When you hear the phrase “data governance,” what is the first thing that comes to mind? While most are thinking about the consistent application of information across an organization, I am thinking about the variations that exist between multiple organizations. We may think that a word or phrase is well understood, but that isn’t always the case because of the variability in the ways humans communicate and interpret information. There are so many factors that can influence how information is processed, and if we think about healthcare, we know that standards are not applied in the same way everywhere. If you visit different healthcare organizations in one day, the differences are often apparent. From state laws that govern specific healthcare requirements to the interpretation or implementation of the required and addressable components of the Health Insurance Portability and Accountability Act (HIPAA), we see organizations handle this information differently.
Recently, I had the pleasure of learning about windows because we needed to replace ours. My house was built in the 1970s, and the single-pane windows that remained were just not fit for the South. I started the process setting up appointments with window companies, but we didn’t choose any of them. While the only difference in our experience with each company was the cost and what they said about each other, we decided to have someone we know and trust do the install. In reading as much as I could about windows, especially the comments, it seemed that most unhappy customers blamed the windows when it actually seemed to be more of an installation issue. We called a recommended company to come out and do the measurements, and then we waited. After several delays, the windows were finally delivered and we could proceed with the installation … or so we thought.
After two windows were removed, we realized we were given the wrong size windows. We asked for a full replacement window, but that is not what we received. As you can see from the picture below, the window is much smaller than the opening. Now, if we had gone with another company, they would have made it fit by building out a frame around the window, but this would leave us in the same situation we have now. The window is designed to do many things, and one of those things is to provide a form of insulation, but you lose that if the window doesn’t fit properly. It also means that I would have a smaller window, and who wants to lose the many benefits a larger window provides?
You may be wondering how in the world this relates to data governance. Well, we currently typically apply data governance at an organizational level and not at the level that considers the entire healthcare ecosystem. “Rough opening” is an industry standard, and it is the actual opening/frame size of the window, which you cannot see because the trim covers it. Usually, from what I understand, people know that the rough opening is larger than what they see and can account for that when entering it into the system. However, this person, who had been in the business for 25 years, entered the trim-to-trim measurements as the rough opening, and so my windows ended up smaller than they would have been had they entered the information correctly. If we think of my poor windows, I asked for a full window replacement, but what I received is basically a sash kit that only replaces the window itself.
To me, my windows represent the continued focus on organizational data governance instead of integrated healthcare data governance. If we keep creating our own interpretations of what governance looks like at an organizational level and keep trying to retrofit standards, we will never have true insight into health information as we should, because things change when that information enters into a new environment.
Just like my windows, asking for a full window replacement didn’t guarantee that I received what I expected, and if someone else would have installed them, I would have been stuck with windows that weren’t correct because the frame would have been altered to accommodate a smaller window.
Healthcare is fluid, and by continually thinking about one setting or one organization type and in trying to accommodate for so much variation, we really do not have reliability of information. It is important that we don’t lose sight of how much we work to accommodate varying information in healthcare and that we consciously work together to form a more unified approach to governance. There will always be subjectivity and variation, but what we do with it and how we do it makes a big difference in the outcome. Just because standards exist doesn’t mean people interpret them correctly or even apply them in a way that makes it usable for someone else.
Jeannine Cain (email@example.com) is a business analyst at Ciox and an evaluator at Western Governor’s University.