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Reflective Writing
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Emerging into E-‐Health Information Management
Reflec%ons on e-‐health and my career aspira%ons -‐Kathy Nickerson, GRU Health Informa%on Management Student
I enthusias+cally believe in electronic health records, e-‐health and electronic health informa%on management for the benefit of each individual pa%ent and the community of people who have been affected with a condi%on or disease that nega%vely affects their lives. I’m excited to get involved in the process of moving health care toward more e-‐health ini%a%ves and to engage physicians and pa%ents in these ini%a%ves. There are barriers to the implementa+on of e-‐health ini+a+ves, electronic health records and health informa%on organiza%ons. The mission of health informa%on management (HIM) professionals is to help break down these barriers to adap%on of electronic health informa%on management.
My personal mission is to find a barrier and break it down.
What is e-‐health?
“Simply stated, e-‐health is the applica%on of e-‐commerce to the health care industry.” (LaTour, 2010) So what does this mean for health care providers and individuals who are consumers of health care? Gunther Eysenbach provided my preferred defini%on of e-‐health in 2001, when he published the 10 e’s of e-‐health. They are: Efficiency, Enhancing quality of care, Evidence based, Empowerment, Encouragement, Educa%on, Enabling, Extending, Ethics, and Equity.
The 10 e's in "e-‐health" 1. Efficiency -‐ one of the promises of e-‐health is to increase efficiency in
health care, thereby decreasing costs. One possible way of decreasing costs would be by avoiding duplica%ve or unnecessary diagnos%c or therapeu%c interven%ons, through enhanced communica%on possibili%es between health care establishments, and through pa%ent involvement.
2. Enhancing quality of care -‐ increasing efficiency involves not only reducing costs, but at the same %me improving quality. E-‐health may enhance the quality of health care for example by allowing comparisons between different providers, involving consumers as addi%onal power for quality assurance, and direc%ng pa%ent streams to the best quality providers.
3. Evidence based -‐ e-‐health interven%ons should be evidence-‐based in a sense that their effec%veness and efficiency should not be assumed but proven by rigorous scien%fic evalua%on. Much work s%ll has to be done in this area.
4. Empowerment of consumers and pa%ents -‐ by making the knowledge bases of medicine and personal electronic records accessible to consumers over the Internet, e-‐health opens new avenues for pa%ent-‐centered medicine, and enables evidence-‐based pa%ent choice.
5. Encouragement of a new rela%onship between the pa%ent and health professional, towards a true partnership, where decisions are made in a shared manner.
The 10 e's in "e-‐health” continued… 6. Educa+on of physicians through online sources (con%nuing medical
educa%on) and consumers (health educa%on, tailored preven%ve informa%on for consumers)
7. Enabling informa%on exchange and communica%on in a standardized way between health care establishments.
8. Extending the scope of health care beyond its conven%onal boundaries. This is meant in both a geographical sense as well as in a conceptual sense. e-‐health enables consumers to easily obtain health services online from global providers. These services can range from simple advice to more complex interven%ons or products such a pharmaceu%cals.
9. Ethics -‐ e-‐health involves new forms of pa%ent-‐physician interac%on and poses new challenges and threats to ethical issues such as online professional prac%ce, informed consent, privacy and equity issues.
10. Equity -‐ to make health care more equitable is one of the promises of e-‐health, but at the same %me there is a considerable threat that e-‐health may deepen the gap between the "haves" and "have-‐nots". People, who do not have the money, skills, and access to computers and networks, cannot use computers effec%vely. As a result, these pa%ent popula%ons (which would actually benefit the most from health informa%on) are those who are the least likely to benefit from advances in informa%on technology, unless poli%cal measures ensure equitable access for all. The digital divide currently runs between rural vs. urban popula%ons, rich vs. poor, young vs. old, male vs. female people, and between neglected/rare vs. common diseases.
In addi%on to these 10 essen%al e’s, Eysenbach stated e-‐health should be: easy-‐to-‐use, entertaining, and exci+ng. (Eysenbach, 2001) These last 3 e’s will make e-‐health become more mainstream and are important aspects of the
evolu%on to e-‐health.
Why isn’t electronic health informa+on more exci+ng and widely executed?
I believe it is because there are too many barriers to the implementa%on of e-‐health ini%a%ves, electronic health records and health informa%on
organiza%ons/or exchanges.
Two type of barriers exist – physician barriers and pa+ent barriers.
Physician Barriers Eight main categories of barriers to physician acceptance of EMR’s have been iden%fied. These eight categories are: A) Financial, B) Technical, C) Time, D) Psychological, E) Social, F) Legal, G) Organiza%onal, and H) Change Process. All these categories are interrelated with each other. (Boonstra, 2010)
1. Financial Barriers – Physicians are concerned about the costs of implemen%ng and maintaining an EMR.
2. Technical – Physicians and their staff may not have the technical skills necessary and may not have the training and support. They have concerns about the complexity, limita%ons and reliability of the EMR.
3. Time – Time to train, %me to enter data, %me to learn, %me to choose and implement – all are %me away from pa%ents.
4. Psychological – Physicians may not be convinced that EMR’s are worthwhile and that the development of an EMR will take away their control of the informa%on.
Physician Barriers continued…
5. Social – Lack of support from vendors, management, and other colleagues and interference with the doctor-‐pa%ent rela%onship are concerns for physicians.
6. Legal – Confiden%ality, privacy and security are essen%al to health informa%on management and physicians make feel that these issues are not adequately addressed.
7. Organiza+onal – The electronic systems may not be applicable to the physician’s prac%ce type and size.
8. Change Process – Ader being in prac%ce for any length of %me, many physicians have their own working processes and styles. Electronic health informa%on management may require a major change in how physicians work.
Patient Barriers
1. Paternalis+c Nature of Medicine – In the past, pa%ents abdicate the responsibility for their health to physicians and assume the physician has all the needed knowledge and specific informa%on to treat them. Pa%ents should realize that physicians don’t always know the most op%mal path to health and they need to share the responsibility for their own health.
2. Data Ownership – While organiza%ons own the physical medical record or the EHR, pa%ents own their medical informa%on. Pa%ents oden need to have this informa%on interpreted by qualified individuals and shouldn’t be in%midated or kept in the dark.
A number of factors create barriers to consumer (pa%ent) engagement and consumer-‐mediated HIE, including the paternalis%c nature of medicine, the current structure of health insurance plans, the indirect nature of third-‐party payment, technology-‐related challenges, and factors related to behavioral economics.
Patient Barriers continued… 3. Third Party Payment – Ever try to make sense of a medical bill? Retail
price, discounted price, insurance contract price, pa%ent co-‐payments, reasonable and customary price, explana%on of benefits, Medicare payment, deduc%bles – it’s enough to make anyone throw up their hands and just hope it turns out OK. Especially when you are ill, infirm or disabled.
4. Technology Challenges – Pa%ents frequently are referred to specialists or
other health care providers. Communica%on between all health care providers involved in an individual pa%ent’s care is frequently non-‐existent or poor. Impor%ng informa%on or data from mul%ple sources to one comprehensive EHR or Health Informa%on Exchange is a challenge.
5. Behavioral Economics – Pa%ents need to have a good agtude about their EHR, to know that it’s normal to get informa%on on their medical condi%on and to have confidence that they are able to access this informa%on. Pa%ents may not have the computer skills to even access to computers or the Internet. (Morris 2010)
How can I break down barriers to e-‐health? Or in other words, where do I go from here?
The profession of health informa%on management (HIM) is evolving and new HIM roles are emerging with vastly improved computer technology and the advancement of electronic health records. “With the 2009 enactment of ARRA as well as other advances in medicine and disease management, the speed of technology in healthcare opens new pathways for HIM professionals.” (Watzlaf 2009)
Studying to become a Registered Health Informa+on Administrator is just the beginning.
My Personal Strengths • Unique combina-on of medical and informa-on technology experience. Twenty years in medical laboratories and 12 years in digital asset management allows me to bring new perspec%ves from both disciplines.
• Sincere and intense interest in learning with the comfort, ability and desire to advance technically. Learning new sodware, new processes, and new management techniques is not only exci%ng, but cri%cal in moving forward. I’ve embraced the challenges of being a non-‐tradi%onal student; my academic and career records prove my ability to adapt and succeed.
• Being a member of the technologically sandwiched genera-on. Individuals older than I am may have adverse feelings toward new technology; younger folks are much more comfortable in the digital environment. I can iden%fy with the reluctance of established, seasoned professionals to change and I enjoy working with Genera%on X and Millennials.
• Detail oriented and data driven. My experiences as a Medical Technologist, Image Bank Archivist and Digital Asset Specialist have sharpened my strong apprecia%on for detail, data and organiza%on.
Interesting possibilities • Healthcare Consumer Advocate -‐ Medical informa%on, insurance issues, and billing issues can be in%mida%ng and confusing. As the popula%on ages and the available informa%on grows, the need for guidance in these areas will increase.
• Client Support Specialist –Maximizing the technology tools available to pa%ents and/or physicians is important to the advancement of e-‐health.
• Clinical Research Coordinator – Acquiring data and transforming it into useful informa%on for the benefit of current and future pa%ents is an honorable and worthy goal.
• Health Data/Informa+on Resource Manager – Data and informa%on needs to be made accessible to the individuals that need it. Finding the informa%on is a cri%cal step before knowledge, change and ac%on can occur.
My plan • Achieve the creden-al. Push for a strong finish to my Post-‐Baccalaureate program and take the RHIA exam as soon as possible.
• Get connected. Akend Georgia AHIMA ac%vi%es and the na%onal AHIMA mee%ng in Atlanta this fall. Stay in touch with students currently in the program and with contacts at DeKalb Medical Center. Con%nue to go to the Emory Health Informa%cs seminars. Improve my LinkedIn profile.
• Find the right first posi-on. Research organiza%ons, academic ins%tu%ons, companies, and the posi%ons they have available. An entry-‐level posi%on of data collec%on or abstrac%on may be more realis%c and would give me beneficial front-‐line experience.
Explore and be open to emerging HIM employment possibili+es, look for a mission and move toward the goal of breaking down a barrier to the implementa+on of e-‐health ini+a+ves, electronic health records
and electronic health informa+on management.
References Boonstra, A. and Broekhuis, M. (2010) Barriers to the acceptance of electronic medical records by physicians from systema5c review to taxonomy and interven5ons. BMC Health Services Research. hkp://www.biomedcentral.com/1472-‐6963/10/231 Eysenbach, G. (2001) What is e-‐health? Journal of Medical Internet Research. hkp://www.jmir.org/2001/2/e20/ LaTour, K.M. and Maki, S.E. (Eds.). (2010). Health Informa5on Management, Concepts, Principles and Prac5ce. Chicago, IL: American Health Informa%on Management Associa%on. Morris, G., Afzal, S., Finney, D. (2012) Consumer Engagement in Health Informa5on Exchange. Office of the Na%onal Coordinator for Health Informa%on Technology. hkp://www.healthit.gov/sites/default/files/consumer_mediated_exchange.pdf Watzlaf, V.J.M., Rudman, W.J., Hart-‐Hester, S., Ren, P. (2009) The progression of the roles and func5ons of HIM professionals: a look into the past, present and future. Perspec%ves of Health informa%on Management. Retrieved from: hkp://www.ncbi.nlm.nih.gov/pmc/ar%cles/PMC2781732/
Many thanks to….. • My instructors at Georgia Regents University – Dr. Amanda Barefield, Dr. Carol Campbell, Dr. Jim Condon, Ms. Lori Prince and Ms. Sherry Smith for preparing me and segng me on this career path.
• Mr. Ron McCranie and the HIM Staff at DeKalb Medical Center for hos%ng me for my Summer Prac%cum.
• Lastly, and most importantly, my husband John, whose support, educa%onal perspec%ves and belief in me have been truly invaluable during my return to school this past year and for the past 36 years.