Impact of the COVID-19 Pandemic on HIM Professionals in a Rural State

Abstract

The COVID-19 pandemic has greatly disrupted the healthcare industry, impacting health information professionals through facility changes, remote work, shifting priorities, and personal stressors. This study explores the impacts of these disruptions on health information professionals in a rural state. Participants indicated involvement in expanding and new responsibilities related to tracing and data collection, the expansion of telehealth services, and disaster planning. Their work was impacted by facility closures and suspended services, an increase in remote work, increased communications during the pandemic, and the shift to virtual continuing education. As with much of society, many participants also experienced worsening mental well-being, social wellness, and stress related to a variety of factors. Despite the stress and uncertainty, participants also found inspiration in the pandemic, taking time to reprioritize, connect with others, and find strength in human resilience.

Keywords: HIM profession, pandemic, remote work, rural, COVID-19

Introduction

The COVID-19 pandemic has created unprecedented disruptions in multiple industries and throughout society. This includes the healthcare industry and health information management (HIM) professionals. Public health officials rely on data from healthcare organizations for case reporting and to inform best practices in addressing the virus and associated complications. HIM professionals are essential to capturing and reporting this accurate data. Despite the increased demand on the healthcare system, many facilities still had to utilize furloughs and reduce staffing due to budget restraints, quarantine restrictions, and other pandemic factors. Those who were able to work had to do so with considerable new restrictions, and many were sent to work from home. This required changes in workflow and communication strategies, necessitating rapid response by health information managers to update policies and procedures. Telehealth expanded rapidly to address the continued needs of patients, impacting HIM processes and requiring enhanced privacy and security measures. The stress of the pandemic, restrictions, and ongoing changes to work situations and environments has impacted employee mental, physical, and social well-being, with many healthcare professionals experiencing heightened anxiety, frustration, and stress.

Literature Review

Addressing the pandemic has required significant data-driven public health efforts. HIM is essential in acquiring and providing this data. HIM professionals have been involved in manual and electronic case reporting (eCR) to public health agencies, ensuring the health record system capabilities to collect and report accurate data. eCR is the automated generation and transmission of care reports from the electronic health record (EHR) and, if available, can save time and provide more accurate and complete data.¹ This data has also been used for contact tracing, early identification, risk scoring, and enhanced understanding of clinical indicators, risk factors, and biomarkers.² Organizations adopted additional tools such as electronic check-in, standard ordering and documentation, secure messaging, and real-time data analytics to help maintain the quality of pre-pandemic care.³ Studies have been done using longitudinal EHR data to create algorithms and models to analyze prognoses, predict the clinical course, and guide decisions and treatment of COVID-19 illnesses.^4,5 Some facilities have even established COVID-19 data registries based on chart review and data extraction.⁶ Such data has been essential to understanding the virus and pandemic, and informing policymakers and the general public on prevention, interventions, and outcomes.⁷

Despite the need for essential data gathered by health information professionals, many suffered furloughs or even loss of employment due to the pandemic. Many facilities were shut down or significantly reduced services provided, eliminating any care not directly related to emergencies and COVID-19.⁸ Education services and research efforts were suspended with laboratory closures and the inability to participate in-person. Many facilities were short-staffed due to both budget constraints and loss of employees to illness and quarantine requirements.⁹ HIM managers had to manage this negative impact on the budget and staffing while still providing the services needed to treat patients, continue the revenue cycle, and meet the reporting requirements of the pandemic. This may have included involvement in disaster planning efforts, addressing and updating a communication plan, informational materials, employee sick leave policies and procedures, physical safeguard requirements, education and training efforts, and surge capacity plans.¹⁰

Many HIM managers had to also manage a larger remote workforce. The HIM discipline is not new to remote work, with many organizations implementing remote coding, clinical documentation improvement, and even release of information prior to the pandemic. However, the pandemic quickly made remote work essential, sending home many employees who had not opted into telecommuting with little notice. This required rapid expansion of policies related to remote work, technical and physical equipment to support secure at-home offices, and expansion of HIM services offered remotely.

In addition to many employees being sent home to work, the pandemic impacted work practices in other ways. According to DeFilippis et al., the number of meetings and emails increased for many employees following lockdown.¹¹ Meetings and emails generally included more attendees and recipients, highlighting an increase in both frequency and scope of communication. However, on average, meeting length and the total amount of time spent in meetings decreased. In addition, many employees adjusted work schedules and sent more emails outside of standard working hours. This may have been related to the rapidly changing situation and potentially returned to normal levels once organizations had their pandemic plan in place.

Despite the limitations of many facilities during these unprecedented times, the pandemic has broadened the use and availability of telehealth across the country as an alternative to provide safe and effective care.¹² In previous years, telemedicine was met with hurdles and some resistance, but demand for commercial telemedicine services has increased and vendor traffic skyrocketed.¹³ Telemedicine can provide less expensive care with improved access, particularly during times of crisis. It offers a way to provide continuity of care for patients while protecting staff and reducing burnout of providers. In 2020, it was supported with expanded flexibility in policies, such as allowing patients to be seen through videoconferencing without a qualifying site visit and allowing prescription of controlled substances through telemedicine without an in-person evaluation.¹⁴ Centers for Medicare & Medicaid Services (CMS) and other payers issued multiple waivers and offered payment parity for Medicare.¹⁵

In response to this expansion of telehealth services, the Centers for Disease Control and Prevention (CDC) has offered guidance related to best practices in telemedicine during the pandemic.¹⁶ Health information professionals may be involved in developing or implementing many of these recommendations, depending on organizational structure. This guidance includes identification of encounters appropriate for telemedicine and protocols for triaging and assessing patients. These policies, practices, and protocols for using telehealth services must be communicated to providers, including those related to appointment scheduling, documentation and billing, referral processes, urgent care, ancillary services, and follow-up visits, among others. Those involved in telehealth services must continuously monitor federal and state regulations and restrictions, temporary mandates and directives, and expiration dates. It is recommended that at-risk populations are prioritized, with outreach to patients with limited connectivity. The CDC also recommends regular communication with payers to verify coverage of telehealth, telemedicine, or nurse advice line services.¹⁷ Although telemedicine has been relatively successful throughout the pandemic, there are still concerns related to privacy and efficacy considerations. Regulation of commercial teleservices should address licensing and liability, and health information best practices should clarify informed consent and protection of data and confidentiality. Medical practice guidelines should consider ethical issues, professional conduct and relationships, patient autonomy and safety, cultural diversity, and malpractice and liability.¹⁸

These strained effects were felt more significantly at facilities in rural communities. Many of these facilities have been and remain under-resourced with issues related to infrastructure, lack of equipment, and disparities in workers, training opportunities, and revenue compared to those in urban areas.¹⁹ The pandemic strained already thin margins, increasing the financial and operational burden on rural hospitals that carry significant administrative burden. The trend toward remote work and expanded telehealth services may be more difficult for rural facilities that lack the infrastructure and technology to support these services, including access to high-speed internet.²⁰

In addition to hospital and service closures, required changes in HIM workflow processes, and expansion of telehealth and remote work, the pandemic has impacted the HIM workforce in a variety of other ways. In a study by Sethi et al., health professionals indicated an impact on mental, physical, and social well-being.²¹ Any type of quarantine can incite mass hysteria and distress, with many feeling a loss of control.²² As with most of society, there have been feelings of anxiety, frustration, and stress among healthcare employees.²³ This relates to a variety of things, including but not limited to: worrying about the safety and wellness of themselves and their families; separation from loved ones; fear of the virus and potential complications; insufficient supplies of basic essentials; and dealing with furloughs, pay cuts, and layoffs. Those that have to work on-site worry about their vulnerability and exposure, particularly in facilities with limited personal protective equipment (PPE) and infrastructure. They may also have to deal with uncooperative, stigmatized, and panicked patients.²⁴ Some have found it challenging to stay motivated, exhausted from public indifference, misinformation, and non-compliance. Despite these challenges, some employees have also reported more time for self and family.²⁵

This study explores the impact of these rapid and unforeseen changes and actions, addressing the following questions:

• How were HIM professionals in a rural state involved in facility changes related to the pandemic, such as data capture, disaster planning, and the expansion of telehealth services?
• To what extent were HIM professionals in a rural state impacted by facility closures, reduced services, and furloughs?
• How were HIM professionals in a rural state impacted by the expansion of remote work?
• How are HIM professionals in a rural state currently coping with the physical, mental, and social stresses of the pandemic?

Methods

The sample population included health informatics and information management professionals in Idaho. This is considered a relatively rural state, with a population less than 2 million, 27 critical access hospitals, and nine rural health clinics.²⁶ Many facilities have HIM professionals that are members of the state’s relevant professional associations, including the Idaho Health Information Management Association (IdHIMA) and the Healthcare Information and Management Systems Society (HIMSS) Idaho Chapter. IdHIMA has over 400 members, and HIMSS Idaho has approximately 250 members. These individuals work in a variety of health informatics and information management areas throughout many types of organizations.

A survey of open and closed questions was created by the researcher based on the findings of the literature review (see Appendix 1). Questions were written to gather information on the participant’s work setting, work, and personal experiences during the pandemic, such as changes to work duties and impact on wellness. Upon institutional review board (IRB) and association approval, it was distributed by email to members of IdHIMA and HIMSS Idaho. A snowball sampling technique was used, asking recipients to distribute the survey to additional co-workers in the health information and informatics disciplines. These individuals were targeted to provide a broad base of professionals in jobs relevant to health information and informatics to provide insight into the impact of the pandemic.

Descriptive analysis was done using Qualtrics software, summarizing results with percentages and frequency distributions. Chi-square and t-test analyses were conducted when appropriate to compare acute care hospital responses with the other patient settings. The questions related to work-related communications, overall rating of organizational response, and the impact of the pandemic on health and wellness of participants were five-point Likert scale questions and were analyzed using dummy codes 1-5 to obtain means and standard deviations where 1: Excellent, 2: Good, 3: Average, 2: Poor, 1: Terrible; 1: Much higher, 2: Slightly higher, 3: About the same, 4: Slightly lower, 5: Much lower; and 1: Much better, 2: Better, 3: Same, 4: Worse, 5: Much worse, respectively. Free-text items, such as responses under the “others” and the three open-ended questions, were reviewed to identify common, recurrent themes. 

Results

The survey was completed by 76 individuals from primarily acute care hospitals (54.1 percent), but also critical access hospitals (5.4 percent), physicians’ offices (5.4 percent), insurance companies (4.1 percent), long-term care hospitals (4.1 percent), skilled nursing facilities (2.7 percent), and other types of organizations (24.3 percent) (see Figure 1). Other types of organizations included health systems, ambulatory settings, state and federal organizations, software companies and other IT vendors, specialty clinics, academic institutions, and consulting companies.

Responses were obtained from directors and managers, coding specialists, systems analysts, registry specialists, consultants, and educators, as well as a variety of other professionals in compliance, health IT, and administration. Specific health information domains included coding (33.3 percent), information systems (22.7 percent), management (17.3 percent), and the revenue cycle (12 percent), with others in registries and indexes, analytics, and education (see Figure 2).

Expanded and New Responsibilities

Tracing and data collection. As outlined in the literature review, the COVID-19 pandemic has necessitated intensive tracing and data collection to track cases and patient outcomes, and organizations have relied on a variety of individuals to assist. Just over a quarter (30.9 percent) of participants indicated they were involved in these efforts in some way (see Table 1). There was no significant difference in involvement of these efforts between those in acute care hospitals and other settings, c²(1, N = 68) = 0.18, p = 0.6714. Of those involved, several participated in data collection for clinical indicators and risk factors (38.1 percent) and case reporting, early identification, and registry development and/or data collection (28.6 percent). Just a few were involved in risk scoring, contact tracing, and tool development. Those involved in other activities (38.1 percent) listed duties related to case identification through coding and coding audits, management of the COVID-19 attestation desk, data collection for employees and visitors, inpatient outcomes tracing, and screening. Fortunately, the majority of respondents indicated that the additional case reporting requirements did not increase burden on their department, although 15 indicated it did. There was no significant difference in this response between those in acute care hospitals and other settings, c²(1, N = 38) = 0.85, p = 0.3568. Some of these responses may have come from the 17.2 percent who indicated that their EHR did not already have the capabilities required for eCR. Of those who did utilize eCR, most (61.1 percent) indicated that it helped them improve reporting efforts. There was no significant difference in whether or not the EHR had eCR capabilities between those in acute care hospitals and other settings, c²(2, N = 62) = 3.06, p = 0.2170. Most participants also felt that the contact tracing and case reporting requirements did not cause privacy and security concerns for their organizations (72.7 percent). Those that indicated concerns addressed them by increasing oversight and limiting access as necessary.

Expansion of telehealth services. Participants were asked if their facility expanded telehealth services during the pandemic, with 84.6 percent indicating they did. Those who indicated that telehealth services were not expanded were from a physical therapy or specialty clinic, or an organization that did not provide direct patient care. Half of the participants of the survey indicated they were directly involved in tasks related to this expansion (see Table 2). There was no significant difference in involvement of these efforts between those in acute care hospitals and other settings, c²(1, N = 68) = 2.514, p = 0.1128. Participants assisted with physician and provider training (50 percent), ensuring compliance with privacy practices (44.1 percent), creating and updating policies and procedures for telemedicine (38.2 percent), communicating with payers to verify coverage (17.6 percent), regulation and restriction monitoring (14.7 percent), identifying and prioritizing patients by risk (8.8 percent), and only one was involved in patient outreach. Other duties included tool development for remote patient monitoring, volume monitoring, setting up telehealth billing, monitoring for fraud and abuse, and coding of telehealth visits.

Disaster planning. Participants were also asked about their involvement in assisting their organization with disaster planning efforts related specifically to COVID-19, with 44.1 percent indicating that they did participate in at least one task category (see Table 3). There was no significant difference in involvement of these efforts between those in acute care hospitals and other settings, c²(1, N = 68) = 3.06, p = 0.0800. Participants were involved in committees (56.7 percent), the communications plan (50 percent), education and training (50 percent), recommending and/or implementing physical safeguard requirements and installation (26.7 percent), updating employee sick leave policies and procedures (23.3 percent), and surge capacity planning (20 percent). Overall, the majority of participants indicated confidence in their organization’s response to the pandemic (M = 1.59, SD = 0.74), with 54.3 percent rating their facility as excellent and 34.3 percent as good. There was no significant difference in these ratings between those in acute care hospitals and other settings, t(68) = 1.59, p = 0.12. Qualitative responses indicated frequent and effective communication, early implementation of policies and procedures, fiscal responsibility, and employee support as reasons for a high rating. The few who responded negatively criticized an overreaction without consideration of consequences or a lack of reaction at all, difficulty in getting employees to return to on-site work, extensive furloughs, and lack of monitoring noncompliance with safety protocols.

Other Work-Related Impacts

Facility closures and suspended services. The pandemic has significantly disrupted facilities, with many having to reduce or eliminate services either temporarily or permanently, and some expanding other types of services. According to respondents, 37.2 percent reported that their facility had to suspend elective surgeries due to COVID-19, and 33.1 percent had to suspend non-urgent surgeries. Outpatient services were suspended slightly less at 17.6 percent, just 2 percent suspended laboratory services, and only a few suspended research activities. Other suspended services included travel, community outreach, in-person meetings and conferences, annual exams, live education lessons, and on-site implementation of system upgrades. A few even indicated that all services were suspended.

Increase in remote work. As mentioned above, the pandemic resulted in significant work disruptions, with furloughs, a dramatic increase in remote work, and an increase in relevant communications. Fortunately, only 10 of the respondents indicated that they were furloughed due to the COVID-19 pandemic. Five respondents were furloughed for one to three months, three for more than three months, and the remaining two for less than a month. The percentage of respondents working remotely was significantly higher. Forty-four percent of respondents began working from home due to the pandemic, and 41.3 percent were already working from home. Of those who were already working remotely, 67.8 percent have done so for three to 10 years, 22.6 percent for more than 10 years, and 9.7 percent for less than three years. The majority of participants (75.8 percent) felt that they were able to effectively achieve their work duties from home. The remaining participants felt they were somewhat effective (19.7 percent) or not effective (4.6 percent). Just 12.2 percent did not work remotely, but several of those participants still managed remote employees.

Increased communications. Participants indicated that work-related communications, including number and length of emails and meetings, increased during the pandemic with 38.8 percent indicating it was much higher and 28.4 percent that it was slightly higher (M = 1.94, SD = 0.87). Some indicated it was about the same (31.3 percent) and just one participant that it was slightly lower. There was no significant difference in these responses between those in acute care hospitals and other settings, t(62) = 0.94, p = 0.35.

Virtual continuing education. The pandemic also caused many live events and conferences to be canceled. Most of the participants (76.8 percent) participated in virtual education events to obtain continuing education units.

Impact on Health and Wellness

In addition to disruptions in the workplace, studies have highlighted a variety of other, personal impacts of COVID-19 and quarantine restrictions. Ultimately, these may impact the ability of an employee to meet the demands of their job. Participants were asked about the impact of the pandemic on their anxiety, general mental well-being, physical wellness, social wellness, and stress. The responses averaged between about the same and somewhat worse (see Table 4). Social wellness (3.67), stress (3.55), and anxiety (3.48) had the highest averages, but general mental well-being (3.35) and physical wellness (3.24) were not far behind. The standard deviations indicate relatively high variations amongst participants.

Negative feelings were associated with a variety of reasons. Many were concerned about loved ones catching the virus (66.2 percent) and/or being separated from them (58.8 percent), and 26.5 percent indicated the loss of a loved one. Many were also concerned about their own health, potentially catching the virus and suffering complications (57.4 percent). Participants were also concerned for patients who were facing potential death without their own loved ones (42.6 percent), co-workers who were involved in direct patient care (35.3 percent), and disgruntled and noncompliant patients (27.9 percent). Furloughs and pay cuts (30.9 percent) also caused negative feelings, as well as fear of insufficient basic supplies at home (29.4 percent). Many were also concerned about misinformation about the virus and CDC recommendations (58.8 percent) and some worried about limited PPE at work (11.8 percent). Other negatives listed by participants included political unrest, an increase in work hours, school closures, and forced masking and lockdowns. (See Table 5.)

Despite the disruption and unease created by the pandemic, participants did denote some positives experienced due to the changes necessitated by COVID-19. Qualitative responses showed that many recognized it as a time to create more balance mentally, physically, and spiritually by taking the opportunity to reprioritize. Many participants mentioned more time with their children and other family members, and some noted more time for home projects, personal hobbies like reading and gardening, and for personal health and fitness. Participants felt that some of this came from the reduced commute time of remote work and reduced work-related travel, which also helped them save money and reduced their carbon footprint. Several participants mentioned that money was also saved by not eating out and reducing shopping. Participants were inspired to reach out to family, friends, and acquaintances that they had not spoken to in a significant amount of time, and were reminded of what to appreciate in life. Some felt recognition for the human ability to adapt, appreciating our strength and resilience. A few participants also mentioned feeling more educated on surface contamination and an appreciation for the heightened cleaning procedures in public spaces.

Discussion

Despite what may have felt as temporary solutions to unprecedented times, many believe the significant changes to the workplace implemented due to the pandemic will continue. According to a survey of industry leaders by Kuofie and Muhammad, the majority definitely or somewhat think that the practices performed during the COVID-19 period will become the new normal, and just over half indicated that the health industry will continue to maintain the same practices beyond the pandemic.²⁷ In addition to hearing from industry leaders, it is important to consider the impact the pandemic has already had on health information management and what these changes mean for the future. The results of this survey provide insight into that impact on a sample of health information professionals in a rural state, demonstrating similar experiences across settings and domains.

The COVID-19 pandemic has emphasized the need for better informatics infrastructure, interoperability, and ethical guidelines.²⁸ AHIMA has highlighted critical areas of focus to improve the readiness of disease surveillance systems and system preparedness for global public health events. These include accurate patient identification, protections for consumer privacy, and comprehensive data collection for public health.²⁹ Without a nationwide patient identification strategy, the data collected and analyzed during public health events such as a pandemic maybe be incomplete or incorrect, which can impact contact tracing and large-scale immunization programs as has been experienced with COVID-19.

As we move forward, we can reflect on the pandemic to learn from the experience and continue to explore ethical, legal, and social issues related to health information technology and disease surveillance.³⁰ Fortunately, as indicated by survey participants, most facilities felt equipped to address privacy and security concerns related to contact tracing and case reporting by increasing oversight and limiting access. Expansion and new forms of communication and technology in healthcare, including consumer-facing applications and products, highlight the importance of established privacy, confidentiality, and ethical principles beyond HIPAA-covered entities.³¹ Consent processes must include protection from potential consequences of technology, and expansion of telehealth services across jurisdictional boundaries requires evaluation of regulations and policies related to areas like licensing, credentialing, and liability. As indicated by the survey, many facilities are expanding these services and relying on HIM professionals to help with training, compliance, and communication. The pandemic may have been the push needed to expand telehealth services permanently, but further consideration of access and quality are needed. Telehealth efforts should include access for all populations, including patients that are cognitively impaired, elderly, disabled, illiterate, or living in areas with little to no internet access.³² Health information professionals will need to continue to be involved in such efforts, including in areas highlighted in the survey such as training, compliance, and regulation. As the industry stabilizes after the height of the pandemic, telehealth best practices should be continuously evaluated while assessing the impact on the patient record and care outcomes. Additional resources may need to be allocated to telehealth efforts to ensure proper documentation, reimbursement, and compliance.

The pandemic has again brought health disparities to the forefront, reinstating the need for standardized data collection of elements related to the social determinants of health (SDOH) to better allocate resources and prevention efforts.³³ Once comprehensive standardized data collection is established, facilities and public health organizations can analyze the data to gain valuable insights into patients and populations.³⁴ As indicated by survey responses, tracing and data collection may continue to be tasks performed by health information professionals in various organizations. Facilities may consider cross-training employees or dedicating an individual position to these tasks, depending on the time commitment. It is also recommended that facilities without eCR functions evaluate this need with their EHR vendor, particularly if the task is burdensome. Health information professionals remain the experts in data governance and are essential to improving the data infrastructure at the national and global levels to be better prepared for the next global incident.

The pandemic created significant strain on the healthcare system, causing many facilities to reduce or eliminate services such as elective and non-urgent surgeries. Fortunately, this is not an impact that is anticipated to be long-term for most facilities, although it may have long-term financial impact on those in rural communities. Managing these reduced services and disaster planning efforts were temporary consequences of the pandemic, but both experiences can help better prepare facilities in the future. It is important that health information professionals remain engaged in these planning efforts and that facilities take note of the practices that instilled confidence in their employees. These include, as indicated by survey participants, a solid communication plan, clear policies and procedures, fiscal responsibility and transparency, and strong employee relations.

As organizations evaluate the continuation or expansion of remote work, it is important to consider best practices. This includes policies and procedures related to expectations and requirements. While the pandemic mandated some employees work remotely, in less restrictive times this should be evaluated on an individual basis since, as indicated by the survey, not everyone feels effective at home. Employees and employers should consider the fit of flexible work arrangements with the organization, position, and person as remote work may not be suited to everyone. Particular challenges potential in remote work identified during the pandemic included procrastination, ineffective communication, disruption of the work-life balance, and social isolation.³⁵ Work and communication expectations should be clarified in policy and monitored regularly. Large virtual meetings or email blasts can be used to share important information to all relevant individuals, ensuring inclusivity in communications. This may include information on new policies or plans, work that has been accomplished, increasing accountability, and/or alignment of priorities. Meeting length should be a consideration, however, as employees may find it challenging to stay engaged in long meetings.³⁶ Remote employees should be encouraged to create a routine within their working hours, designate a space to work, and avoid excessive multitasking.³⁷ Virtual and occasional in-office meetings and social events can provide space for connection between remote employees, strengthening the team environment.

As indicated by the results of the survey, employees are feeling burdens of the pandemic beyond the rapid changes in working conditions. Unfortunately, these may continue for a time after the pandemic ends. Disaster models predict continued stress, exhaustion, and burnout. This can increase the risk of depression, anxiety, sleep disturbances, and even substance abuse, particularly for employees who have poor coping strategies such as self-blame or avoidance.³⁸ As noted in this survey, many HIM employees are already feeling worsened mental well-being, social and physical wellness, anxiety, and stress. This can impact employee work, causing reduced productivity or increased absences.³⁹ While some stressors related to the early days of the pandemic with higher uncertainty and more extreme isolation are becoming less relevant, those related to moral distress, personal safety, economic uncertainty, and a sense of powerlessness still linger.⁴⁰ However, organizations can take action to support employees through training and resources.⁴¹ If feasible, organizations should consider offering access to counseling services and training in effective emotional coping methods. This could include webinars on such topics as resilience, stress management, and the work-life balance.⁴² Facilities can designate further resources to create a wellness response team, resource hub, and dedicated space for employees who need respite.⁴³ Mitigating these external pressures and concerns can help improve employee morale and productivity.

Despite the unprecedented stress, health information professionals can also choose to recognize some positives that have emerged from the pandemic, such as more time with family, reduced commute time, a chance to reprioritize life, and appreciation of the resilience of the human spirit. The actions and consequences of the pandemic can fuel the advocacy for improved infrastructure and the heightened need for interoperability. It has brought data to the forefront, including the need for better documentation of the SDOH and accurate patient identification. Facilities and employees are better prepared for emergencies and disasters, remote work, and telehealth. The importance of employee wellness and support has been highlighted, allocating resources in this area. Health information professionals have more access to virtual continuing education credits and training programs, expanding the opportunity for advancement and improvement of new skills. As these improvements are realized, HIM professionals will be ready to step into new roles in data analytics, research and development, compliance, information governance, project management, and process improvement.⁴⁴

These findings are limited to the respondents of a researcher-created survey in a rural state, primarily targeted at members of HIM professional associations. Further studies should expand the population of interest to other HIM professionals and those in more urban areas. The survey was distributed approximately 16 months into the pandemic and practices continue to change in response to the variants and other factors. The continued uncertainty may have impacted participant responses, heightening the perception of temporary and fluctuating solutions that could feel erratic or unstable. Follow-up studies could further investigate the long-term effects of the pandemic on HIM practice and the health and well-being of healthcare professionals. Post-pandemic, research in this area can focus on the permanent impact and significance on the future of HIM.

Conclusion

The needs and guidelines of the pandemic have impacted many health information professionals, including disruptions in both the workplace and personal lives. This survey provides a snapshot of those impacts on HIM professionals in a rural state where resources and infrastructure can be limited. This included expanding or changing roles in areas such as data collection, case reporting, and most widely, telehealth. HIM managers should consider if and how these demands will continue after the pandemic and how that impacts current job descriptions, workflows, policies and procedures, and needed EHR functions. HIM professionals should continue to be involved in disaster preparedness efforts, reinforcing transparency and inclusion in facility operations, and encouraging frequent communication, early implementation, budgetary responsibility, and employee support. In addition to creating new tasks and priorities, the pandemic clearly impacted ongoing work practices. The long-term impact of the temporary closures and service suspensions on facilities remains to be seen, but health information managers can use the lessons learned during the pandemic to improve transparency and confidence in employees through fair and rational policies and practice. Health information managers can also continue to improve and expand remote work options, a trend that is anticipated to stay at higher levels after the pandemic. The pandemic also pushed many professional associations to expand virtual continuing education opportunities, improving the expansion of this modality in the future. The long-term impact of the pandemic and shutdown on the physical and mental wellness of healthcare professionals and society in general also remains to be seen. As the pandemic transitions to an endemic, hopefully levels of anxiety and stress will reduce to improve overall wellness. HIM professionals should advocate for employee wellness support at facilities, including education and training and other support services. Despite the many disruptions and stressors of the pandemic, experiencing a global life altering event can reignite the passion for our relationships, our profession, and our resilience.

Notes

1. CDC. “COVID-19 Electronic Case Reporting for Healthcare Providers.” U.S. Department of Health & Human Services. (2021): 1.

2. Oetjens, Matthew T., et al. “Electronic Health Record Analysis Identifies Kidney Disease as the Leading Risk Factor for Hospitalization in Confirmed COVID-19 Patients.” PloS one 15, no. 11 (2020): 2.

3. Latifi, Rifat, and Charles R. Doarn. “Perspective on COVID-19: Finally, Telemedicine at Center Stage.” Telemedicine and e-Health 26, no. 9 (2020): 1107.

4. Osborne, Thomas F., et al. “Automated EHR Score to Predict COVID-19 Outcomes at US Department of Veterans Affairs.” PLoS One 15, no. 7 (2020): 1.

5. Tsui, Eva L. H., et al. “Development of a Data-driven COVID-19 Prognostication Tool to Inform Triage and Step-down Care for Hospitalised Patients in Hong Kong: A Population-based Cohort Study.” BMC Medical Informatics and Decision Making 20, no. 1 (2020): 1.

6. Bassett, Ingrid V., et al. “Massachusetts General Hospital COVID-19 Registry Reveals Two Distinct Populations of Hospitalized Patients by Race and Ethnicity.” PloS one 15, no. 12 (2020): 2.

7. Oetjens et al., 7.

8. Blow, Matthew, et al. “The Public and Pandemics”. Journal of AHIMA, (2021): 4.

9. Alvin, Matthew D., et al. “The Impact of COVID-19 on Radiology Trainees.” Radiology 296, no. 2 (2020): 246.

10. CDC. “Comprehensive Hospital Preparedness Checklist for Coronavirus Disease 2019 (COVID-19).” U.S. Department of Health & Human Services. (2020): 2-11.

11. DeFilippis, Evan, et al. Collaborating During Coronavirus: The Impact of COVID-19 on the Nature of Work. No. w27612. National Bureau of Economic Research, 2020: 1.

12. Latifi and Doarn, 1108.

13. Kaplan, Bonnie. “Revisiting Health Information Technology Ethical, Legal, and Social Issues and Evaluation: Telehealth/telemedicine and COVID-19.” International Journal of Medical Informatics, (2020): 2.

14. Latifi and Doarn, 1107.

15. CDC. “Using Telehealth to Expand Access to Essential Health Services During the COVID-19 Pandemic.” U.S. Department of Health & Human Services. (2020): 2.

16. Ibid.

17. Ibid.

18. Kaplan, 13.

19. Lakhani, Hari Vishal, et al. “Systematic Review of Clinical Insights into Novel Coronavirus (CoVID-19) Pandemic: Persisting Challenges in US Rural Population.” International Journal of Environmental Research and Public Health 17, no. 12 (2020): 4279.

20. Segel, Joel E., et al. “The Unique Challenges Facing Rural Providers in the COVID-19 Pandemic.” Population Health Management 24, no. 3 (2021): 304-306.

21. Sethi, Bilal Ahmed, et al. “Impact of Coronavirus Disease (COVID-19) Pandemic on Health Professionals.” Pakistan Journal of Medical Sciences 36, no. COVID19-S4 (2020): S7.

22. Dubey, Souvik, et al. “Psychosocial Impact of COVID-19.” Diabetes & Metabolic Syndrome: Clinical Research & Reviews 14, no. 5 (2020): 779.

23. Sethi et al., S10.

24. Dubey et al., 782.

25. Sethi et al., S9

26. “Idaho State Guide.” Rural Health Information Hub (RHIhub), 2021.

27. Kuofie, Matthew, and Nik Maheran Nik Muhammad. “Leaders Perspective on Post COVID-19 Pandemic Period: Global Business Focus.” International Journal of Health and Economic Development 7, no. 1 (2021): 24-26.

28. Kaplan, 13.

29. Wiggs Harris, Wylecia. “Preparing for the Next Pandemic,” letter to Senator Lamar Alexander. (2020): 1.

30. Kaplan, 11.

31. Wiggs Harris, 1.

32. Kaplan, 11.

33. Wiggs Harris, 4.

34. Blow et al., 5.

35.  Wang, Bin, et al. “Achieving Effective Remote Working During the COVID-19 Pandemic: A Work Design Perspective.” Applied Psychology: An International Review 0, no. 0 (2020): 13.

36. DeFilippis et al., 7.

37. Sethi et al., S10.

38. Adibe, Bryant, et al. “Creating Wellness in a Pandemic: A Practical Framework for Health Systems Responding to COVID-19.” NEJM Catalyst Innovations in Care Delivery 2, no. 2 (2021): 2.

39. Gavin, B., et al. “Caring for the Psychological Well-being of Healthcare Professionals in the COVID-19 Pandemic Crisis.” Irish Medical Journal 113, no. 4 (2020): 51.

40. Adibe et al., 10.

41. Gavin et al., 51.

42. Trougakos, John P., et al. “Working in a Pandemic: Exploring the Impact of COVID-19 Health Anxiety on Work, Family, and Health Outcomes.” Journal of Applied Psychology, (2020): 1241.

43. Adibe et al., 2-6.

44. Eramo, Lisa A. “Leading HIM Reimagined by Example.” AHIMA HIM Body of Knowledge. (2018): 2.

References

• Adibe, Bryant, Charles Hebert, Kathryn Perticone, and Sheila M. Dowd. "Creating Wellness in a Pandemic: A Practical Framework for Health Systems Responding to COVID-19." NEJM Catalyst Innovations in Care Delivery 2, no. 2 (2021).
• Alvin, Matthew D., Elizabeth George, Francis Deng, Shantanu Warhadpande, and Susanna I. Lee. "The Impact of COVID-19 on Radiology Trainees." Radiology 296, no. 2 (2020): 246-248.
• Bassett, Ingrid V., Virginia A. Triant, Bridget A. Bunda, Caitlin A. Selvaggi, Daniel J. Shinnick, Wei He, Frances Lu et al. "Massachusetts General Hospital COVID-19 Registry Reveals Two Distinct Populations of Hospitalized Patients by Race and Ethnicity." PloS one 15, no. 12 (2020): e0244270.
• Blow, Matthew, David T. Marc, and Shauna Overgaard. “The Public and Pandemics”. Journal of AHIMA, (2021).
• Centers for Disease Control and Prevention (CDC). “Comprehensive Hospital Preparedness Checklist for Coronavirus Disease 2019 (COVID-19).” U.S. Department of Health & Human Services. Last modified March 25, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/hcp-hospital-checklist.html
• CDC. “COVID-19 Electronic Case Reporting for Healthcare Providers.” U.S. Department of Health & Human Services. Last modified November 19, 2021. https://www.cdc.gov/coronavirus/2019-ncov/hcp/electronic-case-reporting.html
• CDC. “Using Telehealth to Expand Access to Essential Health Services During the COVID-19 Pandemic.” U.S. Department of Health & Human Services. Last modified June 10, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html
• DeFilippis, Evan, Stephen Michael Impink, Madison Singell, Jeffrey T. Polzer, and Raffaella Sadun. Collaborating During Coronavirus: The Impact of COVID-19 on the Nature of Work. No. w27612. National Bureau of Economic Research, 2020.
• Dubey, Souvik, Payel Biswas, Ritwik Ghosh, Subhankar Chatterjee, Mahua Jana Dubey, Subham Chatterjee, Durjoy Lahiri, and Carl J. Lavie. "Psychosocial Impact of COVID-19." Diabetes & Metabolic Syndrome: Clinical Research & Reviews 14, no. 5 (2020): 779-788.
• Eramo, Lisa A. “Leading HIM Reimagined by Example.” AHIMA HIM Body of Knowledge. (2018).
• Gavin, B., J. Hayden, D. Adamis, and Fiona McNicholas. "Caring for the Psychological Well-being of Healthcare Professionals in the COVID-19 Pandemic Crisis." Irish Medical Journal 113, no. 4 (2020): 51.
• Kaplan, Bonnie. "Revisiting Health Information Technology Ethical, Legal, and Social Issues and Evaluation: Telehealth/telemedicine and COVID-19." International Journal of Medical Informatics, (2020): 104239.
• Kuofie, Matthew, and Nik Maheran Nik Muhammad. "Leaders Perspective on Post COVID-19 Pandemic Period: Global Business Focus." International Journal of Health and Economic Development 7, no. 1 (2021): 13-36.
• Lakhani, Hari Vishal, Sneha S. Pillai, Mishghan Zehra, Ishita Sharma, and Komal Sodhi. "Systematic Review of Clinical Insights into Novel Coronavirus (CoVID-19) Pandemic: Persisting Challenges in US Rural Population." International Journal of Environmental Research and Public Health 17, no. 12 (2020): 4279.
• Latifi, Rifat, and Charles R. Doarn. "Perspective on COVID-19: Finally, Telemedicine at Center Stage." Telemedicine and e-Health 26, no. 9 (2020): 1106-1109.
• Oetjens, Matthew T., Jonathan Z. Luo, Alexander Chang, Joseph B. Leader, Dustin N. Hartzel, Bryn S. Moore, Natasha T. Strande et al. "Electronic Health Record Analysis Identifies Kidney Disease as the Leading Risk Factor for Hospitalization in Confirmed COVID-19 Patients." PloS one 15, no. 11 (2020): e0242182.
• Osborne, Thomas F., Zachary P. Veigulis, David M. Arreola, Eliane Röösli, and Catherine M. Curtin. "Automated EHR Score to Predict COVID-19 Outcomes at US Department of Veterans Affairs." PLoS One 15, no. 7 (2020): e0236554.
• “Idaho State Guide.” Rural Health Information Hub (RHIhub), 2021. https://www.ruralhealthinfo.org/states/idaho
• Segel, Joel E., Hannah I. Ross, Jennifer L. Edwards, Kelly A. Braun, and Lisa A. Davis. "The Unique Challenges Facing Rural Providers in the COVID-19 Pandemic." Population Health Management 24, no. 3 (2021): 304-306.
• Sethi, Bilal Ahmed, Ahsan Sethi, Sadaf Ali, and Hira Shireen Aamir. "Impact of Coronavirus Disease (COVID-19) Pandemic on Health Professionals." Pakistan Journal of Medical Sciences 36, no. COVID19-S4 (2020): S6.
• Trougakos, John P., Nitya Chawla, and Julie M. McCarthy. "Working in a Pandemic: Exploring the Impact of COVID-19 Health Anxiety on Work, Family, and Health Outcomes." Journal of Applied Psychology, (2020): 1234-1245.
• Tsui, Eva L. H., Carrie S. M. Lui, Pauline P. S. Woo, Alan T. L. Cheung, Peggo K. W. Lam, Van T. W. Tang, C. F. Yiu, C. H. Wan, and Libby H. Y. Lee. "Development of a Data-driven COVID-19 Prognostication Tool to Inform Triage and Step-down Care for Hospitalised Patients in Hong Kong: A Population-based Cohort Study." BMC Medical Informatics and Decision Making 20, no. 1 (2020): 1-19.
• Wang, Bin, Yukun Liu, Jing Qian, and Sharon K. Parker. “Achieving Effective Remote Working During the COVID-19 Pandemic: A Work Design Perspective.” Applied Psychology: An International Review 0, no. 0 (2020): 1-44.
• Wiggs Harris, Wylecia. “Preparing for the Next Pandemic,” letter to Senator Lamar Alexander, June 25, 2020.

Author Biographies

Jaime Sand (jaimesand@boisestate.edu) is an associate professor at Boise State University in the Department of Public Health and Population Science.