Kathy is excited about the benefits of e-health initiatives like electronic health records and health information management. She believes these can help both individual patients and communities affected by health conditions. However, there are barriers to implementing these initiatives. As a health information management professional, Kathy's mission is to help break down barriers to adopting electronic health information management. She wants to find a specific barrier and help remove it. E-health involves applying e-commerce principles to healthcare to improve efficiency, quality of care, patient empowerment and more.

1. Emerging
into
E-­‐
Health
Information
Management
Reflec%ons
on
e-­‐health
and
my
career
aspira%ons
-­‐Kathy
Nickerson,
GRU
Health
Informa%on
Management
Student

2. I
enthusias+cally
believe
in
electronic
health
records,
e-­‐health
and
electronic
health
informa%on
management
for
the
benefit
of
each
individual
pa%ent
and
the
community
of
people
who
have
been
affected
with
a
condi%on
or
disease
that
nega%vely
affects
their
lives.
I’m
excited
to
get
involved
in
the
process
of
moving
health
care
toward
more
e-­‐health
ini%a%ves
and
to
engage
physicians
and
pa%ents
in
these
ini%a%ves.
There
are
barriers
to
the
implementa+on
of
e-­‐health
ini+a+ves,
electronic
health
records
and
health
informa%on
organiza%ons.
The
mission
of
health
informa%on
management
(HIM)
professionals
is
to
help
break
down
these
barriers
to
adap%on
of
electronic
health
informa%on
management.
My
personal
mission
is
to
find
a
barrier
and
break
it
down.

3. What
is
e-­‐health?
“Simply
stated,
e-­‐health
is
the
applica%on
of
e-­‐commerce
to
the
health
care
industry.”
(LaTour,
2010)
So
what
does
this
mean
for
health
care
providers
and
individuals
who
are
consumers
of
health
care?
Gunther
Eysenbach
provided
my
preferred
defini%on
of
e-­‐health
in
2001,
when
he
published
the
10
e’s
of
e-­‐health.
They
are:
Efficiency,
Enhancing
quality
of
care,
Evidence
based,
Empowerment,
Encouragement,
Educa%on,
Enabling,
Extending,
Ethics,
and
Equity.

4. The
10
e's
in
"e-­‐health"
1. Efficiency
-­‐
one
of
the
promises
of
e-­‐health
is
to
increase
efficiency
in
health
care,
thereby
decreasing
costs.
One
possible
way
of
decreasing
costs
would
be
by
avoiding
duplica%ve
or
unnecessary
diagnos%c
or
therapeu%c
interven%ons,
through
enhanced
communica%on
possibili%es
between
health
care
establishments,
and
through
pa%ent
involvement.
2. Enhancing
quality
of
care
-­‐
increasing
efficiency
involves
not
only
reducing
costs,
but
at
the
same
%me
improving
quality.
E-­‐health
may
enhance
the
quality
of
health
care
for
example
by
allowing
comparisons
between
different
providers,
involving
consumers
as
addi%onal
power
for
quality
assurance,
and
direc%ng
pa%ent
streams
to
the
best
quality
providers.
3. Evidence
based
-­‐
e-­‐health
interven%ons
should
be
evidence-­‐based
in
a
sense
that
their
effec%veness
and
efficiency
should
not
be
assumed
but
proven
by
rigorous
scien%fic
evalua%on.
Much
work
s%ll
has
to
be
done
in
this
area.
4. Empowerment
of
consumers
and
pa%ents
-­‐
by
making
the
knowledge
bases
of
medicine
and
personal
electronic
records
accessible
to
consumers
over
the
Internet,
e-­‐health
opens
new
avenues
for
pa%ent-­‐
centered
medicine,
and
enables
evidence-­‐based
pa%ent
choice.
5. Encouragement
of
a
new
rela%onship
between
the
pa%ent
and
health
professional,
towards
a
true
partnership,
where
decisions
are
made
in
a
shared
manner.

5. The
10
e's
in
"e-­‐health”
continued…
6. Educa+on
of
physicians
through
online
sources
(con%nuing
medical
educa%on)
and
consumers
(health
educa%on,
tailored
preven%ve
informa%on
for
consumers)
7. Enabling
informa%on
exchange
and
communica%on
in
a
standardized
way
between
health
care
establishments.
8. Extending
the
scope
of
health
care
beyond
its
conven%onal
boundaries.
This
is
meant
in
both
a
geographical
sense
as
well
as
in
a
conceptual
sense.
e-­‐health
enables
consumers
to
easily
obtain
health
services
online
from
global
providers.
These
services
can
range
from
simple
advice
to
more
complex
interven%ons
or
products
such
a
pharmaceu%cals.
9. Ethics
-­‐
e-­‐health
involves
new
forms
of
pa%ent-­‐physician
interac%on
and
poses
new
challenges
and
threats
to
ethical
issues
such
as
online
professional
prac%ce,
informed
consent,
privacy
and
equity
issues.
10. Equity
-­‐
to
make
health
care
more
equitable
is
one
of
the
promises
of
e-­‐
health,
but
at
the
same
%me
there
is
a
considerable
threat
that
e-­‐health
may
deepen
the
gap
between
the
"haves"
and
"have-­‐nots".
People,
who
do
not
have
the
money,
skills,
and
access
to
computers
and
networks,
cannot
use
computers
effec%vely.
As
a
result,
these
pa%ent
popula%ons
(which
would
actually
benefit
the
most
from
health
informa%on)
are
those
who
are
the
least
likely
to
benefit
from
advances
in
informa%on
technology,
unless
poli%cal
measures
ensure
equitable
access
for
all.
The
digital
divide
currently
runs
between
rural
vs.
urban
popula%ons,
rich
vs.
poor,
young
vs.
old,
male
vs.
female
people,
and
between
neglected/rare
vs.
common
diseases.

6. In
addi%on
to
these
10
essen%al
e’s,
Eysenbach
stated
e-­‐health
should
be:
easy-­‐to-­‐use,
entertaining,
and
exci+ng.
(Eysenbach,
2001)
These
last
3
e’s
will
make
e-­‐health
become
more
mainstream
and
are
important
aspects
of
the
evolu%on
to
e-­‐health.
Why
isn’t
electronic
health
informa+on
more
exci+ng
and
widely
executed?
I
believe
it
is
because
there
are
too
many
barriers
to
the
implementa%on
of
e-­‐health
ini%a%ves,
electronic
health
records
and
health
informa%on
organiza%ons/or
exchanges.
Two
type
of
barriers
exist
–
physician
barriers
and
pa+ent
barriers.

7. Physician
Barriers
Eight
main
categories
of
barriers
to
physician
acceptance
of
EMR’s
have
been
iden%fied.
These
eight
categories
are:
A)
Financial,
B)
Technical,
C)
Time,
D)
Psychological,
E)
Social,
F)
Legal,
G)
Organiza%onal,
and
H)
Change
Process.
All
these
categories
are
interrelated
with
each
other.
(Boonstra,
2010)
1. Financial
Barriers
–
Physicians
are
concerned
about
the
costs
of
implemen%ng
and
maintaining
an
EMR.
2. Technical
–
Physicians
and
their
staff
may
not
have
the
technical
skills
necessary
and
may
not
have
the
training
and
support.
They
have
concerns
about
the
complexity,
limita%ons
and
reliability
of
the
EMR.
3. Time
–
Time
to
train,
%me
to
enter
data,
%me
to
learn,
%me
to
choose
and
implement
–
all
are
%me
away
from
pa%ents.
4. Psychological
–
Physicians
may
not
be
convinced
that
EMR’s
are
worthwhile
and
that
the
development
of
an
EMR
will
take
away
their
control
of
the
informa%on.

8. Physician
Barriers
continued…
5. Social
–
Lack
of
support
from
vendors,
management,
and
other
colleagues
and
interference
with
the
doctor-­‐pa%ent
rela%onship
are
concerns
for
physicians.
6. Legal
–
Confiden%ality,
privacy
and
security
are
essen%al
to
health
informa%on
management
and
physicians
make
feel
that
these
issues
are
not
adequately
addressed.
7. Organiza+onal
–
The
electronic
systems
may
not
be
applicable
to
the
physician’s
prac%ce
type
and
size.
8. Change
Process
–
Ader
being
in
prac%ce
for
any
length
of
%me,
many
physicians
have
their
own
working
processes
and
styles.
Electronic
health
informa%on
management
may
require
a
major
change
in
how
physicians
work.

9. Patient
Barriers
1. Paternalis+c
Nature
of
Medicine
–
In
the
past,
pa%ents
abdicate
the
responsibility
for
their
health
to
physicians
and
assume
the
physician
has
all
the
needed
knowledge
and
specific
informa%on
to
treat
them.
Pa%ents
should
realize
that
physicians
don’t
always
know
the
most
op%mal
path
to
health
and
they
need
to
share
the
responsibility
for
their
own
health.
2. Data
Ownership
–
While
organiza%ons
own
the
physical
medical
record
or
the
EHR,
pa%ents
own
their
medical
informa%on.
Pa%ents
oden
need
to
have
this
informa%on
interpreted
by
qualified
individuals
and
shouldn’t
be
in%midated
or
kept
in
the
dark.
A
number
of
factors
create
barriers
to
consumer
(pa%ent)
engagement
and
consumer-­‐mediated
HIE,
including
the
paternalis%c
nature
of
medicine,
the
current
structure
of
health
insurance
plans,
the
indirect
nature
of
third-­‐party
payment,
technology-­‐related
challenges,
and
factors
related
to
behavioral
economics.

10. Patient
Barriers
continued…
3. Third
Party
Payment
–
Ever
try
to
make
sense
of
a
medical
bill?
Retail
price,
discounted
price,
insurance
contract
price,
pa%ent
co-­‐payments,
reasonable
and
customary
price,
explana%on
of
benefits,
Medicare
payment,
deduc%bles
–
it’s
enough
to
make
anyone
throw
up
their
hands
and
just
hope
it
turns
out
OK.
Especially
when
you
are
ill,
infirm
or
disabled.
4. Technology
Challenges
–
Pa%ents
frequently
are
referred
to
specialists
or
other
health
care
providers.
Communica%on
between
all
health
care
providers
involved
in
an
individual
pa%ent’s
care
is
frequently
non-­‐
existent
or
poor.
Impor%ng
informa%on
or
data
from
mul%ple
sources
to
one
comprehensive
EHR
or
Health
Informa%on
Exchange
is
a
challenge.
5. Behavioral
Economics
–
Pa%ents
need
to
have
a
good
agtude
about
their
EHR,
to
know
that
it’s
normal
to
get
informa%on
on
their
medical
condi%on
and
to
have
confidence
that
they
are
able
to
access
this
informa%on.
Pa%ents
may
not
have
the
computer
skills
to
even
access
to
computers
or
the
Internet.
(Morris
2010)

11. How
can
I
break
down
barriers
to
e-­‐health?
Or
in
other
words,
where
do
I
go
from
here?
The
profession
of
health
informa%on
management
(HIM)
is
evolving
and
new
HIM
roles
are
emerging
with
vastly
improved
computer
technology
and
the
advancement
of
electronic
health
records.
“With
the
2009
enactment
of
ARRA
as
well
as
other
advances
in
medicine
and
disease
management,
the
speed
of
technology
in
healthcare
opens
new
pathways
for
HIM
professionals.”
(Watzlaf
2009)
Studying
to
become
a
Registered
Health
Informa+on
Administrator
is
just
the
beginning.

12. My
Personal
Strengths
• Unique
combina-on
of
medical
and
informa-on
technology
experience.
Twenty
years
in
medical
laboratories
and
12
years
in
digital
asset
management
allows
me
to
bring
new
perspec%ves
from
both
disciplines.
• Sincere
and
intense
interest
in
learning
with
the
comfort,
ability
and
desire
to
advance
technically.
Learning
new
sodware,
new
processes,
and
new
management
techniques
is
not
only
exci%ng,
but
cri%cal
in
moving
forward.
I’ve
embraced
the
challenges
of
being
a
non-­‐tradi%onal
student;
my
academic
and
career
records
prove
my
ability
to
adapt
and
succeed.
•
Being
a
member
of
the
technologically
sandwiched
genera-on.
Individuals
older
than
I
am
may
have
adverse
feelings
toward
new
technology;
younger
folks
are
much
more
comfortable
in
the
digital
environment.
I
can
iden%fy
with
the
reluctance
of
established,
seasoned
professionals
to
change
and
I
enjoy
working
with
Genera%on
X
and
Millennials.
• Detail
oriented
and
data
driven.
My
experiences
as
a
Medical
Technologist,
Image
Bank
Archivist
and
Digital
Asset
Specialist
have
sharpened
my
strong
apprecia%on
for
detail,
data
and
organiza%on.

13. Interesting
possibilities
• Healthcare
Consumer
Advocate
-­‐
Medical
informa%on,
insurance
issues,
and
billing
issues
can
be
in%mida%ng
and
confusing.
As
the
popula%on
ages
and
the
available
informa%on
grows,
the
need
for
guidance
in
these
areas
will
increase.
• Client
Support
Specialist
–Maximizing
the
technology
tools
available
to
pa%ents
and/or
physicians
is
important
to
the
advancement
of
e-­‐
health.
• Clinical
Research
Coordinator
–
Acquiring
data
and
transforming
it
into
useful
informa%on
for
the
benefit
of
current
and
future
pa%ents
is
an
honorable
and
worthy
goal.
• Health
Data/Informa+on
Resource
Manager
–
Data
and
informa%on
needs
to
be
made
accessible
to
the
individuals
that
need
it.
Finding
the
informa%on
is
a
cri%cal
step
before
knowledge,
change
and
ac%on
can
occur.

14. My
plan
• Achieve
the
creden-al.
Push
for
a
strong
finish
to
my
Post-­‐
Baccalaureate
program
and
take
the
RHIA
exam
as
soon
as
possible.
• Get
connected.
Akend
Georgia
AHIMA
ac%vi%es
and
the
na%onal
AHIMA
mee%ng
in
Atlanta
this
fall.
Stay
in
touch
with
students
currently
in
the
program
and
with
contacts
at
DeKalb
Medical
Center.
Con%nue
to
go
to
the
Emory
Health
Informa%cs
seminars.
Improve
my
LinkedIn
profile.
• Find
the
right
first
posi-on.
Research
organiza%ons,
academic
ins%tu%ons,
companies,
and
the
posi%ons
they
have
available.
An
entry-­‐level
posi%on
of
data
collec%on
or
abstrac%on
may
be
more
realis%c
and
would
give
me
beneficial
front-­‐line
experience.
Explore
and
be
open
to
emerging
HIM
employment
possibili+es,
look
for
a
mission
and
move
toward
the
goal
of
breaking
down
a
barrier
to
the
implementa+on
of
e-­‐health
ini+a+ves,
electronic
health
records
and
electronic
health
informa+on
management.

15. References
Boonstra,
A.
and
Broekhuis,
M.
(2010)
Barriers
to
the
acceptance
of
electronic
medical
records
by
physicians
from
systema5c
review
to
taxonomy
and
interven5ons.
BMC
Health
Services
Research.
hkp://www.biomedcentral.com/1472-­‐6963/10/231
Eysenbach,
G.
(2001)
What
is
e-­‐health?
Journal
of
Medical
Internet
Research.
hkp://www.jmir.org/2001/2/e20/
LaTour,
K.M.
and
Maki,
S.E.
(Eds.).
(2010).
Health
Informa5on
Management,
Concepts,
Principles
and
Prac5ce.
Chicago,
IL:
American
Health
Informa%on
Management
Associa%on.
Morris,
G.,
Afzal,
S.,
Finney,
D.
(2012)
Consumer
Engagement
in
Health
Informa5on
Exchange.
Office
of
the
Na%onal
Coordinator
for
Health
Informa%on
Technology.
hkp://www.healthit.gov/sites/default/files/consumer_mediated_exchange.pdf
Watzlaf,
V.J.M.,
Rudman,
W.J.,
Hart-­‐Hester,
S.,
Ren,
P.
(2009)
The
progression
of
the
roles
and
func5ons
of
HIM
professionals:
a
look
into
the
past,
present
and
future.
Perspec%ves
of
Health
informa%on
Management.
Retrieved
from:
hkp://
www.ncbi.nlm.nih.gov/pmc/ar%cles/PMC2781732/

16. Many
thanks
to…..
• My
instructors
at
Georgia
Regents
University
–
Dr.
Amanda
Barefield,
Dr.
Carol
Campbell,
Dr.
Jim
Condon,
Ms.
Lori
Prince
and
Ms.
Sherry
Smith
for
preparing
me
and
segng
me
on
this
career
path.
• Mr.
Ron
McCranie
and
the
HIM
Staff
at
DeKalb
Medical
Center
for
hos%ng
me
for
my
Summer
Prac%cum.
• Lastly,
and
most
importantly,
my
husband
John,
whose
support,
educa%onal
perspec%ves
and
belief
in
me
have
been
truly
invaluable
during
my
return
to
school
this
past
year
and
for
the
past
36
years.