Evidence-based Practice Research Part 2
Formal research is the path to developing deeper and broader levels of competence, and it's the next logical step in redefining HIM.
Thank you to Advance Magazine for permission to use this article

Leslie: Last month when we talked with Susan Fenton, MBA, RHIA, the new director of research for the American Health Information Management Association's (AHIMA)Foundation of Research and Education(FORE), she helped us to understand the promise of HIM practice research in advancing the HIM profession. We agreed to follow up this month with further discussion on the role of HIM professionals in doing evidenced-based HIM research as well as becoming more actively involved in supporting the increasing number of studies for clinical research that support evidence-based medicine and the rapid development of new medicines and treatment modalities.

Patty: Well let's get Susan on the phone and get started. Susan, we appreciate you taking the time to talk with us again about this important area of HIM practice. Let's start with talking about the role of HIM professionals in performing HIM research.

Susan: Thanks Leslie and Patty. One way for practitioners to get started in HIM practice research is to do a structured evaluation of the project and publish it when they are implementing new systems or making substantial changes in HIM practice.

Patty: Would you explain structured evaluation?

Susan: Structured evaluation, also referred to as project evaluation, is evaluating results to demonstrate whether or not they are due to the changes made, such as a new system or a new procedure. It is applied research. The Agency for Healthcare Research and Quality (AHRQ) has a tool kit that is publicly available to learn how to do structured evaluation. They have a lot of great resources on their Web site, which is www.ahrq.gov. The National Library of Medicine Web site is also a good resource: www.nlm.nih.gov.

Leslie: How would our readers start to design a practice-based research effort so that it has credibility in their organizations?

Susan: They should start by thinking about what would be of interest to people in management in their organizations. For example, if the purpose of the project is to increase efficiency, to study the impact, one would identify measures that demonstrate such improvements as turnaround time, hours required to accomplish the task or number of people needed.

Although it can take incremental additional effort to evaluate HIM practices with rigor; we must begin publicizing objective results so that people can sit up and take notice of our accomplishments and the value of HIM.

Patty: I am excited to hear about this Susan. It makes research more accessible to HIM practitioners. Many of our colleagues are already spending a lot of time on performance measures; taking those activities a step further into the realm of research seems like a logical next step. People often struggle to answer the question, how well is something working?

Susan: If people start thinking in terms of research they will also start to ask, what else do we need to do to get the results we want? They can present their work to their colleagues very objectively: "I did a project, here is the outcome, and I have good data behind it." Bringing research findings into the daily practice of HIM will elevate the HIM profession in the eyes of other health care disciplines.

Leslie: What are some of the challenges we face as we start doing more research?

Susan: One big challenge is that research takes time. For example, in 2003 the incidence of breast cancer dropped by 14,000 from 2002. An article was published saying that the drop correlated to the time when women were advised to stop using hormone replacement therapy (HRT). We have just learned these facts now, 4 years after people were advised to stop using HRT. It was a good decision for many women to stop using estrogen, and now because of carefully planned and executed research we have the data to back it up.

Patty: What are some ways that HIM professionals need to be involved in clinical research?

Susan: HIM professionals need to help clinicians understand the data. Most clinicians do not understand that the International Classification of Diseases (ICD) was created for morbidity and mortality reporting. They don't know how it was altered for reimbursement purposes in this country. Most do not know how codes are assigned in their facilities or how completely diagnoses and procedures are coded.

HIM professionals can tell clinicians what they can and can't do with the data that is available. They can also help identify data from other sources beyond the patient record. Again, if HIM professionals become more of a resource to clinicians doing research, it increases our stature and credibility.

Leslie: How can HIM professionals be proactive in this area?

Susan: A lot of researchers come to HIM departments to retrieve health data. Our ability to educate and assist above and beyond what they ask for is important.

Patty: Getting to know your customers better is an important place to start. Telling clinicians that you need to know a little more about their studies to be sure they will get the data they need will open some dialogue.

Susan: Exactly. If a clinician is trying to get funding for a pro-ject, you can even suggest that a role for HIM be built into the proposal so that the HIM expertise being brought to the study is also funded. It is all about working your way into being more a part of the research team.

Leslie: Would you elaborate a little more on the role of the HIM professional in clinical research studies?

Susan: The role of the HIM professional depends on the question, what do you want to know? HIM professionals understand data, data collection, assessing data quality and understanding relationships between data elements. This expertise is invaluable to a researcher.

When a researcher tells you, "this is what I am trying to learn and here is how I want to approach it," start thinking about other causality. Or, suggest when data needs to be adjusted for severity. Demonstrate your knowledge and interest in the validity of their results.

Patty: How can FORE create a tradition of HIM professionals being more widely recognized for the value they can bring to research activities? What are you planning in your new role?

Susan: As I mentioned last month, we are having a research summit in February to create a focused research agenda. We are also planning to develop and present a Research Workshop at the AHIMA National Convention and Exhibit in Philadelphia in October so that we can offer continuing education to our members who are interested in becoming more involved in research. We want to increase the number and quality of research presentations that are made at the convention, and we want to encourage our members to present research at other meetings as well.

Leslie: What would a research career path look like for HIM professionals?

Susan: One way to look at a career path in research is to tie it to education. With a bachelor of science degree, one can be a data analyst, a coder and a good data manager. To lead a research team you need more advanced degrees. If progressing in research is of interest to an HIM practitioner, I suggest becoming a graduate assistant at a school. A graduate assistant analyzes and cleans data, re-codes when necessary, and runs preliminary analysis identifying characteristics of the data. They even get their name on the publication. If you want to get your own question answered, that is to do your own research, you will need a PhD to get it funded.

Patty: Susan, we really appreciate you taking the time to discuss this exciting direction of HIM. Do you have any final thoughts to share?

Susan: It has been a pleasure to talk with you about this subject. I was always scared of research, but when I went back to school to learn more, I realized it really isn't scary, it is exciting. I hope that your readers who are interested will join the Research Community of Practice (CoP). People can call or e-mail me at susan.fenton@ahima.org if they are interested in learning more. I am happy to talk more about this subject with them.

Leslie: Thank you again Susan. These two columns on research have inspired me to learn more about the jobs that HIM professionals are already doing in research. Next month we will interview some of our pioneering colleagues who have already gone down this path.

Leslie Ann Fox is chief executive officer and Patty Thierry Sheridan is president of Care Communications Inc., a national HIM consulting and staffing company headquartered in Chicago. They invite readers to send their thoughts and opinions on this column to lfox@care-communications.com or pthierry@care-communications.com .