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Emerging into E-Health Information Management pdf


Reflective Writing

Reflective Writing

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  • 1. Emerging  into  E-­‐ Health  Information   Management   Reflec%ons  on  e-­‐health  and  my  career  aspira%ons   -­‐Kathy  Nickerson,  GRU  Health  Informa%on  Management  Student  
  • 2. I  enthusias+cally  believe  in  electronic  health  records,  e-­‐health   and  electronic  health  informa%on  management  for  the  benefit  of   each  individual  pa%ent  and  the  community  of  people  who  have   been  affected  with  a  condi%on  or  disease  that  nega%vely  affects   their  lives.  I’m  excited  to  get  involved  in  the  process  of  moving   health  care  toward  more  e-­‐health  ini%a%ves  and  to  engage   physicians  and  pa%ents  in  these  ini%a%ves.     There  are  barriers  to  the  implementa+on  of  e-­‐health  ini+a+ves,   electronic  health  records  and  health  informa%on  organiza%ons.   The  mission  of  health  informa%on  management  (HIM)   professionals  is  to  help  break  down  these  barriers  to  adap%on  of   electronic  health  informa%on  management.     My  personal  mission  is  to  find  a  barrier  and  break  it  down.    
  • 3. What  is  e-­‐health?   “Simply  stated,  e-­‐health  is  the  applica%on  of  e-­‐commerce  to  the  health   care  industry.”  (LaTour,  2010)     So  what  does  this  mean  for  health  care  providers  and  individuals  who   are  consumers  of  health  care?       Gunther  Eysenbach  provided  my  preferred  defini%on  of  e-­‐health  in   2001,  when  he  published  the  10  e’s  of  e-­‐health.  They  are:  Efficiency,   Enhancing  quality  of  care,  Evidence  based,  Empowerment,   Encouragement,  Educa%on,  Enabling,  Extending,  Ethics,  and  Equity.  
  • 4. The  10  e's  in  "e-­‐health"    1.  Efficiency  -­‐  one  of  the  promises  of  e-­‐health  is  to  increase  efficiency  in   health  care,  thereby  decreasing  costs.  One  possible  way  of  decreasing   costs  would  be  by  avoiding  duplica%ve  or  unnecessary  diagnos%c  or   therapeu%c  interven%ons,  through  enhanced  communica%on  possibili%es   between  health  care  establishments,  and  through  pa%ent  involvement.   2.  Enhancing  quality  of  care  -­‐  increasing  efficiency  involves  not  only  reducing   costs,  but  at  the  same  %me  improving  quality.  E-­‐health  may  enhance  the   quality  of  health  care  for  example  by  allowing  comparisons  between   different  providers,  involving  consumers  as  addi%onal  power  for  quality   assurance,  and  direc%ng  pa%ent  streams  to  the  best  quality  providers.   3.  Evidence  based  -­‐  e-­‐health  interven%ons  should  be  evidence-­‐based  in  a   sense  that  their  effec%veness  and  efficiency  should  not  be  assumed  but   proven  by  rigorous  scien%fic  evalua%on.  Much  work  s%ll  has  to  be  done  in   this  area.   4.  Empowerment  of  consumers  and  pa%ents  -­‐  by  making  the  knowledge   bases  of  medicine  and  personal  electronic  records  accessible  to   consumers  over  the  Internet,  e-­‐health  opens  new  avenues  for  pa%ent-­‐ centered  medicine,  and  enables  evidence-­‐based  pa%ent  choice.   5.  Encouragement  of  a  new  rela%onship  between  the  pa%ent  and  health   professional,  towards  a  true  partnership,  where  decisions  are  made  in  a   shared  manner.  
  • 5. The  10  e's  in  "e-­‐health”  continued…   6.  Educa+on  of  physicians  through  online  sources  (con%nuing  medical   educa%on)  and  consumers  (health  educa%on,  tailored  preven%ve  informa%on   for  consumers)   7.  Enabling  informa%on  exchange  and  communica%on  in  a  standardized  way   between  health  care  establishments.   8.  Extending  the  scope  of  health  care  beyond  its  conven%onal  boundaries.  This  is   meant  in  both  a  geographical  sense  as  well  as  in  a  conceptual  sense.  e-­‐health   enables  consumers  to  easily  obtain  health  services  online  from  global   providers.  These  services  can  range  from  simple  advice  to  more  complex   interven%ons  or  products  such  a  pharmaceu%cals.   9.  Ethics  -­‐  e-­‐health  involves  new  forms  of  pa%ent-­‐physician  interac%on  and  poses   new  challenges  and  threats  to  ethical  issues  such  as  online  professional   prac%ce,  informed  consent,  privacy  and  equity  issues.   10.  Equity  -­‐  to  make  health  care  more  equitable  is  one  of  the  promises  of  e-­‐ health,  but  at  the  same  %me  there  is  a  considerable  threat  that  e-­‐health  may   deepen  the  gap  between  the  "haves"  and  "have-­‐nots".  People,  who  do  not   have  the  money,  skills,  and  access  to  computers  and  networks,  cannot  use   computers  effec%vely.  As  a  result,  these  pa%ent  popula%ons  (which  would   actually  benefit  the  most  from  health  informa%on)  are  those  who  are  the   least  likely  to  benefit  from  advances  in  informa%on  technology,  unless   poli%cal  measures  ensure  equitable  access  for  all.  The  digital  divide  currently   runs  between  rural  vs.  urban  popula%ons,  rich  vs.  poor,  young  vs.  old,  male   vs.  female  people,  and  between  neglected/rare  vs.  common  diseases.  
  • 6. In  addi%on  to  these  10  essen%al  e’s,  Eysenbach  stated  e-­‐health  should  be:    easy-­‐to-­‐use,  entertaining,  and  exci+ng.  (Eysenbach,  2001)  These  last  3  e’s  will   make  e-­‐health  become  more  mainstream  and  are  important  aspects  of  the   evolu%on  to  e-­‐health.       Why  isn’t  electronic  health  informa+on  more  exci+ng  and  widely   executed?       I  believe  it  is  because  there  are  too  many  barriers  to  the  implementa%on   of  e-­‐health  ini%a%ves,  electronic  health  records  and  health  informa%on   organiza%ons/or  exchanges.         Two  type  of  barriers  exist  –  physician  barriers  and  pa+ent  barriers.    
  • 7. Physician  Barriers   Eight  main  categories  of  barriers  to  physician  acceptance  of  EMR’s  have  been   iden%fied.  These  eight  categories  are:  A)  Financial,  B)  Technical,  C)  Time,  D)   Psychological,  E)  Social,  F)  Legal,  G)  Organiza%onal,  and  H)  Change  Process.  All   these  categories  are  interrelated  with  each  other.  (Boonstra,  2010)   1.  Financial  Barriers  –  Physicians  are  concerned  about  the   costs  of  implemen%ng  and  maintaining  an  EMR.   2.  Technical  –  Physicians  and  their  staff  may  not  have  the   technical  skills  necessary  and  may  not  have  the  training  and   support.  They  have  concerns  about  the  complexity,   limita%ons  and  reliability  of  the  EMR.   3.  Time  –  Time  to  train,  %me  to  enter  data,  %me  to  learn,  %me   to  choose  and  implement  –  all  are  %me  away  from  pa%ents.     4.  Psychological  –  Physicians  may  not  be  convinced  that  EMR’s   are  worthwhile  and  that  the  development  of  an  EMR  will   take  away  their  control  of  the  informa%on.    
  • 8. Physician  Barriers  continued…   5.  Social  –  Lack  of  support  from  vendors,  management,  and  other  colleagues   and  interference  with  the  doctor-­‐pa%ent  rela%onship  are  concerns  for   physicians.     6.  Legal  –  Confiden%ality,  privacy  and  security  are  essen%al  to  health   informa%on  management  and  physicians  make  feel  that  these  issues  are   not  adequately  addressed.   7.  Organiza+onal  –  The  electronic  systems  may  not  be  applicable  to  the   physician’s  prac%ce  type  and  size.     8.  Change  Process  –  Ader  being  in  prac%ce  for  any  length  of  %me,  many   physicians  have  their  own  working  processes  and  styles.  Electronic  health   informa%on  management  may  require  a  major  change  in  how  physicians   work.    
  • 9. Patient  Barriers   1.  Paternalis+c  Nature  of  Medicine  –  In  the  past,  pa%ents   abdicate  the  responsibility  for  their  health  to  physicians  and   assume  the  physician  has  all  the  needed  knowledge  and   specific  informa%on  to  treat  them.  Pa%ents  should  realize   that  physicians  don’t  always  know  the  most  op%mal  path  to   health  and  they  need  to  share  the  responsibility  for  their   own  health.     2.  Data  Ownership  –  While  organiza%ons  own  the  physical   medical  record  or  the  EHR,  pa%ents  own  their  medical   informa%on.  Pa%ents  oden  need  to  have  this  informa%on   interpreted  by  qualified  individuals  and  shouldn’t  be   in%midated  or  kept  in  the  dark.     A  number  of  factors  create  barriers  to  consumer  (pa%ent)  engagement  and   consumer-­‐mediated  HIE,  including  the  paternalis%c  nature  of  medicine,  the   current  structure  of  health  insurance  plans,  the  indirect  nature  of  third-­‐party   payment,  technology-­‐related  challenges,  and  factors  related  to  behavioral   economics.    
  • 10. Patient  Barriers  continued…   3.  Third  Party  Payment  –  Ever  try  to  make  sense  of  a  medical  bill?  Retail   price,  discounted  price,  insurance  contract  price,  pa%ent  co-­‐payments,   reasonable  and  customary  price,  explana%on  of  benefits,  Medicare   payment,  deduc%bles  –  it’s  enough  to  make  anyone  throw  up  their  hands   and  just  hope  it  turns  out  OK.  Especially  when  you  are    ill,  infirm  or   disabled.       4.  Technology  Challenges  –  Pa%ents  frequently  are  referred  to  specialists  or   other  health  care  providers.  Communica%on  between  all  health  care   providers  involved  in  an  individual  pa%ent’s  care  is  frequently  non-­‐ existent  or  poor.  Impor%ng  informa%on  or  data  from  mul%ple  sources  to   one  comprehensive  EHR  or  Health  Informa%on  Exchange  is  a  challenge.   5.  Behavioral  Economics  –  Pa%ents  need  to  have  a  good  agtude  about  their   EHR,  to  know  that  it’s  normal  to  get  informa%on  on  their  medical   condi%on  and  to  have  confidence  that  they  are  able  to  access  this   informa%on.  Pa%ents  may  not  have  the  computer  skills  to  even  access  to   computers  or  the  Internet.  (Morris  2010)  
  • 11. How  can  I  break  down  barriers  to  e-­‐health?   Or  in  other  words,  where  do  I  go  from  here?   The  profession  of  health  informa%on  management  (HIM)  is   evolving  and  new  HIM  roles  are  emerging  with  vastly  improved   computer  technology  and  the  advancement  of  electronic  health   records.       “With  the  2009  enactment  of  ARRA  as  well  as  other  advances  in   medicine  and  disease  management,  the  speed  of  technology  in   healthcare  opens  new  pathways  for  HIM  professionals.”  (Watzlaf   2009)           Studying  to  become  a  Registered  Health  Informa+on   Administrator  is  just  the  beginning.    
  • 12. My  Personal  Strengths   •  Unique  combina-on  of  medical  and  informa-on  technology  experience.   Twenty  years  in  medical  laboratories  and  12  years  in  digital  asset   management  allows  me  to  bring  new  perspec%ves  from  both  disciplines.   •  Sincere  and  intense  interest  in  learning  with  the  comfort,  ability  and  desire   to  advance  technically.  Learning  new  sodware,  new  processes,  and  new   management  techniques  is  not  only  exci%ng,  but  cri%cal  in  moving  forward.   I’ve  embraced  the  challenges  of  being  a  non-­‐tradi%onal  student;  my   academic  and  career  records  prove  my  ability  to  adapt  and  succeed.   •   Being  a  member  of  the  technologically  sandwiched  genera-on.  Individuals   older  than  I  am  may  have  adverse  feelings  toward  new  technology;  younger   folks  are  much  more  comfortable  in  the  digital  environment.  I  can  iden%fy   with  the  reluctance  of  established,  seasoned  professionals  to  change  and  I   enjoy  working  with  Genera%on  X  and  Millennials.   •  Detail  oriented  and  data  driven.  My  experiences  as  a  Medical  Technologist,   Image  Bank  Archivist  and  Digital  Asset  Specialist  have  sharpened  my  strong   apprecia%on  for  detail,  data  and  organiza%on.  
  • 13. Interesting  possibilities   •  Healthcare  Consumer  Advocate  -­‐  Medical  informa%on,  insurance   issues,  and  billing  issues  can  be  in%mida%ng  and  confusing.  As  the   popula%on  ages  and  the  available  informa%on  grows,  the  need  for   guidance  in  these  areas  will  increase.     •  Client  Support  Specialist  –Maximizing  the  technology  tools  available   to  pa%ents  and/or  physicians  is  important  to  the  advancement  of  e-­‐ health.   •  Clinical  Research  Coordinator  –  Acquiring  data  and  transforming  it   into  useful  informa%on  for  the  benefit  of  current  and  future  pa%ents   is  an  honorable  and  worthy  goal.   •  Health  Data/Informa+on  Resource  Manager  –  Data  and   informa%on  needs  to  be  made  accessible  to  the  individuals  that   need  it.  Finding  the  informa%on  is  a  cri%cal  step  before  knowledge,   change  and  ac%on  can  occur.  
  • 14. My  plan   •  Achieve  the  creden-al.  Push  for  a  strong  finish  to  my  Post-­‐ Baccalaureate  program  and  take  the  RHIA  exam  as  soon  as  possible.       •  Get  connected.  Akend  Georgia  AHIMA  ac%vi%es  and  the  na%onal   AHIMA  mee%ng  in  Atlanta  this  fall.  Stay  in  touch  with  students   currently  in  the  program  and  with  contacts  at  DeKalb  Medical   Center.  Con%nue  to  go  to  the  Emory  Health  Informa%cs  seminars.   Improve  my  LinkedIn  profile.       •  Find  the  right  first  posi-on.  Research  organiza%ons,  academic   ins%tu%ons,  companies,  and  the  posi%ons  they  have  available.  An   entry-­‐level  posi%on  of  data  collec%on  or  abstrac%on  may  be  more   realis%c  and  would  give  me  beneficial  front-­‐line  experience.     Explore  and  be  open  to  emerging  HIM  employment  possibili+es,  look   for  a  mission  and  move  toward  the  goal  of  breaking  down  a  barrier  to   the  implementa+on  of  e-­‐health  ini+a+ves,  electronic  health  records   and  electronic  health  informa+on  management.      
  • 15. References   Boonstra,  A.  and  Broekhuis,  M.  (2010)  Barriers  to  the  acceptance  of  electronic   medical  records  by  physicians  from  systema5c  review  to  taxonomy  and   interven5ons.  BMC  Health  Services  Research.   hkp://­‐6963/10/231       Eysenbach,  G.  (2001)  What  is  e-­‐health?  Journal  of  Medical  Internet  Research.   hkp://       LaTour,  K.M.  and  Maki,  S.E.  (Eds.).  (2010).  Health  Informa5on  Management,   Concepts,  Principles  and  Prac5ce.  Chicago,  IL:  American  Health  Informa%on   Management  Associa%on.       Morris,  G.,  Afzal,  S.,  Finney,  D.  (2012)  Consumer  Engagement  in  Health  Informa5on   Exchange.  Office  of  the  Na%onal  Coordinator  for  Health  Informa%on  Technology.   hkp://       Watzlaf,  V.J.M.,  Rudman,  W.J.,  Hart-­‐Hester,  S.,  Ren,  P.  (2009)  The  progression  of   the  roles  and  func5ons  of  HIM  professionals:  a  look  into  the  past,  present  and   future.  Perspec%ves  of  Health  informa%on  Management.  Retrieved  from:  hkp://    
  • 16. Many  thanks  to…..   •  My  instructors  at  Georgia  Regents  University  –  Dr.  Amanda   Barefield,  Dr.  Carol  Campbell,  Dr.  Jim  Condon,  Ms.  Lori  Prince  and   Ms.  Sherry  Smith  for  preparing  me  and  segng  me  on  this  career   path.     •  Mr.  Ron  McCranie  and  the  HIM  Staff  at  DeKalb  Medical  Center  for   hos%ng  me  for  my  Summer  Prac%cum.     •  Lastly,  and  most  importantly,  my  husband  John,  whose  support,   educa%onal  perspec%ves  and  belief  in  me  have  been  truly  invaluable   during  my  return  to  school  this  past  year  and  for  the  past  36  years.