Week 11 - notes PDF

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Welcome to the this lecture on Health Information Management, or HIM, as a profession. This particular lecture will introduce you to the HIM profession as it is in Canada, and the profession’s foundational principles, organization, documents, and the role in health care the HIM professional fills.

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Our time will be spent in reviewing the various aspects of a profession as they relate to the field of HIM. ¶ We will examine the knowledge and skills necessary for the HIM professional. Our discussion will cover the education requirements as well as the domain of practice for HIM professionals in Canada. You will be introduced to the Canadian Health Information Management Association, or CHIMA, as the professional body that governs HIM professionals in Canada. Sister organizations will be presented as a part of that discussion, as there are a number of interrelationships between the various health information organizations around the globe. The Code of Ethics for the HIM professional in Canada will be reviewed, as well as the certification process for an individual to become a certified HIM professional within Canada. Finally, ¶ we will examine the current and future roles of the HIM professional within the Canadian health care setting.

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One fairly comprehensive definition of a profession is supplied by the Australian Competition and Consumer Commission. The Commission’s definition states that a profession is: “A disciplined group of individuals who adhere to high ethical standards and uphold themselves to, and are accepted by, the public as possessing special knowledge and skills in a widely recognised, organised body of learning derived from education and training at a high level, and who are prepared to exercise this knowledge and these skills in the interest of others.” It is interesting to note the second half of their definition which focuses on the ultimate purpose and goal of a profession, stating: “Inherent in this definition is the concept that the responsibility for the welfare, health and safety of the community shall take precedence over other considerations.”

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This slide reproduces the definition CHIMA has provided for the profession of HIM, as cited from the Abrams & Gibson (2013) text. CHIMA notes that HIM is ““…the discipline that focuses on health care data and the management of health care information, regardless of the medium and format. Research and practice in health information management address the nature, structure and translation of data into usable forms of information for the advancement of health and health care of individuals and populations.” We will now move on to examine in more detail the characteristics that make up the HIM profession in Canada.

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The essential knowledge and skills required by the HIM profession in Canada are outlined in the CHIMA document Learning Outcomes for Health Information Management (or LOHIM). That document outlines the competency areas for Canadian HIM professionals, and is used to provide the basis for curriculum development and content for recognized HIM programs in Canada. Currently, this document applies to college diploma and undergraduate degree programs within Canada. The LOHIM documentation also provides the basis for the National Certification Examination (or NCE) administered by CHIMA to graduates of recognized HIM programs.

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This slide outlines the competency areas covered by the LOHIM document. HIM professionals are expected to be well-versed in the biomedical sciences, including anatomy/physiology, pathophysiology, and medical terminology. The Canadian health care system is a major area, and most programs will also focus on how the provincial/territorial health care system dovetails with the federal health care system. Health Information sciences take up the bulk of the curriculum. This includes a variety of aspects including the management of health information through the transition from paper-based records to electronic records. Students are trained in the use of health data and information for analysis and business intelligence within the health care setting. There is also a great deal of emphasis placed on privacy, confidentiality and access of personal health information, with a focus on the local legislation as it applies to personal health information. Students of HIM also receive training in information systems and technology, and IT project management. Management theory and practice is also a key component of the curriculum, as HIM

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professionals are often called upon to manage and direct health information services (human and fiscal resources) within health care organizations. There is an emphasis on ethics and practice, which may be a single course within the curriculum, but is often a thread woven throughout the curriculum with ethics and practice applications for all subject matter.

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Apart from the specifics of the LOHIM document, the HIM profession in Canada identifies three specific domains of practice that together distinguish them from others as a profession. These are Electronic Health Information Management (which CHIMA has trademarked under the name of e-HIM™), Data Quality, and Privacy. We have already covered these aspects of HIM in detail during this course through the lectures and readings. However, it should be noted that HIM professionals go into much greater detail in their training and practice than has been covered in this course.

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We will now turn our discussion to the professional organization for HIM professionals within Canada.

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The Canadian Health Information Management Association (or CHIMA) is the professional association for HIM professionals within Canada. This organization also includes the professional college, the Canadian College of Health Information Management (CCHIM), which is the body that oversees the certification of HIM professionals in Canada through an examination and continuing professional education processes. We will discuss those processes later in the presentation.

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CHIMA has identified its Vision, Mission, and Values as guiding statements. These statements are created by the CHIMA Board of Directors, and reviewed on a regular basis. The Vision is ¶ “advancing the health care system as the change leader in health information management”. The Mission of CHIMA is that ¶ “CHIMA is the national organization that represents leadership and excellence in health information management. In this statement we can see some of the key aspects that characterize a profession. Particularly noteworthy is the notion of being the group of individuals who has the expert knowledge in a particular discipline.

Finally, the values identified by the organization are ¶ learning, leadership, excellence, integrity, and collaboration.

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With regard to the Code of Ethics, professions are often ¶ “characterized by or conforming to the technical or ethical standards of a profession” For the CHIMA, there are two guiding documents relating to the ethics of the profession. They are the ¶ Code of Ethics, and The Interpretation Guidelines for the Code of Ethics. Together, ¶ these documents provide the basis for the conduct of HIM professionals across the country. In reviewing the Code of Ethics, note the emphasis on the character and integrity of the individual, and not so much on the technical aspects of how the duties of an HIM professional should be carried out. T

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We will now examine the process through which an individual becomes certified as an HIM professional within Canada.

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Many professions have requirements as to how an individual enters and remains in the profession. In order to obtain and maintain certification as an HIM professional within Canada, an individual must: 1. ¶ Be a graduate of a CHIMA-recognized HIM program. •

These are 2- and 3-year diploma programs or 4-year undergraduate degree programs who have met the LOHIM criteria within their programs.

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Only those individuals who have graduated from such programs currently qualify to challenge the national certification examination. Remember, the NCE is also based on the LOHIM documentation, so unless the graduate has had preparation in those areas, as guaranteed by the program recognition process, they most likely will not have the subject matter knowledge to successfully challenge the NCE.

2. ¶ Have successfully challenged the CHIMA NCE. •

An overall grade of 60% on the NCE, with at least 50% in each of the eight competency areas

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~ 75% pass rate nationally.

3. ¶ Maintain 36 CPE credits over 3-year period •

Emphasis on lifelong learning

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Reflects the changing nature of the profession from paper-based to electronic world

Only those individuals who meet the above criteria for obtaining and maintaining CHIMA certification are entitled to use the ¶ professional designation “CHIM” in their signature.

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A few comments about the significance of certification as an HIM professional with CHIMA. The CHIMA HIM certification is recognized around the world! In fact, employers from other countries have frequently advertised available positions through CHIMA to its membership for CHIMA-certified HIM professionals. CHIMA has a reciprocal agreement with AHIMA that any individual certified in one organization may challenge the certification examination of the other organization. For Canadian HIM professionals, that means the Registered Health Information Administrator (RHIA) designation may be obtained. However, it is important to note that anyone wishing to do this would need to familiarize themselves with the HIM practices in the United States which differ from Canadian practices (e.g. ICD-10 vs. ICD-9 coding, privacy legislation, coding for reimbursement, etc.) Bottom line, a Canadian HIM credential is recognized around the world, and gives an individual great global portability of their education, training, and skills.

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With the advent of electronic patient records and the need for health information in the form of collected and coded health data, there has been an explosion in the need for HIM professionals. In November 2009, the Information and Communication Technology Council, in cooperation with CHIMA and other related organizations released a health human resources report which outlined the current and immediate future need for HIM professionals within Canada. The next few slides speak to this need, and the emerging roles for HIM professionals.

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According to the report, HIM is one of the fastest growing areas in health care. There is a current shortage and need for HIM & HI professionals, with an estimated need of 6,500 to 12,500 NEW professionals needed nationally by 2014! Ontario, being the largest province, has the greatest percentage of need for these individuals, also considering that many of the main health information organizations (i.e. CIHI and CHI) have their corporate offices in Ontario. The main challenge is that currently, there are only about 100-200 HIM professionals certified each year.

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This slide provides the titles for some of the newer and emerging roles that certified HIM professionals fill. ¶ Clinical Data Specialist The Clinical Data Specialist is responsible for the accuracy and completeness of coding, abstracting and data collection; validating the contents of databases used for outcomes management and specialty registries: and performing clinical research. ¶ Decision Support Analyst The Decision Support Analyst monitors, integrates from sources and systems, reports and analyzes data for clinical and non‐clinical activities. The Decision Support Analyst coordinates the provision of statistical information necessary to support the allocation of health care resources, monitor service delivery and promote fiscal responsibility. The Decision Support Analyst assists in establishing and implementing performance measurement tools. ¶ Health Systems Analyst The Analyst assists in compiling data, information and evidence from a variety of data, research activities, literature and other sources that contribute to the production of health information products. The Analyst works closely with other analysts to research data sources, define data and other reporting requirements and assist with broader more complicated analysis as a member of a team. ¶ Team Lead—Data Standards

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The Team Lead – Data Standards will possess knowledge of the highly specialized technical requirements for EHR interoperability and the complex organizational collaborations related to adopting, adapting and developing standards provincially and nationally. The team lead works with stakeholders and participates in the determination of the organizational/provincial standards, as well as contributing to and influencing national standards development. ¶ Terminology Asset Manager—Mapping The Terminology Asset Manager will manage terminologies linked to clinical content in electronic environments. This position will assist in the linkage of terminologies for data management and the mapping of one terminology to another. There are some current ¶ traditional roles for HIM professionals that one may come in contact with. The traditional role of the Coder is most like the Clinical Data Specialist previously mentioned. However, the usual focus of the Coder role is on collection, codification, and abstraction of health data/information. The Release of Information Technician is a role that generally has the responsibility to ensure that personal health information is disclosed in an appropriate manner, meeting the requirements of various organizational and legal requirements. Health Record Analysts role is most like the Decision Support Analyst role already mentioned.

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This slide provides you with a sampling of other role titles and functions that the education, training, and skills of the certified HIM professional can meet. More on these roles can be found in the related CHIMA Professional Practice Brief.

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HIM professionals work wherever there is health information, or their skills can be applied to related functions. Typically, HIM professionals have been employed by the acute health care industry (i.e. hospitals), but that is rapidly changing with the advancement of electronic patient records in a variety of health care settings, and the need/use of health information and data in a variety of organizations. Obviously ¶ hospitals and government organizations top this list. Other ¶ health care organizations are health care coordination agencies, regional health authorities, primary care health centres, and insurance companies. Health care IT vendors ¶ are also looking for HIM professionals who can act as health information system implementation specialists, client support, trainers, product developers, and marketing. Consulting firms ¶ are also looking for professionals with HIM expertise to assist their clients with health information system implementation, standards development, and a variety of health information-related concerns. Finally, research and development of health information systems and HIM practice is getting more attention on the research and development front. Educational and

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research organizations, such as UOIT, are developing education and research agendas to support the fields of HIM and HI.

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In wrapping up our semester-long discussion on health information management, we are dealing with a field of great change. The foundations of a paper-based profession are being replaced by an electronic world. However, the fundamental principles of managing health information have not changed (like privacy and data quality) the application of the principles in the electronic world is creating big change. ¶ We are seeing changes in • Paper-based records transformed to electronic ones, • Data collection methods changing as a result of information technology, • Reporting requirements changing as overseeing bodies wish to have more understanding of the health care system, and • Legislative changes to address a changing world of health information management. As a result, HIM managers must be ¶ strategic in their thinking and masters at change management.

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This concludes this presentation. If there are any questions regarding the presentation material, or other related material, please use the discussion thread that has been initiated in WebCT for Lecture 1.

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