Children’s Health Raises Efficiency with Revenue Cycle Information Governance

Reducing the volume of paper documents stored in an offsite facility was the first project that the health system’s information governance committee tackled.

Data integrity had always been a priority at Children’s Health—the eighth-largest pediatric healthcare provider in the nation and the leading pediatric healthcare system in North Texas. However, in recent years, hospital executives had begun to turn their attention toward ways in which they could use that data more strategically. In particular, they wanted to use the revenue cycle data to inform business decisions, improve clinical outcomes, and drive population health management.

The question was: How could Children’s Health establish a strategy that would yield a demonstrable return on investment?

“We wanted to leverage our internal structures and synergies while improving the management of information—one of our strategic assets,” says Katherine Lusk, chief health information management and exchange officer. “We had been focusing more on data governance—which is at the micro level—and we really wanted to go to more of a macro level,” she adds. “Information governance really looks at how the data is pieced together to produce information that can be acted upon.”

Defining IG, Identifying Benefits

The American Health Information Management Association (AHIMA) defines information governance (IG) as “an organizationwide framework for managing information throughout its life cycle and for supporting the organization’s strategy, operations, regulatory, legal, risk, and environmental requirements.”

This information includes all types of clinical, financial, and operational data on all types of media throughout the entire organization, says Ann Meehan, director of IG at AHIMA’s IGAdvisors.

“It’s important for every organization to acknowledge that information is an asset much like more tangible assets such as a physical building, equipment, supplies, and human resources,” Meehan said during a recent webinar titled “How Information Governance Can Ensure Compliance in the Revenue Cycle” sponsored by the Health Care Compliance Association.

Meehan shared several direct—and indirect—benefits of establishing an IG program:

• Accurate and timely reimbursement
• Regulatory compliance
• Patient satisfaction and safety
• Reliable data for analytics and quality reporting
• More informed clinical decisions at the point of care

Children’s Health took the following five specific steps to structure its IG program.

Step 1: Identify an Executive-Level Sponsor

An executive-level individual (or group of individuals) performs the following tasks:

• Establishes a positive tone for IG throughout the organization
• Aligns IG with the organization’s overall strategy and mission
• Secures any necessary funding for IG efforts
• Provides general oversight for the IG program

“While this individual is not in the weeds of IG day in and day out, this person is involved ongoing at a higher level,” Meehan said. “This person is not a figurehead. He or she gets involved and knows what’s going on and can speak intelligently about IG and the initiatives and successes that are part of the program.”

Children’s Health began its IG journey in February 2015 by obtaining executive buy-in—something that Lusk says was relatively easy to do given the facility’s increased reliance on data for clinical and process improvement.

“Our executives immediately understood the value of an IG program … We have a great deal of rigor around how we manage our human resources and finances. They saw that information could benefit from that same sort of rigor,” she adds.

Step 2: Form an IG Committee

Next, Children’s Health formed a multi-disciplinary 20-person IG committee that included representation from several departments, including HIM, IT, legal, data intelligence, information privacy and security, regulatory, finance, and clinical.

According to Meehan, an IG committee’s goal is to accomplish the following:

• Establish an IG program charter
• Create and approve policies and procedures
• Provide planning guidance
• Establish and advise task forces or work groups
• Make decisions based on task force/work group recommendations
• Seek funding from hospital executives, as necessary (e.g., for consulting or per diem staff to assist with a project, software to remediate a technology risk, or interfaces to develop internal interoperability)
• Track accomplishments and measure/report progress

Step 3: Create IG Subcommittees

Next, the IG subcommittee at Children’s Health identified subcommittees that would dive more deeply into specific IG initiatives. The subcommittees included departmental leaders and subject matter experts (SME) who seized new opportunities to advance IG within the organization.

Step 4: Dive into an IG Project

Reducing the volume of paper documents stored in an offsite facility was the first project that the IG committee enterprise information management sub-group at Children’s Health tackled.

“We used the structure around IG to manage those offsite records and help everyone in the organization understand that there was a cost to maintaining things and not managing them in a structured manner,” says Lusk. “People don’t always recognize that when you store information past its useful value that you continue to pay for that. An IG program really allowed us to communicate that to our community and help them understand.”

As part of the project, Lusk and her team quantified the following data:

• Number of boxes stored offsite
• Date of last access
• Cost associated with ongoing storage

Next, they communicated this information to operational owners who could then make the decision regarding document destruction. “There were annual savings for this, and the IG structure was paramount in making that happen,” says Lusk.

Step 5: Provide IG Education

IG success wouldn’t be possible without the help of workforce stewards and SMEs who coordinate IG efforts at the local level in each department, said Meehan. “This is a critical role in an IG program,” she added. “You don’t need a workforce steward dedicated to every department. More than likely, you’ll have someone shared across multiple departments who understands the business and systems. They’re really at the heart of the workforce and can make sure that IG is embraced as part of the culture within the organization.”

At Children’s Health, the multi-disciplinary committee members serve as organizational stewards who champion IG efforts. New employees also receive IG education during orientation.  “This started our cultural shift, but we knew we needed to go further to embed these principles into the fabric of our organization,” says Lusk.

The IG committee also worked with the hospital’s marketing department to produce role-specific articles that would ensure all employees—especially front-line staff members—understood the ways in which they can ensure IG daily. Workforce stewards distributed these articles through various newsletters and during departmental meetings.

Reaping the Rewards of IG

Since the inception of its IG program, Children’s Health has not only reduced costs by trimming offsite storage, but it has also seen savings by reducing its IT storage capacity on shared/personal drives as well as decreasing the number of days for archived emails using vaulted technology.

In addition, since its IG program launch, Lusk says employees use the data differently because they have more confidence in its validity. “More and more people are accessing the information that we have made available, and they are understanding the value and using it more at an operational level for decision-making,” she adds. “It’s permeating the fabric of our organization in a secure manner while providing information to the operational and front-line staff as they need it.”

In the future, Children’s Health plans to continue using data strategically to drive business decisions and population health management. “Population health is changing our clinical paradigm by increasing care delivery outside our walls. The structure surrounding IG is the backbone in decision-making on where and what resources are needed,” says Lusk. “Trust in the data is assured with the structure of the IG program.”

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Lisa A. Eramo is a freelance writer based in Rhode Island.

Interviewed for this article:

Katherine Lusk, MHSM, RHIA, FAHIMA, chief health information management and exchange officer, Children’s Health, Dallas.

Ann Meehan, RHIA, director of IG at AHIMA’s IGAdvisors, Chicago.