Reflective Writing for ePortfolio

1. Emerging into E-
Health Information
Management
Reflections on e-health and my career aspirations
-Kathy Nickerson, GRU Health Information Management Student

2. I enthusiastically believe in electronic health records, e-health
and electronic health information management for the benefit of
each individual patient and the community of people who have
been affected with a condition or disease that negatively affects
their lives. I’m excited to get involved in the process of moving
health care toward more e-health initiatives and to engage
physicians and patients in these initiatives.
There are barriers to the implementation of e-health initiatives,
electronic health records and health information organizations. The
mission of health information management (HIM) professionals is
to help break down these barriers to adaption of electronic health
information management.
My personal mission is to find a barrier and break it down.

3. What is e-health?
“Simply stated, e-health is the application 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 definition 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, Education, 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 duplicative or unnecessary diagnostic or
therapeutic interventions, through enhanced communication possibilities
between health care establishments, and through patient involvement.
2. Enhancing quality of care - increasing efficiency involves not only
reducing costs, but at the same time improving quality. E-health may
enhance the quality of health care for example by allowing comparisons
between different providers, involving consumers as additional power for
quality assurance, and directing patient streams to the best quality
providers.
3. Evidence based - e-health interventions should be evidence-based in a
sense that their effectiveness and efficiency should not be assumed but
proven by rigorous scientific evaluation. Much work still has to be done in
this area.
4. Empowerment of consumers and patients - by making the knowledge
bases of medicine and personal electronic records accessible to
consumers over the Internet, e-health opens new avenues for patient-
centered medicine, and enables evidence-based patient choice.
5. Encouragement of a new relationship between the patient 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. Education of physicians through online sources (continuing medical
education) and consumers (health education, tailored preventive information
for consumers)
7. Enabling information exchange and communication in a standardized way
between health care establishments.
8. Extending the scope of health care beyond its conventional 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
interventions or products such a pharmaceuticals.
9. Ethics - e-health involves new forms of patient-physician interaction and
poses new challenges and threats to ethical issues such as online professional
practice, 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 time 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 effectively. As a result, these patient populations (which would
actually benefit the most from health information) are those who are the
least likely to benefit from advances in information technology, unless political
measures ensure equitable access for all. The digital divide currently runs
between rural vs. urban populations, rich vs. poor, young vs. old, male vs.
female people, and between neglected/rare vs. common diseases.

6. In addition to these 10 essential e’s, Eysenbach stated e-health should be:
easy-to-use, entertaining, and exciting. (Eysenbach, 2001) These last 3 e’s will
make e-health become more mainstream and are important aspects of the
evolution to e-health.
Why isn’t electronic health information more exciting and widely
executed?
I believe it is because there are too many barriers to the implementation
of e-health initiatives, electronic health records and health information
organizations/or exchanges.
Two type of barriers exist – physician barriers and patient barriers.

7. PhysicianBarriers
Eight main categories of barriers to physician acceptance of EMR’s have been
identified. These eight categories are: A) Financial, B) Technical, C) Time, D)
Psychological, E) Social, F) Legal, G) Organizational, and H) Change Process. All
these categories are interrelated with each other. (Boonstra, 2010)
1. Financial Barriers – Physicians are concerned about the
costs of implementing 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,
limitations and reliability of the EMR.
3. Time – Time to train, time to enter data, time to learn, time
to choose and implement – all are time away from patients.
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 information.

8. PhysicianBarriers continued…
5. Social – Lack of support from vendors, management, and other colleagues
and interference with the doctor-patient relationship are concerns for
physicians.
6. Legal – Confidentiality, privacy and security are essential to health
information management and physicians make feel that these issues are
not adequately addressed.
7. Organizational – The electronic systems may not be applicable to the
physician’s practice type and size.
8. Change Process – After being in practice for any length of time, many
physicians have their own working processes and styles. Electronic health
information management may require a major change in how physicians
work.

9. PatientBarriers
1. Paternalistic Nature of Medicine – In the past, patients
abdicate the responsibility for their health to physicians and
assume the physician has all the needed knowledge and
specific information to treat them. Patients should realize
that physicians don’t always know the most optimal path to
health and they need to share the responsibility for their
own health.
2. Data Ownership – While organizations own the physical
medical record or the EHR, patients own their medical
information. Patients often need to have this information
interpreted by qualified individuals and shouldn’t be
intimidated or kept in the dark.
A number of factors create barriers to consumer (patient) engagement and
consumer-mediated HIE, including the paternalistic 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. PatientBarriers continued…
3. Third Party Payment – Ever try to make sense of a medical bill? Retail
price, discounted price, insurance contract price, patient co-payments,
reasonable and customary price, explanation of benefits, Medicare
payment, deductibles – 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.
3. Technology Challenges – Patients frequently are referred to specialists or
other health care providers. Communication between all health care
providers involved in an individual patient’s care is frequently non-
existent or poor. Importing information or data from multiple sources to
one comprehensive EHR or Health Information Exchange is a challenge.
4. Behavioral Economics – Patients need to have a good attitude about their
EHR, to know that it’s normal to get information on their medical
condition and to have confidence that they are able to access this
information. Patients may not have the computer skills to even access to
computers or the Internet. (Morris 2010)

11. Howcan I break downbarriersto e-health?
Or in other words,where do I go from here?
The profession of health information 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 Information
Administrator is just the beginning.

12. My Personal Strengths
• Unique combination of medical and information technology experience.
Twenty years in medical laboratories and 12 years in digital asset
management allows me to bring new perspectives from both disciplines.
• Sincere and intense interest in learning with the comfort, ability and desire
to advance technically. Learning new software, new processes, and new
management techniques is not only exciting, but critical in moving forward.
I’ve embraced the challenges of being a non-traditional student; my
academic and career records prove my ability to adapt and succeed.
• Being a member of the technologically sandwiched generation. Individuals
older than I am may have adverse feelings toward new technology; younger
folks are much more comfortable in the digital environment. I can identify
with the reluctance of established, seasoned professionals to change and I
enjoy working with Generation 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
appreciation for detail, data and organization.

13. Interesting possibilities
• Healthcare Consumer Advocate - Medical information, insurance
issues, and billing issues can be intimidating and confusing. As the
population ages and the available information grows, the need for
guidance in these areas will increase.
• Client Support Specialist –Maximizing the technology tools available
to patients and/or physicians is important to the advancement of e-
health.
• Clinical Research Coordinator – Acquiring data and transforming it
into useful information for the benefit of current and future patients
is an honorable and worthy goal.
• Health Data/Information Resource Manager – Data and information
needs to be made accessible to the individuals that need it. Finding
the information is a critical step before knowledge, change and
action can occur.

14. My plan
• Achieve the credential. Push for a strong finish to my Post-
Baccalaureate program and take the RHIA exam as soon as possible.
• Get connected. Attend Georgia AHIMA activities and the national
AHIMA meeting in Atlanta this fall. Stay in touch with students
currently in the program and with contacts at DeKalb Medical
Center. Continue to go to the Emory Health Informatics seminars.
Improve my LinkedIn profile.
• Find the right first position. Research organizations, academic
institutions, companies, and the positions they have available. An
entry-level position of data collection or abstraction may be more
realistic and would give me beneficial front-line experience.
Explore and be open to emerging HIM employment possibilities, look
for a mission and move toward the goal of breaking down a barrier to
the implementation of e-health initiatives, electronic health records
and electronic health information management.

15. References
Boonstra, A. and Broekhuis, M. (2010) Barriers to the acceptance of electronic
medical records by physicians from systematic review to taxonomy and
interventions. BMC Health Services Research.
http://www.biomedcentral.com/1472-6963/10/231
Eysenbach, G. (2001) What is e-health? Journal of Medical Internet Research.
http://www.jmir.org/2001/2/e20/
LaTour, K.M. and Maki, S.E. (Eds.). (2010). Health Information Management,
Concepts, Principles and Practice. Chicago, IL: American Health Information
Management Association.
Morris, G., Afzal, S., Finney, D. (2012) Consumer Engagement in Health Information
Exchange. Office of the National Coordinator for Health Information Technology.
http://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 functions of HIM professionals: a look into the past, present and future.
Perspectives of Health information Management. Retrieved from:
http://www.ncbi.nlm.nih.gov/pmc/articles/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 setting me on this career path.
• Mr. Ron McCranie and the HIM Staff at DeKalb Medical Center for
hosting me for my Summer Practicum.
• Lastly, and most importantly, my husband John, whose support,
educational perspectives and belief in me have been truly invaluable
during my return to school this past year and for the past 36 years.