The CIO-HIM Partnership


Vol. 12 •Issue 10 • Page 49
The CIO-HIM Partnership

The day has come for CIOs and HIM directors to foster collaboration and pursue mutual objectives. In doing so, they’ll position themselves and their hospitals for success.

Do you remember the days when CIOs were data processing managers? When mainframes and large data centers were the norm? And when the Internet was a distant dream concocted by academics?

If so, you’ve been in health care long enough to understand that the CIO’s role and responsibilities have changed dramatically in the past two decades. A job that started with punch cards and super-sized hardware has emerged into a senior executive position in most health care enterprises. Today, CIOs deal with multiple organizations in multiple locations and with varied systems, needs and expectations. Couple this environment with the Internet and wireless devices, and we find the 21st century CIO faced with a world that demands strong leadership skills alongside information system expertise.

Likewise, the role of health information management (HIM) has been rapidly transformed. As more and more hospitals and integrated delivery networks move from paper to electronic records, new skills are required. New perspectives are in high demand.

HIM professionals must face the reality that medical record information is “everywhere” and can no longer be physically placed under lock and key. This is a dramatic change in mindset. After all, HIM directors have been the custodians and protectors of the legal medical record for nearly a century. Today’s HIM director must not only understand technology, but also have the foresight to envision a world where patient information is ubiquitous.

As both professions evolve and technology advances, the working relationship between IT and HIM must keep pace. When the IT and HIM departments work together and maintain mutual respect, the benefits are widespread. Each party becomes more productive, and the organization’s IT and information management is better planned, managed and synchronized. But is it really happening?

To answer this question, ADVANCE teamed up with HealthPort to conduct an online survey of CIOs and HIM directors from June to July 2008. Over 65 CIOs and HIM directors weighed in on such hot topics as EMR involvement, professional relationships and influence over technology purchases. A summary of the results follows.

CIO and HIM roles

In theory, the CIO and HIM director have a similar overarching objective: Facilitate the efficiency and quality of each patient’s care, medical record and experience. CIOs focus on technology to achieve this goal while HIM professionals focus on the completeness and accuracy of the information. CIOs think in terms of data and HIM professionals think in terms of documents. They are two sides of the same coin.

While the CIO seeks ways to leverage new technologies for the advancement of the hospital, the HIM director is grounded in the realities of coding, reimbursement and the “legal” medical record. Our survey results confirmed the importance of HIM in these roles, especially with regard to the legal medical record.

Fifty-one percent of CIOs and 57 percent of HIM directors cited “maintaining the legal medical record” as HIM’s most important role going forward. And that’s a good thing. Most if not all organizations struggle to define the legal medical record — especially in a hybrid environment where part of the medical record is electronic and part is in paper format. Once electronic, information is contained in greater volumes; the information is dynamic versus static; and it is incomprehensible when separated from the originating system.

As discussed in ADVANCE for Health Information Professionals‘ monthly online column titled “Advancing Medical Records – A Hybrid Roundtable” (http://www.health-information.advanceweb.com/Editorial/Search/AViewer.aspx?CC=120799), the industry hasn’t created a clear definition of the legal medical record. And there are dangers in not having a standard. Controversies surround items such as date/time stamps and the metadata behind patient data in IT systems. Is metadata part of the legal record? Are date/time stamps? These questions weren’t even an issue for HIM professionals in the paper world.

One way CIOs can help is to ask clinical information system vendors about the final “output” of their applications. Many clinical information systems create reams of paper, further complicating the task of defining a legal record. And since our survey revealed that 40 percent of CIOs note clinical systems implementations as their most important strategic initiative, it is an important question for them to ask.

According to Doug Turner, MHSA, FHIMSS, FACHE, who is CIO of Maury Regional Hospital in Columbia, Tenn., “Clinical systems can be a source of frustration for many HIM departments, who are tasked with maintaining a legal record and often end up swimming in paper.” Turner pointed out that the IT department, unlike HIM, is often mainly concerned with a system’s integrity — not if it will facilitate completeness, timeliness and departmental objectives. “That’s why the IT and HIM departments must collaborate and establish a formal plan,” said Turner. Defining the legal medical record deserves its own strategic plan and joint meetings between HIM and IT.

Reporting structures in HIM

Health information management departments have traditionally reported to the CFO. Because clinical coding is integral to reimbursement and the revenue cycle, this reporting structure makes sense. In fact, the majority of responders to our survey (47 percent) are still organized in this way.

However, as more hospitals move to EMRs, a new organizational chart is emerging whereby HIM reports to the CIO. In our survey, 39 percent of HIM directors and 40 percent of CIOs confirmed this new reporting structure. Columbus Regional Hospital in Columbus, Ind., is one of those facilities.

“I have reported to the CIO for almost five years and we have an awesome relationship with information services [IS],” stated Cindy Spann, MIS, RHIA, CCS, CCS-P, director of health information and privacy officer. “The CIO always supports HIM and our transition to electronic records. The CIO was instrumental in explaining why we needed interfaces between our electronic document management system and our EMR. The CIO was also instrumental in helping us get the funding and buy-in to back-scan our file room,” she concluded.

Four CIOs responding to the survey had previous experience as an HIM director, but gave conflicting viewpoints as to which reporting model works best. Cheryl DeRosier Martin, MA, RHIA, was formerly an HIM director before joining Tuomey Healthcare System in Sumter, S.C., as CIO. The HIM director reports directly to her. Martin acknowledges that her own experience as an HIM director has helped her foster stronger relationships between HIM and the entire IT team. “In terms of our EMR, there’s nothing we do that doesn’t involve the HIM director,” said Martin.

Another survey participant, who is a current CIO and former HIM director, disagreed: “Just because HIM uses technology does not mean the department should report to IT.”

Finally, one CIO responder concurred that the relationship between HIM and IT needs to become one, but the need for a merged information management and services department has not been recognized at the administrative level.

Two large Atlanta-based organizations combined both worlds in a blended reporting structure. Traditional HIM record-keeping functions report to IT (both organizations have implemented electronic document management systems) while the coding function is part of the revenue cycle department and reports directly to the CFO.

At the end of the day, each hospital must determine which reporting structure is right for its particular situation. Skill sets, personalities and careers must all be considered alongside the long-term direction of the organization.

Common ground and workflow

Electronic records are the intersection point for HIM and IT. Both departments have their own view of the issues, their own domain expertise, and their own departmental policies and perceptions of long-term goals. They are working toward the same goals, but from different ends. Once they arrive at this realization, it makes sense to join forces and have HIM actively involved at all levels of electronic record planning. And, in fact, this is happening.

Our survey revealed that HIM is involved in the organization’s electronic record strategy nearly 100 percent of the time with the majority of responders reporting high levels of involvement by HIM. Other technology purchases, however, did not reflect such high levels of HIM input.

HIM directors reported only “some” or “little” influence regarding technology purchases in 83 percent of the responses. While CIOs reported higher levels of HIM influence, this is a key area where CIOs may be missing the point.

Turner mentioned that HIM professionals are workflow experts and can be used to help all departments during system selection and implementation. As his organization has implemented clinical systems, HIM’s expertise in information workflow has been extremely valuable. “Our HIM director understands how information should flow within and between departments and finally into the legal medical record,” said Turner. HIM professionals agree this is an untapped area of expertise. Eighteen percent of HIM survey responders cited “workflow” as the most important role for HIM in electronic environments.

Relationships and outcomes

How, then, can the two parties merge their objectives to work in harmony? The answer isn’t simple, but from organization to organization, one truth prevails: When the CIO and HIM directors aren’t in sync, the result is adversarial. Forty-seven percent of HIM directors responding to our survey reported only an average or below average relationship with their CIO. Areas for improvement included:

  • more time for meetings;
  • better communication when new systems are being considered;
  • improved CIO understanding of HIM functions;
  • collaborative — instead of adversarial — work relationships; and
  • greater understanding of “legal” medical record requirements.

A few key initiatives and insights may help both parties develop better working relationships — and therefore better information outcomes — for the entire organization.

Healthy CIO-HIM relationships

The survey revealed three ways to improve CIO-HIM relationships:

1) Communicate. When CIOs and HIM directors meet regularly and frequently, many problems dissolve before they become major issues. In our survey, 45 percent of HIM directors said they meet weekly with their CIOs and another 19 percent said they meet at least monthly. (See Figure 2.)

2) Understand the other party’s long-term vision for electronic records and add value where you can. The HIM director’s focus is maintaining accurate, secure, legal medical records. To a CIO who is striving toward better, faster processes via technology, this focus can come across as rigid. To that end, mutual appreciation of each other’s vision for the future becomes all the more important. Each department must share its vision and find ways to add value while working together toward the organization’s common goal.

3) Get involved and demonstrate your skills. Martin’s experience has shown her that, too often, HIM has taken a passive role and “watched IT take over projects.” Martin commented, “It should be a mandate for HIM directors to be involved with these technology decisions.” Martin also said other HIM professionals should set a career path toward earning a CIO position. “The CIO certainly has responsibility for education and quality — two definite skill sets for HIM.”

CIOs and HIM directors who foster collaboration and mutual objectives position themselves and their hospitals for success. This is a partnership whose day has definitely come.

Mr. Brandwein is divisional vice president for HealthPort, formerly SDS.

Ms. Friedman is president of The Friedman Marketing Group, a marketing and public relations firm for health care technology and service vendors.

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