By Mary Butler
Conventional wisdom holds that people seek out advice from mystical sources—psychics, tea leaves, astrology, and other forms—when faced with turmoil and chaos. Most of the time it’s less expensive than therapy and you can choose to ignore or take a soothsayer’s advice depending on whether it feels accurate. If money is an issue, there are plenty of books that teach how to do each of these methods for yourself.
It’s hard to find an industry that is more chaotic at this point in time than healthcare. As of press time, the basic skeleton of the Affordable Care Act was still intact, though regulatory changes from the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services have made modifications, and it is possible that legislative efforts to further dismantle the law could resume. Other regulations such as the 21st Century Cures Act and the Medicare Access and CHIP Reauthorization Act (MACRA) have elements that will be enacted in 2018, further changing the landscape. While there are predictable actions that health information management (HIM) professionals can bank on happening, the healthcare industry is still very much in flux.
In order to have a clearer picture of what the new year will bring, the Journal took a chance and asked AHIMA’s subject matter experts to predict what the biggest stories of 2018 will be in eight key HIM domains: informatics, data analytics, privacy and security, rules and regulations, information governance (IG), education and workforce, clinical documentation improvement (CDI), and inpatient/outpatient coding. Healthcare professionals know better than anyone that anything can happen, but believe in this—AHIMA’s SMEs have a much higher accuracy rate than your local psychic!
Numerology is the mystical belief that certain combinations and sequences detected in sets of numbers have predictive powers. Birthdates are particularly potent for numerologists, as that set of numbers can help foresee one’s life path.1 Believers in numerology use dates and numbers to decide, for example, what day to get married, buy a house, and other major life decisions.
Health data analysts are perhaps the closest thing in the healthcare industry to being numerologists (of course a big difference, healthcare is founded on science, not mysticism). Data analysts are skilled at drilling down into the detail of data—whether it’s gathered from electronic health records (EHRs), the Centers for Medicare and Medicaid Services (CMS), state registries, or other sources—and then finding ways to visually represent it and tell a story with it, says Lesley Kadlec, MA, RHIA, CHDA, director of HIM practice excellence at AHIMA.
It doesn’t take a numerologist to predict that healthcare data analysts will have their work cut out for them in 2018 as demand for analytics services and projects increases in the industry. Kadlec says more HIM professionals are seeing the writing on the wall and are getting trained and credentialed in data analytics, and there is more of an understanding of the difference between informatics and data analytics.
Practicing data analysts will be busy in 2018 helping providers participate in new payment models and revenue initiatives, Kadlec says.
“In pay for performance, data analytics can help organizations make effective use of operational and technical resources, can assist with decisions on mergers and acquisitions, and help identify opportunities for new services in the community,” Kadlec says.
The regulatory reporting requirements that come with MACRA and other initiatives will keep analysts on their toes. “These change constantly and data analysts are needed to evaluate the changes and look at how the organization is collecting data to ensure it can be captured and reported when needed,” Kadlec adds.
In the practice of reading tea leaves, aka “tasseography,” the person doing the fortune telling is referred to as the “oracle” or the “seer” while the person whose fortune is being read is the “sitter.” The sitter drinks a cup of tea brewed with loose leaves until the cup is left with a small amount of water and leaves, which are then swished around the cup by the seer, who looks for patterns and symbols in the formations of leaves scattered around the inside of the cup. The seer gains insight about the sitter’s life through interpretation of the symbols, according to the Tea Association of the U.S.A.
Healthcare informaticists likewise look for patterns in health IT systems and devices to help them run more efficiently. For instance, informatics professionals often have the responsibility of making EHR workflows less tedious. When done properly with the help of data analysts, these tools can help predict things such as hospital readmissions and identify disease outbreaks.
AHIMA is making a concerted effort in 2018 to draw a broader distinction between data analytics and informatics, which frequently get lumped together. There are two separate websites for informatics and data analytics on AHIMA.org, and there will be a new Informatics Practice Council in 2018, as well as a separate Engage community for informatics.
Patty Buttner, RHIA, CDIP, CHDA, CPHI, a director of HIM practice excellence at AHIMA, says challenges for informaticists in the coming year will be helping to mitigate physician burnout with EHRs, protecting patient-generated data in mobile apps, and developing interfaces and dashboards for telehealth services. Informatics-minded HIM professionals can help with physician EHR burnout by considering the provider workflow and processes, and discussing ways to improve and streamline that process while still capturing accurate and complete healthcare data with providers.
“Being involved in the creation of ‘short’ or ‘pick’ lists in the EHR may help to decrease time spent on clicking and scrolling in the EHR. Natural language processing can be implemented as well to help reduce the need to key information into the EHR,” Buttner says.
Advocates of the “art” of palm reading will tell you that the results of a reading aren’t set in stone. A palm reading enthusiast writing for the publication Mic says, “Anything that you read from your palms is only a potential future that you CAN change if you have the desire and believe in yourself.”
This palm reader’s advice isn’t terribly different than what AHIMA’s information governance consultants, IGAdvisors, would tell you after completing an Information Governance Adoption ModelTM (IGAM) assessment. Once a facility takes the time to figure out where they are falling short in terms of information governance (IG), AHIMA has developed a comprehensive program to help secure an organization’s information.
In a recent IG survey conducted by AHIMA that polled 1,500 healthcare professionals, 53 percent of respondents said they have IG practices in place or recognize the need for IG. Additionally, 14 percent of respondents have initiated an organization-wide IG program, and 18 percent have IG-related projects underway. Now that AHIMA has made strides in building awareness for what IG is, providers can get down to the nitty gritty of doing IG.
Kathy Downing, MA, RHIA, CHPS, PMP, AHIMA’s vice president of informatics, IG, and standards, says in 2018 enterprise-wide retention policies will still cause problems for providers.
“There are huge issues in the legacy system space creating cyber[security] issues constantly,” Downing says. “For example, if you have a legacy system and the vendor is no longer in business, no longer ‘supporting’ that software, then when a security patch is issued you can’t take the patch, therefore exposing yourself to cyber threat constantly,” she says.
Downing is also hearing from organizations that have data analytics and informatics tools, but are still having issues with data quality. A tell-tale sign that an organization is struggling with data quality is if chief medical information officers or department heads stop asking for reports from various departments because they know they’ll be getting bad information. Starting an IG program can help improve this, Downing says.
“Or the users of the information like the CMIO and department heads get reports and they ‘know’ they can’t trust the data so they stop asking or stop using the reports to make the important business decisions necessary to succeed and continue to be agile and competitive,” Downing says.
Education and Workforce
Oneiromancy, or interpreting dreams to predict the future, has ancient origins, from sources as diverse as the Bible and ancient Japanese and European traditions. Mystics might suggest that dreams can literally predict a person’s future, but some psychologists suggest that dreams are the subconscious’s way of processing anxiety and events that the waking mind hasn’t dealt with yet.
Yet, notice the way humans talk about dreams—particularly hopefulness about the future. More often than not, these dreams are tied to educational goals. For the last several years AHIMA has asked committees to work on HIM curriculum changes intended to move the HIM profession into the future.
Julie A. Shay, MBA-HIN, RHIA, HIM program director and associate professor at Santa Fe College, has been very involved in the development of HIM Reimagined (HIMR), an AHIMA initiative that provides guidance on how to take the newly updated HIM competencies and use them in the profession to help students prepare for the “new” HIM of the future, centering on newer areas of specialization.
Shay says there has been a flurry of HIMR activity that will continue to shape education in 2018. “Currently, we are preparing for an open comment period in January 2018 based on what the group(s) have proposed to be HIM CORE and specializations, [with] implementation to take place after AOE 2018,” Shay says.
HIMR’s ambitions go well beyond 2018. “AHIMA has done due diligence in identifying the skills that the industry is currently looking for, but more importantly, what skills the industry will be looking for in the future,” Shay says.
Desla Mancilla, DHA, RHIA, vice president of academic and certification services at AHIMA, notes three education and workforce priorities for 2018:
- Upskilling existing practitioners for more advanced roles in data analytics and informatics
- Preparing academic faculty to teach higher-level content in data analytics
- Revising curriculum to ensure students are prepared to meet workplace needs
“Upskilling” means adding or upgrading skills to be ready for the job market. For HIM professionals—both HIM students and existing HIM practitioners—this means acquiring more data analytics and informatics skills. “For instance, I’ve taught numerous data analytics workshops for HIM practitioners that are looking to advance their skills in this space,” says David Marc, PhD, CHDA, assistant professor and health informatics graduate programming director at the College of St. Scholastica.
Clinical Documentation Improvement
In a blog post directed at tarot card readers new to the tradition, a veteran reader advised that it can be overwhelming and easy to get lost in the esoteric systems made up by tarot cards.2 The author told young users to form a personal connection with the cards and identify how elements of the cards are presented in their daily lives.
This same advice could be given to physicians by clinical documentation improvement (CDI) specialists, whose job it is to sort through esoteric terminology to find meaning and patterns in clinical documentation.
And just as someone’s personal background and personality makes them good at reading tarot cards, the same goes for CDI professionals. There’s long been a discussion brewing around the ideal professional background of a CDI specialist, says Tammy Combs, RN, MSN, CCS, CCDS, CDIP, director of HIM practice excellence, CDI/nurse planner at AHIMA. There are two primary schools of thought around the proper CDI background.
“This is a topic that has haunted CDI programs from their initial conception. The ongoing question of who makes the best CDI professionals (nurses or coding professionals). The truth of the matter is that either background has the knowledge to be a successful CDI professional. However, many organizations want to hire CDI professionals with a nursing background. This is very frustrating for coding professionals wanting to work in CDI,” Combs says.
CDI specialists will continue to be deeply involved with claims denials in 2018. Combs says that claim denials teams are increasingly reaching out to CDI and coding professionals as subject matter experts to help identify denials for coding and documentation that should be appealed, and using them to assist in creating solid appeal letters. AHIMA will be releasing a toolkit to assist CDI and coding professionals with this in 2018.
The coming year will also see a continuing expansion of CDI into specialty areas of healthcare. “We are seeing an increase in interest in having CDI in areas such as long-term care, home health, psychiatric units, and rehab facilities,” Combs says. “With the shift to quality-based reimbursement it is becoming crucial for all settings to have high quality documentation across the continuum of care.”
Inpatient and Outpatient Coding
The practice of gazing into a crystal ball, called “scrying,” has been done for thousands of years, and can also be done by looking at reflective surfaces such as mirrors and other crystals.3 Practitioners are advised to reach a meditative state before gazing into the ball to look for symbols. Scrying takes practice and patience.
An HIM domain that also involves lots of practice and patience is coding, which requires a keen attention to detail and can have a major impact on a provider’s revenue. However, it doesn’t take a crystal ball to predict some of the trends and changes that will occur in inpatient and outpatient coding in 2018 since regulatory agencies make it pretty clear that there are new requirements in the pipeline.
According to Sue Bowman, MJ, RHIA, CCS, FAHIMA, senior director of coding policy and compliance at AHIMA, starting in January physicians will have to start reporting modifiers on claims to indicate their relationship to the patient—known as patient relationship modifiers. While this reporting is voluntary in 2018, and not a condition of payment, it is a required part of MACRA and is likely to stay for the foreseeable future, with CMS fine-tuning the requirements along the way.
“There will be opportunities for HIM professionals to help educate physicians on how to apply these modifiers, and coding professionals coding physician claims will likely often be responsible for determining the appropriate relationship modifier as part of the coding process,” Bowman says.
Donna Rugg, RHIT, CDIP, CCS, director of HIM practice excellence at AHIMA, sees four main issues that will impact inpatient and outpatient coding in 2018:
- Copy/paste and cloning in EHRs
- Coding auditing
In terms of reimbursement, MACRA, the Merit-based Incentive Payment System, and hierarchical condition category (HCC) coding will be priorities for providers and coding professionals this year, Rugg says. “Some are still being implemented, others are being revised/changed so challenges exist as well as opportunities for HIM professionals to get involved in these new avenues,” Rugg says. “Coding auditing is something that will be increasing now that ICD-10 has been in place for two years, and organizations are focusing more on the quality and accuracy of the codes.”
Privacy and Security
The study of astrology for the purposes of predicting life and terrestrial events dates back thousands of years and spans ancient and modern civilizations in Asian, European, and North and Central American cultures. Horoscopes, usually not taken seriously, are ubiquitous in magazines and newspapers.
There is perhaps no domain of HIM more interested in predicting the future than privacy and security. Cyberattacks and cybersecurity events have providers on edge—and will continue to throughout 2018.
“I think that HIM professionals need to get more experience and education in cybersecurity. They need to be at the table. They need to lead business continuity and disaster recovery discussions for cyber situations—such as ransomware and denial of service (DOS) attacks,” Downing says.
She points to two online tools that HIM professionals can use to track cyber events as well as track careers related to cybersecurity. One is available at http://cyberseek.org/heatmap.html and another is found at www.fireeye.com/cyber-map/threat-map.html.
Lauren Riplinger, JD, senior director of federal relations at AHIMA, says the Department of Health and Human Services’ Office for Civil Rights (OCR) is expected to do a number of things in the privacy space in 2018. HIM professionals should keep their eyes open for the following actions:
- The issuing of additional “minimum necessary” requirements
- Guidance around mental health information (what can/cannot be shared with families, etc.) as mandated by the 21st Century Cures Act
- Guidance on data sharing for research purposes as required by the 21st Century Cures Act
- An advance notice of proposed rulemaking (ANPRM) on accounting for disclosures
- A notice of proposed rulemaking on the penalty sharing provision of the HITECH Act (i.e., the distribution of a civil penalty or monetary settlement to an individual harmed by a breach)
“We may also see something come out of OCR under an administration-wide strategy to institute ‘regulatory reform.’ What this may or may not look like from OCR is currently unclear,” Riplinger says.
Rules and Regulations
While fortune cookies are associated with Chinese food, their creation is entirely American. The treats are loosely linked to the prophecies of the Chinese philosopher Confucius. Some cookie fortunes contain lucky numbers, stemming from ancient numerology practices, and almost all offer predictions—the content of which can be very unpredictable. Open one cookie, and a soothing analogy for living life to the fullest awaits. Open another, and a cryptic warning follows.
Unpredictability is certainly prevalent in Washington, DC lately, with even the best prognosticators uncertain what to expect from the fast-moving, ever-changing political landscape.
As of press time in early December, there was still uncertainty around year-end negotiations in Congress over raising the debt ceiling, appropriations for the 2018 budget—which impacts the budgets of the Office of the National Coordinator for Health IT (ONC) and the Office for Civil Rights (OCR)—and the potential for additional Medicare reimbursement cuts under the 2011 Budget Control Act and sequestration. Even with regulations already enacted, like the 21st Century Cures Act, there is uncertainty around how its provisions will be implemented and enforced.
For example, ONC’s forthcoming definition of “information blocking” will be a major story to watch in 2018, AHIMA’s HIM experts predict. The way the definition is written will have an impact on a large portion of electronic health record (EHR) users. The 21st Century Cures Act requires ONC to define information blocking so the Office of Inspector General can start enforcing against the practice—issuing up to a $1 million fine, per occurrence, for providers who purposely hinder the exchange of health information.
The 21st Century Cures Act also requires ONC to address the burden of time physicians spend on EHR documentation, another topic to watch this year. The Centers for Medicare and Medicaid Services (CMS) will weigh in on that too, as well as providers, vendors, and other stakeholders. This could have an impact on areas directly related to HIM, such as clinical documentation improvement and data quality.
- DeRusha, Jason. “Good Question: Does Numerology Work?” WCCO-TV CBS Minnesota. January 12, 2011. http://minnesota.cbslocal.com/2011/01/12/good-question-does-numerology-work/.
- Brigit. “12 Tarot Tips for the Tarot Beginner.” Biddy Tarot Blog. February 4, 2015. www.biddytarot.com/12-tarot-tips-for-the-tarot-beginner/.
- Emily Gems. “The Art of Crystal Ball Gazing.” https://crystal-cure.com/article-gazing.html.
More Top Topics to Watch in 2018
Visit the Journal of AHIMA website for additional hot HIM topics and stories to watch in 2018, as predicted by AHIMA’s subject matter experts.
Mary Butler (firstname.lastname@example.org) is associate editor at the Journal of AHIMA.
"Eight Predictions for ’18: Experts Prognosticate the Top HIM Topics for the Year Ahead, and Advise on How to Prepare"
Journal of AHIMA