- The health information management profession goes far beyond the simple - or not so simple - act of coding a medical record for billing purposes. As the healthcare industry begins to recognize the strategic importance of collecting big data to generate actionable clinical and strategic insights, HIM professionals are perfectly positioned and well equipped for the task of translating raw data into a comprehensible, informative patient story.
At the 2015 AHIMA Convention in New Orleans, HealthITAnalytics.com caught up with outgoing President and Chair Cassi Birnbaum, MS, RHIA, CPHQ, FAHIMA, and President and Chair Elect Melissa M. Martin, RHIA, CCS, CHTS-IM to discuss the future of the HIM specialist in the rapidly evolving big data analytics environment.
“It’s been a very exciting journey this year,” Birnbaum said. “We’ll be toasting the transition to ICD-10 on October 1. It’s a modern, relevant code set that will support population health management, global health information exchange, and all of our initiatives. We’ve been working very, very hard over the past 12 years to reach this momentous occasion, and we’re really happy to celebrate it with our friends, colleagues, and industry stakeholders.”
ICD-10 represents a major victory for AHIMA, which has been steadfast in its advocacy for the implementation of the new code set. But now that ICD-10 is here, new challenges will arise from the increased granularity and specificity of future big data.
“We are going to have so much more data and so much more relevant information to be shared at a specific level,” said Martin. “A lot of folks have clinical trials and research units within their organizations, and they’re constantly reaching out to HIM professionals because we have the coded data to help them tell the story. So it all ties together.”
AHIMA unveiled its information governance framework at last year’s meeting in San Diego, and has worked diligently over the past twelve months to raise awareness and adoption of this important set of principles.
“We’ve been able to shine the light on information governance,” Birnbaum said. “At this point, we’re ready to hit the ground running.”
“We feel that information governance is the framework that will propel everything needed to make sure organizations get a return on their data. They’re collecting so much of it, and it’s difficult to normalize it. It’s difficult to do the necessary assessments for analytics and informatics so that we can really make a difference.”
Big data analytics is a top priority for many healthcare systems, but executives often have no clear idea of how to collect the right data or what to do with it when they have it. Martin and Birnbaum believe that the answers may lie in the HIM department.
“Those are some of the areas in the realm of informatics, analytics, and big data that we need to address,” said Martin. “Our members have to better understand a definition that resonates with them. We need to bridge the gaps between all the different types of informatics. Also, we want to focus on quality and CDI. Sometimes, we get very involved in CDI and we forget that there’s a very close tie to quality outcomes.”
Big data that closely follows stringent data integrity guidelines may be more useful for tasks such as predictive analytics and clinical decision support that help providers make more informed, timely, and effective treatment decisions.
“We’re looking at patient-specific data and really trying to move the needle in terms of the integrity of data collected at the patient level,” Birnbaum added. “Obviously that ties in very closely with our ICD-10 strategy, because we want to make sure that we’re telling the patient story accurately, completely, relevantly, and appropriately, and that we’re providing our physicians with tools to be successful and not disruptive.”
“That’s where the rubber meets the road for our profession. We’re there to make things easier, and to help optimize those systems of care.”
Process and workflow optimization are difficult tasks for healthcare systems that often admit to taking a fragmented, siloed approach to data integrity and analytics programs.
“What we’re seeing in major healthcare facilities and systems is that those are sometimes clinical quality and clinical documentation improvement staff work in two very distinct departments,” said Martin. “And both of them have a common cause, which is to make sure we bridge the gap between the physician documentation and the coded data.”
In addition to making its guiding information governance principles available to healthcare organizations of all sizes and types, AHIMA is rolling out its IG HealthRate program in 2016, which will allow providers to gauge their maturity and progress towards a connected big data analytics ecosystem.
Attendees at the conference were able to get a head start on their organizational assessments at the AHIMA booth on the show floor, said Martin. IG PulseRate, a free, web-based benchmarking framework, is one of two new services announced at the conference. The other initiative is AHIMA’s new IG Advisors service, a consulting group that will provide tailored implementation, remediation, and training services for organizations seeking to advance their data governance capabilities.
“Information governance is very exciting, and it will be really interesting to see how folks are responding to that,” Martin said. “If the number of people coming to our PulseRate booth is any representation, then I think they’re really going to flock to the HealthRate tool.”
The popularity of the assessment tool is just one indication that HIM professionals are taking on increasingly complex roles in their organizations. While coding expertise remains an integral part of the HIM department’s duties, ICD-9 and ICD-10 codes only tell part of the patient story. It often falls to health information management experts to find missing information, correct errors, track down stray pieces of data, and present the big picture in a meaningful way to everyone from clinicians to executives to the patients themselves.
“We are the conduit between medicine and the patient, and we make sense of it all,” Birnbaum stated. “We make the systems usable and purposeful, and we have to be able to translate the language of medicine into actionable information. That’s what our contribution to the healthcare industry is: to find out what we’re collecting and why we’re collecting it.”
As patients become more involved in their own care, they may be adding new complications to an already dizzyingly complex process. “Improving the health of populations is our ultimate goal,” said Birnbaum, “but we can’t do that unless the patient is involved and getting the information they need in order to help manage their chronic conditions.”
“We want to make sure that patient-generated health data or other information that the patient wants in their record is being seen and used by their providers, and that the provider feels that it’s coming from a trusted source.”
Curating the pending influx of patient-generated health data is only part of the future role for health information management workers, Martin added. “I think we have to consider the future of coding and the steps to get to informatics and analytics,” she said.
“One of the biggest challenges in a healthcare system is that everyone wants a coder to be on every committee. They’re very good at interpreting the data in the health record, they know how to translate it into the codes, and they know what public reporting entities are presenting. So the future of coding, I think, is moving towards analytics.”
The HIM department, like the clinicians they work with so closely, often faces unanticipated roadblocks from the very health IT tools that are supposed to streamline data collection and provide the heavy lifting for big data analytics. A little patience from both groups may be required until the evolution of EHRs, population health management systems, and analytics dashboards is a little further along.
“Ultimately, once the systems get much more mature than they are right now, and some of the technology tools get better than they are today, I think we’ll minimize some of those gaps and be able to focus on using the data, once we get it to the point where there’s trust and transparency,” Birnbaum said.
“What happens when physicians feel like they don’t have the right resources to make the process of electronic documentation meaningful, there are bad habits that get in place as far as copy/paste, or outdated dictation systems, and rouge notes,” she continued. “If we can set the stage and have the right tools that work with their workflow, that will help everyone succeed.”
The pressing need for cross-organizational collaboration was a theme that ran strongly throughout the convention. As value-based reimbursement, increased quality reporting requirements, and accountable care take hold throughout the industry, neither clinicians nor HIM experts can afford to keep their blinders on.
“Physicians should always reach out to us,” Martin urged. “We have folks that have all the necessary skills to help physicians improve their processes. HIM professionals understand how physicians are documenting in the record. They also understand the technology. HIM staff are typically at the top of the rung in regards to EHR super-users. So we know how to use the system, and we understand what physicians are trying to say.”
“And if there’s a problem that we don’t know how to fix, we can usually interpret it for the right people who can fix it for them,” she added. “So my request would be to reach out to your HIM department, because I think they’re the ones who can actually help physicians improve their workflow.”
“Implementing an EHR is a huge process, and sometimes it spans over many years. Often what happens is that you implement, but you don’t have time to optimize. If we could all look at HIM as the optimizers, then we can help out physicians, which is our goal.”