Dr. GD Mogli
Healthcare problems have haunted human society since time immemorial. Social and economic gains have a direct bearing on the status of people. Cultural progress depends upon the recognition and elimination of health problems. Health therefore is a major ingredient of public welfare. Health is wealth. Good health in any community is possible only when sufficient infrastructural healthcare facilities and patient care services are ensured.
Technology has rapidly transformed time-consuming, tedious, and difficult conventional methods into easy, swift and safe systems that are becoming essentials needs of day-to-day activities.
Undoubtedly, current health information management technology (HIMT) is the outcome of a process that has transformed manual information technology management into swift and accurate computerized HIMT that is typical of this century and that promises to play an even more dramatic role.
With the advent of information technology (IT), most technologically advanced countries, as well as some developing and GCC countries, are in the process of transforming from manual to electronic health information management (HIM) systems. There is a significant impact of IT on the HIM field, resulting in staff (40 percent) and space reduction (70 percent), and accompanied with increasing productivity. Personnel got smarter, became more knowledgeable, and are delivering a more efficient outcome. Incredible benefits will offset the huge investments. The author with his vast experience as senior medical records consultant and adviser for the past four decades in South East Asian and GCC countries states: if HIM does not adopt IT, IT will invade HIM.
Future Healthcare Vision
Despite technological advancement, many nations have been adopting dual systems of maintaining medical records--manual and electronic side by side. Hence, acquired knowledge and skills are still valuable and will keep being so. However, it is foreseen that in the course of the next two decades, the present conventional environment of hospitals, health centers, and clinics will undergo a major transformation, and patients may not leave home for medical attention, and neither will the doctor for patient care. Mobile nursing units, video conferencing, and telemedicine will be prevalent; so patient and doctor may not be in same city or country. The Internet will be used to securely transfer vital signs, which would be remotely processed and monitored by doctors. Prescribed medicines would be delivered to the patient's doorsteps. The concept of a single record would become a reality, so as to achieve treatment from birth to death globally. Conventional recording will be replaced by voice recognition and character recognition technologies. Single online medical records will have tremendous benefits; doctors will gain insight on cause of diseases by cross-referencing other patients' and relatives' records available online, thus expanding the scope of search globally.
Role of Information Technologists
IT professionals play a paramount role in hospitals, from reception to operation theaters to personnel departments to housekeeping. They are ubiquitous--in planning, analyzing, programming, supervising, laying voice and data cables in every nook and corner, thus contributing to patient care service directly and indirectly. Discussions are held with medical, nursing, and other staff to implement hospital information systems that encompass current and anticipated needs. It is apparent, and the perception is there, that HIM professional's role will diminish and IT personnel will takeover. To a certain extent, that's true, because huge filing areas of MRDs will disappear, and so will functions, such as filing, retrieving, lab report mounting, assembling, deficiency checking, record completing, and statistics collecting. HIM personnel without IT knowledge will find themselves insignificant and jobless.
IHIM Professional's Role in a Changed Environment
Conventionally, the major role of the HIM professional has been to organize and manage the huge medical record department with an extensive range of staff and equipment, in addition to massive volumes of records. The manager was to spend two-thirds of his time supervising organizational needs, such as space, personnel, equipment, forms, coding, and day-to-day functions of the MRD. The remaining time was spent dealing with the public and other departments of the hospital, such as medical, nursing, patient care services, lab, and X-ray; preparing statistical and medical reports; and administering insurance and third party payment.
The new role, which HIM professionals are going to assume, will be quite different in terms of management. Our new role would be mainly to develop an appropriate health information software system, in collaboration with software experts. Such a role would incur responsibilities of testing, customizing, and managing the software, and training the medical and nursing staff, as well as others involved in the EMR. Further responsibilities will be to monitor and ensure that (1) the software services are uninterrupted and smoothly functioning, (2) the patient schedule is followed properly, (3) the instant completion of information by care providers in different workstations, including the investigation reports, consultation reports, references, diagnosis, treatment including surgical procedures, follow-up appointments, and recommendations, etc. Furthermore, these will have to be properly integrated into the systems of other healthcare organizations in any part of the globe, provided that confidentiality and security are observed.
In addition to the above, our role will include case-mix studies of various medical and epidemiological information, so as to get all permutations and combinations of information that will help effective analysis of healthcare cost, quality, research, and productivity. The minimal cost and better quality are part and parcel of patient care management. Within the huge patient care data systems, data need to be manipulated and interpreted with different data base management systems, so as to enable taking appropriate decisions on clinical cost, care and quality analyses. HIM professionals have to find new ways to demonstrate their worth to healthcare management by expanding their roles as analysts of data.
Warning to HIM Professionals
Due to the importance of technology, IT professionals are gradually assuming an ever-important role and becoming indispensable--a role earlier enjoyed by HIM professionals. If HIM professionals fail to assume the newly defined dynamic role, their importance and status will wane and IT professionals will assume certain HIM functions. This is definitely a warning signal for HIM professionals. Hence, instead of treating IT professionals as competitors, HIM professionals must have good vision, education, and creativity, in order to adapt to the new environment and to strengthen their status and contribute more effectively. HIM professionals need to introduce HIM standards in their respective national/international organizations and ensure that IT professionals follow them. Health information cannot be pervasive, in a secure manner, if standards of data transfer and privacy do not exist and are not followed.
HIM Educational Requirements
Education acquired earlier by HIM professionals will be inadequate to deal with the advent of IT. Regular updating of their knowledge, especially in IT skills, is essential. They must have clear vision to mould IT personnel to fit into the growing system through ensuring that the latter follow established HIM standards. No technology is without deficiencies; hence, creativity plays a crucial role for HIM professionals in finding ways of eliminating potential and anticipated deficiencies and making a system user friendly to healthcare providers. With the newly assumed role, information should be exploited to the maximum extent, so as to enable those concerned to derive important conclusions with regards to epidemiological case mix studies, cost analysis, quality, etc. This would offset the high cost of investment in introducing IT systems and eventually reduce the cost of healthcare without compromising on quality, swiftness, or safety.
For the endurance of HIM professionals in the 21 st century, the author elaborates that HIM professionals need to change to the IT era. The latest HIM functions can be categorized as follows:
- HIM administration
- HIM standards for data transfers, privacy, etc.
- Computerized HIT
Future HIM Responsibilities
The MRD staff would be categorized into three levels: managerial, supervisory, and operational. For the managerial level, the role includes HIM administration (overall administration of the department), online monitoring of the entire EMR system to ensure its efficacy, maintenance of the computer servers for proper functioning of CPR systems, and coordination with other departments, such as accounts, privacy, and research for effective maintenance of EMR. The supervisory level will be working in each of the different sections of HIM--information technology, cost, quality, and privacy--and would also be responsible for one of the sections. The third level will be the operational staff working in any of the sections, assisting the section supervisor in developing the required experience.
It would be easy to enhance the interaction with IT professionals, informaticians, end users, and administrators, if HIM professionals have an IT background. It can also help them assume some of the key e-HIM knowledge responsibilities needed in the future.
HIM professionals with IT backgrounds can fully participate in reengineering work flow and add further value by defining the data to be captured as well as identifying how data quality and patient confidentiality can be enhanced through various database concepts. Further, HIM professionals can support concurrent, retrospective clinical decision-making systems by recommending how data quality can be enhanced and privacy maintained through the data structure and data extraction, keeping in view how the data is currently stored in the paper record. All these activities would advance HIM professionals as data managers and data analysts.
Curriculum for Future HIM
With the new challenges and roles HIM professionals are going to assume, a minimum of masters degree in health information administration would be appropriate for the managerial level in the specialized and big hospitals. The baccalaureate degree with any one of the specializations, such as HIM administration, computers, coding and data analysis, health costing and quality assurance, or privacy would be suitable for the supervisory personnel working in the second level of management in five different sections of the HIM department. Out of four years of study for the bachelor's of science HIM program, the first three years should cover all of the basic subjects required, and the fourth year should be exclusively allocated for specialization. The operational staff should possess an RHIT credential, as they will rotate in all different sections of HIM with the purpose of gaining multifaceted experience. Past and Future Qualifications and Responsibilities of HIM Roles
|Job Responsibilities |
BS & RHIA
Overall administration of the department
MS & RHIA
Overall administration of department
High school graduate,
Responsible as section head
BS with specialization
Head one of the main sections
HI Assistants (Operational)
High school graduate
Work in any section
of MRD and assist section supervisor
High school graduate,
Assist in any of five HIM sections:
Technology, with all its advances and benefits has also brought certain challenges, which need to be addressed meticulously in a very systematic approach. This has become a blessing in disguise to HIM professionals, as they will have to transform themselves to meet new environmental challenges and to be able to coordinate and use health information to provide the best possible care at a moderate cost, and to accomplish a standard quality in doing so. Care should not be a separate entity; it should include cost and quality.
Current technology with its contributions also brings a heavy cost, which consumers have to bear. Hence, we have to be equipped with an appropriate educational background, as earlier suggested, to assume leadership, dedication, sacrifice, and commitment with the expanded role of integrating the entire range of information related to patient care services. This is only possible through exploiting available information. There is already the perception in the paperless medical record system that the role of HIM is negligible. In order to establish its unique role, HIM professionals need to be equipped with state-of-the art techniques and knowledge and skills to contribute to the requirements of healthcare services. Having the knowledge and expertise of the healthcare field, HIM professionals will facilitate rendering the services that are essential for the efficient functioning of hospitals and healthcare institutions.
- Mogli, GD. Managing Medical Records.
- Mogli, GD. "Computerization of Medical Record Systems." Medical Records Organization and Management.
- Mogli, GD. "Standardization of Paperless Health Record." Journal of the Institute of Health Record Information and Management (UK) 36, no. 1, (February 1995): 10-12.
- Mogli GD. "Challenges of Healthcare Delivery beyond 2000," Proceedings of European Health Record Information Congress April 25-29, 1998, Hull, UK.
- Mon, Donald T., PhD, "Relational Database management: What You Need to Know." Journal of AHIMA 74, no. 10 (2003): 40-45.
|Source: 2004 IFHRO Congress & AHIMA Convention Proceedings, October 2004|