By Mary Butler

 

New Year’s resolutions have been proven—by science!—to succeed when certain qualities are present in the resolvers.1 These traits include a stated “readiness to change” and “self-efficacy of change,” which refers to a person’s confidence in their abilities.

By these measures alone, the health information management (HIM) profession is positioned to succeed in 2020 and beyond as it continues to prepare for the increasingly fast-moving changes in healthcare and how they affect health information.

To play its part, AHIMA enters the new decade ready to execute its transformation and the first stage of its new strategic plan announced in 2019—an initiative that’s admittedly far more ambitious than a typical New Year’s resolution. Part of the transformation is the need to advance the impact of HIM in three areas in the coming years: Integrity, Connection, and Access. It is in that spirit that the Journal looks ahead to explore the HIM stories in those focus areas in 2020.

In her last column of 2019, AHIMA CEO Wylecia Wiggs Harris, PhD, CAE, defined these “impact areas” (see side bar) as part of the “bold vision for ecosystem-wide change.”2 Focus within these areas will loom large in the Journal’s coverage this year, just as they will across the broader health information profession and in AHIMA’s work and advocacy.

Impact Areas: Integrity, Connection, and Access

Journal of AHIMA readers are going to be seeing—and hearing and reading—a lot about “Integrity,” “Connection,” and “Access” this year. Cornerstones of health information management, all Journal feature content in the year ahead will highlight one or more of these areas.

Integrity: Advancing the knowledgeable, contextual, secure, and appropriate creation and use of health data, leading industry conversations on innovative ways to ensure integrity

Connection: Facilitating optimal sharing of data between providers, consumers, health information networks, and health plans through technology-enabled, secure access to electronic health information

Access: Guiding the industry toward the most effective policies and practices to balance the ever-evolving need for appropriate access to protected health information with ensuring the confidentiality, integrity, and security of protected health information

Within these impact areas, 2020 will see significant attention on evolving topics, such as social determinants of health (SDOH), and others that are more familiar, such as interoperability, patient matching, and consumer engagement. Other recurring topics such as coding, clinical documentation integrity (CDI), privacy and security, release of information, data analytics, revenue cycle, and HIM education and professional development sub-topics will continue to be core areas of focus in the profession.

This article provides a preview of some of the topics you will find in the Journal of AHIMA this year, with an emphasis on patient matching, SDOH, and key legislative advocacy areas around privacy, interoperability, and patient identification.

Advocacy Priorities in a Time of Divided Government

On June 19, 2019, AHIMA and its industry partners made significant progress in addressing the challenge of patient misidentification when the US House of Representatives passed HR 2740, the FY2020 Departments of Labor, Health and Human Services (HHS), and Education and Related Agencies Appropriations Act. That legislation included an amendment that strikes decades-old language that prohibits HHS from spending any federal dollars to promulgate or adopt a national patient identifier. It is the interpretation of this prohibition by HHS over the years that has stymied calls for and the adoption of a national strategy to address patient misidentification, including but not limited to a universal patient identifier (UPI). As of press time for this article, it’s unclear whether the Senate will adopt this amendment as well—an action that’s required to clear hurdles toward a broader national conversation about the creation of a UPI.

Regardless of the outcome of a Senate vote, AHIMA and its partners plan to continue advocating on this issue. Lauren Riplinger, JD, AHIMA’s vice president, policy and government affairs, is quick to remind people that “moving legislation can often be like moving glaciers—it can take a really long time,” Riplinger says.

Like all organizations with a legislative agenda in Washington, DC, AHIMA’s government affairs team faces the prospect of the impeachment process upending the end-of-year legislative calendar in Congress. In this uncertain environment, it’s important to consider what additional levers AHIMA can pull to keep its agenda moving if things cannot get done legislatively, according to Riplinger. “We can create consensus in the industry, that’s the other pathway,” Riplinger says.

Despite these hurdles, AHIMA still plans to advance an ambitious advocacy agenda with the help of its members and component state associations (CSAs). Riplinger says the advocacy agenda is aligned with the impact areas of integrity, access, and connection. For example, in alignment with the focus on integrity, AHIMA is advancing the quality of coded data by influencing the development and maintenance of national and international medical coding standards. AHIMA is also advocating for prioritizing standards-based documentation integrity best practices to generate reliable and trusted information and to promote care continuity, quality improvement, research, population health, reimbursement, and other priority issues.

Access is another crucial advocacy area for HIM as it relates to privacy and security, according to Riplinger. AHIMA is working with other healthcare and privacy stakeholders to advance health information sharing policies by aligning the 42 CFR Part 2 regulations, which govern confidentiality and sharing of substance use disorder treatment records under HIPAA, allowing for the appropriate sharing of substance use disorder treatment records for purposes of treatment, payment, and healthcare operations.

Riplinger is also closely tracking the Office of the National Coordinator’s information blocking final rule, formally known as the 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program. At the time this article went to press, the final rule was under review at the Office of Management and Budget, which means it’s one step closer to being finalized. AHIMA was one of many groups to submit comments on the rule earlier last year. Riplinger and the policy and government affairs team will be watching the rule’s final release closely to help monitor its impacts on members. The team will be providing news and updates in their Under the Dome column, with the latest information available on the Journal of AHIMA website at journal.ahima.org. Riplinger is also hard at work planning AHIMA’s Advocacy Summit in Washington, DC, which takes place on March 23 and 24 and is open to all AHIMA members this year.

“We’ll be talking about patient access, interoperability, and I’m sure patient matching will be a topic of discussion,” Riplinger says. “It’s just going to depend on the environment. My intention and hope is to focus it around impact areas.”

CDI Doubles Down on Integrity

In an inevitable change that’s been a long time coming, clinical documentation improvement, or CDI, is getting a name change: the “I” now stands for integrity. According to Tammy Combs, RN, MSN, CCS, CCDS, CDIP, director of HIM practice excellence, CDI/nurse planner at AHIMA, this change has been under discussion by the AHIMA CDI Practice Council and the CDI Thought Leadership Roundtable for quite some time and for a number of reasons.

Combs says the CDI discipline began with the premise that clinical documentation was lacking in certain measurements and needed to be continually improved.

“But now we’ve reached a point [where] we are still finding opportunities for improvement, but it’s more about maintaining the integrity of the documentation. CDI has strived in so many ways to make improvements. So now the focus is on the integrity of the entirety of the health record, not just improving certain elements for greater reimbursement or quality scores. Integrity is more comprehensive. The definition incorporates everything, all that data and information that’s coming together to tell that patient’s story. That’s the focus of CDI now and data integrity,” Combs says.

As Combs notes, CDI supports the integrity of the entire health record, starting with the foundational elements of the documentation and the data that’s entered into the health record. “When a patient’s record has more integrity, then you’re opening the lines of communication to support informed decision-making,” Combs says.

The Year of Patient Matching

There is perhaps no other HIM topic as directly related to the impact area of connection than patient matching.
AHIMA has never waited for Congress to start advocating for better ways to improve patient safety, so the association is ready to make 2020 “The Year of Patient Matching” regardless of whether the Senate votes to remove the ban on a UPI.

“Having a UPI isn’t going to solve it [the problem of duplicate records],” says Julie Dooling, MSHI, RHIA, CHDA, FAHIMA, a director of HIM practice excellence at AHIMA. “We need an end-to-end patient matching solution, and we know as HIM professionals that we have a people, process, and technology (PPT) approach that has worked well. However, it’s not a magic button because every electronic health record’s (EHR’s) algorithms are different.”

The PPT approach has three prongs:

  • People, which refers to properly training registrars to capture the correct information when patients present for care
  • Process, which involves managing the duplicate queue and duplicate reporting
  • Technology, which can include tools such as patient matching algorithms, biometric devices, and third-party data sources

“We are taught as HIM professionals that if there’s daily maintenance involved following certain processes, a lower duplicate record error rate will support better patient safety,” says Dooling.

In other words, while AHIMA continues to advocate for a national strategy to address patient misidentification, there is still a lot that HIM professionals can do to improve duplicate rates in their own organizations, and these are strategies AHIMA will promote this year. At the end of 2019, AHIMA released a one-page infographic that explains the legislative history of patient identification, which HIM professionals can use to explain the patient safety implications to legislators.
With or without action in Washington, “there are known ways to manage your MPI to achieve a low duplicate record error rate,” Dooling says.

Getting to Know Social Determinants of Health

Anyone who has ever worked in healthcare is likely aware of social determinants of health (SDOH), says Cheryl Martin, MA, RHIA, HIM strategic advisor at AHIMA. They’ve dealt with issues such as having incomplete demographic information in the charts of homeless individuals and the resulting failures to coordinate care after their discharge.

Or they’ve been challenged to arrange follow-up care for patients without reliable transportation to future physician appointments and tests. Social determinants include societal and environmental conditions such as food, housing, transportation, education, violence, social support, health behaviors, and employment, which are attributes that contribute to an individual’s inability to access appropriate healthcare for their conditions.

The World Health Organization defines SDOH3 as: “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life, including economic policies and systems, development agendas, social norms, social policies, and political systems.”

SDOH is not a new concept to coding professionals who have long had SDOH codes available to use—but coders aren’t typically required to capture them. And SDOH information often is not documented in a patient’s record, especially in the outpatient setting.

As AHIMA noted in a comment letter to the ICD-10 Coordination and Maintenance Committee4 in May 2019, even when SDOH information is documented, it is difficult to find, as it may be captured in a variety of different places within the EHR. Also, even when a patient’s SDOH data is documented and shared across multiple encounters and healthcare settings, this information still needs to be validated at each patient encounter to ensure it remains accurate as social circumstances can change.

Because capturing data relevant to patient care is in an HIM professional’s wheelhouse, AHIMA is making a concerted effort to participate in and convene conversations around this practice.

To that point, AHIMA is participating in Health Level Seven’s (HL7) Gravity Project, which was initiated in 2018 by the Social Interventions Research and Evaluation Network (SIREN) with funding from the Robert Wood Johnson Foundation. Representing AHIMA on the Gravity Project are Dooling, Martin, and Donna Rugg, RHIT, CDIP, CCS-P, CICA, CCS, a director of HIM practice excellence at AHIMA.

According to Rugg, Gravity was born out of the need to standardize social determinants of health codes to capture social risk data and facilitate its use for sharing and interoperability. The project is tasked with addressing how to document SDOH information in the clinical healthcare setting and reviewing different classification systems such as ICD-10, SNOMED CT, CPT, and LOINC for missing and overlapping codes.

Normalizing data sets in the areas of food insecurity, housing instability and quality, and transportation access are the main areas of focus within the first phase of the project ending in 2019. The path forward for the workgroup in 2020 is to develop and test HL7 FHIR-coded value sets and create an implementation guide.

As noted in AHIMA’s comment letter, the association believes the Gravity Project will lay the foundation for the development of new ICD-10 codes for SDOH.

Nonetheless, HIM professionals “are probably going to be involved in discussions within their organizations about the capture of this information, the privacy and security implications around the capture of this information,” says Sue Bowman, MJ, RHIA, CCS, FAHIMA, senior director, coding policy and compliance, advocacy and policy, at AHIMA.
Incorporating SDOH into the EHR “is going to become an increasingly important aspect of the EHR, and so like the rest of the EHR, that falls under the scope of HIM,” Bowman adds.

Notes
  1. Norcross, John C., Marci S. Mrykalo, and Matthew D. Blagys. “Auld Lang Syne: Success Predictors, Change Processes and Self-Reported Outcomes of New Year’s Resolvers and Nonresolvers.” Journal of Clinical Psychology 58, no. 4: 2002.
  2. Harris, Wylecia Wiggs. “Taking Action for Health Information.” Journal of AHIMA 90, no. 10: 2019, p. 11.
  3. Green, Katie and Megan Zook. “When Talking About Social Determinants, Precision Matters.” Health Affairs. October 29, 2019. www.healthaffairs.org/do/10.1377/hblog20191025.776011/full/?utm_source=Newsletter&utm_medium=email&utm_content=Talking+About+Social+Determinants+Of+Health%3B+Behavioral+Health+Care+And+Firearm+Suicide&utm_campaign=HAT+10-29-19&.
  4. AHIMA. Comments to ICD-10 Coordination and Maintenance Committee. May 6, 2019. http://bok.ahima.org/PdfView?oid=302740.

 

Mary Butler (mary.butler@ahima.org) is associate editor at the Journal of AHIMA.

 

Continuing Education Quiz

Review quiz questions and take the quiz based on this article online at https://my.ahima.org/store/product?id=66096.

  • Quiz ID: Q2019101
  • Expiration Date: January 1, 2021
  • HIM Domain Area: Clinical Data Management
  • Article: “The HIM View for 2020”
Impact Area

Integrity: Advancing the knowledgeable, contextual, secure, and appropriate creation and use of health data, leading industry conversations on innovative ways to ensure integrity

Connection: Facilitating optimal sharing of data between providers, consumers, health information networks, and health plans through technology-enabled, secure access to electronic health information

Access: Guiding the industry toward the most effective policies and practices to balance the ever-evolving need for appropriate access to protected health information with ensuring the confidentiality, integrity, and security of protected health information