Abstract
The papers in this issue of HIMJ all have something important to say about the changing work environment of Health Information Managers (HIMs). The first three papers examine the HIS work environment from the point of view of managing HIM careers, the quality of the work HIMs perform, and how technology impacts upon the way they do their work. Sandra Leggat’s paper focuses on performance management for HIMs with a view to improving outcomes for both staff and organisations through the implementation of transformational leadership. Jude Michel, Hong Son Nghiem and Terri Jackson discuss the contribution HIMs can make towards minimising hospital-acquired complications; and Aziz Jamal, Kirsten McKenzie and Michele Clark have reviewed the published literature on the impact of health information technology on the quality of medical care.

Abstract
Change is inevitable. In a progressive country, change is constant. 
These words, spoken in 1867 by the British Prime Minister Benjamin Disraeli, can equally apply to components of the broader society in the 21st Century. The observation is particularly appropriate for health information management and for the theme of this issue of the Journal (the changing health information service [HIS] work environment) and reflected in many of the papers included in the Issue. As professionals working in the area of health information management, we need to be progressive and adapt quickly to the constant changes that are fundamental to our discipline or we will be left behind. For example, Helen Cooper’s discussion of this issue from an educational perspective challenges Health Information Managers (HIMs) to consider that the change is not about ‘roles’; rather, it is about the evolving breadth, depth and scope of the discipline itself.

Abstract
This paper describes the limitations of using the International Statistical 
Classification of Diseases and Related Health Problems, Tenth Revision, Australian 
Modification (ICD-10-AM) to characterise patient harm in hospitals. Limitations were identified during a project to use diagnoses flagged by Victorian coders as hospital-acquired to devise a classification of 144 categories of hospital acquired diagnoses (the Classification of Hospital Acquired Diagnoses or CHADx). CHADx is a comprehensive data monitoring system designed to allow hospitals to monitor their complication rates month-to-month using a standard method. Difficulties in identifying a single event from linear sequences of codes due to the absence of code linkage were the major obstacles to developing the classification. Obstetric and perinatal episodes also presented challenges in distinguishing condition onset, that is, whether conditions were present on admission or arose after formal admission to hospital. Used in the appropriate way, the CHADx allows hospitals to identify areas for future patient safety and quality initiatives. The value of timing information and code linkage should be recognised in the planning stages of any future electronic systems.

Summary
This article describes a systematic process of geographic and strategic planning for healthcare services as a part of a regional development plan in the Israeli Galilee. The planning process consisted of three stages: (a) assessment of needs, demand and existing resources; (b) prioritisation of initiatives; and (c) scheduling of theoretical priorities. For many years the region has suffered from inequities and inequalities regarding the availability and accessibility of a regional healthcare system, resulting in high mortality and morbidity rates and low quality of life. The aim of the healthcare strategic plan was to suggest initiatives and actions to be taken in order to improve healthcare provision and the health and wellbeing of local residents.

Summary
The Royal Flying Doctor Service (RFDS) of Australia was founded in 1928 by the Reverend John Flynn to deliver health services to the people of the Australian Outback. In this unique environment the RFDS Queensland Section provides both Primary Health Care and Aeromedical services to rural and remote communities throughout Queensland. It provides health services from a hub and spoke model and its clinicians work very closely with other health service providers, such as Queensland Heath, within the communities it visits. Currently, the RFDS’ health records are both paper and electronic and clinicians duplicate much of patient information and data between RFDS and non-RFDS health records. Introduction of an off-the-shelf electronic medical record (EMR) would not meet the RFDS’ clinical and organisational needs because of complexity, the multidisciplinary nature of the teams and the lack of communication technology in the communities the RFDS visits. This article defi nes the vision for a health information system designed to meet the requirements of the RFDS, and describes its implementation throughout RFDS Queensland using the PRINCE2 project management methodology.

Abstract 
Looking back at my career as a health informatics professional has made me appreciate how much our industry has evolved over the years. Health Information Managers (HIMs) have needed to be adaptable to changing demands, practices and technologies. More importantly there have been unique opportunities for our industry, and the people in it, to drive and influence change. The types of roles I have had as a HIM have changed enormously over the years and the entire informatics profession is undergoing, dare I say it, massive change. Factors such as information and digital technology, the Internet and the enormous potential of wireless technologies continue to move us along the path of being a connected society. The demand for instant access to all sorts of data and information, from anywhere, continues to grow and has become an expectation in many industries, including ours.

Abstract 
The National E-Health Transition Authority (NEHTA) was established by the Australian commonwealth, state and territory governments on 5 July 2005 to develop better ways of electronically collecting and securely exchanging health information. NEHTA’s National Clinical Terminology and Information Service (NCTIS) was tasked by Australia’s governments to create, maintain, and represent in a standardised form terminology content for health care domains (predominantly clinical) so that the resulting data can be unambiguously and meaningfully described and used to support ongoing, efficient and accurate information exchange across the health sector. The way clinical information is captured and shared by healthcare providers is vital to the success of Australia’s future e-health system. The NCTIS is developing software that will be able to record and interpret all clinical information about a patient. Forming the basis of this software is SNOMED CT. It will effectively form the data source of e-health, enabling clinicians to exchange their traditional paper-based records for a modern, electronic system.

© 2009 Health Information Management Association of Australia Limited