Getting to Know the Many Sides of HIM
Regardless of whether they’re with a hospital, physician practice, health IT vendor, governmental agency, consulting company, or payer, there is no shortage of job opportunities in health information management (HIM). In fact, few professions offer this level of diversity and job security. Becoming pigeonholed is no longer a reality as the need for data stewards persists throughout the industry. Shannan Swafford, DHA, MBA, RHIT, CHDA, CCS, knows this firsthand. An HIM professional who gained an early appreciation for the power of coded data, Swafford has since applied her knowledge in a variety of settings throughout her career.
The 411 on Shannan Swafford
Location: Dayton, TN
Current role: Manager of coding process improvement at BlueCross BlueShield of Tennessee
Degrees: Associate of applied science in health information technology, bachelor of science in business, master of business administration, doctorate of health administration in information systems
Coding credentials: RHIT, CDHA, CCS
Side gigs: Adjunct professor—taught and developed curriculum for “Current Issues in Healthcare Administration” at John Brown University in Siloam Springs, AR, and taught “Business Ethics in Healthcare” at Bryan College in Dayton, TN
Lisa Eramo: Why HIM—What drew you to the profession?
Shannan Swafford: I’ve always been interested in the business side of medicine. When I started looking at allied health professions I found HIM, and I fell in love immediately.
LE: I hear that a lot—that people don’t know about HIM as a profession until they start digging into alternative careers in healthcare. Do you think that’s changing?
SS: I do think it’s changing; however, there’s still an antiquated view of the profession that has persisted despite the fact that HIM skills and expertise have evolved commensurate with the digital transformation in healthcare. Having to prove myself and my knowledge was frustrating when I was younger, but now I’ve found ways to address it through open conversations. You can’t get defensive. You need to help people understand what you know and how you can help solve the problem at hand.
LE: I know you’ve worked in HIM since 2000. What types of jobs have you had, and specifically how has each job helped you grow professionally?
SS: I began my career in HIM as an individual contributor but quickly became a team leader at a medical center where I wore many hats. I wrote queries, pulled data from the pre-electronic health record (EHR) electronic system, and hand-typed state reporting for mortality, births, deaths, the traumatic brain injury registry, and the cancer registry. This is where I started to understand the implications of diagnosis codes and the power of the coded data. This experience definitely shaped my passion for data.
Next, I worked as a billing department coordinator for a family medicine practice where I was also the super user for the EHR and trained staff on how to use the system. In this role, I learned more about the EHR and how to use it effectively to improve patient care. My third position was hospital health IT consultant for a regional extension center, helping transition rural and critical access hospitals in Tennessee from paper to the EHR or from a non-certified EHR to a certified one. This was an invaluable experience, and it fed my desire to help improve access to care in rural areas. I learned so much about systems, interoperability, and the need for standardization and structured codified data across systems for continuity of care and population health management.
Next, I worked as a manager of patient treatment solutions for a system of five cancer hospitals where I led a team of decentralized clinical analysts in maintaining, upgrading, and correcting the enterprise EHR as well as the more than 30 software applications that fed data into or extracted data from the EHR. I also helped implement document imaging software across the system and worked through challenges of disparate databases as well as bandwidth and infrastructure limitations. My job also required me to mediate challenging discussions with oncologists, naturopathic physicians, pathologists, and others so we could build a cancer staging tool. In this role, I gained the functional knowledge to make data flow properly.
In 2013, I joined BlueCross BlueShield of Tennessee as a research and trending consultant where I examined potential patterns of fraud, waste, and abuse. My coding background was paramount, and I learned a lot about data analytics in this role. In 2017, I became the manager of coding process improvement—a newly created role for which I helped write the job description. In this role, I’ve led the build of an end-to-end data governance program which has pushed me beyond what I thought I was capable of doing. It has been an amazing experience.
LE: Tell me more about the data governance project and your role in it.
SS: The program was originally an effort to implement general equivalence mappings (GEMs) in a timely manner after the transition to ICD-10. This morphed into a program that would ensure timely updates for all ICD-10, CPT, HCPCS, and Current Dental Terminology (CDT) codes. We partnered with a vendor that had a tool that uses artificial intelligence (AI) to determine specific code changes that impact code groups that are used for claims adjudication, analytics, and more. Our coding research and reimbursement team validates the codes before we send them to the enterprise as a complete update. The new steps in our process help us provide business owners with the precise codes they need to review each year. We leverage people, processes, and systems to gain a more automated flow for code maintenance of ICD, CPT, HCPCS, and CDT.
LE: How has BlueCross BlueShield of Tennessee benefitted from the changes you’ve made?
SS: The changes reallocate resources among several teams including configuration and product development groups as well as various stakeholders from multiple lines of business. For example, in our previous process, one of our teams manually reviewed code groups for the Affordable Care Act (ACA) preventive measures, and then sent the information to the team that owned business decisions involving those codes. This process often took six to eight weeks. Now, AI pinpoints new and revised codes that might impact certain policies or products. The first time we utilized our new AI-driven process, these groups handled all of the updates in 45 minutes with the exception of one that needed additional stakeholder input. It’s mind-blowingly amazing.
LE: Throughout your career, it seems like you’ve had a lot of on-the-job learning. Was it intimidating to go from one setting with a certain set of job responsibilities to a completely different setting with a different scope of responsibilities?
SS: It probably should have been intimidating, but not a lot scares me. It was exciting to me. I thought of every opportunity as a new challenge. One of my goals in life is to leave things better than I found them, so when there’s an opportunity to do this either personally or professionally, I jump at it. That helps me be less scared.
With that said, there were times throughout my career when I felt in over my head a bit. For example, when working at the regional extension center, I had to research a lot on my own to learn some of the IT language so I could keep up with conversations. However, my experience with EHRs gave me a foundation of knowledge on which I could build. Another example that comes to mind is when I started my doctoral program at Medical University of South Carolina. When my cohort group started introducing themselves, I realized I was in the company of CIOs, physicians, radiologists, pharmacists, and other highly trained individuals, and I doubted my abilities. However, when we started having dialogues in our forums, I realized how much knowledge I had to share.
LE: What’s the one commonality that you think transcends all of the HIM positions you’ve held?
SS: Respect for the data. If you’re releasing the data, you need to be mindful of patient privacy while also balancing the need for information exchange that enables care continuity. If you’re coding, you need to tell the complete and accurate patient story. If you’re working for a payer, you need to make sure the member receives the most appropriate services based on the diagnoses that are reported. HIM professionals are stewards of the data regardless of the role.
LE: Why diversify your job experiences? Why didn’t you stick with one specialty or setting?
SS: When I took the job with the regional extension center it highlighted the need for HIM professionals in so many other places. I saw the explosion of what was possible with data because of electronic exchange and the new technologies and applications that were going to be sending, receiving, or storing this data. I saw an opportunity to take this data into new places.
LE: What are some of the untapped opportunities for HIM professionals? How can HIM help support the use of big data in nontraditional settings?
SS: The payer world is actually ripe with opportunities for HIM. The Office of the National Coordinator (ONC) and the Centers for Medicare and Medicaid Services (CMS) may publish final rules in November on patient access and information blocking. Both agencies have sent their respective rules to the Office of Management and Budget for review. One of the emerging areas is working for third-party vendors building the portal and transactional forms that enable patients to request their information from a payer. For example, HIM can help payers understand their legal obligations in terms of access and blocking, including how to define their designated record set. HIM can also serve on value-based contracting teams, helping to define outcomes-based quality metrics. When payers include HIM professionals in these conversations, they can actually increase the quality of the data they receive. Finally, HIM can help design reports for medical informatics, quality, and value-based contracting.
LE: If someone wants to move into these new roles, what knowledge do they need?
SS: They need to expand their knowledge of back-end structured data—SNOMED, LOINC, RXNORM—so they can ensure that the most updated structured data links correctly with coded data to flow through Health Level Seven or FHIR-based APIs. They also need to understand data architecture so they can enhance data mapping. It’s one thing to identify applications and business owners but another to identify all of the data that actually flows through those relationships. HIM professionals need to understand change management and how to overcome barriers to change. They also need to understand project management, process improvement, and data governance. Finally, they need to know how the changes they propose affect others and their workflow.
LE: In the nearly two decades you’ve worked in HIM, what’s something you learned about the profession that you didn’t anticipate?
SS: I didn’t understand the power of the data. That has been so instrumental in every choice I’ve made in my career. The story that the data tells impacts both personal and population health, and it also drives organizational decisions around clinical and financial opportunities. It’s thrilling!
LE: Can you provide any advice to younger HIM professionals who want to follow a similar professional trajectory?
SS: Become friendly with IT and have conversations. Be bold and take on new challenges. Be a lifelong learner regardless of whether it’s pursuing higher education, certification, or simply attending a lunch-and-learn event. Always consume knowledge.
Lisa Eramo (leramo@hotmail.com) is a freelance writer and editor in Cranston, RI, who specializes in healthcare regulatory topics, health information management, and medical coding.