IGIQ highlights the trends and opportunities IG presents for ensuring information is treated as an organizational asset. An upcoming series in the Journal of AHIMA’s Working Smart: Road to Governance column will discuss case studies of organizations that have successfully implemented information governance programs. This post describes the information govenrnace goals, structure, functions, process, roles, and benefits that these organizations have established and recognized to achieve success.
By Kathy Downing, MA, RHIA, CHPS, PMP
With information governance (IG) emerging and gaining momentum in healthcare organizations, many questions arise. What are the goals of information governance? Why have some organizations decided they need formal information governance? How do healthcare organizations expect to benefit from IG? How are they implementing IG? What role does executive leadership play in the success of information governance strategies?
To better understand the issues associated with IG and how it is being implemented in healthcare, Journal of AHIMA is launching a case study series in the magazine’s Working Smart: Road to Governance monthly column. The organizations featured reported challenges with the management of health information in the electronic environment because of problems such as duplicate patients that had gone unnoticed in the paper environment or lack of staff training on appropriate use of the documentation tools in the electronic health record (EHR).
Other challenges discussed include creating a culture of change; ensuring that communication and education reaches staff at all levels of the organization; and prioritizing incoming requests such as report requests, desire for new technology, and upgrades to existing systems to ensure that work that was most important was completed when needed.
The IG teams within these organizations prioritized the requests they received based on such criteria as organizational need, expense reductions, regulatory requirements, the alignment of the product or process with strategic goals, budgets, or staffing.
Information Governance Program Goals
The goals of the information governance programs include developing processes to ensure the organizations were analytics-driven with better performance and outcomes, better coordination of care throughout the entire organization, and desire to maintain a competitive advantage in the geographical regions that were being served.
Managing information at the departmental level was not allowing these organizations to capitalize effectively on the economy of scale that could be realized through a centralized governance process. Because of this, these organizations recognized a need for formal information governance.
The organizations all hoped to benefit from information governance by using information to improve decision making, achieve better overall patient outcomes, and protect sensitive data while at the same time allowing necessary access to eliminate impediments for staff that made it difficult to accomplish job duties. Clinical staff desired better and more accurate information on outcomes, and financial leadership needed more precise information to ensure the organizations could meet financial goals.
The organizations in these case studies felt the need for information governance was immediate, as they were not nimble and could not respond quickly enough to information requests and had difficulty with obtaining accurate information for reporting. The goal was to be able to rapidly respond to requests for information and ensure that it was reliable and complete.
Structure and Functions of IG Programs
Each of the organizations had designed an IG structure with an executive to lead the program. The executive had responsibility for managing the program, such as ensuring projects were completed on time and within budget, making certain that communication was reaching all levels of the organization, prioritizing projects appropriately, and ensuring that policies were being written and updated when needed. In some instances, this was a defined role. In other organizations, this executive had a dual role with responsibility for IG functions as well as other job duties. Most of the organizations surveyed for this series assigned IG responsibilities to a leader in an existing position within the organization and updated the title and job description to include the addition of IG responsibilities.
Typical IG core committee membership included representation from HIM, executive leadership, clinical areas including nursing staff as well as physicians, business office, risk management, legal, finance, IT, quality, and compliance. The core team functioned as the approving body for any new policies, technology recommendations, and report requests. The core team was also responsible for oversight of the resolution of any identified problems or information-related issues that were identified by subgroups or departmental leadership.
In addition to a core committee meeting regularly, subgroups from operational areas were commonly utilized to assist when needed to develop policies, review report requests, or evaluate proposed technology. The subgroup members would make recommendations to the core team regarding purchase of additional technology, system modifications, design of new workflows, development of new order sets or documentation flow sheets, etc. This allowed the end users to be involved in the design or purchase decisions related to the new tools. The additional staff members could be brought in to participate on these various subgroups at the request of the core team.
As a supplement to the core team and subgroups, these organizations often designated individual department leaders as data stewards for their respective business units, with those department leaders then reporting up to various committees or an enterprise central office or council. The data steward’s role included:
- Creating and maintaining policies and procedures such as defining access requirements or developing new workflows, for their areas of responsibility
- Monitoring reports as published in scorecards with responsibility for implementing any necessary improvements
- Resolving any data integrity or quality issues
- Providing communication related to IG initiatives to staff
- Identifying existing data or information sources
- Recommending and testing any new technology in the respective area of responsibility
For most organizations, a charter or similar document was drafted and approved, and a core project team with representatives from appropriate business areas was then assembled. Activities were undertaken to finalize processes based on the unique strategic needs and capabilities of each organization.
Common functions of the IG core team included:
- Oversight of the processes and policies related to access, security, and confidentiality
- Information integrity and quality
- Information design and capture
- Technology review and recommendations
- Record content and information management
- Information analysis, use, and exchange
Typical responsibilities of the individual department leaders or data stewards from each organization were to review the policies, procedures, and technology within their areas of responsibility. This information was then shared with the core team members for monitoring. Each core team member was then responsible for reviewing the elements of the information that was being shared from the department leaders or data stewards, and addressing any areas of risk or correcting any identified errors. These core team members met periodically as a group under the direction of executive leadership.
Beyond functions related to EHR data and information, there was variation noted among the organizations as to what other types of information was being addressed through their information governance processes. Some had begun to address other types of information such as physical assets, physician productivity, and coding quality.
All of the information governance programs were continuing to evolve, independent of the length of time that the IG program had been in place. There were future enhancements planned, such as master data management, predictive analytics, collaboration with payers, participation in health information exchange, and continued development or refinement of additional policies and procedures.
Regardless of the type of structure or the goals of the program, executive leadership played a key role in the development, ongoing support, and communication of the goals of the information governance programs in all of the organizations studied.
Use of IG Consultants in Program Design
Some organizations had enlisted the assistance of consulting firms in designing their programs. The consulting firms assisted with developing tools and policies for information security, and also assisted in developing reports and scorecards that allowed for better sharing of the information throughout the organizations. The consultants provided guidance with developing archival systems and plans for appropriate retention and destruction of information. Some of the organizations planned to engage consultants again periodically in the future as they updated or expanded their IG programs, including future planning for analytics and metadata management.
In all the case studies, executive leadership and support was a critical success factor in the implementation of information governance. This is consistent with surveys of executives from other industries, where executive leadership in IG is viewed as critical to navigate any budget constraints, ensure cross-functional collaboration, and lead change management.
Another success factor that was repeatedly identified was ongoing communication with staff and clinicians to maintain the momentum of the programs. Results were regularly shared via a balanced scorecard or through reports that are distributed to the various stakeholders to allow them to monitor results at the entity level. Reporting was through the leadership at the department level so all staff were informed of the work being undertaken. Some organizations used formal scorecards, and others used individual departmental reports.
Some of the benefits reported in the case studies after implementation of an IG program included:
- Improved ability to track quality outcomes and quicker turnaround times on report requests
- Ability to participate in health information exchange
- Increased patient engagement accomplished through the ability to share data with patients
- Greater collaboration with physicians, leading to overall better care documentation
- Lower costs due to shared purchasing of equipment and supplies
The organizations stated they have made progress with improving their quality measures. There are plans to start to do some predictive analytics to improve population health management. Physician productivity reporting is in place, as are more accurate master patient indices that allow sharing of patient information across each enterprise. EHR functionality has been improved and physician documentation tools have been created to improve charge capture and reimbursement.
Most of the benefits cited were related to improvements in the use of health data. Because the subjects interviewed worked predominantly in the field of health information management, it was not clear whether there had been any impact on other areas of the organization, such as business intelligence functions or data analytics. However, an information governance program has the ability to enhance the use of information across all business units, and this may be more evident in organizations where other functional areas in the organization play a greater role in governance.
Information Governance as an Enabler
The case studies reflected that organizations view IG as an enabler of business strategies. IG is seen as a necessary facilitator for implementation of enhancements to capture information for strategic purposes, including new payment models, meaningful use, health information exchange, quality measures, participation in ACOs and other new care delivery, and the use of analytics for population health management.
Each organization that was studied has already incorporated information governance into enterprise-wide strategic planning, and all are keeping the entire organization informed of the successes of the program.
These monthly IG case studies will be a can’t-miss section in the Journal in the coming months.
Kathy Downing (firstname.lastname@example.org) is senior director, information governance at AHIMA.