AHIMA Mobilizes to Meet the e-HIM Call

At the 74th National Convention and Exhibit in September 2002, Executive Director Linda Kloss announced an electronic health information management (e-HIM) initiative designed to expand support to members and the industry to migrate from paper records to an electronic information infrastructure.

AHIMA is issuing a wake-up call! Experts forecast that electronic health records (EHR) will replace paper records over the next three to seven years. We see our healthcare facilities implementing electronic healthcare delivery, record, archival, and communication systems. But we may need to increase our contribution to planning and implementing these systems at our facilities. Our involvement is vital to the success of the EHR and our careers.

"As a community of over 45,000, we are so strong and make such a valuable contribution," said Kloss, who urged HIM professionals to embrace how technology can change HIM practices. "Technology allows us to demonstrate and be recognized for our contributions."

Mobilize Now

Healthcare facilities are deploying information technology at a rapidly escalating rate. The time is ripe for HIM professionals to mobilize, says Leslie Ann Fox, MA, RHIA, who chaired a three-year-long e-Heath Task Force to help the AHIMA board develop the e-HIM initiative.

"If we don't redefine the professional HIM functions in the new electronic environment, other people will define them for us," says Fox, president and CEO of Care Communications, Inc. in Chicago. "And they may define them differently than we would as experts in information management."

The e-HIM initiative has three major goals:

  1. Accelerate the migration from paper to an electronic health information infrastructure. Due to external drivers--an aging patient population, quality concerns, medical science and technology breakthroughs, and the threat of bioterrorism, to name a few--support for a national healthcare information infrastructure is gaining momentum. Through collaborations, position statements, and research projects, AHIMA is encouraging the adoption of new technologies and data and content standards so that healthcare facilities and public health agencies can efficiently collect, store, provide, and share information.
  2. Reinvent how we manage records and information, from creation through use. The new electronic environment will redefine how HIM professional do their jobs. The question is, what does HIM practice look like in the future? AHIMA will convene a panel of industry experts to envision how HIM practice will change in an electronic environment. We'll collect and publish best practices and create migration paths to point members to the most promising techniques and systems. And soon a new online CE curriculum will be available to members.
  3. Deliver measurable cost and quality results from improved information management. If goals one and two are met, the healthcare industry should see a return on its technology investments. But just as a physician consults with a patient to explain treatment alternatives before selecting one, end users must have input into technology solutions. AHIMA is developing an integrated communication plan designed to build members' awareness and understanding of the core issues. The Association urges members to take active roles in convincing their administrators they need to be involved in talking to technology vendors and in anticipating barriers to success before implementation of costly systems.

E-HIM: What's in it For You?

HIM professionals should care about e-HIM because decisions others are making will affect us, for better or worse, says Fox. "A frustration that a lot of HIM professionals have is that electronic components are put in with a lot of attention paid to nurses' and physicians' workflow, but no attention to the issues of the HIM department," she explains.

When left out of the loop, the HIM department may suffer, along with the entire facility. Consider these theoretical examples, all of which could be avoided if HIM professionals had participated in the solution planning process:

  • A large medical practice makes a major financial investment to develop an electronic physician order entry system, but three months after implementation they are found to be noncompliant with healthcare regulations because they don't have a system for getting verbal orders signed.
  • A 900-bed medical center spends two years developing an electronic health record system, but two months after launch the HIM staff is overwhelmed by paper, mainly by preliminary lab results and nurses notes included in the new records. In addition, there aren't enough viewing stations or archive capacity to maintain the electronic records, which prolongs the facility's dependence on paper.
  • The information technology manager at a nursing home develops a system to scan lab data generated at other facilities and inputs them into their computer system; however, the records fail to include the data's origin, which violates HIPAA regulations.

In addition to potential inefficiencies and low returns on investment, in the long term, HIM careers are at stake if we don't pay attention now, says Lynda Mitchell RHIA, CPHQ, facilitator of the e-Health Community of Practice and a master's degree student in HIM at the College of St. Scholastica in Duluth, MN. For example, administrators may divvy up HIM functions between other departments with more technical savvy but less health information expertise. "The bottom line is: if we don't make ourselves known to be the ones who are the experts, they're going to hire an IT person [to do our jobs]," Mitchell warns.

Agents of Change

The e-HIM initiative will advance the profession by helping HIM professionals be change agents in their organizations and to position the Association as a change agent in the industry.

AHIMA is taking a leadership role through a variety of projects and collaborations, such as the e-Health Initiative and the National Alliance for Health Information Technology (NAHIT). The Association is working to anticipate issues that haven't been encountered yet and to stimulate people's thinking about how to solve those problems.

In addition, the initiative gives members the support of research, practice briefs, articles, the CoP and other resources. These tools will help members rethink their jobs, envision new roles, develop new skills, and create a road map for migrating from a paper to an electronic world.

"There is so much to learn and it changes so rapidly!" says Elizabeth Curtis, RHIA, director of medical information management at The Ohio State University Health System. Her facility began developing an electronic health record in the 1980s. An evolving document, their electronic record now includes a physician order entry system, results reporting, online patient-specific discharge instructions, patient registration and scheduling, and much more.

Curtis advises networking with HIM colleagues to hear about their experiences and learning how to develop requests for proposals. (See Migrating to e-HIM, below, for a list of baseline and advanced skills needed to make the migration, which were suggested by the AHIMA members featured in this article.)

Make a Commitment Today

No matter how many resources AHIMA devotes to these issues, members will make the biggest contribution to the e-HIM vision. Credentialed AHIMA members have the perspective to make a big impact at their organizations, says Lisa Paige, RHIA, director of registration, patient accounting, and HIM at Miami Valley Hospital in Dayton, OH.

"We have well-rounded knowledge of how the medical record contributes to the overall well-being of the hospital," says Paige, whose HIM department spearheaded implementation of an optical imaging system six years ago to make their facility's emergency room paperless. This year her HIM department is represented on her facility's new electronic health record task force.

There are a number of things members can do today to champion e-HIM:

  • Make a commitment: This isn't just a job for the HIM director. All HIM professionals should be prepared to lead the charge, from wherever they are: coding, release of information, heading a department, analyzing data, etc.
  • Educate yourself: The excitement--and challenge--of technology is that even if you're completely confident today, in very short time your knowledge will be obsolete. Read IT publications. Check out the Communities of Practice (E-Health, HIM Professionals in IT Roles, and HIPAA: Computer-based Record, for example) or start one of your own.
  • Create a vision and sell it: What can HIM be in the future? Where are you going? Every HIM professional should formulate a picture of where HIM will be in the electronic world, advises Fox. Once you have it, define that vision to your coworkers, upward to the administration and medical staff leadership, and outward to other departments in the facility. Be prepared to sell your vision: don't assume that people who are solely focused on patient care will see what you see.
  • Be more than just a cheerleader: Being a change agent is more than spouting a catchy slogan. Identify real barriers that need to be overcome and work on them. Think critically about proposed solutions and their impact on every HIM task you perform. Remember that even the best plans are useless without proper implementation. Ask yourself: What will happen to this function? How will it change? Will it go away? What will replace it?
  • Forge new paths: If you direct an HIM department, think strategically about how technology impacts the department's workflow. Create migration paths for the professionals who work for you. Make it possible for people to think critically about their jobs.

E-HIM gives us a chance to step outside and see how what we do contributes to the whole. If we can create a broad vision of what an electronic medical record is, its use, and its lifecycle, HIM professionals can make a significant contribution to our institutions.

Migrating to e-HIM: Do you have what it takes?

Below is a list of skills and knowledge sets that will help you migrate from the paper world to an electronic one. How do your skills match up?

Baseline skills:
What you may already have...
  • Basic computer, Internet, and database application skills
  • Working knowledge of regulatory requirements
  • Familiarity with accrediting body requirements
  • Understanding of the patient care documentation process
  • Understanding of how to protect security and privacy of patient information
  • Knowledge of how to capture complete data
  • Familiarity with data standards and data set requirements
Advanced skills:
What you need to learn...
  • Knowledge of emerging information technologies
  • Ability to develop requests for proposals (RFPs), score, and rank the results
  • An expanding network of colleagues with which to share best practices
  • Advanced knowledge of data standards and data set requirements
  • Big picture of how health information is used throughout the facility for patient care, reimbursement, statistical analysis, research, and as a legal record
  • Change management skills
  • Project management skills
  • Negotiation skills to ask for the budget to make change
  • Costs and the return on investment

Source: AHIMA Advantage 7:1 (February 2003)