HIM Principles in Health Information Exchange

HIM Principles in Health Information Exchange (Practice Brief) Emerging health information exchange initiatives must focus on more than their IT model. They must make important early decisions on HIM issues that hard-wire data quality, privacy, and security into the network, ensuring that the ultimate goals of improved patient safety and quality of care are met.

The value of electronic healthcare data exchange was demonstrated in the aftermath of Hurricane Katrina, when healthcare organizations throughout the region and nationwide shared patient data to aid in the care of residents displaced by the storm. The Department of Veterans Affairs found that more than 2,300 users exchanged electronic healthcare data across 48 states in the month following the disaster. Laboratory data represented just 2 percent of all data requests. Text-based reports including 1

demographics, discharge diagnoses, immunizations, and health summaries were the most commonly requested reports.

Technology is a critical tool in achieving the benefits of health information exchange (HIE). However, technology alone is not sufficient. Healthcare industry stakeholders that base their HIE solutions solely on technology do so at the expense of underlying HIM principles. An abundance of disparate HIE principles, models, definitions, products, and standards camouflages some crucial policy and process decisions an HIE initiative must make in the early stages of its development. Transmitting patient data electronically without attending to the business processes surrounding data capture, translation, and transmission has the potential to increase patient risks and healthcare costs. Data accessibility, reliability, and accuracy are critical factors in obtaining the trust of stakeholders, including consumers, and in sustaining long-term data exchange on a large scale. Accordingly, it is imperative for regional health information organizations (RHIOs) to hard-wire patient safety and quality of care measures into the HIE’s processes and systems.

This practice brief outlines the HIM principles essential to HIE initiatives. The manner in which HIM principles apply to an HIE are discussed further in the “Data Quality Attributes Grid”. This Grid is an extension of the “Data Quality Management Model,” developed by AHIMA's Data Quality Management Task Force, which describes key process issues that are important to the success of an HIE.

Establishing Standards in HIE
There has been continued progress in the development of EHR standards, including electronic transmission methods for HIEs and the nationwide health information network. AHIMA is now calling for the development and implementation of HIE standards for the quality of data content, data mapping, and clinical documentation. These standard HIM principles can ensure the accurate transmission of data across participating RHIOs.

A commitment to core HIM principles is as important in the electronic health information environment as it is in the paper realm. HIM professionals must convert their critical principles to the electronic environment and effectively build such principles into HIE workflows. As RHIOs form, HIM professionals must help these organizations: q

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Define the data exchange model and the specific data to be exchanged based on the RHIO’s mission, vision, purpose, and goals
Develop standards for acceptable data quality that will be required of RHIO participants, as well as how data quality will be measured
Assess the process to capture patient identity as well as its consistency across each of the RHIO’s participating organizations Provide standards for each RHIO participant’s duplicate medical record rate and outline how this rate will be measured to

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HIM Principles in Health Information Exchange

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ensure validity
Audit the accuracy of the electronic linking of records within the RHIO and provide evidence of the accuracy rate Audit the accuracy of the clinical documentation within RHIO participants’ electronic medical record and report the results to the RHIO’s governing board

Develop privacy and security policies regarding methods for accessing the RHIO system, provisioning, authorizing, and authenticating users, and auditing access

Defining RHIOs
A RHIO is a group of organizations and stakeholders that exchanges data electronically to improve the quality, safety, and 2

efficiency of healthcare delivery. RHIOs are ordinarily geographically defined entities that arrange for the means to exchange information electronically. They also develop and maintain HIE standards. To successfully exchange information, RHIOs must build their data exchange on sound principles and processes. With significant federal and private investments in RHIOs, new projects are being formed continuously, each with varying purposes and objectives. The purpose drives the method by which a RHIO shares electronic clinical information. The various clinical data-sharing...

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