Anytime a patient interacts with a member of the medical community—from visiting a physician to calling a medical office with a question to filling a prescription—the events are noted in a health record. Thanks to technological advancements, many medical records are electronic. Several clinics, however, continue to use paper-based charts, as the practice may be more convenient to the providers and their staff. A health information records manager ensures the information in physical and electronic records remains up to date and accessible, in accordance with the facility’s document retention policy and privacy standards. The specialists use their expertise to align health care information with security and safety to protect a patient’s privacy and right to confidentiality.
The Role of Health Information Records Managers in the Health Care Industry
Health information management concerns the handling of health-related records. The information within these records includes details regarding patient visits, diagnoses, procedures, medical power of attorney, and authorizations to release and restrict health information. The health information management practice involves receiving, analyzing and securing all medical records to ensure the quality of patient care. The management of health information is guided by the Health Insurance Portability and Accountability Act.
The American Health Information Management Association states that health information management combines science, business and information technology. Health information records managers have various job titles and work in a variety of settings, including medical records departments, patient registries, patient admissions, consulting firms, government agencies, pharmaceutical research, care facilities and law firms. The highly trained specialists are vital to the daily operations of managing health information and records, as they ensure that patient files are accurate, complete and protected. As a result, records managers affect the quality of patient care and information at every touch point in the health care delivery cycle.
Duties that a health information management professional carries out include:
- Document retention policy creation and compliance
- Managing retention schedules
- Planning information systems
- Developing policies
- Identifying information-related needs
- Making records accessible to health care providers and patients
- Connecting operational, clinical and administrative functions in a health care facility or a related system
- Protecting the privacy, integrity and quality of patient information
- Creating disaster recovery and business continuity plans that include document drying and restoration
The concept of privacy is closely intertwined with the notions of security and confidentiality, all of which are paramount in protecting and respecting a patient’s dignity and sensitive information. As technology advances, the roles of health information records managers expand to adapt to the latest methods of capturing, storing, protecting and accessing information.
American Health Information Management Association Overview
The AHIMA is the leading professional association for health information records managers worldwide. It established the “gold standard” in regards to industry content, best practices, education, research and professional credentialing. The association was founded in 1928, when the American College of Surgeons created the Association of Record Librarians of North America to improve the quality of health records and their management. Since its formation, the AHIMA has changed its name a few times as it adapted to the needs of the medical community, expanded the scope of clinical data, and created standards, regulations and document retention policies that establish its members as medical record experts. The organization is one of four entities responsible for the creation of ICD-10 coding guidelines and is a leader in health care-related information governance principles.
Resources and services that the AHIMA offers include:
- Online education
- Textbooks
- Live meetings
- Credentials
- Newsletters
- Community engagement
- Journal of AHIMA
- HIM Body of Knowledge
- E-alerts
As the health care industry evolved, medical records professionals increased their involvement with a variety of health service facilities outside hospital settings. Their decisions have influenced document retention policies and schedules. Their collection, maintenance and appropriate use of medical information are critical to the delivery of health care in the U.S. When physical records receive damage, health information records managers turn to Polygon’s document drying and restoration services. Comprehensive restoration services occur on-site and at secure facilities that comply with HIPAA standards to hasten business continuity, reduce costs and protect sensitive information. Learn how to integrate document restoration into your facility’s disaster preparedness plans by contacting Polygon today.