Elevating HIM leadership in a data-driven world

The HIM landscape is changing. Once primarily tasked with maintaining data integrity and compliance, HIM leaders now find themselves at the forefront of innovation. They are increasingly tasked with bridging the gap between clinical care and advanced analytics.

We asked Stacey Sexton, RHIA, vice president of health information services at TruBridge, to provide insights on these evolving trends. In this Q&A, Sexton details how advancements in data analytics, interoperability, and cyber security are reshaping the skill sets required to excel in the HIM field. She explains how HIM professionals can play a strategic role in supporting hospital revenue cycle teams and adapting to a data-driven healthcare environment. Additionally, Sexton offers insights on the integration of artificial intelligence (AI) and computer-assisted coding (CAC) systems into HIM roles and responsibilities.

Q: How are the roles and responsibilities of HIM professionals evolving in response to technological advancements in healthcare?

Sexton: Traditional HIM roles are transforming. Key areas of evolution include data analytics, interoperability, cybersecurity, and privacy. Telehealth and remote patient monitoring are also opening new career paths.  Once a core HIM responsibility, data integrity has expanded to include predictive analytics and data-driven, strategic decision-making. HIM professionals are the go-to experts on patient data quality. They also play a critical role in dataexchange, standardization, and governance.

With growing cyber threats, HIM expertise is essential to enforcing privacy policies, conducting risk assessments, and ensuring compliance with HIPAA and other industry regulations.

Finally, HIM professionals help make virtual environments safer for healthcare workers and patients by developing standards and enforcing policies.

Q: What emerging trends are shaping HIM skill sets?

Sexton: Data-driven decision-making is essential across industries, and healthcare is no exception. The volume of health data is continuing to skyrocket ,and turning that data into actionable insights is critical to providing effective care.
More data alone isn’t helpful—clinicians also need meaningful interpretations. HIM professionals can help manage healthcare’s data explosion by doing the following:

• Mastering data visualization tools
• Building expertise in statistical and predictive analytics
• Translating complex data sets into actionable policies and strategies
• Understanding interoperability standards to connect disparate systems

As health data grows, HIM professionals are becoming key players in testing and validating new solutions alongside information technology. By acting as the bridge between technology and clinical care, they can help translate tech jargon into healthcare solutions that work.

Q: How can HIM professionals position themselves as strategic partners within hospital revenue cycle teams?

Sexton: HIM professionals have always relied on interdisciplinary collaboration, as it is an integral skill to their role. By leveraging their expertise in clinical vocabulary and disease processes, they become valuable partners to revenue cycle teams. They provide critical insights that complement billing and payer management processes.

As the reimbursement landscape continues to evolve, HIM professionals can strengthen these partnerships and solidify their position by being adaptable and open to learning new processes.

Q: How can AI and CAC systems support HIM professionals in improving coding accuracy and efficiency?

Sexton: AI and CAC systems are transformative tools that can enhance efficiencyand accuracy in clinical coding, but they do not replace human expertise. It is acase of working better together, not substituting decades of HIM knowledge.

By streamlining time-intensive tasks such as clinical data and documentation reviews, coders shift their focus to higher-value work and perform at the top of their license. Here are four specific ways that AI and CAC support clinical coding workflows:

• Ensure consistency and compliance to reduce human error and adhere to standardized guidelines
• Streamline processes to eliminate redundant steps and optimize workflows
• HIM Briefings
• Medicare Insider
• Briefings on APCs
• Strategies forHealthcareCompliance
• News & Insights
• Identify gaps in documentation through proactive alerts and flags formissed details
• Enable real-time issue resolution, improving coding accuracy and reducing denials

These tools complement the skills of HIM professionals, driving better outcomes without replacing human oversight.

Q: What are some key challenges HIM leaders face when integrating AI systems into their workflows, and how can they be addressed?

Sexton: There are significant challenges associated with incorporating AI and other tools into workflows. Clinical documentation remains largely unstructured, and while standardized frameworks exist, ambiguities in clinical vocabulary always require human interpretation.
System training and error identification demand highly skilled professionals, and their roles will evolve as they learn to effectively assess AI outputs. Look for new training opportunities that emphasize error detection, feedback, and monitoring to enhance efficiency and accuracy.

Q: With coding rules and interpretations constantly changing, what strategies can HIM professionals use to ensure that AI tools remain up to date?

Sexton: HIM professionals play a crucial role in ensuring technological tools remain accurate and reliable. Their deep understanding of healthcare processes, data, and organization is essential for maintaining the integrity of these systems.

By continuously refining models and testing data, HIM experts can prevent unexplained deviations in revenue, safety, and quality. When issues arise, their expertise is vital for quickly identifying root causes before they escalate. While technology can be transformative, it requires ongoing oversight, interpretation, and testing to keep organizations on course.

Q: Despite advancements in AI and automation, why is human expertise still indispensable in coding and billing?

Sexton: AI models still face challenges with complex cases, particularly whenthey must rely on ambiguous or inconsistent documentation. Interoperabilitybetween systems often leads to patient data and clinical communication gaps,making it difficult to achieve optimal results.
Ongoing testing and analysis is essential to ensure compliance and deliver accurate outcomes. It’s important to note that AI lacks ethical reasoning. Professionals remain critical for preventing upcoding, down coding, and overbilling issues through fair and appropriate coding and billing practices.

HIM professionals have the expertise to challenge ideas and data, ensuring decisions are well-informed. A balanced approach that values both technology and human expertise is key. Healthy environments and open discussions should focus on solutions and encourage adaptability.

Lastly, AI cannot replace the nuanced discussions required to resolve disputes among clinicians, payers, and auditors. HIM professionals play a vital role in bridging these gaps and resolving discrepancies.

Q: What are some common pitfalls associated with implementing automated coding systems?

Sexton: Making assumptions is one of the biggest pitfalls. I’ve seen some organizations set unrealistic expectations about what technology can and cannot provide. Misalignment between the roles of technology and HIM staff is another area of concern. It can lead staff to distrust new technology and processes. Even worse, it can lead to poor implementation and subpar results. Finally, there is concern across industries that technological advancements can render certain roles or responsibilities obsolete. In most cases, these concerns are mitigated when efficiencies emerge and responsibilities advance into higher-value work. Technology-driven efficiency doesn’t cause job losses. Rather, it leads to reimagining jobs as the roles change.

Q: How can HIM professionals align their work with broader revenue cycle goals to improve hospital financial performance?

Sexton: Collaborate, collaborate, collaborate! The best HIM professionals are the best collaborators. Bring in both clinical and billing teams regularly to align with HIM on opportunities, challenges, and processes. These interdepartmental meetings positively impact documentation, reimbursement, and compliance.

Q: What role does technology play in streamlining the connection between CDI and revenue cycle operations?

Sexton: Translating clinical documentation into revenue has always been one of HIM professionals’ skills and core responsibilities. Ensuring accuracy and timeliness in this process is a problem that technology seeks to solve for us.

Technology can help identify gaps or inconsistencies in the documentation or clinical picture as a whole. By recognizing these disparities, an organization can suggest real-time feedback to speed up the revenue cycle process, maintain compliance, and push for more consistent care.
Predictive analytics can also assist at many stages of the revenue cycle to identify leakage and prevent denials. Better predictability of care and reimbursement helps prevent surprises and unnecessary costs that burden the healthcare system today.

Randomness will always be a factor, and healthcare is largely unpredictable. However, more data that is properly analyzed and applied can highlight potential revenue issues that might otherwise be missed.

Q: How can HIM leaders balance the need for technological efficiency with maintaining compliance and data integrity?

Sexton: It is always important to keep compliance and data integrity front and center. No technology is a viable solution if it does not produce compliant and accurate results. Payer denials carry significant financial impacts, and legal implications are extremely costly for any healthcare organization. These realities make constant accuracy monitoring and testing critical. Auditing technology must be a day-to-day part of the landscape.