Thinking Outside the Box with a Health Information Management Background
by Jana Olivas, RHIA

How do you know what you want to do for the rest of your life? When I graduated from The University of Texas Medical Branch (UTMB) in 1996 I remember wondering if I had chosen the right profession. I wondered if I limited myself in terms of mobility, if HIM was too specific of a degree and whether or not I would get bored. Although I did have these thoughts, I never imagined I would make a change in career four short years after obtaining my RHIA certification, but I did and this is how.

It all started three years ago when I decided to start a family. At the time, I was a Director of Health Information Management for a 235 bed facility in Houston, Texas. The department was fully staffed with a dedicated and hard working team; we were prepared for JCAHO (Joint Commission on Accreditation of Healthcare Organizations); and our medical staff had finally come around to our way of thinking to help us achieve an acceptable chart delinquency rate; then the healthcare company chose to close the facility. I had a sweet baby girl (Claire) just three weeks before the files were boxed up, and the doors of the department were closed forever. I drove by the facility the other day, and it no longer exists. Instead, a Walgreens marks the spot.

So what was I to do? I was a new mother with a new baby and no job. I had interviewed for a couple of promising Health Information Management jobs, but the hours it would take to solve problems and create a smooth running department didn't seem appealing to me with my new challenge – Claire. My husband was trying to be helpful by searching "Houstonchronicle.com" when one day he came across an advertisement for a Legal Records Manager position for a well respected law firm in town. He printed it and encouraged me to apply. I applied, and they quickly called me to set up an interview. During my interview, I was given a tour of the firm and the records centers (all 10 of them). I was amazed and astounded at the volume of material that could belong to one client. It was certainly unlike anything that I had seen in Health Information Management, even for those patients who were in the Intensive Care Unit for three months.

Although I liked the people who interviewed me, I was intimidated by the volume of the Records Department and the manual processes necessary to find material. A week later, they offered me the job claiming they wanted someone with strong records management skills who could think outside the box. They found it advantageous that I didn't have legal experience. I wasn't sure what to do, but considering that my husband worked three blocks away from the firm and the daycare where I had already planned to send Claire was only four blocks away, I accepted. We would all commute together, and I could walk over at lunch to see Claire.

While I was acclimating myself to the legal environment, it became very clear to me early on that records management is records management, and the Bachelors of Science in Health Information Management I received from the University of Texas Medical Branch certainly prepared me with a strong understanding of records management. All of the core records principles applied. I was months into my new career before I stopped thinking of a situation first in the medical world and then relating it to the legal world. Nothing got lost in the translation; however, applying my skills took longer initially.

The only qualification required for the position was a bachelor's degree with some records management experience. One of my first tasks as a Legal Records Manager was to evaluate several software packages to assist us in our quest to implement a records software system that would enable us to move towards an electronic file. I quickly brushed the dust off of the system implementation book from HIM school where we learned to write requests for proposals and the steps to implementing systems. As I was evaluating the systems, I again drew upon my knowledge of the Meditech system that I formerly used in Health Information Management. That knowledge gave me a foundation on which to build what we were looking for. Although there was a lot I didn't know, I was able to bring myself up to speed quickly.

If there were any drawbacks to not having a background in Legal Records management, it was that I didn't have a good understanding of the legal system or legal terminology. Additionally, there are no cookie cutter standards like CMS (Center for Medicare and Medicaid Services) or JCAHO that provide guidelines for what should be maintained in a legal file. This being said, we can't analyze the file components to tell when something is missing. You can imagine how hard it is when someone claims something was sent to the file, and it wasn't. We can't lock the department when we go home and allow limited access to someone like the nursing supervisor, because we have 10 file rooms with hundreds of attorneys who work all hours and need access to the files.

There are some positives to the job compared to traditional hospital HIM positions. In three years, I have never been called in the middle of the night to help an attorney find a file for a patient in the ER. The content of legal records is not life or death, although sometimes attorneys can make it seem that way. People have worked for the firm for many years. There are seven people in the records department who have been here longer than 20 years. The firm treats all of its employees very well, and attorneys don't have an "us versus them" mentality as I often found in health information management. The attorneys consider records management a vital part of the team.

Although pre-graduation jitters made me question whether or not I made the right choice in selecting Health Information Management as the proper education and career choice, that was the only time I have doubted my selection. I will always be thankful for my education and may one day return to health information management where I was formally trained and christened in records management. HIM professionals should know that there is an amazing world of non-health records management opportunities available. Companies you would never imagine have records management departments and we have a "leg up" on a great deal of competition, because we have bachelor or associate degrees in a records discipline. There isn't a specific legal records manager certification, but there is a certified records manager certification (CRM) that records professionals outside of HIM aspire to acquire. Although I haven't sat for the CRM examination, I plan to do so to continue my non-health records education. Of course in addition to this, I will make retaining my RHIA credentials a priority.

The legal records manager community is a close knit group who work together, networking and sharing information. Many of them belong to an organization called ARMA (American Records Management Association), where they learn and acknowledge just how vast the possibilities are for records managers of all organizations - not legal specific. I encourage each of you to check out the ARMA website, www.arma.org, if you're interested in exploring new opportunities. Many best wishes to each of you, and think outside the box!

Jana Olivas, RHIA is presently the Records Manager for Baker Botts LLP in Houston, Texas where she has worked since June 2000. She has a bachelor's degree in Health Information Management from the University of Texas Medical Branch and received her RHIA certification in 1996. She has 8 years experience in the medical industry having held various positions in health information management, quality improvement and risk management. She is a past president for the Houston Area Health Information Management Association and has spoken to various groups on subjects such as the implementation of electronic signature, maintaining a clean master patient index, reducing your delinquent chart count and managing more with less.