Received: 4 December 2020

| Revised: 15 April 2021

| Accepted: 3 August 2021

DOI: 10.1111/hir.12400

REVIEW ARTICLE

The impact of health information management

professionals on patient safety: A systematic review

Trixie Kemp MHIM1 | Kerryn Butler-­Henderson PhD FAIDH FHIMAA CHIA1 |

Penny Allen PhD2 | Jennifer Ayton PhD3

1
College of STEM, School of Health and
Biomedical Sciences, RMIT University, Abstract
Bundoora, VIC, Australia Background: The importance of high-­quality health information for patient
2
College of Health and Medicine, safety has been established in the literature, yet the impact of the professionals
University of Tasmania, Hobart, TAS,
Australia
who are the custodians of health information is absent.
3
Tasmanian School of Medicine, Objectives: This article presents the results of a systematic literature review ex-
College of Health and Medicine, amining the impact of the Health Information Management (HIM) profession on
University of Tasmania, Hobart, TAS,
patient safety.
Australia
Methods: A PRISMA approach was adopted for the review of selected databases
Correspondence and specific journals. Titles identified as relating to HIM and patient quality were
Trixie Kemp, School of Health and
screened using Covidence ® by title and abstract, followed by full text. The quality
Biomedical Sciences, RMIT University,
Plenty Road, Bundoora, Vic. 3083, of selected articles was assessed and thematically analysed.
Australia. Results: Analysis of the 8 included articles found that the key themes from the
Emails: [email protected]
or [email protected]
non-­empirical research were data quality, information governance, corporate
governance, skills and knowledge required for HIM professionals.
Discussion: Most publications focussed on HIM professional involvement in
maintaining standards for data quality and health records, but not the profes-
sional qualifications themselves.
Conclusions: There are links between patient safety and health records, and
between health records and HIM professional work. More empirical research
is needed to demonstrate how qualified HIM professionals contribute to patient
safety.

KEYWORDS
governance; health records; information management; information skills; patient information;
review, systematic

I N T RO DU CT ION professionals are trained in the management of informa-

tion, data and systems required for the medical, legal,
For almost 100 years, Health Information Management ethical and administrative requirements of health de-
(HIM) professionals have been ensuring health records livery (Abdelhak & Hanken, 2016). Their skills allow
are available, accurate and complete with high-­quality them to work directly in health care environments and
information that is used to support patient care, and related fields of epidemiology, population health, health
secondary purposes such as health service manage- policy, health funds, pharmaceuticals, health informa-
ment and population health (Kemp et al., 2021). HIM tion technology, as well as research and academia. HIM

248 | © 2021 Health Libraries Group wileyonlinelibrary.com/journal/hir Health Info Libr J. 2021;38:248–258.
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HIM AND PATIENT SAFETY: SYSTEMATIC REVIEW    249

professionals work in various occupations including

Health Information Manager, Clinical Coder, Clinical Key messages
Documentation Improvement Specialist, Data Analyst,
• HIM professionals could further support patient
Data Quality Officer, Privacy Officer, eHealth Specialist,
safety activities if health leaders recognised and
Clinical Informatics Coordinator, Research Assistant and
utilised their specialised skillset in information
more (AHIMA, 2020a). HIM professionals ensure valid
governance, corporate governance and data.
and dependable data, from paper and electronics sources,
• Health records are the intersection between the
are available for conversion into meaningful informa-
HIM profession and patient safety. The impor-
tion needed for the safe delivery of health care (HIMAA,
tance of this relationship needs acknowledge-
2020a; Hjort, 2011).
ment in policy and patient safety standards.
The World Health Organization (WHO) states that
• Research is required to examine how the HIM
good record keeping practices are a requirement of pa-
profession itself impacts patient safety.
tient safety (World Health Organization, 2015). Quality
data are needed to monitor the burden of harm across the
globe and to support initiatives to address patient safety
with health records identified as a significant informer health information and HIM professionals, we do not
(Flott et al., 2019). The value of data and information on know the contribution they make to patient safety activ-
patient safety was highlighted in To Err is Human (Kohn ities. To the best of our knowledge, there are no existing
et al., 2000), reporting health records and systems are literature reviews discussing the critical importance of
important information sources for documenting adverse health information management to patient safety. The ob-
events, such as accidental patient harm, suffering, injury jective of the study was to explore the impact of the HIM
and death within the health system. In Australia, quality profession on patient safety. A systematic review was used
record keeping practices and the availability of informa- to examine how the literature unpacks both the ‘impact’
tion is regulated by the Australian Commission on Safety and ‘patient safety’ in relation to HIM.
and Quality in Health Care (2017) and assessed as part
of hospital accreditation processes. Similarly, the WHO
Patient Safety Assessment Manual recommends interview- METHOD
ing Medical Records Officers (a HIM occupation). This pa-
tient safety standard includes review on how data are used Search strategy
to improve safety programmes and reviewing the health
record systems in place (Regional Office for the Eastern A systematic review using the Preferred Reporting Items
Mediterranean World Health Organization, 2016). These for Systematic Reviews and Meta-­Analyses (PRISMA)
publications establish health records as a critical informa- (Moher et al., 2009) approach for article selection was
tion assessment for patient safety. undertaken to address the study objective. As the eligibil-
Since the late 1990s, health has been increasingly utilis- ity criteria were articles that discussed the impact of the
ing data and technology to support patient care (Rowlands, HIM profession or functions of the HIM role on patient
2019). It has been stated that health information technol- safety, the following keyword search string was used:
ogy (IT), such as electronic health records (EHRs), has re- [“health information management” OR “health informa-
duced patient safety events, such as medication errors and tion manager”] AND [“safety” OR “quality”]. The fol-
adverse drug reactions (Alotaibi & Federico, 2017), and lowing databases and hosts were queried: EBSCO host,
improve timely access to information (Kaelber & Bates, Informit Online, Ovid, ProQuest Central, Science Direct,
2007). Conversely, EHRs can introduce new elements of Scopus and Web of Science Core Collection. There were
patient harm (Middleton et al., 2013). Middleton et al. no limitations or selection of specific databases or re-
(2013) made several recommendations for best practice sources within the hosts systems of EBSCO, Ovid and
implementation and management of electronic health re- ProQuest. In addition to the databases, a manual search
cords (EHRs), so they can be a useful clinical tool, and for was undertaken on electronic sources of industry spe-
monitoring safety events related to the use of EHRs. As cific discipline journals: Health Information and Libraries
the record custodian, HIM professionals are educated in Journal, Health Informatics Journal, Australian Health
records management, confidentiality, security and health Information Management Journal (HIM-­J), Australian
IT (Hjort, 2011). They are recognised as drivers for EHRs Health Information Management Interchange (HIM-­
(Lawrance, 2017) and manage the quality of the contents I), Journal of AHIMA (American Health Information
(Martin, 2016). However, while we can draw a link be- Management Association) and Perspectives in Health
tween patient safety and health information and between Information Management. Contact was made with the
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250    HIM AND PATIENT SAFETY: SYSTEMATIC REVIEW

author if the full text of a manuscript could not be found, criteria. Articles were excluded if they did not discuss
and the title was excluded if no response was received. the HIM profession and patient safety or quality of care.
The search was completed on 4 July 2020. Titles were Articles selected through the full-­text process were ac-
not limited by publication date, article type or language. cepted for review.
Scholarly articles, systematic reviews, commentaries
and opinion articles were included. Non-­English articles
were interpreted using Google Translate. As each search Quality assessment
occurred, the results were uploaded into EndNote® and
duplicates removed by the first author. After the search, The Quality Assessment Tool for Theory and Literature
all records were extracted and imported into the web-­ (QATTL) (Crawford et al., 2020) was used to assess the
based software Covidence®. A duplicate process within quality of each article by the first two authors. Each arti-
Covidence® removed further articles. The search process cle was assessed against 15 criteria, with scores averaged
is detailed in Figure 1. to provide an overall score. This average score was then
classified as either ‘HIGH’ (≥66%), ‘MEDIUM’ (≥33% and
<66%) or ‘LOW’ (<33%).
Selection procedure

Using the established eligibility criteria, the first author Data extraction and synthesis
used Covidence® to apply the PRISMA process (Figure 1).
Following the screening using titles and abstracts, the full Two researchers undertook data extraction and analysis.
text of each selected article was reviewed independently Each article was reviewed, and data were extracted for
by the first two authors. Conflicts for inclusion or exclu- title, authors, published year, published month, journal,
sion in the review were resolved through a discussion of volume, issue, pages and country. The Braun et al. (2019)
article alignment to the research objective and eligibility method for thematic analysis was used to synthesise the

Records identified through Additional records identified

Identification

database searching through other sources

(n = 966) (n =196)

Records after duplicates removed

(n = 1047)
Screening

Records screened Records excluded

(n = 1047) (n = 1027)

Full-text articles assessed Full-text articles excluded,

Eligibility

for eligibility with reasons

(n = 20) (n = 12)

• 1 no full-text available
• 11 did not meet criteria
Studies included in quality
Included

assessment and
qualitative synthesis
(n = 8)

FIGURE 1 PRISMA flow diagram [Colour figure can be viewed at wileyonlinelibrary.com]

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HIM AND PATIENT SAFETY: SYSTEMATIC REVIEW    251

selected articles and identify themes. Thematic analysis

Assessment Score*
was the most suitable method to extract common themes

Average Quality
for the types of articles. Familiarisation with the pieces
commenced with abstract screening and continued with

Medium
Medium

Medium
Medium
the full-­text review. Initial coding involved reviewing the

High
text, via multiple readings, for references to the HIM pro-

Low
Low

Low
fessions functions or patient safety. Once initial coding
had been completed, the codes were reviewed to identify
sub-­themes and high-­level themes. Each author reviewed
the draft list of themes to decide on the key titles for analy-

Australia
Country
sis. The articles were reviewed a final time to confirm the

USA
USA
USA

USA
USA
USA
USA
high-­level themes and to verify no new themes emerged.

RES ULT S

Published
The search found a total of 1047 articles for screening.
Screening removed 1027 articles with 20 remaining for

Year
2013
2013
2020
2017
2011
2016
2015
2012
full-­text review. Of these, only eight articles were selected
for inclusion in this analysis, as shown in Figure 1. All
papers were non-­empirical pieces; therefore, the majority
only score low to medium quality. Five were commen-

For the Record (Great Valley Publishing

tary or opinion articles published in professional practice
journals. The remaining three comprised of a media re-
lease by the American Health Information Management
Association (AHIMA), an AHIMA newsletter and an
Manufacturing Close –­ Up
article in an online magazine. Seven articles originated
from the United States of America (USA) and one from
Publication Source

AHIMA Advantage

Company, Inc.)
Journal of AHIMA

Journal of AHIMA
Journal of AHIMA
Journal of AHIMA
Australia. All the literature identified has been published
in the last eight years, indicating the HIM profession's in- HIM-­Interchange
tersection with patient safety as a recent research area, as
apparent from Table 1.

Thematic analysis

Analysis of these articles identified four key themes: data

Professional practice article
Professional practice article
Professional practice article
Professional practice article
Professional practice article
Professional practice article

quality, information governance, corporate governance

and HIM skillset. These key themes are an indicator of
what the authors see as valuable for the HIM profession
Media Release

and that the tasks performed is where the impact on pa-

Article Type
Newsletter

tient safety is rather than the profession itself. Each theme

Characteristics of articles

is discussed to reveal the sub-­themes (Table 2, Figure 2)

that emerged and how they connect to patient safety.

Data quality
*Determined using QATTL.
Munn et al., 2015

The theme ‘data quality’ relates to the correctness of data

AHIMA, 2013b
AHIMA, 2013a

Downie, 2017

Martin, 2016

and characteristics of accessibility, accuracy, comprehen-

Butler, 2020

Hjort, 2011

Roop, 2012
TABLE 1

Citation

siveness, consistency, currency, definition, granularity,

precision, relevancy and timeliness (Abdelhak & Hanken,
2016). Five articles explored the sub-­theme of accuracy
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252    HIM AND PATIENT SAFETY: SYSTEMATIC REVIEW

TABLE 2 Article themes

Citation Themes Sub-­Themes

AHIMA, 2013a Information governance Standards
Corporate governance Records management
Knowledge of health systems
AHIMA, 2013b Data quality Accuracy and integrity of information
Information governance Patient identification and matching
Knowledge of data quality management
Privacy and security of information
Butler, 2020 Data quality Accuracy and integrity of information
Information governance Patient identification and matching
Corporate governance Privacy and security of information Knowledge of health systems
Reporting and funding
Downie, 2017 Data quality Accuracy and integrity of information
Information governance Knowledge of data quality management
Corporate governance Standards
HIM skillset Privacy and security of information Knowledge of health systems
Reporting and funding
HIM skillset
Hjort, 2011 Data quality Accuracy and integrity of information
Information governance Patient identification and matching
Corporate governance Knowledge of data quality management
HIMS skillset Educating others on information accuracy
Standards
Privacy and security of information Knowledge of health systems
Reporting and funding
HIM skillset
Martin, 2016 Data quality Accuracy and integrity of information
Corporate governance Patient identification and matching
HIM skillset Knowledge of health systems
HIM skillset
Munn et al., 2015 Corporate governance Patient identification and matching
Data quality Accuracy and integrity of information
Information governance Educating others on information accuracy
HIM skillset Reporting and funding
HIM skillset
Roop, 2012 Data quality Accuracy and integrity of information
Information governance Patient identification and matching
Corporate governance Knowledge of data quality management
HIM skillset Standards
Records management
Knowledge of health systems
HIM skillset

and integrity of information. Hjort (2011) states that pre- Patient identification and matching sub-­theme (n=4,
cise capture of data is essential for reliable, trustworthy 50%) highlighted the patient safety implications of dupli-
and meaningful information. Roop (2012) expanded on cate records, where the same patient has multiple health
this to reflect that this accuracy within the health record records in the same organisation. Duplicate records
is needed to tell the story of the patient's journey through are harmful to patients as they fragment information
the episode of care. The literature examined how the HIM and create incomplete or inaccurate records (AHIMA,
professional is required to undertake maintenance ac- 2013a; Butler, 2020; Hjort, 2011; Martin, 2016). Patient
tivities such as error identification and correction (Hjort, identification and matching are ongoing activities for
2011); data validations, auditing and education (Roop, HIM professionals as the patient master index is contin-
2012); and management of the patient master index ually updated (Butler, 2020; Roop, 2012). The American
(Butler, 2020). Health Information Management Association (AHIMA)
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HIM AND PATIENT SAFETY: SYSTEMATIC REVIEW    253

governance across three sub-­themes—­standards, main-

taining privacy and security, and records management.
The sub-­theme of standards, discussed in four of the
articles, captured different HIM professional role perspec-
tives with this function. AHIMA (2013b) advocates for its
members to be involved in the development of standards
for electronic health records and information exchange,
while Hjort (2011) spoke of the strategic importance of
data standards and their role in robust information gov-
ernance. The perspective from Roop (2012) supports that
documentation standards ensure the complete patient
F I G U R E 2 Article sub-­themes [Colour figure can be viewed at story is recorded which is supported by Downie (2017).
wileyonlinelibrary.com] These pieces highlighted standards contribute to the in-
tegrity and reliability of the information.
has designated 2020 as ‘The Year of Patient Matching’ The sub-­theme of maintaining the privacy and security
to recognise the strategic importance of minimising du- of information, reported in four of the articles, discusses
plicate records. AHIMA is advocating at a national level several points. Finding the balance between the access to
for unique patient identifiers to support cross jurisdiction or provision of information for health care purposes versus
sharing of patient information to support safe patient care the requirement to preserve confidentiality and protect in-
(Butler, 2020). formation was recognised by Hjort (2011) and Butler (2020).
Three articles addressed the knowledge of data qual- The need for policies covering the sharing and exchange of
ity management. Downie (2017) spoke of health systems health information was also recognised by Butler (2020)
moving towards paying for performance models, with a and AHIMA (2013a). It was also acknowledged that infor-
critical driver for safety and quality being relevant quality mation is accessed to monitor and measure the quality of
data. Since the introduction of diagnosis and procedure health care provided (Downie, 2017; Hjort, 2011).
coding, the data have been used to monitor safety and Records management, covered in two articles, was the
quality, and funding (Downie, 2017). HIM professionals final theme identified for information governance. The
are data stewards who ensure guidelines and principles management of records in paper, electronic or hybrid
are in place for data standardisation, to support data ag- format is an area where HIM professionals can impact
gregation, and data being captured once and used multiple on safety and quality according to the articles by Hjort
times (Hjort, 2011). A data dictionary is an example of a (2011) and Roop (2012). Processes for information to be
tool that HIM professionals create, utilise and maintain to assigned to the correct record (Roop, 2012), creating qual-
support data standardisation (Hjort, 2011). The final sub-­ ity checkpoints for data (Roop, 2012) and participating in
theme for data quality is educating others on information the lifecycle of electronic health records (Hjort, 2011) are
accuracy, discussed in two articles. Hjort (2011) advocates all activities performed by HIM professionals.
for HIM professionals to be the educators and leaders for
data capture, validation and maintenance, which estab-
lishes a framework for accurate data leading to improved Corporate governance
quality of care and patient safety. Furthermore, Munn
et al., (2015) highlights how HIM professionals help oth- Corporate governance as the overarching theme repre-
ers to understand and gain meaning from data. sents the operations required to deliver health services
including elements of governance structures, processes,
tasks and funding.
Information governance Six articles discussed the sub-­theme of knowledge of
health systems, which is understanding the different sub-­
Information governance is the creation of a structure and systems that contribute to the safe delivery of health care.
culture that maximises the value of information assets, Butler (2020) spoke of the efforts to address legislation
minimises costs and manages risks (Abdelhak & Hanken, that prohibited a national patient identifier which directly
2016). Munn et al. (2015) described the overarching pur- impacts policies for sharing information and work prac-
pose of information governance for official or legal rea- tices to fix patient misidentification. Misidentification was
sons and that data integrity is necessary for accurate and also raised by Martin (2016) when speaking of the process
complete information, whereas the authors of other arti- to fix mis-­matched patients in EHRs and how the HIM
cles in the reviews discussed the attributes of information professional needs to know the impact of this action to
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254    HIM AND PATIENT SAFETY: SYSTEMATIC REVIEW

TABLE 3 HIMS skillset

other parts of the health system. Knowledge of health sys-
tems was also highlighted in the article by Roop (2012), Skillset Citation
where Health Information Services run a document im- Clinical coding Butler, 2020
provement programme that examines records in real time Clinical knowledge Downie, 2017
for completeness with issues identified and addressed Terminology Hjort, 2011
while patients were still in hospital. Downie (2017) em- Funding Munn et al., 2015
phasised the use of data coded by HIM professionals for Roop, 2012
nationwide benchmarking for performance, and identify- Managing the patient master AHIMA, 2013a
ing best practice methods, to evaluate the safety and qual- index Butler, 2020
ity of health services. These examples all demonstrate the Patient matching Martin, 2016
Roop, 2012
value of HIM professional's knowledge of health systems
in their daily work. Data standards Butler, 2020
Management Downie, 2017
Funding and reporting was another sub-­theme dis-
Reporting Hjort, 2011
cussed in three articles. The articles emphasised the im-
Analysis Roop, 2012
portance of the HIM professional role in the financing
Information technology Hjort, 2011
and reimbursement cycle using coded data and patient
Roop, 2012
safety indicators (Downie, 2017; Hjort, 2011; Martin,
Confidentiality Hjort, 2011
2016). HIM professionals face ethical issues of ensuring
Security of information
the accurate capture of the patient journey versus the cod-
Organisational leadership Martin, 2016
ing to support hospitals’ financial needs (Downie, 2017).
Records management Hjort, 2011
Coding episodes of care include the capture of hospital-­
acquired complications, condition onset, adverse events
and patient safety indicators, which influence the reim-
bursement a hospital receives (Downie, 2017; Hjort, 2011;
Munn et al., 2015). Downie (2017) says funding and pric- safety. Some authors included in this review claim an
ing is part of the push to address safe patient care. Roop association between the HIM professional skillset and
(2012) describes the effort made by HIM professionals to patient safety, though there is no empirical evidence to
accurately capture information makes them a supporting support this position. While the eight non-­empirical ar-
profession to patient safety teams, whereas Butler (2020) ticles provide examples of HIM professional functions re-
reinforces an information integrity focus as required for lated to patient safety, further research is needed on this
organisational and patient decision making. topic to discover the impact of the HIM workforce on pa-
tient safety.
There has been an explosion of data with the introduc-
HIM skillset tion of EHRs, with data quality being vital for trustwor-
thiness (Geissbuhler et al., 2013). The application of ‘big
The knowledge and skills of HIM professionals, listed in data’ within health settings is expanding due to its ability
Table 3, demonstrate the diversity of skills of the HIM to generate new knowledge and disseminate information
profession. Hjort (2011) states that applying these skills (Murdoch & Detsky, 2013). HIM professionals are specially
to improve capture, validation, analysis and reporting of trained on data quality management practices and EHRs
information is where the HIM professional can impact to as part of their qualification. They are uniquely positioned
patient safety. Hjort (2011) and Munn et al. (2015) discuss to work in roles that incorporate both functions. Despite
HIM professionals monitoring the quality of documenta- this, the articles provided little detail on how HIM profes-
tion and working with clinicians to ensure the record is sionals maintain their expertise and learn about the emerg-
accurate and complete. Martin (2016) describes the op- ing practices for managing data quality in this expanding
portunities to showcase the HIM skillset and challenges environment. Continuous professional development is
HIM professionals to make a difference to patient safety essential to not only preserve the individual's knowledge
through functions and processes they perform. and skills but also allows expansion of talent (Filipe et al.,
2014) with the process of credentialing demonstrating a
personal commitment to ongoing education and currency
DI S C US S I O N to peers and employers (HIMAA, 2020b). As HIM profes-
sionals provide education to others on data quality (Hjort,
The review identified no academic or peer-­reviewed re- 2011), it is vital that the HIM workforce maintains their
search on the impact of the HIM profession on patient expertise in contemporary data quality practices to enable
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HIM AND PATIENT SAFETY: SYSTEMATIC REVIEW    255

the ongoing training of this topic to other professions. The organisation and delivery’ including quality and safety
education sector and professional associations have a re- principles (HIMAA, 2017). The USA AHIMA certifies
sponsibility to support HIM professionals’ learning jour- HIM professionals based on eight different roles with each
ney (Butler-­Henderson, 2017). including different elements of safety and quality systems
While the selected articles discussed the contribution to depending on the functions performed. For example,
the development and application of standards, there was the Certified Documentation Improvement Practitioner
little mention of HIM professionals work within legisla- exams knowledge of patient safety indicators, while con-
tion. Legislation creates the expectations for accountabil- fidentiality and privacy is the focus of the assessment to
ity which must be followed. All health professionals are be certified in health care privacy and security (AHIMA,
responsible for the protection of patient data with training 2020b). The Canadian Health Information Management
on requirements on the job (Swede et al., 2019). HIM pro- Association (CHIMA) assigned competencies based on
fessionals learn privacy legislation as part of their qualifi- the HIM professional's career. A career in data quality and
cation (Swede et al., 2019), where other health professions records management has competency in quality informa-
do not receive this education until they become employed. tion, while information governance looks how the infor-
Swede et al. (2019) advocates that receiving education on mation is used (CHIMA, 2020). It has been established
privacy legislation and cybersecurity, while a student, through competency and credentialling schemes that
would establish a commitment to privacy practices during HIM professionals need to know about different quality
clinical placement and then into employment . HIM pro- and patient safety systems and methods. It is essential for
fessionals support the organisations adherence to health continual renewal of HIM curriculum to ensure contem-
information related legislation by interpreting require- porary practices on this topic is taught.
ments and providing education to others (Munn et al., Braithwaite et al. (2011) describe three staffing groups
2015; Swede et al., 2019). If education providers taught primarily responsible for patient safety, including 1. Front
privacy and confidentiality to students, there would be op- line workforce covering doctors, nurses, allied health pro-
portunities for HIM professionals to reinforce these mes- fessionals and staff that support these clinicians; 2. Health
sages through ongoing professional development in the service managers who are accountable for the running and
workplace. delivery of health services; 3. Specially trained quality and
The relationship between the HIM profession and patient safety staff. These groups did not identify the HIM
funding through the function of clinical coding was iden- workforce. Gray et al. (2019) confirm the hidden position
tified. However, they failed to acknowledge the require- by stating the health information workforce behind digi-
ment for skilled HIM professionals or the impact of the tal health initiatives are often forgotten. The invisibility of
predicted workforce shortfalls. The introduction of health the profession is reinforced by Australian National Safety
reforms, such as activity-­based funding, has increased the and Quality Health Services standards identifying health
demands on the HIM workforce (Australian Institute of records as a critical component for clinical governance,
Health & Welfare, 2010). The USA Patient Protection and but not recognising the HIM workforce that manages the
Affordable Care Act and the Australian National Reform records (Australian Commission on Safety & Quality in
Health Act establish the needed for data to fund health ser- Health Care, 2017). HIM professionals remain unseen in
vices (Downie, 2017; Munn et al., 2015). Expertise in clin- the patient safety context outside of their professional net-
ical coding is essential for funding due to these legislative work. There is an opportunity for this professional group
requirements. Coded data are also used for understanding and their work to be included in future research on patient
the burden of disease, predicting future health demands safety.
and planning health services (Duckett & Willcox, 2015). The HIM profession has continued to evolve to meet
Therefore, qualified and skilled HIM professionals are organisational requirements with managing health infor-
vital to ensure the transition of data to meaningful infor- mation. The role has expanded from the traditional areas
mation occurs to support decision making for safe patient of records management and clinical coding to having ex-
care. pert or specialist roles in information governance, data an-
A driver for the creation of the HIM profession was alytics, informatics, and coding classification and revenue
compliance with medical records documentation stan- (AHIMA, 2020a; Brooks, 2015; Butler-­Henderson, 2017;
dards, so clinicians could have accurate records for HIMAA, 2020a). An example is Clinical Documentation
patient care (Abdelhak & Hanken, 2016). Core profes- Improvement specialist who works with clinicians in
sional competencies are maintained in several countries real time to ensure that the documentation tells an accu-
(AHIMA, 2020b; HIMAA, 2017) including Australia, rate account of the patient journey, which supports deci-
USA and Canada. In Australia, these competencies are sion making, communication and funding (Butler, 2020;
spread across nine areas with the domain ‘health services Hay et al., 2020). Rapidly expanding health information
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256    HIM AND PATIENT SAFETY: SYSTEMATIC REVIEW

technology, particularly with electronic health records, is information to provide meaningful conclusions; there-
another area of growth for the profession. HIM profession- fore, findings are indicative only. Notwithstanding this
als have adapted to the change in format of health records, limitation, the study suggests there is a gap in knowl-
and there will need to be continued growth in the digital edge about the impact of the HIM profession on patient
health environment (Australian Digital Health Agency, safety. Further research examining this topic is strongly
2020). However, if the value of the HIM profession is not recommended.
recognised, there is a risk the occupation will be lost or
replaced (Butler-­Henderson, 2017; HIMAA, 2016).
Role substitution and ‘de-­professionalisation’ is leading CONCLUSION
to the HIM profession being invisible (HIMAA, 2016). The
potential impacts of role substitution include the misman- The HIM profession was created to support health care
agement of health information systems, data errors, and delivery by providing high-­quality information, which is
privacy and confidentiality implications (Adeleke et al., vital for patient care. The literature establishes health re-
2019). These issues can lead to incomplete, inaccessible or cords as the intersection point between patient safety and
incorrect information, thus impacting the clinician's deci- the HIM profession. However, a review of the published
sion making for patient care and ultimately, patient safety. literature revealed there is no empirical evidence explor-
The funding of health services depends on quality data ing the impact of this profession on patient safety, only
and the HIM profession, as data custodians, undertake research examining the profession, health information
a variety of activities to ensure information is valid and and linkage to patient safety. The existing literature on
reliable. Unqualified staff may not be aware of legislative this topic is opinion pieces, which indicated HIM profes-
and ethical requirements to protect health information to sionals may impact patient safety through their skill set
ensure privacy and confidentiality. Using unqualified staff across data quality, information governance and corpo-
to perform HIM professionals’ functions is a risk to pa- rate governance.
tient safety (Adeleke et al., 2019). It is imperative that this While the HIM profession itself has suggested they
profession endures and does not follow the same fate as have an essential role in supporting quality and patient
Health Librarians with mixed opinions of the value they safety initiatives, recognition is still needed from other
provide, from being seen as a financial burden (White, professional groups. Further research in HIM and pa-
2014) to an essential service to support clinical decision tient safety is required to demonstrate the profession's im-
making (Taylor & Stephenson, 2018). The contribution pact and involvement for patient safety. For instance, is
of HIMS professionals to the health system, in particular patient safety included in the HIM curriculum?; how do
patient safety, needs more exploration to demonstrate the HIM professionals contribute to patient safety?; and what
value this profession provides. else could the profession be doing with regards to patient
safety? Exploring the workforce in action, speaking with
leaders in patient safety and HIM, and analysing the key
Limitations documents that guide the profession will provide further
insight on this topic. Understanding the relationship be-
This research first limitation was the strict search criteria tween these two areas will enable exploration of oppor-
terms of ‘Health Information Management’ and ‘Health tunities for patient safety endeavours to capitalise on the
Information Manager’ to represent the profession and all HIM skillset for the benefit of safe patient care.
the occupations performed such as clinical coder, clinical
documentation improvement specialist, data analyst etc. ACKNOWLEDGEMENTS
A further limitation was the small number of articles in The authors acknowledge Dr David Marc, College of St
the published literature. While the link between health in- Scholastica for sourcing Blending IT and HIM Staff for End
formation and patient safety and between HIM and health User Support of Electronic Health Records for the full-­text
information has been established in the literature, it is review and Dr Susan Fenton, UT School of Biomedical
difficult to draw this link between the HIM professional Informatics at Houston for sourcing Keeping Current on
and patient safety. Empirical evidence on the HIM work- Legislation Vital to HIM Professionals
force in general is limited (Butler-­Henderson et al., 2017;
HIMAA, 2016). This may, in part, be explained by the lack CONFLICTS OF INTEREST
of a research culture in the profession (Trixie Kemp et al., There are no funding or other conflicts of interest with
2020). This hypothesis is supported by this review in that the design, conduct or reporting of this study. This re-
only commentary or opinion pieces could be identified, search required no ethics approval as it does not involve
no empirical evidence. There is insufficient quantity of humans.
 |

14711842, 2021, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/hir.12400 by Nat Prov Indonesia, Wiley Online Library on [05/06/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
HIM AND PATIENT SAFETY: SYSTEMATIC REVIEW    257

DATA AVAILABILITY STATEMENT of digital transformation?'. Retrieved from Launceston. https://

As the data in this manuscript are journal articles, they www.researchgate.net/publication/313315353_Health_informa-
tion_management_2025_What_is_required_to_create_a_sust.
are available through the provided DOI or citation in the
Butler-­Henderson, K., Gray, K., Greenfield, D., Low, S., Gilbert, C.,
reference list at the end of this article. Ritchie, A., Trujillo M., Bennett V., Brophy J. & Schaper, L. K.
(2017). The development of a National Census of the Health
ORCID Information Workforce: Expert panel recommendations.
Trixie Kemp https://orcid.org/0000-0002-1778-8004 Studies in Health Technology and Informatics, 239, 8–­13.
CHIMA (2020). Career matrix. Retrieved from https://www.echima.
REFERENCES ca/caree​rs/caree​r-­matri​x/
Abdelhak, M. H., & Hanken M. A. (2016). Health Information: Crawford, J., Butler-­Henderson, K. & Kelder, J. (2020). Quality as-
Management of a strategy resource, 5th ed. United States of sessment tool for theory and literature (QATTL): Development
America Elsevier Saunders. https://www.elsev​ier.com/books/​ and validation. In Press.
healt​h-­infor​matio​n/abdel​hak/978-­0-­323-­26348​-­1 Downie, J. (2017). More than just activity: Pricing and funding for
Adeleke, I. T., Suleiman-­Abdul, Q. B., Aliyu, A., Ishaq, I. A., & Adio, quality and safety. HIM-­Interchange, 7(2), 4–­7.
R. A. (2019). Deploying unqualified personnel in health records Duckett, S., & Willcox, S. (2015). The Australian health care system
practice: Role substitution or quackery? Implications for health (5th ed.). Oxford University Press.
services delivery in Nigeria. Health Information Management Filipe, H. P., Silva, E. D., Stulting, A. A., & Golnik, K. C. (2014).
Journal, 48(3), 152–­156. 10.1177/18333​58318​800459 Continuing professional development: Best practices. Middle
AHIMA (2013a, 11/09/2013). AHIMA hosts town hall to address na- East African Journal of Ophthalmology, 21(2), 134–­141.
tional patient matching challenges. Manufacturing close –­ up. 10.4103/0974-­9233.129760
AHIMA (2013b). Standards activities: Building health information Flott, K., Fontana, G., & Darzi, A. (2019). The global state of patient
standards. AHIMA Advantage, 18(5), 8. safety. Retrieved from London: https://www.imper​ial.ac.uk/
AHIMA (2020). Career Map. Retrieved from https://my.ahima.org/ media/​imper​ial-­colle​ge/insti​tute-­of-­globa​l-­healt​h-­innov​ation/​
caree​rmap Globa​lStat​eofPS_DIGIT​AL_16Sep​19%5B2%5D.pdf
AHIMA (2020). Certifications & Careers. Retrieved from https:// Geissbuhler, A., Safran, C., Buchan, I., Bellazzi, R., Labkoff, S.,
www.ahima.org/certi​ficat​ion-­caree​rs/certi​ficat​ions-­overv​iew/ Eilenberg, K., Leese, A., Richardson, C., Mantas, J., Murray,
Alotaibi, Y. K., & Federico, F. (2017). The impact of health infor- P., & De Moor, G. (2013). Trustworthy reuse of health data:
mation technology on patient safety. Saudi Medical Journal, A transnational perspective. International Journal of Medical
38(12), 1173–­1180. 10.15537/​smj.2017.12.20631 Informatics, 82(1), 1–­9. 10.1016/j.ijmed​inf.2012.11.003
Australian Commission on Safety and Quality in Health Care. Gray, K., Gilbert, C., Butler-­Henderson, K., Day, K., & Pritchard, S.
(2017). National Safety and Quality Health Service Standards (2019). Ghosts in the machine: Identifying the digital health
Australia. 2nd edition. Retrieved from Sydney: https://www. information workforce. Studies in Health Technology and
safet​yandq​uality.gov.au/sites/​defau​lt/files/​2019-­04/Natio​nal-­ Informatics, 257, 146–­151.
Safet​y-­a nd-­Q uali​t y-­H ealt​h -­S ervi​c e-­S tand​a rds-­s econ​d -­e diti​ Hay, P., Wilton, K., Barker, J., Mortley, J., & Cumerlato, M. (2020).
on.pdf The importance of clinical documentation improvement for
Australian Digital Health Agency (2020). National digital health Australian hospitals. Health Information Management Journal,
workforce and education roadmap. Retrieved from Sydney, 49(1), 69–­73. 10.1177/18333​58319​854185
NSW. HIMAA (2016). Health information workforce summit report
Australian Institute of Health and Welfare (2010). The coding work- 2015. Retrieved from Sydney, Australia: https://himaa.org.au/
force shortfall. Retrieved from Canberra. files/​web/docs/Healt​h%20Inf​ormat​ion%20Wor​kforc​e%20Sum​
Braithwaite, J., Westbrook, M. T., Robinson, M., Michael, S., Pirone, mit%20Rep​ort.pdf
C., & Robinson, P. (2011). Improving patient safety: The com- HIMAA (2017). Health Information Manager (HIM) competency
parative views of patient-­safety specialists, workforce staff standards. Retrieved from https://www.himaa.org.au/files/​
and managers. BMJ Quality & Safety, 20(5), 424–­431. 10.1136/ Misc/Docs/HIMAA_HIM_Compe​t ency_Stand​a rds_Versi​
bmjqs.2010.047605 on_3_FNL_June2​017.pdf
Braun, V., Clarke, V., & Hayfield, N. (2019). ‘A starting point for HIMAA (2020). Definition of the profession. Retrieved from https://
your journey, not a map’: Nikki Hayfield in conversation himaa.org.au/the-­profe​ssion​s/
with Virginia Braun and Victoria Clarke about thematic HIMAA (2020). Professional credentialing program. Retrieved from
analysis. Qualitative Research in Psychology. 10.1080/14780​ https://himaa.org.au/profe​ssion​al-­crede​ntial​ing/
887.2019.1670765 Hjort, B. (2011). HIM functions in healthcare quality and patient
Brooks, A. (2015). Health information management history: Past, safety…practice guidelines for managing health information.
present & future. Retrieved from https://www.rasmu​ssen. Journal of AHIMA, 82(8), 42–­45.
edu/degre​es/healt​h-­scien​ces/blog/healt​h-­infor​matio​n-­manag​ Kaelber, D. C., & Bates, D. W. (2007). Health information exchange
ement​-­histo​ry/ and patient safety. Journal of Biomedical Informatics, 40(6),
Butler, M. (2020). The HIM view for 2020. Journal of AHIMA, 91(1), S40–­S45. 10.1016/j.jbi.2007.08.011
14–­17. Kemp, T., Butler-­Henderson, K., Allen, P., & Ayton, J. E. (2021).
Butler-­Henderson, K. (2017). Health information management 2025: Evolution of the health record as a communication tool to sup-
‘What is required to create a sustainable profession in the face port patient safety. In C. Chisita, R. Enakrire, O. Durodolu, &
 |

14711842, 2021, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/hir.12400 by Nat Prov Indonesia, Wiley Online Library on [05/06/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
258    HIM AND PATIENT SAFETY: SYSTEMATIC REVIEW

V. Tsabedze (Eds.), Handbook of research on records and infor-

mation management strategies for enhanced knowledge coordi-
AUTHOR BIOGRAPHIES
nation (pp. 1–­440). IGI Global. https://doi.org/10.4018/978-­1-­
7998-­6618-­3.ch008 Trixie Kemp is a Health Information Manager with
Kemp, T., Finlayson, L., Chan, J., Lackey, G., Richards, D., Rupnik, over 20 experience working in public health sector
C., White, H., Butler-­Henderson, K., & Low, S. (2020). Exploring and a PhD candidate with RMIT University School of
the research culture in the health information management Health and Biomedical Science. She is passionate about
profession in Australia. Health Information & Libraries Journal, the role health information management has in patient
37(1), 60–­69. 10.1111/hir.12281
safety and is undertaking a PhD to better understand
Kohn, L. T., Corrigan, J. & Donaldson, M. S. (2000). To Err is Human:
Building a Safer Health System. PubMed (nih.gov).
this contribution. Trixie is an active participant in the
Lawrance, R. (2017). How many clinicians does it take to build a health information professional community within
health information management system?. Retrieved from Australia with research, education and a member of
https://www.pulse​itmag​azine.com.au/news/austr​alian​-­eheal​ several national health information committees.
th/3673-­how-­many-­clini​cians​-­does-­it-­take-­to-­build​-­a-­healt​h-­
infor​matio​n-­manag​ement​-­system Kerryn Butler-­Henderson is the Director of Digital
Martin, M. (2016). President's message. Bringing HIM front and cen-
Health in the College of STEM at RMIT University. She
ter for master data management. Journal of AHIMA, 87(3), 6.
is a well-­respected digital health academic, with more
Middleton, B., Bloomrosen, M., Dente, M. A., Hashmat, B., Koppel,
R., Overhage, J. M., Payne, T. H., Rosenbloom, S. T., Weaver, than twenty years’ experience working in health and
C., & Zhang, J. (2013). Enhancing patient safety and quality of higher education. She is known for her passion and
care by improving the usability of electronic health record sys- dedication to the promotion and advocacy of the spe-
tems: Recommendations from AMIA. Journal of the American cialist digital health workforce and involved with sev-
Medical Informatics Association, 20(e1), e2–­8. https://doi. eral large funded research projects evaluating digital
org/10.1136/amiaj​nl-­2012-­001458 health interventions in various health settings.
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The, P. G. (2009).
Preferred reporting items for systematic reviews and meta-­
analyses: The PRISMA statement. PLoS Med, 6(7), e1000097.
Penny Allen is Senior Research Fellow at the Rural
10.1371/journ​al.pmed.1000097 Clinical School, University of Tasmania. With a back-
Munn, C., Backman, C., Costello, S., Wise, L. A., & Westhafer, K. J. ground in epidemiology and biostatistics, Penny's cur-
(2015). Working smart. Understanding HIM's impact on quality rent research is focussed on rural health outcomes,
at the national level. Journal of AHIMA, 86(10), 58–­60. primary care, training and retention of the rural
Murdoch, T. B., & Detsky, A. S. (2013). The inevitable application of medical workforce and the evaluation of health care
big data to health care. JAMA -­Journal of the American Medical innovations.
Association, 309(13), 1351–­1352. 10.1001/jama.2013.393
Regional Office for the Eastern Mediterranean World Health
Organization (2016). Patient safety assessment manual: second
Jennifer Ayton is a senior lecturer in Public Health
edition, 2nd ed. World Health Organization. Regional Office at the Tasmania School of Medicine, University of
for the Eastern Mediterranean. https://apps.who.int/iris/handl​ Tasmania. She is a qualitative and mixed method re-
e/10665/​249569 searcher with a Ph.D. in sociology. Jenn has an exten-
Roop, E. S. (2012). HIM plays a central role in safety, quality issues. sive clinical background in midwifery/nursing, work-
For the Record, 24(6), 14–­17. ing in rural and remote Australia, United Kingdom and
Rowlands, D. (2019). What is digital health? And why does it matter.
Africa. Jenn's research focusses in infant and young
Retrieved from Australia: https://www.hisa.org.au/wp-­conte​
child feeding, maternal reproductive health.
nt/uploa​ds/2019/12/What_is_Digit​al_Health.pdf
Swede, M. J., Scovetta, V., & Eugene-­Colin, M. (2019). Protecting
patient data is the new scope of practice: A recommended cy-
bersecurity curricula for healthcare students to prepare for this
How to cite this article: Kemp, T., Butler-­
challenge. Journal of Allied Health, 48(2), 148–­155. Henderson, K., Allen, P., & Ayton, J. (2021). The
Taylor, M. V., & Stephenson, P. L. (2018). Demonstrating value in impact of health information management
federal medical center libraries. Medical Reference Services professionals on patient safety: A systematic
Quarterly, 37(4), 403–­412. 10.1080/02763​869.2018.1514914 review. Health Information & Libraries Journal, 38,
White, W. L. (2014). Medical libraries lose their librarians. Missouri 248–­258. https://doi.org/10.1111/hir.12400
Medicine, 111(6), 482.
World Health Organization (2015). Patient safety toolkit. Retrieved
from Web: http://appli​catio​ns.emro.who.int/dsaf/EMROP​
UB_2015_EN_1856.pdf?ua=1&ua=1