Assignment 1: answer real world case 1.1 questions; at least one page; cite textbook and or other sources.
Please see chapter readings from textbook below
Real-World Case 1.1
The electronic health record (EHR) is causing many changes in both the health information management (HIM) profession and the structure of the HIM department. Because of the EHR, many functions of the HIM department can be performed remotely. Some HIM staff such as coders and transcriptionists are now working from home. The file areas where the paper records are housed are disappearing as more and more of the health records are electronic. These changes enable the healthcare organization to use the space previously occupied by the HIM staff and the file areas to be used for other purposes. Some healthcare organizations with multiple locations have centralized their HIM functions, enabling them to standardize the HIM functions and to share staff among the healthcare organizations. The HIM staff at the central location can perform most of the functions of the HIM department. There may be some staff at the healthcare organization to attend committee meetings, take authorization for release of information from patients, and perform other functions that require staff on site. Whether employees work from home or at a centralized location, the privacy and security of patient information must always be ensured at all the locations and employee productivity must meet the standards established by the organization.
1. How is the EHR (Electronic Health Records) changing the roles of the HIM (Health Information Management) staff?
2. What changes would you expect from the centralization of HIM (Health Information Management) functions?
3. What is your view of the HIM (Health Information Management)] profession?
4. Visit the AHIMA website and research the qualifications for taking each certification examination and the continuing education requirements for maintaining each credential. Compare and contrast the exams.
5. Develop a trivia game. For this chapter, students could develop 10 to 15 cards on the mission, code of ethics, and current organizational structure of AHIMA.
HITT 1301 CHAPTER 1
Health Information Management Technology,
An Applied Approach
Nanette Sayles, Leslie Gordon
Copyright ©2020 by the American Health Information Management Association. All rights reserved. Except as permitted under the Copyright Act of 1976, no part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, photocopying, recording, or otherwise, without the prior written permission of AHIMA, 233 North Michigan Avenue, 21st Floor, Chicago, Illinois 60601-5809 (http://www.ahima.org/reprint).
ISBN: 978-1-58426-720-1
AHIMA Product No.: AB103118
This chapter introduces the history of the health information management (HIM) profession and offers insights into the current and future roles and functions of those who manage health information. The role of HIM professionals is even more important now than it was when the Association of Record Librarians of North America (ARLNA) was created in 1928 due to the complexity of today’s information- and technology-driven healthcare environment.
Early History of Health Information Management
The commitment, wisdom, and efforts of HIM pioneers are reflected in what we see today as the HIM profession. Four distinct steps influenced development of the HIM profession. These steps include the hospital standardization movement, the organization of record librarians, the approval of formal educational processes, and an educational curriculum for medical record (now known as health information) librarians.
Hospital Standardization
Before 1918, the creation and management of hospital health records were the sole responsibilities of the attending physician. Physicians of that time often disliked doing paperwork. Unless the physician was interested in medical research, the medical records in the early 20th century were “practically worthless and consisted principally of nurse’s notes” (Huffman 1941, 101).
Health records of that time did not contain graphical records or laboratory reports. Because there was no general management of health record processes, hospitals made no effort to ensure missing or incomplete portions of the health records were completed. Furthermore, no standardized vocabulary was used to document why the patient was admitted to the hospital or the final diagnosis upon discharge.
In 1918, the hospital standardization movement was inaugurated by the American College of Surgeons (ACS). The purpose of the resulting Hospital Standardization Program was to raise the standards of surgery by establishing minimum quality standards for hospitals. The ASC realized one of the most important items in the care of every patient was a complete and accurate report of the care and treatment provided during hospitalization. The health record should contain test results, identification information, diagnoses, treatment, and more (Huffman 1941).
It was not long before hospitals realized that to comply with the hospital standards, new health record processes had to be implemented. In addition, staff had to be hired to ensure the new processes were appropriately carried out. Furthermore, hospitals recognized health records must be maintained and filed in an orderly manner. Cross-indexes of diseases, operations, and physicians must be compiled. Thus, the job position of health record clerk was established.
Organization of the Association of Record Librarians
In 1928, 35 members of the Club of Record Clerks met at the Hospital Standardization Conference in Boston. Near the close of the meeting, the Association of Record Librarians of North America (ARLNA) was formed. During its first year the association had a charter membership of 58 individuals. Members were admitted from 25 of the 48 states, the District of Columbia, and Canada (Huffman 1985). ARLNA was the original name of the American Health Information Management Association (AHIMA), which is discussed later in this chapter.
Approval of Formal Education and Certification Programs
Early HIM professionals understood that for an occupation to be recognized as a profession there must be preliminary training. They also understood such training needed to be distinguished from mere skill. This training needed to be intellectual in character, involving knowledge and learning. Therefore, work began on the formulation of a prescribed course of study as early as 1929. In 1932, the association adopted the first formal curriculum for HIM education.
The first schools for medical record librarians were surveyed and approved by ARLNA in 1934. By 1941, 10 schools had been approved to provide training for medical record librarians. This formal approval process of academic programs was the precursor to the current accreditation program managed by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM). Accreditation is a determination by an accrediting body that an eligible organization, network, program, group, or individual complies with applicable standards. In the case of CAHIIM, it is academic educational programs.
The Board of Registration, a certification board, was instituted in 1933 and developed the baseline by which to measure qualified health record librarians. “Certification is a credential earned by demonstrating specific skills or knowledge usually tied to an occupation, technology, or industry. Certifications are usually offered by a professional organization or a company that specializes in a particular field or technology” (CareerOneStop 2018). The Board of Registration developed the eligibility criteria for registration and developed and administered a national qualifying examination. Registration is the act of enrolling; in this case, enrolling in AHIMA’s certifications (this process is discussed later in this chapter). Today, AHIMA’s Commission on Certification for Health Informatics and Information Management (CCHIIM) functions as the Board of Registration. CCHIIM’s role and function are discussed later in this chapter.
The professional membership of the association of HIM professionals grew over the subsequent decades. Although the name of the association changed several times, the fundamental elements of the profession—formal training requirements and certification by examination—have remained the same.
Evolution of Practice
The various names given to the health record association and its associated credentials reveal a lot about the evolution of the profession and its practice. A credential is a formal agreement granting an individual permission to practice in a profession, usually conferred by a national professional organization dedicated to a specific area of healthcare practice; or the accordance of permission by a healthcare organization to a licensed, independent practitioner (physician, nurse practitioner, or other professional) to practice in a specific area of specialty within that organization. It usually requires an applicant to pass an examination to obtain the credential initially and then to participate in continuing education activities to maintain the credential thereafter. The health record association was known as ARLNA until Canadian members formed their own organization in 1944. At that time, the name of the professional organization was changed to the American Association of Medical Record Librarians (AAMRL). In 1970, the professional organization changed its name again to eliminate the term librarian. The professional organization’s name became the American Medical Record Association (AMRA). The professional organization underwent another name change in 1991 to become American Health Information Management Association (AHIMA).
The changes in the professional organization’s name in 1970 and 1991 reflected the changing nature of the roles and functions of the association’s professional membership. In 1970, the term administrator mirrored the work performed by members more accurately than the term librarian. Similarly, in 1991, association leaders believed that the management of information, rather than the management of records, would be the primary function of the profession in the future.
In 1999, AHIMA’s House of Delegates (HOD) approved a credential name change. Registered Record Administrator (RRA) became Registered Health Information Administrator (RHIA), and Accredited Record Technician (ART) became Registered Health Information Technician (RHIT). These certifications are discussed later in this chapter. This section will address the traditional practice of HIM, the current information-oriented management practice, as well as the future of HIM.
Traditional Practice
The original practice of HIM emphasized the need to ensure that complete and accurate health records were compiled and maintained for every patient. Accurate records were needed to support the care and treatment provided to the patient as well as to conduct various types of clinical research.
Traditional practices of HIM involved planning, developing, and implementing systems designed to control, monitor, and track the quantity of record content and the flow, storage, and retrieval of health records. In other words, activities centered primarily on the health record or reports within the record as a physical unit rather than on the data elements that make up the information within the health record.
In 1928, very few standards “addressed issues relating to determination of the completion, significance, organization, timeliness, or accuracy of information contained in the medical record or its usefulness to decision support” (Johns 1991, 57).
Traditionally, HIM professionals worked in a hospital HIM department. Today, HIM professionals are found in many settings and in many roles. Some of the more common settings and some HIM roles are listed in table 1.1.
Table 1.1 HIM profession’s job setting
| Setting |
Roles |
| Acute-care hospital |
HIM director
Cancer registrar
Discharge analyst
Systems analyst
Privacy officer
Compliance |
| Integrated healthcare delivery sytem
|
HIM director
Privacy officer
Coder
Compliance officer |
| Other provider setting (such as long-term care and psychiatric) |
HIM director
Privacy officer
Coder
Compliance officer |
| Vendor |
Sales
Systems analyst
Consultant
Systems implementation
Trainer |
| Insurance companies
|
Claims coordinator
Auditor
Privacy officer |
| Consulting |
Consultant |
| Educational institution |
Professor |
| Law firm |
HIM director |
| Government agency
|
Reimbursement specialist
Data manager
Data mapper |
| Pharmaceutical companies |
Research assistant |
Source: ©AHIMA.
Information-Oriented Management Practice
The traditional model of practice roles is not appropriate for today’s information-intensive and automated healthcare environment. The traditional model of practice is department focused with an emphasis on tasks. These tasks include the processing and tracking of records rather than processing and tracking information.
