WHEN THE ONCE-dominant retailer Sears filed for bankruptcy in 2018, many attributed its decline—and that of brick and
mortar retailers in general—to the existential threat of Amazon
and online retail. While Amazon played a role in the demise of
Sears, it’s far from the whole story. After all, Sears practically
invented online shopping’s precursor, the mail-order catalog,
which allowed price-conscious consumers to do their shopping at any time of the day. Retail analysts say other mistakes
such as failing to assess the risks posed by big box retailers, a
poorly executed acquisition of Kmart, and a failure to continue
anticipating consumer behavior—an area where the company
excelled in its heyday—led to its bankruptcy.
What these factors have in common is that they stem from a
failure of leadership and lack of imagination. Plenty of analysts
agree that Sears could have recovered from its early missteps if
management had recognized and addressed problems earlier on.
Other competitors, such as JC Penney, Kohl’s, and Home Depot,
have survived the dramatic shift in the retail landscape, proving
that it can be done with the right people at the right time.
Healthcare and health information management (HIM) are
staring down a similar crossroads of change, also spurred by
new technology and a morphing professional landscape. Electronic health records (EHRs), computer-assisted coding (CAC),
natural language processing (NLP), and the push for “HIM without walls” have all changed the way HIM professionals do their
jobs. AHIMA has taken notice, launching initiatives like HIM
Reimagined that call on HIM professionals to supplement their
current skills with continuing education and new credentials.
All these changes have put a strain on HIM professionals and
their leaders, who are now tasked with motivating the workforce
while managing the anxiety that accompanies change. However, if HIM leaders really listen to and engage with members of
their workforce—and act on what they learn in the process—the
industry can and should thrive during times of change. But that
doesn’t mean it will always be easy.
Change is central to the nature of HIM—after all, HIM professionals were originally known as medical librarians. Now,
however, one could be forgiven for mistaking HIM as an information technology role or unexpectedly finding HIM professionals working in clinical areas. The biggest recent change
is the use of EHRs and the transformation that comes with
digitizing nearly every piece of information about a patient.
With EHRs came health information exchange (HIE), patient
portals, querying of databases, and an increase in regulations
such as HITECH, MACRA, and the 21st Century Cures Act.
Other factors, like an increased focus on artificial intelligence
in healthcare and the move to ICD-10-CM/PCS, have also
been sources of anxiety for many.
Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, an independent
HIM coding consultant, admits that the profession’s response
to EHRs was perhaps a little flat-footed. “There are benefits to
EHRs and a big one for me is legibility in coding—it’s huge to
have such a big change in 20 years,” Bryant says. “But at the
same time, I feel we weren’t as prepared for the depth of the
change. Technology is one of those areas where we don’t know
about hidden capabilities. Just as with the telephone, and
iPhones, we didn’t originally see the impact they would have.
And I think we’ve missed the boat a bit with EHRs.”
An individual’s reaction to change varies from person to per-
son. In the years and months leading up to ICD-10-CM/PCS,
there was a lot of talk about coding professionals who planned
their retirements around it in order to avoid the hassle. Others
thrive on change. Christine Methany, RHIA, CHPS, CHTS-IM,
HIM director and chief privacy officer at West Virginia Univer-
sity Medicine (WVU Medicine), recalls a conversation she had
with a former employee that had transitioned to a career in
education but wondered if HIM was still a viable option.
“I started talking about changes in technology and how patients and consumers are becoming more active in their care
and diagnoses, as well as population health. After talking to
me and naming those things she said, ‘That’s enough to keep
my appetite wet because technology is constantly changing,’”
Good leaders must be prepared for the gamut of reactions to
upheaval, according to Bryant. Some employees react with fear
and suspicion and don’t trust the messenger, and leadership actions can make or break the change while it’s occurring. Allowing fear to creep in can create new ethical concerns, particularly
in the coding realm, Bryant says.
Fear can create dishonest behavior and dishonest emotions,
and can manifest itself in the form of such practices as upcod-ing, the “unbundling” of codes, using more codes than are appropriate, or intentionally misinterpreting documentation to
bill for a higher level of services.
“We’re also seeing ethical issues around querying, leading
queries, using the EHR in ways that aren’t allowed or are leading a physician. Drop-down menus, shaded-out boxes next to
diagnoses. All of that is tied to reimbursement. And because we
are a very code-dependent healthcare system, the role of ethics
in coding are actually more important today than they’ve ever
been before,” Bryant says.
She has also found that ethical problems develop when HIM
is absent from a larger organizational initiative or development.
“I’ve often seen in my career new departments and service
lines develop, new medicine developed. HIM leadership needs
to step in and say: ‘We have a new business line?’ HIM needs to
go in and check that out [from a CDI standpoint] and make sure
there’s nothing leading, nothing inappropriate,” Bryant says.
“We need to ask how it’s going to be coded, processed, all that
needs to be in place due diligence-wise. In HIM there’s a role
for us that we’re not utilizing. We need to be the leader in those
kinds of things.”
Keep Calm, SWOT On
Naturally there is a good way and a bad way for leaders to
guide their organizations through change, which can come in