1. A Gradual Transformation in the Health Information Managements’ Public Health Role
Tabrez Uz Zaman
Health Information Management and Technology Department
Faculty of Public Health and Health Informatics

2. Outline of the Presentation
What Is Health Information?
What does it include?
Health Information Management (HIM)
Health Information Technology (HIT)
IOM Report
Public Health Research and Data Management
Disease Classification and Population-Based Registries
Disaster Management
Electronic Health Records
SpringCharts EHR Program
HIM Roles in Privacy and Security
Interoperability
Public Health Surveillance

3. What Is Health Information?
Health information is the data related to a person’s medical history, including symptoms, diagnoses, procedures, and outcomes.

4. What does it include?
Health information records include patient histories, lab results, x-rays, clinical information, and notes.
A patient’s health information can be viewed individually, to see how a patient’s health has changed.

5. Health Information Management (HIM)
According to American Health Information Management Association (AHIMA) - Health information management (HIM) is the practice of acquiring, analyzing, and protecting digital and traditional medical information vital to providing quality patient care. It is a combination of business, science, and information technology.

7. Health Information Management (HIM)
The health information management (HIM) professional can be strategically placed to manage information within the public health arena.
As managers of information flow, HIM professionals utilize increasing levels of technology to link clinical settings, public health departments, research institutions, and consumers with health information.

8. Health Information Management (HIM)
However, as technology increases the amount and accessibility of health information, HIM professionals must expand their role as information managers within the public health field.

9. Health information technology (HIT)
According to American Health Information Management Association (AHIMA) - Health information technology (HIT) refers to the framework used to manage health information, and the exchange of health information in a digital format.

10. IOM Report
The Institute of Medicine report -“The Future of the Public’s Health in the 21st Century” stated that health status and disease monitoring involves the accurate, periodic assessment of community and patient health status, identification of health risks, and determination of health service needs.

11. Public Health Research and Data Management
As the field of technology has grown, the role of the HIM professional has expanded to manage data from paper formats to electronic records.
The traditional HIM professional roles of data management, retrieval, analysis, and privacy/security are expanded through the move to electronic formats.
HIM professionals are integral to the assurance of definitional standards (ICD-10, SNOMED, HL7) and terminology within informational data sets that will facilitate accurate data sharing and exchange.

12. Public Health Research and Data Management
HIM professionals serve vital roles in -
Public health research (querying medical records from health facilities, reviewing medical records for record completeness and accuracy, abstracting data from medical records, and conducting classification coding for research purposes)
Management
Project management

13. Disease Classification and Population-Based Registries
Public health disease reporting and tracking depend on accurate and timely disease classification and registry data.
The early work of Grace Whiting Myers, a pioneer in the field of medical library science, laid the foundation for clinical record indexing and disease documentation. 
Today, HIM professionals have a direct role in disease classification and registry coding and data reporting.
Classification and registry data used in public health focus on population health.

14. Disease Classification and Population-Based Registries
Data are aggregated for entire populations instead of individual patients or for reimbursement purposes.
Disease classification systems such as ICD-9-CM, ICD-10-CM, and ICD-10-PCS are used for capturing and reporting public health diseases such as HIV/AIDS, sexually transmitted diseases, tuberculosis etc.
To know the leading causes of death; and morbidity/mortality data related to bioterrorism.
The International Classification of Functioning, Disability, and Health (ICF) is used for classification of functioning and disability
Bioterrorism is terrorism involving the intentional release or dissemination of biological agents. These agents are bacteria, viruses, or toxins, and may be in a naturally occurring or a human-modified form. For the use of this method in warfare, see biological warfare.

15. Disaster Management
Catastrophic events, such as Hurricanes, floods etc. have influenced the expanding role of HIM professionals in disaster preparedness as well as in recovery planning in post disaster situations.
In the aftermath of these disasters, healthcare consumers were faced with a disruption in the continuity of healthcare services due to the loss of vital records and supportive information. 

16. Disaster Management
As health information data are dependent on the storage media used for patient information, the HIM professional serves a strategic role in the disaster planning and recovery process.
Moreover, with an increase in the utilization of electronic record systems and personal health records (PHRs), HIM professionals are integral in planning for sustainable information technology essential to data record recovery post event. 

17. Electronic Health Records
Electronic Health Records (EHR) and Health Information Exchange (HIE) systems collate information about individual patients from different information systems (e.g., registration, clinical record, laboratory, and imaging) and through information exchange or aggregation from across different provider entities.
Adoption of the systems is being incentivized and facilitated by the Health Information Technology for Economic and Clinical Health (HITECH) Act in the United States.

18. SpringCharts EHR Program

19. HIM Roles in Privacy and Security
HIM professionals must strengthen their roles to facilitate electronic exchange for access and use of health information while protecting the privacy and security of patients’ health information.
There is also a need for development and implementation of standards for data content, data mapping etc.
At the population level, HIM professionals need to advance privacy and security policies, principles, procedures, and protections for information access and use in population health

21. What is Interoperability?
Interoperability describes the extent to which systems and devices can exchange data, and interpret that shared data.
For two systems to be interoperable, they must be able to exchange data and subsequently present that data such that it can be understood by a user.

22. HIM Roles in Interoperability
Information interoperability enables the movement of electronic health information to where and when it is needed to support healthcare needs and uses.
Population-oriented uses include disaster management, bioterrorism surveillance, and community healthcare tracking.
They use a common set of standards for data nomenclature, terminology, content, structure, and messaging of health information.
There are currently several different approaches, such as regional health information organizations (RHIOs) or health data banks, to connect various healthcare organizations to share health information. 

23. Public Health Surveillance

24. Public Health Surveillance
Public health surveillance has benefitted from, and has often pioneered, informatics analyses and solutions.
However, the field of informatics also serves other facets of public health including emergency response, environmental health, nursing, and administration.
Public health informatics has been well-defined as the systematic presentation of information and computer science and technology to public health practice, research, and learning.
Public health informatics is a subdomain of the larger field known as biomedical or health informatics.

25. Uses of HIM in Public Health Surveillance
Planning and system design – Identifying information and sources that best address a surveillance goal
Data collection – 
Identifying potential bias associated with different collection methods (e.g., telephone use or cultural attitudes toward technology);
Identifying appropriate use of structured data compared with free text, most useful vocabulary, and data standards; and
Recommending technologies {e.g., global positioning systems (GPS) and radio-frequency identification} to support easier, faster, and higher-quality data entry in the field.
Data management and collation – Identifying ways to share data across different computing/technology platforms

26. Uses of HIM in Public Health Surveillance
Analysis – Identifying appropriate statistical and visualization applications; generating algorithms to alert users and leveraging high-performance computational resources
Interpretation – Determining usefulness of comparing information from one surveillance program with other data sets (related by time, place, person, or condition).
Dissemination – Recommending appropriate displays of information for users and the best methods to reach the intended audience
Application to public health programs – Assessing the utility of having surveillance data directly flowing into information systems that support public health interventions.

27. References
 Institute of Medicine of the National Academies. The Future of the Public’s Health in the 21st Century. November 11, 2002. 
American Health Information Community. “The Community.” Washington, DC: Department of Health and Human Services. Available at 
Center for Health Workforce Studies. Health Information Management Workforce.  November 2001–April Available at 
AHIMA Foundation. Strategic Research Priorities. Available at

28. References
Department of Health and Human Services, Bureau of Health Professions. Public Health Workforce Study. January Available at 
Center for Health Workforce Studies. Health Information Management Workforce.  
AHIMA. Data for Decisions: The HIM Workforce and Workplace, 2004. 
National Center for Health Statistics. Survey and Data Collection Systems. Available at 
Myers, G. W. “Hospital Records in Relation to the Hospital Library.” Bulletin of the Medical Library Association 1, no. 3 (1912, January): 55–57. Available at