Patty: In our last Hands-on Help column (April 25) we began writing about new roles in HIM departments that are emerging due to the advancement of electronic health records (EHRs). However, new roles are emerging for HIM professionals in other departments of health care organizations as well.
Leslie: That does seem to be a trend, Patty. As we envision the future of the HIM profession, we must recognize that EHRs are changing significantly the organizational structure through which HIM professionals contribute to health care organizations. Today, the majority of HIM professionals still work in HIM departments. What I find most interesting is that the need for our core competencies is increasing throughout the health care organization. I envision more and more departments directly employing HIM professionals.
Patty: Information systems (IS) departments have been employing HIM professionals for several years. Let's talk to Kerry Heinecke, RHIA, about her role in IS at Marshfield (WI) Clinic. She is a software product analyst in the IS department development area. Marshfield Clinic is a large independent nonprofit clinic with 40 centers throughout Northern, Central and Western Wisconsin. They have 730 physicians in more than 86 medical specialties, serving more than 350,000 patients annually. Let's find out more about Kerry's role as an HIM professional working in the IS department, and how EHR is evolving at Marshfield Clinic.
Leslie: Kerry, please tell us how you came to be working in IS at Marshfield Clinic.
Kerry: Early in my career, during the late 1980s, I was an instructor and a manager in a large county teaching hospital on the East Coast. In 1995 I was promoted to a managerial position over imaging services. I worked closely with the IS department and concluded from that experience that the future of HIM was going to be electronic. I wanted to be part of making that future a reality. So I went back to school, taking night courses in programming, operating systems and the Internet so that I would be better educated on the technology side of our profession. While in school I worked full time in the hospital managing imaging services, along with physician services and release of information, as well as second and third shifts.
Patty: It sounds like you had a very full plate at that point.
Kerry: I did, and I also wanted to move back to Wisconsin to be closer to my family. I spent about 9 months job searching to find exactly the right match for my interests and skills. At the time I really wanted to do training and work with document management systems. I found my dream job at the Marshfield Clinic where I was hired to do training on clinical applications. I joined the in-house development team in 2003.
Leslie: Kerry, how did the EHR evolve at Marshfield Clinic?
Kerry: Marshfield Clinic is creating its own homegrown EHR. We chose to do it ourselves so that we could tailor the system to our needs and be able to easily integrate the entire system.
Patty: Please tell us a little about the components that you already have in place.
Kerry: Sure, let's follow a patient through an encounter. A medical assistant (MA) is electronically notified that a patient has arrived. The MA picks up a tablet PC, greets the patient and takes him/her to the exam room. On the way over, the MA stops at the scale and records the patient's weight on the tablet PC. After rooming the patient, the MA finishes taking the patient's vital signs and verifies the patient's current medication list, which is all entered into the EHR. The MA also enters information if a patient calls between appointments.
Leslie: Why did you select tablet PCs rather than having computers in each exam room?
Kerry: Several reasons: First, they can be used for many forms of data entry. The users can use the tablet to input data with a stylus to write notes, use a pick list or dictate notes. Second, we were designing the system with workflow in mind and wanted a point of care device that was portable, making documentation accessible at every point in the encounter. Third, if we had chosen to put computers in the exam room, we calculated that we would need two to three PCs per physician. With the tablets, each physician and each assistant gets one. They are wireless and the physicians can use one from home if they set up a wireless network at home.
Patty: What other components or systems comprise your EHR?
Kerry: When a physician sees a patient, he/she can open the Medication Manager program and view the list that the MA just verified, as well as renew or write new prescriptions. If he is adding a drug, he can check the drug library within the medication program and select the new medication. And, when the physician is dictating his note, the med list is automatically imported into the documentation.