The Canadian Health Information Management Lifecycle

Gibson

Copyright © 2017 Canadian Health Information Management Association.

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Testimonials

The concept of a Health Information Management Lifecycle is an essential underpinning for the increasingly important and complex world of health, health information and its management. The health system depends on information to provide quality care, as well as to support analytics, management and evaluation. Yet, in today’s world there is so much information it can be overwhelming; structure is needed to ensure that we make the best possible use of the information that is available. This reference document provides that needed structure, outlining the health information management lifecycle, its underlying principles and associated best practices. Those who manage health information will find it an invaluable aid in considering many areas of their work including those related to topics such as use, access, disclosure and retention of information.

Joan Roch, M.Sc. Chief Privacy Strategist, Canada Health Infoway

Those who have a responsibility for managing health information will find the guidelines within this resource to be invaluable in dealing with the complexities of information management as we move further into the EHR, combined with the collection of data and information from multiple sources in different formats, and the exchange of health information across the healthcare system.

Altaf Stationwala, CEO, Mackenzie Health, Ontario

With the transition from paper to the electronic record, questions arise regarding those processes that no longer apply consistently across the different media. For example, what is the legal health record in a hybrid or electronic environment? How is information protected, shared, and exchanged across jurisdictions? How are data quality and data integrity maintained when data are collected from a number of different sources and devices? Who is the custodian of the health record in a shared environment? The HIM Lifecycle will provide a framework to help answer these questions.

Kim Wieringa, Assistant Deputy Minister, Health Information Systems Division, Alberta Health

The Canadian HIM Lifecycle resource is a much needed and timely tool for the Healthcare sector which is addressing physical to digital record transformation. The framework is a comprehensive package, outlined by stage, making it easy to adopt as an industry best practice model. The content itself is well supported by research, providing credible sources of references that enable adoption of this recommended approach.

Andrea Bacqué, MBA, PMP, Director of Canadian Solutions, Iron Mountain Incorporated.

A Letter from the CHIMA CEO and Registrar

This Canadian Health Information Management Lifecycle publication is dedicated to the health information management (HIM) profession. The chapters in this publication truly reflect the HIM Domains of Practice.

The project was born out of advice from the Evolve the College working group and from Canadian Healthcare stakeholders. Canada did not have a HIM lifecycle or guidelines and CHIMA was encouraged to work with healthcare stakeholders to produce a guidebook.

The project was initially led by Dr. Kelly Abrams and Dr. Candace Gibson. Shirley Learmonth joined the team in 2016 and contributed substantially as co-lead and subject matter expert.

The guidebook has had input from a pan-Canadian multi-disciplinary group of stakeholders including physicians, nurses, lawyers, HIM professionals, and administrators. This culminating document constitutes hundreds of hours of volunteer work.

The authors and reviewers of this guidebook: This is a very diverse group. Thank you so much for your time, your expertise, your willingness to embrace this new challenge, and your patience with the process.

Special thank you to the editors: Dr. Kelly Abrams, Dr. Candace Gibson, and Shirley Learmonth.

The HIM Program Coordinators: We greatly appreciate and thank you all for championing this cause on behalf of your students.

The HIM Profession: We should be proud of this body of work and share it extensively with clinicians and administrators in all areas of the healthcare industry.

The CHIMA Board of Directors and the Council on Education and Professional Practice: Thank you for championing the writing of this guidebook as a priority for the Association and College.

Gail Crook, CHE, CHIM

CEO and Registrar

Canadian Health Information Management Association

About the Editors

Kelly J. Abrams, PhD, CHIM. Kelly Abrams is the Vice President of the Canadian College of Health Information Management (CCHIM); she is responsible for HIM educational competency content, program accreditation, and certification in Canada. Kelly has been a certified HIM professional for over 30 years and has worked in various HIM roles across Canada including coding classification, decision support, utilization and risk management, privacy, quality improvement, Telehealth, teaching, and curriculum development. Kelly is a member of the Standards Council of Canada’s mirror committee ISO/TC 215 Health informatics and is a Subject Matter Expert on the SMC/ISO/TC 215/WG 3 Semantic content. Kelly has published widely on topics specific to health information and eHealth and is co-editor of the Fundamentals of Health Information Management, 1st and 2nd editions, and the Canadian HIM Lifecycle.

Kelly has a diploma in Health Information Technology, an undergraduate degree in Health Administration, a Master’s degree in Public Administration (Public Policy), and a PhD in Education. Kelly was awarded an honourary diploma from Saskatchewan Polytechnic for her leadership in health and education in Saskatchewan and she was nominated for the 2016 University of Regina President’s Distinguished Graduate Student Award for her academic achievement and dissertation defense.

Shirley Learmonth, MA, CHIM. Shirley Learmonth has over 40 years experience in healthcare and health information management. She holds a Master’s degree in Leadership & Training from Royal Roads University and numerous diplomas in areas such as Project Management, Health Care Management, and Quality Management. Her healthcare work experience spanned over many years within BC and for the later part of her career with Alberta Health Services working as the Director, HIM until her retirement in 2015. Shirley is currently working on projects from beautiful Vancouver Island in B.C.

As a strong advocate for change and committed to making a difference Shirley has dedicated many hours of voluntary work. She has been the Board Chair for professional associations such as the Canadian Health Information Management Association and the Health Record Association of BC and has worked in partnership with learning organizations to develop new curriculum or enhance existing curriculum for health care workers. Shirley has presented on HIM topics at various national and international conferences and has authored or co-authored journal articles and the Canadian HIM Lifecycle.

Candace J. Gibson, PhD, CHIM. Candace Gibson is a faculty member in the Schulich School of Medicine and Dentistry at Western University and is currently the Assistant Dean, Basic Medical Sciences Undergraduate Education, at the Schulich School of Medicine & Dentistry. Over the past decade, she has been actively engaged in the introduction of Health Informatics in the medical curriculum and, as an undergraduate specialization in the School’s Bachelor of Medical Sciences program. In the latter program, she teaches courses in Pathology, Health Informatics and Health Information Management.

Candace served as Chair of the Board of Directors of the Canadian Health Information Management Association (CHIMA) in 2011-2013 and co-edited and co-authored the first Canadian textbooks on health information management. Candace has been the recipient of numerous provincial and national research grants. In 2013 she was the recipient of the AFMC-Infoway eHealth Award recognizing her dedication to improving clinical practice and medical education through digital tools and health solutions; she currently acts as the Senior Peer Leader for the AFMC-Infoway Physician in Training: e-Health Curriculum and e-Learning Project. She is the author of over 80 peer-reviewed publications in experimental neuroscience, health informatics and health information management.

About the Stage Leads

Shirley Learmonth, MA, CHIM has over 40 years experience in healthcare and health information management. Her healthcare work experience spanned over many years within BC and for the later part of her career with Alberta Health Services working as the Director, HIM until her retirement in 2015. Shirley has been the Board Chair for professional associations such as the Canadian Health Information Management Association (CHIMA) and the Health Record Association of BC (HRABC) and has worked in partnership with learning organizations to develop new curriculum or enhance existing curriculum for health care workers. Shirley has presented on HIM topics at various national and international conferences and has authored or co-authored journal articles. Shirley is currently working on projects from beautiful Vancouver Island in B.C. (Stages 1, 3, 5, 6, 7, Conclusion)

Kelly J. Abrams, PhD, CHIM is the Vice President of the Canadian College of Health Information Management (CCHIM); she is responsible for HIM educational competency content, program accreditation, and certification in Canada. Kelly has been a certified HIM professional for over 30 years and has worked in various HIM roles across Canada including coding classification, decision support, utilization and risk management, privacy, quality improvement, Telehealth, teaching, and curriculum development. Kelly is a member of the Standards Council of Canada’s mirror committee ISO/TC 215 Health informatics and is a Subject Matter Expert on the SMC/ISO/TC 215/WG 3 Semantic content. Kelly has published widely on topics specific to health information and eHealth and is co-editor of the Fundamentals of Health Information Management, 1st and 2nd editions, and the Canadian HIM Lifecycle. (Stages Overview, 5, Conclusion)

Candace J. Gibson, PhD, CHIM is a faculty member in the Schulich School of Medicine and Dentistry at Western University and is currently the Assistant Dean, Basic Medical Sciences Undergraduate Education, at the Schulich School of Medicine & Dentistry. Over the past decade, she has been actively engaged in the introduction of Health Informatics in the medical curriculum and as an undergraduate specialization in the School’s Bachelor of Medical Sciences program. In the latter program, she teaches courses in Pathology, Health Informatics and Health Information Management. Candace served as Chair of the Board of Directors of CHIMA in 2011-2013 and co-edited and co-authored the first Canadian textbooks on health information management. Candace has been the recipient of numerous provincial and national research grants. (Stage 1)

Charmaine Shaw, MA (HIM), BA, CHIM, CIPP(C) has over 30 years’ experience in the HIM field. She has a Master’s degree in Health Information Management, is a certified Privacy Professional and was a certified Project Management Professional. Charmaine has served as Director of Health Information/Privacy for Women’s College Hospital, Toronto, St. Joseph’s Healthcare Hamilton and in the former Credit Valley Hospital in Mississauga. She has accrued 10 years’ experience in consulting both in Health Information Management and Privacy. Her work and consulting experiences include hospitals; Community Care Access Centres; the Department of National Defense; First Nations and Inuit Health Branch; Public Health Units and the private sector. Charmaine is currently serving as Vice-Chair of the Board of Directors for the CHIMA and represents CHIMA on the Health Informatics Standards Council of Ontario. (Stage 2)

Laurie E. Kenward, BHRS, CHIM was Coordinator of the Health Information Management program at Douglas College in British Columbia. She has been an educator for over 30 years. She received a bachelor’s degree in Health Record Science from Notre Dame University, formerly in Nelson, BC. She has a continuous history of activities with both CHIMA and the HRABC. Laurie was a member of the advisory committee for the Evolve the College initiative and of the Strengthen Member Relations Task Team (SMRTT). Laurie has served as president and has chaired numerous committees for the HRABC. Laurie retired in August 2016. (Stages 3, 7)

Marci MacDonald, CHIM is the Director, Clinical Information Services/Privacy Officer for Halton Healthcare. She oversees the 3 Clinical Information Services Departments, the 3 Admitting and ER Registration Departments, and corporate Privacy, for the tri-site corporation of Halton Healthcare. As a HIM Professional, Marci has worked with many HIM and related groups, including the Utilization Managers Network of Ontario, the Ontario provincial HIM Association, CHIMA, and the Council on Education for CCHIM. She is currently the President of the International Federation of Health Information Management Associations, which in part involves working on a project implementing worldwide coding standards with the World Health Organization, and working towards creating a global curriculum for HIM professionals. Marci supports education by serving on Advisory Committees with George Brown College and Ryerson University. She has also been involved in the multiple provincial initiatives, including privacy, clinical data quality and various Ministry of Health client registry initiatives. (Stage 4)

Zen Tharani, BSc HINF (Canada), Post Graduate Diploma Health Informatics (UK), CPHIMS-CA is a senior eHealth Consultant with over 16 years of specialized Health Informatics knowledge rooted in experience from across Canada and internationally. Through his career, he has successfully implemented various first ever EHR initiatives such as a Master Client Index, Public Health Information Systems, Provincial Laboratory data repository, Provincial Pharmacy data repository, EMR Integration, Provider Portal, to name a few. He continues to play a significant role in shaping the future of the Health Informatics field by transitioning health informatics from theory into practice throughout the diverse health delivery settings. Zen has a Bachelors of Science in Health Information Science from the University of Victoria and a Post Graduate Diploma in Health Informatics from the University of Central Lancashire, United Kingdom. He is also a Health Informatics MSc. Candidate at the University of Central Lancashire. (Stage 5)

Acknowledgements

The creation of this document would not have been possible without the help and volunteerism from the CHIMA membership and the many other professionals and stakeholders who took the time to write, contribute, and/or review the content. Your time, efforts, and expertise are greatly appreciated and this document would not be what it is today without your support. Thanks to those who took on the task of stage lead in directing the development of the initial input and later revisions. Thank you to Yen Nguyen who acted as project manager for the initial portion of the project. Special thanks go to Laurie Kenward, Marci MacDonald, and Kathryn Frelick who went above and beyond in their contributions to this work, and to Dan Heffernan who took our ideas and rudimentary drawings and turned them into polished graphics. Our appreciation also goes to Ginette Bolt who completed the formatting and references checks and Paula Weisflock for preparing the document for publication.

If we have inadvertently missed someone in the following listings, we sincerely apologize for the oversight and thank you for your participation.

With appreciation,

Kelly, Shirley, and Candace

Authors/Contributors

CHIMA wishes to acknowledge the contribution of the following individuals who acted as authors and contributors to the Lifecycle.

Akeela Jamal, MBA, CHIM

Alexandre Allard, CHIM

Andrew Grant, MD, DPhil, FACMI

Anna Yang, CHIM

Bailey LePage, CHIM

Bhavin Prajapati, MHIS, BA, BSc.

Bojay Hanson, CHIM

Candace Gibson, PhD, CHIM

Charmaine Shaw, MA (HIM), BA, CHIM, CIPP(C)

Cheryl Reid-Haughian, RN, BHScN, MHScN, CCHN(C)

Christine J. Bolduc, BBA, BS, CHIM

Cindy Grant, CHIM

David Musson, MD, PhD

Debra Senger, CHIM

Deena Lorette, CHIM

Derek Manis

Florian Ehrensperger, MLIS, PhD

Gail Crook, CHE, CHIM

Jean L. Eaton, BAdmin, CHIM

Jodi Busche, CHIM

Joshua Hertner, MHIS

Kathleen Addison, CHIM

Kathryn M. Frelick, HBSC, LLB

Kelly Abrams, PhD, CHIM

Kristan Chamberlain, CHIM

Laura Nelson, BHSc, CHIM

Laurie Kenward, BSc (HRS), CHIM

Leah Anscombe, MA, CHIM

Marci MacDonald, CHIM

Margaret Ann Kennedy, PhD, RN, CPHIMS-CA, Procsi®, PMP, PRINCE2 Practitioner, ITILF

Mea Renahan, BScPT, MBA, CHE

Mohamed Hussain

Natalie Kouyoumdjian, BHA, HIM

Natasha Klemack, CHIM

Navid Nabavi, MSc, CHIM

Paula Weisflock, BHA (HIM), MAEd, CHIM

Rosemarie Lourenco, CHIM

Sandra Cotton, BA, CHIM

Sharon Penney, CHIM

Shirley Learmonth, MA, CHIM

Stephanie Tambeau, CHIM

Zen Tharani, BSc HINF, Post Graduate Diploma Health Informatics (UK), CPHIMS-CA

Reviewers

CHIMA wishes to acknowledge the contribution of the following individuals who acted as reviewers.

Agnes Vandervecht, CHIM, BA

Amanda Burridge, CHIM

Andrea Bacqué, MBA (IT Mgmt), PMP

Ann Meehan, RHIA

Carmen Sheridan, MA ODE

Charmaine Shaw, MA (HIM), BA, CHIM, CIPP(C)

Darlene Dale, BASc, FHA

Deena Lorette, CHIM

Diamond Watson-Hill, MBA, CHE

Diane Aldridge, BEd, CIAPP/M

Doris Gemmell, BSc, MBA, CHIM

Eileen Oleski, CHIM, CAE

Florian Ehrensperger, MLIS, PhD

Gail Crook, CHE, CHIM

Jane Kitazaki, CHIM, MHS

Jean L. Eaton, BAdmin, CHIM, CC

Jessica Giesbrecht, MBA, BHA, CHIM

Jessica MacDougall, BSc, BHIM, MHI, CHIM

Jonathon Chui, MBA, BSc

Karen A. Carlson, MA, CHIM

Kathryn M. Frelick, HBSC, LLB

Laurie Kenward, BSc (HRS), CHIM

Leah Anscombe, MA, CHIM

Leah Goguen, CHIM

Lori Claxton, CHIM

Lynn Cartan, PMP, CHIM

Marci MacDonald, CHIM

Margaret Ann Kennedy, PhD, RN, CPHIMS-CA, Procsi®, PMP, PRINCE2 Practitioner, ITILF

Maria Muia, MHSc, BHA, CHE, CHIM

Michael Nusbaum, BASc, MHSA, FHIMSS

Patricia Rothney, MAL(H), BN, RN, CPHIMS-CA, Procsi®, PRINCE2 Practitioner, ITILF

Rosemarie Lourenco, CHIM

Sandra Cotton, BA, CHIM

Sharilyn Kmech, CHIM

Shirley Learmonth, MA, CHIM

Sonya Stasiuk, CHIM

Sue Schneider, BA, CHIM, CPHIMS-CA

Susanne Clark, RIM

Tracy Shaben, RN, MN

Zen Tharani, BSc HINF, Post Graduate Diploma Health Informatics (UK), CPHIMS-CA

Table of Contents

A Letter from the CHIMA CEO and Registrar

About the Editors

About the Stage Leads

Acknowledgements

Authors/Contributors

Reviewers

Table of Contents

Listing of Tables

Listing of Figures

Overview of Canadian Health Information Management Lifecycle

Introduction and Background

A Condensed History of the Health Information Management Profession

The Electronic Health Record

Scope of HIM Lifecycle Document

The Purpose and Use of Health Information

Canadian HIM Lifecycle Model - In Summary

Stage 1: HIM planning

Stage 2: Data collection, capture, and receipt

Stage 3: Organization

Stage 4: Access, use, and disclosure

Stage 5: Maintenance, retention, and protection

Stage 6: Disposition/Destruction

Stage 7: Evaluation

Conclusion

References

Stage 1: Health Information Management Planning

The Importance of Health Information Management Planning

Definitions and Discussion of Terms Used in Information Management Planning

Enterprise information management governance (EIMG)

Information governance

Data governance

Information technology governance

EHR governance

Information management

Information Governance and Accountability Frameworks

Canadian Health Information Management Conceptual Framework

Information Management Principles

Health information governance general principles

Generally accepted record keeping principles

Identification and Classification of Information Assets

Health Information Management Plan Development

Components of a health information management plan

Stewardship and Ownership

Privacy, Security, and Confidentiality of Personal Health Information

Legislation, Regulations, and Standards Governing Health Information

Policies and Procedures

Retention, Disposition, and Destruction Plans

Education Framework: Staff Training and Competencies

Evaluation Framework: Monitoring and Evaluation Frameworks

Conclusion

References

Appendix A — Sample Policy Framework

Appendix B — Common Standards Development Organizations

Appendix C — Common Classification Systems

Stage 2: Data Collection, Capture, and Receipt

Introduction

Data Assets

Data Governance

Types of Healthcare Data

Data and Information Standards

Interoperability

Stakeholder organizations in the development and promotion of standards

Coding and classification standards

Documenting standardized clinical outcomes

Clinical documentation standards

Data Quality

Dimensions of data quality

Data quality frameworks

Quality of databases

Data/Information Access, Use, and Control

Conclusion

References

Stage 3: Organization

Introduction

Following the Health Information Management Plan

The Legal Health Record

Information Models

Information Classification System Framework

Clinical Document Architecture

Data Sets and Data Dictionaries

Data Standards and Guidelines

Content Standards

History and physical examination

Consultation report

Operative report

Discharge summary

Documentation Standards

Use of abbreviations, symbols, and acronyms

Documentation analysis

Format types

Standardization of forms and views

Naming of clinical forms

Authentication

Document and data non-repudiation

Unique client identification

Maintaining the master patient index

Cut and paste functionality

Conclusion

References

Stage 4: Access, Use, and Disclosure

Introduction

Defining Access, Use, and Disclosure

Access and Disclosure

Legislation defining access to patient information

Who owns the health information?

Who can access health records?

Removal of the original health record from the facility

How can individuals access their own PHI?

Uses of Information

Primary use

Secondary use

Privacy Controls for Access, Use, and Disclosure

Security, monitoring, and auditing of access

Privacy impact assessment

Privacy audits

Information sharing agreements

Conclusion

References

Appendix A — Privacy Principles

Appendix B — Secondary Requests for Information

Appendix C — Provincial/Territorial Information and Privacy Legislation

Stage 5: Maintenance, Retention, and Protection

Introduction

Maintenance

Record linkage

Standardized chart order/format

Forms and content management

Record completion

Data quality audits

Primary, secondary, and transitory documents

Thinning of records

Corrections, amendments, deletions, and addendums or late entries

Managing duplicate records and overlays

Reproduction capability

Authentication or electronic signature

Version control

Managing outdated media

Business continuity plan (BCP)

System downtime and recovery procedures

Interoperability

Access controls

Retention

Retention regulations

Retention schedules

Protection

Storage

Security

Administrative controls

Physical security

Technical security

Personnel security

Conclusion

References

Appendix A — Provincial/Territorial Retention of Records

Appendix B — Privacy by Design: The 7 Foundational Principles

Appendix C — Reduction of Risks for Record Storage

Appendix D — Physical Safety Measures

Stage 6: Disposition/Destruction

Introduction

Types of media

Effective Management of the Disposition and Destruction of Health Information

When is a record deemed inactive?

Development of a destruction policy

Legal and legislative requirements

Tracking of disposition/destruction

Methods of physical destruction

Discontinuing records systems

Recovery of records

Purging of records

Transfer of records

Conclusion

References

Appendix A — Sample Contract Clauses

Stage 7: Evaluation

Introduction

Purpose of Evaluation

Health Information Management Lifecycle Evaluation Framework

HIM planning

Data collection, receipt and capture

Organization

Access, use, and disclosure

Maintenance and protection

Disposition/Destruction

Metrics and Methods Used for Evaluation

Performance measurement

Checklists, surveys, and questionnaires

Interviews or focus groups

Audits

HIM Performance Measurement and Evaluation

Turn-around time

Data quality re-abstraction studies

Coding round tables or data quality audits

Data integrity

Privacy impact assessments (PIA) and threat and risk assessment (TRA)

Workflow analysis

Technology usability studies

Accreditation

Conclusion

References

Conclusion

Introduction

How the HIM Profession Can Help

Stage 1: HIM planning

Stage 2: Data collection, capture, and receipt

Stage 3: Organization

Stage 4: Access, use, and disclosure

Stage 5: Maintenance, retention, and protection

Stage 6: Disposition/Destruction

Stage 7: Evaluation

In Summary

References

Resources

Abbreviation List

Glossary

Listing of Tables

Table 1. A Comparison of ARMA® International Record Keeping*, AHIMA Information Governance Program **, and CHIMA HIM Governance Principles

Table 2. Government of Alberta’s Four Levels of Security Classification (2005)

Table 3. Information Asset Inventory

Table 4. Data Quality Activities for Databases

Listing of Figures

Figure 1. Canadian Health Information Management Lifecycle Model

Figure 2. COBIT 5 Governance and Management Key Areas

Figure 3. Relationship between Governance and Health Information Management Lifecycle

Figure 4. Alberta Health Services Information Management Governance Framework

Figure 5. Alberta Health Services Enterprise Information Management Program Framework

Figure 6. Alberta Health Services EIM Model

Figure 7. Canadian Health Information Management Conceptual Framework

Figure 8. Classification Levels for Confidential Information

Figure 9. Example of a Risk Map

Figure 10. Information Hierarchy

Figure 11. Canadian Health Information Management Lifecycle Model

Overview of Canadian Health Information Management Lifecycle

Introduction and Background

The initial decision to create a Canadian Health Information Management (HIM) Lifecycle arose out of the Canadian College of Health Information Management’s (CCHIM) Evolve the College work in 2012/13. A committee of key stakeholders from the Canadian eHealth environment (e.g., the Canadian Institute for Health Information, COACH, Canada Health Infoway) joined with the Canadian Health Information Management Association (CHIMA) and CCHIM to develop recommendations to guide and prioritize CCHIM’s work over the next 5 to 10 years. The creation of a Canadian HIM lifecycle document was considered a priority given the scarcity of standardized policies, processes, and procedures across Canada. The HIM profession, since its inception, has focused on the development of standards for the medical record and the health data it contains (Abrams, 2016). As we move forward into the 21st century; HIM practice in the present supports electronic record implementation, its use, organization, maintenance, protection, and evaluation, and the standards that define the legal record. The Canadian HIM lifecycle document was created to provide support and guidance to those working with health information, in all its various forms, across the country.

The Canadian HIM lifecycle document contains considerations and guiding principles for each of the stages in the lifecycle, more fully described in each subsequent section. The ultimate goal of the Canadian HIM lifecycle is to create a cycle of information flow, whereby data from distributed and interoperable electronic health records (EHRs) are routinely and effortlessly submitted to registries and databases. The resulting new knowledge can then feedback to practitioners at the point of care, using a variety of computer-supported decision support delivery mechanisms. This cycle of new knowledge, driven by experience and fed back to clinicians, has been called a learning healthcare system (Friedman, Wong, & Blumenthal, 2010). A learning healthcare system is based on a policy framework of public trust that allows members of participating jurisdictions to place queries to all other members, allowing the provision of information that may solve problems and advance practice. For example, the ability to query and report new infections during an H1N1 outbreak would provide fast and reliable data to track the spread of disease. As jurisdictions progress in the implementation of their electronic health information systems and the use of the Canadian HIM lifecycle, the public trust required to achieve a national learning healthcare system will be reached.

A Condensed History of the Health Information Management Profession

The maintenance and guardianship of a complete and accurate health record and the information it contains is, and has been since the early 1920s, the foundation of an efficient healthcare system (Crook, Abrams, & Arnold, 2013). The early medical record was a simple, chronological, and often incomplete paper-based account of care received and/or services rendered. As medical education reform gained momentum in the early 1900s, the importance of the medical record and its contents started to become better understood (Abrams, 2016).

In 1910, Abraham Flexner wrote a report for the Carnegie Foundation for the Advancement of Teaching (the Flexner Report as it became known) that is credited with emphasizing the need for original medical research, training in the scientific method, and experiential learning. Flexner (as cited in Abrams, 2016) stated in his report that laboratory findings and information collected at the bedside from the patient were of equal importance when determining diagnoses and should therefore be recorded. Flexner maintained that the medical record, through careful recording and maintenance, was an important tool for the physician and medical student to use in the clarification of their experience with the patient. The Flexner Report is credited with modernizing medical training and placing an emphasis on research and clinical documentation which would indirectly lead to the creation of the American College of Surgeons (ACS).

The ACS was founded in 1913 to monitor and enforce the quality