By Daniel Land, RHIA, CCS
The transient nature of memory is greatly influenced by the passage of time, and successive generations often possess only a vague knowledge of what came before them. Thus is the case of Grace Whiting Myers. Many health information management (HIM) professionals today know little about the actual person behind the name attached to the Grace Award—one of the highest honors from AHIMA that will be issued at the 89th Annual AHIMA Convention and Exhibit this month—a name that is synonymous with quality, best HIM practices, and AHIMA itself.
AHIMA’s Grace Award, named in honor of the association’s founder Grace Whiting Myers, recognizes healthcare delivery organizations that demonstrate industry-leading approaches to AHIMA’s core mission of transforming quality healthcare through informatics, information governance, and trusted health information.
In part, the award recognizes those who are still following Myers’s lead nearly 90 years later and doing their best to ensure HIM is a vital part of quality healthcare. This article explores Myers’s life, the far-reaching effects of her innovative spirit, and examines how the impact of her early leadership in what is now referred to as information governance, data analytics, privacy/security, quality, classification systems, and clinical documentation improvement changed healthcare in the early 20th century, and continues to impact the industry today through the work of her association.
Myers was born on November 14, 1859 in Worcester, MA. Her father, Charles B. Whiting, was a collector of books and other objects that were arranged in an “exceedingly particular and orderly” nature. In her autobiography, Myers credited her father for her systematic nature and love of bringing order out of chaos.1 Myers was five years old when Abraham Lincoln was assassinated on April 14, 1865 and vividly recalled this event throughout her life. She was privately educated until the age of 16 and then entered Classical High School in Worcester, graduating in 1878. After graduation, she spent one year at the Boston Museum of Fine Arts, in the hope that she might eventually become an artist.
Myers’s autobiography shows some rocky moments early in her life, though they offer scant details. “Reverses came to the family and then began my first attempts to take care of myself,” she wrote. Then shortly after her wedding, Myers wrote she was “thrown upon her own resources,” without giving the reader further detail.
Myers began her career in healthcare as assistant librarian at the Treadwell Medical Library at Massachusetts General Hospital in 1897. Her responsibilities included maintenance of the hospital’s medical records, which appealed to her sense of order and accuracy. Myers wrote that she “loved it from the very start.” She began rigorously studying Greek and Latin to better understand the roots of medical terminology. She rearranged the books of the Treadwell Medical Library according to Dewey’s Classification. The priceless artifacts of Massachusetts General Hospital were entrusted to Myers, including the inhaler that was used for the first administration of ether in a surgical operation. She became a member of the Association of Medical Librarians and utilized the networking and educational opportunities offered by the association as a means to grow professionally.
Myers was a rarity in late 19th century America. She was a creative, self-made, self-directed, and self-supporting woman with a rapidly forming vision for the future.
Early Clinical Records Work
One of Myers’s early duties at Massachusetts General Hospital was to compile medical and surgical statistics sourced from patient admission ledgers for inclusion in the hospital’s annual report, a task that proved daunting to her. She had only been in her position for two months and scarcely had looked at clinical records, nor had she yet acquired sufficient knowledge of medical terminology. In her own words, the results “were too bad to be published” but added “never again did that happen!”
She began the tedious process of centralizing a collection of clinical records that began with the hospital’s first admission in 1821. The records had been stored everywhere—in closets, attics, and vaults. The records were safe but inaccessible. Myers created diagnosis catalogs (one medical and one surgical) and a name catalog. She noted that “previously the only means of locating a re-entry was through the admission file in the General Office [kept in a huge book with one line to each patient], then going to the Record Room and hunting it up by service and date.”
Myers visited colleagues in Boston, MA, New York City, NY, and London, England to learn of their best practices, and then applied them to her work. She made her first public speech in 1905 on the topic of “Medical Libraries in Hospitals” during the American Hospital Association’s annual meeting in Boston, MA. She later reported, “I was scared but bound I’d do my best; and I guess I did, for I had applause in the middle of the paper and at the end.”
Myers’s Professional Progression
By 1912, Myers’s title had morphed from assistant librarian to librarian to medical records librarian. Toward the end of that same year a conversation between Myers and Dr. Henry Christian, the dean of Harvard Medical School and physician-in-chief at Carney Hospital and Brigham and Women’s Hospital, resulted in the idea that ultimately sparked the birth of the HIM profession as we know it today—and AHIMA. Myers wrote:
“I was talking with Dr. Christian about some of my difficulties and he said to me ‘Mrs. Myers, why don’t you call together the record clerks from the four or five other big hospitals here in Boston and see if you can’t help each other? You all must be facing the same problems.’ I grasped the idea and never did I cease to thank Dr. Christian for that suggestion! Here was the beginning of what we now call the American Association of Medical Record Librarians. It was looking in the distance but none of us could imagine it. However, at the end of the first meeting, Miss Florence G. Babcock (our first treasurer) did say ‘I believe we have started something big.’ A prophetic remark.”
On January 1, 1914 a classification of diseases was adopted by Massachusetts General Hospital to bring about uniformity in medical nomenclature. The classification system was based on the International List of Causes of Death published by the US government. During World War I, Myers supplied the Red Cross with weekly bulletins on the medical and surgical aspects of the war.
After the war had ended, she noted that: “Record Librarians had kept up their meetings as often as possible and had grown closer together. By this time, similar groups had formed in several places and exchange of ideas was growing popular. The doctors were beginning to notice that the unimportant record clerk was beginning to ask a great many intelligent questions and also to be a bit demanding of them. Something new was in the air.”
Myers resumed travel to large hospitals across the country to observe their methods of handling clinical records. She learned much from these visits and always left with “a strange feeling of satisfaction with my own ways of handling records.” In 1917, she took her first pupil to train as a record librarian. By 1922, Grace’s title of Medical Records Librarian was recognized by the American College of Surgeons.2
Formation of a National Health Information Management Association
Dr. Malcolm T. MacEachern of the American College of Surgeons was an early advocate for better medical records in hospitals. His mantra was “everything we do must be with the patient in mind” and regarded the patient as “the sole reason for the existence of the medical profession and hospitals.”3 MacEachern realized the value of those engaged in “records work” and invited Myers to organize sessions on this topic for the annual meeting of the American College of Surgeons in 1928.
On the last day of the meeting a proposition was made for the formation of a national organization and the Association of Record Librarians of North America (ARLNA) was founded. Myers was elected president. The original intent of the organization, which was to elevate the standards of clinical records in hospitals and other medical institutions, still underlies AHIMA today—and is in part recognized by the Grace Award.
Grace Award Honors Excellence in HIM
Legacy and Impact on Current HIM Practice
Grace Whiting Myers’s legacy in healthcare is inestimable. Her innovation and work on quality standards for HIM are the granite stage upon which healthcare now stands. Myers’s early work set the stage for today’s innovative and sophisticated HIM practices. Specifically, her work has and continues to affect and inspire the following:
Information governance in the healthcare industry recognizes that information is a strategic organizational asset that is necessary for safe, high quality, and cost effective patient care. Information is used for a myriad of purposes including the improvement of the health of individuals and populations, organizational decision-making, performance improvement, reimbursement, and cost management. The concept of information governance entails high-level oversight by HIM professionals who ensure that clinical information is accurate, trustworthy, and safe. AHIMA’s visionary founder recognized the moral imperative to protect patient privacy and wrote a pledge which indicated that no clinical information should be given to anyone, except as authorized. Myers’s focus on the integrity of clinical information and its far-reaching impact for the purposes of patient care and research underlies IG today.
Health informatics is a field of information science concerned with the management of all aspects of health data and information through the application of IT-based innovations in healthcare services delivery, management, and planning. Health informatics, which deals with the framework of healthcare data, is traceable to Myers’s vision for a complete and useful medical record—the concept of which has greatly evolved over time.
Quality measures metrics, in order to be effective and trustworthy, depend on accurate and complete coding. Coding portrays the severity level of the patient and is used in part to assess quality of care and patient outcomes. Coded data ultimately helps shape the public’s perception of providers and institutions alike through the availability of public data and rankings. Myers’s work laid the foundation for robust documentation and modern day coding through her insistence on documentation quality and development of clinical record indexing and disease classification.
The impact of Myers’s and AHIMA’s work on the healthcare industry was evident early on. MacEachern highlighted this when he wrote the preface to her autobiography in 1948: “This is the autobiography of a grand and beloved woman who pioneered in a needed endeavor and accomplished great progress through her qualities of graciousness, kindness, ability, and leadership. Without accurate, complete, and scientific medical records, properly indexed and filed for ready availability for use, the physician or surgeon is much handicapped in the study of his patient to reveal the diagnosis and determine the treatment to be followed. We look upon the medical record librarian as indispensable as ‘hands to a clock’ or ‘water to a river.’”
HIM professionals are strategic corporate assets who drive quality reporting, reimbursement, and ultimately enhance patient care. Myers’s “Club of Record Clerks” has grown into AHIMA—an organization recognized as the world leader of HIM knowledge that serves 52 affiliated component state associations and more than 103,000 health information professionals.
Grace Whiting Myers’s life is a study in creativity, courage, and the ability to think globally. Her life experience mirrors many of ours—the process of finding our courage and our voice and the need to take care of ourselves with a profession. Her motto, “Give of your best to anything you attempt to do,” is applicable to every HIM professional today. As the guardians of the patient’s story, we all can lead health information management with grace.
AHIMA Timeline of Name Changes and Credentials
 Myers, Grace Whiting. A Practical Diary by the First Lady of the Medical Record Librarian Profession: An Autobiography by Grace Myers. Chicago, IL: Physicians’ Record Co. Publishers, 1948.
 Henry, Gwendolyn Fougy. “Grace Whiting Myers (1859-1957): Library Director, Reference Librarian, Archivist, and Records Manager All in One!” The Watermark 34, no. 4 (Fall 2011).
 American College of Surgeons. “Malcolm T. MacEachern, MD, CM, 1881-1956.” ACS Archives Highlights.
Daniel Land (firstname.lastname@example.org) is director of compliance review services at MedPartners.
"Legacy of the ‘First Lady of HIM’ Lives on through Grace Award: AHIMA Founder Grace Whiting Myers’s Work Set Stage for Award Winners to Thrive in HIM"
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