LYNNE THOMAS GORDON, CEO of the American Health Information Management Association, says a grounding in information governance is crucial in today's hospital C-suite. As electronic health records proliferate, the amount of patient data a typical hospital collects, stores and shares doubles every day by some estimates. Other industries that are data-reliant, such as banking and retail, use information governance techniques, and AHIMA is launching an initiative to promote those practices in health care. | Interviewed by Jan Greene
Does data management really rise to the C-suite level?
GORDON: I don't think the C-suite yet recognizes the criticality of making sure there's information governance. They see symptoms, such as inconsistent metrics from one month to another, but they may not understand where the symptoms are coming from. If you are trying to work on a strategy such as value-based purchasing, or trying to reach the Triple Aim, it's all going to boil down to information. Information is power. I heard a speaker who was doing predictive analytics say recently that hospitals are going to go out of business if they don't have the right information. You are trying to drive change, and you need data to make that happen.
Shouldn't hospital employees know how to collect and provide accurate data?
GORDON: I think right now a lot of us are just unaware of where the problems are because systems have become so complex. We don't even know that there's garbage out there. Then when something happens, an event occurs, or we're trying to make decisions, you find yourself saying, "How come I asked for this data and it's totally different every month?" Or you ask for data and you get it from different parts of the hospital, and they have so many different answers for one question. It depends on what system you pull it from, what field you pull it from, who enters the data — did everybody know the definition for this data was the same? Everybody thinks they're doing a good job.
Who should be responsible for data governance?
GORDON: The health information management department has the people who take care of all the information — how it's created, how it's stored, how it's used, how it's archived; that's our job. We need to step up in health care as they've done in banking and retail. We've slammed in these electronic health records; we now have a lot of information. A lot of it is wrong, so now we just have faster incorrect information. As we move on to new payment models, it's going to be critical that you can follow the information from the doctor's office to the acute care stay, perhaps to rehab, on to skilled nursing, hospice — it's going to be the whole continuum. And it's not just clinical information. We're looking at a bigger, broader picture of how long you keep your human resources records, your financial records, how you create them. It will impact everybody.
So the huge investment in health IT is now potentially undermined by inaccurate, poorly organized data? What are executives supposed to do?
GORDON: What I'm hearing is that it can be very overwhelming. It's big and it can be difficult to get traction. We suggest that you can get some early quick wins on specific pain points, then you can take it to the stakeholders and say, "Wow, this is what the data were telling us! We need to put in good information governance principles, framework, policies, procedures." If I'm in the C-suite, I'm going to go, "Whew, I'm so glad we've now figured this out."
I used to think when starting an information governance program that you'd get a team together, you'd get going, you'd have big hype. But, no, no, no. What I'm hearing the most successful programs saying is that they start small. You take a pain point, somebody who says, "I'm having trouble collecting my information. Every time I try to come up with an infection rate it comes up differently. I don't know what's going on."
When I was at Rush Children's Hospital in Chicago, I remember working with the head of pediatrics, who was an infectious disease specialist, and he was getting information suggesting our pediatric infection rate was one of the worst in the state. I said, "No, no, no, doctor. You're amazing, probably one of the best infectious disease doctors in the country. There's something wrong with the data. Let me go check it out." We actually had one of the lowest infection rates. We had to improve how the data were being collected.
What are the risks from poor information governance?
GORDON: Hospitals will be at risk because the name of the game is going to be to continue to reduce costs and improve quality, and make sure our communities are healthy. If you have good information, you can make good decisions. If you have bad information, you're at risk of making decisions and spending money only to find out later that you didn't have the right information at your fingertips. It's going to be hard to be 100 percent correct with every piece of information, but you're going to do the best you can. Hopefully, you have the cleanest, clearest information you can get, then you make changes, you go back, remeasure, make more changes and keep going.
Many information systems don't talk to each other, and the ways patients are identified in their records is all over the map. How can there be more standardization?
GORDON: Informatics is another strategic initiative of ours. What are the standards we need to have in place for health information exchange, or for using electronic health records? We had rules of the road when we had paper, and then we went to electronic health records and we're not there yet. We're trying to develop standards for such things as patient matching. We are recognizing that it doesn't make sense that every hospital or doctor you go to has different methods for patient matching. Hopefully, it will be adopted by ANSI and ISO, so everyone is doing the same thing — playing by the same rules. There's a lot of heavy lifting to do there.
With so many other critical issues to deal with, how can a hospital executive pay attention to yet another?
GORDON: I totally understand. There's so much pressure; everyone is trying to do more with less. But if I'm a C-suite executive and I want my hospital to be the best, it's going to boil down to who has the best data, and with that data, are they making the best decisions? You're going to start seeing a big divide between the haves and the have-nots in terms of data. I don't think hospitals want to be left behind. If they don't have that information, they're not going to be as agile and be able to adapt to all the changes.
The Gordon File
A veteran health care executive whose experience also includes academia and a wide spectrum of association involvement. Joined AHIMA after serving as associate vice president for hospital operations and director of the Children's Hospital at Rush University Medical Center, Chicago.
Gordon is also a member of the American College of Healthcare Executives. She has served on the information management task force of the Joint Commission and as a governor on the ACHE board.
"Information is power and you want to be sure you have the best information. The way you do that is through information governance."