Standing your ground: the importance of Health Information ...

Editorial

Standing your ground: the importance of Health Information Managers sharing what they do

Joan Henderson

Abstract: Health information management professionals have a broad range of skills that are invaluable to the health sector. The advent of the electronic health record has provided the opportunity to aggregate patient data to answer clinical and policy questions in a systematic, timely and reproducible way.The possibility of linking datasets provides greater opportunities for answering clinical and policy questions, and Health Information Managers (HIMs) have the best skill set to inform about data quality, coding and classification, privacy, security, and medicolegal implications involved in the ethical handling of such datasets. HIMs have access to a wealth of data that could improve patient care and reduce unnecessary service utilisation, and that could be used to answer many research questions. Undertaking and publishing research is an excellent avenue for HIMs to promote and strengthen their profession.

Keywords (MeSH): Health Information Management; Research; Health Information Management Profession; Health Information Management Workforce; Health Information Manager

At a recent conference dinner, a couple of doctors asked about my background. Their attitude about health information management was one I'd encountered before ? we're pretty much superfluous `now that there are computers looking after patient records'... aren't we? I shared Mitch Ratcliffe's view with them (then Principal Content Manager at Microsoft) ? `a computer lets you make more mistakes faster than any invention in human history ... with the possible exception of handguns and tequila.' I shared a few more facts with them too.

Health information management professionals have a broad range of skills that are invaluable to the health sector. In the current climate, with ever expanding technology, there's an assumption that the interface being developed between clinician and computer will soon negate the need for our profession. Health professionals involved in patient care will just enter information into a computerised record and everything will function perfectly. It isn't even that they believe patient data will be automatically coded and classified in the background ... or that information will be complete, and all of it entered in the correct location ...they just don't seem to even be aware of these sorts of issues. With no understanding of the effort required to make these data meaningful, or the repercussions when things go wrong, they believe that world to be just around the corner - and are ok with it ? because the computer will solve everything!

One way to alter this perception is to `publicise' your role and the contribution you make, to show how important you are to the larger health system.

Many of the projects Health Information Managers (HIMs) and Clinical Coders are involved with produce important information and experiences that could be shared with peers and other health professionals, to both educate and promote the health information management profession. Every day, someone in our profession, whether employed in a hospital environment or in a non-traditional health information management role, is involved in a project or process, of significant importance to their workplace or the broader health system. These projects are worth sharing. They may include the challenges and opportunities of implementing a new electronic health record system or an additional feature to an existing system, assessing the impact of such an implementation, the identification or resolution of a problem involving: activity based funding; coding and classification; performance reporting; human resources; change management; privacy and other medico-legal issues; or workforce and training concerns.

If you have been involved in these processes, you have valuable expertise and experience (e.g. unforseen pitfalls that may affect timelines and budgets, etc) that can really benefit colleagues about to embark on just such a project or process ? the sort of information that would have been useful to you, had others thought to publish their experiences before yours commenced.

An area that provides HIMs an opportunity to show their worth is research. Historically, the medical record's primary function is to support patient care. More recently, the advent of the electronic health record has provided the opportunity to aggregate

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HEALTH INFORMATION MANAGEMENT JOURNAL Vol 44 No 3 2015 ISSN 1833-3583 (PRINT) ISSN 1833-3575 (ONLINE)

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patient data `to answer clinical and policy questions in a systematic, timely and reproducible way' (Jackson 2014a). Within all levels of government, local health districts, primary health networks, health economists, academics, medical educators, the pharmaceutical industry, health insurance industry, health and legal consultants ? the demand for data has never been higher. The possibility of linking datasets provides greater opportunities for answering clinical and policy questions, and HIMs have the best skill set to inform about data quality, coding and classification, privacy, security and medico-legal implications involved in the ethical handling of such datasets.

Given this huge interest in health information, the quality of data will have a vital impact on conclusions drawn from analyses of these datasets. The assumption that electronic data is of higher quality or will improve patient outcomes is not yet supported at either primary (Henderson et al. 2010) or tertiary levels (Callen J 2014; Lehnbom et al. 2014). Data classified in the International Statistical Classification of Diseases and Related Health Problems (ICD) are used internationally for `a range of epidemiological and health services research' (Jackson 2014b). HIMs have a significant role to play in the discussion around the usefulness of the personally-controlled electronic health record in its current format, and how it might be improved to reflect more accurately the patient's health problems and management. HIMs have access to a wealth of data that could improve patient care and reduce unnecessary service utilisation, and that could be used to answer many research questions. But just as importantly, HIMs have the capability to assess and report its limitations.

Your international journal, Health Information Management Journal, is a great platform for publication of this research and assessment. Some examples have been published in recent volumes, by both HIMs and other researchers and health professionals working with health data. For example: Cunningham (Cunningham et al. 2013) reported

deficiencies in medical record documentation to underpin external cause coding, compounded by flaws in the ICD-10-AM classification.

Emergency Department data were used to inform Public Health policy around road safety (Mitchell & Bambach 2015).

Australian Coronial data highlighted the lack of standards that result in disparity between what the coroner is legally required to document and what is needed to inform suicide prevention programs in the community (Dodds et al. 2014).

Steenkamp (Steenkamp 2014) highlighted the need to consider the implications of cluster effects when analysing and interpreting perinatal data.

Forster (Forster et al. 2015) reported on the introduction and uptake of a patient portal for maternity patients to access their electronic medical records.

Hanafi (Hanafi et al. 2012) demonstrated the impact of missing health information in delivering treatment to patients infected with the H1N1 virus. Through publishing, you promote and strengthen

your profession. You provide an ever-expanding knowledge resource for your peers. You improve health care delivery and outcomes through ongoing surveillance of data quality and highlighting areas where improvement is needed. You educate policy makers and other health professionals of your unique and valuable skill set. You inform and contribute to the decisions underpinning our Public Health programs. You train and encourage the next generation of HIMs and Clinical Coders to ensure a succession of excellent professionals to continue the important work you do. You achieve these goals internationally through your journal.

So give some thought to the experiences you have that could ? and should ? be shared. It's time to stand your ground and let the world know how valuable you are.

References

Callen, J. (2014). What is the impact of electronic health records on the quality of health data? Health Information Management Journal 43(1): 42-43.

Cunningham, J., Williamson, D., Robinson, K. M., Carroll, R., Buchanan, R., & Paul, L. (2013). The quality of medical record documentation and External cause of fall injury coding in a tertiary teaching hospital. Health Information Management Journal 42(3): 4-11.

HEALTH INFORMATION MANAGEMENT JOURNAL Vol 44 No 3 2015 ISSN 1833-3583 (PRINT) ISSN 1833-3575 (ONLINE)

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Dodds, L., Robinson, K. M., Daking, L., & Paul, L. (2014). The concept of `intent' within Australian coronial data: factors affecting the National Coronial Information System's classification of mortality attributable to intentional self-harm. Health Information Management Journal 42(3): 13-22.

Forster, M., Dennison, K., Callen, J., Georgiou, A., & Westbrook, J.I. (2015). Maternity patients' access to their electronic medical records: use and perspectives of a patient portal. Health Information Management Journal 44(1): 4-11.

Hanafi, S., Hayatshahi, A., Torkamandi, H., & Javadi, M.R. (2012). Evaluation of treatment with Oseltamivir during the 2009 H1N1 (swine flu) pandemic: the problem of incomplete clinical information. Health Information Management Journal 41(1): 31-35.

Henderson, J., Miller, G., Britt, H., & Pan, Y. (2010). Effect of computerisation on Australian general practice: does it improve the quality of care? Quality in Primary Care 18(1): 33-47.

Jackson, T. (2014a). Building the `continuous learning' healthcare system. Health Information Management Journal 43(1): 4-5.

Jackson, T. (2014b). Data quality: not selling ourselves short. Health Information Management Journal 43(2): 4-6.

Lehnbom, E. C., Raban, M. Z., Walter, S.R., Richardson, K., & Westbrook, J.I. (2014). Do electronic discharge summaries contain more complete medication information? A retrospective analysis of paper versus electronic discharge summaries. Health Information Management Journal 43(3): 4-12.

Mitchell, R. & Bambach, M. (2015). Examination of narratives from emergency department presentations to identify road trauma, crash and injury risk factors for different age groups. Health Information Management Journal 44(1): 21-29.

Steenkamp, M. (2014). Clustering in Northern Territory perinatal data for 2003-2005: implications for analysis and interpretation. Health Information Management Journal 43(1): 37-41.

Joan Henderson, BAppSci(HIM)Hons, PhD Senior Research Fellow Family Medicine Research Centre Sydney School of Public Health The University of Sydney Paramatta NSW 2006 email: joan.henderson@sydney.edu.au

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