Intro

Professional practice experience: externship or internship

Health Information Management Careers

The American Health Information Management Association (AHIMA) is a not-for-profit global organization that originated in 1928 as the Association of Record Librarians of North America and is considered an industry leader in the management of health information.

-      Primary mission is to increase the standards of clinical information that was used in medical organizations such as hospitals, physician offices, and other organizations.

1934 the first educational program was accredited

2004 AHIMA established the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM).

CAHIIM functions as an independent accreditation commission to establish standards for HIM educational programs.

-      Graduates from CAHIIM can sit for the Registered Health Information Technician (RHIT) and Registered Health Information Administrator (RHIA) national exams

2008 the Commission on Certification for Health Informatics and Information Management (CCHIIM) was established as the commission that oversees all AHIMA certifications. CCHIIM oversees all policies that impact an individual’s initial certification and ongoing recertification.

Cancer Registrar

Cancer Registrars collect cancer data from a variety of sources and report cancer statistics to government and health care agencies.

-      The primary responsibility of the CTR is to ensure the timely, accurate and complete collection and maintenance of cancer data.

-      CTR credential include a combo of experience in the cancer registry profession and/or formal education.

-      NCRA administers the CTR exam

-      The National Program of Cancer Registries (NPCR) a product of the 1992 Cancer Registries Amendment Act, authorizes the CDC to provide funds to states and territories to improve existing cancer registries. to plan and implement registries where they do not exist; to develop model legislation and regulations for states to enhance the viability of registry operations; to set standards for data completeness, timeliness, and quality; to provide training for registry personnel; and to help establish a computerized reporting and data-processing system. As a result of the program, employment opportunities for cancer registrars have grown.

Coding and Reimbursement Specialist

Coding and reimbursement specialist or (coding specialist) acquires a working knowledge of CPT and ICD-10-CM and ICD-10-PCS coding principles, governmental regulations, and third-party payer requirements to ensure that all diagnoses, services, and procedures documented in patient records are coded accurately.

-      AAPC and AHIMA offer coding certifications

-      AAPC creds include the CPC, CIC, and COC, CPC-P

-      AHIMA offers CCA, CCS, and CCS-P

Chief Information Officer

A CIO is responsible for the overall technological direction of an organization and is increasingly becoming part of the executive team.

-      Propose budgets for projects and programs

-      Make decisions about staff training and equipment purchases

-      Hire and assign computer specialists, information technology workers, and support personnel to carry out information-technology-related projects.

-      CIOS manage the work of employees, review output, and establish admin procedures and policies.

-      Institute of Certified Professional Managers offers the Certified Manager (CM) credential

Chief Knowledge Officer

CKO leads the development, management and sharing of knowledge within HCO for the purpose of improving patient care and its day-to-day operations.

-      Actively promoting the knowledge agenda within and beyond the company

-      Collecting relevant data useful to the organization as knowledge

-      Developing an overall framework that guides knowledge management

-      Facilitating communications, connections, and ­coordination

-      Overseeing development of a knowledge ­infrastructure

Health Information Managers

Patient data (patient’s current symptoms, medical history, results of examination, treatments rendered along with outcomes, ancillary report results, diagnoses, and plans for treatment) is organized, analyzed, and maintained by health information managers to ensure the delivery of quality health care.

health information managers: Expert in managing patient health information and medical records, administering computer information systems, and coding diagnoses and procedures for health care services provided to patients.

A health information technician (HIT) earns an associate degree from a community, junior, or technical college. A health information administrator (HIA) earns a bachelor’s degree from college or university.

Most employers prefer to hire Registered Health Information Technicians (RHIT) or Registered Health Information Administrators (RHIA), who must pass a written credentialing examination offered by AHIMA. 

Health Insurance Specialist

Health insurance specialist or claims examiner reviews health-related claims to determine whether the costs are reasonable and medically necessary, based on the patient’s diagnosis.

-      involves verification of the claim against third-party payer guidelines to authorize appropriate payment or refer the claim to an investigator for a more thorough review. A health information manager can also perform medical billing, coding, record keeping, and other medical office administrative duties.

-      The American Medical Billing Association (AMBA) was created to facilitate networking, share information and ideas, provide member support, and publicly market professional services as a group. AMBA is targeted toward assisting small and home-based professional medical billers with similar needs, interests, and goals. AMBA offers the Certified ­Medical Reimbursement Specialist (CMRS) exam.

-      The International Claim Association (ICA) prov­ides a program of education for its member life and health insurance companies, reinsurers, managed care companies, third-party administrators (TPAs), and Blue Cross and Blue Shield organizations ­worldwide. The ICA offers Associate, Life and Health Claims (ALHC) and the Fellow, Life and Health Claims (FLHC) examinations to claims examiners in the life and health insurance industries.

-      The Medical Association of Billers (MAB) is an insurance claims organization that offers certification as a Certified Medical Billing Specialist (CMBS), Certified Medical Billing Specialist for Hospitals (CMBS-H), Certified Medical Billing Specialist-Chiropractic Assistants (CMBS-CA), and Certified Medical Billing ­Specialist–Instructor (CMBS-I).

Health Services Manager

Health Services managers plan, direct, coordinate, and supervise the delivery of health care.

-      Include specialists who direct clinical departments or services and generalists who manage an entire facility or system.

-      Often deal with evolving integrated health care delivery systems, technological innovations, complex regulations, and an increased focus on preventive care.

-      Required to improve health care efficiency and quality.

o   Reciprocity: recognition of credentials by other entities.

o   Health services managers who become nursing home administrators are required by all states and the District of Columbia to have a bachelor’s degree, pass a licensing examination, complete a state-approved training program, and pursue continuing education.

-      The ­American College of Health Care Administrators (ACHCA) offers the Certified Nursing Home Administrator (CNHA) credential

Medical Assistant

Medical assistants Performs routine administrative and clinical tasks to keep the offices and clinics of physicians, podiatrists, chiropractors, and optometrists running smoothly. Do not confuse medical assistants with physician assistants who examine, diagnose, and treat patients under the direct supervision of a physician.

Medical assistants who perform mainly administrative duties answer telephones, greet patients, update and file patient medical records, complete insurance claims, process correspondence, schedule appointments, arrange for hospital admission and laboratory services, and manage the office’s billing and bookkeeping.

-      A medical assistant becomes credentialed as a ­Certified Medical Assistant, abbreviated as CMA (AAMA), through the American Association of Medical Assistants (AAMA) or a Registered Medical Assistant (RMA) through the American Medical Technologists (AMT).

-      students must graduate from a medical assisting program accredited by either the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting ­Bureau of Health Education Schools (ABHES).

Medical Transcriptionist

Medical transcriptionists Transcribes prerecorded dictation, creating medical reports, correspondence, and other administrative documents. Uses a special headset to listen to dictation and a foot pedal to pause dictation while keying text into a personal computer (editing grammar as necessary).

-      Employers prefer to hire medical transcriptionists who have completed postsecondary training in medical transcription offered by many vocational schools, community colleges, and distance-learning programs.

-      The Association for Healthcare Documentation Integrity (AHDI), formerly the American Association for Medical Transcription (AAMT), offers the Certified Healthcare Documentation Specialist (CHDS) credential to ­experienced professionals and the Registered Healthcare Documentation Specialist (RHDS) credential to those who do not qualify to take the CHDS exam.

-       A health care documentation specialist with fewer than two years’ experience in health care documentation in acute care, and/or practitioners who work in a single-specialty environment are eligible to sit for the RHDS exam.

-      The RHDS is a prerequisite for earning the CHDS credential

Other Employment Opportunities in Health Information Management

Consultant One who practices a profession. A general term that can be applied to any number of individuals with a wide variety of educational backgrounds, knowledge, and skills.

-      consultants are retained to provide advice and direction for the needs of organizations that do not have a permanent HIM professional on staff. 

-      Consultants typically will not work for any one organization on a full-time basis, but rather will work for a number of organizations at the same time.

medical office manager Coordinates the communication, contract, data, financial, human resource, health information, insurance, marketing, and risk management operations of a provider’s office; also called medical office administrator

            Management Area and Responsibilities

-      Communication Conflict resolution (e.g., patients, office staff) Public speaking (e.g., staff training) Telephone (e.g., patients, sales representatives) Written communication (e.g., policies, procedures)

-      Contracts Analysis and interpretation Development and negotiation

-      Data Computer applications (e.g., database, spreadsheet, word processing) Interpretation of computer data Vendor systems (e.g., medical office management software) Software analysis and training

-      Financial Accounts payable and receivable Budget—personnel and supplies/expenses Inventory control Payroll Purchasing

-      Human Resources Benefits Interviewing, hiring, training, counseling, and terminating personnel Job descriptions Legislation Performance evaluation

-      Health Information Legislation (e.g., retention laws, privacy, and security) Patient record management (e.g., storage, retrieval)

-      Insurance Claims processing Coding Third-party payers

-      Marketing Community referrals Medical practice products

-      Risk Confidentiality Ethics Medical malpractice

A medical office manager usually earns at least a certificate or an associate degree from a community, junior, or technical college. 

Medical staff coordinators Responsible for managing the medical staff office functions and assisting with physician credentialing process.

privacy officer Oversees all ongoing activities related to the development, implementation, maintenance of, and adherence to the organization’s policies and procedures covering the privacy of, and access to, patient health information in compliance with federal and state laws and the health care organization’s information privacy practices.

quality manager Coordinates a health care facility’s quality improvement program to ensure quality patient care, improve patient outcomes, confirm accreditation/ regulatory compliance, and prepare for surveys.

risk manager Responsible for gathering information and recommending settlements concerning professional and general liability incidents, claims, and lawsuits.

utilization manager (case manager) Responsible for coordinating patient care to ensure the appropriate utilization of resources, delivery of health care services, and timely discharge or transfer; also called case manager.

o   Utilization managers work closely with physicians on a daily basis, and they are a logical choice to facilitate the physician query process. In this role, they serve as the liaison for coders (and physicians) by helping coders write appropriate queries and clarifying queries for physicians to ensure timely and complete responses.

Vendor salespersons Manages a company’s sales for a given territory, provides information about available consulting services, and demonstrates products to potential customers.

Other employment settings for health information managers include attorney offices, government agencies (e.g., state departments of health, peer review organizations), information technology companies (e.g., Dell), the pharmaceutical industry (e.g., data collection/studies for new drug approval), research support (e.g., Centers for Disease Control), third-party payers (e.g., Blue Cross Blue Shield), and veterinary hospitals.

Ethical Standards of Practice

Ethics Judgments about what is right and wrong.

Each professional association has a code of ethics that is to be followed by its membership. 

American Health Information Management Association Code of Ethics

One of the primary roles of the HIM professional is to safeguard information and to protect the privacy and security of health information as well as educate other health care professionals as to the need to protect health information.

Preamble: The ethical obligations of the health information management (HIM) professional include the safeguarding of privacy and security of health information; appropriate disclosure of health information; development, use, and maintenance of health information systems and health information; and ensuring the accessibility and integrity of health information.

o   Core health information issues include what information should be collected, how the information should be managed, who should have access to the information, under what conditions the information should be disclosed, how the information is retained, when it is no longer needed, and how is it disposed of in a confidential manner. 

Purpose: serves 6 purposes. The code is relevant to all AHIMA members, non-members with the Commission on Certification for Health Informatics and Information Management (CCHIIM) certifications, and students enrolled in a formal certificate or degree granting program directly relevant to AHIMA’s Purpose regardless of their professional functions, the settings in which they work, or the populations they serve

o   Promotes high standards of HIM practice

o   Summarizes broad ethical principles that reflect the professions core values.

o   Establishes a set of ethical principles to be used to guide decision-making and actions.

o   Establishes a framework for professional behavior and responsibilities when professional obligations conflict or ethical uncertainties arise.

o   Provides ethical principles by which the general public can hold the HIM professional accountable.

o   Mentors practitioners new to the field of HIM’s mission, values, and ethical principles.

Principles:

1. Advocate, uphold, and defend the consumer’s right to privacy and the doctrine of confidentiality in the use and disclosure of information.

2. Put service and the health and welfare of persons before self-interest and conduct oneself in the practice of the profession so as to bring honor to oneself, their peers, and to the health information management profession.

3. Preserve, protect, and secure personal health information in any form or medium and hold in the highest regard health information and other information of a confidential nature obtained in an official capacity, taking into account the applicable statutes and regulations.

4. Refuse to participate in or conceal unethical practices or procedures and report such practices.

5. Use technology, data, and information resources in the way they are intended to be used.

6. Advocate for appropriate uses of information resources across the health care ecosystem.

7. Recruit and mentor students, peers, and colleagues to develop and strengthen professional workforce.

8. Represent the profession to the public in a positive manner.

9. Advance health information management knowledge and practice through continuing education, research, publications, and presentations.

10. Perform honorably health information management association responsibilities, either appointed or elected, and preserve the confidentiality of any privileged information made known in any official capacity.

11. State truthfully and accurately one’s credentials, professional education, and experiences.

12. Facilitate interdisciplinary collaboration in situations supporting ethical health information principles.

13. Respect the inherent dignity and worth of every person.

Which of the following is not an ethical obligation of a HIM professional?

a)   appropriate disclosure of health information

b)   ensuring the integrity of health information

c)   safeguarding the privacy of health information

d)   all of the above are ethical obligations of HIM professional

The AHIMA Code of Ethics is relevant to all of the following except:

a)   AHIMA members

b)   non-members with CCHIIM certifications

c)   medical students

d)   students enrolled in certificate or degree programs relevant to AHIMA’s Purpose

Which of the following is false?

a)   Health care consumers are concerned about the security of health information.

b)   The AHIMA Code of Ethics only applies to acute care hospital settings.

c)   HIM professionals have an obligation to ensure the accessibility of health information.

d)   Sensitive health information, such as substance abuse information, requires special attention.

Cultural Diversity

Cultural diversity The differences that exist among people based on differences in age, education, gender or gender identity, national origin, occupation, religion, sexual orientation, and socioeconomic status.

A health information management professional shall:

• 13.1. Treat each person in a respectful fashion, being mindful of individual differences and cultural and ethnic diversity.

• 13.2. Promote the value of self-determination for each individual.

• 13.3. Value all kinds and classes of people equitably, deal effectively with all races, cultures, disabilities, ages and genders.

• 13.4. Ensure all voices are listened to and respected.

Cultural competence The ability to identify and understand the cultural differences that exist among individuals, thus creating an environment that respects all.

Health care organizations are legally responsible to abide by federal law that prohibits discrimination based on age, ethnicity, race, religious faith, and physical disability.

The US federal government established the Equal Employment Opportunity Commission to facilitate equal employment opportunities for all individuals.

The federal government, through the Office of Disease Prevention and Health Promotion, has studied and identified national strategies to promote the delivery of health care to all people thus promoting health equity and improving the quality of health care delivered to all. Through a project, known as Healthy People 2030, the government has identified that disparity in health care exists based on cultural and social determinants of health.

o   The findings from the project show that disparities in health care include lack of health care access for underrepresented populations, economic instability of population groups to obtain health care, educational inequality regarding overall health care, inconsistent health behaviors, and inconsistent access to care for rural communities, lack of care for people with disabilities, to name a few.

The U.S. Department of Health and Human Services defines health equity as the attainment of the highest level of health for all people.

In order to have a positive impact on the quality of health care delivered to all, AHIMA states that the following guidelines must be followed:

1. Encourage the standardized collection of accurate and complete patient demographic and social determinants of health data.

2. Guarantee the right for all to have access to affordable, high-quality health coverage.

3. Promote the leveraging of technology to analyze quality-of-care and outcomes using both patient demographics and clinical data to identify and address health disparities.

4. Promote health care delivery and finance models and quality measures that focus on promotion and prevention strategies to reduce health inequities and disparities.

5. Address human capital and educational needs of the health care workforce.

6. Identify and support efforts to overcome historical mistrust in health care institutions.