HIM Professionals Vital in Transition to e-HIM

Reach into the future and consider this scenario: You start work at 9 a.m. one day, but you don't hit the third floor elevator button for the HIM department…because it physically doesn't exist. There are no walls, no file rooms or shelving. Instead, you and other HIM colleagues are now fully integrated into your organization. You use a tiny, powerful portable device as your computer and communication system. You might join clinicians on their rounds to ensure patient health information is complete, accurate, and timely. Or you might analyze data for outliers to validate the accuracy of automated code assignments. Or you might study your organization's information-collection processes to find ways to improve data collection or quality of care.

Sound exciting? Scenarios like this are actually not far away, according to a specially appointed electronic health information management (e-HIM) task force that convened in March. Experts in healthcare, HIM, academics, information technology, and government wrangled with the issues facing the healthcare industry, hammered out a clear vision of future HIM practice, and constructed a game plan to achieve the vision.

Their bottom line: By the end of the decade the industry will transition from paper-based to electronic health records (EHR) as a means of more effectively organizing, sharing, and analyzing health data. The Association will help lead this transition and help members be agents of change within their organizations, explains AHIMA President Barbara Siegel, MS, RHIT, director of health information at Hackensack University Medical Center in Hackensack, NJ.

"There is an important place for us in the future. The task force identified many new opportunities for HIM professionals," says Siegel, who participated on the e-HIM task force. "As the healthcare industry transitions to electronic information, HIM professionals have a very crucial role."

The Association is arming every member with the task force's findings. A report, "A Vision of the e-HIM Future" outlines a clear and far-reaching vision for the transition to e-HIM by the year 2010. The report was delivered to members along with the September issue of the Journal of AHIMA. Publication of the report was supported by a generous grant to AHIMA's Foundation of Research and Education from Siemens Medical Solutions Health Services.

Vision of the Future

According to the task force report, EHRs will cover the entire course of patients' lives and will include not only treatment information but also prevention and health and wellness information. These records will be organized based on a national infrastructure so that clinicians can improve quality of care, the healthcare industry can improve operational efficiencies, and government agencies can track and address emerging public health problems.

The task force envisions that HIM professionals will become knowledge managers who will ensure the availability of timely, complete, and meaningful health information. HIM professionals will work in integrated teams of clinicians, finance employees, and technology experts in the whole gamut of healthcare settings.

An important concept in the task force report is leadership. AHIMA will help to lead the transition to e-HIM through activities such as industry partnerships and collaborations, public policy initiatives, developing and disseminating best practices, and implementing changes in HIM training, education, and curricula.

"We're going to have to be prepared for rapid change," says e-HIM task force member Danita Forgey, MIS, RHIA, CCS, CCS-P, program director and assistant professor of health information administration at the Indiana University School of Informatics in Indianapolis, IN. "We're also going to have to advocate our profession...AHIMA is concerned that we stay in the forefront of HIM and maintain the position that we are the leaders in the field."

AHIMA is empowering members to be leaders within their own organizations during this transition. Our communication with members will reinforce this theme and point to ways HIM professionals can lead the way to e-HIM for the entire healthcare industry.

"In its simplest form, the HIM professional will transition from managing records to managing information and knowledge," says e-HIM task force member Mary Ellen Mahoney, MS, RHIA, vice president and general manager of Digital EMR at Cerner Corporation, a leading international healthcare information solutions company headquartered in Kansas City, MO. "In the interim, it is imperative that HIM professionals step up to the challenge to help support and drive the change within their organizations."

HIM professionals currently working in a paper-based environment will not be left behind. A major focus of AHIMA's efforts is helping members develop the knowledge, confidence and support network they need to make the transition to e-HIM. New educational programs, career development opportunities, the Communities of Practice (CoP), and practice briefs published in the Journal are a few of the valuable resources members can tap. (For more on how AHIMA is working with the healthcare industry to promote the EHR, see "AHIMA, Industry Groups Make Connections to Promote Electronic Health Records" AHIMA Advantage 7:6, September 2003.)

AHIMA is reviewing the existing competencies for HIM education. Current curricula are being reworked to incorporate relevant concepts, proficiencies, and technology skills. These will guide college and university HIM programs and open doors to new graduate programs embracing e-HIM.

The New Knowledge Managers

An easy way to visualize HIM professionals' new role of knowledge manager is to think of an electrical conduit. We will conduct an energy source-in this case data and information-to power patient care, quality improvement, organizational decision-making, and cost management throughout our institutions.

To a large extent, HIM professionals will be fulfilling roles and responsibilities they've always had, according to Meryl Bloomrosen, MBA, RHIA, who facilitated the e-HIM task force meeting and compiled task force members' comments to create the report.

"However, they will also serve in new functions, such as the bridge between their organizations' technology staff and other departments as well as between their organizations and patients, caregivers and other information users," says Bloomrosen, an independent consultant. "HIM professionals will be translators and knowledge brokers, converting information into understandable language. They will also be enablers, helping assure that the technology and the systems that are implemented are useful and usable."

The task force report outlines new roles and competency areas to help you envision ways to expand your scope of knowledge.

Business process engineer, information system designer and consumer advocate are just a few new paths open to HIM professionals. Decision support is another important area, where HIM professionals will be building, querying, and analyzing databases to give clinicians the information they need to decide how to treat current patients or analyze patterns in past patient care.

Coders will have several migration paths once code assignment becomes automated. Coders will play key roles as data quality and integrity monitors and data analysts. Others will become clinical vocabulary managers, helping to make the national information infrastructure a reality by ensuring consistency and linkages between different codes.

E-HIM Practice Briefs Rolling Out

To make the vision a reality, work groups are moving into action to produce practice briefs. AHIMA colleagues on the cutting edge of e-HIM thinking and practice are establishing standards for specific e-HIM topics. These will help guide AHIMA members who are just starting the trek toward e-HIM, according to Kathy Downing, RHIA, member of a work group on electronic document management.

"Many of our work group members have already implemented scanning solutions," says Downing, director of patient privacy and HIM operations at HCA in Nashville, TN. "We will offer all AHIMA members clear and concise steps, documents, and tools to help them discover if they want to do this or not."

Work group members are collaborating, drafting, and reviewing via telephone conferences and the CoP. For Lynn Kuehn, RHIA, CCS-P, FAHIMA, a member of another work group on core data sets for physician practice EHRs, the experience has been challenging and rewarding. She has been working with 10 other group members experienced in EHR implementation and management to define common work flows and data sets, develop a list of HIM responsibilities, and, time permitting, create self-assessment criteria that would help people discover where they might need to update their current knowledge.

"As the EHR becomes the standard in physician offices more HIM professionals will seek jobs in that environment," says Kuehn, of Kuehn Consulting, LLC in Waukesha, WI. "Our work will attempt to help them become acclimated and able to implement and manage the EHR more quickly and effectively."

In addition to the electronic document management and physician practice core data sets work groups, four other work groups are collaborating on the following topics:

  • the complete medical record in a hybrid EHR environment
  • implementing e-signatures
  • provider/patient e-mail and other computer-based communication
  • speech recognition in the EHR

The first six practice briefs will be delivered at the National Convention in October via CD-ROM and via AHIMA's Web site (www.ahima.org). Moving forward, new work group topics will be announced. Members with relevant experience are invited to get involved. Standards on future e-HIM topics will be published periodically as practice briefs in the Journal and on the Web site.

How to Become an e-HIM leader in 10 steps

  1. Embrace the idea that e-HIM is the wave of the future. Decide to become a part of it.
  2. Starting today, think of your self as a knowledge manager.
  3. Read the task force report and decide where your interests and skills fit into e-HIM.
  4. Provide copies of the task force report to your organization's executive team. In addition to offering an insightful look at the future of health information, the report will help them understand how to best use HIM professionals during the transition to e-HIM.
  5. Make a commitment to education. Some people may need to take courses in statistics and learn how to present data. Others may need to enhance their understanding of database management and how the use of information technology will support care processes.
  6. Think about where information gets hung up at your institution. Are physicians complaining because EKGs aren't in the system? Is the ER having trouble getting charts in a timely fashion from an offsite storage company? Pay attention to the information systems your organization is embracing. Are departments setting up disparate systems or is there an integrated approach?
  7. Ask the IT director or CIO to lunch. It's important to begin building relationships that emphasize joint contributions.
  8. Get to know senior management (number four on this list is a great way). Lobby for opportunities to jointly lead e-HIM projects with IT.
  9. Once your organization makes inroads into e-HIM, become a professional practice site to provide students the opportunities to reinforce what they're learning in the classroom.
  10. Become the point person and take the lead on an e-HIM project. Help define what the EHR means to your organization.

Source: AHIMA Advantage 7:6 (September 2003)