IG Pulse Check

New AHIMA Study Measures IG Adoption Rates

By Mary Butler

It’s safe to say that information governance (IG) has moved on from its status as a healthcare buzzword to being understood by healthcare professionals at all levels—even if implementing actual IG initiatives still remains somewhat out of reach for some organizations. That’s according to the results of the third annual IG survey conducted by AHIMA and its partner, Immersive. The survey, conducted in July and August of 2017, sought to capture the current state of information governance in healthcare and gain an understanding of IG projects that organizations are undertaking.

The publication of the AHIMA white paper “The Pulse on Information Governance in Healthcare”—set to be released in early 2018—aims to summarize the survey’s complete findings. The results offer a verifiable “pulse check” on where healthcare stands with IG—a report card that AHIMA and health information management (HIM) professionals can use to create awareness for IG in more targeted communications.

The IG survey showcases key recommendations for organizations seeking to transform their use of data and information through IG. Conducted with more than 1,500 healthcare professionals, the survey found that 53 percent of respondents said they have IG practices in place or recognize the need for IG. Also, 14 percent of respondents have initiated an organization-wide IG program, and 18 percent have IG-related projects underway. The survey determined recommendations for organizations looking to implement an IG program. The survey wasn’t limited to HIM professionals; it also solicited responses from chief medical information officers, CEOs, IT professionals, and security professionals.

In addition to providing a general look at IG adoption in the healthcare industry, the survey will also help AHIMA better plan its own IG initiatives, products, and service offerings to advance IG.

“The survey will help us know how to focus our education and awareness efforts,” says Kathy Downing, MA, RHIA, CHP, PMP, AHIMA’s vice president of informatics, IG, standards, privacy and security. “When we see which IG competency areas people are more knowledgeable in and which [competency areas] they need the most assistance with, that helps AHIMA customize the [IG] Boot Camp content, Road to Governance (Journal of AHIMA) articles, and Practice Briefs that the practice council group is working on.”

Awareness and Adoption of Information Governance

When kicking off the process of adopting an IG program, one of the foremost metaphors used to illustrate the concept is that of a road map. To stretch that metaphor a little further, the recent survey results represent a giant “You Are Here” flag.

One of the primary conclusions of the 2017 IG white paper is that while there is increasing recognition of IG as an initiative in healthcare, the “current level of IG adoption at above 30 percent is not where it should be, given the importance of information in the industry,” states the forthcoming IG white paper summarizing the IG survey results. “Further awareness raising, prioritization, and connection to drivers and benefits are essential to increasing adoption in this industry.”

The survey parsed the concept of overall awareness of and familiarity with IG in two different questions. One addressed familiarity with IG as a concept and the other asked about AHIMA’s official definition of IG. Responses to both questions demonstrated improved recognition of IG when compared to AHIMA’s 2015 survey that asked the same questions.

“84.6 percent responded that they were familiar with IG, and 74.9 [percent] responded ‘yes’ to a question on familiarity with AHIMA’s definition of IG. The latter was up from 69 percent in the 2015 survey,” the white paper states. Additionally, the white paper notes that while the same question was not asked in 2015, “89 percent of respondents said AHIMA was their chosen source for IG resources.”

Kristi Fahy, RHIA, information governance analyst at AHIMA, says she struggles to understand why adoption rates of IG are low when awareness is high. One factor, according to Fahy, is that a big portion of survey respondents were people working in HIM departments—and while IG projects can start there, they usually require engagement and initiative from the C-suite and other leaders.

An explanation is also visible when looking at common barriers to IG adoption. “A common barrier to IG is lack of funding and stakeholder engagement,” Fahy says. “IG is still a relatively new concept in healthcare so it is difficult to move forward with it if no one really understands it. That is where AHIMA comes in and tries to offer up several excellent IG resources, including the white paper, and of course the IGHealthRateTM assessment tool which is available free to qualified organizations.”

According to survey results, even in organizations that have IG programs, organization-wide lack of awareness and understanding has proven to be a barrier, with funding for IG being the second-largest factor. The white paper suggests that the best way to mitigate barriers such as lack of awareness is to continue education efforts and ensure that resources are available to train staff.

SunCoast RHIO Sets the Bar for IG Adoption

Louis Galterio, MBA, HIMSS Fellow, CPHIMS, founder and president of SunCoast RHIO, knows firsthand the benefits of implementing a robust IG program. His organization, a regional health information organization (RHIO) actively exchanging patient information, was the first to obtain an Information Governance Adoption Model (IGAM)TM Level 4 award from AHIMA, a designation that he believes will function as a competitive advantage for healthcare organizations looking to join a RHIO.

“IG touches every aspect of our organization. But overall it makes me feel much more confident that I’m meeting and am consistent with regulatory requirements,” Galterio says.

RHIOs must comply with regulations set by the Office of the National Coordinator for Health IT and the Department of Health and Human Services’ Office of Inspector General.

“We also report quality measures, so data integrity is very important for us. When doctors want to report their quality data, they can do it through their EHR (electronic health record systems) or send us the data,” Galterio says. “It got me thinking in a more structured way and about the overall process, and that was extremely good for us. Now it’s much easier to have everything managed in one place. I have one place to go for all my policies. It helps me think about things I didn’t think about before.”

In working with his RHIO clients, Galterio says many organizations are working on IG-like programs, especially as healthcare mergers add complexity to harmonizing EHRs and master patient index data.

“Hospitals have been doing this, but they didn’t really have the structure of an IG committee to bring it all together,” Galterio says, referencing AHIMA’s recommendation that IG works best when interdepartmental committees collaborate and work together. “There’s a catalyst with the IGAM with AHIMA that makes people think about it.”

Data Governance Prioritized

Though the rates of IG adoption were lower than IG advocates would like, a bright spot illuminated in the most recent IG survey is the progress demonstrated by adoption rates and understanding of data governance. While the survey found that 30 percent of respondents affirmed data governance has been formalized in their organizations, data governance was the highest-rated IG priority in organizations with formalized IG programs. What’s more, respondents displayed a high degree of comfort with data governance projects, and data governance was the highest expected benefit of having a good IG program.

This wasn’t surprising for Fahy, who says data governance is a priority because organizations are struggling with data quality in areas such as their master patient index and metadata management.

“Some organizations already have some form of data governance going on so they are tackling IG by starting with the roots of information, data, and repurposing current data governance programs so that they align with the IG program. If you don’t have good data, you won’t have good information that can be used as an asset and for strategic decision-making,” Fahy says.

Recognition of data governance’s importance has grown rapidly in a short period of time, the white paper notes.

“It is of interest to note that the 2014 IG survey respondents ranked ‘lack of trust or confidence in data’ as the last/lowest level driver,” the paper states. “This could indicate that responders had a higher sense of the quality/trustworthiness of their data at that time. As organizations progress with their analytics efforts many are recognizing that added focus on data quality and on data governance efforts are critical to achieving trust in their data and information.”

Data governance is critical for many IG functions and provider operations—it enables more accurate data analytics, which providers can use for business intelligence and their competitive advantage, Downing says.

For example, every emergency department (ED) is trying to figure out how to get through patients faster to help decrease wait times. As long as 10 years ago, Downing says one major hospital chain in the Nashville area bought billboards that could be continually updated with up-to-the-minute information about wait times in their facilities—an early illustration of the power of data and metrics. Having good data helps administrators understand when their facilities experience the highest patient volumes, which enables them to more efficiently make staffing decisions.

“If a CEO says ‘I want to know how many patients had a fall when the nurse was on the 11th hour of their shift?’ they want to be able to pull a report out of their EHR [electronic health record] that shows how many risk factors there are. However, the EHR might only be able to show the number of falls, but there’s nowhere they can look to study data on nurses shifts,” Downing explains. “That’s the sort of thing you’re talking about when you start talking about data governance. ‘What’s our data quality, our ability to look at data across systems?’ That’s why it [data governance] comes up on the top of the list.”

Priorities for Information Governance

ACCORDING TO THE 2017 IG survey, data governance had the highest priority for IG projects at 43.1 percent. And considering the fact that the two next-highest priority projects (Data Dictionaries and Data and Record Inventories) are seen as a part of data governance/data management projects, that brings the overall percentage for data governance priorities to 76.5 percent.

Knowledge of IGAM™ Competencies

This 2017 survey question asked respondents “Which of the following IG competencies are you most familiar with or knowledgeable about?” Knowledge in organizational competencies signals professional readiness to support IG implementation and movement into emerging roles.

IG Adoption Levels

AHIMA’s IG team said they found it encouraging to see that a total of 33.2 percent of respondents’ organizations have initiated IG programs, either formally or informally. It was also encouraging to see that an additional collective 21.8 percent have recognized the need for, and have interest in establishing, an IG program.

Upcoming IG Activities

AHIMA’s recent IG survey and white paper will help set the tone and direction of the association’s IG work in 2018 and beyond. Now that they have a firmer understanding of just where the industry currently stands in terms of IG adoption, AHIMA’s IG team can begin updating training materials and content for organizations interested in launching their own programs.

Fahy says her team is developing a training program for IG consultants built around the Information Governance Adoption Model (IGAM)™. The IGAM is a tool that’s used to measure and evaluate IG readiness based on a set of 10 competencies. The training program, Fahy hopes, is similar to the “AHIMA-approved ICD-10 Trainer” model employed to train coding professionals on the new code set with the idea that they then go on to train others.

This follows the big IG news at the 2017 AHIMA Convention and Exhibit that IGHealthRate has been made free to the public, thanks to a co-branding partnership with the IG vendor Immersive.

The “AHIMA Standards for Information Governance in Healthcare,” a set of 80 IG adoption standards derived from all of the IGHealthRatematurity markers, will also be published soon, though whether they will be published as a textbook or a set of standards is yet to be determined.

Fahy’s IG team is also updating AHIMA’s IG Boot Camp training materials with an eye on the findings from the new survey. Another change is that AHIMA won’t be hosting an IG Strategic Forum in 2018. Instead, IG will become part of the content covered in the Privacy and Security Institute, which precedes the official beginning of the 2018 AHIMA Annual Convention and this year is named the Privacy, Cybersecurity, and Information Governance Institute, Fahy says.

Downing says that even though AHIMA is the primary resource for a lot of healthcare organizations working on IG, people want to hear more from their peers and see concrete examples about how their competitors are tackling IG. That’s another way the survey data helps AHIMA create training materials.

“When we see which areas [of IG] people are most knowledgeable about, and which areas they need the most assistance with, that helps us customize content… HIM directors may not always be involved in making strategic decisions in their organization. We need to make sure they know how to get to the table for IG projects and that they understand how IG supports strategy,” Downing says.

Mary Butler (mary.butler@ahima.org) is associate editor at the Journal of AHIMA.

Article citation:
Butler, Mary. "IG Pulse Check" Journal of AHIMA 89, no.2 (February 2018): 17-21.