In this web series, HIM professionals working in emerging roles give advice on tackling difficult HIM problems.
The HIM Problem
Defining the responsibilities for the role of “eHIM Director” in an increasingly electronic HIM world.
The HIM Problem Solver
Mary Sunahara, BS, RHIT, eHIM Director, Health Networks, Sisters of Charity of Leavenworth Health System, Denver, CO
Evolving Job Titles
Mary Sunahara, BS, RHIT, has yet to meet anyone outside of her own organization, Sisters of Charity of Leavenworth Health System (SCL), that shares her job title of eHIM manager. But within SCL, she is one of four eHIM directors. She credits her manager, the health system’s senior director of HIM, for recognizing that HIM job titles need to reflect how quickly the profession is changing. Sunahara’s manager is very focused on how the system manages electronic data as electronic health records (EHRs) and health information exchanges (HIEs) become more pervasive.
“I think my boss is very visionary. She’s constantly looking at the changing environment. In 2007 and 2008, she started to look at HIM really moving very quickly toward the electronic world, and that’s where she just started creating these eHIM positions, really focusing on the electronic world,” Sunahara says.
Though she is not sure whether other healthcare organizations will start adopting the title of eHIM director, Sunahara definitely views it as an emerging role. As to whether there is a major difference between the title of HIM director and eHIM director, Sunahara notes that it varies from provider to provider, but she suspects eHIM directors have a slightly bigger focus on health IT.
“I think the difference, the big difference I see is if you just have a focus on IT, you don’t understand the business process side of it. Almost in the same way. HIM may not necessarily understand the IT side of it. [In] my position, we vary the two. We’re the liaison between the business processes and the business operations and technology,” Sunahara explains.
She adds that as healthcare delivery shifts to models such as accountable care organizations (ACOs), “our focus needs to change. I think maybe not the title ‘eHIM,’ but the role is emerging definitely,” Sunahara says.
eHIM Director Duties
When Sunahara was hired, the role of eHIM director was a new position. Her primary focus was to bring SCL’s nearly 200 clinics on board with an EHR and document management programs. Though she is based in Denver, Sunahara helps to oversee EHR implementation in ambulatory clinics in rural Montana, Wyoming, Kansas, and Colorado, requiring her to travel about 20 percent of the time. Now, she has three business analyst direct reports who work remotely.
Much of her time is spent improving and introducing EHR workflows in the clinics. Currently, 55 of her 200 clinics are completely on an EHR, with the rest working on a hybrid of paper records and electronic records. Originally the plan was to have all the clinics on an EHR by 2014, but that plan has been revised and now the target date is the end of 2015.
While Sunahara considers herself an EHR cheerleader, she also understands that the smaller clinics can feel overwhelmed by the pace of change. She says there’s not enough time in the day, or enough individual clinic staff to ensure proper use of EHRs.
“I hear all the time ‘Oh, well, I have this workflow where I copy and paste.’ For them it’s the greatest thing since sliced bread, it’s awesome, it makes their life easier,” Sunahara says. “From my perspective, you’re killing me. Are you auditing that, how are you making sure what you copy and paste in there is correct?”
Sunahara also has responsibilities related to HIEs, and getting smaller clinics on board.
“It is my responsibility to figure out how this [HIEs] impacts the clinics, how the clinics need to change their workflows. What do we need to train them on. We work closely with two Colorado HIEs,” Sunahara says, adding that she worries that small clinics won’t be able to afford access to HIEs in the short term.
eHIM Director Qualifications
When Sunahara saw the job description for eHIM director, she was immediately drawn to the requirements that called for project management and implementation skills. The SCL position called for extensive knowledge of isystems analysis, project management, change management, EHR implementation, and hands on operational experience working with physicians and clinical staff within an ambulatory setting.
This was a perfect match for Sunahara, who has an eclectic HIM background, having worked for vendors, physician offices, and other ambulatory settings. The position also didn’t require any additional training.
“Based on my strong project management background, my IT background, and my implementation experience, it wasn’t anything that I needed to gain additional skillsets for,” Sunahara says. However, she does plan to start studying for project management certification, as those skills are a crucial part of her job.
When Sunahara took this job, she soon had to bring on a project manager to help with all the EHR implementations she had to oversee.
“I think project management is a requirement for anyone at the director level,” Sunahara says. “Any time you’re at a director level and you have a team underneath you, even in your daily operations, there’s always a project going on. Even if it’s a project to improve your processes, it’s still a project.”