25 Emerging Trends in Health Information Management: Insights from the 2015 HIM Benchmark Report

As the healthcare industry enters the “post-International Classification of Diseases (ICD)-10” era, the landscape of Health Information Management (HIM) is evolving. In this context, how should HIM professionals address current challenges such as ICD-10 implementation, coding efficiency, Clinical Documentation Improvement (CDI), Computer-Assisted Coding (CAC), and service outsourcing? Recently, ADVANCE for Health Information Professionals and himagine solutions, Inc. released their “2015 Health Information Management Frontier Benchmark Report.” This report surveyed over 140 HIM professionals within a 30-day period, gathering their insights on HIM departments, ICD-10, outsourcing, and related topics, with the aim of providing a comprehensive perspective for more HIM professionals across China. VCBeat has compiled a summary of the report’s findings to offer a forward-looking view of 25 trends in HIM.

Key trends in the report include:

• HIM Department

1. HIM professionals identified managing DNFB or other financial metrics (26%), productivity (25%), and quality monitoring (23%) as the greatest challenges in overseeing HIM departments. These were followed by personnel management and turnover (15%) and managing external vendors (9%). Note: DNFB stands for “Discharged Not Final Billed,” referring to the period between patient discharge and the finalization of billing.

2. 65% of surveyed medical device companies employ 10 coders, while fewer than 22% employ 11–20 coders.

3. Key performance indicators used by the HIM department include: coding accuracy (32%), production efficiency (24%), and various financial metrics, such as impact on DNFB (19%), impact on days in accounts receivable (15%), and third-party audit results (8%).

4. Different HIM departments rarely reach a consensus on the frequency of auditing their internal coders.

• - Quarterly (34%)




• - Monthly (28%)




• - Annually (26%)




• - Weekly (12%)

• ICD-10 Ready

5. Respondents were generally optimistic, with over 63% stating that they expected to be fully prepared for the transition from ICD-9 to ICD-10 coding by the October 1 deadline. Another 29% reported being slightly behind schedule, while 7% indicated that they were significantly behind their planned timeline.

6. HIM professionals are concerned about the impact of ICD-10 on coders. Forty percent of respondents believe that productivity will decrease by at least 40%, while 25% indicate that the reduction in coder productivity will be 25% or less. Another 35% of respondents expect a 30% decline in productivity, 14% anticipate a 50% drop, and 8% believe the decrease will exceed 50%.

7. 75% of respondents believe that ICD-10 will impact coder productivity by at least 30%; however, more than one-third of respondents do not plan to increase coding resources to address this issue.

8. One-fifth of respondents did not implement dual coding before the system’s official launch. Among the 80% of respondents who adopted dual coding, 28% reported an adoption rate of 11–30% or lower, 20% reported an adoption rate of 10%, 18% reported an adoption rate exceeding 50%, and 14% reported an adoption rate of 31–50% or lower. The significant variation in adoption rates indicates that best practices in this area have yet to be established.

9. Among healthcare facilities that have already implemented dual coding, 80% of respondents reported that they are auditing their results.

10. More notably, 83% of respondents reported that they had implemented educational follow-up and feedback after the completion of the dual-coding review process.

11. 93% of respondents stated that they were either prepared for ICD-10 or only slightly behind the ICD-10 implementation schedule; however, among the 80% of respondents who implemented dual coding, there was no consensus on whether to adopt dual coding prior to the official system go-live, as shown in the figure above.

• Computer-Assisted Coding (CAC)

12. 56% of respondents are not currently using CAC technology; however, 75% of these individuals indicate that they expect to purchase this technology within the next 12 months. Will CAC prove to be a panacea for enhancing production efficiency? Only time will tell.

• Clinical Documentation Improvement (CDI)

13. 70% of respondents have established formal CDI programs within their healthcare facilities, yet nearly two-thirds of these facilities have not implemented technological solutions for CDI.
14. Approximately 60% of HIM professionals outsource a portion of their coding tasks. Nearly 50% collaborate with one or two outsourcing vendors; however, shockingly, 45% of respondents work with seven or more outsourcing providers. This not only reflects the fragmented nature of the industry but also makes it difficult for outsourcing vendors to meet the needs of healthcare providers.

15. HIM professionals reported that 52% of their CDI specialists are registered nurses, while 22% are coders. However, more than one-quarter of respondents indicated that their CDI specialists hold dual qualifications as both nurses and coders.

16. Similar to the varying numbers of coders in healthcare facilities, there is a wide disparity in the number of CDI specialists among the respondents’ facilities, as detailed below.

• – 1-2 individuals (47%)




• – 3-4 (26%)




• – 8 or more (5%)




• – 5-7 people (12%)

17. 56% of CDI professionals report to the HIM department, 35% report to nursing management, and only 9% report to the Chief Marketing Officer or Chief Information Officer.
18. The ubiquity of CDI is undeniable, yet 63% of respondents indicated that they do not incorporate IT solutions (such as natural language processing tools) into their CDI workflows. Does this present a significant opportunity for CDI technologies, or does it underscore the relative value of existing solutions?

19. 64% of HIM professionals reported that they have engaged an active physician advisor to provide guidance for their CDI programs.

• Outsourcing

20. The biggest problem service providers face with outsourcing vendors is coder quality (34%), while issues such as excessive loading times (20%), low audit efficiency (19%), and poor coder availability (17%) are also prevalent. Interestingly, respondents were relatively lenient regarding their outsourcing vendors’ readiness for ICD-10, with only 10% expressing concern.

21. Nearly 60% of respondents outsource a portion of their coding resources; however, among those who collaborate with outsourcing vendors, the majority outsource 30% or less of their coding needs.

22. The number of outsourced vendors collaborating with respondents varies significantly; the specific proportions are shown below.

• - 1–2 manufacturers (47%)




• - More than 7 manufacturers (45%)




• - 3 to 7 manufacturers (8%)

23. The quality of coders is the biggest issue faced by service providers when collaborating with outsourcing vendors.

24. Respondents indicated that accuracy and productivity are the primary metrics they use to evaluate the performance of outsourced coders. Beyond a certain baseline, service providers place greater emphasis on the accuracy and productivity of outsourced coders compared with the metrics used for in-house coders, while paying relatively less attention to financial indicators. This may present a strategic opportunity for outsourcing vendors to differentiate themselves from competitors by quantifying their impact on financial metrics.

• - Accuracy (38%)




• - Production Efficiency (34%)




• - Impact on DNFB (14%)




• - Impact on Days Sales Outstanding (DSO) (8%)




• - Third-party audit results (6%)

25. In outsourced medical facilities, 83% of respondents reported that it takes outsourcing vendors an average of less than four weeks to train a new coder for onboarding; the specific breakdown is shown below.

• - 2 weeks or less (58%)




• - 4 weeks (25%)




• - 4–6 weeks (10%)




• - 6–8 weeks (6%)

Compiled by Chen Xin
Editor | Mo Renying