{
  "source": "Cooked Index — occupational AI risk register",
  "page": "https://cookedindex.com/jobs/health-information-technologists-and-medical-registrars/",
  "methodology": "https://cookedindex.com/methodology",
  "notice": "Verdicts are re-examined as evidence accumulates. Re-fetch before relying on this; the page above always carries the current score.",
  "scored_at": "2026-08-11",
  "model": "claude-opus-5",
  "occupation": {
    "title": "Health Information Technologists and Medical Registrars",
    "soc_code": "29-9021",
    "category": "Healthcare",
    "us_employment": 38100,
    "median_annual_wage": 68020
  },
  "verdict": "COOKED",
  "risk_resistance": 25,
  "contested": false,
  "near_boundary": false,
  "dimensions": {
    "task_resistance": 6,
    "embodiment": 2,
    "liability_shield": 6,
    "trust_premium": 4,
    "judgment_accountability": 7
  },
  "reasoning": {
    "task_resistance": "Abstracting stage, histology, and treatment dates from pathology reports into a NAACCR-formatted registry record, running quality reports, and reconciling coding to the chart are exactly the extraction tasks that clinical NLP handles end-to-end — a 6 rather than lower only because contradictory or missing documentation still forces a human to go chase the physician for a clarification.",
    "embodiment": "The job is a workstation, a tumor registry application, and the EHR; the 2 rather than 0 reflects walking a floor for paper charts, scanning legacy records, or sitting in on a tumor board rather than any physical task that resists a remote worker.",
    "liability_shield": "RHIT, RHIA, and CTR are hiring filters and CoC staffing requirements, not state licenses — no one loses a personal credential-to-practice when a registry field is wrong, and the covered entity absorbs the HIPAA penalty, which puts this at certification-preferred rather than the 11+ of a licensed clinician signing an order.",
    "trust_premium": "Oncologists, surveyors, and researchers consume your abstracts without knowing your name; the 4 rather than 0 comes from the standing working relationships with physicians you query for staging clarification and with the CoC surveyor who returns every three years.",
    "judgment_accountability": "Assigning stage when the op note and path report conflict, deciding whether a records request meets the minimum-necessary standard, and calling reportability edge cases are genuine discretion — but you work inside NAACCR/AJCC/FORDS coding manuals and HIPAA rules that specify the answer for most cases, which caps this at the low end of the discretion band rather than the 14+ of someone making an unscripted call."
  },
  "rationale": "The modal worker abstracts data from charts into registries (cancer, trauma, EHR quality databases), audits coding accuracy, runs reports, and maintains system documentation — text-in, structured-data-out work that NLP over clinical notes already does at usable quality. Certifications (RHIT/RHIA, CTR) are employer-preferred credentials, not licensure with personal liability, so there is no legal requirement that a human touch the record. What survives is the accountability layer: defending registry data quality to CoC/state accreditation surveyors, resolving ambiguous or contradictory documentation, and owning HIPAA release and system-configuration decisions.",
  "outlook": "Headcount shrinks as NLP abstraction eats case-level chart review; the remaining jobs concentrate into a smaller informatics-and-governance tier that validates machine output and answers to accreditors.",
  "what_would_raise_it": {
    "levers": [
      {
        "dimension": "liability_shield",
        "change": "Commission on Cancer / NCDB accreditation standards (or state central cancer registry statutes and their reporting regs) amended to require that each abstracted case be attested by a credentialed CTR — i.e., AI-generated abstracts are non-reportable unless a named certified human signs. CoC already requires CTR staffing ratios and reviews casefinding audits, so tightening from 'staffed by' to 'signed by' is a small step on an existing hook.",
        "plausibility": "plausible",
        "would_add": 5
      },
      {
        "dimension": "liability_shield",
        "change": "CMS quality-program rules (eCQM/MIPS, Promoting Interoperability) requiring a named individual — in practice the HIM/registry lead — to attest personally to the accuracy of machine-extracted measure numerators, with False Claims Act exposure for knowingly submitting unvalidated AI output. Analogous attestation-with-liability already exists for PI attestations.",
        "plausibility": "plausible",
        "would_add": 4
      },
      {
        "dimension": "judgment_accountability",
        "change": "ONC HTI-1 predictive-decision-support transparency obligations, plus state AI-in-utilization-review laws, being operationalized inside hospitals as a standing duty to validate and locally re-test any NLP abstraction/coding tool — with the HIM department named as the validating owner in the compliance plan. That converts 'runs reports' into 'certifies the model's output against sampled charts and documents the drift'.",
        "plausibility": "already happening",
        "would_add": 4
      },
      {
        "dimension": "judgment_accountability",
        "change": "HIPAA Privacy Rule enforcement trends (reproductive-health privacy attestations, right-of-access initiative penalties) pushing organizations to designate a specific HIM/registrar role as the accountable decider on ambiguous release-of-information and re-disclosure requests, rather than routing them to automated portals.",
        "plausibility": "plausible",
        "would_add": 3
      },
      {
        "dimension": "task_resistance",
        "change": "Task-mix shift is genuinely available here: the occupation has a routine tier (chart-to-field abstraction, report generation) and a judgment tier (reconciling contradictory pathology vs. clinical documentation, casefinding edge cases, defending data quality to CoC/state surveyors, resolving coding disputes with physicians). If the routine tier is fully automated and headcount collapses, the residual job is mostly the judgment tier and per-worker resistance rises — note this is a smaller-occupation effect, not a safer one.",
        "plausibility": "already happening",
        "would_add": 4
      }
    ],
    "ceiling_note": "No plausible route on trust_premium: patients and payers never see the registrar and no buyer selects a hospital for human-abstracted data. Embodiment is fixed near zero. Even with every lever above, this is an attestation-and-audit role whose headcount tracks the volume of human review regulators demand — the score can rise while the job count still falls."
  },
  "adjudication": null,
  "employment_history": {
    "points": [
      {
        "y": 2021,
        "emp": 37900,
        "wage": 55560
      },
      {
        "y": 2022,
        "emp": 35500,
        "wage": 58250
      },
      {
        "y": 2023,
        "emp": 34430,
        "wage": 62990
      },
      {
        "y": 2024,
        "emp": 37620,
        "wage": 67310
      },
      {
        "y": 2025,
        "emp": 38100,
        "wage": 68020
      }
    ],
    "from": 2021,
    "to": 2025,
    "change_pct": 0.5,
    "comparable_from": 2021,
    "spans_soc_revision": false
  },
  "pivots": [],
  "license": "https://cookedindex.com/terms"
}