Role of Health Information Managers in this Millennium

Dr. G.D. Mogli, FHRIM(UK)
Sr. Consultant & Adviser,
Dean, Oman Medical Record Institute
Ministry of Health, Sultanate of Oman
Visiting WHO Consultant

I. Introduction:
The Existing concept of conventional health care delivery system through hospitals, clinics, wards and diagnostic centers has undergone a dramatic change with the advent of modern communication technologies like the internet and telemedicine, and it has become possible to provide safe, speedy and quality care with less cost through the electronic media. The health record profession has undergone a major transformation during the last century, especially in the last three decades, and has reached the present stage where it tries to meet the needs of hospital information management. Professional educational needs were restructured to meet the pace of changing technology. The tremendous rate of growth of information technology had a big impact on the environment of institute infrastructure that affected the health care delivery management system. This, in turn, had a direct impact on patient care services where the aim was to render utmost care in the least possible time, at a reasonable cost, with due respect to the quality in all parts of the globe.

These changes can be implemented effectively, provided the management and the professionals are well equipped with the growing technology. The need of the hour for the health record professional is to provide the expected services in a fast changing environment and to reap the benefits that accrue in terms of better health care; preventive, curative, promotive and rehabilitative - by using the latest technology. Here we have to ask ourselves - Is it possible with our conventional educational background? In view of rapid changes, it is imperative for us to mould our educational system and syllabi to meet the developments in our profession. An appropriate educational background would make us an effective and efficient associate of health information for care, cost and quality assurance.

II. Health Record Profession - Transformation:
The role of the Health Records Professional has undergone a gradual transformation over the last 8 decades and today, it occupies a significant role in the health care delivery system, especially in the hospital environment. In fact, the American Health Information Management Association (AHIMA), has contributed enormously to the field of health record information management system by enhancing the role of the health record professionals and at the same time ensuring appropriate status for the professionals, which is commendable. In spite of all this profess, the medical record professionals have not benefited to the optimum level. The HR professionals of the third world, have also touched the important positions, but with great amount of struggle, because of lack of very concept of good medical records maintenance system. However, the present technology of electronic communication, can change the very facet of global thinking in terms of delivering effective, safe and fast health services to the needy in the shortest time through enhancing the role health record professionals; which was not possible earlier. In the present context, the professional educational system has to be transformed vigorously and the professionals should be acquainted with necessary subjects, to meet their professional responsibilities.

Conventionally, the medical record manager / administrator has to spend more than 70% of his professional time on organization and management of the department. The conventional educational qualifications focused on day-to-day functions rather than innovation through education, and the role of MR professional is not fully exploited.

III. Technology 
Undoubtedly, the current HIMT is the product of change from the manual information technology management phase to a fast and accurate computerized HIMT era. The evolving technology is poised to play an even more dramatic role, especially in the field of medicine in the coming days. It is foreseen that in the course of the next two decades, the present conventional environment of hospital, health centers, clinics will undergo complete transformation. The patient may not have to leave home for medical attention, not will the doctor have to visit the patient. The Internet will be used to input vital signs like pulse rate, blood pressure, health rate, temperature, blood samples, X-ray, ECG, EEG, CAT scan, MRI etc., that would be processed by the regular desktop device through internet. Doctor's prescription will be transmitted to the nearest pharmacy, and it will be delivered immediately. Mobile nursing units and video conferencing will be very common; hence the patient and doctor may not be in the same city or country. Access to other patients with similar ailments on a mutually consensual basis with anonymity, if desired, would be possible. Electronic chips or bands on patients to monitor vital signs of the patients round the clock, with the doctor's inputs, will be automatically logged into the patient's record. There will be only one medical record for a patient from birth to death containing vital information such as vaccination, drug reactions, current medication being administered, etc. which can be accessed globally. Electronic chip will be used to administer exact dosage on schedule and to observe the feedback from the patient. Doctors, instead of writing or recording will just speak into the medical record (voice recognition software which will convert it into the text and store it in a audio file). Diagnosis will be more accurate, due to new sources of information through Internet. Minimal hospital stay would be required, as treatment will be administered at home, with the doctor monitoring using electronic devices over the Internet. Benefits of a single online medical record are huge. Doctors gain insight on cause of diseases by cross-referencing other patients' records and also those of relatives. This can also help in discovery of causes, prediction of trends etc. Availability of inference engines (online chatting) on the Internet that will diagnose based on answer to the question will prevent doctor's visit for minor ailments. Global health insurance will ensure the availability of care from any country without leaving the shores, especially remote / rural areas. Technological advances such as these indicate that conventional educational background will not be adequate in future. We professionals, have to look into this aspect and see how far technology can be exploited in our endeavor to provide safe, best, cost effective and fast patient care services. This is one of the reasons, the author had felt and started questioning, whether the present designation and educational qualifications are appropriate? 

IV. Drawbacks of the Current Technology:
The current technology used by health care delivery system poses certain challenges. These have to be analyzed and overcome to protect and gain benefits, which would be flowing through. Some of these challenges are - Access to health records from anywhere in the world in a secure way, authentication of doctors and their credentials, authentication of patients to access their records using retinal scans or finger printing, standard formats for representing medical information across nations, language translations, unit translations, billing, compact data formats to represent audio, video, and images, data storages (it is easier for the patient to hold his medical record rather than a medical institution as vast amount of information can lead to misuse). For electronic bands and to work effectively, wireless internet has to take off in a big way and finally the confidentiality.

V. Role of HIM in this Millennium:
In today's interdisciplinary, technology - driven health care environment, HIM professionals are called upon to be crucial members of the care delivery team - the equals of nurses, the right hands of physicians and the skilled helpmates of healthcare practitioners. To keep pace with change and fulfill their duties as information managers, HIM professionals need to widen their focus and broaden their horizons. The education and training has to be different due to technological changes, to enhance quality and reduce the cost of the patient care by improving its stability. The present tele-seminars and Internet-based programs, which are fast becoming common place in and around the world, are easy to share from any corner of the globe, in terms of formal academic education. Internet technologies have changed the HIM professional's job responsibilities. An electronic system, in the final analysis will reduce the conventional MRD workload. However, understanding technology needs time and effort to accomplish optimum results.

The new role which the Health Record professionals, are going to assume, will be quite different in terms of management. The newly accepted role would be mainly to develop an appropriate Health Information software system with association of software experts, testing, customizing and managing the software, training the medical, nursing and other involved in the EMR, and to monitor and ensure that (1) the software services are uninterrupted and smoothly functioning, (2) the patient schedule is followed properly (3) the instant completion of information by the care providers in different work stations such as the investigation reports, consultation reports, references, diagnosis, treatment, including surgical procedures, follow-up appointments and recommendations etc are properly integrated. One of the major responsibility of the HIM professionals, besides routine conventional patient care management would be to ensure the cost is controlled by applying several suitable measures and performance indicators. Effective and efficient medical record managers have proved to be good quality assurance officers. 

VI. Cost and Quality:
According to the author's views, minimal cost and better quality should become part and parcel of the patient care. This is possible, as HIM's responsibilities includes monitoring the entire patient care services and related health information, which could be scientifically analyzed and exploited to the maximum to find cost saving methods without sacrificing the patient's time or safety.

VII. Qualification:
To face the new challenges, HIM professionals must be equipped with minimum Masters degree specializing in Computer Applications, Software and Hardware, Health Information Management, Healthcare Management, Legal aspects of maintaining, transforming the records, Cost Accountancy, Quality Assurance, knowledge of computer programs, organize, monitor and enlighten patient EMR, coordinate with inside / outside agencies, collect, update dis-integrated information, align and interpret care providers data, analyze, report to higher authorities for execution. 

VIII. Conclusion:
The ultra modern technology has brought along with all its benefits, certain challenges which need to be addressed meticulously, in a very organized way. In fact, this has come as a blessing in disguise to our profession. The HIM professionals should utilize this opportunity to transform to meet new environmental challenges. HIM professional's effort should be to coordinate and integrate health information to provide best possible care with reasonably moderate cost, and to accomplish a standard quality. Although the present technology is commendable, it also involves heavy cost, which the consumers have to bear. Hence, the HIM professionals has to equip themselves with appropriate educational background as suggested to assume qualities such as leadership, dedication, sacrifice and commitment with expanded role to integrate entire information related to patient care services to ensure the highest quality with a reasonably moderate cost by exploiting the entire information available at his disposal.

IX. References:

1. "Introduction of Quality Assurance Programme in the Hospital" published in German Medizainische Documentation in Forschung and Praxis, Augusburg, 27-8, April 1990, Numberg '90, 1 Auflage:A3/1-8.

2. "Standardization of Paperless Health Record" published in the Journal of the institute of Health Record Information and Management (UK) Vol. 36, No. 1, February 1995 pp. 10-12.

3. "Development of Unified Medical Record System in Oman to Improve Quality and Economize Health Cost" published in Proceedings of 12th International Health Record Conference held in Munich, Germany, from April 15-19, 1996.

4. "Challenges of Health Care Delivery beyond 2000AD., published in proceedings of European Health Record Information Congress held in April 25-29, 1998 at Grange Park Hotel, Hull, U.K.

5. Role of Associate of health Information for Care, Cost and Quality Assurance presented as Poster in 13th International Health Record Congress, 2-6th October, Melbourne, Australia.