Workforce Transformation Health Information Management Alberta Health Services Kathleen Addison Senior Provincial Director, HIM, AHS

Agenda HIM Organizational Structure Vision Measures of Success Why Do We Need to Change New Expectations HIM Business Transformation Program (BTP) Relating New Roles to HIM BTP What Are We Doing About It Your opportunities Conclusion Questions

HIM Vision One Patient – One Record Electronic access to longitudinal health information through a single access point

HIM Measures of Success Adoption of standards-based technology and establishing/ implementing leading practice. Through enablement of people, process and technology Expand services to support information integration/ interoperability. Technology enabled health information management workflow to support the full life cycle of health information. A workforce with the credentials, knowledge and skills to work in a fully electronic health information environment. e-HIM® or Electronic Health Information Management is the process by which electronic health records (both institutional and personal) are created, managed and retained for both business and legal purposes. Local Service Delivery Centralized Provincial Services Standardization

Why Do We Need to Change Overarching Trends: Shift to supporting, optimizing, and utilization of e-Health technologies; Continued expansion of EHR repositories to inform clinical decisions – data standards, data quality & information governance becoming more critical; Health system use of data (information to change care delivery) will expand & become more critical; Introduction of SNOMED CT coding into point of care systems (i.e. Clinical Information Systems) and the need for maintaining reference sets, data mapping, provider education, monitoring data quality, supporting automated coding, etc.; The paper health record is the legal record of care. The “bulk” of health records are generated in paper format and are primarily site or program based. Information contained in most clinical information systems is printed and stored. Management of the hybrid health record. Clinical and organizational risk in managing multiple sources, formats and versions of the same information. The amount of paper generated exceeds physical storage capacity. New/redeveloped sites are planned and designed for the electronic health record and without adequate physical storage capacity for the paper health record. High labour costs due to manual paper processes and duplication of effort i.e. number of times the health record is “handled” from receipt to archive. The amount of medical dictation exceeds the supply of traditional Transcriptionists. Health Record Completion by physicians is primarily a manual process. Little to no infrastructure to enable client “self serve” i.e. remote access to health information.

Why Do We Need to Change Overarching Trends: (Cont’d) Overarching Trends: EHR/EMR information sharing will be the norm; more multi-disciplinary/multi-site teams, more integration with other jurisdictions will create the need for more skilled HIM Professionals in information management issues; Changes in professional practice for the electronic environment; Increasing use of mobile and cloud computing; Increasing involvement of consumers in entering and using health information (Personal Health Portal / Personal Health Record); Increasing and diverse range of data quality and data integrity issues;

Why Do We Need to Change Overarching Trends: (Cont’d) Overarching Trends: Integration of new technologies into the healthcare system; Clinical devices connected to EHR’s for direct input of information; Use of Terminology Services and Taxonomies to support clinic content; Increasing clinical and productivity benefits from existing investments will create a demand for corresponding roles; Need to broaden the skills of current clinical professionals; and Retirement of current professionals will be a challenge.

New Expectations (Roles) HIM and eHealth systems working in collaboration Privacy: Monitoring and auditing; enterprise-wide web-based education; support team-based breach education; Standards: Assisting clinicians to do a better job of documenting; expertise in taxonomies, terminology management; demonstration of adoption of standards through audit and interoperability; Data Quality Management: Data quality and integrity i.e. source systems, repositories, registries, etc. Content Management

New Expectations (Roles) (Cont’d) Decision Support: More clinical decisions at point of care i.e. synoptic coding; Health Record Management: Less doing and more oversight; less records and more information; Coding, Terminology and Classifications Shift in focus to coding activity to working with professionals to improve documentation and information. Auditing, assisting and supporting others at the point of care. Understanding of language, clinical documentation, classification & terminology frameworks by specialty. Data Repositories and Dictionaries: Metadata management, enterprise dictionary maintenance and management;

Background of HIM BT in AHS In the fall of 2010, and refreshed in the spring of 2012, HIM developed a Strategic Roadmap, using an outcome and value based process, identifying HIM Business Transformation as a priority program with 5 strategic initiatives: Enterprise Information Management Program HIM Workforce Transformation Information Capture Service Optimization New Services

Coordinated Structure of Initiatives HIM Business Transformation Program Enterprise Information Management Workforce Transformation Information Capture Service Optimization New Services Enterprise Information Management Program Workforce Transformation Plan Registries (Client, Provider, Delivery Site, & Location) Information Stewardship Office Enterprise Content Management Workforce Modeling Personal Health Portal Registry Dictation/Speech Recognition / Transcription System Consolidation Registration Roadmap Terminology Services Professional Development Program Personal Health Record Coded Data Quality Improvement Plan Collaborative Toolset (SharePoint/Lync) Document Scanning Centers

Major Objectives Care delivery is information enabled; Information is managed as an asset; Manual functions are automated to enable electronic health information management, such as: Digitizing paper to electronic format; Automated coding from structured clinical documentation; Automated health record completion; Front-end and back-end speech recognition including e-Signature of transcribed reports. Costs are decreased (burden in managing the paper based and hybrid systems are significantly reduced).

Relating New Roles to HIM BTP Business Transformation Program Enterprise Information Management Enterprise Information Management: .Data/Information Governance Specialist Standards Analyst/Coordinator/Specialist Information Lifecycle Management Metadata Specialist Data Steward Taxonomist Policy Analyst Auditor Business Intelligence Analyst Information Management Liaison Enterprise Information Management Program Information/Knowledge Management: Health Information Semantic Content Expert Clinical Terminologies Standards Specialists Terminologist Code/Data Mapping Specialist Terminology Services

Enterprise Information Management Organizational Structure Executive Director HIM Provincial Standards & Strategies Senior Provincial Director Health Information Management Sample for HIM Enterprise Information Management Organizational Structure Director Enterprise Information Management Senior Advisor IMG Business Unit Standard Specialist Administrative Support Administrative Assistant Standards Information Management Lead Data Standards HL7 Messaging Data Architect Standards Analyst Clinical Documents Standard Analyst Registries Reference Data Management Information Architecture Data Governance

Provincial Terminology Services Organizational Structure Sample for HIM Provincial Terminology Services Organizational Structure Executive Director HIM Provincial Standards & Strategies Senior Provincial Director Health Information Management Director Provincial Terminology Services Senior Advisor Terminology Standards Terminology Lead (Generalist) Provincial Lead Clinical Documentation HIM Learning & Development HIM Compliance Project Manager Terminology Services Strategy Project Health Informatics Consultant Learning & Development Communication Coordinator Admin Assistant

Business Transformation Program Relating New Roles to HIM BTP (Cont’d) HIM Business Transformation Program Information Capture Identity Management: .Master Data Management Specialist Reference Data Management Specialist Repository/Registry Management Data Quality Analyst Data Integrity Specialist Identify Management Coordinator Data Integration Specialist Registries (Client, Provider, Delivery Site, & Location) Registration Roadmap Data Capture: Specialist In: Clinical Data Code Validation Concurrent Coding Clinical Documentation Improvement Code/Data Mapping Clinical Data Analyst Data Steward Coded Data Quality Improvement Plan

Organizational Structure Sample for HIM Registry Management Organizational Structure Executive Director HIM Provincial Standards & Strategies Senior Provincial Director Health Information Management Director Registry Management Provincial Lead Client Registry Provider Registry Delivery Site Registry Administrative Assistant

Business Transformation Program Medical Transcription: Relating New Roles to HIM BTP (Cont’d) HIM Business Transformation Program Service Optimization Legal Record of Care: .Enterprise Content & Records Management Content Management Expert Compliance Officer Process Improvement Engineer Enterprise Content Management Enterprise Content and Records Management – combines 2 concepts – electronic records management and enterprise content management Medical Transcription: Medical Text Editor Dictation/Speech Recognition / Transcription System Consolidation

Business Transformation Program Information Manager Services: Relating New Roles to HIM BTP (Cont’d) HIM Business Transformation Program Information Manager Services: .Data/Information Steward New Services Information Stewardship Office Consumer Support: Information Broker Registry Agent Portal Agent Consumer Services Agent Information Reconciliation Officer Registration Application Coordinator Personal Health Portal Registry Personal Health Record Wait Time Measurement Program Document Scanning Centers

Sample for HIM Information Stewardship Office Organizational Structure Senior Provincial Director Health Information Management Director Information Stewardship Office Service Coordinator Research Coordinator Administrative Coordinator ISO

So, What Are We Doing About It Creating an organizational structure that supports the leadership for future roles i.e. EIM, Terminology Services, etc.; Leaders mentoring staff into new roles i.e. Terminology services, Standards Specialists, etc.; Delivering and supporting learning opportunities that identify and explain future roles i.e. Lunch and Learns, conference/webinar attendance, etc.; Working with our staff on their career path that identifies opportunities for future roles; Advocating professional bodies and educational institutions to develop and deliver Informatics Programs.

Your Opportunities Become more informed and knowledgeable such as: Membership in your Professional Association Read Practice Briefs and Professional Journals; Access websites i.e. HIMAA, CHIMA, AHIMA, COACH, etc. ; Attend Webinars; Volunteer for Committee Participation; Identify and work with your employer to plan your career path; Formalize learning i.e. continuing education and advanced certifications; Join a Standards Development Organization; and Write an article and contribute it to your departmental newsletter or professional association.

“And…..that is how change happens. In Conclusion “Destiny is not a matter of chance; it is a matter of choice. It is not a thing to be waited for, it is a thing to be achieved.” Quote by William Jennings Bryan “And…..that is how change happens. One gesture. One person. One moment at a time.” Quote by Libba Bray

Q & A

Appendix

Future Work Skills Social Intelligence Novel and Adaptive Thinking ability to develop solutions and responses that are beyond rote or rule based Computational Thinking: ability to translate vast amounts of data into abstract concepts and applying reasoning to understand New Media Literacy: Ability to develop content that uses new media forms Trans-disciplinary: Understand concepts across multiple disciplines Virtual Collaboration