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H.I.M. IN THE AGE OF E.H.R. JOSEPH NG, MD CHIEF MEDICAL INFORMATION OFFICER AT JOHN T. MATHER MEMORIAL HOSPITAL CRITICAL CARE INTENSIVIST PROGRAM DIRECTOR,

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Presentation on theme: "H.I.M. IN THE AGE OF E.H.R. JOSEPH NG, MD CHIEF MEDICAL INFORMATION OFFICER AT JOHN T. MATHER MEMORIAL HOSPITAL CRITICAL CARE INTENSIVIST PROGRAM DIRECTOR,"— Presentation transcript:

1 H.I.M. IN THE AGE OF E.H.R. JOSEPH NG, MD CHIEF MEDICAL INFORMATION OFFICER AT JOHN T. MATHER MEMORIAL HOSPITAL CRITICAL CARE INTENSIVIST PROGRAM DIRECTOR, TRANSITIONAL YEAR RESIDENCY

2 INTRODUCTION EHRs are reshaping the work of healthcare professionals Improving healthcare delivery Enabling payment reform Huge effect on HIM professionals New day to day demands

3 INTRODUCTION Accelerated change in the HIM environment Physical records are being phased out More stringent regulatory directives Multiple versions of the medical record Multiple pieces of the record in multiple systems Analyst, I.T. specialist, and HIM professional all-in-one

4 INTRODUCTION Envision and develop new opportunities Engage and drive change Redefine the role of HIM professional

5 STATE OF ELECTRONIC HEALTH RECORDS (EHR) EHR adaptation is at all time high 59% (6 out of 10) 5 fold increase compared to 2008 Increase of 34% in 2013 compared to 2012

6 INFORMATION EXCHANGE 41% of Hospitals are able to SEND and RECEIVE secure electronic messages containing PHI Printing out records Faxing Mailing

7 OFFICE OF THE NATIONAL COORDINATOR (ONC) HITECH WORKFORCE DEVELOPMENT PROGRAM The HITECH Act authorized ONC to establish the Community College Consortia to Educate Health IT Professionals Program.

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10 GOVERNMENT IS COMMITTED Meaningful use payouts March 2014, $22.9 Billion dollars $14.3 billion to eligible hospitals $8.6 billion to eligible providers March 27, 2015 – EPCS rollout in NYS and Ohio

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19 I-STOP EPCS – Electronic Prescribing of Controlled Substances Starts March 2015 for NYS and Ohio Needs 2 factor authentication for controlled substances HUGE AMOUNTS OF TRAINING NEEDED FOR USERS

20 WHAT DOES THIS MEAN FOR THE HIM PROFESSIONAL??? ENTERPRISE INFORMATION MANAGEMENT GOVERNANCE IS CRITICAL

21 CURRENT STATE EHRs are rapidly replacing paper records Volume and sources of data is overwhelming the information management capacity of most healthcare organizations What is your source of truth as a legal record when information is coming from all systems What is your institution’s policy to aggregate all this information? Who is the final manager of all this information? Who releases the information?

22 CURRENT STATE HIM manage health records Departments would manage their piece of information Problematic Difficult to integrate all these pieces of information Impossible to piece together patient course Hinders an organization’s ability to implement, oversee, and enforce standardization Data is being managed to varying levels of completeness, quality and accessability

23 CURRENT STATE LIJ – So many facilities – So many workflows – So many levels of usage Physician Documentation is at varying levels of usage Paper in chart, dictation Medication Reconciliation CHSLI – Same problems Consults are not on EHR Trickle down from Good Samaritan to St. Charles may take years

24 CURRENT STATE Mather – Community Hospital, Stand alone Competing priorities – Limited staff resources Multiple systems trying to communicate with each other

25 PROBLEMS Increasing cost due to inefficient storage practices IT cost to manage dozens of applications Exposure to preventable risk Unauthorized access Lack of trust hinders effective use Multiple versions of chart (some updated, other not) Question of accuracy

26 FUTURE STATE Information is managed as a strategic asset Correctly aggregated information can increase the bottom line Value Based Purchasing Prevent loss of capital due to law suits Governance is integral How information is managed needs to be clear Adds value to the information obtained Improves decision making capabilites Information Management needs to be an enterprise-wide function Everyone on the organization must “Buy-In”

27 THE ENTERPRISE MODEL FOR INFORMATION GOVERNANCE Information Governance Design and Capture

28 DESIGN AND CAPTURE FUNCTIONS Beginning of the Information Management Life Cycle Architecture Content Definitions Standards Reference Terminologies Mechanisms that improve efficiency and quality of data collection, downstream information use, interoperability and reuse Ideally data should be captured once and used for a variety of purposes

29 THE ENTERPRISE MODEL FOR INFORMATION GOVERNANCE Information Governance Design and Capture Access and Use

30 INFORMATION ACCESS AND USE FUNCTIONS Advances and supports critical data use Support to: Clinical and business process owners Patient access to health information HIM role Educate users about data characteristics Reliability and accuracy Collaboration to build trust in data for population health management, community, and public health

31 THE ENTERPRISE MODEL FOR INFORMATION GOVERNANCE Information Governance Design and Capture Access and Use Life Cycle Management

32 LIFE CYCLE MANAGEMENT FUNCTIONS Defines and maintain designated record sets Legal health records and other types of records For: Business needs of the organization Legal and regulatory requirements Management of plans and processes Storage Retention Disposition of medical and business records

33 THE ENTERPRISE MODEL FOR INFORMATION GOVERNANCE Information Governance Design and Capture Access and Use Life Cycle Management Privacy, Confidentiality, and Security

34 PRIVACY, CONFIDENTIALITY, AND SECURITY FUNCTIONS Protect PHI Information is only available to authorized persons For Authorized purposes Risk assessment and audits HIPAA compliance Complicated by expansion of users Expansion of access points Mobile

35 THE ENTERPRISE MODEL FOR INFORMATION GOVERNANCE Information Governance Design and Capture Access and Use Life Cycle Management Privacy, Confidentiality, and Security Integrity and Quality

36 INFORMATION INTEGRITY AND DATA QUALITY FUNCTIONS Data needs to be: Accurate Reliable Up-To-Date Consistent Fit for use

37 INFORMATION INTEGRITY Begins with data architecture, definitions and relationships How is data compiled and sorted? Legal record? Define it… How does the paper in the chart combine with the data in the EHR to form the legal record? Provenance or lineage of data Processes for error correction and amendments Analysis of medical record for completeness – this process now needs to be redesigned for real-time, electronic systems Signing orders both in HIM system and EMR

38 EXCELLENCE IN HIM – NEEDS TO: View information as an asset that must be deliberately managed Encompass patient records and other clinical and business data Implement and continuously improve on the component functions reflected in the model Encompass the life cycle of information and records Be guided by effective governance and stewardship focused on “getting it right” Measureable and sustainable improvement over time

39 Forward thinking HIM leaders understand the need to transition from traditional HIM to an enterprise view of information

40 ERRORS HIM leaders have been left out of critical decisions such as EHR selection Find workarounds for information and records management shortcomings Unique understanding Information contents and records Information flow User needs Compliance

41 BLURRING OF THE LINES Joining of I.T. / I.S. / H.I.M. Need to understand the basics of: How the information is stored How it is retrieved What technical processes occur in the background to obtain the output Example: Siemens E-HIM/Soarian AND Allscripts EMR Data  Aggregation into report  Integration into the HIM system When information is updated – versioning – When does that occur? Out of sync with patient’s course – Have to wait until patient is discharged

42 COMPETITION Priorities Transition to ICD-10 Demonstrating meaningful use Strengthening privacy and security Budget constraints All hinder progress the Holy Grail of Enterprise Information Management Solution: Outsource resource heavy low-value functions so that you can “Keep your eye on the ball” and shift staff to new roles for higher-value work

43 MAKE YOUR INSTITUTION SUCCESSFUL AT INFORMATION MANAGEMENT Break from paper Outsource records storage Production functions Transactional work Make a case for electronic information management Understand the state of information and records management across your institution

44 Organize for governance Extend support for appropriate governance Collaborate Measure results Cost savings Operational improvement Risk reduction Educate Enterprise information management needs to be built and improved over time Raise awareness Explain how everyone is involved to improve and reach the goal

45 HOW DO YOU LEVERAGE HIM SKILLS? Unique and valuable skill set Assume managerial and subject matter expert roles Realize that you all have the knowledge for theses roles already They rest on foundational HIM competencies However to adjust to the changing landscape – further training or even an advanced degree

46 Rapid adoption of technology and volume of data have made challenges more complex and costly To get support and buy-in from senior leadership, concepts of EIM need to be relayed as organizational goals and translated to dollars saved, performance improved, and risks mitigated SELL HIM’s NEW ROLE

47 EPILOGUE – WHAT ABOUT ELECTRONIC HEALTH RECORD MANAGEMENT (EHRM)? Reminder: EHRM requires that HIM be part of the decision-making and planning throughout the entire life-cycle of the EHR Lack of involvement will mean hundreds of hours of re-working Not only involvement in implementation but in maintenance and even in disposal Someone has to know what records to keep from a defunct EMR and for how long Make critical decisions about rollout to avoid maintaining a hybrid system

48 HIM LEADERSHIP – BACK TO GOVERNANCE HIM professionals are ideally suited to provide the institution with the leadership to ensure the EHR is optimally managed BUT – you need to get involved sooner rather than later! HIM professionals, with their training are best suited to make sure standards are consistently applied across various systems Maintain information integrity

49 NEW RESPONSIBILITIES FOR THE HIM PROFESSIONAL Patient Portals E-mail communications Personal Health Records Maintenance of scheduling of appointments

50 NEW RESPONSIBILITIES, NEW BENEFITS Charts get completed in a timely manner Chart analysis Coding Able to code from home Dynamics of the job Availability of charts online

51 ARE HIM PROFESSIONALS BEING EDGED OUT? Hopefully with what I’ve presented to you so far, you can see the growing need for people who possess the expertise in this room Not only is the prediction that HIM professionals won’t be needed, wrong They are going to be in a much more visible role Transformation of the HIM role

52 QUALITIES NEEDED TO MANAGE THE PAPER RECORD ARE THE SAME REQUIRED TO MANAGE THE EHR Attention to detail Ability to compare competing data sources and reach conclusions about data accuracy Project management Categorization of data Data reporting Evaluating, understanding and interpreting regulatory standards

53 BLURRING OF THE LINES… RECAP HIM will interact and overlap with HIT (health info tech) Clinical informatics overlap HIM department should have a close and ongoing relationship with HIS department Understand each others lingo Comprehend complexities of making things happen in each other’s department New hires are those that have HIM and HIT experience

54 HIM ROLES WILL MOVE FROM TASK ORIENTED ROLES AND SKILLS TO: Analytical thinking Process design Project management Cross-operational management / leadership Change management Planning and implementing new systems Educating providers and administrators Solving strategic and operational problems Developing/installing/operating clinical and financial applications related to the medical record

55 WHAT NEW ROLES ARE AVAILABLE? Enterprise Information Management Leadership Privacy / Security Officer Revenue Cycle Management Data Quality and Integrity Clinical Vocabulary and Classification Compliance and Risk Information Policy and Standards Records Life Cycle Management Information Access and Release Health Data Analyst Data Dictionary Patient Information Advocates Health Information Exchange

56 What you choose to do depends on your skills and interests

57 RESOURCES Transition and Change Management Books Lundin, Stephen C., Harry Paul, and John Christensen. Fish! A Remarkable Way to Boost Morale and Improve Results. Hyperion, 2000. (And other Fish! books by the same authors.) Johnson, Spencer. Who Moved My Cheese? An Amazing Way to Deal with Change in Your Work and in Your Life. Penguin Putnam, 1998. Carnegie, Dale. How to Stop Worrying and Start Living. Pocket, 1990 (revised edition). Bridges, William. Managing Transitions: Making the Most of Change. Perseus, 2003. Kotter, John, and Dan S. Cohen. The Heart of Change: Real-Life Stories of How People Change Their Organizations. Harvard Business School Press, 2002

58 RESOURCES E-HIM Practice Guidelines These standards can be found at www.ahima.org/infocenter/ehim:www.ahima.org/infocenter/ehim “HIM Practice Transformation” “Delving into Computer-assisted Coding” “The Strategic Importance of Electronic Health Records Management “Core Data Sets” “The Complete Medical Record in a Hybrid EHR Environment” “Implementing E-Signatures” “E-mail as a Provider-Patient Electronic Communication Medium and Its Impact on the Electronic Health Record“ “Electronic Document Management as a Component of the Electronic Health Record” “Core Data Sets for the Physician Practice Electronic Health Record” “Speech Recognition in the Electronic Health Record”

59 REFERENCES Redefining the Role of Healthcare Information Management in the New World of Information Governance; Iron Mountain; Linda Kloss Visioning e-HIM: A Process for Imagining—and Anticipating—HIM’s Future; Patty Thierry Sheridan, MBA, RHIA, Michele D’Ambrosio, MBA, RHIA, Kerry Heinecke, RHIA Redefining the Role of Health Information Management in the New World of Information Governance; Linda Kloss, 2013 AHIMA Work Group on Electronic Health Records Management. "The Strategic Importance of Electronic Health Records Management: Checklist for Transition to the EHR". Journal of AHIMA 75, no.9 (October 2004): 80C-E. AHIMA e-HIM TM Task Force. "The Strategic Importance of Electronic Health Records Management.“ Journal of AHIMA 75, no.9 (October 2004): 80A-B.


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