Healthcare's Data Revolution: How Data is Changing the Industry and Reshaping HIM's Roles

By Lisa A. Eramo

The hunger for analyzed healthcare data to improve delivered care and to better meet quality measures is spurring a revolution in healthcare. Providers are demanding better health IT systems that allow HIM and data analytics professionals to sift through large amounts of data and turn it into "information" that can change the business and function of healthcare.

Rayan McMackin, CHDA, CCS, MHA-INF, senior data analyst at Minnesota-based New Ulm Medical Center, part of Allina Health, won't hesitate to tell you how the hunger for healthcare data can reshape an HIM department. She knows first-hand having worked through many different transitions.

McMackin began working at New Ulm Medical Center 13 years ago as a file clerk and then as a coder. She eventually learned how to write queries to access her hospital's enterprise data warehouse so she could report on hospital charges. As the need for data analysis grew, McMackin moved into her current role, reporting to the director of operations. She spends most of her time writing structured query language (SQL) queries, running scheduled and ad hoc reports, and attending meetings to explain the data and make suggestions for process improvement.

"Everything changes and evolves, and it needs to," says McMackin, adding that her employer has supported her through each transition, providing any extra training she needed to perform her duties.

New Demand, New Roles, Old Work

Although the formal title of data analyst may be new for some, the function and responsibilities are anything but novel, says Gloryanne Bryant, RHIA, CCS, CDIP, CCDS, a HIM consultant based in Fremont, CA. HIM professionals have long been lauded as the individuals who can tell the stories behind the numbers, explaining such concepts as morbidity, mortality, and diagnosis statistics as well as shifts in case-mix index, she says.

"Some of the core competencies of HIM directly relate to data analysis," she says. "Understanding what the data is telling you is key to the HIM role."

However, now the numbers have grown and the stories have become more complex. Having an effective narrator of those stories is essential. Eugene Richard, RHIA, CHDA, CCS, CCS-P, coding integrity program manager at Stanford Hospital and Clinics in Redwood City, CA, says his job revolves around data, particularly chargemaster data. Not only does he update the chargemaster when annual code changes are published, but he also educates clinicians, department members, and staff about those changes and projects the effects on reimbursement. He frequently monitors payer coverage and ambulatory payment classification code (APC) changes and presents data to managers who can make informed business decisions.

For example, when a department wants to provide point-of-care lab testing, Richard determines whether it's financially beneficial to do so or whether it's better to send patients to the lab for testing. "There may be no difference in reimbursement, but there may be additional costs involved. The differences in cost need to be weighed against patient convenience and quality of care issues. There are many variables," Richard says. "We would help them analyze the information and identify how much time, energy, personnel, and supplies in each clinic [are needed] to do their own point of care testing. You have to do a fair amount of data mining in order to perform this type of data analyses."

Richard currently reports to the director of charge description master (CDM) and revenue management. Three other revenue integrity program managers also report to this individual, as well as a senior financial specialist who serves as a liaison with the IT department.

Richard says data analysis will eventually become a part of every HIM professional's job. "Information management is migrating toward an entirely electronic medium," he adds. "Paper is quickly becoming a thing of the past. You have to be able to feel very comfortable working with electronic data. Most of the time, it's just raw data. You have to know what to do with it."

As the demand for data expands exponentially, HIM professionals will increasingly be called upon to harness data's power, explain its context, and help to ensure its integrity. Experts say HIM's unique combination of clinical and IT skills makes them ideal leaders in the emerging data revolution.

The Data Explosion

In the past, only payers were able to tap into voluminous healthcare data and use it strategically, says Kris Joshi, global vice president of healthcare at Oracle. "Payers had all of the claims data, so they knew who was getting paid how much and could actually do some analytics on it to compare different providers," he says. Many providers, on the other hand, were typically unaware of the information about them that was being generated.

This dynamic is quickly evolving as providers realize that they, too, can tap into a data goldmine. "They're realizing that they can't just generate the data, send off the claim, and let somebody else worry about [the implications]," Joshi says. Providers are realizing that they need similar or even more robust analytics capabilities than payers in order to thrive in today's healthcare market. The good news is they may have an advantage. Unlike payers who can only access claims data, providers have access to both financial and clinical data, he says.

Ben Loop, senior director, analytics and business intelligence at Siemens Healthcare, says the data explosion can partially be attributed to initiatives such as the "meaningful use" EHR Incentive Program and the move to value-based purchasing, both of which have essentially mandated the collection of data. "Everybody is moving into analytics and business intelligence in a fairly significant way," Loop says. "It's not just the early adopters, large health systems, and academic research. It's really all the way from there down to critical access hospitals and community healthcare settings.

However, simply collecting the data isn't sufficient. Providers want to understand it as well, says McMackin. McMackin frequently answers questions about data related to meaningful use, such as where that data resides in the EHR or what numbers drive a particular statistic.

As the industry shifts from volume-based to value-based reimbursement, data—and its implications—becomes the hot commodity, Loop says. "Even if the data has been there [to show the efficacy of a particular procedure], now there is accountability for the performance. Now you have to report on performance, and you're accountable to a performance threshold." he adds.

"There are payment withholdings if you're not at the top of the distribution curve."

Pay-for-performance and the push for greater efficiency has forced providers to look more closely at what their own data are telling them, says Susan E. White, PhD, CHDA, associate professor, clinical health and rehabilitation sciences at Ohio State University. Many organizations are using predictive analytics, for example, to improve care. "Predictive analytics allows you to look at the profile of your patients and what your book of business usually looks like and then set up triggers for when you're going off track," she says. "So it really allows you to be more efficient."

Organizations are also using predictive analytics to avoid penalties related to hospital-acquired conditions and 30-day readmissions, she says. Some accountable care organizations, health plans, and other providers use predictive modeling to identify patients who could benefit from personal healthcare and one-on-one interventions, such as those who are more likely to be non-compliant with post-discharge medications because they live alone.

"Our customers are all trying to streamline their operations and align information across the enterprise and put it out at the front lines for those who can drive performance [improvement] and change management," Loop says.

Data is also being used in population health. For example, some healthcare organizations are looking at disease patterns and genetics to identify habits or traits that make people healthier or unhealthier, White says.

Personalized medicine is an ever-evolving area of healthcare that requires an enormous amount of data about an individual's biology and his or her disease or condition, Loop says. "There's a lot of work done to incorporate all of this information as well as mine data from large populations and look at comparative effectiveness," he says.

HIM Fosters Data Integrity

HIM plays a crucial role in collecting, mapping, and ensuring the integrity of the data that supports business intelligence and clinical support, Loop says. HIM professionals understand care process, quality management, reimbursement, and terminology/nomenclature. "Nobody else has this global view," he adds. "They can contribute the most by capitalizing on their unique position in the provider space."

However, HIM professionals know that data carries with it a host of inherent challenges, all of which they are qualified to handle. First, there are privacy challenges. Data must be de-identified so that those working with it don't have access to protected health information (PHI). Second, there are concerns about the growing volume of data. "The more you have, the more you need to understand what you're looking for," McMackin says. HIM can not only hone in on the most important data elements, but they also know where and how to access that data, she adds.

"Too much [data] isn't a bad thing, but what can happen is that you can get data that looks like the same from different sources, but it's significantly different," Richard says. "It's like the old saying, 'A man with one watch can tell you exactly what time it is. A man with two watches is never quite sure.'

"You've got to be able to look at it and say, 'Is this accurate? Is this complete? Is this what I really need for this project? If I need to clean up the data, how do I go about doing it?'"

Data integrity is also an ever-present challenge, given the sheer number of data users, Bryant says. "We have to ensure that we can rely on the data. We don't want garbage in, garbage out," she says. "You can have a lot of data, but what if it's wrong? We need HIM to provide oversight for data integrity." HIM collects the data, but the department staff also ensures that it's correct. "This is a challenge because we have many sources and users—far more than we had 20 years ago especially with EHRs," Bryant says.

Patient-entered information also presents challenges and could raise data validity concerns during analysis, says McMackin. However, patient-entered data could also provide a greater context for information. "With the PHR, there must be standards in place for certain data elements," Bryant says. Personal health record (PHR) data must also be clearly labeled as such. Part of the data analysis would be to compare and contrast the PHR and EHR to see whether it's consistent.

New and Emerging Data Roles

The data revolution will certainly increase opportunities for HIM professionals who are willing to think of creative ways to use the data to improve their work and the work of their facility, Bryant says. New and emerging roles include—but aren't limited to—terminology analyst, data reporting analyst, and clinical informatics reporting analyst. "All of these require the expertise to acquire, manage, and manipulate the data and interpret it for others," Bryant says.

Healthcare data analyst roles are becoming more common, especially in institutions that have roles centered on data management and use analytics for secondary purposes. These roles are typically filled by IT and HIM professionals, Joshi says.

HIM is also well-suited for the role of business operations analyst, Loop says. An individual in this role provides actionable data that drives process improvement and is actively involved in executing goals and providing data to measure outcomes along the way.

Siemens Healthcare often hires HIM professionals as business analysts when developing analytics solutions. "HIM is really useful for us as a talent base because [people with those skill sets] can really pull together the big picture," he says. "These analytics solutions are requiring more and more often that we break down the silos between clinical, financial, and operational data and pull it all together to get an enterprise view of performance for the healthcare provider.

"People with an HIM background have this lateral view."

Data governance analyst and data mapping specialist are two other important roles for which HIM is qualified, says Denise Dunyak, MS, RHIA, FAHIMA, marketing manager, HIM and ICD-10-CM/PCS initiatives, at Siemens Healthcare. As systems and code set changes occur, HIM professionals must ensure that data is mapped correctly. And as facilities incorporate best-of-breed and other solutions that feed into data streams, HIM must also be involved in all of these implementations to ensure that what's being captured is correct, Dunyak adds.

"HIM professionals, particularly those who are certified data analysts, can evolve into data scientists," says David Dimond, chief strategist, healthcare solutions at EMC. "So much of what goes on in data science and Big Data isn't necessarily about data models. It's much more around the stewardship of data and how the data can be refined going forward."

Those interested in data scientist roles typically possess higher-level statistical and IT knowledge to understand data architecture. However, these domains are certainly within reach for HIM professionals, says Dimond. The title of data scientist is flexible. For example, it may encompass a more active facilitator role working with outside organizations such as ambulatory care, physician offices, and home health agencies. "A lot of the patient data is transcribed or paper-based. What a data scientist would do is facilitate that data and revise how it's captured or look at how to evolve it and maybe capture more data," Dimond says.

Many universities have created professional master's degree programs and degrees specific to healthcare informatics. EMC has also developed a data science curriculum that it shares with universities. McMackin says Allina Health is currently hiring privacy and security data analysts in its HIM department. Unlike McMackin, who is more of a generalist in terms of data analysis, these individuals will focus specifically on auditing and running reports related to the privacy and security of health data.

Data Initiatives Pave the Way for HIM Involvement

Experts agree that it has always been difficult for HIM professionals to break free from the perception that the profession is focused on coding, data entry, record keeping, and little more. Overseeing data from its creation to the time it becomes obsolete and is deleted—termed life-cycle data management—is one way in which HIM professionals can put a new spin on something they've always done, Bryant says.

"Life-cycle management of data is the management of Big Data. It's the governance of the data," she says. "We've always overseen health information. Now we're declaring that the data is key to HIM leadership."

ICD-10-CM/PCS will certainly be a game changer because it will allow for a deeper type of analytics that simply wasn't possible before, Dimond says. It will also provide opportunities for HIM professionals to become more involved because they understand the new code set and its added specificity.

For now, focusing on data quality and integrity may be one way that HIM professionals can get their foot in the door, Dunyak says, especially in new and emerging quality-related roles such as data quality managers and clinical data quality specialists. "Based on our [HIM] background and education, I think a lot of the skill sets are inherent. You need to be a logical thinker, you need to be organized, and you need to be able to interpret and analyze data," Dunyak says.

The increased focus on quality of care and pay-for-performance practically paves the way for HIM involvement, Loop says. HIM professionals can assist with data sampling and quality assurance for various quality initiatives. "If HIM isn't getting invited to the table, they need to force themselves there, and smart CEOs are bringing them proactively," he adds.

Since analytics and quality go hand-in-hand, there is a need for HIM involvement and expertise in data roles. "One of the areas where data quality and data integrity is most important is analytics," Joshi says. "Analytics magnifies the scope of any problems in the data. When you're doing analytics, the value of data quality is absolutely paramount."

Lisa Eramo (leramo@hotmail.com) is a freelance writer and editor based in Cranston, RI, who specializes in healthcare regulatory topics, HIM, and medical coding.