IG Roundtable: Assessing Organizational Progress in Implementing IG Practices

Rita Bowen MA, RHIA, CHPS, SSGB; Cindy Phelps, RHIA; and Maria A. Muscarella, RHIA

While some healthcare organizations have made progress in formalizing information governance (IG) programs, many remain in the infancy phase of planning and implementation. At the 2015 Annual HIMSS Conference and Exhibition, the session “Seven Opportunities for Stronger Information Governance” attracted 800 attendees. Of the 400 attendees who had initiated a program, fewer than 20 said they were 25 percent of the way through implementing their programs, according to estimates given by meeting organizers. Challenges included leadership support, proving a need for IG, education, planning, and monitoring.

As healthcare continues the transition to an electronic environment, enterprise information governance must pick up the pace. Poor IG practices affect quality of care, patient safety, compliance, and financial performance. Information is a strategic asset that requires effective IG practices.

In a roundtable discussion led by Rita Bowen, MA, RHIA, CHPS, SSGB, senior vice president of HIM at HealthPort, HIM professionals discussed the status of organizational IG and data governance implementation, challenges that hinder progress, and strategies for securing support and charting a course for the future.

Rita Bowen: Where is your organization in the process of implementing information governance?

Cindy Phelps, RHIA, director of HIM at Carilion Clinic’s technology services group: We’ve adopted a data governance framework that builds on AHIMA’s IG principles, but have not begun full implementation. As an initial step, we established data definitions to ensure consistency throughout the organization. Additionally, IT governance, data stewardship, data quality, and policies alignment are quickly developing. It’s a work in progress, with a solid foundation.

Maria Muscarella, RHIA, assistant vice president, HIM, EMR and privacy officer at Newark Beth Israel Medical Center: We’re in the early phase as well. Our EMR [electronic medical record] has been up and running for a year and a half, and we’re currently introducing IG at the traditional medical record committee level.

Bowen: In your experience, what are the main challenges to initiating an IG program?

Muscarella: Getting everyone to understand why we need IG is a hurdle. Prior to implementing the EMR, many were under the impression that it would cure all that was wrong in the paper world. However, like most organizations, we’ve identified new issues with the EMR. The integrity of the record has taken on a life of its own, one that requires enterprise-wide governance and management.

Phelps: Securing leadership support is a key challenge. Without top level involvement, we have no chance of succeeding. Providing education is also important for adoption. We’re in the process of educating everyone in the organization about IG, seeking every opportunity to give presentations at management meetings to make the case. Alignment with similar programs is essential to longevity. If competing programs drift, rather than converge, IG may suffer unrecoverable collateral damage.

Muscarella: Another pressing challenge is that we want to avoid adding another committee. We need everyone who documents in the record to own IG—physicians, nurses, and other ancillary disciplines. As HIM professionals it is our role to ensure that clinicians understand the importance of concise, clear, quality documentation. In so doing, we also have to make it as user friendly as possible, so that time spent caring for patients is not diminished by time spent documenting.

Bowen: What is the role of HIM in the process? How are they taking the lead in IG?

Phelps: I’m not as involved in the IG project as I would like, though I keep pushing. HIM professionals have to be assertive to assume a lead role. I am primarily involved in security governance which falls within the overall IG program. I do see HIM roles changing, increasingly embedded throughout healthcare organizations like Carilion Clinic, a multi-specialty system including six hospitals and six HIM departments. The opportunities are there for HIM to guide IG implementation.

Muscarella: I see HIM taking a lead role. In our organization, I’ve engaged the medical record committee as a vehicle for getting started. While it’s a multidisciplinary group that looks at basic documentation discrepancies, I don’t see it becoming the IG team. We need a dedicated IG group to identify and address the complexity of documentation challenges. We’ve performed qualitative reviews to focus on issues from a data integrity perspective. We also have a significant role with IT, working hand in hand to identify IT issues that are hindering progress. HIM is definitely steering the effort.

Bowen: Do you have executive support, and who are your most valuable champions?

Muscarella: The CMO and medical department chairpersons, along with the assistant vice president of standards and the assistant vice president of quality will play an active role as champions of the IG initiative.

Phelps: We have strong executive support from our chief strategy officer, chief operating officer, chief financial officer, chief information officers, and chief medical information officer. Working closely with HIM and other disciplines, they have emerged as our most valuable champions.

Bowen: How do you engage senior leadership?

Phelps: Senior leadership evolved through the CMIO, chief strategy officer, and an IT director who is passionate about data governance and has helped drive IG for the organization. We have to show how IG enables the organization to set strategic priorities and achieve its goals, such as quality of care, cost reduction, compliance, improved outcomes, and accurate reimbursement.

Muscarella: HIM must be assertive to be heard amid competing priorities. This is a challenge. Patient safety is a priority for all disciplines at all levels. There is a strong focus on core measures, as well as the patient safety indicators. Given such quality initiatives, it is the perfect platform to move into the data governance realm. We’re strengthening the effort, engaging clinicians who are already pro quality and patient safety—clinicians who understand the importance of quality documentation. As a result, the chairperson of the patient safety committee and chairperson of the department of surgery have also stepped up as key leaders.

Bowen: Discuss the importance of collaborative leadership and creating a multidisciplinary team.

Phelps: Enterprise-wide collaboration among disciplines is critical. Our multidisciplinary team includes quality, auditing, reporting, medical management, privacy and security, compliance, and IT. The emphasis is on three aims: data governance, security governance, and technology governance. Our chief strategy officer is leading projects focused on pay for performance, population health, patient engagement, and others that require governance and management practices. Simply put, IG really comes down to everyone doing the right thing. Bringing the entire organizational family together and sharing in this effort is required.

Muscarella: Having a multidisciplinary team is essential to prevent “tunnel vision.” Through collaboration, HIM gets a broader perspective and is better equipped to meet the challenges of the EMR and to successfully implement an IG program.

Bowen: How are you working with IT to achieve IG?

Phelps: I have the security governance piece—oversight and controls of information flow, how information is requested and provided. IT is driving the information governance effort with a primary focus on shared enterprise-wide partnership and accountability. It is important to note that our CIO and other executive champions support all aspects of IG, not just the privacy and security components.

Muscarella: In our organization, teams at the corporate level look at EMR data from a structured perspective—templates, documentation. All change requests are channeled through a dedicated change request group to ensure standardization across the board at a local level. We work closely with IT to ensure any issues are addressed immediately.

Bowen: How can HIM professionals help make the case for IG?

Muscarella: It’s up to HIM to demonstrate why governance is necessary, how to get there, and develop an effective IG process that is functional and makes a positive difference. Our role requires bringing a multidisciplinary team to the forefront to prove the value of information governance. HIM must be active, assertive, informed, and keep pushing to be heard. Some of the data integrity challenges we face are the result of not being at the table when systems were developed and rolled out. Taking a seat at the development table—invited or not—is critical.

Phelps: With a strong clinical, regulatory, and financial background, HIM professionals have the knowledge and expertise to lead an interdisciplinary approach. HIM is well positioned to help senior leadership make the case for IG. HIM knows how information is collected, where it’s going outside the organization, and how it is used during the patient stay and after discharge. We bring unique talent and experience to the C-suite table.

Bowen: What challenges do you see ahead, and how should HIM assume a leadership role?

Phelps: One big challenge is the acquisition of ambulatory practices. As these offices are on-boarded, HIM plays a key role incorporating records from other systems. HIM leadership is essential in this process. I’ve invested a significant amount of effort reaching out to help establish best HIM practices, assisting with standardization—setting up ROI processes and transferring paper records to the EMR.

Bowen: This is definitely an avenue for the expansion of HIM leadership roles. Many larger systems are establishing a service line for HIM across all settings, versus a single department as in the past. This is being done through knowledge of information governance.

Muscarella: From a larger perspective, we don’t know how data will be used in the future. With ICD-10, data quality becomes even more critical. EMR technology is in the early stages of development, much like a Model T Ford versus the vehicles of today. We can’t be sure where we’re going with all the data collection. That’s why it is so important for HIM to serve as responsible stewards and leaders of IG, managing information assets for all stakeholders as we bring the future of health data forward.

Bowen: Yes, and if we don’t get the foundation right internally, we are at risk of having government regulations manage healthcare information for us.

Looking to the future, AHIMA recently announced plans to launch pilot projects in which organizations will use the IG principles and IG maturity self-assessment in actual practice. AHIMA has also recently completed another IG survey focused on professional IG knowledge and readiness, along with organizational progress in implementing IG practices.

HIM professionals have an ideal opportunity to guide enterprise-wide information governance and management for their organizations. Now is the time to lead the way as catalysts for change—making the case for IG.

Acknowledgement

AHIMA thanks ARMA International for use of the following in adapting and creating materials for healthcare industry use in IG adoption: Generally Accepted Recordkeeping Principles® and the Information Governance Maturity Model. www.arma.org/principles. ARMA International 2013.

Rita Bowen (Rita.Bowen@HealthPort.com) is senior vice president of HIM at HealthPort. Cindy M. Phelps (cmphelps@carilionclinic.org) is the director of HIM at Carilion Clinic’s technology services group. Maria A. Muscarella (mmuscarella@barnabashealth.org) is assistant vice president, HIM, EMR and privacy officer at Newark Beth Israel Medical Center.