuals generally have the right to review and obtain a copy of protected health information in a covered entity's designated record set ⁶. Under the HIPAA right of access, covered entities have up to 30 days to respond, extendable by a further 30 days ⁷. Demand for records access therefore runs on a legal timetable. The pack has no verified data on actual request volumes, turnaround times or fulfillment rates.

Hospital demand for exchange is high on the sending and receiving side. 96 percent of hospitals electronically sent information and 93 percent received it ². Routinely interoperable hospitals reported 92 percent availability of outside patient information, compared with 80 percent for sometimes-interoperable hospitals ³. Still, 22 percent of hospitals did not integrate electronic health information ³. Exchange with post-acute and behavioral health providers lagged exchange with hospitals and ambulatory providers ³.

Demand drivers include chronic disease, which BLS links to rising coding needs ¹. Barriers are structural. Hospitals in the most deprived areas were significantly less likely to adopt health information technology, including electronic data query capability and data availability ⁴. Rural hospitals continue to lag urban hospitals in telehealth, patient engagement and health information exchange ⁵. Purchasing criteria for HIM services are not covered in the pack, so data are not available on what buyers prioritize.

• Hospitals electronically sending patient information 96percent of hospitals Observed United States, non-federal acute care hospitals, Latest available data [2]

Adoption figures are self-reported survey measures from the AHA IT Supplement as reported by ONC.

4Competitive landscape and key players

The pack names no HIM vendor, EHR supplier or records company with verified performance, market share or pricing data. Company-level comparison is therefore not possible, and comparable company examples are limited. The fair comparison available is between provider types, using adoption measures from official and peer-reviewed sources.

Provider types differ in readiness. Acute care hospitals report high exchange rates ², yet rural and urban comparisons show persistent gaps in exchange, patient engagement and telehealth ⁵. Adoption also varies by neighborhood deprivation, with the most deprived areas less likely to adopt key functions ⁴. Adoption increased over time across all hospitals and deprivation levels in pooled data ⁴. Comparisons of public, private and community provider performance on HIM quality, staffing or cost could not be verified.

Competitive pressure comes from technology and regulation rather than from named rivals. BLS notes AI-powered coding tools may affect demand for medical records workers ¹. Information blocking rules prohibit practices likely to interfere with access, use or exchange of electronic health information ¹⁰, which shapes how providers can handle data control. Law firm and publisher commentary ⁷⁸¹⁰ explains the rules but is not neutral, so it is used here only for rule description.

Provider types are compared on adoption measures only. No company performance data are asserted.

5Technology, operations and workforce

Interoperability is the central technology measure. The share of hospitals engaging in all four interoperability domains reached 76 percent, up from 70 percent in an earlier period ². Integration of outside information into EHRs stayed at 79 percent, with little change over time ². The gap between receiving data and integrating it into the record suggests that exchange does not automatically mean usable records. The chart below summarizes the latest hospital measures.

Established practice includes EHR-based exchange and HIE queries, which are widely used ²⁹. Emerging practice includes AI-assisted coding and automation. BLS notes AI-powered coding tools may affect demand ¹, but the pack gives no verified adoption rate or productivity effect. A productivity claim for ambient AI scribes, reported as 20 percent of the workday, appeared only in a non-peer-reviewed provider blog and was excluded.

Workforce: BLS projects about 14,000 openings each year on average over the projection period ¹, reflecting both growth and replacement demand. Wage and staffing vacancy data for HIM roles were not verified, so data are not available on pay or shortages. BLS links rising chronic disease to coding needs ¹, which implies demand for coding skills, but the pack does not document credential requirements.

• Projected annual job openings, medical records specialists 14,000job openings per year (average) Forecast United States, Latest BLS projection period [1]

The ambient AI productivity claim was excluded because it rests on a single non-peer-reviewed blog.

6Regulation, standards, risk and sustainability

The jurisdiction is US federal law. Binding requirements include the HIPAA Privacy Rule, which requires covered entities to maintain reasonable administrative, technical and physical safeguards against improper use or disclosure of protected health information ⁶. The rule's right of access is also binding ⁶.

Information blocking is a separate Cures Act provision codified at 45 CFR Part 171 and applies to actors regardless of HIPAA status ⁷. The rule prohibits practices likely to interfere with access, use or exchange of electronic health information ¹⁰. Before the expansion, EHI was limited to data elements in the United States Core Data for Interoperability ¹⁰. The expansion extended information blocking rules to electronic information in a HIPAA designated record set ⁸. These descriptions come from secondary sources, and the pack includes no regulator text for the expansion, so the current rule text should be checked before reliance.

Proposed rules and voluntary guidance: the pack identifies none specific to HIM, so this report does not assess pending proposals. Main operational risks are privacy exposure, incomplete integration ³ and information blocking exposure ⁸. Ethics, safety and environmental or sustainability factors are not documented in the pack. This section describes regulation. It is not legal advice, and it does not interpret the rules for compliance.

Jurisdiction is US federal. State laws are not covered in the pack.

7Challenges, opportunities and case examples

Equity and access are the main constraints. Deprivation ⁴, rurality ⁵ and weaker post-acute and behavioral health exchange ³ show where records may not follow patients. 22 percent of hospitals did not integrate electronic health information ³, which is a continuity-of-care risk, although the pack does not measure safety outcomes. Cost and turnaround data are not available.

Adoption is rising. Across deprivation levels, adoption increased over time in pooled data ⁴. With sending and receiving near universal ², the next step is integration and exchange with post-acute providers. Rising chronic disease needs for coding ¹ create demand for HIM skills.

Comparable company examples were limited. Two attributable examples from the pack are: (1) the JAMA Health Forum deprivation study ⁴, which reports that hospitals in the most deprived areas were significantly less likely to adopt health information technologies; and (2) the Journal of Rural Health study ⁵, which compares metropolitan, micropolitan and rural acute care hospitals using AHA IT Survey data. A third example is the hospital comparison in which routinely interoperable hospitals reported 92 percent availability of outside information versus 80 percent for sometimes-interoperable hospitals ³.

• Hospitals not integrating electronic health information 22percent of hospitals Observed United States, Latest available data [3]

Case examples are studies and hospital groups, not company performance data.

8Outlook and strategic implications

Near term: exchange and records demand are likely to keep growing if current rules hold. Verified projections point to employment growth of 8 percent ¹. Interoperability is likely to keep rising from high sending and receiving levels ², while integration at 79 percent suggests slower gains ². These are interpretations drawn from a small set of indicators.

Medium term: two uncertainties stand out. AI coding tools may reduce demand for some medical records work ¹, while chronic disease drives coding needs ¹. Expanded information blocking coverage of designated record sets ⁸ may raise the volume and complexity of access and exchange. Data are not available to quantify either effect.

Implications: hospitals should prioritize integration and post-acute exchange. HIEs and software suppliers should address rural and deprivation gaps ⁴⁵. Regulators and researchers should fill the missing data on turnaround, fulfillment and cost. Patients benefit from the right of access, which sets a 30-day response period, extendable by a further 30 days ⁷.

Outlook statements are interpretation, not verified forecasts, except where a source projection is cited.

9Conclusion

US HIM and medical records work is growing and increasingly regulated. Hospital data sending is near universal, but integration and equity gaps persist ²³⁴⁵. The most defensible takeaways are that exchange is widespread, adoption gaps track deprivation and rurality, and verified cost, quality and turnaround data remain unavailable.

How this was built

Sources

1. 1

   Medical Records Specialists: Occupational Outlook Handbook

   U.S. Bureau of Labor Statistics Official statistics

   bls.gov
2. 2

   Electronic Health Information Exchange by Hospitals

   ONC Health IT Research & Analysis (based on AHA IT Supplement) Official statistics

   healthit.gov
3. 3

   Interoperable Exchange of Patient Health Information Among U.S. Hospitals

   ONC Health IT Research & Analysis Official statistics

   healthit.gov
4. 4

   Adoption of Health Information Technologies by Area Socioeconomic Deprivation Among US Hospitals

   JAMA Health Forum (peer-reviewed study) Peer-reviewed

   ncbi.nlm.nih.gov
5. 5

   Revisiting the rural and urban divide in hospital health information technology adoption

   Journal of Rural Health (peer-reviewed study) Peer-reviewed

   ncbi.nlm.nih.gov
6. 6

   Summary of the HIPAA Privacy Rule

   U.S. Department of Health and Human Services Regulator

   hhs.gov
7. 7

   Information Blocking in Healthcare (45 CFR Part 171) and HIPAA right of access

   HIPAA Journal (secondary commentary) News report

   hipaajournal.com
8. 8

   Information Blocking Rule Expands to Cover Electronic Designated Record Set

   Davis Wright Tremaine LLP (law firm blog) News report

   dwt.com
9. 9

   EHR Industry Statistics By Digital Record Technology

   Market.us Market research

   media.market.us
10. 10

    Medical Records Ownership and the Information Blocking Rules

    Holland & Knight LLP (law firm publication) News report

    hklaw.com