IFHRO Initiatives

IFHRO and the Globalization of Health Record/information Management

In June 2003, delegations from the Canadian Health information Management Association (CHIMA) and the American Health Information Management Association (AHIMA) met to exchange ideas about issues of shared interest. A consensus was reached that three advanced practice issues present challenges for health record/information management professionals and their associations:

• The electronic health record
• Privacy and security of personal health information
• Clinical data management (including classification systems and terminologies and data quality)

The importance of these issues surely extends beyond North America as health record/health information management (HR/HI) practice becomes more global. Change is happening very quickly and the delegation believed that the international HR/HI must work more closely to advance standard practice solutions and to learn from one another. This includes both advanced practice and developing practice. It also includes closer collaboration on academic curricula so HR/HI education is more universally recognized as an applied health informatics discipline. Mobilizing the international community to address today’s challenges is entirely consistent with the purposes of IFHRO.

Five statements of need related to the three issues and including education and needs of developing countries were developed and posted on a special IFHRO “community of practice” via the AHIMA website. This was to provide a virtual discussion of the five issues among the national delegates to the 14th Congress and General Assembly (GA) in October 2004. The General Assembly would then hold an open forum during the GA that would provide information to IFHRO Executive Committee for planning over the next three years. The five statements of needs are outlined below.

The Electronic Health Record              Back to top
There is a growing consensus that health care systems are under performing because of the inadequacy of the information and communications technology infrastructures that support them. The electronic health record system (EHR) is key technology in this infrastructure. Many countries are promoting the EHR as a matter of public policy. The EHR will transform traditional HR/HI practice, as we know it today. Yet, there is a strong international component to what is happening in each of our countries:

• Standards development organizations are international in scope (HL7, ISO-TG 215)
• EHR technology vendors are international corporations
• ICD-10 and other classification systems are developed by the World Health Organization
• SNOMED, other terminologies, and systems such as DRGs are being adopted by many countries
• The drivers of change in our health care systems such as the need to improve quality, control costs, manage chronic diseases, and improve public health surveillance are universal.

It is important that IFHRO understand the status of the EHR initiatives in countries around the world and what skills and competencies are necessary for HR/HI professionals to manage the EHR.

Privacy and Security of Personal Health Information               Back to top
The health record is a compilation of the patient’s personal information, including administrative or demographic data and clinical data. It is the who, what, when, where, why and how of provisions of health care. The record is retained according to legislative requirements and should be accessible to authorized individuals when needed. The collection of the information is a result of the interaction between a patient and the health service provider.

There are a number of different categories into which those requesting access to health information fall. The policies and procedures by which access is granted must be in accordance with the applicable legislation. It is also important to distinguish between use of health information and disclosure of health information. Use refers to the handling of information within a health care agency, and disclosure refers to making information available to those outside the health care agency.

Health service providers have an ethical, moral and legal responsibility to protect personal information. Protection of personal information includes ensuring against unauthorized access, use, disclosure, modification or destruction but it also includes ensuring complete, accurate and timely information is available to authorized individuals when and where they need it.

Confidentiality, privacy and security of health information have always been at the forefront of the health record/information professionals’ duties and responsibilities. The words confidentiality, privacy and security have often been used interchangeably. They are three distinct concepts. Confidentiality is the obligation a health care agency has to ensure the service recipient’s right to privacy is respected by limiting the disclosure or improper use of information without the service recipient’s authorization. Privacy is the right individuals have to control how their personal information is handled, that is, their right to determine what personal information is shared, when, how and with whom. Security is the administrative, physical and technological safeguards a health care agency has in place to prevent accidental or intentional disclosure by inappropriate access or by unauthorized individuals. It also includes the mechanisms in place to protect the information from alteration, destruction or loss.

A number of factors have compelled health care agencies to closely examine and assess their personal information management practices. The enactment of various pieces of National, State, Provincial/territorial freedom of information and privacy legislation, the increased use of global communication networks, the need for a secure environment in which to implement the Electronic Health Record, public expectation and demand. These have all created an alert for health care agencies to develop and implement rigorous confidentiality, privacy and security policies and procedures.

The public is more informed and has a high expectation of the health care delivery system than ever before. They are aware of their privacy rights and they demand grater security of their personal information. They are also aware of the increased use of technology, such as, computer networks, Internet, electronic mail (e-mail), wireless devices, cellular telephones, and telemedicine in the delivery of health care and the means by which the service provided is recorded. Health care agencies must be able to demonstrate to the public that they take confidentiality, privacy and security very seriously and that they have the appropriate policies, procedures and processes in place to minimize the likelihood of inappropriate and unauthorized access.

IFHRO needs to have a broader understanding of how the nations comprising IFHRO are approaching the issue of privacy legislation as well as the skills and competencies needed by HR/HI professionals. IFHRO should take a position global privacy and confidentiality of patient records/information.

Clinical Data Management              Back to top
The patient’s record serves as a means of ongoing communication among health care providers. Health care providers use the information recorded in the record to make decisions about diagnoses, further investigations, and interventions, treatment plans and follow-up care. They use the information to monitor the patient’s progress and evaluate the response to the health care provided. Therefore, it is extremely important that the information upon which health care providers base these decisions is accurate, complete and timely.

The patient’s record is a legal document made in the normal course of business. It serves as a record of the health service provided. The record is admissible in a court of law and can be used as evidence in legal proceedings. It serves as proof of what was done, by whom and when during the health care encounter. The record can be used as evidence for or against the health care agency, the health service provider(s) and the patient.

Information from the patient’s record is also used for strategic planning, decision making, allocation of human and financial resources, education, epidemiological studies, quality assurance, risk management and outcome measurement activities, research and, in some jurisdictions, for funding formulae and reimbursement.

Decisions are based on health information whether they are decisions referable to delivery of health care that will directly or indirectly impact the patient’s. Users of health information must feel comfortable with its integrity. In order for them to feel the information is credible, users must feel assured that the information is secure and free from unauthorized access, use, and from corruption or tampering.

Given the multiple uses of health information, it is important that the users/payers feel all of the characteristics of data quality have been met. These are accuracy, accessibility, comprehensiveness, consistency, currency definition, granularity, precision, relevancy, and timeliness. It is important for IFHRO to have a broader understanding of how countries are approaching clinical data management and data quality as well as identifying the skills and competencies needed by health record/information managers who work with data and information.

Health Record / Health Information Management Education
Health record/health information management education is a global issue. Academic programs in this discipline exist in many countries and while degree status and curricular content may vary to reflect the practice needs of the country, programs have many current issues in common. These include professional identity. HR/HI is not widely recognized as a distinct body of knowledge and the growing attention on applied health informatics often fails to acknowledge the discipline. Curricular content needs to be advanced rapidly to keep pace with changes in the discipline, such as the electronic health record. In some countries, baccalaureate programs are at risk due to low enrollment and availability of qualified faculty. Post-graduate education has been slow to develop. External accreditation of programs varies widely as does requirements for certification of practitioners.

Current issues that would benefit from dialogue and sharing among IFHRO member countries include:

• A shared professional definition
• Competencies for HR/HI practice
• Curriculum models that are based on requirements of national job markets
• Faculty development
• Nurturing new programs/tracks at the technical, baccalaureate and master’s levels
• Best practices in student recruitment
• Gaining recognition in the health informatics discipline
• External program accreditation practices
• Certification of individual practitioners

IFHRO needs to have a broader understanding of how the nations comprising IFHRO are approaching the issues of HR/HI education, access to resources that may be useful to educations efforts within a country and a better understanding of the skills and competencies needed by HR/HI educators.

Needs of Developing Countries
IFHRO’s role is to promote the benefits and opportunities to be achieved by participation and collaboration with colleagues of developing and advanced practice at the global level.

Over the years, IFHRO has facilitated supports to developing countries, with the assistance of its national and associate members. These supports have been primarily targeted to:

• The establishment of basic health record practices and related standards
• Exchange of information on health records education requirements and training programs
• Opportunities for communication between persons working in the field of health records
• Guidance on establishing national HIM associations.

However, much more is needed to assist developing and supporting countries that wish to establish a HR/HI national organization. Additional IFHRO opportunities to assist developing countries (although not inclusive) lie in providing access to resources, communication and networking. IFHRO must identify the needs of developing countries and identify strategies to facilitate, guide and support the formation and functioning of new organizations and the advancement of health record practices and related standards.

The 14th General Assembly validated the issues identified by the CHIMA and AHIMA and gave high priority to IFHRO’s involvement. The delegates provided information from their countries and identified action items that IFHRO needs to take in addressing the five issues. The IFHRO Executive Committee has incorporated the five initiatives as permanent strategies for the organization that will further IFHRO’s purpose as well as health records/information management around the world.