President Bush has set a goal of assuring that most Americans have electronic health records (EHRs) within the next 10 years, which was announced at a conference in Baltimore on April 27, 2004. To address issues of privacy, Bush said enrollment would be voluntary: "Your records are private if that's the way you want them to be." To push the electronic patient records initiative, Bush created a national health information technology coordinator, a sub-Cabinet-level position, at the Department of Health and Human Services (HHS).
President Bush has indicated that the federal government will set technical standards for the switch from paper to electronic medical records by the end of the year, so that doctors and hospitals can share patient records nationwide.
These are exciting times and very timely that the American Health Information Management Association's e-HIMT initiative has developed three major goals:
1. Accelerate the migration from paper to an electronic health information infrastructure.
2. Reinvent how we manage records and information, from creation through use.
3. Deliver measurable cost and quality results from improved information management.1
AHIMA has encouraged each member to take active roles in convincing their administrators they need to be involved in talking to technology vendors and in anticipating barriers to success before implementation of costly systems.
We know that in developing an electronic record, two approaches have generally been used. In the first approach, the facility seeks to take all patient information included in the paper-based medical record and make it available to multiple users at the same time via an imaged medical record system, also called an electronic medical record (EMR). In the alternative approach, the facility seeks to create a patient database containing data elements critical to patient care known as a computerized patient record (CPR) or a clinical data repository (CDR).
What are the e-HIM skills required to understand the planning and successful implementation of a completely EMR or CPR/CDR?
The transition from paper to electronic records requires time and careful planning. Experts forecast that EHRs will replace paper records during the next decade. The HIM professional must be part of the planning process as they are the ones who understand all the documentation requirements, retention requirements and uses of the medical record.
Have you examined the skills needed to be successful in the transition to a paperless HIM environment.
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Baseline skills:
What you may already have...
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Sources...options for gaining this expertise
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Basic computer, Internet and database application skills
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Consultants; college courses; evening courses in your neighborhood school system; computer technology programs.
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Working knowledge of regulatory requirements
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Research; Internet surfing on your own; working with your legal department and compliance officer or privacy officer; attending programs and conferences such as your local HIM association.
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Familiarity with accrediting body requirements
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Becoming active in your hospital's JCAHO survey preparation team; attending sessions at the AHIMA national convention.
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Understanding of the patient care documentation process
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Reading and research; working with the patient care/nursing team on forms and documentation processes and clinical care guidelines.
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Understanding of how to protect security and privacy of patient information
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Take the AHIMA online programs for Privacy and Security; attend AHIMA and HIMSS meetings; become active on your hospital's privacy and security initiatives.
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Knowledge of how to capture complete data
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Work with your facilities CIO and information technology team to learn what is available today; attend seminars provided by various vendors; work with nursing informatics teams;
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Familiarity with data standards and data set requirements
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Conduct your own Web research of health data and tools; AHIMA's Body of Knowledge; read health care informatics articles; volunteer to work on a data standardization committee at your hospital.
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Advanced skills:
What you need to learn...
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Possible solutions for your personal professional development plan......
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Knowledge of emerging information technologies
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Take a college course or graduate level course in an IT program; attend AHIMA and HIMSS conferences; and reading.
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Ability to develop requests for proposals (RFPs), score and rank the results
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Participate in a requirements definition/vendor evaluation process in your facility or as a volunteer of an IT committee for your school; work with consultants in learning best practice methodologies for RFPs and selection processes.
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An expanding network of colleagues with which to share best practices
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Start a best practices network in your local or state HIM association; participate in the AHIMA CoP and share best practices.
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Advanced knowledge of data standards and data set requirements
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Take a graduate course; attend special workshops on data standards; research health care data set requirements on the Internet; work with your consultants and vendors.
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Big picture of how health information is used throughout the facility for patient care, reimbursement, statistical analysis, research and as a legal record
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Prepare a data flowchart of all health information with sources and uses for your hospital; attend HFMA meetings to learn more about the data needs in the revenue cycle; take a statistical analysis course.
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Change management skills
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Attend change management programs offered by your organization's training and development department; read books from the library on change management; take a college level course on change management and organizational effectiveness.
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Project management skills
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Take courses offered by the Project Management Institute (PMI); join a local PMI association in your community and learn from others; think about seeking certification in project management and six sigma.
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Negotiation skills to ask for the budget to make change
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Read books on negotiation skills; enroll in courses that are aimed at sales; practice negotiating in your personal life;
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Costs and the return on investment (ROI)
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Work with your hospital's consultants to learn various methodologies on 'ROI'; review proposals for programs and services in your facility/department and inquire about each item that is reported to be a ROI; conduct your own cost/benefit analysis on a program or service to learn hands on;
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These are suggested next steps depending on your own self-assessment of your baseline and advanced skills/needs. Realize that this is a journey and that you are not alone. It is a major transformation that everyone in the health care industry is embarking on in 2004!
Reference
1 AHIMA Mobilizes to Meet the e-HIMT Call, AHIMA Advantage, February 2003.
Bonnie Cassidy is a vice president of client services for Precyse Solutions, in the Atlanta Office.