The US Department of Labor's Bureau of Labor Statistics uses the system of Standard Occupational Classification (SOC) codes in order to track occupational statistics.1 The codes are based on skills, training, education, credentials, and work performed and are meant to include all occupations where work is performed for profit or pay.1 The SOC codes are organized into broad and detailed occupations and major and minor groupings. For example, the SOC code for both the broad occupation and the detailed occupation for registered nurse is 29-1140 and 29-1141, under the major occupation code of Healthcare Practitioners and Technical Occupations (29-0000) and the minor group Health Diagnosing and Treating Practitioners (29-1000).1 The codes are updated approximately every 10 years.

In 2007, an opportunity arose to provide input for additional SOC codes. The American Medical Informatics Association's (AMIA's) Nursing Informatics Working Group and the Alliance for Nursing Informatics (ANI) submitted a letter requesting an addition to the SOC system to include nursing informatics (NI) as a major group. Without an SOC code, it is difficult to determine how many nurses are working in NI. The workgroup argued:

Nursing informatics is not only an advanced practice specialty of professional nursing, but a distinct discipline with a unique body of knowledge, formal preparation within the specialty, and identifiable techniques and methods. NI differs from other advanced nursing specialties in the melding of informatics concepts, tools, and methods within nursing[horizontal ellipsis]. Without a distinct SOC, informatics nurses are precluded from being hired into key positions, as well from being awarded grants and contracts that require a specific SOC.2

The request was rejected. While no specific rationale was offered for the decision not to pursue it at a higher level in the Bureau of Labor Statistics, comments suggested that the title could be coded into different areas because of the various roles and work locations associated with NI. For example, a nurse may be working in the capacity of informaticist, but the job title may not reflect those responsibilities. In addition, the submitted definition suggested that an "informatics nurse" was not always in a clinical role, which is accurate.

In 2014, we were given the opportunity to try again-this time as part of a larger multistakeholder informatics effort to obtain SOC codes for a broader group of health informatics professionals. Nursing informatics would be included with other health informatics professionals holding similar roles. The SOC Policy Committee (SOCPC) and the Office of Management and Budget (OMB) reviewed all the received comments and released initial recommendations in July 2016, requesting comments on those recommendations. The initial recommendations included informatics in a new broad and detailed occupation (299020 and 29-90210) for health information technology (IT), health information management (HIM), and health informatics specialists and analysts. The codes also proposed adding clinical informatics director, chief medical information officer, and health information services manager as examples to the existing code of medical and health services managers (11-911).3

Although the multistakeholder group was enthusiastic about recognition of the distinct field of informatics, AMIA, ANI, and others were disappointed that the codes were combined, and nursing was not included as an example. The first author was asked to serve as liaison from ANI to the AMIA group working on the response to the request for comment, the second author served as her mentor, and the third author represented ANA in the deliberations.

The group gathered information between July 2106 and September 2016 to understand more about the reasoning for the decision of the SOCPC and OMB and determine the best recommendations for change. Our team met with Peter McMenamin, health economist for the American Nurses Association, who was familiar with the history of SOC code development and associated decision-making process. McMenamin reminded the group that SOC codes are used mostly by economists and are collected at the state level by Labor Department offices contacting individual local businesses. Personnel offices of those businesses are provided with information on the definitions of the SOC codes, but job ladders and specific job titles of employees do not always match SOC codes. He noted that this is a common occurrence, as local employers, states, and even the federal government often do not label positions with a term that would be accurately reflected as an SOC code.

After discussing the matter, HIMSS, ANI, AMIA, and other stakeholders decided to recommend separate codes for health IT, health informatics, and HIM under the broader category of health informatics:

We strongly recommend the SOCPC develop detailed codes under the new broad code 29-9020, separating the occupations of health informatics, HIM, and health IT. Additionally, we recommend the 2018 SOC revisions include new definitions for each of the distinct occupations of health informatics, health IT and HIM, using the currently proposed 29-9021 definition as a foundation. Separate detailed codes will allow both industry and government to track organic changes to each job category, over time, and it will enable both government and industry to forecast expected changes in the workforce more accurately[horizontal ellipsis] each of these occupational areas includes workers with distinct skills, job titles, and education and/or training, which will be difficult to reflect under a single detailed code, as proposed in the current draft SOCPC recommendations.4

The ANA was instrumental in also including nursing language in the letter, adding "chief nursing information officer" to the examples listed in 11-911 Medical and Health Services Managers.4

The comment letter was submitted in September 2016 and included signatures from more than 30 organizations. As of this writing, feedback on our request has not been forthcoming. The SOC Web site indicates that the release of the final 2018 SOC codes via a Federal Register notice is scheduled for spring 2017, and the finalized manual with codes and definitions will be available in the summer of 2017.1 We are hopeful that the recommendations and inclusion of NI will be accepted so that we can accurately count nursing informatics and other informatics professionals and recognize the importance of the occupation.

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