By Lesley Kadlec, MA, RHIA
In an effort to begin to answer basic questions related to the state of information governance (IG) in healthcare, AHIMA invited several different types of organizations from across the country to participate in a case study analysis.
Below are the results of the de-identified IG case study that focuses on an “academic medical center system.”
Executive Information Governance Program Sponsor
This facility is an academic medical center with two hospitals, behavioral health services, and multiple outpatient clinics. The system has:
More than 20,000 admissions annually
300,000 outpatient visits
More than 600 beds
Information Governance Program Description
This organization has had an information governance program in place for three years. The goal of their information governance program is to ensure that the organization is analytics driven to ensure better performance and outcomes.
The information governance program was launched by the company’s CEO. It was his desire to be an analytics driven organization in both performance and outcomes that led to the development of the program.
The individuals interviewed during the case study stated that communication has been the key to the success of their program. HIM leaders play a significant role in the IG program. The leaders that were interviewed felt that there were significant emerging roles for HIM professionals in information governance. Changing the corporate culture to embrace information governance initiatives was key. One of the benefits to this system’s IG program has been the ability to identify existing reports and find data when it is needed.
Balanced scorecards are shared with staff, and all scorecards are driven up to the executive level of the organization for review. The senior leadership has used the data derived from the scorecards to drive change in the organization. People in the organization have said they continue to want more data. They have been live on their EHR for more than three years, and being able to respond to the requests for information has become paramount to the success of the information governance program.
No new staff members were hired for the information governance program. Existing staff were promoted within the organization to higher levels of responsibility. It was noted that the organization recognized the value of having HIM professionals in quality and integrity roles.
Report request forms were developed, and all report requests must align to an organizational priority or strategy to be considered for development. A lot of data requests are sent for executive approval to ensure that key stakeholders are aware of what data is being developed and distributed, and to ensure that only those with proper authority have access to the information.
Prior State Analysis
Before the adoption of the IG program, the organization developed reports in silos. They already had multiple reports built, but staff did not know they existed. So time was spent recreating reports due to this lack of knowledge. The company utilizes a balanced scorecard approach for reporting and measuring outcomes. As a result, the organization developed more than 20 recommendations for inclusion in their data/information governance model. The organization brought in a consultant to assist them in developing their program.
Information Governance Drivers
The organization recognized a number of information management issues that brought the IG initiative forward, including inaccurate data for decision-making, quality issues, data integrity issues, reimbursement issues, inadequate data storage and retention, and the impact on processes from recently expanding into health information exchange (HIE).
The organization is driven by the desire to use information to improve population health and outcomes, and is looking at future enhancements that will utilize predictive analysis in an attempt to prevent hospital readmissions.
Highlights of the information governance program include:
- Senior-level executive support (CEO project champion)
- Organizational design that supports quality and integrity of information
- IG program built around strategy
- Improved privacy of reports—Reports now require executive approval prior to build
- Initial policies are in place, but there are still gaps in metadata management and data dictionaries
- Centralized management of reports–Reduced redundancy in report requests and enhanced delivery
- Enterprise report management enables rerun of reports vs. rebuild
- Reports archived for future needs
Information Governance Program Structure
Components addressed with the enterprise information management governance structure include access, security, and confidentiality; information integrity and quality; information design and capture; content and records management; and information analysis, use, and exchange—including participation in an HIE.
There are clear decision makers related to sun setting existing IT systems as well as acquiring new systems, though there have not been a lot of systems that have been sunset to date. The organization is in the process of getting more systems at this time, and the vetting of new applications is dependent upon the scope of the application. Any application requiring more than 160 hours of IT time or $50,000 needs be approved by the executive committee. Smaller dollar projects that meet certain thresholds are vetted at different levels.
All privacy breaches come through HIM, and the HIM staff works in collaboration with the privacy officer, legal, and IT staff to ensure breaches are addressed appropriately.
A 12 to 18 month roadmap has been developed to assist in building more core structure, increased focus on building functional areas, and ongoing policy development and governance work.
The organization is moving to a predictive analytics model in an attempt to identify what can be done to prevent readmissions to the hospitals. There is an organizational goal in place to ultimately use the tools to improve population health in the communities served.
The organization has a fair number of challenges and recognizes that there is still work to do before they complete their IG model. Developing policies and procedures as well as defining the roles and responsibilities of stewards and owners has proven to be challenging. There is a recognized need to improve standards around metadata and establish enterprise level metadata management structures. The organization also needs more definition around architecture and standards. The organization is following AHIMA guidance on metadata management.
IG Benefits Realized
Benefits to the program have included a cost/benefit realization of several million dollars, the development of a better way to track quality outcomes, and lowered transcription costs. In addition, the program has been seen as a priority for the organization, and a significant amount of resources have been allocated to make it successful. One of the immediate tangible benefits noted was the ability to quickly turn around reports.
This healthcare organization is taking a lead in the development of information governance. Driven by the desire to use information to improve population health and outcomes, the organization is also looking at future enhancements to include predictive analysis in an attempt to prevent hospital readmissions. The organization values the input of HIM professionals in information governance, and has promoted three individuals to key roles within the governance program. As the value of data becomes more apparent to the organization, the desire for quicker and more reliable data has increased such that demand has outgrown capacity. Despite having the program in place for more than 18 months, there is another 18-24 months planned for additional improvements to the program, including the implementation of master data management, metadata analysis, and predictive analytics.
"State of Health Information Governance in Healthcare: Case Study—Academic Medical Center System"
(AHIMA, February 2014)