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 “interstate integrated delivery system.”
Executive Information Governance Program Sponsor
Director of Data Quality
This facility is an interstate integrated care delivery system with a wide range of inpatient and outpatient services. It is one of the largest integrated healthcare systems in the United States.
The organization has:
- More than 100 hospitals
- 1,400 outpatient clinics
- 50,000 providers
- 8 million visits
This organization has had an information governance program in place for more than 10 years. The goal of their information governance program was to ensure that patients’ records could be accessed and retrieved at any of their system locations, creating a single source of truth for seamless coordination of care. The organization also formed a data council which aids in tying together all of the data from each separate facility at the enterprise level.
Prior State Analysis
As mentioned, this organization has had an information governance program in place for more than a decade. Prior to that time, there was a decentralized model for data collection and analysis. However, the decentralized model made care experiences inconsistent for their patients and coordination of care was not always efficient. The desire to ensure seamless transitions of care throughout the network of providers, regardless of geographic location or setting, prompted the organization to developing a consortium at the enterprise level. The goal was to make certain that information was available when and where needed for patient care. There was also a desire to analyze patient data for improved outcomes that could not be effectively accomplished with the prior model. In addition, there was a desire to benchmark physician productivity, which was difficult to accomplish.
Information Governance Drivers
The organization wanted consistent data across all of its facilities that would enable them to analyze the data for trends. Data was inaccurate for decision making, and third party billing was difficult, which created reimbursement issues. There was also a desire to monitor physician productivity and enable more functionality for downstream data use.
Highlights of the information governance program include:
- An enterprise wide consortium to capture and disseminate information across the entire care delivery system
- Executive staff working together to achieve a common platform
- A charter establishing a data governance council
- Data governance council used as a central governing body for information governance efforts
Information Governance Program Structure
This organization uses a hybrid approach to their management of information. They have created a centralized authority (consortium) with a decentralized model allowing individual organizations to have some control and decision making authority for information obtained at the local level. The enterprise data council is led by the Director of Data Quality. Within the consortium are representatives from all areas of the business, including HIM, finance, the business office, clinical and patient care leadership, information systems, privacy/security, and nursing.
Components addressed with the enterprise information management governance structure include information access, security, and confidentiality; information integrity and quality; information design and capture; data warehouse maintenance; content and records management, and information analysis, use, and exchange.
A roadmap has been developed to assist in building more infrastructure, with an increased focus on metadata, ensuring that information is interoperable and can be exchanged with any health system. There are plans for greater use of analytics to improve outcomes and developing improved methodology for data capture and use. Work groups have also been established to evaluate data management and data architecture.
This organization has clear processes in place around sun setting of IT systems, and centralized authority over the acquisitions of new systems or upgrades to existing technology. They have the ability to quickly address any data quality issues that might arise, as well as have practices in place to quickly address any type of privacy breach.
The organization has future activities planned to better analyze and improve their data quality.
IG Benefits Realized
The organization reports that they have seen a lot of positives from the information governance program. They have achieved a network-wide health information exchange across their entire care system. Coded information is used to tie patient conditions with clinical reminders. There is easier access to information for decision making, and the organization has an increased confidence in the accuracy of their data.
This organization had an enterprise consortium for more than 10 years which is composed of council representatives from all the various business units and led by the Director of Data Quality. The organization recognized a desire to utilize data downstream, which led to a requirement for consistent data to analyze for trends. Third party billing was difficult under the previous model, as was analyzing physician productivity.
No individual leader was responsible for getting buy-in for the IG program. Instead, it was driven by a desire to improve coordination of care and improve patient outcomes across the organization since many patients seek care at multiple geographic locations. Health Information Management staff are responsible for looking at data for peer review at the enterprise level and evaluate data for the establishment of patterns. HIM staff also provide training to clinicians on CPT and ICD coding, and they give education to staff and coders on proper code assignments.
The formation of the consortium has brought executives together from across the system to achieve a common goal, and this has resulted in an improved culture of care for the populations the system serves.
"State of Health Information Governance in Healthcare: Case Study—Interstate Integrated Delivery System"
(AHIMA, February 2014)