The healthcare industry is made up of many moving parts. The scope and complexity of the healthcare industry make it incredibly challenging to explain how data governance provides value.
There are many different types of providers, facilities, electronic systems and networks. To complicate matters even more, regulations and HIPAA requirements intensify the complexity of how to govern healthcare data. In the truest sense, data governance means developing the methods to connect data from all the elements and mechanisms of healthcare processes into a well-connected, meaningful network.
In the pursuit of quality healthcare, numerous stakeholders within the healthcare industry often need to share clinical and medical data. Data governance in healthcare is the process of how systems, information and organizations obtain, share and use data as an operational asset that can improve the health of all individuals.
Appropriately connecting systems could mean the difference between someone’s health condition improving or worsening. In many cases, it can make the difference between life and death. When data systems fail to connect on the same level, it’s as if multiple people are trying to speak to one another but they’re all speaking a different language and no one understands anyone else. Communication becomes a total fail. For this and other important reasons, data governance is a fundamental component in healthcare.
Data Governance Aids Healthcare Providers, Employees and Patients
Healthcare data touches those who provide care and those who receive care. Data is important because it reveals where healthcare providers practice, to whom they make their referrals, and which patients they serve. Data governance in healthcare helps to link patients with the services and providers that help individuals achieve and maintain good health.
One of the many challenges that healthcare providers have is being able to keep information on providers current. Data governance provides a way for providers to understand the services that may be covered under insurance, whom to bill and whether those on the provider list are still in the business of providing healthcare services.
Many healthcare providers are now using enterprise master patient indexes (EMPI) to help manage electronic medical records (EMR). Indexes use patient information, such as names, addresses, gender, and Social Security numbers, to develop a single view of a patient’s health records. EMPI gives healthcare providers clinical information; information on admittance, discharge and transfers; and other vital information by matching different records of the same patient and linking systems together.
Data Governance Enhances HIPAA Protections
Another of the challenges in data governance is how to connect healthcare data while complying with HIPAA. Data governance in healthcare helps to protect against unauthorized access to patients’ private health information.
Data governance serves to clearly define personal health information (PHI) and to set policies that safeguard health data and keep it private. Information governance will help to draw out the many places that providers store health data and develop systems to protect it.
Data Governance Supports the Transition From ICD-9 to ICD-10
All healthcare providers use the international classification of diseases (ICD) to analyze and interpret health claims data. As health research brings us new information, it’s necessary to update the health coding systems. The number of medical codes has increased substantially between ICD-9 and ICD-10.
Completing the transition in the coding systems will require dispersing reference data to healthcare providers and providing the mappings between the codes. The transition for updating coding systems will require transition time and staff training. Everyone who uses medical coding will need data to be able to translate the codes between the versions.
Standardizing Terms and Definitions Throughout the Industry
Having standardized clinical coding standards is crucial for the quality and safety of health service delivery. Currently, EMRs don’t all use the same data domains. In many cases, they don’t share the same business definitions, clinical terminology or metadata, which means that they refer to health symptoms, diseases, medications and procedures differently.
It’s vital for patient care and healthcare research and development to share data across disparate systems, providers, networks and applications in a meaningful way.
Data Governance Enhances Health Information Exchanges
As patients visit various healthcare providers, they leave various bits of their health data in many places; yet, no one provider can access all of it at one time. This is more indicative of an application-centric data system than a patient-centric data system. Health Information Exchanges (HIE) are forcing a change to a patient-centric data system.
Health Information Exchanges (HIE) serve as a useful warehouse for medical information where disparate stakeholders can share clinical information between health systems, hospitals, physicians, diagnostic centers, clinics and insurers using electronic means. Data governance would further the development of facilitating a continuous exchange of patient data within HIE and other systems.
Obstacles That Impede the Progress of Data Governance
The volume of each individual’s health data and the speed at which providers can transfer it creates risks in sharing data. Regulators continue to assess how they can govern health data without compromising a patient’s confidentiality. The evolution of HIPAA is one way for regulators to protect patient data.
Changes in the insurance industry have also had a serious impact on data governance in healthcare. Recent changes in how commercial health insurers and Medicare claims are handled are increasing healthcare costs in general as healthcare providers try to adjust to rising labor costs and thinner profit margins.
Yet another challenge presents itself when healthcare organizations experience mergers and acquisitions, which tend to silo healthcare data even more.
As data governance processes expand and mature, it will be challenging to conjoin health data while enabling patient records to have the necessary customization for providers to personalize their approach to healthcare services.
While the bulk of healthcare providers and systems have made it a priority to enhance healthcare data governance, the very nature of healthcare makes it extraordinarily challenging to build a consensus on how to ascertain the best data governance policies and practices across the board.
There’s no question that technology has complicated the exchange of healthcare data. At the same time, advances in board portal technology and other governance software solutions are sure to be instrumental for boards of healthcare organizations as they navigate these challenging waters.