Moving the Needle toward a Data-Driven Health Care System: Optimizing the EHR through Information Governance

Developing a Program that Engages Critical Owners and Has Executive Support Will Help Ensure Success The recent 2013 HIMSS National Meeting provided a glimpse into a more mature electronic health record (EHR) environment, where quality, performance improvement, patient engagement, and reimbursement models are under close scrutiny and strategies addressing those topics center around EHR.

Across the board, the message was clear that the EHR has progressed from implementation to optimization and that provider organizations are beginning to realize the benefits of EHR technologies in their service delivery models, using them to better support clinicians in utilizing best practices of care as well as a means to capture data that provides evidence of care quality; they also can be used for decision-making.

But how do organizations move from implementation to optimization? In spite of health care reform's focus on data-driven care, organizations still face many challenges in getting and using the right data. The organizations that are doing it best describe multi-phased, multidisciplinary approaches to getting the right information out of their EHR and, in fact, all their hospital information systems. Management of information across the enterprise, through information governance (IC), can help organizations optimize their technology resources to become data driven.

Hawaii Pacific Health, the 2013 Davies Award Winner from HIMSS, set a goal of demonstrating a return on investment (ROI) from its EHR to kick start its in maximizing the EHR. The company focused initially on a revenue cycle measure, improving (decreasing) its "cost to collect" as a means of demonstrating its ROI. To address the problem, the company gathered a multidisciplinary team with representation from finance, information systems (IS), patient safety, health information management (HIM), clinical staff, and other frontline users (such as registration and scheduling staff)

Tackling the problem from the perspective of the data, the company first had to agree on which data was critical to understanding and/or solving the problem. Early on, Hawaii Pacific realized that a lack of standardized internal definitions was making it difficult to apply consistent measurement across the organization. The organizational team, in coordination with their vendor, came to agreement on key data and definitions that were needed (what was the point of collection; was it coded data or data generated directly from the patient encounter; if there were multiple collection points, which system or data field was the source of truth). They were able to identify areas where data was not captured accurately (basic data did not match across various reports and/or functional areas) and develop a solution to get it corrected (determining whether it was a people, process, or system issue) to bring improvements to the patient administrative workflows.

Once they achieved success in the revenue cycle cost of collection indicator, they turned their attention to clinical quality indicators, making significant improvements in obstetric and pediatric care and, ultimately, using their EHR and other information systems to bring improvements to the population health of their care constituency, with outreach to patients for screenings and chronic disease management.

To make this happen, the organization made it a priority to get maximum value from its technology systems and the data. The company recognized the value of the information as a key resource and asset in achieving quality of care and used the data and its EHR to achieve improvements in its bottom line and clinical quality of care.

The recognition that the information is a valued asset is a key first step in information governance (IG), a structured approach to managing the information systems and data of an organization. An information governance program sets a structure of accountability for the information assets, sets priorities for the overall management of the organization's information systems and data, and ensures policies and procedures are available to guide the appropriate use of data, from initial capture through retention or disposition.

A fully established IG program must address information quality, the information lifecycle, security and privacy of information, and data and documentation standards. When Hawaii Pacific Health focused on improving its bottom line through its information assets, it focused on the information quality aspect of IG, drilling into the data to determine what it really needed and how to get it accurately captured.

Where does your organization fall in the information governance spectrum? If you are not aware of an established data or information governance program, you can do a quick pulse-check of your organization's information assets with these questions: When you try to get information or data to solve a problem, is there a clear way or place to get it (dashboards, current reports, et cetera)? Once you do get it, is the data in good shape, and ready to use, or does it need a lot of re-work? Does it seem that every data project requires cleanup of the data? Do one or more persons have responsibility for data quality, ensuring that data is collected appropriately and consistently? These are all facets that should be addressed in an information governance program.

Where do you begin, if a program is not already established? The place to start is policy each year and requiring each employee to submit a signed acknowledgement that they received the policy is an effective method of keeping the policy fresh and relevant.

CONCLUSION

Email has become an essential and effective communication tool in conducting day-to-day business; however, there are also some inherent risks associated with the use of email. This article has attempted to highlight some of these risks and to offer some very common-sense solutions to help reduce that risk. A comprehensive compliance program will have a very detailed section on the use of email and what the expectations are that the organization will have of its employees with executive leadership. If you are an end[1]user of the information, raise awareness of the need for information governance with your executive leaders. Whether you are in an executive leadership role yourself or an end-user, here are some ideas for determining an approach:

Sell the idea to obtain executive-level champions.

You can start from anywhere. It makes sense to begin with what you know. Set priorities around the data you know most about or the data that is most visible across the organization. Determine where the data originates (is there a sole source, or can it come from multiple points and systems) and how you can improve the quality and reliability of that data.

If you do not have executive-level support, work from the bottom up to make progress on your own. Focus on policy development. Research externals requirements and develop policies that will support them.

Develop strategic partnerships or alliances (such as information technology (IT), business/operations owners, legal, and financial disclosures). You will need input and involvement from all these groups for the long-term success of your IG program.

Expect to take at least 12 to 18 months to establish your program if you are starting from the beginning. An information governance program is critical for maximizing your EHR and other information systems to get accurate and actionable data that can help your organization achieve improvements in care and costs. Developing a program that engages critical owners (clinical, legal, compliance, HIM, IT, finance, et cetera) and has executive-level champions will help ensure your success.

Read the Case Study 10-2, Crowdsourcing at AOL. Answer the following questions:

An initial identification of the article (author, title of the article, title of the journal, year of publication, and other details that seem important, e.g., it is originally a French edition), and an indication of the major aspects of the article you will be discussing.

A brief summary of the range, content, and argument of the article. You may occasionally summarize section by section, but in a short review (1,000-1,500 words) you usually only pick up the main themes. This section should not normally take up more than one-third of the total review.

A critical discussion of 2-3 key issues raised in the article. This section is the core of your review (50-60%). You need to clarify the author's own argument before you criticize and evaluate it. You must support your criticisms with evidence from the text or from other writings. You may also want to indicate gaps in the author's treatment of a topic, but it is seldom useful to criticize a writer for not doing something they never intended to do.

A final evaluation of the overall contribution that the article has made to your understanding of the topic (and maybe its importance to the development of knowledge in this particular area or discipline, setting it in the context of other writings in the field). How can this help small businesses?