Health information management (HIM) is information management applied to health and health care. It is the practice of acquiring, analyzing and protecting digital and traditional medical information vital to providing quality patient care. With the widespread computerization of health records, traditional (paper-based) records are being replaced with electronic health records (EHRs). The tools of health informatics and health information technology are continually improving to bring greater efficiency to information management in the health care sector. Both hospital information systems and Human Resource for Health Information System (HRHIS) are common implementations of HIM.
Health information management professionals plan information systems, develop health policy, and identify current and future information needs. In addition, they may apply the science of informatics to the collection, storage, analysis, use, and transmission of information to meet legal, professional, ethical and administrative records-keeping requirements of health care delivery. They work with clinical, epidemiological, demographic, financial, reference, and coded healthcare data. Health information administrators have been described to "play a critical role in the delivery of healthcare in the United States through their focus on the collection, maintenance and use of quality data to support the information-intensive and information-reliant healthcare system".
The World Health Organization (WHO) stated that the proper collection, management and use of information within healthcare systems "will determine the system's effectiveness in detecting health problems, defining priorities, identifying innovative solutions and allocating resources to improve health outcomes".
Health information management professionals plan information systems, develop health policy, and identify current and future information needs. In addition, they may apply the science of informatics to the collection, storage, analysis, use, and transmission of information to meet legal, professional, ethical and administrative records-keeping requirements of health care delivery. They work with clinical, epidemiological, demographic, financial, reference, and coded healthcare data. Health information administrators have been described to "play a critical role in the delivery of healthcare in the United States through their focus on the collection, maintenance and use of quality data to support the information-intensive and information-reliant healthcare system".
The World Health Organization (WHO) stated that the proper collection, management and use of information within healthcare systems "will determine the system's effectiveness in detecting health problems, defining priorities, identifying innovative solutions and allocating resources to improve health outcomes".
History and development of HIM standards in the United States
HIM standards began with establishment of AHIMA
Health information management's standards history is dated back to the introduction of the American Health Information Management Association, founded in 1928 "when the American College of Surgeons
established the Association of Record Librarians of North America
(ARLNA) to 'elevate the standards of clinical records in hospitals and
other medical institutions.'"
In 1938, AHIMA was known as American Association of Medical
Record Librarians (AAMRL) and its members were known as medical record
experts or librarians
who studied medical record science. The goal was to raise the standards
of records keeping in hospitals and other healthcare facilities. The
individuals involved in this profession were promoters for the
successful management of clinical records to guarantee accuracy and
precision. Over time, the organization's name changed to reflect the
evolving field of health information management practices, eventually
becoming the American Health Information Management Association. The
association's current name is meant to cover the wide variety of areas
which health professionals work in today.
AHIMA members affect the quality of patient information and
patient care at every touch point in the healthcare delivery cycle. They
often serve in bridge roles, connecting clinical, operational, and
administrative functions.
HIMSS establishment in 1961 increased industry knowledge
The Healthcare Information and Management Systems Society (HIMSS) was organized in 1961 as the Hospital Management Systems Society (HMSS), an independent, unincorporated, nonprofit, voluntary association of individuals. It was preceded by increasing amounts of management engineering activity in healthcare during the 1950s, when teachings of Frederick Winslow Taylor and Frank Bunker Gilbreth, Sr. began to attract the attention of health leaders.
The HIMSS grew to include chapters, membership categories,
publications, conventions, and continues to grow in different parts of
the world via its Europe, Asia Pacific, and Middle Eastern branches.
Accredited HIM educational program development
The Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM) defines standards which higher education health information management and technology programs must meet to qualify for accreditation. Students who graduate from an accredited associate's, bachelor's or certificate program are qualified to sit for their respective exams for certification as a Registered Health Information Technician (RHIT) – via graduation from an accredited associate or certification program or Registered Health Information Administrator
(RHIA), which requires education through an accredited bachelor or
certification program. Competency requirements are maintained by CAHIIM
in their associate degree Entry-Level Competencies and Baccalaureate
Degree Entry-Level Competencies definitions.
Modern development
Electronic health records
The electronic health record has been continually expressed as an
evolvement of health record-keeping. Because it is electronic, this
means of record keeping has been both supported and debated in the
health professional community and within the public realm.
In the United States, 89% of those who responded to a recent Wall Street Journal
poll described themselves as "Very/Somewhat Confident" in their health
care provider who used electronic health records compared to 71% of
respondents who responded positively about their providers who didn't or
don't use electronic health records. As of 2008, more than fifty-percent of Chief Information Officers
polled listed that they wanted ambulatory electronic health records in
order to have the health information record available to move across
each stage of health care.
Health information managers are charged with the protection of
patient privacy and are responsible for training their employees in the
proper handling and usage of the confidential information entrusted to
them. With the rise of technology's importance in healthcare, health
information managers must remain competent with the use of information
databases that generate crucial reports for administrators and
physicians.
Educational programs
The requisites and accreditation processes for health information
management education and professional activity vary across
jurisdictions.
In the United States, the CAHIIM requires continued accreditation
for accredited programs in health information management. The current
standard is that accreditation may be maintained with periodic site
visits, submission of an annual report, informing CAHIIM of adverse
changes within the program and paying CAHIIM administrative fees. HIM students may opt to participate in a full-time bridge program
called the Joint Bachelor of Science/Masters Program. With this
program, students can achieve both the Bachelor of Science in Health
Information Management and the Master of Health Services Administration
Program (BSHIM/MHSA). The full-time bridge program allows students to
achieve both degrees in five years. Students pursuing the BSHIM/MHSA
will be prepared to assume management and executive positions in
health-related organizations such as: hospitals, managed care
organizations, health information system developers and vendors, and pharmaceutical companies, and bring their knowledge in HIM to these positions.
In Canada, graduates of Canadian Health Information Management
Association (CHIMA) programs are eligible to write a national
certification examination to pursue a profession in HIM.
Online program availability
There
are many programs that are also available online. Online students
collaborate with in-class students using internet technology. With
online learning, students are allowed to go through the programs at
their own pace. Online students are included in class through group
lectures that are recorded and put online, discussion boards and are
members of group projects with in-class students. Some online students
are even allowed to attend some classes on campus and take some classes
online.
The CAHIIM lists accredited online programs on its website.
Further education for health information professionals
Education
is an important aspect in being successful in the world of health
information management. Aside from initial credentials, health
information professionals may wish to pursue a Masters of Health
Information Management, Masters of Business Administration, Masters of Health Administration,
or other Masters programs in health data management, information
technology and systems, and organization and management. Gaining further
education advances the health professional's career and qualifies the
individual for upper-management positions.
Canada (CHIMA)
In
Canada, current HIM employees are mostly called the "Health Information
Management Professionals", with the designation of "Certified Health
Information Manager" (CHIM). The accrediting association here is the
Canadian Health Information Management Association (CHIMA).
The following list below consists of Canadian post-secondary schools
that have given full accreditation for their HIM programs from CHIMA:
Diploma level
- Alberta: Southern Alberta Institute of Technology in Calgary
- British Columbia: Douglas College in Coquitlam
- Manitoba: Red River College in Winnipeg
- New Brunswick: New Brunswick Community College in Moncton
- Nova Scotia: Nova Scotia Community College in Halifax
- Ontario: Fleming College in Peterborough
- Ontario: George Brown College in Toronto
- Ontario: St. Lawrence College in Kingston
- Ontario: Westervelt College in London
- Quebec: Collège Ahuntsic in Montréal
- Quebec: Cégep régional de Lanaudière in L'Assomption
- Quebec: Collège Laflèche in Trois-Rivières
- Quebec: O'Sullivan College in Montreal
- Quebec: Cégep de la Gaspésie et des îles in Gaspé et Îles-de-la-Madeleine
- Saskatchewan: Saskatchewan Polytechnic in Regina
Bachelor degree level
- Ontario: Conestoga College in Kitchener
- Ontario: Ryerson University in Toronto
Distance learning
- Nova Scotia: Heritage Professional Centre in Sydney
- Ontario: HealthCareCAN/CHA Learning in Ottawa
- Saskatchewan: Saskatchewan Polytechnic in Regina
- Nova Scotia: Centre for Distance Education
Elements
Healthcare
quality and safety require that the right information be available at
the right time to support patient care and health system management
decisions. Gaining consensus on essential data content and documentation
standards is a necessary prerequisite for high-quality data in the
interconnected healthcare system of the future. Continuous quality
management of data standards and content is key to ensuring that
information is usable and actionable.
Records
- The patient health record is the primary legal record documenting the health care services provided to a person in any aspect of the health care system. The term includes routine clinical or office records, records of care in any health related setting, preventive care, lifestyle evaluation, research protocols and various clinical databases. This repository of information about a single patient is generated by health care professionals as a direct result of interaction with a patient or with individuals who have personal knowledge of the patient.
- The primary patient record is the record that is used by health care professionals while providing patient care services to review patient data or document their own observations, actions, or instructions.
- The secondary patient record is a record that is derived from the primary record and contains selected data elements to aid non clinical persons in supporting, evaluating and advancing patient care. Patient care support refers to administration, regulation, and payment functions.
Practices
Methods to ensure Data Quality
The
accuracy of data depends on the manual or computer information system
design for collecting, recording, storing, processing, accessing and
displaying data as well as the ability and follow- through of the people
involved in each phase of these activities. Everyone involved with
documenting or using health information is responsible for its quality.
According to AHIMA's Data Quality Management Model, there are four key
processes for data:
- Application: the purpose for which the data are collected.
- Collection: the processes by which data elements are accumulated.
- Warehousing: the processes and systems used to store and maintain data and data journals.
- Analysis: the process of translating data into information utilized for an application.
Each aspect is analyzed with 10 different data characteristics:
- Accuracy: Data are the correct values and are valid.
- Accessibility: Data items should be easily obtainable and legal to collect.
- Comprehensiveness: All required data items are included. Ensure that the entire scope of the data is collected and document intentional limitations.
- Consistency: The value of the data should be reliable and the same across applications.
- Currency: The data should be up to date. A datum value is up to date if it is current for a specific point in time. It is outdate if it was current at some preceding time yet incorrect at a later time.
- Definition: Clear definitions should be provided so that current and future data users will know what the data mean. Each data element should have clear meaning and acceptable values.
- Granularity: The attributes and values of data should be defined at the correct level of detail.
- Precision: Data values should be just large enough to support the application or process.
- Relevancy: The data are meaningful to the performance of the process or application for which they are collected.
- Timeliness: Timeliness is determined by how the data are being used and their context.
Health information professionals
HIM is a very broad and successful field for health care professionals.
There are several career opportunities in Health Information Management
and many different traditional and non-traditional settings for an HIM
professional to work within.
- Traditional settings include: Managing an HIM medical records department, cancer registry, coding, trauma registry, transcription, quality improvement, release of information, patient admissions, compliance auditor, physician accreditation, utilization review, physician offices and risk management.
- Non-traditional settings include: consulting firms, government agencies, law firms, insurance companies, correctional facilities, extended care facilities, pharmaceutical research, information technology and medical software companies.
Health information managers
Professional
health information managers manage and construct health information
programs to guarantee they accommodate medical, legal, and ethical
standards. They play a crucial role in the maintenance, collection, and
analyzing of data that is received by doctors, nurses, and other
healthcare players. In return these healthcare data contributors rely on
the information to deliver quality healthcare. Managers must work with a
group of information technicians to guarantee that the patient's
medical records are accurate and are available when needed.
In the United States, health information managers are typically certified as a Registered Health Information Administrator
(RHIA) after achieving a bachelor's degree in health informatics or
health information management from a school accredited by the Commission
on Accreditation for Health Informatics and Information Management
Education (CAHIIM) and after passing their respective certification
exam.
The Certified Health Informatics Systems Professional (CHISP)
certification offered by American Society of Health Informatics Managers
(ASHIM)
is to credit a working level IT or clinical professional who is able to
support physician adoption of Health IT. A CHISP professional needs to
process knowledge of the health care environment, Health IT, IT, and
soft skills including communication skills.
RHIAs usually assume a managerial position that interacts with
all levels of an organization that use patient data in decision making
and everyday operations.
They may work in a broad range of settings that span the continuum of
healthcare including office based physician practices, nursing homes,
home health agencies, mental health facilities, and public health
agencies.
Health information managers may specialize in registry management, data management, and data quality among other areas.
Medical records and Health information technicians
Medical records (MR) and Health information technicians (HIT) are
described as having the following duties according to the U.S. Bureau of
Labor Statistics' Occupational Outlook Handbook:
assemble patients' health information including medical history, symptoms, examination results, diagnostic tests, treatment methods, and all other healthcare provider services. Technicians organize and manage health information data by ensuring its quality, accuracy, accessibility, and security. They regularly communicate with physicians and other healthcare professionals to clarify diagnoses or to obtain additional information.
The International Labour Organization's International Standard Classification of Occupations
further notes: "Occupations included in this category require knowledge
of medical terminology, legal aspects of health information, health
data standards, and computer- or paper-based data management as obtained
through formal education and/or prolonged on-the-job training.
MRHITs usually work in hospitals. However they also work in a
variety of other healthcare settings, including office based physician
practices, nursing homes, home health agencies, mental health facilities, and public health agencies. Technicians who specialize in coding are called medical coders or coding specialists.
In the United States, health information technicians are certified as a Registered Health Information Technician (RHIT) after completing an associate degree in health information technology
from a school accredited by the Commission on Accreditation for Health
Informatics and Information Management Education (CAHIIM) before they
may take their certification exam.