A profession of it's own: The rise of health information professionals in american health care

Professionalism means many things to many people, and those meanings are sometimes at odds with one another. In some accounts, professionalism means simply the ethical and competent practice of a particular set of occupational skills. Other accounts add a dispositional component, such as a lifelong commitment to client service, or to the mastery and embellishment of a particular body of knowledge. And still other (often darker) views emphasize political and economic dimensions, such as the capacity to control entry into, and practice within, a lucrative market niche, or the ability to assert authority and command deference in the workplace. An expanded reliance on new information technologies will undoubtedly affect all these aspects of professionalism in the medical arena. As clinical information technology (IT) grows in prevalence and power, medical professionals will increasingly interact with patients through digital media, make care decisions in light of computerized data, and perform medical procedures by electronic control, sometimes over great distances and across multiple legal jurisdictions. Professional knowledge will increasingly be acquired through digital archives and computer simulations, and professional expertise will increasingly be organized and implemented through the decision trees, search algorithms, and menu structures of "helper" software. The digital revolution may reconfigure the market for professional services, too, as online quality ratings and price comparators computerize and depersonalize the construction of professional reputations, and as telemedicine expands the scope of practice beyond the spatial boundaries of bricks-and-mortar workplaces and flesh-andblood communities. Even face-to-face workplace relations may change, as skills at the bedside vie with skills at the keyboard, and as dexterity with laboratory rats competes against dexterity with computer mice-a change which has already become evident in certain specialties.₁ The other chapters in this volume shed light on these and other ways in which information technology, qua technology, promises to reshape the understanding of professionalism among medical practitioners. As great and often wrenching as these transformations may be, however, we must also consider the possibility that IT may exert its greatest impact on medical professionalism not directly, by changing what practitioners do, but indirectly, by changing with whom they collaborate in doing it. As the sociologist Andrew Abbott has famously observed, professional occupations form a "system," in which the fates of different professions (and hence professionalisms) are linked, sometimes competitively, sometimes cooperatively.₂ Nowhere is this more true than in health care, a field where the practitioners of multiple clinical and, increasingly, administrative professions work in close proximity and in tight coordination to provide crucial time-sensitive care. Thus, to understand medical professionalism in the information age, one must look beyond the absorption of IT into medicine itself, to consider how the introduction of IT may restructure the larger "system of professions" that constitutes the health care enterprise as a whole. As other chapters in this volume illustrate, clinical IT poses a number of significant governance challenges for health care relations, implicating critical issues of integrity, integration, and control.₃ These governance challenges can-and to some extent no doubt will-be resolved by a range of essentially non-professional (or even anti-professional) social structures, such as market competition and bureaucratic oversight. The history and the current direction of American health care, however, suggest that one likely consequence of the rising prominence of health information, health information technology, and health information technology governance will be a concomitant rise in the prominence of new health-information professions. This chapter lays out some preliminary thoughts-and some tentative evidence-on what these new professions will be, who will be their members, and how those members will conceptualize their work, their workplaces, and their own "medical professionalism." We begin by enunciating a sociological account of professionalism, not as an idealistic aspiration but as a distinctive type of occupational structure. We then assess the state of today's health information occupations against this archetype, to determine where and to what degree new health information professions may be emerging. Finally, we consider possible futures for professionalism and professionalization in the health information field, and we briefly speculate on how these futures might shape the impact of information technology on the professionalism of the health care sector's more longstanding and familiar occupational groups.