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Katherine Downing, MA, RHIA, CHPS, PMP Sr. Director AHIMA IG and IGAdvisors™

2016

DG versus IG: Why Better Data Drives Improved Care Coordination and Provider Engagement

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Introductions and Welcome!

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• According to IBM – 2.5 quintillion bytes of data are generated every day and 90% of the data in the world has been created in the last two years

• According to Cisco - Connected healthcare applications such as health monitors, medicine dispensers, first-responder connectivity, and telemedicine … the fastest-growing industry segment in the big data picture.

Healthcare Information Surge

Source: Cisco The Zettabyte Era: Trends and Analysis, July 2016 White Paper

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Studies suggest that nearly 20% of EHR data is

unusable due to quality issues

Quality Patient Care and Safety

According to IBM, medical data will double every 73

days by 2020

• Volume is growing on a exponential

path in healthcare.

• The age of big data is here–

massive growth in data volumes

and velocity.

• Only about 25%of data being

stored has real business value.

Information is a High Value Asset

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HealthIT.Gov Benefits of the EHR but…

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EHR’s in the News - 2017

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EHR’s in the news - 2017

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Issues Examples

Data design and capture issues

•Inconsistent data definition across/between systems•Inability to tag and capture high value data elements•Inconsistencies between data in structured and unstructured notes.

Information integrity and quality issues

•Lack of trust in data (impedes ability to utilize for analytics)•Patient identification and patient data from devices, other records•Lack of data quality management efforts / tools•Process breaks / redundancies (shadow records) •Errors found at the ‘end of the line’ in patient portals

Inability to use data for analytics / advanced reporting

•Insufficient knowledge and skill of analysts•Errors found in data are not traced back to source•Siloed ownership at business or clinical level•Little or no ability to report across systems

Lack of interoperability •Cost of interoperability•Systems ability to trade data and information •Trust in inbound information from other organizations

Issues with Information for Care Delivery

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2016 Patient Misidentification

Source: 2016 National Patient Misidentification Report by Ponemon Institute available at: http://healthitanalytics.com/resources/white-papers/ponemon-institute-2016-national-patient-misidentification-report?elqTrackId=b4ca2207f18d4043ab67529cb33f3cab&elq=b772a1845cda4f7eaf1668ec63a12a3b&elqaid=2140&elqat=1&elqCampaignId=1958

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2016 Patient Misidentification –Clinical Impact

Source: 2016 National Patient Misidentification Report by Ponemon Institute available at: http://healthitanalytics.com/resources/white-papers/ponemon-institute-2016-national-patient-misidentification-report?elqTrackId=b4ca2207f18d4043ab67529cb33f3cab&elq=b772a1845cda4f7eaf1668ec63a12a3b&elqaid=2140&elqat=1&elqCampaignId=1958

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EHR practices contribute to data quality and integrity issues. Risky documentation practices create the potential for patient safety, quality of care, and compliance concerns. Examples include:– Template Challenges

– Patient Identification Errors

– Amendment Integrity

– Copy Paste

– Addendum / Late Entries

Risks to EHR Documentation Integrity

Source: AHIMA Integrity of the Healthcare Record Documentation

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• Risks of Copy Functionality– Inaccurate, redundant, or outdated information in

the patient record

– Inability to identify original author

– Propagation of false information

– Inability to follow the care of the patient (inaccurate coding)

– Unnecessarily lengthy and redundant progress notes

– Legal / Liability issues (per the AMA)

– Negative patient outcomes (per OIG)

EHR Copy Function & Information Integrity

Source: AHIMA: A Practical Guide: Information Management and Governance of Copy Functions in EHR

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Report: Examining the Copy and Paste Function in the Use of Electronic Health Records

• Researchers noted problems with attribution of information.

• Concerns about EHR Integrity

• Lock certain areas from copy paste

• Chain of custody issues

2017 NIST Report – Copy Paste 1/2017

NIST Report available at: https://www.nist.gov/node/1140716

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• Financial– Increased operating costs

– Decreased revenues

– Missed opportunities

– Reduction or delays in payments / pay for performance $

• Satisfaction– Patient satisfaction / decreased organizational trust

when portal, billing or other information is incorrect

– Low confidence in forecasting by leadership

– Inconsistent reporting and re-work / validation

– Delayed decision making

The Cost of Poor Information Quality in Healthcare

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• Productivity– Duplication in the EHR creating increased workloads,

decreased throughput, increased processing time, or decreased end-product quality.

• Risk and Compliance– Patient safety

– Patient identification (should be 99.99% accurate)

– Potential for fraud

– Data leakage (physicians texting nurses / notes not in chart)

The Cost of Poor Information Quality in Healthcare

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1

2 3

4ORGANIZATION-WIDE

ALL TYPES—INFO

ALL TYPES—ORGANIZATION

ALL MEDIA

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Robert F. SmallwoodInformation Governance Concepts, Strategies, and Best Practices

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Healthcare strategy How Information Governance Supports:

Reduce Operating Costs

•Reduced data storage costs•Technology decisions based on IG (interdisciplinary) assessment of demonstrated need and cost benefit•Improved data quality improves decision making

Quality and Safety Benchmarks

•Enterprise standards for capturing consistent quality and safety metrics•Desired standards throughout the organization•Trusted data for analytics and business intelligence

Population Health Initiatives

•Reduces obstacles from data silos•Trusted data to evaluate and reengineer processes•Timely and complete information speeds up process

Reimbursement Models

•Reduces obstacles from data silos•Timely, trusted, complete information•Standards based claims•Value based purchasing and MACRA (Medicare Access and CHIP reauthorization act)

Excerpt based on Figure 3.5 (p34) Implementing Information Governance Kloss 2015. Purchase in the AHIMA store: https://www.ahimastore.org/SearchResults.aspx?SearchString=kloss

Quality Information is Vital for Healthcare

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Healthcare strategy How Information Governance Supports:

Data Breach Avoidance

•Sensitive information is better protected from corruption, loss, theft, hacking and inappropriate use•Uniform policies for all types of information not just PHI•Mitigation of fines and investigations

Support Mergers,Acquisitions and New Affiliations

•Avoid new risk, redundancy, costs of inefficiency•Quicker transition of information from one organization to another•Standardized use and definition of data and information

Improve Care Management

•Longitudinal information to manage avoidable admissions, readmissions and ED visits •Trusted data•Patients have more confidence (aren’t finding issues via portal)•Better data for supporting chronic disease, research, etc

Excerpt based on Figure 3.5 (p34) Implementing Information Governance Kloss 2015. Purchase in the AHIMA store: https://www.ahimastore.org/SearchResults.aspx?SearchString=kloss

Quality Information is Vital for Healthcare

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• Core disciplines in a Data Governance program include: – use of data stewards,– data life cycle management, – data quality management, – master and reference data management, – metadata management, – data architecture management, – data development, and – business intelligence management.

Data Governance – A Key IG Competency

Source: Enterprise Information Management and Data Governance, Merida Johns. https://www.ahimastore.org/ProductDetailBooks.aspx?ProductID=17054

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Information Governance or Data Governance?

Excerpt based on 2 Enterprise Health Information Management and Data Governance. Merida Johns.

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Information Governance v. Data Governance

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Program Elements: People and Organizational Bodies

INFORMATION GOVERNANCE COMMITTEE

• Cross-functional: Many stakeholders involved (HIM,

C-Suite, IT, Legal, Analytics, Privacy and Security etc.)

• Policy & Standards Setting: Consistency of these

between departments

• Issue Resolution

DATA/INFORMATION STAKEHOLDERS

• Affects decisions or are affected by

data/information decisions

• Data/information creators

• Data/information consumers

• Data/Information users

DATA/INFORMATION STEWARDS

• Execute policies

• Surface issues

• “Super users”

INFORMATION MANAGEMENT OFFICE

• Runs Governance Program

• All information initiatives are centralized here

• Provides SME to the health system

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• Engaging patients to decrease costs and improve outcomes increase the health of your populations

• Map information creation, usage, storage (we can’t keep everything forever!)

• Use industry standard frameworks (AHIMA’s Information Governance Adoption Model (IGAM)) and best practices (e.g., healthcare and beyond, IG Blogs, IG Toolkit)

Focus on the Central Impact

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AHIMA’s Data Quality Management Model

"Data Quality Management Model (2015 Update)" Journal of AHIMA 86, no.10.

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Better Data is a Team Effort

IG Competency Competency Leaders

Information Governance Structure –defining responsibilities and accountabilities for data / info efforts

IG Project Leader, IG Executive Sponsor, Health Information Management (HIM)

Strategic Alignment – aligning data efforts with organization strategies

IG Executive Sponsor, CIO, HIM Director, Quality, Risk, Compliance, CMIO

Privacy and Security Chief Information Privacy & Security Officer(s)

Legal & Regulatory Requirements Compliance & Regulatory Leaders, Attorney

Data Governance IT and Data/Business Intelligence Leaders, CIO, HIM

IT Governance IT, Clinical, CMIO, and HIM Leaders

Analytics IT, HIM and Data/Business Intelligence Leaders

IG and DG Performance Data/Business Intelligence Leaders, Internal Audit

Enterprise Information Management IT & HIM Leaders, Quality, Risk, Compliance

Awareness & Adherence – for all staff Chief Learning Officer, VP/Dir of Human Resources

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Effective Use of Data Stewards Example

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• IG provides a competitive advantage that allows the organization to improve business agility and to introduce new products into the market more quickly

• The courts will be looking for Information Governance Programs

• Governing information isn’t going to get any easier / information is vital for patient care and running the business

Reasons IG Makes Business Sense

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• HHS Report on Improving Cybersecurity in the Healthcare Industry– The report includes information governance definition as a way to

advance privacy and security practices. – “Information governance is a relatively new concept in the industry and should include not

just IT and security stakeholders, but also information stakeholders. Governance structures should also include clinical and non-clinical leaders. Governance of information shifts from technology to people, processes, and the policies that generate, use, and manage the data and information required for care”

– The report includes information governance and IGAM™ competencies in many of the recommendations and action items across all sections of the report.

• Information governance – healthcare industry top 10 buzzword and top 10 buzzword of big data analytics.

• TJC has linked our IG principles and Safe Use of Health IT• Survey- What are your knowledge and training sources for IG? 89%

responded AHIMA.

Recognition of AHIMA IG

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AHIMA is Committed to IG for Healthcare

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IG Executive Training Video @ IGAdvisors.com

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IG Executive Training Video @ IGAdvisors.com

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IG Executive Video

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IGIQ.com Blogs Include Insights on Program Start Up (*New* bi-weekly)

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IGIQ.com – IG Tools and Resources

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• AHIMA Information Governance Adoption Model for Healthcare©• AHIMA www.IGHealthRate.com• AHIMA www.IGAdvisors.com• Information Governance Concepts, Strategies, and Best Practices, 2014.

Robert F. Smallwood – available in AHIMA store

• Implementing Health Information Governance, 2015. Linda Kloss, MA, RHIA, FAHIMA – available in AHIMA store

• Enterprise information management and data governance, 2015. Merida Johns – available in AHIMA store www.ahima.org

• Images from www.images.google.com

• Cisco The Zettabyte Era: Trends and Analysis, July 2016 White Paper

Resources and Recommended Reading