Visioning e-HIM: A Process for Imagining—and Anticipating—HIM’s Future
by Patty Thierry Sheridan, MBA, RHIA, Michele D’Ambrosio, MBA,
RHIA, Kerry Heinecke, RHIA
In times like these, every HIM department needs a plan. Visioning techniques
help managers picture the future and draw a road map to e-HIM.
The transformation from paper-based health records to electronic health
records (EHRs) is ushering in the age of the virtual HIM department. Every
HIM function that supports the paper record today will be re-engineered;
some will be eliminated. Every HIM fundamental will require rethinking.
Within individual organizations, HIM professionals and their executive
leadership must envision the virtual HIM department and map the way there
if the transition is to be successful.
Envisioning the future of e-HIMTM
can be a daunting task. A formal set of exercises helps the process by
facilitating discussion. A good visioning approach helps staff think
about the future of HIM practice and readies them for the most significant
transition in HIM history.
Visioning does not have to be complex. It should
be an interactive process that combines readings and exercises. It is
helpful for the facilitator to understand the principles of change management
and transition management and to be current on the EHR and its impact on
HIM practice. A suggested visioning process is outlined below.
Secure a Senior Manager as a Change Sponsor for the Transition from
HIM to e-HIM
The sponsor will play a key role in helping to create
urgency for change and in providing senior management presence throughout
the change. The sponsor should also serve as a sounding board and
provide needed support during the transition.
- Initiate the Visioning Exercises
with HIM Managers and Supervisors
a sponsor is secured, begin visioning exercises with the HIM management
team. When managers gain a sense of urgency about the future and
have a better idea of what it might look like, it will be time to
begin working with the HIM staff (step 4).
It is important to get
HIM managers and supervisors on board. Change efforts will unravel
if the change sponsor and the management team fail to move in the
Visioning exercises should begin with reading assignments, networking,
and subsequent discussions. Assignments should include one or more
readings from each category below. Selected readings should be based
on the audience and the types of readings that evoke a response.
Networking opportunities exist online and at national, state, and
local meetings of professional associations. Readings provide a foundation
for visioning discussions, and they ensure that the management team
is familiar with the latest HIM standards. Discussions should be
scheduled in the same manner you would schedule any meeting. In some
instances, particularly when participants have been asked to read
a book, it can be helpful for the facilitator to provide a brief
PowerPoint presentation on the highlights of the book. This helps
frame the discussion and focus on key messages. A sample agenda for
a step-2 team meeting is shown below.
Articles and Presentations
Amatayakul, Margaret, and Steven Lazarus. “Planning
to Manage Information without Records.” Presentation at AHIMA
2004 National Convention. Available online at www.ahima.org.
Leslie Ann. “Fitting in, Standing Out: Leading Effectively
within Your Organization.” Journal of AHIMA 76,
no. 1 (2005): 24–28.
Transition and Change Management Books
Lundin, Stephen C., Harry Paul,
and John Christensen. Fish! A Remarkable Way to
Boost Morale and Improve Results. Hyperion, 2000. (And other Fish!
books by the same authors.)
Johnson, Spencer. Who Moved My Cheese? An
Amazing Way to Deal with Change in Your Work and in Your Life. Penguin
Carnegie, Dale. How to Stop Worrying and Start
Living. Pocket, 1990 (revised edition).
Managing Transitions: Making the Most of Change. Perseus,
Kotter, John, and Dan S. Cohen. The Heart of Change:
Real-Life Stories of How People Change Their Organizations. Harvard
Business School Press, 2002.
E-HIM Practice Guidelines
These standards can be found at www.ahima.org/infocenter/ehim:
“Delving into Computer-assisted Coding”
“The Strategic Importance of Electronic Health Records Management
“The Complete Medical Record in a Hybrid EHR Environment”
“E-mail as a Provider-Patient Electronic Communication
Medium and Its Impact on the Electronic Health Record“
Document Management as a Component of the Electronic Health Record”
Data Sets for the Physician Practice Electronic Health Record”
Recognition in the Electronic Health Record”
AHIMA’s Communities of Practice
National meetings such
as the AHIMA National Convention and those of the Healthcare Information
and Management Systems Society
State and local HIM organizations
State hospital associations and similar
organizations based on work settings
Seminars such as AHIMA’s “Renaissance
for the 21st Century: Leading the Change to e-HIM”
Create Pictures of the Future
Continuing with the management team, sketch
out a picture of future practice—a
diagram, flowchart, or other visual representation of roles and
functions. There are many techniques for this. The most effective
are those that require the participants to create the picture themselves
rather than providing a picture for them. Whichever technique you
choose, it is important to be timely with iterations of the picture.
A sample agenda for a meeting at this stage is shown on the following
In the interview technique, the facilitator frames the exercise
by asking participants to imagine that it is five years in the
future and they are being interviewed for an article in the local paper
and several HIM magazines. Individually or in groups, partcipants are
asked to answer questions such as:
- What is different today about the
way you deliver HIM in your organization?
- What bumps did you encounter
along the way?
- How did you deal with those bumps?
- How did you help the HIM staff
accept the change?
- How did you help physicians accept the change?
- What challenged you
as a leader?
- What was the best part of this experience?
In scenario-based exercises, the facilitator asks participants
to identify the external factors affecting the healthcare industry and
the HIM profession. Imagining that the time is five to 10 years in the
future, participants describe what a day in their life looks like as
a result of those factors. The facilitator can divide the group into
small subgroups or have the entire group answer collectively. Participants
write a scenario that describes their work day.
Mind mapping is a pictorial way to record brainstorming
and show relationships between ideas. The process enables the group
to create a picture from its brainstorming activity. The exercise starts
with writing down a central idea and then capturing all the ideas that
branch off of it. For example, write the words “virtual HIM department” in
a circle in the middle of a sheet of paper (see the example at right;
note that it is a sample only—it does not include all HIM activities).
Then brainstorm issues related to that future vision and draw spokes
radiating out from the center of the circle. As needed, draw circles
around the related issues and related spokes. From there, further
define each of the spokes and create a work plan, diagram, and other
documents that describe the future state.
Site visits of other HIM departments are a great way to
see what the future might look like and are a good complement to readings
and visioning exercises. You should include HIM and IS staff who are
in critical leadership positions. Visit facilities that are similar
or larger in size and that have implemented EHR components comparable
to the ones you are interested in. Ask the HIM director and staff how
the EHR has changed HIM roles and what lessons they learned as EHR components
were rolled out.
- Work with HIM Staff
Once managers have a sense of urgency about the future and a better idea of what it might look like, it is time to begin working with the HIM staff. The techniques used with HIM staff vary and generally start with the HIM leader communicating the changes in healthcare, the organizationís plans and timeline for an EHR, and what the EHR means to the organization, patients, and the HIM department. Before meeting with staff, it is a good idea to read a book such as Managing Transitions by William Bridges. Such books provide ideas on how to deal with the emotional aspects of change, how best to talk about it, and how to help people through transition.
A sample agenda for a meeting during
step 2. The group discusses previous reading assignments, receives
reading assignments for the next meeting, and is introduced to additional
e-HIM resources. If participants were asked to read a book for this
meeting, the agenda might include a brief presentation by the facilitator
summarizing the book’s key points as a way to frame the discussion.
County Memorial Hospital
HIM Management Team Meeting
|May 12, 2005
| Old Business
Approval of minutes, April 8, 2005
New Business Facilitator: (Name)
Group discussion: HIM transformation and leadership readings
- “Fitting in, Standing Out:
Leading Effectively within Your Organization”
Practice guideline reading assignments for
June 9, 2005, meeting
- “The Complete Medical Record in a
Hybrid EHR Environment”
- “Delving into Computer-assisted
Introduction to e-HIM resources
e-HIM Brainstorming Meeting Date—
Mark your Calendars: June 23, 2005
Clinical Systems Users Group
On the agenda for the meeting during the third
step is a review and discussion of reading assignments from the previous
meeting. This meeting also includes the brainstorming session, conducted
as a mind mapping exercise with the central idea of “virtual HIM department” as
the starting point.
County Memorial Hospital
HIM Management Team Meeting
|June 23, 2005
| Old Business
Approval of minutes, June 9, 2005
|Review highlights from reading materials
- “The EHR’s Impact on HIM Functions”
e-HIM brainstorming session (mind mapping)
point: virtual HIM department
Joint Commission Preparation
Clinical Systems Users Group
Professional Practice Update
AHIMA HIM Practice Transformation e-HIM Work Group:
Cassi Birnbaum, RHIA, CPHQ
Cathy Brown-Smith, RHIT
Connie Calvert, RHIA, CCS
Bonnie S. Cassidy, MPA, RHIA, FAHIMA, FHIMSS
Kathy Downing, RHIA, CHP
Marcia Duncan, RHIA
John Eckmann, MPH
Elisa Gorton, RHIA, MAHSM
Paul Gustafson, RHIA
Terri Hall, RHIT, CPC
Susan P. Hanson, MBA, RHIA, FAHIMA
Lynne Henderson, RHIA
Carol Hermsen, RHIT
Maribeth Hernan, RHIA, CHP
Karl Koob, RHIA
Carol Melvin, RHIA
David Mozie, PhD, RHIA
Sandra Nunn, MS, RHIA, CHP
Cecilia Plata, RHIA, CHP
Carol Ann Quinsey, RHIA, CHPS
Pam Ross, RN, CCS-P
Yvette Sylvester, MPA, RHIA, FHIMSS, PMP
Anne Tegen, RHIA
Cecilia Thomson, RHIA
Belinda Wiegand, RHIA
Pat Wilson, RHIA
Ann Zeisset, RHIT, CCS, CCS-P
Patty Thierry Sheridan (firstname.lastname@example.org)
is president of Care Communications in Chicago, IL; Michele
D’Ambrosio is enterprise application specialist at Shore Memorial Hospital in Somers
Point, NJ; and Kerry Heinecke is software product analyst, information
systems, at Marshfield Clinic in Marshfield, WI.
This work group was supported in part by grants to FORE, Foundation of Research and Education of AHIMA.
Sheridan, Patty Thierry, Michele D'Ambrosio, and Kerry Heinecke. "Visioning e-HIM: A Process for Imagining—and Anticipating—HIM’s Future." Journal of AHIMA 76, no.5 (May 2005): 24-28.