panel discussion: developing the health … napulan...ao 2012-0012: rules and regulation governing...

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Panel Discussion: Developing the HealthInformation Workforce

Moderator: Deborah Green, MBA, RHIARoderick NapulanG.D. Mogli, PhD, MBA, FHRIM, FAHIMA

The Philippine Context ofManaging Hospital HealthInformation:Workforce, Challenges andOpportunities, andStrategies


The Philippine Context ofManaging Hospital HealthInformation:Workforce, Challenges andOpportunities, andStrategies

• Roderick M. Napulan, MSPH (c)• Hospital Health Information Management Adviser• Health Facility Development Bureau, Department of

Health (Philippines)• [email protected] ; +6399-8837340

Learning Objectives

• To provide overview of the Philippine HealthAgenda 2016-2022 and its policy directionsfor health information management

• To present and discuss the health humanresource standard requirements for HospitalHealth Information Management Department

• To identify challenges and propose strategiesfor the improvement of health informationmanagement in the Philippines


• To provide overview of the Philippine HealthAgenda 2016-2022 and its policy directionsfor health information management

• To present and discuss the health humanresource standard requirements for HospitalHealth Information Management Department

• To identify challenges and propose strategiesfor the improvement of health informationmanagement in the Philippines


P H I L I P P I N E H EALT H AG E N DA 2 0 1 6 - 2022

Lahat Para sa Kalusugan!Tungo sa Kalusugan Para

sa Lahat

The Health System We Aspire For

GOALS


Filipinos,especially the poorare protected fromhigh cost of healthcare

FINANCIALPROTECTION

Filipinos attainthe best possiblehealth outcomeswith no disparity

BETTERHEALTHOUTCOMES Filipinos feel

respected,valued, andempowered in allof theirinteraction withthe health system

RESPONSIVENESS

Our Strategy

A Advance health promotion, primary care andquality

C Cover all Filipinos against financial health risk

H Harness the power of strategic HRH

I Invest in eHealth and data for decision-making



E Enforce standards, accountability andtransparency

V Value clients and patients

E Elicit multi-stakeholder support for health


1. Require online data* submission asrequirement for licensing & contractingof health facilities and drug outlets

2. Mandate the use of Electronic MedicalRecords (EMR) in all health facilities

3. Invest in nation-wide surveys,administrative data and disease registries

4. Automate major business processes5. Facilitate open access to anonymized data

* clinical and administrative


1. Require online data* submission asrequirement for licensing & contractingof health facilities and drug outlets

2. Mandate the use of Electronic MedicalRecords (EMR) in all health facilities

3. Invest in nation-wide surveys,administrative data and disease registries

4. Automate major business processes5. Facilitate open access to anonymized data

* clinical and administrative

• Revise licensingrequirements toreflect regularelectronic datasubmissionrequirement

• Open up dataset forresearchers

• Revise accreditation/contracting rules toreflectregular electronicsubmissionrequirement

• Open up data set forresearchers

• Provide incentives

LGU• Implement EMR in all

health facilities

• Improve local civilregistration and vitalstatistics data

• Submit dataelectronically


• Revise licensingrequirements toreflect regularelectronic datasubmissionrequirement

• Open up dataset forresearchers

• Revise accreditation/contracting rules toreflectregular electronicsubmissionrequirement

• Open up data set forresearchers

• Provide incentives


LGU• Implement EMR in all

health facilities

• Improve local civilregistration and vitalstatistics data

• Submit dataelectronically


AO 2012-0012: Rules and Regulation Governing the New Classification of Hospitals and Other Health Facilities as Amended

The Hospital Organizational Structure

The Health Information ManagementDepartment (HIMD) is responsible inenhancing patient care through the use of datacontained in the health record, eitherindividually or collectively. The general functionof the HIMD is to provide an organized systemof measuring quality patient care and to ensurethat sufficient data is written in sequence ofevents to justify the diagnosis, warrant thetreatment and end results. The department istasked to process, analyze, maintain, andsafekeep all health records created/maintained inthe health facility in the course of health facilityand its supervisor are mandated to implementfacility wide coordination and linkage. Thedepartment plays a key role in the generation ofhealthcare statistics to evidence-based medicalcare and management practices.


The Health Information ManagementDepartment (HIMD) is responsible inenhancing patient care through the use of datacontained in the health record, eitherindividually or collectively. The general functionof the HIMD is to provide an organized systemof measuring quality patient care and to ensurethat sufficient data is written in sequence ofevents to justify the diagnosis, warrant thetreatment and end results. The department istasked to process, analyze, maintain, andsafekeep all health records created/maintained inthe health facility in the course of health facilityand its supervisor are mandated to implementfacility wide coordination and linkage. Thedepartment plays a key role in the generation ofhealthcare statistics to evidence-based medicalcare and management practices.

Maintain all health records in accordance with the principles and practices ofefficient and effective health record management.

Maintain comprehensive indexes (e.g. Master Patient Index, Disease Index) andregisters (e.g. Admission, Discharge, Operation/ Procedure, Delivery room (DR),Out-Patient Department (OPD), Emergency Department (ED), Birth and DeathRegisters).

Review records for completeness and accuracy, coding of diseases, operations,and special therapies according to approved nomenclature and classification.

Maintain a comprehensive and up-to-date unit healthy record for each patient,ensure that all relevant information is collected and written in the record and filescorrectly.

Respond to all subpoena duces tecum addressed to the HIMD. Maintain and safeguard the confidentiality of the health record. Provide health records, upon request for patients’ visit to the OPD and Emergency

Department (ED), and admission to the patient’s ward.

The HIMD Main Functions:


Maintain all health records in accordance with the principles and practices ofefficient and effective health record management.

Maintain comprehensive indexes (e.g. Master Patient Index, Disease Index) andregisters (e.g. Admission, Discharge, Operation/ Procedure, Delivery room (DR),Out-Patient Department (OPD), Emergency Department (ED), Birth and DeathRegisters).

Review records for completeness and accuracy, coding of diseases, operations,and special therapies according to approved nomenclature and classification.

Maintain a comprehensive and up-to-date unit healthy record for each patient,ensure that all relevant information is collected and written in the record and filescorrectly.

Respond to all subpoena duces tecum addressed to the HIMD. Maintain and safeguard the confidentiality of the health record. Provide health records, upon request for patients’ visit to the OPD and Emergency

Department (ED), and admission to the patient’s ward.

Ensure that all diagnostic reports/results are promptly and accurately filed in theirrespective patient’s record.

Collate and compile data and generate statistical reports required by respectivehealthcare facility management, the DOH, as the health regulatory body, and thePhilippine Health Insurance Corporation (PHIC), as the country’s healthaccreditation agency.

Prepare periodic statistical reports on morbidity and mortality, birth, utilization ofhospital services, as well as surgery performed, and cases receiving specialform of therapy and other related data.

Provide data/information from patient’s health record for use in approvedresearch and study programs.

Participate in studies and research activities conducted by doctors andauthorized researchers by providing needed data/information.

Cont..

The HIMD Main Functions:


Ensure that all diagnostic reports/results are promptly and accurately filed in theirrespective patient’s record.

Collate and compile data and generate statistical reports required by respectivehealthcare facility management, the DOH, as the health regulatory body, and thePhilippine Health Insurance Corporation (PHIC), as the country’s healthaccreditation agency.

Prepare periodic statistical reports on morbidity and mortality, birth, utilization ofhospital services, as well as surgery performed, and cases receiving specialform of therapy and other related data.

Provide data/information from patient’s health record for use in approvedresearch and study programs.

Participate in studies and research activities conducted by doctors andauthorized researchers by providing needed data/information.

HospitalCategory

BedCapacity

TotalPositions in

Hospital

MedicalService

Positions

HIMDepartment

Positions

% of HIM overthe Total

Positions inthe Hospital

Level 125 113 52 7 6%50 144 64 7 5%75 166 74 7 4%

100 292 122 10 3%

Standard Staffing Requirements for GovernmentHospitals


Level 2100 292 122 10 3%150 404 161 13 3%200 493 192 16 3%

Level 3

200 609 306 24 4%300 869 455 30 3%400 1122 592 37 3%500 1349 727 42 3%

Standard Ratio of HIM Staff1 Staff : 20 Approved Bed Capacity1 Staff : 50 OPD visits per day

Positions Minimum Qualifications

HIMD Head/Supervisor of Level 2and 3 Hospitals

Must have a master’s degree relevant to the position; Must have second grade civil service eligibility; Must have thorough knowledge of Anatomy, Physiology Medical Terminologies; Must have attended a Certificate Course in HIM and training course of at least

120 hours in HIM conducted by a Department of Health recognizedinstitution/organization or academe;

Must have at least five (5) years of experience in the HIM Department of a Level1 or Level 2 hospital, one year of which must have been in a supervisorycapacity.

Hospital Positions and Minimum QualificationStandards


Must have a master’s degree relevant to the position; Must have second grade civil service eligibility; Must have thorough knowledge of Anatomy, Physiology Medical Terminologies; Must have attended a Certificate Course in HIM and training course of at least

120 hours in HIM conducted by a Department of Health recognizedinstitution/organization or academe;

Must have at least five (5) years of experience in the HIM Department of a Level1 or Level 2 hospital, one year of which must have been in a supervisorycapacity.

HIMD Head/Supervisor of Level 1Hospitals

Must have a college degree preferably with units in graduate studies; Must have second grade civil service eligibility; Must have units thorough knowledge of Anatomy, Physiology medical

terminologies; Must have attended a Certificate Course in HIMD and training in International

Classification of Disease-10 conducted by a Department of health recognizedinstitution/organization or academe;

Must have at least four (4) years of experience in the HIM Department of level ofa Level 1 hospital, one (1) year of which must have been in a supervisorycapacity.


Statistician Must have a college degree preferably with units in statistics and graduate studies; Must have second grade civil service eligibility; Must have knowledge in disease and operation coding; Must have attended Certificate Course in HIMD to include related training course in

International Classification of Diseases and healthcare statistics conducted by aDepartment of Health recognized institution/organization or academe;

Must be computer literate and familiar with available statistical packages; Must have at least three (3) years of experience in the HIM Department



Must have a college degree preferably with units in statistics and graduate studies; Must have second grade civil service eligibility; Must have knowledge in disease and operation coding; Must have attended Certificate Course in HIMD to include related training course in

International Classification of Diseases and healthcare statistics conducted by aDepartment of Health recognized institution/organization or academe;

Must be computer literate and familiar with available statistical packages; Must have at least three (3) years of experience in the HIM Department

Clinical Coder Must have a college degree preferably with knowledge in Anatomy, Physiology, andmedical terminologies;

Must have a second grade civil service eligibility; Must have attended Certificate Course in HIM and basic course in International

Classification of Diseases conducted by a Department of Health recognizedinstitution/organization or academe;

Must be computer literate; Must have at least one (1) year of experience as disease and operations coder;

and Must be well acquainted with the different coding tools.


Health RecordAnalysis/ AssemblyClerk

Must and have a college education; Must have a second grade civil service eligibility; Must have attended a training course in health record documentation standards; Must have thorough knowledge of medical terminologies; Must have at least work in the HIMD or other related office; and Must be computer literate.

MedicalTranscriptionist

Must have a college education; Must have a second grade civil service eligibility; Must have attended a medical record related training; Must have knowledge in Anatomy, Physiology and thorough knowledge in medical

terminology; Must have undergone training in medical transcription and/or is a certified medical

transcription.



MedicalTranscriptionist

Must have a college education; Must have a second grade civil service eligibility; Must have attended a medical record related training; Must have knowledge in Anatomy, Physiology and thorough knowledge in medical

terminology; Must have undergone training in medical transcription and/or is a certified medical

transcription.Filing/RetrievalClerk

Must have at least two (2) years of college education; Must have a first grade civil service eligibility; Must have a background or experience in the process of filing and retrieval; and Must have attended a training course in HIM.

Challenges and Opportunities

• Existing HIM positions in government hospitals areadministrative positions (e.g. Head = Supervising Admin Officer)

• No law that requires competency in hospital HIMpractitioners

• HIM staff lack of understanding in theimplementation of RA 10173 or Data Privacy Act

• Lack of accreditation mechanism for institutionsoffering HIM course and other related trainings

• Increasing national insurance coverage (2016 Data:US $ 2 Billion, 9.8 Million claims)

• Increasing number of hospitals and other healthcarefacilities (Existing: 24k+ HFs >>>> addtl 13k++ HFs)


• Existing HIM positions in government hospitals areadministrative positions (e.g. Head = Supervising Admin Officer)

• No law that requires competency in hospital HIMpractitioners

• HIM staff lack of understanding in theimplementation of RA 10173 or Data Privacy Act

• Lack of accreditation mechanism for institutionsoffering HIM course and other related trainings

• Increasing national insurance coverage (2016 Data:US $ 2 Billion, 9.8 Million claims)

• Increasing number of hospitals and other healthcarefacilities (Existing: 24k+ HFs >>>> addtl 13k++ HFs)

REGIONGENERAL SPECIALTY TOTAL

No. Beds No. Beds No. BedsI 86 4066 0 0 86 4066

CAR 25 1962 0 0 25 1962II 57 3325 0 0 57 3325III 165 9900 1 10 166 9910

NCR 147 22098 16 7625 163 29723IV-A 217 12428 0 0 217 12428IV-B 25 1407 0 0 25 1407

V 50 3027 1 450 51 3477VI 60 5593 1 300 61 5893

Distribution of Hospitals and Beds, byCategory, by Region


VI 60 5593 1 300 61 5893VII 55 6272 5 179 60 6451VIII 46 2962 0 0 46 2962IX 42 2483 2 471 44 2954X 88 6824 0 0 88 6824XI 34 3353 1 17 35 3370XII 57 4621 0 0 57 4621

CARAGA 18 1289 0 0 18 1289ARMM 25 915 0 0 25 915

PHILIPPINES 1,197 92,525 27 9,052 1,224 101,577Source: HFSRB, as of December 31, 2016

Approx. 5,000 HIM Staff

Challenges and Opportunities

• Majority of the HIM Department Heads andSupervisors have no formal training in HIM

• HIM staff has lack of trainings in clinicaldocumentation improvement, health data analytics,basic health records management (includingretention and disposition of health records), dataprivacy, risk management

• Lack of monitoring in the implementation of HospitalRecords Management Improvement program

• Lack of standards on HIM for primary care facilities(e.g. barangay health stations, rural health units,Polyclinics, etc)


• Majority of the HIM Department Heads andSupervisors have no formal training in HIM

• HIM staff has lack of trainings in clinicaldocumentation improvement, health data analytics,basic health records management (includingretention and disposition of health records), dataprivacy, risk management

• Lack of monitoring in the implementation of HospitalRecords Management Improvement program

• Lack of standards on HIM for primary care facilities(e.g. barangay health stations, rural health units,Polyclinics, etc)

Strategies• Develop standard competencies of HIM staff in hospitals and

other healthcare facilities• Revisit and rename existing staffing positions in hospitals and

other healthcare facilities• Lobby for the passage of law that professionalize the HIM

practitioners• Institutionalize policies on Clinical Documentation

Improvement and Health Data Analytics• Further review and integrate the HIM standards in hospital

and healthcare facilities licensing requirements• Analyze Training Needs and Requirements for HIM Staff• Strengthen collaboration and partnerships with other learning

and development intervention providers (e.g. AHIMA WC,PMRA, PAHRIO, etc)


• Develop standard competencies of HIM staff in hospitals andother healthcare facilities

• Revisit and rename existing staffing positions in hospitals andother healthcare facilities

• Lobby for the passage of law that professionalize the HIMpractitioners

• Institutionalize policies on Clinical DocumentationImprovement and Health Data Analytics

• Further review and integrate the HIM standards in hospitaland healthcare facilities licensing requirements

• Analyze Training Needs and Requirements for HIM Staff• Strengthen collaboration and partnerships with other learning

and development intervention providers (e.g. AHIMA WC,PMRA, PAHRIO, etc)

REFERENCES

• Philippine Health Agenda 2016-2022 ( Department of Health,Philippines, 2016)

• Hospital Health Information Management Manual, 3rd Edition(Department of Health, Philippines, 2010)

• Republic Act No. 10173 or Data Privacy Act of 2012

• Republic Act No. 9470 or National Archives of the PhilippinesAct of 2007

• DOH Administrative Order No. 2012-0012 or Rules andRegulation Governing the New Classification of Hospitals andOther Health Facilities


• Philippine Health Agenda 2016-2022 ( Department of Health,Philippines, 2016)

• Hospital Health Information Management Manual, 3rd Edition(Department of Health, Philippines, 2010)

• Republic Act No. 10173 or Data Privacy Act of 2012

• Republic Act No. 9470 or National Archives of the PhilippinesAct of 2007

• DOH Administrative Order No. 2012-0012 or Rules andRegulation Governing the New Classification of Hospitals andOther Health Facilities

PHYSICIAN TREAT PATIENT ANDHIM TREAT HOSPITALFOR EFFICIENT MANAGEMENT


PHYSICIAN TREAT PATIENT ANDHIM TREAT HOSPITALFOR EFFICIENT MANAGEMENT

• Prof. DR. G. D. MOGLI• PH.D., MBA. FHRIM (UK), FAHIMA (USA)• VISITING PROFESSOR, MEDICAL INFORMATICS, MGM SCIENCES, MAHARASHTRA,

INDIA• EX. WOLRD HEALTH ORGANIZATION CONSULTANT• ASSOCIATE PRFESSOR HIM PROGRM KING FAISAL UNIVERSITY, SAUDI ARABIA• DEAN OF HIM PROGRAM, MOH, SULTANATE OF OMAN

Learning Objectives

End of presentation, the participant should be ableto clearly know1. Role of HIM Professional2. Physician treat patient –HIM treat hospital2. Modification of HIM education4. Creativity and Innovative changes5. Why HIM is capable of treating Hospital?6. How to earn recognition –Learn to improve

revenue?7. HIM Leadership and New Challenges


1. Role of HIM Professional2. Physician treat patient –HIM treat hospital2. Modification of HIM education4. Creativity and Innovative changes5. Why HIM is capable of treating Hospital?6. How to earn recognition –Learn to improve

revenue?7. HIM Leadership and New Challenges

HIM Professional Role

• Extending services in efficient management• Develop and implement HIM standards• Coordinate with entire hospital functions• Diagnosis inefficiencies through data

analysis• Studies on case mix, cost analysis & quality

care• Economic measures in saving expenditure


• Extending services in efficient management• Develop and implement HIM standards• Coordinate with entire hospital functions• Diagnosis inefficiencies through data

analysis• Studies on case mix, cost analysis & quality

care• Economic measures in saving expenditure

PHYSICIAN TREAT PATIENTwell known phenomenon

HIM TREAT HOSPITAL• Somewhat unbelievable!!• When HIM ranks high,

mid, low in hospitalhierarchy


HIM TREAT HOSPITAL• Somewhat unbelievable!!• When HIM ranks high,

mid, low in hospitalhierarchy

When Patient becomes sick or injured?


Who is a patient & What he needs?• Any recipient of health care services is called a

patient• Patient when is ill or injured and in need of

treatment• Visits a physician, hospital, or other health care

provider.


• Any recipient of health care services is called apatient

• Patient when is ill or injured and in need oftreatment

• Visits a physician, hospital, or other health careprovider.

Hospital functions

• Patients• Clinical: medical, nursing etc• Lab, radiology, ECG, EEG etc• Therapy: physio,

occupational, nutrition,pharmacy and other

• CSSD, Laundry, biomedical,etc.

• Adm: HR, Finance and other


• Patients• Clinical: medical, nursing etc• Lab, radiology, ECG, EEG etc• Therapy: physio,

occupational, nutrition,pharmacy and other

• CSSD, Laundry, biomedical,etc.

• Adm: HR, Finance and other

When Hospital becomessick & Who can diagnose?


Why other departments cannot diagnosehospital problems?

• Hospital is a complex with low to high level staff• Each dept., is specialty oriented• Hospital ADM manage non-medical depts.• Med. Director coordinate all clinical dept.• All depts., are busy with their own specialties• HIM is the only dept., deals with all dept., and patients

throughout• Has a coordination role can well diagnose wellness and

sickness of an hospital


• Hospital is a complex with low to high level staff• Each dept., is specialty oriented• Hospital ADM manage non-medical depts.• Med. Director coordinate all clinical dept.• All depts., are busy with their own specialties• HIM is the only dept., deals with all dept., and patients

throughout• Has a coordination role can well diagnose wellness and

sickness of an hospital

Why HIM is capable to treat Hospital?

(Handle beginning to end even after)

• Only dept. that has close relationship with patients/relatives• HIM deals prior, during, even after discharge or death• Maintains complete health information related to patient• Coordinates with clinical & related departments• With digital information best suited to diagnose sickness• Improve efficiency through QA and other audit methods


• Only dept. that has close relationship with patients/relatives• HIM deals prior, during, even after discharge or death• Maintains complete health information related to patient• Coordinates with clinical & related departments• With digital information best suited to diagnose sickness• Improve efficiency through QA and other audit methods

Diagnose and find solution toinefficiency & spiraling cost

Cause for inefficiency & Increased HC Cost


D a n I

I o g s s

Provide Best Possible Care @Moderate Cost

HIM to Equip With Appropriate Educational Background

To Accomplish

Modification of HIM Education

(Change or Perish)• Customary duties of HIM will diminish• HIM education need revision to corporate syllabus• Produce innovative HIM professionals for 21st

century• Absorb in effective & efficient management of

hospital• Focus on healthcare, efficiency, cost & quality

assurance• Make a difference by novel HIM education program


• Customary duties of HIM will diminish• HIM education need revision to corporate syllabus• Produce innovative HIM professionals for 21st

century• Absorb in effective & efficient management of

hospital• Focus on healthcare, efficiency, cost & quality

assurance• Make a difference by novel HIM education program

Creativity, Innovation, and Change

• Bring HIM professionals on single platform• Explore creativity, innovation and change• Discover creative rareness through Creative Diversity• Use intelligent Past Failure to build innovative skills• Focus intent objectives to drive personal change• HIM will gain due to new faces and fresh ideas


• Bring HIM professionals on single platform• Explore creativity, innovation and change• Discover creative rareness through Creative Diversity• Use intelligent Past Failure to build innovative skills• Focus intent objectives to drive personal change• HIM will gain due to new faces and fresh ideas

HIM to Earn Recongniton …Learn to Improve Revenue

• HIM to be influential take challenging duties• Staff in IT and Petroleum are paid high with

esteem• HIM to raise revenue by taking leadership

role• Various avenues e.g., as the HR unit

consumes more than 60% of total instituteexpenditure


• HIM to be influential take challenging duties• Staff in IT and Petroleum are paid high with

esteem• HIM to raise revenue by taking leadership

role• Various avenues e.g., as the HR unit

consumes more than 60% of total instituteexpenditure

HIM Leadership New Challenges• HIM Professionals utilize new environmental challenges• HIM focus on Efficiency, Care, Cost and Quality Assurance• HIM own leadership, dedication, sacrifice and commitment• Expanded role to integrate entire patient care information• HIM to be part of the senior management team by

– providing facts for business opportunities,– clinical care improvement,– efficient Revenue Cycle Management etc.


• HIM Professionals utilize new environmental challenges• HIM focus on Efficiency, Care, Cost and Quality Assurance• HIM own leadership, dedication, sacrifice and commitment• Expanded role to integrate entire patient care information• HIM to be part of the senior management team by

– providing facts for business opportunities,– clinical care improvement,– efficient Revenue Cycle Management etc.

Theme“Better HIM For BetterCare, Cost &Quality assurance ”(HIMccQa)

in the futureHIM professionals should be known ashim expert on care, cost & quality assurance


References• Physician treat patient and HIM treat Hospital for

Controlling Healthcare Cost –Published in theProceedings of 18th International Federation ofHealth Information Management (IFHIMA-2016)” heldon 12-14th October, 2016 at Tokyo InternationalForum, Tokyo, Japan.

• Efficient Management of Hospital with ElectronicHealth Records” published in the Proceedings ofHIMA India-INFO-2016, held on 10-11th December,2016 at NCED Sterling Institute of Pharmacy,Mumbai, India


• Physician treat patient and HIM treat Hospital forControlling Healthcare Cost –Published in theProceedings of 18th International Federation ofHealth Information Management (IFHIMA-2016)” heldon 12-14th October, 2016 at Tokyo InternationalForum, Tokyo, Japan.

• Efficient Management of Hospital with ElectronicHealth Records” published in the Proceedings ofHIMA India-INFO-2016, held on 10-11th December,2016 at NCED Sterling Institute of Pharmacy,Mumbai, India

Questions?


Questions?

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