History has been defined as an aggregation of past events or a course of human affairs. When I started researching the history of the profession I faced the dilemma of how best to portray the development of the profession over its first fifty years. Decisions on how to present the information were made and changed. Should I take a schematic approach focussing on topics such as education, the journal, state associations and international developments or take a chronological approach, integrating topics by date? Both approaches were tried. The final decision was to present the history in loose chronological order by decade dealing with particular topics as they arose within each decade.
Delving into the past, I found it fascinating to see the story unfold. Each page produced another milestone. Sometimes it seemed to take a long time to reach the goals early members had set but they never seemed discouraged and did eventually succeed in accomplishing most of what they set out to do.
It also became evident that the development of the profession and the professional association were so intertwined that I would not try to separate them.
Just as Australia started out as a collection of separate colonies, the medical record profession in this country started with two state associations, one in New South Wales and the other in Victoria. This young profession was established by a small group of people with no formal medical record education. Most worked in the medical record departments of our hospitals. From the beginning participation was encouraged from all persons interested in medical records in the foundation states and in other parts of the country. The aim was to improve medical record services in our hospitals.
Inevitably the newly formed profession reflected the way our nation developed, particularly with regard to the state focus of many people. Reading the minutes of both associations it appeared member states did not want to lose their individuality or their independence. There was pride in the accomplishments at state level and a strong desire to maintain an independent state association while at the same time developing a national entity and ethos.
It took the Australian nation thirteen years to form a federation. The medical record profession took only six years to form a federation made up of the two state associations but it was to take another twenty-three years to achieve a profession comprising all states and territories in the Commonwealth. As you read the following pages you will become aware of a certain hesitance toward changes essential to expansion of the profession.
After establishment of the federation in 1955, council members continued to encourage medical record workers in other states of the Commonwealth to form their own state association and become part of the federation. Although there was some early interest, the achievement of this goal took many years to accomplish, becoming an increasingly difficult task.
An interesting discovery during my research was the close link between the establishment of the national association in Australia and the development of the international federation. In fact, it became evident as I read through the early documents that the desire and need for international recognition was a moving force in finally establishing a national association.
Formal medical record education was a major concern. When reading early documents I sensed the frustration of original members with the many delays and setbacks that confronted their efforts to establish a professionally based medical record course. Within three years a basic short course was established in New South Wales. It took a further four years before a three year program was established in this state and another five years for a training course to be set up in Victoria. Many more years were to pass before two more courses were established.
One of the difficulties was the emerging desire to protect the profession by limiting membership to existing members and graduates from formal medical record programs. This made it difficult for medical record officers in other states without a state association or any formal medical record education to be accepted as full members of the two existing state associations. In fact it became a barrier to the early expansion of the national association into all states of Australia.
By the end of 1959 the profession was well established in New South Wales and Victoria. During the 1960s and 1970s members were able to accept and deal with the many changes taking place in health care and the Australian federation continued to develop a strong international identity. The need to promote the profession outside both states however remained.
The greatest changes appear to have taken place in the 1980s and 1990s. During this period there was an acceleration of interest in the profession and in the employment of medical record professionals. More programs were commenced, computer systems were introduced, casemix and Diagnosis Related Groups (DRG) arrived on the scene and coding became a key issue not only within the profession but also at Commonwealth and state government level. The professional association went from strength to strength. This rapid growth presented a challenge in writing the history as it was difficult to decide what to include as the information stored in the association minutes, annual reports, the professional journal and in conference proceedings was so detailed and voluminous. Some presentations at conferences in the early years have been discussed in detail as they often reflected the support given to the profession by doctors and hospital administrators as well as government personnel. In the latter years topics discussed show how subjects such as medico-legal issues and clinical coding were important to the pro-fession from the beginning.
Ultimately I decided to tell the story by simply recording events as they happened and include available photographs.
I have tried not to be judgmental and to record significant events, some in more detail than others due to availability of information. I hope I have done justice to the story and that you find it enjoyable to read.
Professor Phyllis J. Watson AM