M12S18 - Records and Information Management: What Healthcare Should be Learning From Other Information Intensive Industries
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M12S18 - Records and Information Management: What Healthcare Should be Learning From Other Information Intensive Industries

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Speakers: Hon. Ronald J. Hedges, Linda Kloss, & Deborah Kohn, MPH RHIA FACHE ...

Speakers: Hon. Ronald J. Hedges, Linda Kloss, & Deborah Kohn, MPH RHIA FACHE

Healthcare organizations are making unprecedented investments in information technology to accelerate the transition from paper to electronic health records as a foundation for improving care delivery.

The health care industry is learning that implementing information management and communications technology does not ensure that information is complete, accurate, reliable, secure, or used appropriately.

In fact, research is revealing new data errors and other information-related unintended consequences can impede safe use of technology.

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M12S18 - Records and Information Management: What Healthcare Should be Learning From Other Information Intensive Industries Document Transcript

  • 1. Cohasset Associates, Inc. NOTES Records and Information Management: What Healthcare Should Be Learning from Other Information-Intensive Industries May 8, 2012 1:30 – 2:45 pm Ron Hedges Ronald J. Hedges, LLC Linda Kloss Kloss Strategic Advisors, Ltd. Deborah Kohn Dak Systems Consulting AGENDA 1. Current state of healthcare information technology adoption 2. Unintended consequences and current lessons learned 3. Current i iti ti 3 C t initiatives to improve information t i i f ti governance, records and information management 4. What healthcare can learn from other information-intensive industries 5. Key digital information challenges anticipated in the next decade 1. Current state of healthcare information technology adoption2012 Managing Electronic Records Conference 18.1
  • 2. Cohasset Associates, Inc. NOTES  Focus on Healthcare Provider Organizations  Focus on Acute Care (Inpatient / Outpatient)  Focus on Patient Records  Focus on Clinical Records TRANSITIONING From Paper /Film-based Records (Analog Records) To Electronic Health Records (EHRs) (Digital Records) patient clinical record Current state of ^ technology adoption provider (inpatient / outpatient) by healthcare ^ organizations = H Y B R I D Record Systems Analog Records and Digital Records ELECTRONIC HEALTH RECORD SYSTEM CR/DR CT Laboratory Orders / Results MR Medication Orders / MARs Nuclear Med Dx Images Recv’d Online Charting from the Outside and Discrete, Pathology and Diagnostic Documentation Structured, Other “Ology” Image Data ASCII Images Data Document Signed Patient Text Data Transcribed Image Data Consent Forms Reports Handwritten Notes Video Signal and Drawings Data Audio Tracing Data Data Documents Recv’d from the Outside Ultrasound, Cardiac Catheterization, Heart ECG, EEG, Fetal Telemedicine Sounds Voice Dictations Monitoring Examinations & Annotations © 1996 Deborah Kohn2012 Managing Electronic Records Conference 18.2
  • 3. Cohasset Associates, Inc. NOTES ARRA/HITECH - February 2009  The American Recovery and Reinvestment Act (ARRA) a.k.a., a k a the Economic Stimulus Bill PL 111-5 Bill, with its  Health Information Technology for Economic and Clinical Health (HITECH) Act ARRA/HITECH - February 2009  revitalize the economy over the next 10 years (until ~ 2018 - 2020)  generate government savings g g g  guarantee EHRs for all Americans by 2014  continue to protect the privacy of the individual and the security of the individual’s health information  continue to improve the safety of the patient and the quality of the patient’s care ARRA/HITECH - February 2009 Key Components Medicare / Medicaid HIPAA Incentive Comparative Confidentiality/ Payments Effectiveness Privacy Research and ADOPTION & ( (CER)) Security Standards S it St d d MEANINGFUL USE Quality of Outcomes / CERTIFIED EHRs Reporting Providers / Hospitals Work Force Regional Health Broadband Expansion Extension Information Telemedicine Centers Exchange Public Health Intra- / Inter- Organizational2012 Managing Electronic Records Conference 18.3
  • 4. Cohasset Associates, Inc. NOTES Medicare / Medicaid Incentive Payments ADOPTION & MEANINGFUL USE of CERTIFIED EHRs Providers / Hospitals ADOPTION and MEANINGFUL USE of CERTIFIED Electronic Health Records Medicare / Medicaid Incentive Payments ADOPTION & MEANINGFUL USE of CERTIFIED EHRs Providers / Hospitals As of April 2012: Current state of achieving interoperability What is interoperability?  sharing data between different software, residing on different hardware, from different software and hardware vendors  allowing the seamless passing of vital health information from application to application, system to system, and setting to setting within and across the healthcare enterprise2012 Managing Electronic Records Conference 18.4
  • 5. Cohasset Associates, Inc. NOTES Current state of achieving interoperability between patient clinical record systems in acute care provider organizations = Still a long way to go!  Proprietary vs. Open source  National Patient Identifier  Standards 2. Unintended consequences of electronic health records and current l t lessons learned l d Unintended Consequences  Outcomes of actions that are not originally intended in a particular situation it ti  May be positive or negative  May be sudden and obvious  Go undetected until the process has played out some2012 Managing Electronic Records Conference 18.5
  • 6. Cohasset Associates, Inc. NOTES Describing Consequences Human & Organizational Fiscal Cognitive Policies & Technology Regulations Health Information and Communications Technology Types of Stakeholder consequences (who is affected) Current Research  More/New work issues  Workflow issues  System demands  Communication  Emotions  New kinds of errors  Power shifts  Dependence on the system Campbell, E. M., Sittig, D. F., Ash, J. S., Guappone, K. P., & Dykstra, R. H. (2006). Types of unintended consequences related to computerized provider order entry. J.Am.Med.Inform.Assoc., 13, 547-556 What Healthcare is Learning  Reporting and sharing EHR-related hazards and adverse events  Enhanced EHR certification program - high-reliability software development practices  Competency development  A culture of safety  Standards to support interoperability  Information governance and enhanced RIM2012 Managing Electronic Records Conference 18.6
  • 7. Cohasset Associates, Inc. NOTES 3. Current initiatives to improve information governance, records and information management through improved regulations, policies, and standards The Case for Information Governance Data breaches: 7.8 Million individuals affected in first 15 months of new breech reporting 1 in 10 computer-generated More than 500,000 Americans prescriptions included at were victims of medical identity least one error theft in 2009 Error rates for provider- FY 2010 was 10.5 percent, or maintained master person $34.3 billion in estimated indices (MPIs) are between improper claims payments 7 and 10 percent Building Blocks for Enterprise Health Information Management Information Governance I Information Content & Information Design & Records Analysis & Capture Management Use Information Integrity & Quality Access, Security & Confidentiality2012 Managing Electronic Records Conference 18.7
  • 8. Cohasset Associates, Inc. NOTES Information Governance Drivers  Information as an organizational asset  Third party accreditation  Reimbursement policy  Standards  Consumer demand for information transparency  Legal and regulatory The Legal and Regulatory Environment  HITECH (Health Information Technology for Economic and Clinical Health, 2009)  HIPAA (Health Insurance Portability and Accountability Act, 1996)  Affordable Care Act (2010)  Other regulatory options (FDA, Commerce)  Case law  State statute and regulation 4. What healthcare can learn from other information- intensive industries2012 Managing Electronic Records Conference 18.8
  • 9. Cohasset Associates, Inc. NOTES A. Enterprise Content Management Systems consist of a cluster of technologies that manage the enterprise’s unstructured intellectual substance (a.k.a. CONTENT) of its documents and records, such as symbol, image, video, and audio data y , g , ,  eMail Management technologies classify, store, and destroy eMail messages consistent with organization standards, just like any other organization document or record  Web Content Management technologies address web-based content creation, review, approval, and publishing processes B. Electronic Records Management Systems consist of a cluster of technologies that electronically identify records, retain records in a secured repository, provide controlled access to records, and destroy records in accordance with pre-determined pre-determined, organization and regulation retention schedules  Record Preservation Format/Legal Hold  Record Retention Calculation  Record Disposition Control  Record Deletion & Destruction Management C. Information Governance Research and case studies about how information governance is operationalized and what best practices are emerging  Benefits Stories  Organizational Competencies  Tie to IT Governance and Data Governance  Engaging the C-suite and Boards2012 Managing Electronic Records Conference 18.9
  • 10. Cohasset Associates, Inc. NOTES 5. Key digital health information challenges anticipated in the next decade 1. Ongoing privacy and security challenges (Breaches) 2. Social media technology evolution 3. Smaller form factors (mHealth) 4. Achieving interoperability 5. Data 5 D t content standards and standardization t t t d d d t d di ti 6. Health data analytics and business intelligence 7. Consumer engagement and health literacy 8. Health system and health care delivery reform 9. Evolution of technology 10. e-Discovery Questions and Discussion Deborah Kohn @ y dkohn@daksystcons.com Linda Kloss linda@kloss-strategicadvisors.com Ron Hedges r_hedges@live.com2012 Managing Electronic Records Conference 18.10