1. Pierotti, Danielle PhD, RN, CENP, CHPN
  2. Meehan, Ann RHIA

Article Content

Information is critical to healthcare. Today, information is largely digital. Home healthcare nurses often interact with numerous programs and systems during the workday. Programs for medical records, patient and staff scheduling, coding and billing, quality auditing, medication management, and interdisciplinary communication may or may not interact with each other. The complexity of the system has prompted some to consider opportunities to organize and streamline information technology (IT) by applying a governance structure to the problem.


Ann Meehan is the Director of Information Governance with the American Health Information Management Association's IGAdvisors(R) in Chicago, who encourages agencies to adopt the strategies for information governance. Ms. Meehan has over 30 years of healthcare experience, both in leadership and consulting. She led the information governance program and committee at Ardent Health Services, where she worked with home health and hospice care in assessing documentation requirements.


The American Health Information Management Association (AHIMA) defines information governance (IG) as "an organization-wide framework for managing information throughout its lifecycle and supporting the organization's strategy, operations, regulatory, legal, risk, and environmental requirements."


This is a huge definition, Ann. What does it mean to everyday operations?

Healthcare organizations produce an unparalleled amount of information that includes demographic, clinical, and financial information. All types of information are used in taking care of patients, as well as in determining the quality and cost of that care. Now more than ever, it is crucial that organizations take all steps necessary to ensure that information generated, captured, shared, and used is of the highest quality for making patient care decisions. Whether this information is electronic or on paper, collaborative oversight is needed to ensure standards and consistency around all decisions about information. The health of your patients is dependent on it, as well as the financial health of your healthcare organizations.


Home healthcare agencies are typically smaller than most hospitals. As smaller community-based providers, is this really an issue for everyone or just some agencies?

Home healthcare organizations are not immune to the many challenges that healthcare organizations face daily. Having the right information on the right patient at the right time is critical to ensuring that all caregivers have what is needed to take care of patients. That information must be captured, documented, and accurately maintained for continuity of patient care. It is also must be available to be shared across caregivers both within the home healthcare agency and any other healthcare treatment setting. Additionally, more information will be gathered from patient-generated health data and wearables to assist caregivers in gathering needed information on patients. Although this is exciting and innovative, it also comes with challenges resulting in an increased volume and questionable quality of data being produced. IG ensures that this data are not only harnessed for patient care but are also trustworthy.


Think of information as you would water flowing through the pipes of your neighborhood. Just like water, information flows throughout the healthcare ecosystem. And just like water, we all share and use it. When we go to the water tap, we want to know that we can use that water for whatever purpose without questions. When we use information, we want to know that it's clean. We have an ethical obligation to ensure that our information is trustworthy.


If information is the water and information equipment is the pipes, does that mean IG affects every aspect of a home healthcare agency?

Yes, in today's technology-driven care environment, the governance of clinical and financial information is required in support of:


* Quality patient care


* Serving the needs of the community


* Accurate and appropriate reimbursement


* Regulatory requirements


* Reduced operational costs through improved efficiencies


* Minimized risks


* Standardized auditing and monitoring processes



Without purposeful attention to how all of these systems work, connect, and evolve together, an agency may not even recognize risk areas.


What are the parts of an IG program?

There are several key components for success.


* An organization-wide framework. IG is a formalized program with a defined infrastructure that reports to senior leadership and upward to the governing body across all healthcare organizations, including home healthcare.


* Lifecycle. IG addresses every aspect of information: its creation, use, sharing, reporting, and disposition and is important in making sure that information is available when needed and destroyed when it has met regulatory retention requirements and no longer meets business needs.


* Organization's strategy. An IG program must be aligned to support the organization's strategic goals, mission, and values.


* Regulatory, legal, risk, and environmental requirements. The goal of an IG program is to fully support and ensure that the organization meets all regulatory, legal, and business requirements that require reliable information.



Is there a particular challenge for home healthcare agencies trying to manage information?

All healthcare organizations have challenges in managing information from large academic centers to small physician practices. However, home healthcare agencies may have more acute challenges with gaining funding and approval for the technology necessary to ensure that information is managed in a meaningful way. IG provides the infrastructure to ensure that technology decisions are made with the outcome in mind.


How do issues of interoperability impact home healthcare IG?

IG provides the guardrails around decisions about data and information that ensure the most trustworthy and accurate information is captured, used, and shared. Sharing of information with exchange partners requires diligence and confidence. IG takes away the guesswork in a home healthcare agencies' information sharing and reasonably ensures that the information exchanged is of the highest integrity.


Additionally, as part of the decisions made around technology solutions, IT governance as a part of IG works with vendors to ensure that those solutions are interoperable.


How does an agency get organized to build an IG program?

A formal IG program ensures health information is effective and trustworthy. If your organization does not have a formalized IG program, there are several steps to get that discussion going:


* Learn as much as you can about IG in healthcare. Articles are surfacing on the Internet and in person and virtual training options are available.


* Educate your organization's leaders on IG and what it means. Start with your direct manager, and together determine the best senior leader to get involved.


* Download available tools and resources and share them with other key stakeholders. Think in terms of your peers who experience the same challenges with information. Garner their support.


* Evaluate trends in patient care challenges, identifying those where consistency in information management, policies, and practices would have reduced issues.