h.i.m. in the age of e.h.r. joseph ng, md chief medical information officer at john t. mather...
TRANSCRIPT
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H.I.M. IN THE AGE OF E.H.R.
JOSEPH NG, MD
CHIEF MEDICAL INFORMATION OFFICER AT JOHN T. MATHER MEMORIAL HOSPITAL
CRITICAL CARE INTENSIVIST
PROGRAM DIRECTOR, TRANSITIONAL YEAR RESIDENCY
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INTRODUCTION
• EHRs are reshaping the work of healthcare professionals
• Improving healthcare delivery
• Enabling payment reform
• Huge effect on HIM professionals
• New day to day demands
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INTRODUCTION
• Accelerated change in the HIM environment
• Physical records are being phased out
• More stringent regulatory directives
• Multiple versions of the medical record
• Multiple pieces of the record in multiple systems
• Analyst, I.T. specialist, and HIM professional all-in-one
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INTRODUCTION
• Envision and develop new opportunities
• Engage and drive change
• Redefine the role of HIM professional
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STATE OF ELECTRONIC HEALTH RECORDS (EHR)
• EHR adaptation is at all time high
• 59% (6 out of 10)
• 5 fold increase compared to 2008
• Increase of 34% in 2013 compared to 2012
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INFORMATION EXCHANGE
• 41% of Hospitals are able to SEND and RECEIVE secure electronic messages containing PHI
• Printing out records
• Faxing
• Mailing
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OFFICE OF THE NATIONAL COORDINATOR (ONC)
HITECH WORKFORCE DEVELOPMENT PROGRAM
• The HITECH Act authorized ONC to establish the Community College
Consortia to Educate Health IT Professionals Program.
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GOVERNMENT IS COMMITTED
• Meaningful use payouts
• March 2014, $22.9 Billion dollars
• $14.3 billion to eligible hospitals
• $8.6 billion to eligible providers
• March 27, 2015 – EPCS rollout in NYS and Ohio
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E-PRESCRIBING
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E-PRESCRIBING
• I-STOP
• EPCS – Electronic Prescribing of Controlled Substances
• Starts March 2015 for NYS and Ohio
• Needs 2 factor authentication for controlled substances
HUGE AMOUNTS OF TRAINING NEEDED FOR USERS
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WHAT DOES THIS MEAN FOR THE HIM PROFESSIONAL???
ENTERPRISE INFORMATION MANAGEMENT GOVERNANCE IS CRITICAL
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CURRENT STATE
• EHRs are rapidly replacing paper records
• Volume and sources of data is overwhelming the information management capacity of most healthcare organizations
• What is your source of truth as a legal record when information is coming from all systems
• What is your institution’s policy to aggregate all this information?
• Who is the final manager of all this information? Who releases the information?
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CURRENT STATE
• HIM manage health records
• Departments would manage their piece of information
• Problematic
• Difficult to integrate all these pieces of information
• Impossible to piece together patient course
• Hinders an organization’s ability to implement, oversee, and enforce standardization
• Data is being managed to varying levels of completeness, quality and accessability
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CURRENT STATE
• LIJ – So many facilities – So many workflows – So many levels of usage
• Physician Documentation is at varying levels of usage
• Paper in chart, dictation
• Medication Reconciliation
• CHSLI – Same problems
• Consults are not on EHR
• Trickle down from Good Samaritan to St. Charles may take years
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CURRENT STATE
• Mather – Community Hospital, Stand alone
• Competing priorities – Limited staff resources
• Multiple systems trying to communicate with each other
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PROBLEMS
• Increasing cost due to inefficient storage practices
• IT cost to manage dozens of applications
• Exposure to preventable risk
• Unauthorized access
• Lack of trust hinders effective use
• Multiple versions of chart (some updated, other not)
• Question of accuracy
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FUTURE STATE
• Information is managed as a strategic asset
• Correctly aggregated information can increase the bottom line
• Value Based Purchasing
• Prevent loss of capital due to law suits
• Governance is integral
• How information is managed needs to be clear
• Adds value to the information obtained
• Improves decision making capabilites
• Information Management needs to be an enterprise-wide function
• Everyone on the organization must “Buy-In”
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THE ENTERPRISE MODEL FOR INFORMATION GOVERNANCE
Information Governance
Design and Capture
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DESIGN AND CAPTURE FUNCTIONS
• Beginning of the Information Management Life Cycle
• Architecture
• Content Definitions
• Standards
• Reference Terminologies
• Mechanisms that improve efficiency and quality of data collection, downstream information use, interoperability and reuse
• Ideally data should be captured once and used for a variety of purposes
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THE ENTERPRISE MODEL FOR INFORMATION GOVERNANCE
Information Governance
Design and Capture
Access and Use
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INFORMATION ACCESS AND USE FUNCTIONS• Advances and supports critical data use
• Support to:
• Clinical and business process owners
• Patient access to health information
• HIM role
• Educate users about data characteristics
• Reliability and accuracy
• Collaboration to build trust in data for population health management, community, and public health
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THE ENTERPRISE MODEL FOR INFORMATION GOVERNANCE
Information Governance
Design and Capture
Access and Use
Life Cycle Management
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LIFE CYCLE MANAGEMENT FUNCTIONS
• Defines and maintain designated record sets
• Legal health records and other types of records
• For:
• Business needs of the organization
• Legal and regulatory requirements
• Management of plans and processes
• Storage
• Retention
• Disposition of medical and business records
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THE ENTERPRISE MODEL FOR INFORMATION GOVERNANCE
Information Governance
Design and Capture
Access and Use
Life Cycle Management
Privacy, Confidentiality, and Security
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PRIVACY, CONFIDENTIALITY, AND SECURITY FUNCTIONS
• Protect PHI
• Information is only available to authorized persons
• For Authorized purposes
• Risk assessment and audits
• HIPAA compliance
• Complicated by expansion of users
• Expansion of access points
• Mobile
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THE ENTERPRISE MODEL FOR INFORMATION GOVERNANCE
Information Governance
Design and Capture
Access and Use
Life Cycle Management
Privacy, Confidentiality, and Security
Integrity and Quality
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INFORMATION INTEGRITY AND DATA QUALITY FUNCTIONS
• Data needs to be:
• Accurate
• Reliable
• Up-To-Date
• Consistent
• Fit for use
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INFORMATION INTEGRITY
• Begins with data architecture, definitions and relationships
• How is data compiled and sorted?
• Legal record? Define it…
• How does the paper in the chart combine with the data in the EHR to form the legal record?
• Provenance or lineage of data
• Processes for error correction and amendments
• Analysis of medical record for completeness – this process now needs to be redesigned for real-time, electronic systems
• Signing orders both in HIM system and EMR
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EXCELLENCE IN HIM – NEEDS TO:
• View information as an asset that must be deliberately managed
• Encompass patient records and other clinical and business data
• Implement and continuously improve on the component functions reflected in the model
• Encompass the life cycle of information and records
• Be guided by effective governance and stewardship focused on “getting it right”
• Measureable and sustainable improvement over time
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•Forward thinking HIM leaders understand the need to transition from traditional HIM to an enterprise view of
information
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ERRORS
• HIM leaders have been left out of critical decisions such as EHR selection
• Find workarounds for information and records management shortcomings
• Unique understanding
• Information contents and records
• Information flow
• User needs
• Compliance
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BLURRING OF THE LINES
• Joining of I.T. / I.S. / H.I.M.
• Need to understand the basics of:
• How the information is stored
• How it is retrieved
• What technical processes occur in the background to obtain the output
• Example: Siemens E-HIM/Soarian AND Allscripts
• EMR Data Aggregation into report Integration into the HIM system
• When information is updated – versioning – When does that occur?
• Out of sync with patient’s course – Have to wait until patient is discharged
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COMPETITION
• Priorities
• Transition to ICD-10
• Demonstrating meaningful use
• Strengthening privacy and security
• Budget constraints
• All hinder progress the Holy Grail of Enterprise Information Management
• Solution: Outsource resource heavy low-value functions so that you can “Keep your eye on the ball” and shift staff to new roles for higher-value work
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MAKE YOUR INSTITUTION SUCCESSFUL AT INFORMATION MANAGEMENT
• Break from paper
• Outsource records storage
• Production functions
• Transactional work
• Make a case for electronic information management
• Understand the state of information and records management across your institution
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• Organize for governance
• Extend support for appropriate governance
• Collaborate
• Measure results
• Cost savings
• Operational improvement
• Risk reduction
• Educate
• Enterprise information management needs to be built and improved over time
• Raise awareness
• Explain how everyone is involved to improve and reach the goal
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HOW DO YOU LEVERAGE HIM SKILLS?
• Unique and valuable skill set
• Assume managerial and subject matter expert roles
• Realize that you all have the knowledge for theses roles already
• They rest on foundational HIM competencies
• However to adjust to the changing landscape – further training or even an advanced degree
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• Rapid adoption of technology and volume of data have made challenges more complex and costly
• To get support and buy-in from senior leadership, concepts of EIM need to be relayed as organizational goals and translated to dollars saved, performance improved, and risks mitigated
• SELL HIM’s NEW ROLE
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EPILOGUE – WHAT ABOUT ELECTRONIC HEALTH RECORD MANAGEMENT (EHRM)?
• Reminder: EHRM requires that HIM be part of the decision-making and planning throughout the entire life-cycle of the EHR
• Lack of involvement will mean hundreds of hours of re-working
• Not only involvement in implementation but in maintenance and even in disposal
• Someone has to know what records to keep from a defunct EMR and for how long
• Make critical decisions about rollout to avoid maintaining a hybrid system
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HIM LEADERSHIP – BACK TO GOVERNANCE
• HIM professionals are ideally suited to provide the institution with the leadership to ensure the EHR is optimally managed
• BUT – you need to get involved sooner rather than later!
• HIM professionals, with their training are best suited to make sure standards are consistently applied across various systems
• Maintain information integrity
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NEW RESPONSIBILITIES FOR THE HIM PROFESSIONAL
• Patient Portals
• E-mail communications
• Personal Health Records
• Maintenance of scheduling of appointments
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NEW RESPONSIBILITIES, NEW BENEFITS
• Charts get completed in a timely manner
• Chart analysis
• Coding
• Able to code from home
• Dynamics of the job
• Availability of charts online
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ARE HIM PROFESSIONALS BEING EDGED OUT?
• Hopefully with what I’ve presented to you so far, you can see the growing need for people who possess the expertise in this room
• Not only is the prediction that HIM professionals won’t be needed, wrong
• They are going to be in a much more visible role
• Transformation of the HIM role
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QUALITIES NEEDED TO MANAGE THE PAPER RECORD ARE THE SAME REQUIRED TO MANAGE THE EHR
• Attention to detail
• Ability to compare competing data sources and reach conclusions about data accuracy
• Project management
• Categorization of data
• Data reporting
• Evaluating, understanding and interpreting regulatory standards
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BLURRING OF THE LINES… RECAP
• HIM will interact and overlap with HIT (health info tech)
• Clinical informatics overlap
• HIM department should have a close and ongoing relationship with HIS department
• Understand each others lingo
• Comprehend complexities of making things happen in each other’s department
• New hires are those that have HIM and HIT experience
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HIM ROLES WILL MOVE FROM TASK ORIENTED ROLES AND SKILLS TO:
• Analytical thinking
• Process design
• Project management
• Cross-operational management / leadership
• Change management
• Planning and implementing new systems
• Educating providers and administrators
• Solving strategic and operational problems
• Developing/installing/operating clinical and financial applications related to the medical record
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WHAT NEW ROLES ARE AVAILABLE?
• Enterprise Information Management Leadership
• Privacy / Security Officer
• Revenue Cycle Management
• Data Quality and Integrity
• Clinical Vocabulary and Classification
• Compliance and Risk
• Information Policy and Standards
• Records Life Cycle Management
• Information Access and Release
• Health Data Analyst
• Data Dictionary
• Patient Information Advocates
• Health Information Exchange
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• What you choose to do depends on your skills and interests
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RESOURCES
Transition and Change Management Books
• Lundin, Stephen C., Harry Paul, and John Christensen. Fish! A Remarkable Way to Boost Morale and Improve Results. Hyperion, 2000. (And other Fish! books by the same authors.)
• Johnson, Spencer. Who Moved My Cheese? An Amazing Way to Deal with Change in Your Work and in Your Life. Penguin Putnam, 1998.
• Carnegie, Dale. How to Stop Worrying and Start Living. Pocket, 1990 (revised edition).
• Bridges, William. Managing Transitions: Making the Most of Change. Perseus, 2003.
• Kotter, John, and Dan S. Cohen. The Heart of Change: Real-Life Stories of How People Change Their Organizations. Harvard Business School Press, 2002
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RESOURCESE-HIM Practice Guidelines
These standards can be found at www.ahima.org/infocenter/ehim:
• “HIM Practice Transformation”
• “Delving into Computer-assisted Coding”
• “The Strategic Importance of Electronic Health Records Management
• “Core Data Sets”
• “The Complete Medical Record in a Hybrid EHR Environment”
• “Implementing E-Signatures”
• “E-mail as a Provider-Patient Electronic Communication Medium and Its Impact on the Electronic Health Record“
• “Electronic Document Management as a Component of the Electronic Health Record”
• “Core Data Sets for the Physician Practice Electronic Health Record”
• “Speech Recognition in the Electronic Health Record”
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REFERENCES
• Redefining the Role of Healthcare Information Management in the New World of Information Governance; Iron Mountain; Linda Kloss
• Visioning e-HIM: A Process for Imagining—and Anticipating—HIM’s Future; Patty Thierry Sheridan, MBA, RHIA, Michele D’Ambrosio, MBA, RHIA, Kerry Heinecke, RHIA
• Redefining the Role of Health Information Management in the New World of Information Governance; Linda Kloss, 2013
• AHIMA Work Group on Electronic Health Records Management. "The Strategic Importance of Electronic Health Records Management: Checklist for Transition to the EHR". Journal of AHIMA 75, no.9 (October 2004): 80C-E.
• AHIMA e-HIMTM Task Force. "The Strategic Importance of Electronic Health Records Management.“ Journal of AHIMA 75, no.9 (October 2004): 80A-B.