When the desire to go paperless creates reams of paper, CIOs and HIM directors need to focus on the bigger picture--patient care.
When the desire to go paperless creates reams of paper, CIOs and HIM directors need to focus on the bigger picture—patient care.
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| Aaron Brandwein |
In theory, the chief information officer and the health information management director share a similar overarching objective: to use technology to enhance the efficiency and quality of each patient’s care, medical record and experience. Day-to-day operations, however, can tell a different story: The two parties are often at odds.
While the CIO seeks ways to leverage existing and new technologies for the advancement of the hospital, the HIM director manages the realities of coding, reimbursement and the legal medical record. In particular, HIM has always had a hand in establishing policies related to record access. Likewise, yesterday’s data processing managers are now chief information officers, an integral part of the executive team.
How can the two parties merge their objectives to work in harmony? The answer isn’t simple, but from organization to organization, one truth prevails: When the CIO and HIM director aren’t in sync, the result is adversarial. And to the facility’s detriment, their individual objectives may suffer.
Conversely, when the CIO and HIM director have mutual respect as well as frequent, planned communication, the benefits are widespread. Not only is each party more productive (and most likely, happier), the organization’s technology and information management is better planned, managed and synchronized.
Easier Said Than Done
CIOs and HIM directors in a less-than-ideal work relationship with the other are now thinking, “A nice sentiment, but easier said than done.” In particular, the hybrid medical record, which includes both paper and electronic elements, has many CIOs and HIM directors at odds. With an eye toward competitive advantage and improved informatics, CIOs are implementing more elaborate clinical documentation systems. These systems create reams of paper that can muddy the waters for HIM directors trying to maintain a pristine legal record. To ease—and improve—relations between the two leaders, the following four actions are recommended:
Communicate: It sounds simple, but when CIOs and HIM directors keep each other informed through regular, frequent meetings, many problems are dissolved before they become major issues. Cheryl DeRosier Martin, CIO and administrative director for Tuomey Healthcare System, Sumter, S.C., was an HIM director before joining her current organization. Martin says that her experience as an HIM director has helped her foster stronger relationships with the entire IT team and current HIM management. “In terms of our EMR, there’s nothing we do that doesn’t involve the HIM director,” she says. “We’re practically joined at the hip; we’re both present at every meeting [related to EMR], whether it’s about modifications to current systems, forms or inputs.”
Martin notes that the HIM director often reports to the chief financial officer, not the CIO, which makes proactive communication even more important. “The CFO and CIO have different objectives, but there’s no reason these objectives can’t be synergistic,” she says. For CIOs and HIM directors who aren’t in sync, she recommends meeting to define the HIM director’s ongoing role in EMR adoption.
Understand the other party’s reference point for the hybrid medical record and add value where you can: The HIM director’s focus is maintaining accurate, secure, legal medical records. To a CIO who is striving toward better, faster processes via technology, this focus can come across as rigid. To that end, mutual appreciation becomes all the more important. A hospital’s technology is a liability if the legal record isn’t accurately maintained and reimbursements suffer. On the other hand, trends in health care consumerism, retaining the best clinicians and countless other factors make staying on the edge of technology a must.
Besides understanding the other party’s reference point, the CIO and HIM director can also add value to the other’s role. Doug Turner, CIO of Maury Regional Hospital in Columbia, Tenn., was never an HIM director but an internal auditor. He considers his role as part consultant, part executive. “My team has meetings with key departments who implement and manage technology,” Turner says. “We facilitate program management, since that’s a strength and skill set for IT. As a result, we add value while helping these departments—including HIM—maintain ownership of their new workflows and processes in an electronic vs. paper world.”
Have a formal plan for reducing paper while maintaining a legal record: It’s ironic that many clinical information systems create reams of paper, defying hospitals’ strategic plans to become paperless. It’s also a source of frustration for many HIM departments, who are responsible for maintaining a legal record and often end up swimming in paper. Turner points out that the IT department, unlike HIM, may be more concerned with a system’s integrity instead of its ability to facilitate completeness, timeliness and departmental objectives. “That’s why the IT and HIM departments must collaborate and establish a formal plan,” he says. This initiative deserves its own strategic plan and meetings in addition to activities surrounding the EMR.
Network inside and outside of your organization: Another common theme of hospitals that are successful in making the transition from the paper to electronic world is networking and learning. First, CIOs and HIM directors should reach out to clinicians and department directors within their organization. Turner’s team conducts a workflow analysis of any department seeking a new information system and regularly shadows doctors as they do rounds. “That’s how we add value and help the organization become more technology-literate while also understanding the various needs and what drives technology purchases,” he says. Turner also notes that as the HIM department’s role evolves, it takes more responsibility for the timing, content and quality control of each medical record. Ultimately, this means that HIM should meet with physicians more frequently as physicians become more of a “customer” to the HIM department.
Second, peer-to-peer networking outside the hospital can help to establish best practices for becoming wired. Beth Kost-Woodrow, chief privacy officer and executive director of WellStar Health System, Atlanta, says many EMR and clinical documentation vendors have user groups and roundtables for just that reason. “Rather than reinventing the wheel, see if your EMR vendor conducts forums, site visits or roundtables. Seeing post-implementation, redesigned workflow is very eye-opening and can help you solidify your own vision.”
At the end of the day, the two parties are charted toward a converging rather than diverging course. With this in mind, CIOs and HIM directors who foster collaboration and mutual objectives are setting up themselves and their hospitals for success.
Aaron Brandwein is vice president, HealthPort, Alpharetta, Ga.
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This article 1st appeared on July 9, 2008 in HHN Magazine online site.
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