The Burgeoning Role Of HIM In Population Health Management

By Subbu Ravi, COO, Amphion Medical Solutions

Effective population health management begins at the point of care, where strong governance processes must be established to guide how data is collected, structured, accessed, maintained, and analyzed. Many healthcare organizations continue to struggle with creation of these policies, hampered by the sheer volume of data and the pace at which change is taking place.

That struggle can end on the doorstep of health information management (HIM), which can apply its intimate understanding of patient information and the medical record to put facilities on the right path toward leveraging data at the point of care to shape population health management.

 The need to tap HIM’s expertise is urgent. The healthcare system’s evolution is not waiting for hospitals and other healthcare organizations to catch up. This is evidenced by the rapid-fire launch of federal initiatives targeting readmissions, preventable events, and hospital acquired infections – not to mention the transition to risk-sharing and performance-based care and reimbursement models where the ability to control chronic conditions among patient populations can make or break participating organizations.

However, while the foundation is in place, HIM does have work to do before it can create the intuitive processes necessary to ensure compliant data capture at the point of care. This includes strengthening analytics skills so data can be put to work improving care and reducing costs.

Uniquely Qualified
HIM controls as much as 80 percent of all patient data and serves as a key partner in the oversight of clinical data entry processes and integration of medical record information into other clinical and financial systems. Thus, it is natural for HIM to be the primary steward of patient data, managing its collection and utilization at the point of care to improve care and quality outcomes, influence core measure performance, and maximize reimbursements.

This expanded role should also include establishing the governance and processes to ensure accurate and thorough documentation, as well as ensuring appropriate sections of the patient record are mapped to drive patient-specific clinical decision support and intuitive rules and alerts.

This ultimately leads us to the next natural evolution of HIM. That is the assumption of responsibility for the analytics and reporting necessary to identify gaps in data collection and utilization that, if closed, would help drive business and clinical goals and objectives, including effective population health management.

HIM and Population Health
HIM’s deep understanding of the medical record and the sources of data populating it is ideal for designing the intuitive processes prompting clinician actions at the point of care that will maximize revenues and ensure compliance. Its stewardship of patient data can also be leveraged to influence physician actions during patient encounters to align them with specific initiatives rolling out under healthcare reform. Population health management is a prime example.

The first step in population health management is identifying at-risk patients through preventive screenings and patient education – activities for which the Centers for Medicare and Medicaid Services (CMS) is now reimbursing. This could be anything from scheduling an overdue glucose test to advising a smoker on how to quit to screening an expectant mother for substance abuse. However, none of these activities will take place if clinicians are not asking the right behavior-related questions and recording those responses at the point of care for immediate action.

Few do. Not because this knowledge is not important for the long-term well-being of their patients, but because, until recently, there was no real incentive to proactively document this information during the patient encounter. Thus, while physicians may historically have asked patients about smoking or alcohol consumption during an exam, the information itself typically wasn’t entered into the patient record until well after the encounter had ended.

Today, delays mean lost revenue opportunities. In the future, they’ll mean financial penalties for non-compliance.

With its proficiency in CMS requirements, expertise in documentation, coding, and billing, and exceptional understanding of the medical record and data sources, HIM is in the best position to establish the processes necessary to drive appropriate data collection, presentation, and utilization at the point of care. Specifically, its ownership of patient data uniquely equips HIM to design and manage the processes needed to guide information capture and alert clinicians to the most appropriate queries based on the data and the next best practice steps, while also fully and compliantly documenting the encounter to support reimbursement and avoid penalties.

Beyond reimbursements and compliance, properly collected and maintained point-of-care data can be put to use to provide hospitals and healthcare organizations with a clear picture of risk and the costs associated with that risk. Similar to influencing clinician behavior, HIM is in the best position to manage risk analysis and predictive modeling. HIM has the deepest understanding of both the severity of case mix and the stratification of DRGs across the patient population, and for specific providers for whom quality measures are reported.

Closing Proficiency Gaps
To be truly effective, HIM must shore up its understanding of analytics tools and techniques and the formal knowledge of business modeling across all levels. HIM leadership typically has an enviable level of expertise in these areas, but it is not yet a norm at the mid-level. By incentivizing professionals to enhance their analytic skills, HIM can make significant contributions to a facility’s success in today’s performance-driven healthcare environment.

This includes closing several skill gaps. The first is a lack of understanding of analytics tools and techniques and formal knowledge of business modeling, in particular value chain and workflow modeling. HIM leadership typically has an exceptional level of expertise in these areas. However, it does not seem to be shared by mid-level practitioners. AHIMA now offers a professional certification to assist with analytics which holds promise for closing this particular gap.

Another area where HIM falls short is the ability to evaluate the severity of case mix for a specific provider for whom a quality measure is reported, which is the foundation of risk-sharing initiatives. Finally, knowledge of point-of-care usability and instructional design will also be highly beneficial to HIM managers.

These skill gaps are easily addressable. With the proper training and education to bring analytic skills up to speed, HIM is a natural driver of population health management. Its ownership of and familiarity with the complete patient record as well as claims and other healthcare data uniquely positions HIM to extract the information necessary to properly weight risk and identify population trends.

Making the Case
There is a clear business case for HIM’s expanded involvement in population health management. When HIM steps up to take control, it can drive quality outcomes, increase physician and patient satisfaction and build the foundation for successful participation in emerging risk-sharing and collaborative care models designed to improve the overall health and wellness of the patient population.

On the surface, this appears to be a significant change, but the reality is that taking ownership of patient data at the point of care and leveraging it to improve population health is simply expanding much of what HIM already does as part of its daily activities.

Improving the quality of data shared by providers is integral to improving care coordination and reducing costs across the patient population. Formalizing its role in driving those improvements simply enables HIM to streamline processes and carry them out more effectively and efficiently.

About the author
Subbu Ravi is COO of Amphion Medical Solutions, a leading provider of advanced transcription and coding solutions and services, and a recognized expert on issues and trends related to the field of Health Information Management and technology. He can be reached at Subbu.Ravi@amphionmedical.com.