Greg-Louis Austin | Health information management, COVID-19 and NIDS
The week of October 18-24, 2020, was recognised as Health Records Week under the theme ‘Preserving Health Information Integrity for Future Development’. A number of activities were staged, within the confines of the COVID-19 protocols, to highlight the work and worth of the more than 900 employees who form the cadre of health information management (HIM) practitioners across the island.
More commonly referred to as health records or medical records staff, these workers are critical to the efficiency of healthcare delivery worldwide. Though not often given the recognition they deserve, these professionals provide the ‘shoulder’ on which the medical, nursing, and allied health staff stand in order to be functional. The HIM practitioners must be applauded for keeping the health sector alive even during this pandemic.
HIM is essential to healthcare delivery
Health information management primarily revolves around effective management of health information to support patient-care delivery, health administrative processes, and provide health statistics to inform policymaking, regulation, and education.
The health record (docket – curse word in HIM) is a compilation of pertinent facts of a patient’s life and health history, including past and present illness(es) and treatment(s), written by the health professionals contributing to that patient’s care. In simpler terms, it documents the who, what, when, where, why, and how of patient care. This document contains sufficient data to identify the patient, support the diagnosis, justify the treatment, and accurately document the results of that treatment. The quality of the data provided in the health record is critically relied on by clinicians and administrators, and so incomplete or missing data compromise patient care.
The data in a health record ought to be of the highest quality, and so the standards of the health information management profession have to be maintained to ensure the highest levels of confidentiality, reliability, and transparency. Health information management practice incorporates a number of critical areas including patient registration, appointments, statistics, qualitative analysis, medical data classification (coding), and medico-legal.
HIM operations during COVID-19
The health information management operations in government facilities seemed not to have changed much, if any at all, during COVID-19. Even though there are computerised systems of sorts (OCS, PAS) within our hospitals, activities remain concentrated around the predominant paper-based (records) system. As usual, there has to be face-to-face interactions within these healthcare settings, and sometimes social distancing is not possible. The HIM staff, however, reported that they received functional protective gear. The distribution was a practice prior to the COVID-19 dispensation.
Fortunately for us in Jamaica, we are spared the high morbidity and even mortality indices experienced in other countries – even though we are climbing – kudos to our government and public-health practitioners island-wide. Notwithstanding, we are now seeing a dramatic influx of admissions and even cases in the accident and emergency departments related to the pandemic.
In order to effectively manage HIM operations during this pandemic, a protocol document was developed and circulated by the Ministry of Health and Wellness in keeping with the general guidelines outlined by the World Health Organization. This spoke to, among other things, the initiation of remote access (by telephone) in the handling of health information, especially in relation to isolation wards and quarantine areas.
Outside of the healthcare setting, however, e-health systems underpinned the operations of the National Emergency Operations Centre, the designated administrative hub to coordinate efforts to address the COVID-19 pandemic. This facilitates the currency (real time) and relevance of the information that is relied on by the various stakeholders of the health system and the general public. Additionally, there is a pilot of an e-HIM initiative in the public-health arena, which facilitates contact tracing.
The Registrar General’s Department (RGD), in response to the COVID-19 crisis, launched the e-burial order for corona-related deaths. This facilitates the downloading of the burial order by the informant ,who would not have to ‘go in’ to the office of the RGD. This has assisted greatly in maintaining social distance and has removed the possibility of discrimination. The practice of issuing e-burial orders, based on my understanding, could become the ‘new-normal’ in the death-registration process for deaths from natural causes.
COVID-19 has provided the wonderful opportunity to ‘test’ the electronic health information system in our health system even as persons in every profession and industry sought to implement strategies that would reduce face-to-face interaction. This opportunity seemed premature as the public-health system may not have been in a position to innovate any e-HIM processes even within the National Health Information System Strengthening and E-Health Strategy. The University Hospital of the West Indies, on the other hand, enjoyed the benefits of an HIMS (hospital information management system) that was implemented in June 2017. The pertinent information is accessed in a digital environment, and so a physical paper-based record is not ‘passed around.’
HIM AND NIDS
What is next? We don’t know for sure, but one thing is certain, all signs point to the need for the accelerated implementation of the National Health Information System Strengthening & E-Health Strategy to underpin the government’s NIDS initiative. NIDS is coming soon – even before the ink dried on his instrument of appointment, Prime Minister, Andrew Holness proclaimed that “we would like, before the end of the year, this year, that we should be seeking to pass the bill into law”. Could this ‘twinning’ be a critical piece of the puzzle? Definitely. The demographic subsystem that is critical to the operations of any national health information system would have to be integrated in a national database that NIDS would provide.
This integration requires a multisectoral collaboration ranging from deliberate budgetary allocation on the Government’s part to stringent behaviour-change modification of potential users and the public. Prudent health-information practices should prevail to ensure that the users and the public are fully cognizant of and sensitive to the legitimate concerns regarding confidentiality, data protection, and data privacy.
The Ministry of Health and Wellness should proceed with full force to execute the National Health Information System Strengthening and E-Health Strategy to its functional point to facilitate the improvement in the quality of healthcare and increased access to care and services. Health information management education will also play a critical role in developing competences and subsequently providing training for HIM staff to be functional in this digital space.
Let’s go forward and drive our health delivery system on the wheels of a national e-health information management platform to assure optimal provision of a world class health system.
Greg-Louis Austin, PhD, is a senior lecturer in health information management and senior quality assurance officer at The University of Technology, Jamaica. Send feedback to firstname.lastname@example.org.