July 2013

An International Perspective on HIM
By Sandra Nunn, MA, RHIA, CHP
For The Record
Vol. 25 No. 10 P. 26

The International Federation of Health Information Management Associations (IFHIMA) opened its 2013 Congress in Montreal, Canada, with Education Day. Keynote speaker Merida Johns, PhD, RHIA, discussed leadership and the need to develop HIM curricula that can help HIM professionals move into more advanced roles. Pointing to the need to make “multidimensional social progress,” she told HIM professionals to challenge themselves and establish HIM programs to create future leaders.

Johns was followed by educators from HIM programs around the world. A common theme was the increasing difficulty of placing students in internships where they could gain hands-on experience prior to launching their HIM careers. Discussions focused on bachelor’s and master’s programs that have adopted new approaches, such as staying in constant contact with health care entities and having students participate in internships as early as their junior year. These ideas are an about-face from the more structured traditional internships.

Programs also have recognized that their undergraduate and graduate students no longer are necessarily 18-year-olds just entering the workforce. The majority of HIM programs now attract candidates with previous experience, often with existing undergraduate or graduate degrees. They also often work full or part time and have family obligations during their studies.

With that in mind, internships are being redesigned to accommodate those who cannot take off three or four unpaid weeks to get experience in a new field. Programs now offer weekly internships featuring hospital tours, project work that doesn’t require on-site participation, specialized speakers and career specialists, and simulations. There also are software programs, such as AHIMA’s Virtual Lab, that give students an idea of what it’s like to work in an EHR environment.

Programs are becoming more individualized, contouring internships to students’ experiences and inherent talents. The IFHIMA speakers mentioned several innovative projects, including some that focused on learning how to create databases, write HIPAA business associate or security agreements, evaluate discharge not final billed workflow problems, establish HIM career ladder progressions, and assess coding accuracy in specialized areas.

Sue Walker, senior lecturer in public health and health services at the Queensland University of Technology in Australia, discussed the organization’s efforts to ensure coding integrity, while longtime IFHIMA member Carol Lewis chronicled her own efforts to pilot test the training of morbidity coders in Africa. Lewis expressed concerns about the quality of coded data and their effect on health care in places where metrics are absent and audits are not conducted. She emphasized the value of the World Health Organization-Family of International Classifications core curriculum, which lays the foundation for measures to ensure more accurate morbidity and mortality coding to enable nations to compare apples to apples when issuing disease and death statistics.

A Busy Agenda
Although the numerous general sessions extended over three days, several common themes emerged. For the most part, the congress focused on data and how technology professionals could transform their organizations by unearthing valuable nuggets buried in reams of information. Canada’s efforts to promote the well-being of its citizens were on prominent display. Because of the unified nature of the country’s health care system, Canada’s leaders have been able to create a national vision in which all Canadians benefit from a more intelligent approach to health care.

Key terms became commonplace during many of the presentations. Terms such as “transformation” and “conversion” not only apply to how data and information were being managed, they also described the manner in which new jobs are creating a demand for higher skill levels. An educational track dubbed “workforce transformation” drew overflowing crowds eager to learn about how the enormous volumes of EHR data can be utilized to deliver better care.

At one session, HIM professional Maria Muia and IT expert Eugene Wong of North York General Hospital in Toronto labeled the changes at their organization as an “information-led transformation.” They had been conducting retrospective data analytics but needed to find someone with a predictive analytics background to give them a competitive edge and provide strategic direction. The unavailability of skilled resources stretched their search for a competent data person to more than one year.

Unlike in the United States, HIM in Canada is less a force in revenue cycle management and more of a business intelligence resource. For example, Emerald Health Information Systems in Ottawa, which is working on standards for its multiple legacy and disparate systems, devotes scarce information management resources to data analytics and data manipulation.

Elsewhere, Germany’s Ulrich Wirth chronicled the genesis of a new information specialist role being created in his HIM program, while Lorraine Nicholson, an IFHIMA past president, detailed how Marshall McLuhan’s The Gutenberg Galaxy, a 1962 book examining the effects of mass media on European culture and human consciousness, influenced the development of an information management program in Tanzania.

Closer to home, Pam Oachs, MA, RHIA, an assistant professor, and Ryan Sandefer, MA, CPHIT, chair, both of the department of health informatics and information management, at the College of St Scholastica in Duluth, Minnesota, presented “Curriculum Analysis and Assessment Through Collaboration and Dialogue,” which touched on two core competencies in HIM education: a strong need for analytical skills and the ability to develop communication and collaboration skills (team or group focus). Oachs and Sandefer are in the process of creating their first massive open online course, an introduction to data mining.

They can take a page from the book of the Canadian Institute for Health Information, whose educational treatise was presented by Janet Manuel, CHIM (RHIA equivalent), an HIM professional who delighted the audience with a summary of the vast list of attributes required by today’s HIM students, including the following:

• the ability to map data and convert information, including understanding one-to-one and many-to-one relationships;

• a deep knowledge of standards that Manuel dubbed “tabulation rules”;

• skilled wordsmith capabilities (ie, the ability to document well for data-reporting purposes);

• an understanding of data-quality methodologies, including reabstraction studies, coding and classification standards, and database response methods;

• the wherewithal to conduct presentations and “think on your feet”;

• collaboration skills, including participating in research studies; and

• a good ear to understand the patient’s voice.

Noteworthy Guests
Plenary speakers were equally as interesting. Hugh MacLeod, CEO of the Canadian Patient Safety Institute, could have been summarizing the entire event when he said, “Accurate information must be the air we breathe.”

Lynn Nagle, RN, PhD, founding president of the Canadian Nursing Informatics Association, suggested it would be worthwhile to capture codified nursing data to better manage and enrich Big Data. On an educational note, she heralded forward-thinking efforts to prepare today’s nurses for tomorrow’s challenges. “We are currently educating students for jobs that don’t exist yet,” Nagle said.

Technical professionals also were in abundance. Anjul Bhambhri, of the magazine Association for Computing Machinery, offered “Six Tips for Students Interested in Big Data Analytics,” stressing that students should gain domain expertise, or industry knowledge, across several fields before applying data analysis to gain the best insights. He recommended that students work in health care—whether on the clinical or HIM side—prior to learning data analytics.

Applying analytics across an entire province, Kathleen Addison, vice president of HIM at Alberta Health Services, and Sharilyn Kmech, CHIM, director of provincial standards for HIM, detailed the creation of an electronic information framework, work only dreamt of so far in the United States.

Alberta also is ahead of the curve in terms of data governance, employing three full-time employees under the charge of Karanne Miller Lambton, CHIM, CPHIT, CPEHR, executive director of standards and strategies for HIM who has developed an information-sharing framework that includes the college of physicians and surgeons. Together, they are developing “shared control of the content and use of the EHR” with 37 processes to monitor.

At the national level, Canadian organizations employ a governance structure for “nonapproved actions” with corporate policies and procedures for the mandated use of health care data. Numerous other speakers addressed issues such as how to handle unstructured information in terms of establishing standards to capture a significant amount of unanalyzed data. Specialists in structured data (coded and defined) discussed pending health information exchanges and how reference terminologies and a more skilled workforce would allow for high-integrity data to be exchanged, all for the good of the patient. In that respect, the experts agreed that education is a key enabler.

— Sandra Nunn, MA, RHIA, CHP, is a contributing editor at For The Record and the principal of KAMC Consulting in Albuquerque, New Mexico.