HIM: The Journey to the Best Seat in Healthcare

Jeannine Pugh Cain, MSHI, RHIA, CPHI

By Jeannine Pugh Cain, MSHI, RHIA, CPHI

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Health information management (HIM) is a diverse profession and an integral part of healthcare.


HIM professionals fill roles at all levels of the healthcare ecosystem. This is by design. The best practices embraced by HIM teams are rooted in undergraduate curricula that connects information governance, PHI compliance, data analytics and informatics, revenue cycle management, and leadership development to ensure data quality model domains are achieved.

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While HIM professionals have much in common with each other, each person’s professional journey is unique. To better understand these journeys, I interviewed my HIM colleagues at Ciox, in anticipation of Health Information Professionals (HIP) Week coming up April 18-24.

My first interview was with Geoff New, MBA, RHIA, CHFP, CRCR, FHFMA, FAHIMA. In our conversation, I learned that there is not much he hasn’t done. New started his career in HIM over 28 years ago after a friend told him about a career path in medical records.

After meeting with an advisor, he knew it was the career for him because he was drawn to the methodical approach to organizing and analyzing health information and the standards that govern it. His journey began working with the state prison system where he worked on file conversions, and it transformed over the years into more management and leadership roles. He held positions including director, corporate regional director, sales, vice president, and teacher.

As a leader in HIM, one of the greatest takeaways from our conversation relates to the mindset needed to be a leader in health information today.

“Learn all you can, and never stop learning. There are so many opportunities, and all it takes is that first step, whether full-time or part-time, to gain experience and prove your skills,” he advises students and HIM professionals. “Whether you are just starting out or [are] established, ask for extra assignments to prove value or volunteer for those jobs that others do not want to take on and do it better. Enhance your credibility and spread your wings through involvement in other organizations and acquire more certifications.”

I interviewed two colleagues in compliance roles, including Elizabeth Delahoussaye, RHIA, CHPS, and Doreen Bonno, RHIT, CHPS. Delahoussaye started off her career with a business degree, and her first job was an office manager of Industrial Organization.

However, Delahoussaye found herself wanting a job that’s more specialized, so she returned to school and pursued HIM, which caught her attention because it was specialized but covered many areas such as science and the study of disease. The legal and regulatory aspects of healthcare appealed to her as well, because it aligned with her desire to study law.

After graduating, she started working at a release of information (ROI) company where she made her way to district manager before leaving to become an HIM director. This role helped her recognize what kind of jobs she didn’t enjoy, and when the time was right and a position was open, she returned to the ROI world and served as regional manager.

As time passed, Delahoussaye began focusing more on the legal space and moved into the role of chief privacy officer.

However, her business degree has been very useful operationally in helping to create a business plan that led to the successful implementation of an audit program. Her HIM background provides a common ground and language that helps with client interaction. Delahoussaye not only has the respect of the external HIM community but is also well respected by the legal team she works with internally.

Delahoussaye’s advice to new graduates: “It is OK to play around and find out what you want to do.”

Doreen Bonno, RHIT, CHPS, audit manager, compliance, started out in HIM later in life when she already had a family. After working in a skilled nursing facility (SNF) running lab reports, Bonno talked with a career coach who steered her career in a direction that appealed to her interest in computers and medicine. HIM was attractive to Bonno because “it represents the patient and the provider.”

After graduation, Bonno started out as a manager in behavioral health, moved to a cancer registry, then educated providers on how to document for Healthcare Effectiveness Data Information Set (HEDIS), and worked on implementing an electronic system. In addition to an HIM degree, Bonno also has a Bachelor’s degree in computer science. This pivotal move has been very beneficial in Bonno’s career as we continue to move into a more technology-driven healthcare environment. Seeing the signs and identifying the trend early is a very forward-thinking approach and necessary for an HIM professional to accurately manage health information in any medium.

“An HIM professional needs to be accurate and detailed-oriented. If we do something wrong, the care for the patient could be wrong,” Bonno says. “HIM supports patient care, and although we are not directly speaking to the patient, we are representing all aspects that impact the care a patient receives.”

Other interesting career journeys come from the real-world data (RWD) team, which includes Denise Berry, RHIA; Suzanne Wenmoth, RHIA, CHDA; Donna Dopuch, RHIA, CHDA; and Amanda Thomas, RHIT, CPhT.

Berry serves as director of clinical research services. She started her journey in HIM while still in high school after reading an article in a magazine about careers in “medical record science.” She was intrigued because this field offered involvement in the healthcare industry without direct patient care. She discovered that an acquaintance from her church was the director of the medical record department in her hometown hospital and asked if she could work in the department over the summer to gain experience. Berry took full advantage of this opportunity and spent time learning about all the different roles in the department, shadowing staff so she could learn more.

While in college, she was able to work in the department during holiday and summer breaks. This allowed Berry to learn some valuable lessons early on in her career on how everything in healthcare fits together.

Berry has held jobs in hospitals managing health information departments, abstraction software training, and clinical trial monitoring, but her true calling has been in clinical data abstraction and the direction of teams doing that work. Berry worked with Wenmoth and Dopuch at various times in other companies. She recruited them to join her at Ciox because they shared her passion for clinical data abstraction and demonstrated the level of knowledge and focus on quality that is necessary to ensure client satisfaction and overall success. “Abstracting for clinical research is like solving a puzzle or riddle, but you must understand each project’s research questions to know how to approach clinical documentation. Abstraction is about untangling the documentation and putting it in clinical research data format,” Berry says. “Comprehending the intent of each study is necessary for focusing on and finding what is important to report from medical records as opposed to a more patient care–centered perspective, which involves judging how patient diagnosis and treatment should have been handled.”

Wenmoth is a clinical data integrity manager, real-world data. Wenmoth knew she was interested in patient information and healthcare as documented in patient records, but she also knew that traditional HIM career roles such as HIM director or coder did not appeal to her. Her dream was to work in the field of forensic medicine, and nontraditional HIM roles fulfilled part of that dream.

In her first nontraditional HIM job, Wenmoth started as a utilization review coordinator and then moved into clinical data abstraction. As a clinical data abstractor, Wenmoth was able to combine her knowledge of clinical information and her passion for understanding what pieces are missing or conflicting in medical record documentation, with the result being quality abstracted data.

Wenmoth became a liaison between IT and clinical data abstraction teams, and in this role, she learned data processing skills and acquired knowledge of Microsoft Access, SQL, SAS, and Microsoft Excel. Developing these skills opened the door to additional opportunities, including designing of clinical data collection software. Clinical data abstraction does require a very diverse background, with strengths in understanding of medical record documentation, clinical information, IT, and analytics. Each of these domains has its own specific skill sets. “You have to be detail-oriented and have the wherewithal to dig into documentation for hours and hours. It is tedious and time consuming, but everyone cares about the quality of the abstracted data,” Wenmoth says. “During database QA, after all abstracted data is merged, I get to use SQL to slice and dice the information to find oddities in the data sets captured. If errors are found that were never thought about during the data collection phase, I get to query and make sure all other similar errors are resolved. This improves data quality, and clients are pleased with the work performed.”

Dopuch is a clinical data abstractor whose first job was as a health information analyst where she assigned DRGs and analyzed records for about a year before someone told her about clinical abstraction. In addition to clinical abstraction, Dopuch held jobs in management, as a performance improvement tech, and in medical transcription. Her coding skills provide familiarity and understanding of the medical record and her jobs have helped develop important skills of self-discipline and organization.

“Being detail-oriented, having problem-solving skills, and using analytical skills are necessary for data abstraction. It involves putting the puzzle pieces together to determine what information should be captured to reflect accurate data,” Dopuch says.

Thomas is a clinical data analyst and a recent graduate who has returned to school to complete her BSHIIM degree and earn the RHIA credential. She applied to 40 jobs before applying to Ciox, and found her vocation as a researcher, abstractor, and data analyst.

As a pharmacy tech, she was a superuser for an electronic health record (EHR) and has always been proactive, whether it’s asking for more work or if she can help with anything else. To stay current on skill sets that may be needed to enhance her career, Thomas looks at job postings on Indeed and Glassdoor to compare the qualifications and requirements with her current skill set to see if it is something that she has or something she can or should acquire. “You really have to go into depth and learn the information and the regulations. Having healthcare knowledge and a pharmacy background helped with interpretation of the data,” Thomas says. “It is important to know what to do and to be the advocate for the patient. Reviewing documentation is like a triage of the whole medical record with the goal of trying to determine what needs to be done and when it needs to be done.”

Having a curious mind and a strong desire to ask “why” seems to be the foundation for learning how all the pieces fit together and a common trait shared by everyone I interviewed.

A privacy officer, compliance professional, revenue cycle professional, and all the clinical abstractors not only have to know how everything works together, but they must also possess the “detective” skills necessary to identify and uncover information.

Knowledge of the medical record, and the clinical information within it, is the unique perspective that an HIM professional brings to any role. It is the knowledge, experience, and understanding of where all points of health information intersect that gives HIM professionals the ability to provide an unbiased view and true representation of the patient medical record,

“Many times, data scientists think of the world in terms of linear tabular concepts—the best way to make sense of large amounts of data is to create a concept of personal identifiers, time, and/or attributes and relate one or more attributes across time for each identifier. That is where the HIM professional brings in most of the value,” says Ana Bargo, MS, data scientist, real world data. “While natural language processing (NLP) and machine learning (ML) can provide a humongous data dump in potentially (and hopefully) contextual buckets of the information found in a medical record, we need someone with subject matter expertise, aka a HIM professional, to bring about subject matter expertise—reviewing the output, referencing the medical records and the content, and providing much needed understanding of what is and what is not working. Much of the hard work by the HIM professional involves gaining a better understanding of how the process for NLP processes ultimately buckets the medical record information, and how to steer the processing and push data science professionals to change their way of thinking and try different algorithms to accomplish the goal of correctly bucketing the crucial information found in the medical record.”

As an HIM professional, you can begin your journey anywhere health information exists. Each journey is unique, and while the skill sets needed for each journey may be different, the theme remains the same. HIM is a necessary component of healthcare, and HIM is respected by those who engage with an HIM professional regularly. An HIM professional is an important member of a team that can help make healthcare better as a representative for the patient.

“Today’s complex data ecosystem is made up of dozens if not hundreds of different viewpoints and philosophies. All this is further complicated by limitations in technology, politics, and many other unaccountable factors that shape the data,” says Mark Yap, MSN, FNP-C, real-world data. “As a family nurse practitioner and data scientist, I definitely look at the data in a certain way. Other members of the team also have their own view and emphasize certain aspects of the data. If we only look with our own lenses, then we really aren’t able to unlock the full potential of what is possible.”

Jeannine Pugh Cain ([email protected]) is business analyst, real world data for Ciox.

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