Transforming the HIM department into a strategic resource - health information management unit

Healthcare Financial Management, May, 1998 by Linda F. Odorision, John B. Piescik

The success of integrated delivery systems (IDSs) in achieving their enterprisewide strategic objectives depends, in part, on having mechanisms for maintaining accurate, accessible health information to support clinical, legal, and business requirements. IDSs, therefore, should work toward development of sophisticated systemwide information technology capabilities that can provide:

* Secure access to patient medical records, any time, from any location within and, perhaps, outside the system;

* Physician-friendly mechanisms for completing charts at any system location;

* Rapid, reliable mechanisms for getting clinical information coded for billing purposes;

* Integration of health records with clinical information systems that provide decision support at the point of care;

* Information and the analytical tools that promote continual improvement in service delivery and optimal outcomes; and

* Conformity with the rules for managing the privacy, confidentiality, authentication, and retention of health information established by the Joint Commission on Accreditation of Healthcare Organizations, HCFA, and state regulatory authorities.

IDSs that attain such capabilities can gain a distinct advantage in delivering high-quality patient care, satisfying both patients and medical practitioners, measuring and demonstrating outcomes, and making health care more affordable.

For hospital-sponsored IDSs, the traditional health information management (HIM) department holds the key to meeting these demands cost-effectively. (IDSs anchored by organizations other than hospitals typically lack a robust HIM department and normally must create information systems capabilities from scratch.) The HIM department is staffed by individuals who know how to build and maintain permanent, legal records of patient encounters. By arming HIM personnel with the appropriate information technologies, the HIM department can become a powerful force for achieving IDS objectives.

The "Virtual" HIM Department

As IDSs expand to encompass multiple facilities and physician practices, the HIM department's charter should be expanded to support these entities. Traditional HIM departments should be transformed into "virtual" HIM departments that give authorized users systemwide immediate electronic access to patient information.

This transformation of the HIM department should be a gradual, carefully planned process that reflects the IDS's ongoing commitment to achieving a fully integrated information system. The virtual HIM department should retain centralized control over the HIM function to ensure efficient distribution of the HIM workload across multiple facilities and consistency of information provided across the continuum of care. To achieve such control, the virtual HIM department should institute common information collection and storage systems that include standard templates for each category of health information.

In creating a virtual HIM department, however, IDSs need to overcome a number of perceived barriers to delivering patient records electronically. These barriers include the enormous volume of patient records generated on paper both internally and externally; physician resistance to automated systems; tight budgets for HIM and similar support activities; and concerns about privacy.

Nonetheless, the experiences of three healthcare organizations show that these barriers can be addressed and overcome. The case histories involve three hospital-sponsored IDSs: an emerging, local IDS anchored by a 340-bed hospital; a metropolitanarea IDS anchored by a three-facility, 1,000-bed hospital system; and a regional IDS with 2,500 beds in six hospitals.

Linking HIM and PFS Functions

Scenario: A not-for-profit, 340-bed acute care hospital enjoyed a respected position in an increasingly competitive, mid-sized market with limited managed care penetration. This market was ripe for provider consolidation, and the hospital was unsure that it could retain its organizational identity if it were to become part of an IDS. The hospital's basic organizational strategy was to continually improve service to both patients and physicians and to prepare itself to become a long-term leader when consolidation trends reached the area.

The hospital began to reshape itself into an IDS, benchmarking service delivery costs against other hospitals and striving to gain cost advantages that would make it an attractive partner. To ensure a steady stream of referrals from independent and affiliated physician practices, the hospital also planned to create an MSO to provide these practices with an array of management services.

The hospital invested in integrated document management technology and built applications systems to streamline the work flow in both HIM and patient financial services (PFS). Although hospital decision makers believed the investment in needed technology infrastructure, including a high-capacity network, could not be justified for just HIM, they decided the investment was reasonable when shared across the two departments.