In this web series, HIM professionals working in emerging roles give advice on tackling difficult HIM problems.
The HIM Problem: The Federal Aviation Administration (FAA) manages the autopsy records of hundreds of pilots killed in accidents every year, but until 2008, health information management (HIM) professionals weren’t leading the efforts.
The HIM Problem Solver: Christy Hileman MBA, RHIA, CCS, team coordinator, autopsy records administrator, for the FAA’s Autopsy Program Team, brought her HIM expertise to a position—as well as a federal agency—that had never hired an HIM person. Hileman implemented HIM practices at the FAA and helped to build the program from the ground up.
Every year the Federal Aviation Administration (FAA) investigates between 280 and 300 aircraft accidents—including commercial aircrafts, hot air balloons, helicopters, gliders, private planes and jets. Within the FAA is the Civil Aerospace Medical Institute, a research division that, among other tasks, manages autopsy records for pilots killed in aircraft accidents. Autopsy records are used for two purposes: first is to help determine the reason and accident occurred and the second is for research purposes. Autopsies of pilots can reveal whether the pilot suffered a heart attack that may have contributed to a fatal crash, or if they were taking a medication or had drugs or alcohol in their system, or suffered some other medical impairment or incapacitation. The research branch uses the autopsies to determine if there are trends in disease processes that are unique to pilots, or whether certain medications have adverse events that can impact a pilot’s health.
In 2008, Christy Hileman, MBA, RHIA, CCS, saw a job listing on USAjobs.gov for an autopsy records administrator, located in Oklahoma City, OK, that required applicants be knowledgeable in medical records, anatomy, and physiology. Hileman, who had spent her HIM career in coding and cancer registry roles, instantly recognized this as a role that someone with a background in HIM was well-qualified for. There were two open positions in this newly created role, and Hileman was hired with one other person. The FAA, according to Hileman, was not aware that the HIM profession existed or that there were certification and credentialing programs. As such, when Hileman was hired, the autopsy records were not managed according to typical HIM policies.
“I helped to start the program so there wasn’t a guidebook on ‘This is How You Should Do it.’ My counterpart and myself , the team coordinator at the time, we built the program. We did a lot of research on what we thought it should be like and we built it from the ground up. It was different than hospitals because hospitals are corporate and have their policies and procedures in place in the beginning, but…we built them, so it’s different.”
HIM Responsibilities in a Non-traditional Setting
Hileman’s job, among many other responsibilities, involves protecting the privacy of the information on autopsy records. The autopsy records are exempt from Freedom of Information Act requests for the FAA, so Hileman is not authorized to release records related to an investigation to the general public or the press. Nor is the FAA governed by HIPAA, although Hileman frequently works with HIPAA covered entities if, for example medical records need to be obtained from a hospital in the event that a pilot was transferred from a crash site to a hospital.
Because aircraft accidents are high-profile events, Hileman has to refer requests for information to a media officer who meets with the public, or she may refer the press to the coroner, medical examiner, or her counterparts at the National Transportation Safety Board. But just as hospitals have to more carefully monitor who has access to a VIP patient’s records, the FAA puts similar precautions in place in their record databases.
“We have a database we manage, we have autopsy records that are electronic. We keep those and do audit logs to make sure that people who shouldn’t be accessing them aren’t accessing them. So I think I use all the normal HIM skills that you would in a traditional role, just in a nontraditional way,” Hileman says.
Another difference between managing medical records for the FAA versus a typical provider is coding. The FAA codes records using ICD-10-CM/PCS and has used it since 2008—in part because they thought it would be adopted nationwide sooner than 2015. The ICD-9 code set isn’t specific enough for FAA researchers, and since billing and reimbursement isn’t an issue for autopsy records, they chose to stick with ICD-10 because of the greater level of specificity needed for research purposes, Hileman says.
Although Hileman worked in inpatient and outpatient coding prior to joining the FAA, it’s not one of her primary duties.
“A physician does the coding and he asks me questions frequently, but I don’t do coding. I do records management, I do research, I do more queries, budget management, that kind of thing,” she adds.