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 a “large regional integrated delivery system.”
Executive Information Governance Program Sponsors
Vice President of Information Systems
Director of Data Governance
A large regional medical system with more than 20 hospitals, and more than 30 outpatient clinics, outpatient surgery centers, and urgent care clinics. The system has:
200,000 admissions annually
10 million outpatient visits
35,000 annual births
Information Governance Program Description
This organization’s information governance (IG) program started several years ago when Health Information Management (HIM) staff needed an enterprise master patient index (EMPI) to consolidate patient records for the more than 20 hospitals in the system. The hospitals were duplicating patient records, making coordination of care difficult. The data team was able to successfully implement a single shared EMPI to eliminate duplicate patient records.
Prior to the start of their IG program, the organization was transforming from a decentralized care model to a shared service organization model. The vision for the organization was clinical integration. Staff members were requesting data but did not have the appropriate access to obtain it. Data that they did have access to receive was taking too long to obtain. It was recognized that there needed to be an information governance program in place to better enable coordination of care throughout the entire shared services organization and also to maintain a competitive advantage in the various service regions.
Prior State Analysis
The organization had recently implemented an electronic health record (EHR) and access was being managed by giving only a limited group of employees access to perform job duties. There was a process set up to manage access to data, but it was inefficient in some areas. Depending on one’s role, an employee may or may not have been able to see or share data, and there was no formal structure in place for managing processes. Regional hospitals were assigning duplicate medical record numbers to patients, making it difficult to coordinate care across the organization.
Information Governance Drivers
Senior leadership recognized that the organization required an information governance model. Trying to manage information at the local level was not allowing the organization to capitalize effectively on the economy of scale that could be realized through a centralized governance process.
Initial information governance program drivers included:
- A need to manage costs around supplies, in particular devices and prosthetics
- Desire for a standardized approach to understand data and share this information within their community hospital affiliate network
- An enterprise master patient index was needed to ensure smooth care coordination throughout the regional organizations
- Need for a centralized information governance process to allow the organization to capitalize on economy of scale
Highlights of the information/data governance program at this large regional integrated delivery system include:
- Organizational design designed to address the need for access to data and reports
- Executive level support through vice president-level sponsorship
- Use of a physician champion for the project
- Centralized management of access and reports
Information Governance Program Structure
Components addressed with the enterprise information management governance structure include:
- Data quality and classification
- Retention/storage/disposal of data
- Access, security, and confidentiality
The organization has had their information/data governance program in place for more than two years, and they are still developing additional infrastructure. Although they do have business unit stewards in place, there are not consistent processes across all business units. Business unit stewards are in place in the clinical, financial, and supply areas. The desired future state includes a roadmap for a standardized approach to data governance for all of the community hospital affiliates. Policies have been created and are in the process of being updated and implemented.
It is recognized that the cultural shift in the organization toward information governance is challenging, and communication at all levels is a key to program success. Change management and accountability are being addressed as a significant component to the overall IG program.
IG Benefits Realized
Benefits of the program for this system have included:
- Reduced costs around supply management in the areas of devices and prosthetics
- A unified EMPI, with regional hospitals no longer duplicating patient records
- Improved coordination of care across the system
The information governance program at this organization began with the realization of the need for an EMPI to enable successful implementation of an enterprise EHR. Prior to the implementation of the IG program, each patient was given a new medical record number at each individual facility, therefore making coordination of care difficult. A project was initiated to pull together all of the separate medical records into a unified master patient index from the more than 20 hospitals that had previously operated independently.
Over several years before the implementation of the IG initiative, the organization began to realize that they needed an approach to information governance. The organization was transitioning to a shared services model. Members of the shared services organization were requesting data, but they did not have appropriate access to obtain it, and what they were able to obtain was taking too long to get. A physician champion created a vision of an information governance program wherein clinical information could be integrated throughout the organization. The physician lead approached the Vice President of Information Systems with a proposed governance model. Executive leadership agreed that the approach was appropriate and necessary to ensure that information and data could be obtained, understood, and analyzed.
The organization felt there was an immediate need for information governance, as they were not nimble and could not respond quickly enough to requests for information. A charter was drafted, and a Director of Enterprise Data Governance was hired. Business Intelligence staff acted as project managers on the program, and activities were undertaken to finalize processes.
The biggest hurdle to overcome has been the culture shift that needed to occur with 40,000 employees. Therefore, a change management and accountability structure has been implemented to ensure success of the information governance program.
The organization currently addresses data quality and classification; retention, storage, and disposal of data; and access, security, and confidentiality issues. There are business unit stewards in place for mapping and in other functional areas, including clinical, financial, and central supplies. The Vice President of Information Systems has oversight of the program from a clinical perspective and the Business Intelligence team project manages all of the IG program activities.
At this time, Health Information Management staff is not involved in the information governance program. The majority of the program is designed around Information Systems infrastructure, with an online data warehouse and data vault serving as a key function of the program.
The organization recognizes that they are in the beginning of a long journey to accomplish their goals and have a future state analysis underway to continue to map out the future state of their program.
"State of Health Information Governance in Healthcare: Case Study—Large Regional Integrated Delivery System"
(AHIMA, February 2014)