AHIMA Letter to President Bush Regarding Computerized Health Records

January 23, 2004

George W. Bush
President, United States of America
The White House
1600 Pennsylvania Avenue
Washington, DC 20500

Dear Mr. President:

Congratulations on your State of the Union address. Like most Americans, I listened to your speech to the nation on Tuesday with great interest and anticipation. As CEO of the American Health Information Management Association (AHIMA)-a national professional organization representing 46,000 health information management (HIM) professionals-there was one message in particular that captured my attention. I was extremely pleased to hear that you are dedicated to the computerization of health records as a way to improve our nation's healthcare system, and to jobs and education initiatives that will help our profession meet the demands of this electronic health information future.

I am delighted that we share the same vision for improving the nation's healthcare system by improving quality of health information and fully using all the tools of information technology available to us. To this end, I offer AHIMA's support in achieving this goal.

AHIMA Members

Our members are educated, certified professionals dedicated to the effective management of personal health information needed to deliver quality healthcare to the public. Our members work with data/information systems to collect, organize, analyze, and protect patient information to support healthcare providers, research, public health, payment and reimbursement, and healthcare policy decisions. They are the human factor in the electronic health information equation. Computerized health records alone are not enough. Skilled, specially trained health information management professionals are needed to reap the full benefits of information technologies in healthcare.

The Electronic Health Record

AHIMA has already responded to the call from Secretary Thompson and the Institute of Medicine and is leading many of the Health Level - Seven (HL-7) standards groups in the development of a standard electronic health record (EHR). A standard EHR will help provide those important benefits of reducing medical error and providing health information at a lower cost. In addition, a standard EHR will also allow for the "interoperability" or sharing of healthcare data. This is an essential function, absent from our current healthcare system, which will greatly improve the effectiveness of research, the safety of patient care, public health monitoring, bio-terrorism response, payment and reimbursement, and healthcare policy decisions.

A Standard "Language" and Improved Data

Thanks to Secretary Thompson's bold action, the National Library of Medicine now has a standardized lexicon or terminology that is needed to build a standard EHR and the required interoperability necessary for its effective use. Currently, the Department of Health and Human Services (HHS) is considering recommendations from both Congress and the National Committee on Vital and Health Statistics (NCVHS) to upgrade America's system for classifying diseases and inpatient medical procedures, also needed to meet your vision. The current classification system - ICD-9-CM - dates back to the Carter Administration and is obsolete. As a result, our country does not have data describing the "amazing medical technologies" you mentioned in your address.

There is a better system-ICD-10 - that is used in nearly every other developed country in the world today. If HHS moves quickly, the US could adopt its version of ICD-10 and complete the upgrade by late 2006. I urge you to encourage HHS to publish a Notice of Proposed Rulemaking and a subsequent final rule for ICD-10 adoption and implementation as soon as possible. The longer this action is delayed, the longer and more expensive it will be to achieve a fully functioning EHR and the interoperability necessary for the sharing of healthcare data.

I also urge you to require all health plans, payers, and providers, including those in HHS, to fully comply with approved guidelines and ethics in coding diagnoses and procedures as required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) The lack of compliance produces data that is inconsistent and inaccurate and undermines all the goals for EHRs.

National Health Information Infrastructure

To build the national healthcare system that you have described we also need an infrastructure. A infrastructure similar to the one described in your Information Technology Advisory Committee's report: Transforming Health Care Through Information Technology, and the one proposed by the NCVHS in 2001 . We need federal leadership and assistance. Your administration has taken positive steps in this direction, but I firmly believe that more must be done to make certain that public and private sectors of the healthcare industry move forward together to ensure uniformity, interoperability, and accountability.

AHIMA supports the work of Representative Nancy Johnson (HR 2915, The National Health Information Infrastructure Act) and other Congressional leaders working towards this goal, and I hope you will do the same. I also hope that you will take steps with management and budget to ensure that the necessary funding and leadership are in place to foster industry collaboration. As you know, funding for technology and the management of the technology is crucial if healthcare is to come quickly into the information age while still providing all of the privacy and security measures necessary to ensure the public's trust.

Jobs and Education

According to the Bureau of Labor Statistics and AHIMA's own research data, demand for skilled HIM professionals will increase significantly over the next 10 years. Some 6,000 jobs will need to be filled each year - a 49-percent growth in the HIM workforce. Right now there are simply not enough students enrolled in college HIM programs to meet this demand.

While federal and healthcare industry attention has focused on shortages of physicians, nurses, and pharmacists, it has ignored increasing shortages of technicians and allied professionals that support these roles. We must take action now to ensure we can meet future industry demands for trained HIM professionals in order to avoid this impending workforce shortage.

We welcome your call for higher education support, scholarships, and jobs. Twenty-first century information technology combined with twenty-first century HIM professionals will ensure that we are able to manage quality of healthcare data in an electronic environment. Please support Congressional action to:

  • Reauthorize Title VII of the Public Health Service Act and allocate funds to allied health education.
  • Support passage of the Allied Health Reinvestment Act sponsored by Florida Congressman Cliff Stearns and Ohio Congressman Ted Strickland. Funding from this bill will allow allied health professions, such as HIM, to recruit students into allied health professions by promoting these lesser known and often overlooked health careers. To succeed in attracting enough students to fill the projected need for allied health professionals and to ensure that their curriculum meets 21 st century requirements, assistance is necessary in the form of scholarships, grants, and loans similar to the federal support currently offered to the nursing profession.
Your words, Mr. President, have energized me and I am eager to work with you to realize our shared vision of an electronic health information future. I have enclosed several items for your review, including AHIMA's position statements on the initiatives I have described above, as well as our e-HIM® Taskforce Report, A Vision of the e-HIM® Future.

With our strong membership base, expert professional staff, and 75 years of experience, AHIMA stands ready to work with you and your administration. If I can respond to any questions you have regarding this letter or the accompanying materials, please feel free to contact me. I can be reached at 312-233-1166 or linda.kloss@ahima.org. You may also contact Dan Rode, Vice President for Policy and Government Relations, in our Washington, DC office at 202-659-9440 or dan.rode@ahima.org.

I look forward to the opportunity to work with you to improve our nation's healthcare through improved health information. Thank you.


Linda L. Kloss, RHIA, CAE
Executive Vice President and Chief Executive Officer

enc: Position Statements; e-HIM® Task Force Report

cc: Melanie Brodnik, PhD, RHIA - AHIMA 2004 President
Dan Rode, MBA, FHFMA - AHIMA Vice President, Policy and Government Relations