Editor’s Note: This practice brief has been updated. See the latest version here. This version is made available for historical purposes only.
Securing the support of senior leaders for information governance (IG) requires demonstrating how the initiative enables the organization to better achieve its goals and strategies with trusted, reliable information. Healthcare is a highly regulated and competitive industry. This is reflected by the top issues identified as C-suite executive challenges from the report titled “Into the Minds of the C-Suite.”1 These issues include:
- Managing the switch to value-based reimbursement models
- Coordinating care
- Managing patient population
- Patient engagement
- Managing data
- Regulatory compliance
- Improving information security
Information governance does not appear on this list, but when implemented properly IG can position an organization to effectively and efficiently overcome these challenges—resulting in a return on investment for the organization. To “sell” IG to executive leaders and secure their sponsorship, health information management (HIM) professionals should build the case by demonstrating how the organization can use quality information to achieve the triple aim of reduced costs, better care, and improved population health. Trusted information strengthens every organizational strategy.
More often than not today, IG is a tough sell. Unless there has been some major compliance sanction, fine, legal loss, or colossal data breach, it can be difficult to make the business case for IG. In fact, “the largest impediment to IG adoption is simply identifying its benefits and costs,” according to the Economist Intelligence Unit.2 Sure, the enterprise needs better control over its information. But how much better? At what cost? What is the payback period and the return on investment?
HIM professionals can and should provide leadership in IG regardless of the position they hold. Below are examples of how HIM leaders are involved with enterprise information governance and implementation of programs that demonstrate return on investment.
Examples of IG’s Return on Investment
Karen Proffitt, MHIIM, RHIA, CHP, is vice president of identity enterprise solutions for Just Associates, Inc., a consulting firm focused on identifying and resolving patient data and integrity issues. She has worked with several healthcare clients to centralize management and control of the enterprise master patient index (EMPI) for accurate patient identity. She recommends that the EMPI strategy, policies, and performance monitoring initiative be a key component of an enterprise information governance program. The return on investment for EMPI program centralization and management includes increased efficiency, productivity, and reduced costs. To achieve the return on investment, Proffitt recommends HIM be the owner of the EMPI, as they are uniquely qualified to provide:
- One authority for adoption of consistent maintenance methodologies
- Standardized/simplified error correction processes
- Consistent MPI conversion decisions with minimal required resources
- Numerous hand-offs minimized to improve turnaround times
- Cross-trained team members who are interchangeable for coverage
One of Just Associates’ clients who implemented centralized EMPI identified a potential return on investment in the form of full-time employee (FTE) reductions. Previously under the decentralized model there were 40 FTEs with a cost of $21 per task for duplicate medical record number reconciliation. Under the centralized model, the total staffing decreased to 21 FTEs, and the duplicate reconciliation cost was reduced to $12 per task. Another example of total EMPI centralization for eight hospitals in a corporate structure model resulted in an overall savings of $4.6 million.
A focused strategy to minimize duplicate medical record number creation can lead to additional reduced costs. The average cost of a duplicate medical record is $100 due to delayed treatment, duplicate tests, and other administrative issues. Another Just Associates client had significant FTE reductions from 24 to nine by centralizing the EMPI and reducing duplicate creation rates. These examples provide compelling rationale to initiate an enterprise information governance program with centralized EMPI. This is IG at “ground zero.”
Seth Jeremy Katz, MPH, RHIA, is the assistant administrator of information management and program execution at Truman Medical Centers, located in Kansas City, MO. He has been involved in multiple IG projects as directed by Truman’s IG committee, named the Analytics Coordination Team (ACT). ACT is focused on all aspects of data governance at Truman, with their current attention placed on data reporting standards, information technology (IT) project life cycle, balanced scorecards, and data flow diagrams. Even in the absence of documented financial return on investment for these projects, Katz says he believes IG is “the right thing to do.” The return on investment is manifested in increased efficiency, accuracy, transparency, and reliability of data for the organization’s internal processes. All employees have access to actionable analytics to drive measurable results in real time at Truman Medical Centers, as demonstrated by these examples:
- The Data Quality Standards Committee (DQSC) was established to review every data request ticket. Analysts from all the different Truman reporting systems (i.e., electronic health record system, billing system, etc.) sit on DQSC and ensure the validity and consistency of the requested data, while also determining the “source of truth” for the requested data. DQSC maintains and reviews the organization’s report inventory to determine if there is an existing report that may be easily modified to satisfy the request and senior leadership must approve each request, requiring the requestor to complete a business case answering the basic question of “Why are you asking for this data?” The Data Quality Standards Committee has streamlined the data request process and reduced the turnaround time for most reports to four hours or less.
- The IT project life cycle process was completely overhauled at Truman Medical Centers to better streamline the approval process. The Project Management Office drives this and ensures there is a standardized governance structure for all IT-related projects.
- A balanced scorecard for departments and the organization as a whole is now available with real-time dashboards offering “at a glance” reviews. The CEO was the executive sponsor of the balanced scorecard with a goal to have analytics available to drive strategic change with measurable results.
- ACT’s current focus is on creating data flow diagrams, which provide visual representations of data flow and touch points for all major systems. Though a time consuming task, the end result will help safeguard the security of data as it flows through various systems.
IG Helps in Mass Consolation of Alberta Health Services
In May 2008, 12 separate health regions united to become Alberta Health Services, the health services delivery organization for the Canadian province of Alberta. Alberta Health Services includes 126 hospitals and all other healthcare services with the exception of primary care facilities. Kathleen Addison, CHIM, was appointed vice president of HIM at Alberta Health Services, responsible for implementing a single provincial HIM service delivery model.
Soon after the 12 regions consolidated, IG issues became apparent, most obviously in health information exchange with an absence of enterprise data standards. Each former region had implemented data standards in their own way with little data integrity monitoring in place. As an example, when community lab results began to be shared, it was discovered that the data elements weren’t defined and used in the same way nor entered into the appropriate data field for each region. Lab results were going to the wrong patient’s medical record—an obvious patient safety issue. This was a wake-up call and a lesson learned about the urgent need for IG and data standardization prior to any new projects being launched. The lab data standardization program had an unquestionable return on investment of ensuring quality patient care, safety, and risk avoidance.
Another Alberta Health Services IG initiative with a return on investment of increased patient safety was the enterprise patient identity management program. A provincial Registration Standards and Practices e-Manual was created as a standard for patient identification. Thanks to this IG initiative, when patients seek healthcare anywhere in Alberta the same data elements will be collected in standard formats and the same questions will be asked regarding patient identity. The goal is that all patient registrars will receive and follow the mandatory online training.
Within Alberta Health Services, an enterprise IG framework was established with six standing committees. The IG program was aligned with key organizational strategies. Regarding HIM being at the IG table, Addison says that “it requires a constant pumping of life support for many battles—some you win and some you lose.”
Additional opportunities for enterprise IG return on investment can be found in e-discovery activities and enterprise-wide retention schedules. By proactively managing information exposed to e-discovery and simplifying the task of finding and producing information, one can significantly reduce the cost of discovery. A comprehensive retention schedule that applies to clinical, business, and operational records and unstructured data such as e-mails, word processing documents, and social media is a fundamental requirement for sound governance and management of information. Return on investment includes lower storage costs and avoidance of legal and compliance risks.
IG Fosters ‘Return on Information’
At AHIMA’s 2015 Annual Convention and Exhibit, Deborah Green, MBA, RHIA, executive vice president and chief innovation and global services officer at AHIMA, summed up why information governance means real return on investment:
“As organizations move up the IG maturity curve they increase their ability to trust and leverage their data and information, minimize risk, and make critical decisions confidently… we like to call this, in IG terms, return on information.”
IG is a multifaceted initiative that requires additional training and expertise from HIM leaders. February is IG month at AHIMA, featuring free IG webinars and two IG boot camp events. It’s important that HIM professionals find their place in IG and lead.
- peer60. “Into the Minds of the C-Suite.” 2015. www.peer60.com/wp-content/uploads/2015/01/Into-the-Minds-of-the-C-Suite-Quick-Report-by-peer60.pdf.
- Smallwood, Robert F. Information Governance: Concepts, Strategies, and Best Practices. Hoboken, NJ: John Wiley & Sons, Inc., 2014.
Mary Reeves, RHIA
Reeves, Mary G.
"Why Information Governance Means Real Return on Investment - Retired"
Journal of AHIMA