Debi Senger has been an HIM leader in Ontario for more than 30 years. Currently, she is the Manager of Health Information Services for Women’s College Hospital in Toronto. Debi is perhaps best known for the 17 years during which she served as SickKids – Director of Health Information and Registration Services. She is also the former chair of the Directors of Records of Ontario Teaching Hospitals (DROTH).

You chaired the DROTH group for many years. What are the time periods during which you took this on?

In 1998, I joined DROTH as a member representing the Hospital for Sick Children and I became chair in 2005. I remained chair until 2015 and, for a short time period in 2018–19, became an interim chair while at my current position at Women’s College Hospital.

What changes did you observe in the membership of DROTH over that time period?

I observed substantial changes in membership. When I first joined DROTH, only one representative from each teaching hospital was allowed to become a member of DROTH—and it had to be either the director or manager of the entire health records department (at that time, the departments were called health records). Over time, multiple members from one hospital were allowed to join and participate in the meetings, although the hospital could only have one voting member (e.g., manager of coding, ROI, medical transcription, etc.). 

The membership and the number of hospitals that participate has grown significantly over the years. Today, we have 34 hospitals throughout Ontario represented with 71 members, including ex-officio members from CIHI, CHIMA, Ontario Health, and the MOHLTC.

In what ways did the topics of discussion change over time?

The topics in the early 2000s focused mainly on common issues affecting day-to-day operations, such as:

• Policies and procedures with regards to the paper health record
• The limited number of coding resources
• Expectation of meeting quarterly/annual CIHI data submission timelines
• Impact of new legislation such as PHIPA (2204)
• Management of systems such as Kard Veyers, Manual Out-guides, etc. 

With the transition from paper to the EMR/EHR, a lot of procedures that were implemented in relation to the paper record no longer applied and hot topics for discussion at DROTH included:

• What constitutes the legal health record in a hybrid environment?
• How do you ensure the privacy and security of the EHR?
• How do you ensure secure sharing of information (e.g., provincial repositories such as ConnectingOntario, Hospital Report Manager, OLIS, etc.)?
• What HIM skills will be required to manage the EHR?
• Who is the custodian of the various hospital databases containing PHI?
• What about legacy systems?

In most recent years, with the addition of members from CIHI, CHIMA, eHealth and MOHLTC, the agenda items not only focused on local operational issues, but on provincial and national initiatives. The addition of these members benefitted all of us because DROTH is considered to be the SMEs for HIM and these organizations sought our feedback, guidance, and advice on initiatives and programs being developed. In turn, as members, we became aware and informed about upcoming developments and opportunities for HIM professionals.

In addition, in the last year CHIMA has provided DROTH with a community facilitator who supports the chair in facilitating the meetings, selecting current topics of interest, managing the DROTH membership listing, consolidating surveys, etc.

Do you think that DROH has made a difference in terms of best practice for DROH members?

Absolutely! People turn to DROTH to learn best practices in health information management.

Do you think that DROTH has made a difference in terms of best practice for HIM beyond DROH—in Ontario and/or Canada?

Yes, provincial and national bodies such as CHIMA, CIHI, MOHLTC, Ontario Health, and/or companies who develop software for HIM departments reach out to DROH to determine best practices for HIM.

What are the top two or three issues that DROTH addressed most frequently during this time?

• Transition to the EHR
• Standardization of policies/procedures to support legislation and HIM practices
• Shortage of certified HIM professionals and changes in skills required

Of all your accomplishments while leading this group, what are you most proud of?

• The increase in membership
• The addition of ex-officio members from CHIMA, CIHI, MOHLTC, and Ontario Health
• Collaborating with CHIMA to provide a community facilitator

What was the biggest surprise?

The amount of time and energy it takes to coordinate meetings for so many members across so many hospitals. The maintenance of the DROH membership listing alone can be very time consuming. It’s very surprising how often there are changes in management in hospitals. 

One major advantage of chairing a committee such as DROTH is that it affords you the opportunity to get to know your colleagues across many hospitals in the province and to stay current with HIM best practices.

How does participation in DROTH today help you in your role as a leader of HIM in a downtown Toronto teaching hospital?

I reach out to my DROTH colleagues on a regular basis to seek their advice and determine best practices in our industry.

If you could carve the future of DROTH, what would it look like?

I would like DROTH to be:

• Always sustainable
• Established as a provincial HIM advisory committee to CHIMA, MOHLTC, CIHI, and Ontario Health as the subject matter experts for health information management in Ontario