"Our focus for virtual health is making sure encounters are documented in such a way that it is not burdensome"

Q. What has been your professional journey and how did it lead you to your current role at AHIMA?

Katherine: I think it’s inspiring because if I can do it, anyone can do it. I’m from Gainesville, Texas, which is a small town in North Texas, and I went to work in 18 years of age at Gainesville Memorial Hospital. I worked my way up from a clerk to become the director of Health Information Management. From there, I went to Fort Worth and worked in the Osteopathic Medical Center of Texas, which was an academic medical center focused on the geriatric population, where our average age was eighty-three. Then, I went to Children’s Health System of Texas, which is a pediatric healthcare system with the average age being four. So, I’ve worked at two very different spectrums of healthcare delivery. The documentation and the rules and the governance and the empathy that needs to happen to support patients and families is the same regardless of the setting. Recently, I’ve gone to work for the Texas Health Services Authority with a focus on health information exchange within Texas that includes public health. I’m taking what I learned from the frontline at a local hospital to a geriatric healthcare system to a pediatric healthcare system and applying it at a state level on how we can exchange information in an accurate and complete manner, across the state of Texas to improve healthcare delivery.

Q. We are still in very early stages of harnessing data in a comprehensive way, especially relative to other sectors. Would you agree with that? And what are you seeing across health systems in this regard?

Katherine: I would have to agree and disagree a little bit. I think healthcare is beginning to harness data and efforts to improve patient safety. With clinical decision support to identify duplicate tests and take advantage of tests completed, they’re beginning to map data so that it appears within the electronic health record and allows the frontline care providers to have that information front and center. They are also beginning to look for different ways to streamline the administrative processes. What is curtailing us from doing that is normalizing the data across platforms and organizations. Most organizations in electronic health records have the normalizing data process down using SNOMED and then using intelligent medical objects to translate the very diverse, nuanced clinical data into clinical languages and classification systems to normalize within themselves. So, the EMR vendors have taken advantage of that and they normalize data within their own EMR vendors. But with the care quality and with e-health exchange, that data normalization has occurred on a much broader spectrum. Things are much better than they were even in twenty seventeen. The pandemic forced things to move along at a much more efficient manner and a much faster pace. Before the pandemic there was lots of discussion about mapping laboratory test results across different EMR platforms so that they wouldn’t have to be repeated and using LOINC codes. And it was lots of discussion and hashing with pathologists and with other clinical care providers on how you actually go about normalizing this data. But with the pandemic and COVID-19 people came together and figured it out. I think things are much better than they used to be.

Q. What are your key themes that you’re focusing on, your advocacy efforts this year at AHIMA?

Katherine: We have a big year planned at AHIMA and our 2021 advocacy agenda seeks to transform healthcare by connecting people, systems, and ideas. We’ve embraced three principles that directly align this vision and underpin our work, outlook, and our advocacy efforts – access, integrity, and connection. We’re advocating for the use of accurate and timely data for public health responses and initiatives while protecting confidentiality, privacy, and security of individuals health information. With the pandemic, we feel that public health was not supported sufficiently in the past, and we’d like to focus our attention on making sure that sector of the ecosystem has the information they need. We are firm advocates for the individual’s right to have timely and seamless access to their health information. We had a consumer advocacy pledge campaign earlier this year where we had our members reaffirm our pledge to consumer advocacy on having access to their records. We have been advocating for accurate patient identification to improve patient safety, interoperability, and the appropriate use of workforce resources.

We also understand that with the pandemic and with all of the social issues that we’re currently experiencing, social determinants of health must be the focus to enrich clinical decision making and improve health outcomes. We believe that public health is supported, and health inequities are diminished. We must can gather this information and culturally respect and manner and portray it accurately. We really believe in advancing a complete, accurate and timeliness of data by influencing the development and maintenance of national and international coding standards. Where policy goes, so does the public. We started the Patient Identity Now Coalition, where we worked with six of our partners, the American College of Surgeons, CHIME, HIMSS, Intermountain Healthcare and Premier. There is a coalition of healthcare organizations that are really advocating discussion around a unique patient identifier. So, if you haven’t looked at that, I want to encourage everyone to look at the Patient Identity Now initiative.

Q. Can you touch upon one or two things in the context of telehealth, which obviously in the wake of the pandemic has been on a tear? Can you talk to us a little bit about how this growth in telehealth needs to be viewed in the context of AHIMA’s mission and your priorities?

Katherine: The convenience of telehealth has changed delivery models. Telehealth was being embraced prior to the pandemic, but with the pandemic, it was a wholesale embrace. It moved healthcare delivery from solely brick and mortar into the virtual arena much faster. With AHIMA and our work, we focus on what are the documentation requirements for telehealth, how do we classify the diagnoses that are captured in that arena, how do we make sure that patients have consented to their information being shared in that manner, and how do we keep it safe and secure. Our focus for virtual health is making sure that the patient’s information is safe and secure, making sure that the encounter is documented in such a way that it completely explains the encounter but not be over burdensome.

Q. Where is the challenge in harnessing all the data we receive from different sources? Is it a technology challenge, a better-quality challenge, policies challenge?

Katherine: I believe it’s probably a data quality challenge, because just like all other clinical data, when we began the journey, we had to figure out how to normalize the data. We had to translate the clinical language into SNOMED and accurately capturing that in the electronic health record and then transferring that to clinical language or the classification system. So I believe social determinants of health is our next step on that clinical journey. While they’re not widely used now, we do capture some with ICD 10. Now, are there more that is needed? Absolutely. I believe that as we go through this journey and begin to utilize information and embrace these concepts, data normalization process will only get better and better.

Q. What is the State of the Union today as it relates to a patient privacy? Are there adequate privacy safeguards, especially when we see data being moved to the cloud, or now that we’ve got the final interoperability ruling that’s coming up. And patients are now going to have access to their own data and can share it with anyone they like. What should we be careful about?

Katherine: At AHIMA, we worry the most about is apps, and patients and families using these apps and not really understanding that how their information might be shared. How they have really given away the most personal thing they have, which is their clinical information to an app without completely understanding that information might be sold to someone else, used for marketing, used for a vendor’s personal financial benefit, and it might not be protected. I think that’s one of our biggest concerns now. I personally love an app and I love the convenience. And I’m like everyone else. I have a Garmin and my husband has a Fitbit that we track our health. We take advantage of all those things. We also do 23andme. From a human standpoint, we want to make sure that patients and families and individuals like you and I understand that we are giving away pieces of our very personal information and we want that information to be kept secure and private. The healthcare organizations are ruled by HIPAA and so patients and families and you and I believe that our healthcare information is protected. We’re forced to sign HIPAA requirements when we go to the physician’s office or to an ED or anything like that. So, we’re lulled into this feeling that healthcare information is so sacred and that is so protected. Then when we give that information to an app or a personal health record and a portal, that information is not held to the same standards. We want to make sure that everyone understands that they’re not following the same rules of engagement and to be very considerate of that.

Q. What is your advice for startups and digital health companies that want to go deep into the data and take the data and combine it and use it and analyze it and create new offerings out of it? What is your advice to them to safeguard the data, but also to be successful with it?

Katherine: My advice to them is, be the crane that rises to the top. People will choose to use their apps if they are convenient, useful, safe, and secure. When you develop these healthcare apps, you want to be able to normalize that data and integrate it into the longitudinal record of care. You don’t want to be standalone. These apps need to understand the clinical languages and the classification systems that the big vendors understand. They need to have a depth of knowledge with them. I would also advise that they use standards and look at what those standards are and not be frightened of them, but to embrace them so that they can leverage those standards and integrate with the EHR. They must understand that they are a cog in the healthcare wheel, that we’re all cogs in the healthcare wheel. And we’ve got to figure out how to integrate the data into the entire ecosystem so that it can be shared with everyone. What I would suggest that they do is engage the health information management professionals to help them understand the clinical language or classification system for data mapping and to serve as a guiding hand with patient privacy. This discipline serves in that middle space, and I think it could be very, very helpful to them.

Q. If I were to summarize you here – adopt standards, be interoperable with the EHR systems, but also with other similar applications, take care of patient privacy and protect their privacy with all their applications. And finally, you referred to us being cogs in the wheel. I like to say that healthcare is a team sport, and we are all part of the same team. Do you agree with that?

Katherine: Absolutely. Healthcare is a team sport, and the patient is the captain of the team.