Moving the HIM Profession from Good to GREAT!

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Moving the HIM Profession from Good to GREAT!
While creating Job Roles for Today and the
Future!.
Rita K. Bowen, MA, RHIA, CHPS 2010 AHIMA President
Rita
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Raising Expectations Future Vision (WHAT YOU
SEE IS WHAT YOU GET)

• Mind your Mind
• Behavior and Performance
• What you Choose
• Without vision, the people perish (Proverbs)
• Expect a Miracle

We Can Soar Like an Eagle
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The Mechanics of Soaring

• Use the Inner Eye for the aha! moment.
• Truly Listen to the environment

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Give Yourself a Soaring Test

• Build on a firm foundation of HIM within the
  community
• Walk the walk and talk the talk
• Hold fast to your faith in times of short
  staffing and increasing demands to do more with
  less.

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CURRENT STATE

• The Presidents goalElectronic health records
  (EHR) for every individual by 2014
• ONCHIT Strategic Framework Private sector HIT
  product certification is one of eight key actions

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Near Future Success AttributeStrategically,
AHIMA expands its influence to become the central
professional association focused on the holistic
management of health information
So, the scope of the core model is intended to
encompass AHIMAs expanded position.
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The HIM Core Model
The development of the HIM Core Model is to
identify and define the complex roles,
responsibilities, and opportunities of HIM
Professionals today and in the future.
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HIM Core Model (Draft)
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HIMCore Model Components
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Learn to See the Big Picture

• Become eagle eyed
• Dont develop tunnel vision
• Inspire and motivate others

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• Establish health data capture and maintenance
  practices and procedures
• Capture and maintain health data
• Develop and maintain data architecture and
  models.
• Design functional attributes of data structures,
  data fields, and input templates.
• Provide nosology, data mapping and taxonomy
  support for information retrieval or secondary
  use.
• Ensure appropriate protocols to support secondary
  data uses, such as research, quality reporting,
  public health, risk assessment, etc.

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• Establish and maintain uniform definitions of
  data.
• Design, operate and ensure appropriate data
  capture mechanisms with edits to identify
  variance with expected values (includes speech
  recognition, menus other approaches).
• Design and operate data quality and integrity
  validation strategies and methods.

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• Manage terminology assets (evaluate, acquire,
  use and maintain vocabulary and clinical code
  sets through their life cycle).
• Code health record content using data content
  standards (e.g., ICD, CPT).
• Develop and map health information related
  process, work and information flows
• Identify, develop operate required registries.
• Manage patient identity mechanisms and processes.

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• Develop and maintain data architecture and
  models.
• Design functional attributes of data structures,
  data fields, and input templates.
• Provide nosology, data mapping and taxonomy
  support for information retrieval or secondary
  use.
• Ensure appropriate protocols to support secondary
  data uses, such as research, quality reporting,
  public health, risk assessment, etc.
• Establish and maintain uniform definitions of
  data.

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• Design, operate and ensure appropriate data
  capture mechanisms with edits to identify
  variance with expected values (includes speech
  recognition, menus other approaches).
• Design and operate data quality and integrity
  validation strategies and methods.
• Manage terminology assets (evaluate, acquire,
  use and maintain vocabulary and clinical code
  sets through their life cycle).
• Code health record content using data content
  standards (e.g., ICD, CPT).

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• Develop and map health information related
  process, work and information flows.
• Identify, develop operate required registries.
• Manage patient identity mechanisms and processes.

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• Establish data analysis and reporting practices
  and procedures
• Analyze, transform and report health information
• Develop the functional requirements for data
  retrieval and analysis
• Design the criteria and metrics to met the end
  users needs through the collection and
  interpretation of data
• Integrate clinical and business decision support
  rules into systems

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• Integrate data from internal and external sources
  to provide data for analysis and/or reporting
• Provide data from primary records for secondary
  data use ( research, public health, quality
  reporting)
• Analyze health data to generate findings to form
  recommendations for clinical, financial, and
  operational processes. Evaluate systems output
  and fit for use
• Apply appropriate statistical methods and data
  mining techniques
• Conduct clinical data and clinical process
  modeling
• Produce accurate and properly reported data
• Abstract data

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• Manage the health information resource
• Innovate and adopt advanced health information
  management processes
• Lead the development, deployment and operation of
  organizational information management policy.
• Define functional, technological and
  communication requirements.
• Optimize the use of information in decision
  making.
• Evaluate the effectiveness of information
  systems.
• Optimize reimbursement through management of the
  revenue cycle and information for business
  intelligence

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• Perform health information management research.
• Participate in the leadership of quality
  improvement via health information.
• Lead the development of strategic information
  plans and assist in the development of strategic
  information technology plans.
• Shape and manage information architecture across
  EHR/PHR/HIT systems.
• Advance information-based process innovation.
• Influence the decision-making for the adoption of
  information technology.
• Manage implementation, e.g. project management,
  user preparation, change management, training .

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• Shape the e-HIM environment (standards, policy,
  regulations).
• Manage information management projects and
  operations including financial and human
  resources.
• Employ performance improvement techniques.
• Deploy artificial intelligence technologies.
• Design human-computer interface.

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• Provide appropriate governance for the health
  information environment, including cohesive
  policies, processes and decision-rights and
  responsibilities
• Protect assure the ethical use of health
  information
• Envision and develop HIM practice (HIE,CAC,
  personalized medicine).
• Develop, maintain and operate a patient identity
  management program.
• Manage access, disclosure, use and control of
  protected health information.
• Administer organization infrastructure for
  privacy, security, confidentiality, access,
  integrity and controls.

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• Ensure and monitor compliance with state and
  federal laws and regulations, payor policies, and
  legal requirements pertaining to health
  information, reimbursement and privacy/security.
• Demonstrate and promote legal and ethical
  standards of practice.
• Establish and manage process for verifying and
  controlling access authorizations and privileges,
  including emergency access.

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• Administer the Content and Records Management
  Program (including record lifecycle management,
  record alternation management, business
  continuity planning, retention/storage,
  archiving, destruction, disaster planning, and
  legacy information).
• Design and implement business continuity,
  information integrity and risk management plans.
• Advocate on behalf of the individual(s).

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New or changed Roles
Electronic Records are standard practice!
Information content and technology -- must form
the perfect union
Privacy and Security issues -- expand
In-home monitoring and diagnostic tools
information link up !
Healthcare will truly become integrated medicine!
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New or changed Roles

• Department Director redefinition
• Enterprise focus
• Information flow
• Titles Director of
• Enterprise HIM
• Clinical Informatics
• HIM Services
• Clinical Content Management/standards

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New or changed Roles

• Coding redefinition
• Impact of machine driven process
• Editing
• Titles
• Coding data analyst
• Clinical data editor
• Coding data quality specialist
• Decision support analyst
• Revenue Integrity

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NEW ROLES - Include

• Patient Advocate
• Public policy Advocacy Approaches
• Genomic impact
• Chief Knowledge Officer
• Critical thinking at higher taxonomic level
• Problem Solving

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New Roles - continued

• Data Ware House Manager
• Quality management report output
• Health Statistics
• Data Mart Manager
• Data analytics and outcome measurements
• Coded data quality/outcome measurements

GOAL making the data meaningful!
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New Roles - continued

• Research
• Clinical Transformation Data Coordinator
• Emerging Employers
• Bio-Tech groups
• Pharmaceutical firms
• System designers
• Practice/organizational based

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New Roles, continued

• Integration vs. Interfaced
• Selecting, designing or implementing applications
  or systems for ease of
• Data entry
• Data transfer
• Data display
• EMPI Locator Service

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New Roles, continued

• Data Comparability
• Textual/Contextual Registry Data
• Cancer, Trauma, implant, etc.
• Growing as data is shared electronically in
  disease management and product tracking
• Subject to interpretation/local usage
• Data reliability
• Data integrity
• Data predictability

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Classifications Terminologiesin the EHR

• Mapping data
• Data standards
• Data vocabularies
• Architectural models (for clinical, financial and
  administrative data)
• Defining functionality
• Within e-HR for inter-organizational HDE
• Structured VS Unstructured data

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NEW ROLES -

• Any thing in technology is wide-open
• Product Development Analyst
• Clinical Terminology Specialist (Lexicon)
• Health Industry Relations (consulting)

Tecnology is the thread that ties innovation
together
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New Roles, continued

• Project Management
• Planning
• Timelines (Gantt chart)
• Keeping things moving
• Monitoring and control

Technology has the potential to alter every
department in the hospital.
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Role Transformation

• FROM a post-care, compliance-oriented and
  archival role
• TO a central role in the development of
  treatment plans, the informed management of
  personal health and the design of health system
  modification based on real data

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Systems-based Leadership and Change
Management A Framework Leading Change MGT
Systems-based Leadership
Transition Management
Change Management
Project Management
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Example 1

• Our Journey to the EMR Document Imaging
• Using a different strategy
• Building the team
• A collaborative effort so who leads?
• Support from the top
• Which battles are worth fighting for?

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Example 1

• Our Journey to the EMR Document Imaging
• Document imaging on the fast track
• HIMs commitment to change
• Recognizing emotions staffs and leaders
• Cheering the group on

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GOALS for E-HIM

• Discuss how code sets are connected to data
  standards
• Explain the connection of data standards to HL7
• Describe HL7 and its connection to HIM
• Illustrate how HL7, code sets, and data standards
  translate to managing information today for
  quality healthcare tomorrow

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Importance of Data Standards

• Knowledge in medicine is increasing
• Machines (computers) are necessary to process
  data and turn it into information
• Standardization is needed to link data within an
  EHR system or share health information between
  systems
• Fosters the use and exchange of structured and
  consistent information

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Importance of Data Standards (cont)

• EHR data are expected to be accessed on a broader
  scale than paper medical records
• Data standards will help facilitate the exchange
  and reporting of clinical data
• Healthcare data must be accurate, complete,
  consistent, and universally understood
• Patient information must be captured and
  communicated in a timely manner

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Connecting Code Sets to Data Standards

• At the most basic level, data standards are
  about the standardization of data elements (1)
  defining what to collect, (2) deciding how to
  represent what is collected (by designating data
  types or terminologies), and (3) determining how
  to encode the data for transmission.

Institute of Medicine. Patient Safety Achieving
a New Standard of Care. Washington, DC National
Academy Press, 2003.
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Connecting Code Sets to Data Standards

• Examples of data standards
• (1) defining what to collect
• Continuity of Care Document (CCD)
• (2) deciding how to represent what is collected
• SNOMED CT
• (3) determining how to encode the data for
  transmission
• HL7 Version 3 Communication Standard

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Data Capture at the Back End
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Managing Information Today for Quality
Healthcare Tomorrow

• Collect once, repurpose many times
• Clear emphasis on standard, discrete data
• Computable, not just searchable
• Reduction in document images
• Increase in standard terminology, coded data
  (e.g., SNOMED CT)
• Guidance to physicians on information needed
• Collect computable data on the front end

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Data Capture at the Front End
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Managing Information Today for Quality
Healthcare Tomorrow

• HIM professionals must
• Advocate for (demand)
• standards use in healthcare organizations
• and in HIE activities

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Managing information today for quality healthcare
tomorrow

• Without standards, information technology
  systems built over the coming decades will be
  inadequate to support the delivery of safe and
  effective care.

Institute of Medicine. Patient Safety Achieving
a New Standard of Care. Washington, DC National
Academy Press, 2003.
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Example 2

• Clinical Documentation Improvement CDI Program

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Example 2

• Why HIM?
• HIM crosses all levels of the revenue cycle
• HIM drives the revenue cycle
• HIM accepts change and HIM professionals are
  eager to accept additional responsibility

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Example 2Stages of Successful Large-Scale CHANGE

• Urgency
• Guiding team
• Vision and strategy
• Communication

• Uncovering the obstacles
• Demonstrate the wins
• Maintain focus/hold the gains

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Example 2

• Bridge Building for CDI
• Take control of the revenue cycle (ABCs)
• Acknowledge, Access, Address and Apply
• Bring HIM to the forefront
• Collaborate, Cooperate, Communicate, Common Goals
  and Celebrate

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Example 3

• Charting The Course for Enterprise Strategy for
  HIM
• Crystallizing vision and strategy statements
• Lessons learned
• Transition planning
• Managing self
• Fighting the right battles
• Learning from the detours on the road to success

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Example 3

• Key Milestones an Ongoing Journey for Enterprise
  HIM Recognition
• Organizational realignment
• Leadership for Consistent EHR/e-HIM strategic
  planning

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Example 3

• Key Milestones (cont.)
• Lessons Learned
• Collaboration with clinical/physicians is the
  name of the game!
• Being at the table is a privilege to be earned.
• It doesnt have to be perfect to be remarkable.
• Progress may be slow, but it is progress.
• Transforming is not a once in a life-time event,
  but rather a life-long journey!

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Act with Confidence and Self Esteem

• DESIRE - ACT AS IF - remember you become what
  you think about
• DISCIPLINE - Believe in YOURSELF (be focused and
  self-disciplined)
• DETERMINATION - Have the faith to. Sell the need

Remember the three Ds
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Goal Setting

• Take a chance!
• Review and share (support others)
• Believe in yourself
• Invest in yourself and the professionals within
  your community
• PRESS ON!

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Dont give up when you are told, NO

• Avoid being controlled by circumstance
• Take charge (courage and fearlessness)
• Think possibilities
• Learning opportunities
• What is the worst that can happen?

light up your creativity
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Networking and Teambuilding

• Climb Your Ladder to Achievement
• Take Time to Network
• The Power of a Personal Note
• Develop Your own Tool Kit

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Time Management

• Utilize the 3 D principle
• Think it - Ink it
• Plan
• Weve practiced no but sometimes you have to
  say yes
• Eat the crust first

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Develop Enthusiasm

• A grateful mind garners attention and respect
• Bloom accept challenges
• To whom much is given - much is expected
• Ride a horse in the direction it is going!

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Remember Anything in Life is POSSIBLE
P Picture Your Dream O Open Yourself to
Success S Set Clear Goals S Savor the
Unexpected I Imagine the New World B
Believe in Miracles L Learn from Experience E
Enjoy the Journey
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QUESTIONS
Parting Thoughts

• What you see is what you get
• Million dollar habits
• Mind your mind
• What goes around, comes around
• Act as if..

rita.bowen_at_erlanger.org or Rita.bowen_at_comcast.net