July/August 2021

HIM Challenges: Extending the Value of HIM Services
By Mark Gum
For The Record
Vol. 33 No. 4 P. 28

The days of HIM professionals functioning as medical record librarians are long gone. Today’s HIM professionals oversee the crossroads of clinical documentation, revenue cycle management, data privacy protection, and physician support services. A busy intersection indeed.

To do the job effectively, HIM departments orchestrate a constantly evolving mix of technology and human assets. Driven by changes in government regulations, EHR updates, and/or new technology aimed at adding revenue, reducing costs, or both, it seems all document creation efforts are in a constant state of evolution. Nothing stays the same for very long.

History has shown us that technology can save time and add value to document creation, revenue cycle management, privacy protection, and physician support—for example, the evolution of speech recognition (SR) and other artificial intelligence (AI) tools used in document creation. Over the past 20 years, SR and AI have reduced the medical transcription industry to a shell of its glory days while delivering savings to the health care market. At the same time, it is just as important to note that the transcription services market is still a billion-dollar industry driven by ease of use in certain workflow settings and the personal preferences of select physicians.

Given the complexities of patient care, if there is anything we can be certain of, it is that technology alone is not the answer. Like any tool, technology’s true value can be measured only by its capability to have a meaningful impact for a particular user at a particular time. As circumstances evolve, both the users and the technology must change to keep pace. Unfortunately, keeping pace with that change has proven to be one of the main contributors to physician burnout.

In response, HIM departments coordinate a wide range of evolving technologies and human support assets as change management has become the new norm. How such evolving options are orchestrated and optimized against the spectrum of physician's skills and preferences in support of their individual EHR user experience determines how smoothly and cost-effectively things will run. Cost-effective and efficient document creation and data management that serves the objectives of providers, patients, and organizations have become the ultimate balancing act.

Constantly evolving government regulations for data capture, privacy, and reimbursement are inherent to certified EHRs, as are the software updates required to keep pace. Accordingly, it would be unrealistic to expect every user to willingly embrace these changes. Nor should it be assumed they’ll seamlessly become competent with these changes. In the last decade alone, a multitude of technology and human-based document improvement initiatives were spawned simply to react to the inevitable problems caused by the constant state of flux.

The Value of HIM Services
As the value of clinical data continues to increase, it’s time to acknowledge that document creation has evolved from a basic clerical function into a clinical tool that ensures optimal ongoing care and accurate financial reimbursements. In short, a need has emerged for improved HIM support services to ensure consistent data results, regardless of a provider’s selected workflow.

Due to this constant state of flux, it’s important to remember the value HIM services add to technology development. With the complexities and challenges faced by today’s EHRs and supporting applications and before “fully automated” physician-centric workflow can take over, dedicated HIM support services will be required to help train that technology—provided physician burnout is not an acceptable side effect.

Given the constant evolution of clinical documentation requirements and tools, several critical issues arise: How can HIM services relieve provider documentation burdens, assist technology development, and ensure optimum value from today’s health care data? The predominantly clerical duties of the past simply will not cut it. Today’s HIM support teams can and should add value to the clinical variables that drive revenue cycle and compliance at the point of document creation. Physicians went to school to focus on patients, not paperwork.

One example of the conflict that can occur between labor support and technology can be found in the development of coding products dedicated to reducing full-time coding staff. Significant advances have been made since the launch of ICD-10, but, due to the exponential variables added, the result has been more about getting production volumes back to ICD-9 levels than effectively reducing the workforce, although some progress has been seen in specialties with minimal diagnosis and procedure variables.

Seasoned professionals know the true value added by today’s coders goes way beyond simple code selection and production benchmarks. Automated prompts now direct coders (or physicians) down certain paths based on preprogrammed algorithms and the software’s interpretation of what the data may (or could) justify. Such predictive patterns, vs unique circumstance considerations, can result in missed opportunities, cloned-looking results, and, more significantly, overcoding. Since program aggressiveness can be dialed up or down, coders must be diligent to avoid the significant fines levied when those prompts lead to overbilling.

Today’s savvy coders remain wary of the prompts and take into account more of the clinical care supporting data that traditionally fall under the domain of clinical documentation improvement (CDI) specialists. When given relevant clinical training, coders can expand their skillset and adjust their overall approach, while simultaneously improving CDI and increasing coding accuracy.

Clerical and clinical support do not need to be mutually exclusive. For example, clinical training of noncredentialed team members can help them contribute to the charts they touch and, as a result, enhance machine learning input for the technology tools they use.

Virtual Scribes
Another fast-growing HIM sector benefitting from a deliberate evolution from clinical to clerical support is virtual scribing. Unlike traditional HIM functions, in which a quality assurance function is easily scaled up or down in between the production team member and the client, scribing workflow necessitates front-line staff be on point all the time. Consequently, to proactively support providers and downstream document data use, the more scribes understand the clinical factors that contribute to care, the better.

While absorbing as many clerical duties as possible from the physician can reduce burnout factors and improve documentation accuracy, clinical understanding helps influence machine learning, facilitates improved ongoing care, and supports coding efficiency and other CDI functions that are traditionally done in retrospect.

Virtual scribes can directly impact care. For example, during a review of patient notes, a physician may question a scribe about a particular symptom that was included. The scribe may confirm it being mentioned by the patient, prompting the physician to order additional tests that may lead to a life-saving diagnosis of a serious condition.

Additional virtual scribe functions that benefit from improved clinical understanding include the following:

• previsit chart reviews with providers;
• sorting/prioritizing e-mails and voice mails;
• filtering/prioritizing EHR messages and tasks; and
• supporting patient data requests.

Keeping pace with changing technology and market expectations requires an evolution of HIM professionals’ skillsets, including becoming part of the clinical support team through additional training.

To support this value shift, some universities are developing HIM degree programs that include clinical course material. This includes adding specific clinical content to virtual scribe training and working with domestic partners such as vocational colleges and private sector training businesses.

The very survival of the HIM profession may depend on its ability to upgrade clinical support skills. Enhanced understanding of the clinical decision-making process and how and where HIM staff can add value will ultimately ensure the profession’s long-term security.

— Mark Gum is general manager of virtual scribing services at AQuity Solutions.