In early 2016, Suzanne Goodell, co-chair of AHIMA’s Information Governance Practice Council and director of meaningful use in a large regional health system, invited our blog readers to accompany her on her IG journey. At that time, she stated, “I feel like I am Dorothy taking the first step on the Yellow Brick Road. I don’t know where the path will lead or if I will be successful. But I’m willing to try, and plan to take you, the readers, along by providing updates on my IG Journey if you would like to join me. It should be quite an adventure.” In this blog post, Goodell updates us on her progress. She uses the pictograph, “Developing and Sustaining Information Governance—A Process” from the AHIMA IG Tool Kit 2.0 to guide her. Let us know what questions, comments, and suggestions you have about Suzanne’s journey.–Lydia Washington
By Suzanne Goodell, MBA, RHIA
I started down the Yellow Brick Road by meeting with my boss, our CMIO. I shared my concerns about our standard registration method for patients who do not want us to disclose their hospitalization. We register these patients with an “XXX” prefix to their last name. I explained the importance of standard registration procedures to facilitate interoperability and how interoperability relates to Stage 3 of the “meaningful use” EHR Incentive Program metrics.
Our CMIO listened intently, thought for a while, and said “Hmm, interesting.” Her style is to take in information, think about it, and let it “cook” for a while. So I backed off to let the information simmer. In the meantime, I had a chance meeting with our CMO, where I expressed the same concern. He has a completely different style, and tends to respond quickly. He suggested that responsibility for interoperability belongs with our accountable care organization (ACO), which pulls data from 28 different electronic health records (EHRs) to run analytics and report to the Centers for Medicare and Medicaid Services (CMS). Though the ACO has no direct authority over our health system, and I doubted they would take an interest in our internal registration procedures, the CMO’s thoughts did suggest another ally for my cause.
Recently I came back to my boss about interoperability and meaningful use, focusing on broader stage 3 requirements. I didn’t specifically mention our XXX registrations, but was very pleased when she mentioned them as part of the interoperability puzzle. Clearly, the information had sunk in! I told her I had a meeting scheduled that week with the director of patient access, who manages registrars for hospital admissions and high-dollar outpatient procedures. I offered to report back at our next meeting.
As shown in the figure below, the first two steps for developing and sustaining IG are to gain executive support and to engage business stakeholders. Ideally, Step 1 occurs before Step 2, because once I have executive backing, it can be easier to engage stakeholders. Because I work in a reasonably large and complex health system, I have found more success by simultaneously cultivating support from the top-down and the bottom-up. The more voices and perspectives I can add to build the business case, the better.
So far, I feel like I have made slow, but small steps forward to establish IG around our registration data, patient matching, and interoperability:
- Our CMIO is thinking about interoperability as it relates to meaningful use.
- I have identified a possible ally in our ACO clinical data warehouse manager.
- I have identified a definite ally in our director of pathology and histology, who has encountered problems matching pathology report from a source system with our patients registered using XXX last names.
- I am hopeful that my upcoming meeting with our director of patient access will yield another strong ally. I don’t know her well, but our meeting is an opportunity to learn more about our registration process and understand her issues and concerns.
There still many miles of the Yellow Brick Road to travel. Of course, there are other stakeholders to enlist:
- Our HIM executive director
- The director of our EHR identity team
- Senior leaders of our physician practice group
- Senior leads of our hospital outpatient departments
- Physician leaders who are eager to receive outside records electronically
Most importantly, we must develop the case for change and gain executive support. My plan is to enlist a group of interested stakeholders, build the business case together, and present the case to our executive leadership team.
Suzanne Goodell (Suzanne.firstname.lastname@example.org) is director, meaningful use at Cone Health.