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HIM Education: Prepare for Healthcare’s Future

Personal Health Information & Ebola
November 5, 2014 1:02 PM by HIM Professionals
Recently, Fox Rothschild LLP published a blog questioning the continuous stream of information shared about Ebola patients Thomas Eric Duncan and his former nurse Nina Pham. The blog author brings up a great point: amid all of the Ebola chatter, has anyone stopped to think, "How are we getting all of this personal health information?"

It sounds like most of the information on Duncan has been shared by his family members, a nephew and his mother, according to the blog. While his family isn't restricted by HIPAA as covered entities and business associates are, the vast amount of detailed medical care, "hundreds of pages of medical records," shared in an Associated Press article has some questioning whether or not the family should even have access to all of this information. Citing HIPAA Regulation section 164.502(g)(4), the blog explains that Duncan's family should only have access to his medical records if an "executor, administrator, or other person has authority to act on behalf of a deceased individual." Perhaps the executer obtained the reams of medical records legally and shared it with other members of the family, but it does lead healthcare providers to wonder.

Pham's eventual discovery is a bit more suspect, according to the blog, as media reporters and researchers deduced her identity after cross-referencing her known address with public records and nursing databases. The blog goes on to postulate: "if the sources were hospital personnel who revealed sufficient information about these patients to allow their identification when cross-referenced with public sources, they likely  crossed the line even if they did not reveal patient names, particularly if the leakers had knowledge that the information could be combined with other information to identify the individual."

Of course, the CDC's and other covered entities' need to disclose PHI in order to notify those at risk of contracting or spreading Ebola might account for the continued spread of information via family and friends. But that PHI continues to find its way into media reports, which should be raising some eyebrows.

Identifying and treating patients with communicable diseases is no doubt an extremely difficult task ... but as the blog concludes, "the rules don't change because of controversial, highly dangerous diseases." Some of this PHI may have been shared without any HIPAA violation; yet some of it might have.

While your facility prepares for Ebola with safety and protocol training, are you thinking about PHI too?     

Eeny, Meeny Miney Moe...Catch a Kitten, or a Code, by its Toe
September 22, 2014 7:51 AM by HIM Professionals

By Girija Yegnanarayanani, PhD, director of applied CLU research at Nuance Communications.

"Eeny, meeny, miney, moe/Catch a tiger by the toe..." It's a familiar nursery rhyme, recited by children looking for a way to select who will be "it" for a game. The main principle of this ditty is choosing one (eeny) over another (moe). This is not unlike what can occur in the classification assignment when transitioning to ICD-10 from ICD-9. Important details can be lost in translation.

Take, for example, the dangerous encounter described above: catching a tiger by its toe. If we were to select the details using ICD-9 to document this today, we would accurately note that we caught an orange and black-striped, furry mammal, with four legs, a long tail, and whiskers - by the toe. However, that same basic description could allow someone to interpret the dangerous tiger as just a small kitten. It doesn't convey the same sense of severity or urgency.

Is it a Roar, or a Purr?

The granularity required for the ICD-10 transition has caused a lot of anxiety for providers and health organizations alike. But the lack of specificity available in ICD-9 codes (in relation to that provided by ICD-10) can lead to diagnosis confusion or the misidentification of important patient information.

According to a recent study published in Pediatrics, 26% of ICD-9 codes are convoluted when mapped to ICD-10, which can have a substantial negative impact on pediatricians' bottom line. It is this level of detail required in ICD-10 that makes general equivalence mappings (GEMS) an unreliable way to prepare fully for the transition. While GEMS does allow coders to see how most general ICD-9 codes will translate to ICD-10, this practice does not account for the level of specificity required under ICD-10, which will require that clinicians record additional identifiers to more fully describe care being provided. The new level of detail captured in the documentation will help to improve quality patient care and enable providers to better manage the health needs of their specific patient populations - and can clarify whether the furry, original animal purrs or roars.

How is technology impacted?

Natural Language Processing (NLP) engines that can understand clinical narrative as well as the right level of details using ICD-10 specificity can be leveraged to meet coding and quality measures accurately. However, if health IT can only recognize and manage those details recorded by clinicians using an ICD-9 lens and discards additional information, the picture changes dramatically from a savage beast to a house pet. Using intelligent systems and tools that accommodate specificity and "learn" which details are needed to ensure that the appropriate information is captured can help ease the burden being placed on the care teams documenting their patients' conditions. It can also help the coders and clinical documentation specialists who are working to ensure a patient's story is complete, accurate, and compliant.

The level of specificity isn't just for physicians and coders. These details also require that technology keep pace with the level of sophistication required under new coding standards. Although we've been able to hit the reset button on the ICD-10 countdown, it's important to continue to keep the momentum going. Strategies that take into account the increased levels of clinical documentation specificity will ensure healthcare organizations are paid for the high quality care they are providing to their patients and to their community. The danger of not doing so places organizations at risk for RAC denials, and in the dangerous position of misrepresenting a tiger as a kitten.

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Gearing Up for Change: Target Your Physician Documentation
August 21, 2014 8:21 AM by HIM Professionals

By James P. Fee, MD, CCS, CCDS, AHIMA Approved ICD-10-CMS/PCS Trainer, Associate Director, Huff DRG Review

Plan-Do-Study-Act. These are the four steps for any educational or quality improvement endeavor-the same process required to ready your physicians' clinical documentation for ICD-10. The challenge is getting physicians educated, engaged, and involved.


Plan an assessment of your current physician documentation by specialty using physician advisors in collaboration with coding and clinical documentation specialists. Keep the focus on known ICD-10 documentation requirements to clearly identify existing gaps.


Analyze physician documentation before final billing with these four objectives in mind:

  • Identify documentation gaps for ICD-10
  • Correlate lost dollars under ICD-10
  • Examine impact of current documentation regarding quality metrics with ICD-10 translation
  • Compile clinical topics where physician education will have greatest impact

Physicians are data-driven. Careful study of the data derived from this pre-bill review yields a plan of action for documentation improvement that is physician centric.


Study your pre-bill review data. Given the complexities of ICD-10, especially the procedural coding system, establish specialty physician advisors as team members. Maximize your impact through a methodical approach.

  • Organize findings by specialty and clinical topic to align with the physicians' approach.
  • Streamline data and concisely outline "what's missing" within their documentation.
  • Involve the specialty physician advisors to enhance clinical validity and peer "buy-in".
  • Develop a trend analysis to continually modify your focus allowing for longitudinal documentation improvement.


Implement change through customized education utilizing your data analysis. Keep physician education concise, clinically focused and specific for each specialty. Use a carefully selected and comprehensively trained physician advisor for maximum impact and medical staff engagement. Ongoing engagement by the physician advisor through daily pre-bill reviews fosters long-term effectiveness with the medical staff.

Once physician advisors are in place, begin your physician education program for ICD-10. Here are four important guidelines to follow:

  • Begin training your physicians on their documentation needs for ICD-10
  • Target physician education on "what's missing" for each specialty and share ongoing pre-bill review data to demonstrate improvement
  • Leverage physicians' drive for competition every step of the way with data reflecting their quality and efficiency scores.
  • Combine ongoing training and daily CDI rounds with regular pre-bill reviews, committee reporting and mentoring sessions

Benefits Extend Beyond ICD-10

ICD-10 is as much a documentation issue as a coding issue. Better physician documentation for ICD-10 drives powerful improvements within other executive indicators.

  • Quality metrics
  • Case mix index (CMI)
  • Severity of illness (SOI)
  • Risk of mortality (ROM)
  • Return on investment (ROI)

The rewards of better clinical documentation are truly endless. Pre-bill reviews in conjunction with the right physician advisor team propel ICD-10 change and establish a firm foundation for long-lasting clinical documentation improvement.

Congressional Communication & ICD-10
July 14, 2014 1:55 PM by HIM Professionals
By Michael Baney, president, Woodham HIM Solutions

In a letter to CMS dated June 4, 2014, Congress made it clear that it wants providers to adopt the new coding system successfully in 2015. This letter comes in the wake of the federal government's delay of the new coding system this past spring. Congress' message for 2015 is clear: ICD-10-CM/PCS is coming, and the industry needs to be ready.

According to its recent letter, Congress says CMS must perform these four actions between now and October 1, 2015:

1. Provide ongoing communication regarding "progress in reaching meaningful milestones toward full ICD-10-CM/PCS readiness," including the following:

  • Provide ICD-10-CM/PCS outreach and education for providers
  • Allow stakeholders to participate in ICD-10-CM/PCS readiness planning
  • Share best practice strategies for implementation
  • Clearly describe the end-to-end testing that will occur - this includes information about whether the testing will occur directly with providers or indirectly with clearinghouses or others as well as how often it will occur

2. Explain why CMS delayed end-to-end testing until next year as well as provide a timeline for the new testing

3. Provide ongoing progress reports for ICD-10-CM/PCS activities, including expected timelines for completion

4. Keep tabs on stakeholder involvement and engagement in outreach, education, and testing

Will Congress' increased oversight of CMS improve the likelihood that we'll move forward with ICD-10-CM/PCS in 2015? That remains yet to be seen. One could argue that many of the barriers to ICD-10-CM/PCS that exist today will continue to exist in 2015. Increased oversight doesn't exactly target the root cause of the problem, i.e. physician resistance.

Getting There

True progress will be made only when those who have opposed ICD-10-CM/PCS understand its value and are convinced that the new date will stick.

ICD-10-CM/PCS is the gateway to improved patient care. Work collaboratively with your physician practices to ensure they fully understand how the new code set drives more comprehensive data on which clinical research, cures and medical innovation will be based. Secondly, surgical denials will trickle down to negatively impact physician reimbursement-a key point to explore with your surgical services team.

The toughest challenge will be convincing physicians that October 1, 2015 is reality. There are many naysayers and skeptics. After all, the NGR "fix" has been repeatedly postponed and ICD-10 is now on its third delay. To counteract pessimism, hospital executives should keep up-to-date with all ICD-10 news and actively share information throughout the coming year.  

Stay the Course

The healthcare industry has worked hard to prepare for this transition. All stakeholders must stay the course with ICD-10-CM/PCS implementation. Greater physician understanding alongside clearer Congressional communication may work together to ensure October 1, 2015 marks true progress in our healthcare system.


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What Will Be Your HIM Legacy?
June 11, 2014 10:43 AM by HIM Professionals
By Debi Nelson, RHIT

As I wrap up a career in Health Information Management, I ponder what my legacy will be. Starting in 1979, I was fortunate to have positions I truly loved. While managing departments, planning and implementing budgets and drafting policies, I was also able to teach and give counsel on career choices. Will my legacy be about process or about the people's lives that I touched?  How do you want to be remembered in the HIM profession?


I've had this Chinese proverb posted in my offices "Give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime." No matter what position I held in HIM, I always wanted others to understand the ‘why' for things and not just the answer. This included students, co-workers and colleagues. I had a passion for teaching others information they could use for a long time, not just to get over the current hurdle. I remember an on-going discussion with Radiology on the coding of diagnostic versus screening mammograms. It was important to use the opportunity to discuss the purposes of coding and how it fit in health information for the accuracy of the patient's record, the welfare of the patient, along with reimbursement. I wanted others I worked with to see HIM and its value to the patient and organization along with giving them the answer they sought. Teaching was always important to me and I hope this has become part of the legacy I will leave from my HIM life.

I have had the privilege of working with HIM professionals who are outstanding in their areas of expertise. They were willing to teach students and co-workers not only their skill, like coding or transcription, but also their passion do it right. I know they will be remembered for loving what they did AND helping shape coding and transcription programs by passing down their expertise to those they taught.                        


While conducting employee performance appraisals each year, I would ask the same question "If you are doing this same job next year when we meet, will you be happy?" As I was fortunate to truly love the positions I held, I wanted nothing less for my employees. Most of the time, they would say yes or share the next level they would like to achieve. Once in awhile they would say ‘no' and then we would explore how they could get to their desired position. More than once it was a totally different profession and I encouraged this also. I would surprise new students by asking them early on in their internship if they truly liked what they were learning and if they could see themselves doing a particular task 8 hours/day. I counseled more than one that they should not look at the HIM position that paid the highest but should look at the duties that they would be doing each day. ‘Career counseling' and caring about people's goals could be another legacy to leave in HIM.                                     

People Before Process

"Live a good, honorable life. Then when you get older and think back, you'll be able to enjoy it a second time." This quote from the 14th Dalai Lama is worth pondering when looking at what legacy you will leave in HIM. As I look back at my HIM life, I know I certainly have made some mistakes. I wish I could re-do some situations AND some conversations. However, through it all, I tried to place people before process and tried to do the right thing. I would stress that we needed to do the right thing. Not because we had to, but because it was the right thing to do. To me this was another piece of being honorable. Sometimes people would question why I tried so hard when it might not make a big difference. I would remind them of the ‘starfish story' where a guy was seen walking along the beach tossing starfish that had washed ashore back into the ocean. He couldn't save them all, but he made a difference to the ones he could. Do you want to be remembered for doing the right thing even when it is not the most economical or profitable?  Will this be the legacy you leave from your HIM life? 

If you have been in the profession for many years, you will be known and remembered for something - what is the legacy that you wish to be remembered for? If you are just starting out in the profession, remember that you also will leave a legacy - now is the time to ponder what you wish it might be.



Learning On The Job
February 17, 2014 11:16 AM by HIM Professionals

By Ryan Sandefer, chair of the Health Informatics and Information Management at The College of St. Scholastica

Health Information Management is often cited as one of this decade's ‘Hot Jobs' and journalists love to single it out as a growth area everyone should be considering. It's easy to see why they pick out our profession.

The authors of a recent study published in the journal Industrial Relations found that health IT job postings, which are a key indicator of demand, have tripled as a share of the broader healthcare job postings since 2007. As I've mentioned in previous ADVANCE Blog posts, health organizations are increasingly relying on information professionals to manage big data. HIM professionals are in demand.

The problem is that demand for highly trained professionals is currently outweighing the pool of available talent. The latest Workforce Survey from the Healthcare Information and Management Systems Society (HIMSS) found that half of the healthcare organizations surveyed placed an IT initiative on hold due to a shortage of qualified staff.

Therein lies the opportunity for employees and employers to make up this shortfall and begin filling all these crucial jobs.

Opportunity To Learn On The Job

Many companies have professional development perks available to employees, enabling participants to learn the latest health information management and informatics trends and skills.

Results from the same HIMSS survey show that 60 percent of healthcare provider organizations and 64 percent of vendor organizations offer their employees professional development opportunities. Many companies offer paid tuition and also pay association membership dues.

At the College of St. Scholastica, we offer undergraduate and graduate degrees in health informatics and information management online. Approximately 80% of our online HIM students begin their educational program having over a year of healthcare experience. They know that furthering their education helps them access better jobs and marshal higher wages. This information is backed up by a recent report released by the American Health Information Management Association.

For employees, the benefits of continued education are significant. Those who master data analytics, understand the value of interoperability in health organizations, and remain ahead of the technology curve, are far more likely to achieve promotion or find more impressive positions elsewhere. In short, these employees become invaluable teammates. Thanks to the national revolution that's happening in healthcare, there are job opportunities from coast to coast.

And for employers, the value of continued education is equally substantial. Health organizations that emphasize ongoing education are able to achieve their IT goals with fewer obstacles. Additionally, human resources departments save time and money when they cultivate talent within their organizations versus hiring new people.

Try Before You Buy

A new, progressive model of continuing education is Massive Open Online Courses, or MOOCs. Available in nearly every field of study, MOOCs are hosted online and can accommodate an unlimited amount of students. They are free and open to anyone, and we recommend anyone who is unsure about investing in an online HIM course to try a MOOC first. We just created a health data analytics MOOC, one of the first of its kind. The course is self-paced and designed to be completed within eight weeks. It also earns the student American Health Information Management Association (AHIMA) professional development credits.

This March we will be offering a MOOC on SNOMED CT. The course will cover background information on the terminology, benefits of using it, challenges associated with implementing it, and some a bit more on the advanced topic of mapping SNOMED CT terms to other classification systems. The course will be taught by Rita A. Scichilone, MHSA, RHIA, CCS, CCS-P, former Senior Advisor for Global Standards at AHIMA and current Board Member for the IHTSDO, the organization that owns and maintains SNOMED CT. 

MOOCs may not be usurping traditional higher education institutions quite yet, but for those who want a taste of online education or want to gain some knowledge on the job, they are a great resource.

Evolving Educational Opportunities

Just as healthcare continues to evolve, so does education. In addition to traditional degrees, there are also industry certifications. For example, AHIMA offers a host of certifications, depending on your preferred category of professional development. If you want to stay abreast of the ICD-10 transition, you might become an Approved ICD-10 Trainer. Or, if you're interested in managing and analyzing patient health data, you could pursue a Certified Health Data Analyst credential from AHIMA.

The blistering pace of HIT reform is not going to slow anytime soon. Talented, well-educated health informatics professionals will be valued among all health organizations.

I encourage you to capitalize on this transition by seeking out continuing education courses. The health informatics community has developed wonderful resources to help us grow. We're all students in this evolving field.


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The Value of Online Self-Paced Training for ICD-10
November 20, 2013 11:52 AM by HIM Professionals

By Pam Wirth, RHIA

When it comes to ICD-10, many think the 10 months remaining until the transition deadline provides ample time to get coders fully training on the complex new code set. Not only is that unrealistic, but those that haven't already locked in their on-site training programs may find themselves out of luck.

Escalating demand is quickly creating a shortage of qualified instructors, a situation that will worsen as October 2014 draws near. One way to circumvent this shortage is to take advantage of one of a growing number of online, self-paced training programs.

Not all online programs are equal, however. The key is to find a quality program designed by qualified ICD-10 experts.

Convenience and Flexibility

Online training programs are ideal for coders whose schedules do not permit them to attend on-site training, or for facilities whose coders require training only on certain specialties. Properly designed online self-paced training programs will meet or exceed AHIMA training guidelines of 16 hours for ICD-10-CM and 24 hours for ICD-10-PCS, with an additional minimum of 10 hours practice on each classification.

The best programs will also be flexible, so courses can be tailored to meet a facility's and coder's specific training needs. This not only includes addressing learning styles- visual, verbal and written-but also enabling courses to be personalized by offering options ranging from comprehensive packages to individual and specialty specific modules. This ensures coders will receive exactly the training they need in a manner that will enhance their retention of the information.

When evaluating self-paced online training programs, make sure they are taught by AHIMA-approved ICD-10-CM/PCS instructors. Also important are supporting resources to ensure coders can attain - and maintain - ICD-10 proficiency. A must-have is direct access to instructors, most often via email with a short timeframe for responses. Other beneficial features are:

  • A robust library of practice records coded by ICD-10 experts
  • Pre- and post-training assessments to measure readiness and identify areas where more training is needed
  • A single source from which to access codebooks and terminology manuals

The best online programs will also enable coders to return to courses and access resources after they have successfully completed their training.  This is important because there will likely be a gap between when training is complete and when ICD-10 coding becomes a daily activity, particularly for coders whose facilities have not yet (or will not) implement dual ICD-9 and ICD-10 coding. If too much time elapses before coders can use what they've learned, the skills will be lost.

The Right Fit

Will your coders have the knowledge-and hands-on experience-needed to succeed in an ICD-10 coding environment? With thousands of new codes to learn, coders need education solutions that are comprehensive, convenient and easily understood.

The right online, self-paced training program will encompass all the elements listed above to ensure coders are proficient in ICD-10-which will ultimately reduce post-transition productivity declines and help ensure that facilities are prepared for all that ICD-10 will bring.

Pam Wirth, RHIA, is president of the Coding, Compliance and Quality Division of Amphion Medical Solutions (

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The State of Health Information Education in 2013
August 28, 2013 12:51 PM by HIM Professionals

By Ryan Sandefer

We recently returned from an exciting few days at the American Health Information Management Association's (AHIMA) Assembly on Education Symposium and Faculty Development Institute in Baltimore. A mouthful for sure, but it was great insight into what will be driving Health Informatics and Information Management (HIIM) over the coming academic year. The key takeaway? It's all about data, data and more data.

A New Vision For Health Information Curriculum

Much of the discussion at the AHIMA Assembly focused on how all three higher education pathways are being revised in 2013 to put ‘big data' at their heart. Associates degrees, bachelor's degrees and master's degrees have all been changed with an inherent recognition of how huge amounts of data and the analysis of that data will be at the center of every level of HIIM education.

The content domains and subdomains of all three pathways, as well as their taxonomic level, have been mapped to emerging HIIM roles. A good example of this ‘mapping' is the expansion of the domain of Data Governance (or the accuracy of data as it is collected, integrated, used and shared). As the quantity of healthcare data explodes, it is important the quality of that data is assured. Too often in the recent past, electronic medical records (EHRs) have been filled with poor data for the sake of meeting quotas. This does not help anyone and our students. The next generation of HIIM professionals need to be the torchbearers of quality over quantity.

Big Data Is The New BIG Focus

Big data will be at the heart of healthcare in the U.S. going forward, also quid pro quo big data must be at the heart of all healthcare education. HIIM curriculum will focus on data management this coming year, and 2013's students can expect to experience manipulating large data sets in the classroom.

The use of statistics, data analytics techniques, and the understanding of computer programming languages are increasingly important for HIIM students. Healthcare software systems are notorious for making it easy for individuals to enter data but extremely difficult to get it out. While electronic health records are improving in their ability to analyze data, students are now expected to know more about databases and programming.

Dipping Into Federal Data Mines

On his first day in office in 2009, President Obama signed the Memorandum on Transparency and Open Government. It was a pledge for federal departments to share large and meaningful datasets of information, and was soon followed by the launch of, a treasure-trove of big data. Today, there are thousands of great datasets available through the website, available to the public for free. It's searchable and includes a dizzying amount of healthcare data that can be downloaded and used in the classroom.

At the College of St. Scholastica this year, we're taking the data sets into the classroom and using them to teach data management and data analytics. For example, we'll use data collected from the Medicare program and asking our students to manage, analyze and manipulate that data to get a grip on what big data looks like and how it can be used to understand population health. We are also having students analyze the publically available EHR Incentive Program data (Meaningful Use attestation information). Not only is this data pertinent for understanding current federal regulation, it is also BIG data.

Expect Big Data, and Demand Big Data

If you're a student about to embark on your health information management education this year, be prepared to focus on big data sets. The clear message coming out of the AHIMA symposium was that faculty must plan classes around using data in the right place and at the right time for the best outcome. Health Information Management students are being trained to be knowledge workers, so they must be able to turn this big data into information, and ultimately knowledge.

If your classes aren't touching big data sets, you should request it. Every job in healthcare information management will involve some level of big data mining and manipulation. So ask yourself, what's the relationship between the class you're taking and data analytics? The data is all there and free to access. We just need to find the pertinent information to make it useful.

Ryan Sandefer is chair of the department of Health Informatics and Information Management, The College of St. Scholastica.

Clinical Analytics
July 16, 2013 11:08 AM by HIM Professionals

By Margaret Czart, DrPH

Historically, health insurers relied on information technology mainly to automate reimbursement procedures and crunch numbers for actuarial tables. They collected the historical claims data for a patient, while the provider collected the clinical data - two very different kinds of health information, used in very different ways by two groups with very different goals. Insurers focused on the financial aspects, while providers aimed to improve the health of their patients.

Today, payers face monumental changes in the way they use data. Increasingly, payers turn to the same kinds of clinical information systems used by hospitals to review diagnoses and treatments to monitor their costs and appropriateness. And as the healthcare industry shifts to new payment models that pay for value and outcomes rather than for volume of services, health insurers are also investing in clinical analytics to standardize health information.

Why the shift? As a provision of the Affordable Care Act (ACA), payers will no longer be able to reject consumers with pre-existing conditions. To manage their risk and control their costs, they're placing a new emphasis on health outcomes in the insured population.

They are using that data to assess patient outcomes and to determine best practices in terms of interacting with patients to improve health. For example, health insurers are now using hard data to drive initiatives with goals such as preventing hospital readmissions, managing chronic diseases more effectively, and tracking medication compliance.

As a result, health plans may soon end up with a better idea of the type of treatment a patient receives by the provider because they get a big-picture view of all provider encounters, while each specialist is likely to view only a limited subset of patient data. The evolving practice of health information exchange (HIE), still in its very earliest stages, is expected to change this, by allowing providers from one health system to "see" into another health system where a patient may have had tests, outpatient procedures, etc.

With all this clinical data now being collected and analyzed by both payers and providers, the next logical step will be for the two parties to share data in a collaborative way, to actually improve patient health and population health, rather than just for billing and reimbursement purposes. Moving forward, it only makes sense to bring data resources together for a common goal.

The idea would be for payers to not only pull data from providers to calculate payments, but to push data to clinicians and hospitals as well. By pooling all these types of patient data, both parties can gain greater insights as previously unseen trends or associations become apparent. With the right type of analytics tools, the industry can establish a kind of feedback loop that would benefit everyone: Payers channel their analytics capabilities to help providers target the patients in need of interventions, protecting their bottom line while ultimately promoting health and wellness.

For example, a physician alone may have no way to know if patients with high blood pressure are filling their prescriptions each month - but the insurer can extrapolate this from claims data. If claims data pertinent to medication compliance is shared with physicians, they can take steps to improve compliance. Perhaps the patient is experiencing troubling side effects that the physician can address - or perhaps a case manager can make a monthly reminder call or recommend a smartphone app designed for forgetful patients. While this is a very simple example of the benefits of collaboration, the possibilities are broad. With a large pool of clinical data to draw from, payers may even be able to help providers identify which treatments are truly evidence-based.

A possible scenario for provider-payer collaboration is this: A payer and provider agree upon clinical goals for improving the health of their diabetic patients. One such goal might be to move from episodic care to continuous care, as a way to prevent diabetic complications from developing. The provider then uses clinical analytics tools in conjunction with the EHR to identify all diabetic or potentially diabetic patients in the practice. These patients receive an evidence-based care plan that includes regular screenings, patient education, etc. The payer uses analytics to support the physician, acting almost like a member of the care team. Both parties collaborate on financial compensation as well - perhaps agreeing that physicians will receive a bundled payment to care for a defined diabetic population and are allowed to allocate the money as they see fit.

In this way, the goals of healthcare providers and healthcare insurers have become more closely aligned to collect and leverage clinical data in ways that can enhance care delivery, manage costs, maximize patient safety, and ultimately improve the health of a whole population.

The role of education in this new landscape

It seems certain that HIM HCI, HIT and professionals from other related fields will need to be flexible and adaptable in this changing environment. As the goals for managing clinical data change, so will the roles of HI staff. Managing patient records will very likely evolve from a task-oriented role to one that requires skills such as analytical thinking, process design, change management, and project management. Health informatics professionals also may  be called upon to support providers, payers, and administrators as they implement clinical and financial applications related to the medical record and employ predictive analytics. They will need continuing education to build and maintain these skills, as the impact of technology on healthcare industry increases.

Industry trade groups  such as the Health Information & Management Systems Society are gearing up with expanded programs for professional development. Advanced degree programs are also putting a spotlight on analytics - not just on the technical skills needed, but on the business applications that are specific to healthcare, as colleges and universities respond to the industry's changing needs. These master's level education programs can provide both future and current HIM professionals with the skills they need to qualify for emerging job roles.

Margaret Czart holds the post of assistant professor of health care informatics at American Sentinel University.  


Students: Enhance Your Prospects by Becoming an Inter-departmental Expert
June 20, 2013 11:38 AM by HIM Professionals

By Ryan Sandefer, chair of the department of health informatics and information management, The College of St. Scholastica, Duluth, Minn.

One of the most important aspects of the modern health information revolution is the ability to connect and share data across healthcare disciplines. Healthcare decision-making needs good information, and that has to come from multiple departments - the provider, the nurse, the specialist, the therapist, and the assistant. This is why any health information professional needs to be an inter-professional expert. Demonstrable experience in this area will enhance your job prospects.

Inter-professional Data Key to Success
As care providers switch to the Accountable Care model, they must access diverse information to make sure care is administered efficiently, and data exchange will be a prerequisite for success. Using a EHR, a physician or nurse is able to download hospital discharge summaries, see a record of emergency department visits, and access medication lists. Practices also use their EHRs to initiate lab orders, view results, and prescribe medications and therapy.

The hub of this data management, the health information specialist, has to have a good grasp on how each department manages and handles data.

This inter-professional ability needs to be nurtured in the classroom. Luckily, for many health information students, there are many opportunities where you can work with and engage various healthcare professionals, whether on campus or in the local community.

Students Working with Professionals
The College of St. Scholastica just wrapped up a project that allowed our health information management students to work with its college's occupational therapy and physical therapy clinics on issues of data privacy and security.

The students were able to walk through the clinics' daily practice and assess their physical, technical, and administrative safeguards for patients' data privacy and security. This helped the students learn how OT and PT professionals document patient data. They were able to discuss their findings with the practice, which helped the clinics better safeguard protected health information. It was a win-win for our students and for the clinics.

We also recently completed a projected focused on the use of personal health records (PHR) by vulnerable populations. The project was in collaboration with our social work department. Students worked with practicing health professionals across the healthcare spectrum - HIM, social work, nurses, and physicians.

The students developed and implemented systems that allowed PHRs to be populated for patients with developmental disabilities. This population has a high rate of ER visits, so it's useful information for providers and can help them triage patients appropriately.

How You Can Become an Inter-professional Expert
If you want to become an inter-departmental expert, many opportunities exist on campus and in your community. The key is to make the right connections.

  • Volunteering: Find community projects in your campus' city. Speak to your campus affairs or careers office about what is going on in your healthcare community. Alumni relations also may be able to connect you with professionals working in the local community.
  • Faculty mentoring: Your department's faculty or other department's faculty should be more than happy to discuss potential research projects such as those detailed above.
  • Funding: You might be surprised to find that there student research dollars are available to develop healthcare and community projects. Again, speak to your faculty members, or just Google it.
  • Bridge departments: Suggest ways in which your health information department can work with other campus departments. For example, we have organization called SSHIP. It's a student-run organization with faculty reps that strive to bring different departments together. They run networking events, dinners, and social events where different students and faculty can talk, collaborate and identify needs, and develop projects through the year. It allows students to better understand what other professionals do, and it shows us how curricula can be developed to incorporate other disciplines.

The future of health information will rely on smart professionals understanding every part of the healthcare system. Students who can show employers that they have experience working with different professionals will be the future leaders of our industry.