1. Research Results: Impact of Payment Reform on HIM Professional

2. Voice of Market Research
HIM Vice Presidents/Corporate Directors
Population Health Management Initiatives
Pay-for-Performance
HIMSS Stage 6 and 7 (EHR Adoption)
Common Theme: Information Governance

3. Information Governance Defined (AHIMA)
The specification of decision rights and an accountability framework to ensure appropriate behavior in the valuation, creation, storage, use, archiving and deletion of information.
It includes the processes, roles and policies, standards and metrics that ensure the effective and efficient use of information in enabling an organization to achieve its goals.

4. Information Governance Goals
Enable better decision-making
Increase the confidence and trust in information
Optimize quality of care/patient safety
Improve prediction and analysis of patient care and outcomes
Reduce costs and increase effectiveness through coordination of efforts
Ensure information is consistently defined and understood
Drive new business opportunities
Improve patient experience

5. Information Governance is a Continual Process
Executive Team
Finance
Business Intelligence
Clinical Safety
Consumers
ACO
People
Process
Technology
HIM
Utilization
Legal/Risk HR
Care Coordination
Patient Experience
EHR
Clinical Systems
Mobile Devices
NLP
ACO
PHR
EMPI
Reporting
Decision Support
Business Objects
IG Framework
Methodology
Redesign
KPIs BI
Metrics
Dashboards
Critical Success Factors
Privacy and Security

6. Data Governance Maturity Levels*
Predictive
Process feedback loops are tuning as opposed to fixing
DQM processes fully automated with complete audit trail
Top-down strategy fully in tune with the bottom up application of stewardship => complete cultural alignment across the enterprise
People, process and technology operating in harmony
Proactive
Continuous improvement feedback loops operating
Root cause analysis feeding into feedback process
Pro-active approach to management of data and rules dictionary
DQM process automating measurement of function performance
All information silos fully integrated with master data systems
Defined
KPIs identified and measured
Data dictionary and rule dictionary documented and maintained
N-Tiered stewardship established
Master data plan executed
Supporting technology framework deployed
Root cause for issues being tracked and measured
Reactive
Standards established
Basic DQM process established
Master data plan identified
Strategy defined and communicated
Chaotic
No standards
Reactive approach
No master data plan
No strategy
*Data Quality Management Maturity Model from Tabb Forum

7. Health Payment Reform and HIM Impact - Research Results
Clinical Documentation and Coding
Business Process Redesign
Technology Efficiencies
Unique Patient Identification
Analytics
Patient Portals
Leadership

8. Clinical Documentation and Coding
Now People Care”
Payment is increasingly reliant on abstracted indicators and the quality of coding
Emerging population health relies on accurate and complete coding
Accountable care and other payment arrangements
State All Payer Claims databases
Hierarchical Condition Codes
Physicians recognizing link between clinical documentation codes P4P
Public reporting of hospital performance

9. Clinical Documentation and Coding (cont.)
CDI and Coding teams increasing their focus on capturing ROM and SOI
Risk adjustment explains the differences in clinical outcomes
Risk adjustment puts a premium on accuracy and completeness of documentation and code capture
Risk adjustment helps:
Determine patients/population at risk
Analyze adverse events
Supports case management efforts
Negotiate P4P contracts with payers and clinicians
Building CDI prompts in templates
Few HIM leaders are moving CDI into OP, ED, Quality - big opportunity exists!

10. Clinical Documentation and Coding (cont.)
HIM’s leadership in data integrity expanding to include physician coding
New payment arrangements need merged hospital, other facility and professional coded data
Shared models (e.g. ACOs) put a premium on accuracy and completeness of documentation and code capture across the continuum
Data sharing enabled by EHRs
Majority of HIM are validating codes vs. coding “from scratch” trend is shifting
Experiencing challenges with affiliated practices

11. Business Process Redesign
Focusing on improving coding veracity and data integrity
“Closing the loop” when physician coding is modified by HIM
Redesigning Radiology workflow
Examining and redesigning physician office data capture and coding processes
Diagnosing root causes for coding inconsistencies across the enterprise – then leading effort to fix

12. Technology Efficiencies
EHRs enabling coordination of care
Some physicians will be on same EHR as hospital
Many physicians have their own EMR
Transforming HIM operations
Focusing efforts on reducing poor data integrity so information can be trusted
Templates – insure appropriate data capture at point of care
Cut and Paste
Problem lists

13. Technology Efficiencies
Focusing on implementing Computer Assisted Coding and Computer Assisted CDI
Increase staff productivity
Optimize clinical documentation and data integrity across the enterprise
Organizations implementing ACO Solutions
HIM not “at the table” in most cases – big opportunity exists!
ACO organizational structure is different than hospital’s structure
ACO IT Infrastructure is not focus
Time pressures/conflicting priorities
HIM efforts focused on data integrity/source of truth

14. Unique Patient Identification
During EHR implementation, many organizations outsourced MPI clean-up
On a daily basis, HIM maintains unique patient identification by:
Allocating resource(s)
Leveraging EHR patient matching tools
Reconciling duplicates
Defining structure and business processes
MPI Coordinators Data Integrity positions
Population based MPI (needed with ACO) not currently focus of HIM – big opportunity exists!

15. Analytics Health Systems focused on obtaining data from across the ACO
Creating infrastructure (data repository, business/clinical intelligence, ACO technology)
Pulling in clinical, pharmacy, laboratory, etc.
Integrating/aligning care across the continuum
Tools are evolving/fragmented causing confusion
Few HIM are in “analytics” roles – big opportunity exists!
HIM Focused on improving data integrity
No information governance framework
Poor data integrity across the continuum
Data is not trusted
Lack of standards, processes

16. CCHIT HIT Framework for Accountable Care
An Infrastructure to Support
Healthcare Transformation
Aims of Accountable Care Providers
High Quality Health Care
Cost Efficiency
Customer Loyalty: Providers and Patients
Primary HIT Requirements to Support Accountable Care
Information Sharing between and among clinicians, patients, and authorized entities
Data Collection and Integration from multiple clinical, financial, operational and patient-derived sources
HIT functions supporting Patient Safety
Strong Privacy and Security protections
Primary HIT Requirements to Support Accountable Care
Care Coordination
Cohort Management
Patient & Caregiver Relationship Management
Clinician Engagement
Financial Management
Reporting
Knowledge Management
Source: CCHIT ACO HIT Framework

17. Patient Portals
Growing number of patients accessing health information online
HIM time supporting patient use of their health information is increasing
Responding to errors
Focusing efforts
Understanding root causes for errors
Evaluating how/what information is presented
Creating solutions to increase information value
Creating Proxy policies and procedures
Few HIM involved early with defining policies, data analysis and flow – big opportunity exists!

18. Information Governance Leadership
HIM emerging with responsibility for Information Governance
Conducted Information Governance Audit
Created a vision to drive change; defined value; connected to strategy
Created an organizational business plan and structure for information governance
Secured executive sponsorship
Created a Steering Committee and assigned roles
Supported strategic plan – early wins
Demonstrated high leadership skills and acumen
Started small; defined success; developed work plans; maintained momentum

19. Summary
Emerging delivery and reimbursement models require clinical and financial data to be integrated across the continuum of care.
Moving to population health management escalating importance of critical role of HIM in ensuring patient safety and quality of care.
Population health management coupled with EHR adoption are creating growing opportunity for HIM to move into enterprise-wide information governance and analytics leadership positions.

20. Questions and discussion