It all starts with data.
As technology assumes a larger role in the way care is delivered and the ways in which providers and patients communicate, it’s becoming increasingly important that data is being entered, stored, and utilized as effectively as possible. It’s why having a solid governance structure has risen to the top of priority list for many healthcare organizations.
“Strong data governance ensures that the right information of the right quality is available to the right person for the right purpose at the right time,” said Zafar Chaudry, MD, one of three panelists featured in a recent healthsystemCIO.com webinar.
With a strong governance strategy in place, organizations can leverage data to ensure reimbursement criteria are met, deliver quality reporting, and drive research initiatives. But, like many initiatives in healthcare, it comes with its share of challenges, which Chaudry addressed during the discussion, along with Steven Goriah, VP of IT, CIO, and CISO at Westchester Medical Center, and Kamal Patel, CIO at ELLKAY.
Finding the Right Approach
According to Goriah, whose team is in the early stages of implementing data governance, it starts with taking an honest look at your organization and finding a model that fits your needs. “It’s not one model fits all,” he said. “You have to assess the level of adaptability within your culture, determine what value it can bring, and assess your organization’s appetite for risk. You can’t just push something forward for the sake of pushing it forward.”
Defining Roles and Responsibilities
Once a decision has been made — and dedicated resources have been secured — it’s important to clearly define roles and responsibilities, at the executive, strategic, tactical and operational levels.
At Seattle Children’s, where Chaudry serves as SVP and CIO, it started with determining the key stakeholders. “This isn’t an IT-led project; it has to include operations and clinical.” It also includes the legal department, who can ensure compliance with to regulatory requirements, and other key constituents who can guide the processes of storing, protecting, and managing data in the long term.
“You need to know who has access to the data, and make everyone a data steward,” added Goriah. “Everyone should feel engaged and empowered, and understand their relationship with the data, the risks associated with the data quality, and the importance of following the guidelines established by the data governance committee.”
And that means securing support from the highest levels to enforce disciplinary actions for those who don’t company, he said.
Separating the Bad from the Good
Where things get thorny, according to Chaudry, is in managing data that’s housed across multiple warehouses, data that’s insufficiently labeled, and data that isn’t searchable.
“In healthcare, we tend to have data sprawled all over the place,” he said, noting that Seattle Children’s has more than 750 systems that store data. The problem? When organizations start to centralize the data, “you find data quality issues. Bad data in, bad data out.”
This, according to Patel, is where training comes in. “All of these problems can be resolved with proper training. You need to go to all the various departments and train users on the importance of quality data.”
Chaudry, who has walked the clinical walk, agreed, adding, “If you don’t train people on how to enter data correctly, they’re not going to enter it correctly.” And while many physicians and nurses prefer free text functionality, which allows for much quicker entry, it comes with its share of issues.
“When data is entered as free text, especially in smaller EHRs, if information isn’t stored in the appropriate field, it’s not reportable,” noted Patel. However, when organizations have a data governance team that’s well-versed in processes and communicates regularly with other departments, they can help identify and clean discreet data, and have it housed in one location.
As a vendor, Patel believes is critical to “ensure all of these teams align with the customer’s requirements — with their quality guidelines, their security guidelines and their HIM requirements.” And, based on feedback, they can made the adjustments needed to keep health systems on the right track.
For many organizations, that track is one that enables a self-service environment where users are able to extract the information they need at their convenience. The challenge, of course, is that the technology needs to catch up, says Chaudry. “In healthcare, a lot of the systems we use are built on antiquated codes. And although EHRs are getting better at allowing physicians and nurses to consume the data, without the context of what that data really means, it makes reporting difficult.”
One solution? Having data analysts available to help physicians and nurses understand the data that’s being produced in reports.
Providing Better Metrics
Chaudry would also like to see more automation around data quality monitoring and detection. “By aligning with statistically driven detection methods and implementing standardized reporting with real-time dashboards, we can help measure data quality and improve clinical decision support,” he said.
Goriah believes better parameters are needed to ensure users are able to extract the right data. “With EMRs today, it’s not that difficult. Having everyone engaged in the same processes and understanding the risks associated with not following data governance guidelines is the most effective way to get the right information to the right person.”
Remembering the Mission
One component that can’t get lost in all of this is clinician satisfaction. “The more information we ask physicians to enter into systems, the more unhappy they become, because it’s taking time away from the patient, which is why you tend to get into medicine,” Chaudry said. “The quality of data that goes into a system is directly related to the quality of training you give an individual. Remember, physicians have evolved from a world of writing notes in a paper chart, into the technology domain, so if you’re not training them as to how the information should be entered so it can be mined, you’re going to get that same level of quick entry.”
Finally, the panelists urged listeners to evaluate their maturity in the space — and where they are in their data governance journeys — by answering the following questions:
- Who is responsible for data governance?
- What are the roles and responsibilities around data?
- How do you communicate what’s happening in the data space with stakeholders?
- How do you manage your assets?
- How do you enable processes?
- What standards are you following?
- What metrics are you putting in place?
“Physicians and nurses want to spend more time with a patient versus clicking through multiple fields,” said Chaudry. And it’s the leader’s role to make that happen.
Bear in mind, however, that “doing it correctly takes time,” said Patel. “Having patience and having a clear vision and strategy around this is important, as well as having the right people who can invest in education and importance of the quality of data across organizations.”
To view the archive of our webinar — Data Governance Best Practices to Keep Your Quality High and Users Empowered (Sponsored by ELLKAY) — click here.