Risks of poor quality data and information point to the need for proper governance
As healthcare makes the shift to new value-based models, data integrity is the most critical asset for hospitals, health systems and physician practices—and information governance is critical to data integrity. Yet IG must contend with priorities such as budget cuts, payment for value, population health and competition for resources. Even though IG is essential to managing those priorities, the question still arises among healthcare executives: Why do we need IG?
Author of Implementing Health Information Governance: Lessons from the Field, Linda Kloss, MA, RHIA, FAHIMA, refers to the cost of poor data and information quality as mentioned in a Harvard Business Review article: “It costs 10 times as much to complete a unit of simple work when the data are flawed in any way as it does when they are accurate. Such rework is non-value-added—intolerable for resource-constrained healthcare organizations.”
Poor Quality EHR Data Leads to Medical Errors
Clearly, there are consequences of not moving forward with an IG program. For example, the impact of medical errors continues to draw attention as the third leading cause of death in the United States. And the No. 1 cause of medical malpractice is inaccurate EHR data.
According to a recent report on EHR risks, 16% of 97 medical malpractice cases involving EHRs were due to incorrect information entered into the system. The most common errors were related to diagnoses (27%) and medications (19%). Other EHR risks affecting record integrity and patient safety include e-prescribing, copying and pasting data, use of drop-down menus, difficulty editing progress notes, autopopulation of fields, increased data access and failure to comply with record retention laws.
Faced with the economic impact of value-based reimbursement, healthcare providers must implement best practices for achieving information integrity and quality standards. Many IG initiatives begin with the implementation of a new EHR system. To achieve a successful and meaningful implementation, providers—including staff at all levels—need to understand how data is created, organized, converted into trusted information, disseminated and retained. This knowledge enables users to fully embrace the functionality of the system and the value of correct information that is created—for the organization and all stakeholders who require access for legitimate purposes.
In addition, the need to educate EHR vendors on health information management (HIM) and the importance of data accuracy has become evident based on our experience at various implementation sites. While the term “data integrity” is often used, many vendors are unfamiliar with the language of IG—the importance of ensuring accurate, complete and timely information—and the value of HIM outside a paper environment.
Capturing Correct Information Up Front is Critical
Patients now have access to their information from patient portals. Proper governance of that information is essential to patient trust, safety and satisfaction. As an integral part of an IG program, patient access teams must collect correct data in a timely and consistent manner. During this time of transition on many levels, we’re still cleaning up data on the back end—correcting and monitoring after the fact. In that case, are you making sure all information is being updated in a timely manner? What tools and processes are in place to ensure correct information is captured on the front end? Are the right people properly trained to make the most of the right tools and processes?
As the IG experts, HIM professionals can help ensure accuracy, transparency and accountability of information to mitigate both tangible and intangible risks. We must leverage the commitment of HIM and others in the organization who are knowledgeable and passionate about IG. Having practiced governance for decades, HIM has the experience and expertise required to lead information governance and management throughout the enterprise.
A Grassroots Approach Can Move IG Forward
An alternative to a top-down approach is to initiate a grassroots IG effort that resonates with specific organizational priorities, goals and resources. Many of the HIM activities already in place are central to a successful IG program—cleaning up data, putting dashboards in place, assessing quality, providing training, conducting root-cause analysis, leading data integrity teams to monitor overlays and duplicates—all aligned with IG principles and ensuring effective use of analytics.
As an example, the vice president of HIM at one of our client sites recently engaged an interdisciplinary data stewardship team focused on standardization of data definitions. HIM saw an opportunity to work with IT to implement a standardization tool and provide hands-on system training. The goals were to improve communication, create accurate data, provide meaningful information and support informed decision making. The outcomes of this project and related initiatives have built trust and partnership among HIM, IT and senior executives. HIM leadership—the ability to communicate, collaborate and educate—is essential to the success of efforts to ensure data integrity.
HIM must engage IT and executive leaders to help articulate the importance of such programs on an enterprise-wide level—making sure data becomes trusted information. Strengthening and communicating the value of our skills and commitment will help move IG into all areas of the organization.
Data, Information and Knowledge Become Wisdom
I recently had a rare opportunity to attend a session with Tom Chi, founder at Prototype Thinking LLC, who said, “Data becomes information which becomes knowledge which becomes wisdom. A machine can do the first part (data) but humans own the last three.” Within the context of data governance versus information governance, organizations are responsible for transforming data into information, which makes it our responsibility to govern this valuable strategic asset—the data and the information. HIM professionals possess the knowledge and wisdom required to lead the way. Our profession is built on the principles of accuracy, accessibility, accountability, transparency and integrity—monitoring the quality of trusted information throughout its lifecycle.
Kloss and other experts in the field of IG emphasize the importance of a lifecycle approach to the challenge of medical errors and related quality issues. Data stewardship designed to ensure the integrity of information is the responsibility of everyone in the organization—HIM, clinical, C-suite, compliance, finance, privacy and security, patient access, IT, revenue cycle, contractors. While each area has its individual role, interdisciplinary teamwork is the foundation for effective governance.
IG Plays a Key Role in Managing Emerging Trends
Doing anything new takes courage and commitment—in the case of IG, building on what works to guide enterprise governance of data and information. With so many competing priorities, making the case for IG is a challenge—one that requires collaborative leadership, culture change and process improvement.
In future issues, we’ll focus on the practical role of IG as it relates to evolving healthcare trends and topics such as value-based care, population health, patient engagement, revenue cycle performance, ICD-10 coding, clinical documentation improvement (CDI) and more as we address the growing complexity of healthcare today.