HIM Professionals Get Into the NHIN Game

One of the biggest challenges of your career is facing you: the creation of a national health information network (NHIN). Over the next decade the US healthcare system will transition from paper-based records to electronic health records (EHRs) to share healthcare data, reduce medical and pharmacy errors, avoid redundant tests, and improve patient safety. The Health and Human Services Department (HHS) created an Office of the National Coordinator for Health Information Technology (ONCHIT) to coordinate the effort. But individual communities will do the lion's share of work.

The NHIN is currently envisioned as a "network of networks." Local healthcare entities will form regional health information organizations (RHIOs) that will implement regional health information exchange networks. Eventually there may be 150 RHIOs across the country. A few RHIOs are in their infancy and even the most established projects, such as the Santa Barbara Data Exchange, are not yet sharing the full complement of data envisioned for the NHIN.

The NHIN is a work in progress. The current vision is to exchange health information between physicians, hospitals, labs, pharmacies, public health agencies, and eventually patients. Health records will reside in more than one place, as they do now, and users could pull all or part of that data together.

Suit Up and Get on the Field!

The field is wide open, and there are only a few things you need to do to get involved. First, investigate any activities already taking place in your community and consider joining an advisory board, committee or workgroup. Find recent grant awardees (two grant sources, the eHealth Initiative and Agency for Health Research and Quality [AHRQ], are mentioned later in the article). If you work for a hospital or large clinic, find out from your CEO or CIO if your organization is considering participating in a RHIO. Network with local trade associations such as your hospital association, nursing home association, or medical society. Approach the local quality improvement organization. Check to see if your state has a data bank or data collection process.

If you can't find a project in your area, why not assemble other interested HIM professionals, invite local health and quality organizations and start up a RHIO?

Next, find other interested HIM professionals. Members' greatest resources are the component state associations (CSAs). Through the CSAs, you can find other AHIMA members to partner with, share expertise and information, and carry the ball when you get tired.

You can find HIM professionals such as Rhonda J. Hisle, RHIT, who are getting into the game. Hisle, director of health information services and privacy/compliance officer at Wellmont Hawkins County Memorial Hospital in Rogersville, TN, is participating in her regional project, the Central Appalachian Health Improvement Partnership (CAHIP).

"Like a lot of other people in HIM, I'm a hands-on person, and I don't want somebody else coming in and dictating to me how things are going to work," Hisle says. "I want to have input ... and I want to know how our information is going to be shared with others."

While self-promotion may not be the first thing you learned when you earned your HIM degree, it's time to get assertive. Organizations in your region or community may not have heard of HIM. Let people know you are there and what your capabilities are.

Hisle and others in the Upper East Tennessee Health Information Management Association got involved when Wanda M. Johnson, RHIT, executive director of the Tennessee Health Information Management Association, sent out a call for volunteers to local HIM professionals. Johnson had read about the funding of CAHIP in an AHIMA e-alert. She sent the list of HIM volunteers to CAHIP's project coordinator, who assigned the volunteers to several work groups on the project.

Finally, this is a team effort, so work together. Another HIM group in Florida collaborated to invite itself onto a governor's advisory board. Florida's Health Information Infrastructure Project plans to adopt an EHR among all Florida healthcare providers. Barbara Flynn, RHIA, CCS, vice president of HIM services at the Florida Hospital Association and president-elect of the Florida HIMA at the time, tried to get a FHIMA member onto the advisory board through contacts at the Florida legislature. However, she learned the governor made the appointments. Ashlyn Dellenger, RHIA, HIM consultant at Unlimited Technologies, Inc. and FHIMA president, wrote several letters to Governor Jeb Bush asking to participate. Success! FHIMA got an appointee on one of the work groups.

"I work with the Data Privacy and Security Group," says Jacquie Jones, RHIA, MBA, CPHQ, senior HIM consultant at the Florida Hospital Association in Orlando, FL. "We are advising the [Florida] Agency for Health Care Administration as they formulate plans for RHIO-like demonstration projects. The main concern is privacy and access of health information as a RHIO develops, and as the state seeks to provide safe, cost-effective healthcare to its constituents."

If your local RHIO project has begun and all committees are filled, attend meetings anyway. Some states have "sunshine" laws that require all meetings be open to the public. "Even if you can't get someone on the advisory board or committee, have someone attend the meetings. They will recognize what you can contribute," says Flynn.

Connect your own e-HIMTM activities to the bigger picture, taking stock of all the skills and knowledge you can share. You may have been pushed around lately. The IS department encroached on your territory. Maybe you weren't even invited to help set criteria for your organizations' EHR system purchase. Remember that HIM professionals have a lot of intellectual muscle to offer.

We can train people who need to learn about medical records. We're experts in release of information issues. We can make contributions in work flow issues, since we know where data is stored and how it moves within organizations. We're guardians of data quality, ensuring data sources are reliable and the output is usable. We're familiar with state laws governing how healthcare data crosses state borders into neighboring states. We're the go-to people for protecting patient information privacy. Some of us know the rules and laws governing security. We can make our way around an EHR, which will form the backbone of the NHIN. And don't forget about vocabularies and standards. This expertise is ours and it is needed to make the NHIN work.

AHIMA Is on Your Team

Since the subject is so new, we're all learning together. AHIMA offers many resources to help members be e-HIM leaders. A NHIN/RHIO related Community of Practice (CoP) is launching in March. The FORE Library: HIM Body of Knowledge contains many articles about the national health information infrastructure, EHRs, standards, and RHIOs. AHIMA's virtual campus offers classes and workshops on the EHR and other e-HIM concepts. Members can connect what they are learning on the CoP and in national and state-based programs. AHIMA is helping lead the transition to the NHIN by participating in a variety of industry initiatives. First, since the EHR is a key building block for health information exchange, AHIMA is helping to refine the Health Level 7 (HL7) EHR draft standard for trial use (HL7 EHR DSTU) into a fully accredited, "gold" standard for EHR systems. In addition,

AHIMA is leading the charge to make the EHR serve as a legal record, so that organizations won't need to keep redundant paper records. AHIMA is also leading a project with HL7 to link the personal health record (PHR) to the HL7 EHR standard.

EHR systems must be widely adopted so health information can be exchanged electronically on a broad scale. Incentives are being offered by government and payers that encourage adoption of EHRs, including ones for purchasing certified products. Along with HIMSS and NAHIT, AHIMA helped found and staff the Certification Commission for Health Information Technology, which is developing product certification criteria for EHR systems used in ambulatory settings. CCHIT has agreed to use the HL7 draft standard as its organizing framework, forming a direct tie between the gold standard and product certification, which will reduce confusion in the marketplace.

Another building block of the NHIN is the technical infrastructure for regional information exchange networks. In January Connecting for Health, a Markle Foundation project, brought 13 organizations together, including AHIMA, to respond to a request for information (RFI) by ONCHIT for strategies to exchange health information both regionally and nationally. The collaboration had impressive representation from a broad range of leading healthcare and technology groups. AHIMA ensured that HIM issues were addressed in the RFI response. To see the RFI response, go here or visit www.connectingforhealth.org.

AHIMA is also participating on the Connecting for Health Common Framework technical subcommittee of a regional health information exchange initiative. The subcommittee will develop detailed specifications for regional health information exchange.

Game Strategies

There's no magic formula for how RHIOs are being formed. Individual communities must decide how their RHIO will work.

"There are a lot of different ways the RHIO may be organized, in terms of organizational and legal structure, data governance and data warehousing," says Lorraine Fernandes, RHIA, senior vice president for the healthcare practice at technology vendor Initiate Systems Inc. in Chicago. "What's fundamental to any RHIO is getting data from a lot of different source systems. You've got to be able to identify the patient, and then based on how the RHIO is organized, provide pointers to where the data is, access to the data itself, or access to the central repository."

Last October, the Agency for Health Research and Quality (AHRQ) awarded $139 million to demonstration projects in 18 states, including Florida. In July 2004 CAHIP was one of nine projects awarded grants through e-Health Initiative's Connecting Communities for Better Health program. Still, both Jones and Hisle say their projects are under-funded. More federal and private grants will likely be available, but communities will need to get creative to find adequate funds. Visit www. ehealthinitiative.org for a list of quality improvement organization activities organized by state.

Grants can be announced any day; there is no timetable. Grants often have very short application deadlines, so check for announcements often. Look at AHIMA's Research CoP's "Community Links" menu to find online directories, including www.Grants.gov, a clearinghouse of federal grant funding. Seek out similar resources about state funding. Sign up to receive email announcements about new funding. Think creatively to play the angles: sometimes a grant doesn't immediately sound like it would apply to your project. Now is the time to give your expertise to improve the quality of healthcare for patients everywhere.

Source: AHIMA Advantage 9:2 (March 2005)