IG 101: The Role of HIM Professionals

A solid information governance initiative allows healthcare organizations to capitalize on information in multiple ways. Information can be utilized to quantify and qualify new business opportunities. Accurate information removes ambiguity among multiple users of the information. Information can serve as a means of benchmarking products and services as well as to address the need for population health management. Information can also be leveraged to enable organizational efficiency. And all this while supporting the strategic goals of the organization.

Initiating an Information Governance Program

Initiating a program often starts by building a compelling business case. Start with an existing problem, pain point, or business opportunity. The opportunity is usually narrow in scope in the beginning, but is an important step to building an overall governance program. Next, develop a strategy, identify goals, and define the purpose. Determine who in charge or responsible for the opportunity. Finally, create a high-level work plan and define measures of success. Keep in mind that a successful governance program take time to develop, often 12-18 months, and requires not only executive sponsorship, but executive leadership, support, and funding as well.

Current State Assessment

Conducting a current state assessment help to identify current needs and “pain points” so that appropriate prioritizations can be made within the strategic plan. The organization must address cultural issues. Leadership support for the vision of managing information as an asset must be in place. Stakeholders need to be identified and represented as the program is adopted and implemented. Finally there needs to be an established authority to develop enterprise policies, processes, standards, definitions, and metrics.

Tools that may be used to conduct the current state assessment may include:

• Demand Analysis:Identify successes, issues, and barriers to meeting the organizational needs for information and, ultimately, business intelligence; could involve user/customer survey tools to elicit demand feedback
• Data Assessment: Where is the data, who are the stewards, what data do you get back, and how do you validate and use the data (consumer comparison websites, registries)?
• Trust Assessment: Do the stakeholders trust the data? Where are the perceived information trust issues?
• Governance Infrastructure Assessment: Are there information standards, policies/procedures, audits, or controls in place to ensure an effective information governance program? Assess what information management policies are in place and which are absent. Are there more specific information management policies within individual business units which may have stewardship of one or several information domain(s)?

• Inventory Management Assessment: How well does the organization track its information assets?
• Information Management Resource Assessment: This should include an objective (and perhaps independent) leadership assessment with regard to EIM. How well is the organization resourced for successful EIM? Does staff have proper resources, training, and tools to deploy an effective EIM program?

Health information management (HIM) professionals should begin by assessing their existing policies and procedures and can assist executive leadership in identifying new areas of opportunity for information governance in their organizations. Many information governance programs stem from HIM pain points, such as developing an enterprise master patient index or getting involved in a health information exchange.

The core HIM professional domains of knowledge provide clear value-added subject matter expertise with respect to information governance program development and oversight.

HIM professionals understand the federal and state laws and regulations governing health information, including:

• Retention/destruction laws
• Privacy and security laws regulations
• Reimbursement regulations (I.e., Medicare/Medicaid/RACs)
• Risk management (both clinical and business-related)
• Litigation/e-discovery processes (I.e., release of information, sequestration, legal holds)

HIM professionals are aware of the financial picture and how clinical coding and clinical documentation are critical to the overall financial well-being of organizations. They understand the timing requirements for claims submissions, timely payment, and claims denial/appeal management. In addition, HIM is knowledgeable about the clinical documentation requirements to ensure optimal reimbursement and to mitigate risk for the organization.

HIM professionals understand the foundational clinical terminology and language necessary to navigate complex health information management issues within organizations, particularly from a regulatory and compliance perspective. HIM professionals are deeply involved in supporting quality of care and patient safety initiatives.

HIM professionals have experience in managing, organizing, operating, and controlling organizational resources (people, processes, technologies). In addition, they have the management skill base across all of the information management program initiatives, and are already well-equipped with knowledge and management know-how in key information governance areas.

Next steps that HIM professionals can take to get started include:

1. Identify pain points

2. Determine if the initiative will make money or save money

3. Collect and assess existing policies for gaps and deficiencies

4. Identify and engage an executive sponsor

5. Create a plan of attack

6. Engage stakeholder group of committed individuals (look for those who are not happy with or mistrust current state about data/info quality, availability, security, etc.)

7. Develop metrics to assess progress and support evaluation