President’s Message – October 2007

Your California AHIMA Delegates are preparing to represent you in Philadelphia

Two resolutions were considered for electronic vote in September on Diversity and Personal Health Records. California’s Delegates to AHIMA also expect three more to be considered at the October AHIMA House of Delegates (HOD) meeting in Philadelphia. We have two resolutions in draft form that propose resolutions on Quality Data and Documentation in the EHR and a proposed resolution for e-HIM® Professional Standards. I have provided summaries below of the four proposed resolutions and the fifth resolution will be based on an educational white paper. When this becomes available I will summarize this proposed resolution, along with the outcome of the electronic and HOD votes in the November issue of the CHIA Journal.

The California AHIMA Delegates and I have been busy this summer participating in the HOD Chats as well as reading up on the resolutionsand amendments. We plan to hold another meeting prior to the electronic vote and another meeting prior to the AHIMA Convention to assure we have the most up to date information, along with considering any feedback we receive from you prior to these votes.

The California AHIMA Delegates have been assigned geographically to assure that we provide our entire membership the opportunity to discuss the proposed resolutions prior to the Convention. Also, we have tasked the delegates under the leadership of our CHIA Past President and Bylaws Chairperson, Shirlie Marymee, the opportunity to obtain feedback from you to help us to prepare the best way to structure our CHIA Board. We are exploring the need to require the officers of the CHIA Board to be credentialed as the companion AHIMA amendment last year required of the AHIMA Board. Each component local association (CLA) also needs to explore this issue to determine if we should allow all of our members the same opportunities. Shirlie Marymee, RHIA, CHP, has written an article detailing this issue and some options for CHIA to pursue as we craft a proposed revision to our CHIA Bylaws, which will be presented at the CHIA House of Delegates at the Convention in San Jose in June of 2008. Please feel free to let us know what you think as we prepare for the update to our Bylaws.

At the end of September, the CHIA Board will be updating our strategic plan based on the great feedback we received at the House of Delegates meeting, plus incorporating the input from the CLAs. Our plan is to present this back to you through the CLA Leadership and Committee Chairs as it pertains to their charges for this year. I will also be summarizing the outcome of this discussion in the November CHIA Journal.

Please let your AHIMA Delegates know what you think. We appreciate your involvement in this important process.

AHIMA Resolution Summaries

Proposed resolution on HIM adoption of the personal health record

Intent

This resolution is intended to charge Health Information Management (HIM) professionals with the responsibility of creating and maintaining their own personal health record (PHR). HIM professionals are ideally suited through their education and professional capabilities to inform consumers and health care providers about the benefits of the PHR. They are leading the way and serving as role models in this effort.

The American Health Information Management Association (AHIMA) through its PHR workgroup developed a definition of a PHR in March 2005.

“ ..an electronic, universally available, lifelong resource of health information needed by individuals to make health decisions. Individuals own and manage the information in the PHR, which comes from health care providers and the individual. The PHR is maintained in a secure and private environment, with the individual determining rights of access. The PHR is separate from and does not replace the legal record of any provider.”

Personal health information is a valuable resource to individuals, their families, and the doctors, nurses, and other health care professionals who provide treatment and care. For example, in case of an emergency, having knowledge about a patient’s allergies, medications or pre-existing conditions can save a life. Yet, even as advances are being made in development of electronic medical records systems, it is still almost universally the case that a complete record of any individual's personal health information cannot be found in any single location or consistent format. The various elements of any one person's health information are likely scattered across several health care providers, possibly in different cities, states, or even countries and are kept currently in various combinations of paper-based and electronic record-keeping formats.

This reality means that individuals need to recognize that they are the most effective source of their own complete medical history and that by managing their own health information, they can help improve the quality of care they receive.
The AHIMA Consumer Education Campaign launched in March 2005, is a public service initiative that draws upon the unique expertise of AHIMA and its 51,000 members. This campaign has allowed health information management (HIM) professionals to share their knowledge of health information and medical records directly with the public—at the community level—in order to help them better understand how to access, manage, and protect their personal health information.

HIM professionals are charged with the responsibility of:
• Creating their own PHR in the format of their choosing and to the level of complexity with which they are most comfortable, but containing all of the elements outlined in the AHIMA/AMIA joint position statement for consumers of health care.
• Ensuring all pertinent information from each health care encounter is properly documented and maintained in their PHR.
• Remaining informed and knowledgeable about the current trends and continuous development of the PHR concept.

Proposed resolution on diversity

Intent

This resolution is intended to advance AHIMA’s commitment to a culture that respects diversity throughout its organization, the federation, and the HIM profession at large. To achieve this end, this resolution calls upon AHIMA and its affiliates to reaffirm:
• Inclusiveness of membership within AHIMA and the availability of opportunities for all.
• Adoption of meaningful, actionable, and durable diversity practices to expand the real opportunities available to all HIM professionals, including opportunities to fully participate in AHIMA.
• Engaging the AHIMA community in advancing the goals of enhanced professional opportunities for all and improved value of the membership experience.
• Respect of individual sensibilities, personal beliefs, differences, and privacy and other rights of all HIM professionals and AHIMA members.
• Monitoring the impact of these practices to improve and strengthen them over time.

AHIMA’s Board of Directors will examine and update, as necessary, the standing Diversity Program and continue to enable and encourage participation by national and state leaders of AHIMA and its membership. The AHIMA Diversity Program will serve as an effective means for promoting a culture of diversity and expanding professional opportunities for all and volunteer leadership opportunities in the AHIMA and its affiliated organizations.

The component state associations affiliated with AHIMA should be encouraged to adapt and implement AHIMA’s Diversity Program practices to serve their members better. AHIMA’s Foundation of Research and Education should evaluate on an ongoing basis the scholarship opportunities for students of personal or professional characteristics currently underrepresented in the HIM profession and the faculty that teach them, and seek additional scholarship funding where needed.

Quality Data and Documentation in the EHR.

AHIMA advocates that organizations developing or implementing EHR systems take steps to ensure that the functionality of their EHR system supports quality care, valid documentation, and data integrity. HIM professionals, particularly those with expertise in data capture methods, compliance, and data quality management, actively participate in EHR system selection, design and development, implementation, and maintenance. Organizations implementing EHR systems should ensure that process analysis and improvement is performed in order to enhance documentation and avoid inaccurate, incomplete, inappropriate, or non-compliant documentation. HIM professionals collaborate with clinician users of the EHR, including training, to ensure that the best quality of data and documentation is maintained for patient care, quality management, compliance, health information exchange; and secondary use purposes; and that HIM professionals actively participate and contribute to organizations that develop standards for the EHR to ensure that data and documentation in the EHR meet the needs of health care organizations.

Proposed Resolution for e-HIM® Professional Standards

This resolution is intended to advance AHIMA's commitment to being a leader in the management of health information for patient care, quality measures, reimbursement, and all other uses. While standards are being developed and adopted that address the technology of health information, electronic health information practice standards are needed to guide the management of health information in an electronic environment.

Here are some examples of areas where practice standards are needed:
• Establishing a closed health record in an electronic environment.
• Making amendments/addendums/corrections to the electronic health record.
• Managing the migration of data into an electronic health record.
• Correcting laboratory results in the electronic health record.
• Correcting dates of service.
• Correcting/merging patient records (duplicate medical records; reports on wrong patient’ record)
• Importing of laboratory/medication/allergies/problems to physicians’ notes.
• Appropriate use of “cut and paste.”
• Management of electronic forms/templates: development, indexing/categorizing, inventory, approval, revision.
• Appropriate inclusion/use of patient photos.
• View only/sequestering.
• Auditing for privacy violations – volume, focus, frequency.
• Use of electronic record to prevent/identify identity theft.
• Alerts in electronic record – advanced directives, power of attorney, other legal documents.
• Verbal orders in electronic record.
• Patient completed forms; patient input on medication lists.
• Patient communication/referring physician communication.

AHIMA should convene qualified workgroups of HIM professionals to examine and evaluate existing criteria and standards to determine areas of HIM practice in which professional guidelines and professional practice standards, where needed. AHIMA will devote necessary resources, including but not limited to, providing speakers/topics for programs of allied health care professions, to promote establishment of these professional standards as expected practice within the health care industry; and AHIMA will publish a registry of e-HIM practice standards in the public domain.