Chapter 11. Expanding Roles and Functions of the Health Information Management and Health Informatics Professional

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1 Chapter 11 Expanding Roles and Functions of the Health Information Management and Health Informatics Professional

2 11-2 Learning Outcomes When you finish this chapter, you will be able to: 11.1 Discuss how traditional health information management roles are expanding as a result of electronic health records and patient-centric healthcare Explain the new health information management roles that are emerging as a result of electronic health records and patient-centric healthcare Assess the steps that health information professionals need to take to progress and evolve in their careers.

3 11-3 Key Terms Certified Health Data Analyst (CHDA ) Disease registry General equivalence mapping (GEM) ICD-10-CM/PCS implementation or conversion specialists Information governance Structured data Unstructured data

4 11.1 Expanding Roles in an Environment 11-4 Digital health records are stored in a standard format, making it easier to perform sophisticated analysis, track trends, and make predictions Increased use of digital records has resulted in a greater need and ability to record and analyze patient data, which is a greater need for HIM professionals Code and abstract data being collected Verify data meets regulatory requirements

5 11.1 Expanding Roles in an Environment 11-5 Registry use has increased, and registries are used to track a single patient or a group of patients with a specific diagnosis Registries allow for benchmarking against standards and performance measures, identifying issues in care delivery, and improving performance of clinicians Registries are important because reimbursement will be increasingly be based on performance under the fee-for-value payment model

6 11.1 Expanding Roles in an Environment 11-6 Data analysts are becoming more critical because they are responsible for identifying trends or patterns in health data, collecting and validating data, and presenting findings from the data Data analysts make sure that all data becomes actionable information HIM professionals have knowledge about healthcare data that provides significant insight into essential details needed to efficiently analyze health data

7 11.1 Expanding Roles in an Environment 11-7 Skills in data analytics are used to map one coding system to another ICD-9 codes must be mapped to the new ICD-10 code, and vice versa, to compare data Data analytic skills are becoming increasingly important as the industry continues to shift toward EHRs and a patient-centered healthcare model

8 11.1 Expanding Roles in an Environment 11-8 Coding is an expanding field; with the implementation of EHRs and the move toward ICD-10-CM/PCS, the increase in detail and specificity of documentation becomes more important Clinical documentation improvement specialists (CDI) work with providers to implement new clinical documentation improvement practice and analysis digital workflows Coding and CDI s roles are expanding and have continued importance

9 11.1 Expanding Roles in an Environment 11-9 Auditors work with providers to ensure accuracy, timeliness, and appropriateness of documentation as well as government, accrediting agency, and third-party payer regulations Auditors look for trends in coding and documentation and provide appropriate education where needed Release of information coordinators educate patients about health information and portal functions providing good customer service and assisting the organization in meeting Meaningful Use requirements

10 11.1 Expanding Roles in an Environment Data collected being turned into information that is used in a meaningful way has always been done in healthcare, but digital health records have changed and expanded the process Informatics involves analyzing, assessing, and reporting data used for patient care, measuring performance, and shaping processes

11 11.1 Expanding Roles in an Environment Health informatics apply information system management to support clinical information technology and medical research Research is critical to modernizing healthcare delivery in the U.S. Healthcare professionals trained with research design and methodology will have the opportunity to work with applied research as well as academic research

12 11.1 Expanding Roles in an Environment Many changes have occurred surrounding the gathering, analyzing, archiving, and protection of health information in the last century, but it is still necessary for healthcare professionals to understand the basic concepts and procedures of these responsibilities Dual/hybrid systems and system outages Educational curriculum preparing individuals has expanded to incorporate electronic systems Educational institutions need qualified teaching personnel in associate, baccalaureate, and master s programs

13 11.2 Health Information Professionals New Roles and Responsibilities in an Health System ICD-10-CM/PCS implementation/conversion specialists assist with the training of staff for changes in coding and documentation as well as preparing the organization for changes in internal processes Individuals in this position must be proficient in ICD-9-CM and ICD-10-CM/PCS systems, disease processes, anatomy, and physiology and have good communication and time management skills

14 11.2 Health Information Professionals New Roles and Responsibilities in an Health System Increased EHR installations and conversions have amplified the number of individuals that vendors need to assist with these processes HIM professionals are sought by companies specializing in EHR software, voice recognition practice management, encoders, release of information software, and health information exchanges

15 11.2 Health Information Professionals New Roles and Responsibilities in an Health System Health informaticists possess technical skills in computer interfaces, database management, business intelligence applications, report writing, and analytics Health informaticists work with registries and other databases for reporting, performance assessment, benchmarking, and predictive analytics

16 11.2 Health Information Professionals New Roles and Responsibilities in an Health System Health information professionals must have knowledge about the documentation standards per governmental regulations, accrediting standards, and third-party requirements Chief knowledge officers are responsible for information governance within the organization

17 11.3 Health Information Education and Beyond Health records must be kept on every patient encounter no matter the setting Individuals who work with health information want a career in healthcare but prefer not to work in patient care New roles in health information and health informatics are developing as healthcare is changing

18 11.3 Health Information Education and Beyond Numerous degree programs and credentials are available for individuals who want to work in the field Associate degrees from CAHIIM-approved institutions enable individuals to sit for the Registered Health Information Technicians (RHIT) certification exam

19 Health Information Education and Beyond Title Health information specialist Release of information coordinator Patient access specialist Insurance/billing positions Coder Job Description Retrieval and archival of documents, quality monitoring for record completion, electronic health record processes Processes written or electronic requests for health information, ensures information is released only with valid authorization or as required by law, assists patients with patient portal access Makes appointments, registers patients, collects and enters demographic and administrative data, verifies insurance Insurance verification, insurance authorizations, medical claim filing, follow-up of medical claims Inpatient or outpatient: codes diagnoses and procedures using ICD and HCPCS coding systems and MS-DRG, APC, or other reimbursement methodology

20 11.3 Health Information Education and Beyond Title Quality improvement specialist Trainer Registrar Transcriptionist Medical office administrator Job Description Reviews health records against pre-determined criteria for clinical indicators Instructs staff on the use of EHR or other health information related software Cancer, trauma, birth defect, and so on: collects data on all patients appropriate for a specific type of registry, including identification of appropriate cases, data abstracting, reporting of cases to state registries, statistical report preparation, follow-up of cases, ensures regulatory requirements are met Transcribes reports from physicians dictation or edits output from speech recognition software Day-to-day management of a physician s practice

21 11.3 Health Information Education and Beyond Baccalaureate degrees from CAHIIM-approved institutions enable individuals to sit for the Registered Health Information Administrator (RHIA) certification exam Individuals who wish to perform the duties listed previously at a management level or for larger institutions should get at least a bachelor s degree

22 11.3 Health Information Education and Beyond Individuals prepared with a master s degree in health information management will gain specific skills in data structure and design, policy development, systems planning, workflow, operations management, and cost-effective management of information processing VP or executive of information privacy and security VP or executive of informatics Chief compliance officer Chief knowledge officer Department chairperson or program director

23 11.3 Health Information Education and Beyond Health Informatics programs are generally master s programs emphasizing information systems including analysis, design, implementation, and management of the entire system Certified Healthcare Technology (CHTS) exam AHIMA proficiency exam Certified Associate in Healthcare Information and Management Systems (CAHIMS) HIMSS certification Certified Professional in Healthcare Information and Management Systems (CPHIMS) HIMSS Certification

24 11.3 Health Information Education and Beyond Healthcare professionals earn their way to higher positions by Seeking out positions and promotions Earning higher degrees Pursuing continuing education Taking certification exams Attending professional association meetings Networking with others in the field Serving on committees Presenting at conferences Writing articles Authoring books

25 11-25 Chapter Summary Traditional health information roles are expanding as patients are becoming more active in their health decisions and as organizations are utilizing electronic health records. New roles are developing pertaining to database management and information governance. Various degree options and credentials through professional organizations are available to start or grow an individual s career in health information management or health informatics.