ABSTRACT
Computer technology has advanced through the 1960s and 1970s to the point where medical facilities have recognized the importance of utilizing advanced equipment, software, and hardware for the processing, storage, and accessing of patient medical records. As the majority of health care providers have moved into the domain of using electronic medical records in daily practice, the need for skilled employees trained in technology, science, and health care has become apparent. Today, health information system professional work within hospitals and clinics, doctor’s offices, law offices, government buildings, research facilities, and any organization requiring authorized transmission, reception, and storage of confidential patient information. With the ability to classify diseases and treatments in addition to function as technical support, the responsibilities of the HIM professional has moved out of strictly clinical departments into the areas of legal, financial, and administrative assistance as well. The field of health information management professionals continues to grow and training and advancement opportunities reflect the need of global technicians, directors, and consultants for organizational success in both patient outcomes and profitability.
Prior to the development of the current technology regarding the acquisition, management, and storage of health information, hospitals and other facilities used hand-written entries on paper that required assembly, filing, and storage in space-consuming locations by paid staff members. In addition to being often difficult to read and loss from inaccurate filing, paper records were susceptible to unauthorized access and in danger of destruction from fire, flood, and other destructive elements. The introduction to computers and then more sophisticated programs for the collection, storage, and transmission of health records within health care facilities gave rise to the need for trained staff members to manage the digital information. The position of the health information system professional was created for this purpose.
As a relatively new staple in the structure of health care facilities from the doctor’s office to a multi-billion dollar medical complex, the responsibilities of the health information system professional continue to evolve in scope and necessary skills. This paper discusses the birth of the position, role of the professional within the health care system, possible career paths, and the importance of the results to an organization in terms of corporate goals and profitability. The health information system professional is a crucial member of the health care team that will only become more essential as time passes.
Health data is the information gathered and created by a medical facility that relates to the medical history of an individual (Terry, 2016). Patient history, demographics such as address and contact information, treatments and results, and much more is filed for very long periods of time not only by the facility that initiates the collection, but by any other entity which the patient allows communication; patients may request records be sent to other doctors, medical facilities, insurance companies, lawyers, or even relatives. Patient data may be viewed for the purpose of individual care, but it may also be used by agencies for the creation of statistical analysis of changes in general population health, outcomes for specific treatments, or evaluation of influences such as environment impact.
The history of health information management actually dates back to the 1920s when physicians began to document and retain data on their patients (Rasmussen College, 2016). Having a record of patient illness, injury, and treatments allowed doctors to provide improved care for both the patient and for others with similar health problems. The health information industry became formalized in 1928 when the American College of Surgeons proposed standards for patient records in clinical settings. The journal The Hospital published a letter in May 1946 from the Institute of Hospital Administrators promoting the creation of a universal method of gathering and storing patient health information (AHIMA, 2016). Computer technology developed in the 1960s and 1970s promoted the use of electronic medical records which continues to this day.
A significant impact on the health information system was made by the passage of the Patient Protection and Affordable Care Act in 2010 (HHS.gov, 2013). A portion of the law included a health insurance exchange requirement that stated health care providers must put into place the use of electronic health records by January 2014; if they did not do so, reimbursement penalties for Medicare and Medicaid patients would be affected. The Centers for Medicare and Medicaid Services report that as of 2015, 95 percent of all hospitals that are eligible for incentive programs have adopted electronic health records and 56 percent of physicians have demonstrated meaningful use (CMS, 2016). As a result of compliance such as this, the demand for employees capable of managing electronic health records rapidly increased.
Health information technology (HIT) indicates the structure used to handle digitally formatted health information and exchanges (Terry, 2016). The Health Information Technology for Economic and Clinical Health Act of 2009 defines health information technology as,
“hardware, software, integrated technologies or related licenses, intellectual property, upgrades, or packaged solutions sold as services that are designed for or support the use by health care entities or patients for the electronic creation, maintenance, access, or exchange of health information. (Congressional Act, 2009, Section 3000.5)”
This definition might apply to healthcare information technology from dealing with robotics to home monitoring devices for patients suffering from chronic disease.
The view of an HIM professional as being a computer technician working in a medical facility is simplistic. The importance of population health management (PHM) has become a primary focus of programs that maintain the health of individuals not requiring medical care while preventing patients who have chronic illnesses from needing additional and more expensive care. The definition of population health management is “the discipline of managing the clinical and financial risk of a defined group of individuals.” (McKesson.com, 2016). Initially, a PHM program must have the ability to analyze statistics on the health of the population served in order to define clinical risk, measure financial risk, and determine the metrics for analysis of sick members suffering from chronic for present and future needs (AHIMA, 2016). It is also necessary to calculate trends in patients were are currently in healthcare facilities, those who are not, and those who utilize emergency rooms (Institute for Health Transformation, 2016). In order to maintain and offer preventative care, a PHM program needs the HIM professional to provide patient alerts for continuing management. The use of automated software provides opportunities to contact clients for effective interventions at various levels of need.
Professionals charged with working with health information technology focus on the technical requirements of coordinating the processes of the data, working with the hardware and software components of computer systems that manage and store the information. Health information professionals generally come from backgrounds in information technology and provide guidance for electronic health records and other systems. Health information management (HIM) requires professionals to combine training in science, business, and information technology to effectively perform their responsibilities.
The health information management professional appreciates the flow of data from complex medical facilities to the solo private practice of a single doctor. Their primary responsibility is to guarantee the health information of a patient’s records is accurate, complete, safe, and accessible. The HIM professional may be given a number of different titles may include Employee Health Case Manager, Systems Analyst, Director of Health Information Technology, and many more. Employers range from HIM management in medical facilities to consulting firms, government agencies, law firms, insurance companies, correctional facilities, medical software companies, pharmaceutical research, and others. HIM professionals often fulfill the role of bridges between facility staff members in administration, operations, and clinical areas. By classifying treatment procedures and diseases, the HIM professional allows for quality information for use in legal, financial, and clinical departments.
As new breakthroughs in technology occur, the role of the HIM professional changes and often expands. New ways of collecting, storing, accessing, and utilizing information are evolving and the health system information manager must add to his knowledge and skills in order to allow the organization to continue to operate in an efficient and effective manner. The days of faxing patient records across telephone lines are history, primarily due to lack of confidentiality. The HIM professional is aware of his duty to work within the arena of information interoperability. The ability to move electronic health information where it is required involves more than simply transferring patient records. Uses for sharing of population data include tracking trends in diseases such as the Ebola virus outbreaks, managing natural and man-made disasters, and surveillance of bioterrorism activities (Zeng, Reynolds & Sharp, 2009). The key to effectiveness is to develop common standards for content, data classifications, structure, vocabulary, and methods of transmission.
As the responsibilities and educational and technical requirements for health information systems professionals continue to rise, they are becoming more valuable in the marketplace. As medical facilities become more reliant on HIM professionals, the average salary continues to climb. According to Allied Health Schools, the median annual income is $92, 810 with employment opportunities growing by 17 percent through the year 2024, much more quickly than average job rates (Allied Health Schools, 2016). Some positions include bonuses close to $14,000 per year and possible profit sharing of almost $3000 (Payscale, 2016). Generally HIM professional stated on a survey that they liked their job and have high levels of satisfaction in their career. Most benefits provided by employers include medical insurance and most also provide dental and vision coverage.
Targeted recruitment of HIM professionals is a responsibility of the human resources department of an organization (Willis-Shattuck et al., 2008). Retention of qualified employees is even more important as experienced workers leave for better opportunities with other employers; this type of activity on a consistent basis has the ability to compromise the quality of care offered. Rural areas are most effected as skilled HIM professionals migrate to urban locations for more attractive positions.
Human resource managers are required to screen candidate for expertise in three areas of skill: managing terminology assets, maintaining and using patient data, and keeping the patient’s data secure and confidential (AIHMA, 2008). Seven major considerations are cited as impacting the decision of a quality employee to accept and stay in a position with a health care employer: 1) Monetary compensation such as salaries, 2) career development such as ability to promote or specialize, 3) opportunities to attend classes or seminars to stay current with technological innovations, 4) the physical condition of the workplace environment, 5) the availability of adequate equipment, 6) the relationship between staff and administration, and 7) the level of appreciation from superiors or the community. Additional considerations are fringe benefits, job security, personal demands of the job, adequate staffing, and personal safety. Health sector reforms in health care management have brought focus on the importance of all the previous influences on attracting and retaining qualified HIM professionals.
The future for job capacities for the HIM professional is numerous within many capacities, in multiple forms of environments, and with many types of employers. In terms of technological advances opening even more choices for the HIM professional, there is a need for providers to evaluate the entire population served and divide it into levels of care. At the present time, there are no platforms that allow data collection, aggregation, and analysis across settings within a specific geographical location; however, the development of such software is expected soon.
The Agency for Healthcare Research and Quality has suggested that an agency be put into place to establish and monitor “principles and guidelines that ensure the uniform and consistent collection and exchange of data for quality measurement and other purposes. (AIHMA, 2008). There is also the need for adopting standards for HMI professionals in terms of data mapping, content, and documentation for the health care industry. Due to the realization of the changing role of the health information system professional, the perception of the responsibilities have grown from a person who keeps patient records to one who balances security, access, and confidentiality on a global scale.
Health information technology management is critical for health care professionals to practice evidence-based and patient-centered medicine with real-time availability (Medicare Payment Advisory Commission, 2004). All stakeholders agree that HIT is at the core of the United States healthcare system in the future (Institute of Medicine, 2016). There is a national strategy developing within the healthcare industry to build an infrastructure that will allow patients, payers, and providers to share information (Zeng, Reynolds & Sharp, 2009). These changes will give providers incentives to use electronic medical records for patients who are both inpatients and outpatients, patient data will be incorporated into a local and national exchange for allowed access, and consumers are being educated to the advantages of keeping their health records on a long-term basis for provision to their care providers.
There are some problems with implementing electronic health records when the doctor’s practice or the medical facility is small, as in rural areas. Consumers are also slow to adopt the concept of maintaining electronic personal health records due to inexperience and limited resources. It is in this area that HIM professionals have the ability to make a significant impact. Through counseling and consulting, initiating negotiations with vendors, working as student interns, providing online or personal training classes, giving motivation, and working in collaboration with entities that struggle to meet the demands for digital servicing and equipment. It will not be possible to establish a national infrastructure for the sharing of health information without the vast majority of providers contributing daily transactions and HIM professionals are the people most capable of making a significant contribution toward that end.
As stewards of health information, the health information system professional is a key player in the success of data analytics and governance. New and unique career opportunities continue to arise for skilled employees as health care facilities strive to provide quality care to their patients. By reducing unnecessary tests, visits to the emergency room, hospitalizations, and treatment procedures, health care management decreases expenditures by all stakeholders; however, this is not possible without the services of a capable individual or team of HIM professionals. The practice of population health management focuses on both the well and the sick. Patients who represent high-risk treatments, those with chronic needs, and people who need preventive care are included in the data generated and managed by the HIM department. For these reasons and many more, health information system professionals have become an integral part of the health care team and will remain so far into the future.
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