Looking Into the Crystal Ball

Change is inevitable. No one knows this sentiment to be truer than health information management (HIM) professionals. Technologies such as electronic health records (EHRs), health information exchange (HIE), computer-assisted coding (CAC), patient portals, and natural language processing have revolutionized information management. HIM skills are more important than ever. However, professionals must learn to embrace the new roles and functions that continue to emerge in an increasingly automated and data-driven environment.

Data Integrity and Staff Efficiency
As the HIM profession shapes its new identity in this electronic world, the concept of enterprise-wide data management is paramount. The successful HIM department of the future will take a holistic approach to data integrity. They will embrace people, processes and technologies to drive stronger health information compliance across their entire organization.

From an operational perspective, HIM professionals must continually learn to thrive in organizations that seek to cut costs and “do more with less.” Technology will be the impetus for refining workflows, eliminating redundancies and improving productivity. HIM departments of tomorrow will surely be more efficient, diversified and technology-savvy than they have ever been in the past.

What might HIM departments of the future look like, and what changes can we expect? Here are six predictions for tomorrow:

1. More remote work
EHRs enable coders, analysts, CDI specialists and others to access the health record securely from virtually any location. Employing remote workers reduces overhead costs, frees up valuable space within the organization, and gives employees the flexibility that they prefer. Remote work will only continue to increase as organizations move from hybrid records to ones that are completely electronic — and virtual access becomes more secure.

2. Centralized HIM departments
Along with the move to a remote HIM workforce, many organizations will centralize their HIM functions. One department (physical, virtual or a combination of both) supports multiple hospital locations. Secure remote EHR access coupled with encrypted online communication tools enable this trend.

Centralized HIM departments may expand their services to support affiliated and owned physician practices through coding services, document scanning and management, HIPAA privacy and compliance, release of information, and more.

3. Increased HIM outsourcing
As HIM functions go virtual and are centralized across locations, outsourcing to third-party HIM vendors becomes a more viable option. Hospital oversight of third-party vendors’ productivity and quality is easier with today’s web-based reporting tools and dashboards. Additionally, outsourcing saves organizations considerable money and physical space as they work to consolidate and reduce costs. In order to make HIM outsourcing a viable option, hospital-employed vendor liaisons are required alongside strong HIM management. The third-party HIM vendor must also provide substantial productivity and quality reports, working with an account manager.

4. Advanced skill sets
HIM professionals of the future must have skills related to project management, technology, statistics, data analysis, and data manipulation.

Technology is a vehicle for data integrity, privacy and interoperability. Analysis of data produced by technology and successful application of business intelligence gleaned from that data will shape the future of healthcare improvement. IT helps produce data, but HIM plays a critical role in its analysis. The two disciplines must work together to achieve full return on investment (ROI) from technology investments, especially the EHR.

5. More inclusion at the corporate level
The need for data integrity and analysis is growing in healthcare. Along with these advancements comes growing awareness of HIM’s role in health information accuracy and governance. Over the next several years, organizations may opt to include HIM experts in the C-suite. Potential reporting structures include:

  • Corporate HIM directors oversee several HIM directors, each of whom is responsible for one or more hospitals.
  • Corporate informatics departments include a HIM leader alongside medical staff and IT leadership.
  • Organization-wide CDI teams unite under a single HIM vice president in larger integrated health systems.
  • HIM directors lead privacy initiatives and launch new information governance programs.
  • Vice president of data integrity/chief data officer ensures that the data is of the utmost quality.

Savvy HIM leaders are already starting to climb the corporate ladder. First steps include increasing awareness of HIM’s expertise and role at all levels of organizational leadership.

6. Increased efficiency at the operational level
New technologies will drive greater efficiencies in HIM operational areas. Productivity, accuracy and quality will also improve as staff save time and organizations save money.

Inevitably, some HIM positions may be combined or eliminated as technology automates more of HIM’s paper processes. Those who remain must operate at maximum efficiency and fully utilize their technology applications.

7. Decentralized HIM functions
The most controversial prediction is the shift from a formal HIM department to a model in which HIM professionals are embedded throughout the organization. HIM professionals increasingly work in revenue cycle, IT, informatics, quality management, CDI, privacy, compliance, research and patient access. We expect this shift to continue as other hospital departments expand their appreciation and perception of HIM skills.

One common model visible today involves splitting HIM functions between the revenue cycle and IT departments. In this model, coders report directly to the revenue cycle department while release of information specialists, transcriptionists and clerical staff, report to IT and cancer registry staff report directly to Oncology. However, there are hurdles to overcome, such as disconnects between HIM’s and IT’s professional focus — which can often lead to a misunderstanding of HIPAA and HITECH rules that govern health information privacy and sharing.

For example, some EHR implementations didn’t take HIM concerns into consideration during initial system setup and go live. Fortunately, they are involving HIM now!

As the HIM profession continues to evolve, IT professionals may eventually report directly to HIM leadership.

Emerging Roles
Although filing and scanning functions will eventually become obsolete, other new HIM roles and functions will emerge in an electronic environment. AHIMA has developed a career map that outlines several of these roles, including:

  • Coding editor. As organizations implement CAC technology, coders won’t assign codes but will edit what has been assigned automatically. This requires clinical validation and a strong understanding of coding guidelines.
  • Transcription editor. Speech recognition technology has moved transcriptionists into an editing role as well, requiring validation that the dictated speech has translated accurately in terms of content as well as placement into the EHR.
  • Data quality management and analytics specialists. These individuals possess the know-how to manipulate data for reports and analyses. These specialists will also increasingly be called upon to integrate data from disparate health systems that don’t use the same EHR technology.
  • Patient advocate. Patient portals, health information exchange, and rules related to release of information in a digital age present HIM professionals with many new opportunities to educate and assist patients.

By the year 2020, organizations may no longer view HIM professionals as back-end, clean-up crews, but rather as front-end experts necessary to guide information integrity facility-wide. HIM departments as we know them today may cease to exist entirely. As functions are embedded throughout the organization, outsourced, or accommodated remotely, the HIM department essentially becomes one “without walls.”

Along the Journey
Many of the changes outlined in this article are already well underway. Technology will continue to shape the future of HIM. As a profession, we must take steps to understand these changes and identify ways in which our current and new skill sets can be best put to use. The power is in our hands — now we must seize the opportunities.

Karen Gallagher Grant has over 25 years of experience in the health information services industry and currently serves as chief operating officer for MRA Health Information Services. Prior to joining MRA, Karen worked for Partners HealthCare System, Inc. for 17 years and most recently served as the corporate director of Health Information Services/chief privacy officer (CPO). As CPO for Partners, she oversaw activities related to the development, implementation and maintenance of the privacy program and general HIM. Karen was also responsible for the planning, implementing and managing of inter-entity initiatives and functions in health information services as they related to the Electronic Health Record.

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