What is HIM?
It can simply be described as the practice of acquiring, analyzing, and protecting the digital and traditional medical information to support the provision of quality health care. This process combines the aspects of business, science, and technology
History of HIM
Many people are wondering when and how the HIM began. Let us begin by analyzing the history of HIM
The field of health information management (HIM) has been a recognized field of professional study for 75 years. It was originally called medical record science and members of the profession were originally called medical record librarians. From its inception, the mission of the profession was to elevate the standards of clinical recordkeeping in hospitals, dispensaries, and other healthcare facilities. Since its founding, the professional association, now known as the American Health Information Management Association (AHIMA), and the professionals affiliated with it have been advocates for the effective management of clinical data and health records to ensure their confidentiality, integrity, and availability in every type of healthcare setting.
HIM professionals serve the healthcare industry and the public by managing, analyzing, and utilizing the information vital for patient care, and making it accessible to healthcare providers when and where it is needed . AHIMA and its members strive to support the delivery of “quality healthcare through quality information”
Beginning with the managed care movement in the 1980s, effective information management began to emerge as a top priority for healthcare institutions. Subsequently, events affecting healthcare delivery and the management of healthcare delivery services have placed even greater pressure on healthcare organizations to improve their information-handling capacity and functionality.
Johns (2006) emphasizes that the healthcare industry now fully recognizes the importance of information flow across departmental boundaries and the necessity of broad dissemination throughout the organization. Currently, there are significant government and industry initiatives focused on the goal of improving the delivery of healthcare by “bringing timely health information to, and aiding communication among, those making health decisions for themselves, their families, their patients, and their communities”.
These initiatives have been supported through a series of public and private endeavors to address critical elements in accomplishing the goal. The efforts include a series of Institute of Medicine reports, the Department of Health and Human Services (HHS) recommendations for creating a National Health Information Infrastructure, the Markle Foundation’s Connecting for Health, and efforts toward standards development. This chapter provides a brief introduction to the HIM profession and focuses on the changing nature of its core domain of practice. It sets the stage for the remaining chapters by providing a context for the broad range of topics that must be addressed in a textbook whose purpose is to describe the concepts, principles, and practices associated with the HIM profession in its current state of transformation
The Modern Healthcare Environment
In the 1990s, several forces at work in the U.S. healthcare industry had a transformational effect on the HIM profession. During that decade, competition among healthcare providers was stimulated by major changes in the reimbursement system used by Medicare and Medicaid (two federally mandated healthcare programs). Integrated healthcare delivery systems also began to emerge as significant organizational models, and managed care delivery systems continued to expand. As a result of these developments, the availability of timely and accurate clinical information has become critical to the viability of healthcare organizations. Medical and administrative staffs recognize that the information gathered from clinical records is an invaluable organizational asset. They also understand that this information represents an important quality indicator and a vital tool for efficiently managing the business of healthcare in a tight financial environment. The wise application of increasingly sophisticated computer technology also has received increased attention among healthcare professionals and organizations. Technology is the obvious solution to the industry’s need for greater efficiency in managing the ever-increasing volume of healthcare data. In addition, as diverse healthcare decision makers look for flexibility in how to access and analyze vast electronic repositories of clinical data, advanced decision support technology is critical to meeting that demand.
Today, these trends continue to affect the practice of health information management and healthcare in general as:
- The federal government strategic vision includes every American having an interoperable electronic health record (EHR) by the year 2014. In his first message to Congress in January 2009, President Obama pledged economic stimulus support to the development of HIT initiatives.
- State governments and regional public/private partnerships work to establish health information exchange (HIE) systems that facilitate the transfer of health information among authorized parties to enhance the quality of care and reduce the cost of healthcare services.
- Payers pilot healthcare reimbursement systems that provide incentives for healthcare organizations to implement health information technologies (HIT) to support quality-of-care programs.
- Regulators and accreditation agencies focus on the use of computer-based information technologies to improve patient safety and reduce the number of medical errors.
- Healthcare consumers are creating and maintaining personal health records (PHRs) with the support of many employers, healthcare providers, third-party payers, and independent HIT vendors to facilitate access to more complete and accurate information for continuing care.
- Workforce shortages place greater emphasis on technological systems for improving productivity of the healthcare workforce.
- Integrated information system (IS) solutions as well as clinician-friendly hardware and applications are continuing to evolve.
- The Internet and its derived technologies make connectivity across otherwise disparate information systems accessible and affordable for healthcare organizations.
Contemporary Health Information Management
The HIM profession is the only profession that has as its core professional mission the quality of the data collected and maintained in the course of delivering healthcare services. Although clinical and allied healthcare professionals depend on the availability of high-quality data to perform clinical decision making, their primary concern is providing diagnostic and therapeutic services, not managing clinical information.
The administrators and managers of healthcare organizations also use collected clinical information to plan and manage healthcare services, but managing the quality of the data they use is not their major concern.
Similarly, computer scientists and technicians are concerned primarily with the performance of software and hardware configurations; researchers are concerned primarily with the development of scientific solutions to important questions; third-party payers are concerned primarily with the control of financial resources; and policy makers are concerned primarily with incentives for cost-effectiveness, social justice, and ethical practice. Although they all rely on high-quality data, only the HIM profession is charged with ensuring the availability of high-quality data for a variety of uses and users.
In an information-intensive environment embedded within a technology supported framework, HIM professionals must continuously build and market their unique knowledge base and competencies in the following areas:
- Practice standards, laws, and regulations related to ensuring the accuracy, completeness, integrity, privacy, and security of healthcare information
- The legal health record, as the business record for each healthcare organization
- Healthcare data standards
- Healthcare data analytics and reporting methods
- Clinical coding, classification, and reimbursement systems • Health record and information systems design, functions, and maintenance
- Organizational and cross-disciplinary modes of functioning to achieve quality and productivity goals.
Once applied in a world of paper-based records and manual systems, the HIM knowledge base and competencies are now needed to effectively transition vital clinical data resources into electronic clinical repositories and EHR systems. These modern technological systems support both the operational and strategic needs of the organization’s workforce and decision makers. In addition, “The shift to electronic practice has enlivened the profession and opened doors to new work settings…such as biotechnology, public health, pharmaceuticals, and government”
Today the HIM profession remains committed to its original mission to elevate health record standards and practices. It does so, however, in a healthcare environment that is becoming more and more technology driven in both its work processes and information flow, as well as more and more dependent on the quality and accessibility of the information contained within clinical records.
HIM professionals work to ensure that their communities and customers are provided high-quality and cost-effective healthcare information services. HIM skills and competencies are needed by all organizations that use person-specific or aggregate patient data. The national push to adopt health information technology will accelerate the demand for a qualified HIM workforce.
Working in strong collaborative partnerships with specialists in information technologies and with specialized healthcare data and information users (physicians, nurses, pharmacists, therapists, administrators, researchers, policy makers, and others), health information managers have become key players within the emerging discipline of healthcare informatics.
Healthcare informatics focuses on designing and implementing technology-based information systems to support the specialized activities associated with each type of healthcare worker. For example, nursing informatics focuses on systems that support the work of nurses, and medical informatics focuses on systems that support the work of physicians. Similarly, consumer informatics systems support the activities of patients, long-term care residents, and healthcare clients.
Thus, to carry on the important legacy of their predecessors, today’s HIM professionals support an adapted vision of their unique contribution. They build and maintain an accompanying set of strengthened competencies for the healthcare industry they serve. They envision how the concepts, principles, and practices at the core of the HIM knowledge base and competencies continue to apply in their changing work environment and settings. In addition, they assess their adaptive strengths and weaknesses relative to that vision and, most important, they take action to position themselves appropriately to contribute their unique expertise to the organizations they serve.
The HIM profession began with the founding of the Association of Record Librarians of North America in 1928. The association’s original goal was to improve clinical recordkeeping in healthcare facilities. The association, now known as the American Health Information Management Association, and a new generation of HIM professionals have inherited a powerful legacy from those original medical records pioneers. Today, HIM professionals have an extraordinary opportunity and obligation to build on their professional legacy by elevating the standards for clinical data and information systems in a healthcare environment that demands integrated, computer-based, user-focused data repositories and warehouses. The viability and vitality of the HIM profession in the future depends on the commitment of current and future professionals to think and act strategically in order to address the data and information needs of an evolving healthcare industry. To meet that challenge, HIM professionals must continually update their knowledge base and competencies through self-assessment and commitment to lifelong learning, and they must actively take part in their professional organizations’ activities at the local, regional, state, and national levels.