Making the Business and Professional Case for Information Governance
In her keynote presentation at AHIMA’s Clinical Documentation Improvement Summit on Monday, Laura Zubulake discussed her firsthand experiences with information convergence and governance on Wall Street in the 1990s, as well as her encounters with the legal system.In February 2002, Zubulake became involved in a case that transformed the practice of law. She made the decision to search for e-mail evidence that she believed existed on backup tapes. As a result, landmark opinions (known as Zubulake I-V) were issued concerning counsel’s obligations for the preservation of electronically stored information. These opinions established the foundation for what is known as electronic discovery (e-discovery).
Prior to her presentation in Washington, DC on Monday, Zubulake talked with the Journal of AHIMA about the influence of Zubulake I-V opinions and information governance in healthcare.
Your CDI Summit keynote address, “Information Convergence: Transforming Data into Health Intelligence” includes real life examples of how other industries confronted information convergence challenges. Can you share some of those here for AHIMA members who can’t attend the Summit?
I will explain how information converged while I worked on Wall Street. Over the years, technology progressed from paper documents, fixed-line phones, typewriters, facsimile machines, and magnetic tape systems to desktop computers, mobile devices, electronic records (e-mail, word documents, texting, instant messaging), market data terminals, automated trade reporting, algorithm-based trading, and computerized sales platforms.
Communication and sources of information increased in velocity, volume, and went 24/7 globally.
Although I am not an attorney, I will discuss my experiences regarding the evolution of e-discovery law. When my case began, the legal industry was very much paper-based—I found that communication and analysis was not digitally oriented. A decade later, electronic documents and the applicable technologies are now part of the legal nomenclature.
What can the healthcare industry and HIM professionals learn from information convergence experienced in the finance/banking industry? How are they different? How are they similar?
The healthcare and finance/banking industries share many similarities. Both industries: are regulated; rely on information to make decisions; have privacy and security issues; are exposed to litigation and e-discovery risk; have sworn duties to the benefit of their clients; want better outcomes (health and financial, respectively); are impacted by technology; and are a “business” that must manage resources, maximize revenues, and control costs to achieve better results.
With evolving technology, Wall Street managed, processed, and interpreted data for the benefit of their client and the firm. The transitions from paper to digital sources, from domestic to global data, from fixed-line phones to mobile devices, from mainframe computers to desktop systems and new applications were not always smooth and were often frustrating. We encountered time consuming and repetitive data entry, user interfaces that were not always parallel to processes, systems that were not compatible and privacy issues. New technologies were beta tested.
I imagine that HIM professionals have had similar experiences implementing EHRs. It is important for HIM professionals to become knowledgeable about all technology at their disposal, how to use it, communicate feedback, demand accuracy, and have patience.
What degree of risk does a healthcare organization face if it doesn’t implement an information governance program?
While healthcare professionals’ primary focus is wellness promotion, healthcare is a “business” and should be managed as such. Certainly healthcare is more complicated than most businesses because of government involvement, regulations, numerous stakeholders, privacy issues, and volumes of sensitive data. However, the question really should be: What degree of risk does any organization/business face when it does not proactively manage a strategic asset? The answer is: significant risk.
This includes healthcare organizations. By “manage” I mean account for, control, oversee, govern, administer, audit, protect. Information is not just an asset; it is a strategic asset. In service organizations, like healthcare, it may be the most important strategic asset. The failure to proactively manage a strategic asset jeopardizes the organization’s ability to achieve and advance its goals and desired outcomes. The process requires more than appointing a new C-level executive to assume the title of “chief information officer and at a minimum requires policies and procedures to establish standards. It requires all management, at every level, to endorse the notion that information is as important as all other assets—information must be proactively managed, accessible, secure, and accurate. In addition to policies and procedures, it requires accountability and continuing education. It requires not just the recognition of potential risks but also a true understanding of risk.
Understanding the value of information should not be the responsibility of one C-level officer. It cannot be solely mandated by an information program and forced upon staff. It should be natural and intrinsic to employee’s roles and responsibilities and the organization as a whole. Failure to instill this thinking exposes organizations to significant risks. As healthcare organizations have the mission and core value of wellness for their patients, they need to respect and protect the wellness and integrity of their information assets.
Was e-discovery even a concept before the Zubulake I-V opinions were issued? What are the implications of those cases on information governance in healthcare?
The phrase “e-discovery” (or electronic discovery) did not exist prior to the Zubulake opinions. Prior to the opinions, the discovery of electronic documents had been contemplated by the legal system. However when I confronted my discovery challenges in 2002, there was little, if any case law that addressed the issue. The Zubulake opinions resulted from the motions I filed. I filed the motions, in part, because I wanted access to the information. The Zubulake opinions provided the foundation for what is now known as e-discovery—the identification, preservation, collection, processing, review, and production of electronically stored information (ESI).
E-discovery is a subset of information governance. For those truly understanding my case (Zubulake) and who have read my book, they know my case was an early example of information governance, although it was not solely an e-discovery case.
I worked years on Wall Street with access to volumes of rapidly changing information. I knew that informed decision-making required access to accurate and full information. In my case, I firmly believed the information existed and I persisted in locating it. I understood the technology and industry records retention rules. Once the electronic records were discovered, I recognized the need to organize and prioritize them.