HEALTH INFORMATION MANAGEMENT
THE BACK BONE OF MEDICAL PRACTICE
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".
HISTORICAL BACKGROUND OF HIM
The
First Medical Records
The
earliest forms of medical records were narratives written by ancient Greeks to
document successful cures, share observations about symptoms and outcomes, and
teach others who provided medical advice through these case studies. While
written reports describing patients’ complaints and diagnoses predate the
records of Simon Forman and Richard Napier – astrologers who documented
clients’ medical questions and treatment – their records from 1596 to 1634 form
the earliest complete collection of medical records in existence.
The
1920s
As
health care advanced, physicians realized that the best way to continue
improving diagnosing and treating illnesses was to carefully document
observations and actions while treating patients – and share this information
as a way to teach other health professionals.
As
early as 1600, physicians offered advice on how to present information in a
medical record, but it wasn’t until 1928 that the American College of Surgeons
(ACOS) took steps to standardize the growing number of medical records by
establishing the American Association of Record Librarians (AARL) – known today
as the American Health Information Management Association (AHIMA). “Record
librarians” was the term used because early medical records were documented on
paper.
Standardization
of medical records and growth of complete record-keeping continued from the
1920s through the 1960s, but records were paper-based.
The
1960s
The
development of computers presented the opportunity to maintain records
electronically, but the expense of purchasing and maintaining a mainframe, and
the expense associated with storage of data, meant that only the largest
organizations could use technology to handle medical records.
The
field of health informatics, as it is known today, emerged when computer
technology became sophisticated enough to manage large amounts of data. One of
the earliest efforts took place under the jurisdiction of the American Society
for Testing and Materials (ASTM). These first standards addressed laboratory
message exchange, properties for electronic health record systems, data
content, and health information system security.
The
1960s also saw the introduction of Medicare and Medicaid, which required nurses
to collect data to document care for reimbursement. While computers were
increasingly used for accounting and billing functions, the use of computers to
collect and manage medical records was not common.
In
1964, El Camino Hospital in Mountain View, CA worked with Lockheed Corporation
to develop a hospital information system that included medical records, but
generally computer manufacturers did not understand the healthcare industry’s
needs.
Organizations
that did opt for a computer system that handled medical records offered limited
access to records –access only available at the site it was created. Records
often only contained information about the hospital stay and tests or
treatments provided within the walls of the hospital.
Even
though implementation of technology was slow, the need to standardize was
recognized by several organizations, with SNOP by the American College of
Pathology developing what would eventually become Systematized Nomenclature of
Medicine (SNOMED) to systematize the language of pathology. Also, the concept
of a Uniform Minimum Health Data Set (UMHDS) was formulated in an effort to
develop national health data standards and guidelines.
The
1970s
As
computers became smaller, software designed to support clinical functions for
pharmacy, clinical laboratory, patient registration and billing began to
proliferate. The disadvantage of these health information systems was their
department-specific functions – they were not accessible by other departments.
The
first attempt at a total, integrated health records system was implemented in a
gynecology unit at the University Medical Center in Burlington, Vermont in
1971. Based on the problem-oriented medical record, the system was patient
oriented all disciplines included in care made notes in the record to provide
an overview of care to see the relationship between conditions, treatments,
costs and outcomes.
Acceptance
of the Problem Oriented Medical Information System was not widespread due to
resistance to share information across disciplines. Although the idea for
collaborative care was presented in the 1970s, the acceptance of collaboration
and enhanced communication supported by a holistic health record system did not
take place until the 1990s with the advent of managed care.
The
1980s
The
introduction of diagnosis related groups (DRGs) and data required for
reimbursement increased the need for hospitals to pull detailed information
from clinical systems as well as financial systems to ensure claims payment.
Because
personal computers and widespread health-related software applications had
grown in popularity, hospital information technology (IT) staff were tasked
with the responsibility to integrate multiple, disparate systems. As network
solutions were developed, IT departments were able to connect financial and
clinical systems for limited functions.
But
as technology advanced, in most cases, hospital departments still could not
access information outside their own silos preventing data-sharing from
disparate system.
The
1990s
The
introduction of the master patient index (MPI), a database of patient
information used across all the departments of a health care organization in
the 1980s laid the groundwork for initiatives such as The Indiana Network for
Patient Care (INPC), the foundation for today’s Indiana Health Information
Exchange. In 2017, the health information exchange (HIE) leverages an
internally developed MPI that includes 100 hospitals, representing 38 health
systems; 12,000 practices with over 20,000 providers; 1,100 Veterans
Administration sites and 12 million patients.
As
competition in health care created consolidation of individual hospitals to
form health systems, the need for integration grew. Technology advances gave
hospitals access to computing systems that could share information across
disparate systems to set the stage for data-sharing.
In
recognition of the expanded scope of its members’ role in health informatics
and data management, the organization that began in 1928 as AARL underwent its
fourth name change – to AHIMA. Health information professionals’ responsibility
now expanded beyond the data included in a single hospital medical record to
health information comprising the entire continuum of care.
The
2000s
As
hospitals continued to merge into larger health systems and to acquire
individual physician practices, the increased need for interoperability that
supported data-sharing grew.
The
importance of integrated electronic health records (EHRs) to enable providers
to make better decisions grew, and more hospitals and physicians implemented
them to reduce the incidence of medical error by improving the accuracy and
clarity of medical records. In his 2004 State of the Union Address, President
George W. Bush called for computerized health records – the beginning of the
electronic health record (EHR) revolution.
Adoption
of fully-functional EHRs grew more significantly with the passage of the
American Recovery and Reinvestment Act (ARRA) in 2009. One of the measures
included in ARRA was the Health Information Technology for Economic and
Clinical Health (HITECH) Act. The HITECH Act promoted the concept of meaningful
use of EHRs and supported financial incentives to encourage the adoption of
EHRs and the interoperability necessary to share data among providers.
As
of 2015 96 percent of hospitals and 87 percent of office-based physician
practices were using electronic health records (EHRs).
Also,
the introduction of cloud computing for a wide range of industry, including
health care, supported expanded networks that went beyond specific sites and
locations to tie all entities in a health system or HIE together without a
significant investment in new technology.
The
increased volume of data, ease of access to data and the need for health
information professionals to guide the management of health data has led to an
increasing reliance on health informatics, which is defined by the American
Medical Informatics Association (AMIA)
as
a field of information science concerned with the management of all aspects of
health data and information through the application of computers and computer
technology.
In
the 2010s
Increased
focus on value-based care as opposed to fee-based care and a drive to improve
patient outcomes propel the growing accumulation of data to support clinical as
well as operational decisions in health care.
Just
as clinicians in the 1920s understood the importance of previous health records
as learning tools that would improve outcomes, healthcare professionals
leverage data to enhance care on a larger scale using tools that analyze
population health data.
New
delivery models, such as accountable care organizations (ACOs), are implemented
to contain costs, promote collaboration and improve patient health care. While
ACOs, HIEs and growing health system networks have EHR and other systems to
collect data, there is still a gap in aggregating and harmonizing the
information from various systems to produce data that can be easily analyzed.
The
Future
While
there is no crystal ball to predict the future, it is safe to say that as
health systems grow and expand to include other hospitals, physician practices
and outpatient clinics, and as the volume of data grows with expansion, the
need to integrate and harmonize data to make it available to all users is
critical. Finding the right platform to support and enable access to structured
and unstructured data across disparate systems is the first step to better
preparing for a value-based future.
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