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Appendix A

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Appendix A A Vision from the e-HIM Future: A Report from the AHIMA e-HIM Task Force

Executive Summary
Electronic health information management (e-HIM) is one of the American Health Information Management Association’s (AHIMA’s) major strategic focuses for 2003 and beyond. Its goals are to:1 • • • Promote the migration from paper to an electronic health information infrastructure Reinvent how institutional and personal health information and records are managed Deliver measurable cost and quality results from improved information management

As AHIMA celebrates its 75th anniversary as the association representing the profession of health information management (HIM), e-HIM looks ahead to and embraces the real benefits that will accrue when healthcare comes fully into the information age. In early 2003, AHIMA appointed a special task force to participate in a 1-day meeting to articulate visions to guide the e-HIM initiative. The task force consisted of recognized experts with extensive experience in healthcare, HIM, academics, information systems and technology, and government. The goals of the meeting were to: • Identify the factors influencing healthcare industry trends and developments including the future state of HIM

Please note that the following report was published as a supplement to the September 2003 issue of the Journal of the American Health Information Management Association.

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Develop a vision statement describing the future state with a description of corresponding HIM roles Develop an action plan and approach to achieve the vision

This report documents the task force meeting, summarizes the discussions, and presents recommendations.

Health Information 2010 Statement
The task force confirmed that the healthcare industry is in crisis and faces increasingly difficult questions related to financing, including cost control, coverage, and benefits. Problems in the areas of patient safety, efficiency, public health, health promotion, and equity are now well documented. There is a growing public-private consensus that a modern information infrastructure for health is needed to successfully meet these and other challenges. The task force discussed trends from a number of perspectives and viewpoints and formulated the succinct vision of health information in 2010:

The future state of health information is electronic, patient-centered, comprehensive, longitudinal, accessible, and credible.

Vision Statement for Health Information Management Practice
Next, the task force considered HIM practice in 2010 in the context of the envisioned health information environment. HIM professionals manage individual and aggregate patient and healthcare data and information resources in all types of healthcare organizations.1 The HIM field was established in 1928 to elevate the standards of clinical records to improve patient care. While this remains the central focus, HIM professionals now serve in a broad range of roles throughout healthcare that involve planning, organizing, and managing clinical information resources-content, integrity, accessibility, use, and protection. The e-HIM initiative signals the need to advance HIM practice to fully utilize standardsbased technology and adopt best practices. The importance and expectation of having better ways and means to understand, organize, and analyze health data will increase as the automation of health information continues. The healthcare industry’s ability to manage information and to easily access and use best practice and clinical data will be vital to successfully controlling healthcare costs while improving productivity and health outcomes. Enhanced HIM is also essential to meeting the requirements for a patient-centered health information system, for longitudinal e-records, for research and population health, and for public health preparedness. In this time of rapid change, HIM professionals must continuously transform their knowledge, skills, and abilities to keep pace. They must also continue to apply the core fundamental functions of HIM to ensure quality health information for all healthcare settings and organizations that create and use it. These core HIM functions do not disappear when healthcare moves further into the information age. In fact, they become more critical.2

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Based on task force discussions, comments, and suggestions, the following HIM vision statement has been developed:

Health information management is the body of knowledge and practice that assures the availability of health information to facilitate real-time healthcare delivery and critical health-related decision making for multiple purposes across diverse organizations, settings, and disciplines.

Recommendations for Action Items
To achieve the health information and HIM 2010 visions, the task force identified several action items for AHIMA: • • • • • • • • Lead a consortium of groups and organizations in influencing national efforts to move toward e-HIM. Take steps to expand the visibility of AHIMA, its members, and health information management to the general public and within the healthcare industry. Enhance efforts to increase the understanding of the value and benefits of HIM and the HIM profession. Fund efforts to establish the business case for solid and sound e-HIM practice. Develop and widely disseminate best practices related specifically to e-HIM. Design and implement innovative strategies to attract qualified candidates to the field of HIM from new market segments. Accelerate plans and activities to implement changes in health information management training, education, and curriculum. Establish periodic recertification, focused continuing education (CE) requirements, and tiered certification for AHIMA members to document their skills and continued education in e-HIM areas. Develop and implement programs to better prepare and train HIM professionals to pursue leadership roles in current and future areas of health information management. Establish interim milestones in the achievement of the health information and HIM visions and track progress toward goals. Expand grants and awards programs to further efforts in establishing innovative e-HIM practice or policy.



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Conclusion
The e-HIM initiative encompasses a wide range of crosscutting issues related to ensuring that health information is available whenever, wherever, and however it is needed. Accurate information is increasingly critical to address the diverse and complex issues currently facing the industry, including those related to disease and injury prevention and treatment, environmental health, and public health research and surveillance. AHIMA must continue to assume a leadership role in ensuring the availability of credible, accessible, and meaningful health data. AHIMA and its members currently play a key role in managing health information for patient care and various types of decision making. Enhanced health information management will help ensure greater efficiency and effectiveness throughout the healthcare industry. AHIMA must accelerate efforts to further the transformation of HIM. AHIMA and its members must quickly execute and adopt innovations in e-HIM to ensure the competencies of current and prospective HIM professionals. AHIMA has a crucial and pivotal role to play in continuing to help the industry address its current and future collective and diverse health information needs to sustain and improve the healthcare system.

Introduction
Background
One of AHIMA’s goals is to help members prepare and meet the continuing challenges and opportunities of the evolving healthcare industry and marketplace. Launched in late 2002, AHIMA’s electronic health information management (e-HIM) initiative is one of the Association’s major strategic focuses for 2003 and 2004. The initiative aims to reinvent the management of health records and information—specifically through accelerating the migration from paper to an electronic health information infrastructure. The resulting improvements in information management should result in measurable cost and quality improvements throughout the healthcare system, and, ultimately, better patient care. The e-HIM initiative builds on prior AHIMA efforts such as Vision 2006 and the e-health expedition. These activities identified changes in HIM practice and related evolving roles for HIM professionals. They also reflect the Association’s commitment to building an evolving professional definition in light of changes in the industry. Currently, several factors continue to greatly affect HIM practice. These include continued movement away from a focus on acute care to a focus on integrated care delivery along a continuum of care; increased and changing government regulations and legislation; continued deployment of electronic health record systems; new evolving public health and surveillance initiatives; and an emerging focus on patient-centered information management. The e-HIM initiative requires consideration of all these forces. It also requires a vision. AHIMA’s goal is to articulate a vision of the future state of HIM, outline roles that HIM professional will play, and discuss the strategic plan for transitioning existing HIM functions into the e-HIM future.

The e-HIM Task Force and Its Charge
In early 2003, AHIMA appointed a special e-HIM task force. The group consists of recognized experts with extensive experience in HIM, academics, information technology, and

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government. Task force members represent a great breadth, depth, and diversity of experience and knowledge of the current healthcare environment. The group also included one AHIMA Board of Directors liaison and three AHIMA staff members. The task force was asked to: • • • Identify the factors influencing healthcare industry trends and developments including the future state of HIM Develop a vision statement describing the future state with a description of corresponding HIM roles Develop an action plan and approach to achieve the vision

Contents of this Report
This report summarizes the deliberations of the task force, offers an evaluation of current industry forces, and describes a vision of healthcare in the future and related roles for HIM professionals. It also offers several recommendations for AHIMA to consider and highlights that the timeline for implementation is critical. For the e-HIM initiative to be successful, AHIMA’s vision and plans in this area need to be shared, disseminated, and recognized at all levels within the membership and throughout healthcare industry. This report is the first step.

Methodology
The e-HIM task force participants convened on March 10, 2003. The agenda was designed to encourage productive dialogue among participants. To this end, the group discussed the evolution of the e-HIM initiative in the context of prior and ongoing AHIMA strategic initiatives such as the coding futures task force, the e-health task force, work force assessment research, and analysis of issues in academic HIM education. • The coding futures task force studied the likely futures in the domain of coding practice. Its findings were reported in the January 2000 Journal of AHIMA article “A Crystal Ball for Coding.” The e-health task force explored new roles for HIM professionals in e-health. Its work resulted in “AHIMA’s Recommendations to Ensure Privacy and Quality of Personal Health Information on the Internet,” and “Report on the Roles and Functions of E-health Information Management.” AHIMA’s work force study is a major research initiative that aims to help assess future directions of the HIM work force. Numerous reports resulting from the study began to emerge in late 2002 and will continue to be published. AHIMA’s 1999 “White Paper on the Health and Well-being of Professional Education in the Health Information Management Discipline,” challenged the academic community to accelerate curriculum reform to better prepare graduates for new roles in the electronic practice environment.







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The general brainstorming sessions focused on the driving forces in the healthcare, information management, and technology industries that affect the future state of health information and HIM professionals’ roles. The group sought to confirm the relevance of the HIM profession in this future context. To propel the discussions, participants were provided with discussion questions and a preliminary list of general forces affecting healthcare. Following the general brainstorming on driving forces, the task force continued its discussions in three work groups to develop a vision of the future state of health information and appropriate roles for the HIM professional. The task force as a whole then reviewed each working group’s deliberations and ultimately reached general consensus on the future state of HIM and the future roles of HIM professionals. The group then identified priorities requiring AHIMA’s attention and made recommendations for action items. Task force discussions focused on three areas: • • • Factors affecting the future state of HIM HIM practice Future roles of HIM professionals

Each of these is summarized in the discussion on the following pages.

Key Findings
Factors Affecting the Future State of HIM
An Industry Buffeted by External Forces

Changes caused by patient demographics, spiraling costs, and advancements in technology present substantial challenges to the healthcare industry. Although information cannot solve all these problems, better and more efficient use of information promises to make the system more effective. Finding a way to fulfill that promise is the current challenge. First, it is necessary to consider the external forces that affect HIM. These include: Economic factors: The growing number of uninsured and underinsured consumers presents a problem. In addition, providers and consumers continue to face increasingly complex and frequently changing healthcare financing and payment policies. Demographic changes: The patient population is older and more mobile. Patients are diagnosed earlier, as a result of improved diagnostics, and treated longer. They’re more dispersed, moving from traditional inpatient facility care to other outpatient-based care, thanks to pharmaceutical, biotechnical, treatment, and medical device breakthroughs and developments that dramatically alter how and where care is delivered. They’re also becoming “sicker” as a consequence of living longer but with multiple chronic conditions. Need for standards: Government mandates, such as those required by HIPAA, have wide-ranging implications for the industry. However, the industry lacks health information standards, uniform and consistent coding and classification systems, and uniform protocols for information systems. The result is an increasingly complex industry. Where standards have emerged in health data reporting (coding and classification systems, and claim forms)

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and in technology (Internet and Web protocols), they have stimulated linkages and diverse uses of information among providers, consumers, and payers. Technology: Continued investment in computing resources has resulted in diverse deployment of technology. Technology has become more complex, pervasive, and interlinked, enabling more sophisticated exploitation of information. This, in turn, highlights the need for better and enhanced information management policies, practices, and procedures and more uniform information content and messaging standards. Workforce concerns: The HIM profession, like nursing and other healthcare professions, faces a work force shortage, particularly in traditional practice settings. At the same time, many health and allied health training programs, including HIM programs, face challenges in funding and in attracting and recruiting qualified students. Consumer awareness: Many patients and caregivers seek to be better informed about their treatment and want to know more about their care, their health information, and the qualifications and competencies of their health providers. With high-profile media coverage of security breaches and publicity related to the implementation of the HIPAA privacy regulation, consumers are also concerned about their health information privacy, confidentiality, and security. Media coverage also has brought issues such as patient safety to the forefront. Public health: There has been an accelerated and heightened awareness of changing public health imperatives such as the need for biodefense and terrorism preparedness, including disease surveillance initiatives. There are growing challenges to identify and solve community and global health problems. The movement toward a national health information infrastructure promises a significant change in the landscape. Other factors: There are still other factors affecting information management that are likely to have impact in the future. These include the ongoing malpractice insurance dilemma, continued efforts to develop and use evidenced-based clinical practice guidelines, and, of course, increased interest and activity in genetic research.
An Information-driven Industry

Data is critical to the healthcare industry today. Sound, accurate, available, and reliable data is the foundation of many decisions at many levels. Of primary importance is the need for data to improve patient care. Providers need data in order to treat their patients and to choose among treatments. On the administrative side, payers require data to verify eligibility for treatment and determine medical necessity for care. Scientists, practitioners, and researchers need data for various initiatives such as outcomes measurements, patient care effectiveness, risk assessment, and susceptibility and environmental exposure studies. Regulators and policymakers need data to make prudent and cost-effective decisions to ensure public health and to ensure the availability of healthcare services. Technology and innovation promise much in this environment, particularly in the collection, processing, and accessing of health information. Advancements such as voice recognition, the maturity of the Internet, introduction and deployment of wireless and handheld devices, improvements in imaging techniques and technologies, and voice data capture are all powerful tools. Similarly, the evolution of the electronic health record continues to move the industry—and HIM—forward.

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Technology Alone Is Not the Answer

Despite technological advancements, the information that clinicians, consumers, policymakers, and researchers have to work with is fragmented, disjointed, and often inaccurate. There are industrywide efforts to address this ongoing fragmentation and lack of coordination, and many organizations are working to improve the quality and performance of healthcare delivery through standards-based information systems. In a data-driven system, HIM professionals will continue to play a central and leading role. The most efficient way to make data available to its many users in a timely manner is through automation. Providers have long recognized the need to maximize the effectiveness of healthcare delivery through the use of automated systems. Nevertheless, the industry remains in a state of flux. Providers are at different levels of automation and satisfaction with existing systems. Meanwhile, the ever-expanding variety of provider settings makes the need to make information available across a diverse spectrum of care more urgent. And the question of “who pays for this?” remains unanswered. Some task force participants believed that in the absence of high-level federal direction in the form of guidelines and incentives, the healthcare industry would not voluntarily attain consensus on all standards needed to reach the e-HIM future. Other participants questioned the role of government in developing national standards, regulating their implementation or setting deadlines for the implementation of the fully paperless electronic health record system. While this issue was debatable, it was acknowledged that in the foreseeable future, the industry is unlikely to see guidelines on the scope of the HIPAA regulations again. The e-HIM future will require superior data content, accuracy, and validity. The ongoing implementation of the electronic health record will help providers make important decisions about healthcare. Those decisions will rely on secure access to clear, concise, accurate, and easy-to-understand information about people who present with increasingly complex and highly dynamic circumstances.
Information Management Is Critical

In the future, the industry will continue to need to collect, link, and maintain increasingly larger and more disparate volumes of data. But it also will need to move beyond these activities and turn data into information and knowledge. The ability to organize the information includes being able to determine who needs what information, when, and where; how information is defined; how information accuracy and consistency is verified; and how information is explained. In addition, the need for more and better data requires a concentrated movement toward processes that place value on how the data is defined, understood, analyzed, and interpreted. The task force emphasized that the ability of the healthcare industry to successfully migrate to the e-HIM future will be greatly enhanced by transformations in HIM practice.

Health Information Vision 2010 Statement
The task force confirmed that the healthcare industry is in crisis and faces increasingly difficult questions related to coverage, benefits, and financing. Sound, timely, and accessible health information is needed to successfully answer these and other questions, while

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making the healthcare system more efficient. The task force discussed several perspectives and viewpoints on the vision of health information in 2010. The group concluded that additional efforts are needed to transcend the current practice of HIM in light of expected technological changes in clinical and technical operations. The healthcare industry faces challenges that are complex and multifaceted, but HIM primarily focuses on a single entity—the consumer. Based on task force discussions, comments, and suggestions, the following health information vision statement has been developed:

The future state of health information is electronic, consumer-centered, comprehensive, longitudinal, accessible, and credible.

Data across all points and places of service and types of encounters will be collected, linked, and organized around a unique personal identifier. Users will have ready access to health information whenever and wherever health data is needed. Health information will be comprised of multiple forms of media, including data, images, voice, or text from various and diverse sources. Health information collection will span the individual’s life and allow for comprehensive views of illness, health promotion and wellness, and disease and injury prevention activities. Health information will be used concurrently for multiple and diverse purposes, including healthcare delivery and treatment, outcomes measurement, finance, and support of health services and policy research, clinical trials, and disease prevention and surveillance at the individual, community, national, and international levels. It will be difficult to attain the future vision if investments are made only in technology. Equal or greater attention must be paid to the management of data contained within the electronic technologies. The task force noted that in this future state, data sharing and exchange would not be constrained by vendor-specific technology requirements. Further, the vision assumes the establishment and implementation of uniform health data standards and data conceptual models that allow for connectivity of appropriate systems across vendor platforms and applications. Additionally, the vision implies that health information will be exchanged only in accordance with appropriate security, privacy and confidentiality rules, regulations, and requirements. HIM professionals will lead and mobilize support for ongoing and sustained improvement to current practices, processes, and procedures.

Vision Statement for Health Information Management Practice
The task force worked to envision HIM practice in 2010. As the automation of health information continues, the importance and expectation of having better ways and means to understand, organize, and analyze health data will increase. The healthcare industry’s ability to manage information and to easily access and use best practice and clinical data is key to successfully controlling healthcare costs and improving health outcomes. Based

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on task force discussions, comments, and suggestions, the following HIM vision statement has been developed:

Health information management is the body of knowledge and practice that ensures the availability of health information to facilitate real-time healthcare delivery and critical health related decision-making for multiple purposes across diverse organizations, settings, and disciplines.

Health information management will involve the ongoing collection, analysis, and processing of information and its appropriate dissemination in a timely manner throughout a person’s lifetime across various sites of service and care. HIM professionals will work collaboratively with information technology (IT) professionals in the acquisition and deployment of technology. HIM professionals also will have crucial leadership roles in data and information resources management. They will have major roles in diffusing technology across organizations and disciplines. As members of integrated healthcare teams, HIM professionals will serve as information conduits between the diverse clinical, financial, and IT users within their organizations and outside as information “bridges” between providers and consumers. HIM professionals will also work as information brokers by ensuring timely and accurate sharing, transferring, and interpreting of health information among healthcare disciplines and organizations and across sites of service.

Future Roles and Competencies of HIM Professionals
The growing accessibility of technologies such as the Internet and the enhanced performance of Web browser-based software for data accessibility and analysis have placed more health information in the hands of consumers. The deployment of technologies such as wireless and handheld devices has placed more timely data in the hands of clinicians. HIPAA has paved the way for industry implementation of clinical data and transmission standards as well as consistency in security, privacy, and confidentiality standards. HIM professionals will increasingly function as conduits of health information and will interpret how data will be used. HIM practice will be integral to the continuum of healthcare and decision making processes. HIM professionals will have these roles: • • • • • • Business process engineer Clinical research protocol designer and manager Clinical trials manager Clinical vocabulary manager Consumer advocate Data analyst

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Data facilitator Data/information broker Data/information presenter Data sets, nomenclature, and classification standards developer Data miner Data navigator Data quality and integrity monitor Data resource manager Data security, privacy, and confidentiality manager Data translator Information system designer Work and data flow analyst

The HIM professional will have competencies in these areas: • • • • • • • Establishing and guiding national, local, and state health information policy development and implementation Establishing and implementing policies, practices, and procedures governing all aspects of HIM Establishing and implementing standards for privacy, security, and confidentiality of health information Establishing and implementing policies and standards for monitoring of data integrity, accuracy, validity, authenticity, and version control Developing health information format and content standards to ensure the collection of complete, accurate, timely, and compliant health information Facilitating communication of health information across organizational healthcare teams and between different entities Facilitating the concurrent use of health information for multiple purposes (such as for direct patient care, outcomes measurement and evaluation, wellness and prevention, research, public health and policy development) Managing compliance, regulatory, accreditation, licensure, and (re)certification programs and activities Analyzing and synthesizing qualitative and quantitative health information for various and diverse needs and audiences Developing, designing, and implementing clinical vocabularies

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• • • • • •

Translating and interpreting health information for consumers and their caregivers Helping consumers to access and obtain diverse and often complex health information Informing and educating consumers about health information issues Providing the context to understand, analyze, and interpret health information Helping providers understand data flow and reporting requirements within the context of dynamic rules, regulations, and guidelines Leading business process redesign efforts

Action Item: Lead a consortium of groups and organizations in influencing national efforts to move toward e-HIM.

Recommendations for Action Items
Health information management will involve the multifaceted flow of data across multiple entities involving various and diverse automated processes and systems. To achieve the health information and HIM visions of 2010, the task force identified several action items for AHIMA: AHIMA should continue to advance the improved management of health information through industry partnerships and collaboration in areas such as data and communications standards, clinical vocabularies and content, nomenclature, coding and classification, and regulatory compliance. AHIMA and its members are well positioned with the requisite knowledge, skills, and abilities to provide this leadership. In addition, the current framework of HIM practices, training, and education provides the solid foundation upon which to transform to the future vision of HIM. It is not clear whether the future state of health information can or will be achieved without government intervention in the form of guidelines, regulations, or legislation. Nevertheless, with or without a government mandate (to overcome logistical and technical barriers so that various brands of devices and operating systems can communicate), AHIMA should take a stronger and more visible leadership role in ensuring the achievement of the visions of 2010.

Action Item: Expand the visibility of AHIMA and health information management to the general public and within the healthcare industry to enhance the understanding of the value and benefits of HIM and the HIM profession.

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AHIMA should enhance efforts to increase the recognition and value of HIM and the profession beyond AHIMA members. AHIMA must demonstrate that the continued viability of the healthcare system requires better management of health information. AHIMA should also undertake a “popular” marketing and communications campaign aimed directly at the healthcare consumer. For instance, HIM professionals should emphasize how they can help consumers better understand their health information and manage their own personal health records. HIM professionals can also highlight their roles in assisting consumers navigate the complex and often confusing processes for claims payment, understand how to access health information, and assure the security of consumers’ health information.

Action Item: Fund efforts to establish the business case for solid and sound e-HIM practice.

AHIMA should develop the business case depicting the economic benefits of the future health information vision. HIM professionals need to be further convinced to advance HIM practices. Tools and techniques supporting the rationale to transform to e-HIM are needed. AHIMA should also identify prominent HIM champions to help propel the vision and get commitment from within and beyond the membership. AHIMA members need to be mobilized to facilitate e-HIM.

Action Item: Develop and widely disseminate best practices related specifically to e-HIM.

AHIMA must take steps to convince HIM professionals to abandon some of the more outmoded but deeply ingrained practices of the past. Paper-based and manually driven data collection and related HIM practices and approaches should be discouraged. HIM professionals must be willing and able to manage health information and advance the profession in the face of constant and significant change. HIM practice needs to continually evolve in response to new and revised initiatives. Best practices in the following areas should be developed and disseminated throughout the healthcare industry: • • Achieving productivity improvements and greater efficiencies with the implementation of e-HIM practices Collecting and managing integrated clinical, demographic, environmental, and health and wellness data in the support of care delivery, research, and/or public health activities

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• • • • • •

Collecting and managing longitudinal health information that spans an individual’s lifetime Planning and implementing procedures, policies, and processes that meet the information needs of diverse and multiple providers and consumers Facilitating coordination across organizations, departments, and/or agencies to improve health information communications Managing health information in an electronic and paperless environment Assessing and analyzing organizational data in comparison to national aggregate data Facilitating the transfer of health information from clinical care delivery information systems to public and environmental health data reporting and surveillance systems Developing data sets and data definitions for specific health information applications Working directly with consumers (patients and their care-givers) to help them understand their health information Contributing to the monitoring and preventing of medical errors Facilitating and actively participating in the collection of health information needed for research, clinical trials, and public health reporting as a byproduct of patient care data Designing, developing, and evaluating systems beyond the clinical setting Implementing business process redesign methodologies

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Action Item: Design and implement innovative strategies to attract qualified candidates to the field of HIM from new market segments.

There is a sense of urgency in the area of work force adequacy and preparedness. HIM career opportunities must be made more attractive to future students. The need for accelerated recruitment and training of HIM professionals in order to meet future industry needs is clearly a priority. Ongoing workforce recruitment and retention, even in the face of a growing healthcare economic sector, is a major obstacle. Thus, more expansive, creative, and comprehensive approaches to potential student recruitment are vital. The HIM profession should be marketed to at least two different groups of potential candidates: current younger students (elementary, middle, and high school) and

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the more mature candidate (those reentering the workforce or changing professions). AHIMA should expand its efforts to align educational programs with other disciplines, such as information technology, health administration, and management engineering to attract candidates with diverse skills and capabilities. Additional student recruitment and marketing should be directed toward other related fields, such as statistics and process engineering.

Action Item: Accelerate plans and activities to implement changes in health information management training, education, and curriculum.

Education, training, and continuing education programs should be quickly revised and updated so that HIM professionals are more fully prepared to apply their knowledge, skills, and expertise in increasingly diverse settings and organizations in the future state of e-HIM. In particular, education programs need to immediately emphasize current and growing requirements for competencies in project management, change management, and communication skills. Closer alignment of education and training programs with those of other related disciplines (such as process engineering) would overcome some current barriers and obstacles. Training programs need to prepare graduates to assume increasingly diverse roles and responsibilities in settings beyond those of current types of provider organizations (such as in public health and research), and across and between settings and communities. As an incentive for education programs to update their curriculum, AHIMA should link school accreditation requirements to e-HIM program initiatives.

Action Item: Establish periodic recertification, focused continuing education (CE) requirements, and tiered certification for AHIMA members to document their skills and continued education in e-HIM areas.

AHIMA must continue to take steps to prepare current HIM professionals to embrace and implement the 2010 visions. HIM professionals must “modernize” their skills and competencies to maintain and (re)certify their credentials. HIM professionals need to be trained and retrained in core e-HIM competencies. Periodic recertification should be explored, particularly in areas of critical importance. Ongoing training and certification in e-HIM is a necessary means of staying current. AHIMA needs to develop competencies related to the health information and HIM visions. HIM professionals need to document proficiency in these new competencies. AHIMA needs to design and develop continuing

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education products and (re)certification programs to increase members’ abilities to achieve the visions of 2010.

Action Item: Develop and implement programs to better prepare and train HIM professionals to pursue leadership roles in current and future areas of health information management.

AHIMA needs to prepare its members to assume new roles and functions. The healthcare market is increasingly global. Patients seek and obtain care from multiple providers across state and country lines and over long time periods. Employers and vendors increasingly consider the global community as the marketplace. Thus, the practice of HIM must continue to expand. Future HIM professionals need to have skills in increasingly complex and diverse areas. These areas include data integration, privacy and security enhancing capabilities, methods of encryption and deidentification, data analysis tools and techniques, data presentation and visualization, development, enhancement, and maintenance of clinical vocabularies, ways to use health data and data sets to support healthcare quality, outcomes and effectiveness monitoring, public health surveillance and population health risk assessment, compliance requirements, integration of data across multiple data sources, and linkages between various health data sets. HIM professionals currently possess a wide range of diverse skills and experience. HIM professionals need to leverage their unique blend of technical and functional expertise to assume new e-HIM roles and responsibilities.

Action Item: Establish interim milestones in the achievement of the health information and HIM visions and track progress toward goals.

AHIMA should develop and implement an e-HIM project plan that includes both short-term (the next 2 to 3 years) and long-term (in 3 to 5 years) milestones. Critical to the attainment of the visions of 2010 is the establishing and adhering to project milestones and dates; successfully managing and deploying several tasks and activities simultaneously; communicating both inside and outside AHIMA; having flexibility to adapt to changes in milestones or dates. The plan needs to be flexible and dynamic and include interim milestones to allow for enhancements or adjustments as warranted.

Action Item: Expand grants and awards programs to further efforts in establishing innovative e-HIM practice or policy.

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Grants and awards should be established to encourage innovation, leadership, and excellence in e-HIM. AHIMA should establish specific mechanisms for recognition in e-HIM topics. Areas for recognition include developing new strategies for e-HIM policy improvement, recognizing exemplary practices, and highlighting contributions to the HIM industry. Grants and awards can be awarded to support new ideas or strategies that have not yet been implemented or for exemplary practices that demonstrate results (better healthcare or decision making through improved health information management). Recognition could be given to AHIMA members and to other individuals or organizations for activities such as initiating new or revised legislation, regulations, or guidelines, or successfully leading partnerships toward achievement of e-HIM.

Conclusion
The e-HIM initiative encompasses a wide range of crosscutting issues related to ensuring that actionable health information is available when and where it is needed. AHIMA and its members play a key role in managing health information for direct patient care and diverse types of decision making. AHIMA must continue to assume a leadership role in ensuring the availability of essential and accessible health information. Enhanced health information management will help ensure greater efficiency and effectiveness in healthcare delivery, policy, and research. Technology is certainly transforming the way healthcare is delivered, managed, and assessed, with a continued shift from records management to data management. The healthcare industry faces dynamic regulatory and legislative requirements, ongoing program safeguard initiatives, and evolving payment systems and related coverage issues. Converging interests in using information technology to increase quality of care and improve documentation of services while also reducing costs and making the delivery system more cost effective and efficient is evident. At the same time, there is heightened interest in requirements for HIPAA implementation and more national attention on issues related to clinical safety, medical effectiveness, epidemiology, and biosurveillance. In addition, there is a current and growing recognition of the shortage of a skilled and trained workforce. The healthcare industry needs a competent HIM workforce that is prepared to successfully manage health records, data, and information in this increasingly electronic environment. The continued availability and further development of this future workforce includes revising training, curriculum, and specialty certifications. AHIMA must accelerate efforts to further the transformation of health information management. AHIMA and its members must quickly execute and adopt innovations through its e-HIM initiative to ensure the competencies of current and prospective HIM professionals. AHIMA has a crucial and pivotal role to play in helping the industry address its current and future health information needs to sustain and improve quality healthcare.

Notes
1. AHIMA 1999 and 2000 Committees on Professional Development. “Health Information Management: Professional Definition.” Journal of AHIMA 72, no. 4 (2001). 2. “Position Statement on the HIM Work Force.” Journal of AHIMA 73, no. 9 (2002). Core HIM functions include managing records, data, and databases; protecting and securing confidential information; developing and managing data integrity systems and processes; and ensuring compliance with information regulations and laws.

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Appendix A
Discussion Questions
Key Forces Influencing the Future State of HIM and HIM Roles and Practice in This Future State 1. What are the forces affecting the future state of HIM? How is the future state of HIM affected by: a. Regulations and legislation b. Changes to the provision and financing of healthcare delivery c. Economic and political issues d. New or revised public health surveillance and reporting programs e. Consumers’ increasing access to health information f. Issues related to ethics, privacy, security, and ownership of health information g. Variation in healthcare delivery settings h. Other? 2. How are technologies affecting the future state of HIM? To what extent are current and emerging technologies affecting how and what functions are performed? How are current and emerging technologies affecting the workers performing these functions? How is the variability of specific healthcare settings affecting the deployment of current and emerging technologies? What does the future state of HIM look like? How diverse or homogeneous is this future state of HIM? How will these forces and technologies impact HIM roles and functions? How variable will this impact be across various healthcare settings? Which aspects of the current HIM professional definition are relevant in the future state of HIM? To what extent are the current functions suitable for adaptation to the future HIM state? How will HIM roles and practice be affected by changes in healthcare delivery and information technology?

3.

4.

How to Implement the Future State of HIM (The Vision) 1. 2. 3. How can we implement the future vision of HIM? What role should the HIM industry play in this implementation? What role should AHIMA play? What are reasonable and practical next steps to take to implement the e-HIM vision? Short-term (in the next 2 to 3 years)? Long-term (in the next 5 to 7 years)? What are the priority areas to address? What are likely barriers and obstacles to these areas? What are potential solutions to overcoming these barriers?

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4.

What aspects of the current HIM professional definition are relevant in the future state? Given the current HIM professional definition, how might HIM roles and practices be revised? To what extent should we consider the diversity of specific healthcare or workplace settings? How should personnel be prepared to effectively and efficiently perform in an increasingly electronic environment? What skills and knowledge are required? What academic and other training is needed? How should we deal with current and projected work force shortages and changes?

5.

Appendix B
General Health Industry Forces 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Federal, state, and local budget deficits Prospect of war Continued effects of globalization An aging population Medical science and technological breakthroughs Role of telemedicine initiatives Continued efforts to develop and use evidence-based clinical practice guidelines Increasingly complex and frequently changing healthcare financing and payment options Increased numbers of uninsured and underinsured Issues related to quality of care, clinical safety, and adverse events Medical malpractice costs and related issues Implementation of HIPAA Growing awareness of health information privacy, confidentiality, and security concerns More integrated and interconnected electronic health information infrastructure More uniform information content and messaging standards Continued and growing regulations and compliance issues Changing public health imperatives Need for biodefense and terrorism preparedness Need for disease surveillance initiatives Growing awareness and concerns about public health issues such as biopreparedness

20

Appendix A

21. 22. 23.

Increased interest and activity in the genome movement and related genetic research and interventions Growth in commercial medical databases Increased and diverse deployment of computing technology

Work Force Issues 1. 2. 3. Shortage of nurses and other caregivers Growing shortage of health information workers Increased need for public health workers trained in detection, response, and treatment

Appendix C
Selected References and Resources
Agency for Healthcare Research and Quality. “Bioterrorism Preparedness and Response: Use of Information Technologies and Decision Support Systems.” Summary, Evidence Report/Technology Assessment: Number 59. Rockville, MD: July 2002. Agency for Healthcare Research and Quality. “Patient Safety Reporting Systems and Research in HHS.” Fact Sheet. Rockville, MD: April 2001. AHIMA Advantage e-Alert 5, no. 5, 2003. AHIMA. “e-HIM. Electronic Health Information Management.” 2002. AHIMA. Evolving HIM Careers: Seven Roles for the Future. Chicago, IL: American Health Information Management Association, 1999. AHIMA. “Final Report: Coding Futures Task Force: A Study of the Convergence of Factors Impacting the Domain of Coding and HIM Practice.” 1999. AHIMA E-health Task Force. “Report on the Roles and Function of e-Health Information Management.” 2002. AHIMA Joint Committee on Education. “The Health and Well-being of Professional Education in the HIM Discipline.” 2000. Baxter, R., Rubin, R., Steinberg, C., Carroll, C., Shapiro, J., Yang, A. “Assessing Core Capacity for Infectious Disease Surveillance. Final Report.” Prepared for Office of the Assistant Secretary for Planning and Evaluation, DHHS. The Lewin Group, Inc.: 2000, pp. 1-47. Corn, M., Rudzinski, K.A., and Cahn, M.A. “Bridging the Gap in Medical Informatics and Health Services Research.” Journal of the American Medical Informatics Association 9 (2002): pp. 140-143. Committees on Professional Development. “Health Information Management: Professional Definition.” Journal of AHIMA 72, no. 4 (2001): insert before page 49. Dixon Lee, Claire. “A Shot in the Arm for Public Health.” Journal of AHIMA 74, no. 1 (2003): 36-42. Fitzmaurice, J.M., Adams, K., and Eisenberg, J.M. “Three Decades of Research in Computer Applications in Healthcare.” Journal of the American Medical Informatics Association 9 (2002): 144-160.

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Institute of Medicine. “Priority Areas for National Action: Transforming Health Care Quality.” January 7, 2003. Institute of Medicine. “Fostering Rapid Advances in Health Care: Learning from System Demonstrations.” November 19, 2002. Institute of Medicine. “The Future of the Public’s Health in the 21st Century.” November 11, 2002. Institute of Medicine. “Who Will Keep the Public Healthy: Educating Public Health Professionals for the 21st Century.” November 4, 2002. Jeffries, Jane. “New e-HIM Initiative Will Reinvent HIM Practice, Support Infra-structure.” Journal of AHIMA 74, no. 1 (2003): 70. “Health Data Monitored for Bioterror Warning.” New York Times, January 27, 2003. National Cancer Institute and the Robert Wood Johnson Foundation. “Online Behavior and Disease Management. A Research Dialogue.” August 2, 2001. National Committee on Vital and Health Statistics. “Information for Health: A Strategy for Building the National Health Information Infrastructure.” Washington, DC: November 15, 2001. National Electronic Disease Surveillance System Working Group. “National Electronic Disease Surveillance System (NEDSS): A Standards-based Approach to Connect Public Health and Clinical Medicine.” Journal of Public Health Management and Practice, 2001. Pindus, N., Koralek, R., Bernstein, J., Selter, B., and Owens, C. “The Health Passport Project: Assessment and Recommendations: Final Report.” Prepared by The Urban Institute and MAXIMUS. Washington, DC, and Rockville, MD: December 2001. Romano, P.S., Elixhauser, A., McDonald, K.M., and Miller, M.R. “HIM’s Role in Monitoring Patient Safety.” Journal of the American Health Information Management Association 73 no. 3 (2002): 72-74. “The Churn. The Paradox of Progress.” Federal Reserve Bank of Dallas. Reprint from 1992 annual report.

e-HIM Task Force Members
AHIMA
AHIMA is the name you can trust for quality healthcare education. AHIMA has represented the interests of health information professionals since 1928 and has a membership roster of more than 45,000. For information about the Association, go to www.ahima.org. AHIMA strives to reflect in its membership and leadership the diversity within the United States, including race, ethnicity, gender, age, sexual orientation, special needs, and other diverse populations. AHIMA encourages the celebration and promotion of diversity through education, mentoring, recognition, leadership, and other programs.

FORE
The Foundation of Research and Education of the American Health Information Management Association provides financial and intellectual resources to sustain and recognize continuous innovation and advances in health information management for the betterment of the profession, healthcare, and the public. For more information about FORE, go to www.ahima.org/fore.

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Appendix A

e-HIM: Electronic Health Information Management
As the next step in advancing the recommendations of the e-HIM Task Force, AHIMA has created workgroups to develop practice standards that focus on areas or issues that play an integral role in the transition from paper to electronic health records. The outcome of the workgroup effort will be resources and guidance, which will position HIM professionals to play key roles in advancing the electronic health record. The following issues were selected for initial standards development: • • • • • • The complete medical record in a hybrid EHR environment E-signature Provider/patient wired/e-mail communications and the impact on the EHR Imaging as a transition tool to EHR Data elements of the physician practice EHR The natural language patient record; the benefits of voice recognition in the EHR

The results of the above workgroups, including Practice Briefs and best practice criteria, will be available on a CD-ROM to all attendees of AHIMA’s 75th Convention and also available through www.ahima.org. Additional issues will be addressed as the e-HIM initiative continues in 2004. Publication of this report is supported by a grant from Siemens Medical. Darrell L. Bailey, EdD Executive Associate Dean School of Informatics Indiana University Purdue University Indianapolis Indianapolis, IN Marion Ball, EdD Vice President Clinical Informatics Strategies Healthlink, Incorporated Baltimore, MD Meryl Bloomrosen, MBA, RHIA Consultant AHIMA Silver Spring, MD Teresa M. Foley, MA, CPHQ, RHIA Medical Records Consultant Office of the Surgeon General Falls Church, VA Danita Forgey, MIS, RHIA, CCS, CCS-P Director, Health Information Administration Program School of Informatics Indiana University Purdue University Indianapolis Indianapolis, IN Susan P. Hanson, MBA, RHIA Chief Operating Officer WANG Healthcare Information Systems Billerica, MA

A Vision from the e-HIM Future: A Report from the AHIMA e-HIM Task Force

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Cynthia K. Hilterbrand, RHIA Director, Information Technology Business Development INTEGRIS Health Oklahoma City, OK Mary Ellen Mahoney, MS, RHIA Vice President and General Manager Cerner Corporation Kansas City, MO Donald Mon, PhD Assistant Dean and CIO The Division of the Biological Sciences University of Chicago Chicago, IL Helga Rippen, PhD, MD, MPH Director, Science and Technology Policy Institute RAND Arlington, VA Barbara A. Siegel, MS, RHIT President, AHIMA Director, Health Information Hackensack University Medical Center Hackensack, NJ Scott Stratton, MPH Director, Global Medical Applications Pfizer, Inc. New York, NY

Paul C. Tang, MD Chief Medical Information Officer Palo Alto Medical Foundation Palo Alto, CA Judith J. Warren, PhD, RN, BC, FAAN University of Kansas School of Nursing Kansas City, KS William A. Yasnoff, MD, PhD Senior Advisor, National Health Information Infrastructure Department of Health and Human Services Washington, DC Jon Zimmerman Vice President, e.Health Siemens Medical Solutions Health Services Corp. Exton, PA

AHIMA Staff
Claire Dixon-Lee, PhD, RHIA, FAHIMA Vice President, Education and Accreditation Sandra Fuller, MA, RHIA Senior Vice President and COO Linda L. Kloss, MA, RHIA, CAE Executive Vice President and CEO Anne Zender, MA Director of Communications

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