Becoming A HIM Professional

Health information management, also known as HIM, has been acknowledged as an allied health profession since 1928. HIM is a profession dedicated to the effective management of patient information and healthcare data needed to deliver quality treatment and care to the public. The original objective was to elevate the standards of clinical recordkeeping in hospitals, dispensaries, and other healthcare facilities (Sayles, 2014). Today HIM is known as the American Health Information Management Association or AHIMA. It still holds similar underlying purposes: to ensure the quality, confidentiality, and availability of health information across diverse organizations, settings, and disciplines (Sayles, 2014). HIM plays a critical role in the successful implementation of electronic health records and ensures that providers, healthcare organizations, and patients have access to the right health information when and where it is needed while maintaining the highest standards of data integrity, confidentiality, and security. It ensures compliance with legal mandates, but it has proven to be a challenge with the constant change in legislation and regulatory environment. Past surveys suggest that HIM plays some type of importance in accordance to HIPAA privacy and security compliance. In a 2006 AHIMA survey, members were asked about the progress of their organizations’ privacy and security compliance efforts. Margret Amatayakul & Mitch Work discuss those results in a 2007 journal article

After decades of paper based medical records, a new type of record keeping has surfaced - the Electronic Health Record (EHR). EHR is an electronic or digital format concept of an individual’s past and present medical history. It is the principle storage place for data and information about the health care services provided to an individual patient. It is maintained by a provider over time and capable of being shared across different healthcare settings by network-connected information systems. Such records may include key administrative and clinical data relevant to that persons care under a particular provider. Examples of such records may include: demographics, physician notes, problems or injuries, medications and allergies, vital

At a general level, HIM (health information management) represents the totality of efforts completed in the adequate collection, storage and usage of information related to the patients and relevant within the context of health care provision. Health information management is subjected to pressures and changes from both the internal as well as the external environments, and is constantly subjected to the need to change and adapt.

Electronic health records were a technological advancement in the healthcare industry in which paper patient record’s became digital. The transition from paper to digital charting allowed easier, quicker access to patient information for those who were authorized to do so. EHRs are secure and protected with username and password access only. It contains information such as patient medical history, procedures, diagnoses, medications, labs, tests, and treatments. Healthcare professionals and organizations who are authorized to access a patient’s electronic health record can do so at ease via a secure network or online database (HealthIT, 2013).

Electronic Health Record (EHR) is an electronic version of a patients medical history, that is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that persons care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports (Ehlke & Morone, 2013). The incentives from both of this articles will result in the delivery of quality care to many individuals in

All staff directly or indirectly connected to the EHR will be educated in the safe and professional use of patient information. The first group of staff to be trained on the EHR will be “super users” (SU’s). The super users will be the clinicians provided with extensive training on the software program and its safety features. (Simmons 2013. Pg 53). These clinicians will be the mainstay in the building between the staff and the informatics department. Each department in the facility will have 3 super users, 2 full time employees and 1 part time employee to rotate and fill in the gaps ensuring there is never a day without a super user. These individuals will receive 6 months of training comprised of 3 days/week at 5 hrs/day. After this is completed, all staff will be educated including employees, medical staff, contractors, volunteers and students. These training events will be a time to ask for feedback on health information safety and HIPPA laws. The feedback received during training will be used to monitor risks to the facility. (MN DOH, 2014 pg 4). Also we will be “sending compliance reminder emails routinely” (MN DOH, 2014 pg

The Health Information Management (HIM) existence to the health care provides quality to patient care from different settings connecting administrative, clinical and operation responsibility. Clinical, legal and financial knowledge allow HIM professionals to manage patient’s health record, capturing healthcare

An Electronic Health Record is a computerized form of a patient’s medical chart. These records allow information to be readily available to authorized providers during a patient’s encounter with the healthcare system. These systems do not only contain medical histories, current medications and insurance information, they also track patients’ diagnoses, treatment plans, immunization dates, allergies, radiology images and lab tests/results (source). The fundamental aspect of EHRs is that they are able to share a patient’s information quickly across service lines and even between different healthcare organizations. Information is at the fingertips of lab techs, primary care physicians, pharmacies, clinics, etc. The

Many health care facilities are already starting to use an electronic health record in some of their departments. An electronic health record is a system that allows health care employees to input patient information into a computer system and saves that information into a database for the facility. The information that is being stored directly into the computer system is patients’ personal information (name, date of birth, address, emergency contact information, insurance information, and primary care physician and/or admitting physician), medical history, allergies, current medications, nurses and doctors’ notes, and other information that may pertain to the reason for the visit. Radiology and lab results are also saved into the electronic health record. Even though some health care facilities use a computer system to save some information, there may also be paper work that is also being used. This paper work is scanned into the facilities database so that it can also be saved and viewed if necessary.

What is Health Information Management? 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. Currently, Northwest Arkansas Community College had launched out the Health Information Management program for the purpose of getting more people to join the health care system. I am currently enrolling in the Health Information Management program. This program can give a graduating student a variety choice of career. Therefore, we have a project to research and interview RHIT or RHIA people, to get more understanding and knowledge about their job or duties as an RHIT or RHIA. To know more about jobs that are available out there, I had researched about RHIT, RHIA, interviewed two health professionals and compare both of them to have a better idea of what I want to do in the future when I am done with the Health Information Management program.

It is hard to take a snapshot of the current technology used in healthcare as tomorrow a new innovative idea is right around the corner. A major change that has occurred over time comes from the use of electronic health records (EHR). Electronic health records usage has been on the rise for several years. It has been used by physicians, ambulatory staff, and HMOs. Since data can be easily altered the copies that must be certified for any medical provider to reference. There is a criterion for the composition of this data due to the exchanging of patient information within an interoperable medical

The federal government established a nationwide health information technology (HIT) infrastructure which requires all health care facility personnel to use an electronic health record (EHR). According to Sewell & Thede, in 2004, President Bush called for adoption of interoperable electronic health records for most Americans by 2014. Electronic health records (EHR) is an automated system created by healthcare providers or organizations, such as a hospital in documenting patient care. In addition, EHR is an interoperable healthcare record that can comprise of multiple EMRs data and the personal health record (PHR). Furthermore, electronic health records can be created, managed, and accessed by approved clinicians and staff across more than one health care society (Sewell & Thede, 2013, p. 231-232). On the patients’ perspective, EHR will be used to support healthcare by providing electronic record of patients’ vital signs, demographics, allergies, medications, diagnoses, and smoking status. Consequently, on the providers’ perspective, EHR will support healthcare by use of decision support tools, enter clinical orders, such as prescriptions, provide patients with electronic versions of their health information, use systems that protect the privacy and security of HER patient data. Another meaningful use of EHR is to support activities such as conducting drug formulary checks, including clinical laboratory test results, recording advance directions for patient 65 years and

Health Information Management, ‘The purpose of the HIM Committee is to provide physician-based oversight to the acquisition, and use of Information Technology and Management Services. The HIM aims to improve the overall quality of patient care, and services at SHC,’ (SHC).

Meaningful use is the adoption and use of certified health record tech, entry/capture of data (vitals, orders), movement of data (transitions of care), report data (to larger clinical systems) (SuccessEHS, 2012). Issues

“An electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users.” (healthit.gov) The EHR mandate was created “to share information with other health care providers and organizations – such as laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and workplace clinics – so they contain information from all clinicians involved in a patient’s care.” ("Providers & Professionals | HealthIT.gov", n.d., p. 1) The process has proved to be quite challenging for providers. As an