- NEW ORLEANS - Physicians who are struggling to muster up the enthusiasm to continue the practice of medicine may not feel like adding a mountain of big data to the mix will do much to help them recapture the joy of patient care. After all, burdensome reporting programs, an inundation of quality metrics, and increased documentation requirements are some of the primary reasons why clinicians are so disgruntled in the first place.
But as the healthcare system evolves into a value-based, data-driven care continuum, big data analytics is poised to become the solution to physician dissatisfaction, not its cause. If providers can make meaningful changes to their information governance programs in the present, they will be positioning themselves for success in the very near future.
At the 2015 AHIMA Convention in New Orleans this week, industry leaders including Doug Fridsma, MD, PhD, FACP, FACMI from the Office of the National Coordinator and Steven J. Stack, President of the American Medical Association, discussed the role of information governance and big data analytics in the fight to keep physicians engaged as they struggle to meet expectations.
“We have to think not only about the problem we’re trying to solve now, but how we can strategically use data governance and data quality to set up the fundamental building blocks that will help us ten years from now, when healthcare is going to be delivered in different ways,” said Fridsma, Chief Science Officer and Director of the Office of Science and Technology at the ONC. “We have to ensure that we haven’t created systems that impart our ability to deliver quality care and access that data.”
Data silos and interoperability woes arising from the industry’s reluctant adoption of patchwork health IT systems have produced frustration among physicians left fighting with the very tools that are supposed to help them make smarter decisions and access more complete patient data.
Not only are providers facing roadblocks from inadequate and cumbersome EHR workflows, but they are also being asked to change the way they produce documentation in response to ICD-10 and the pressures of value-based reimbursement.
Clinical documentation improvement programs often feel like an attack on the very physicians they are trying to help, and the health information management (HIM) department becomes the enemy of overwhelmed physicians.
“It’s very easy to set up us-versus-them sort of battles,” said Brian Murphy, Director of the Association of Clinical Documentation Improvement Specialists during a panel discussion.
“CDI should really be a partnership with the physician,” he said. “As we explore this confluence of clinical care and big data, clinical documentation improvement shouldn’t just be about getting the diagnosis into the chart. The most effective CDI departments make it relatable to the doctor. How will all this ICD-10 and EHR data actually impact the physician? Make it really meaningful and powerful for their business interests.”
“Remove the firewalls with physicians,” Murphy urged. “Show them the data. One of the best ways to mitigate a lot of these issues is to have a strong physician advisor to bridge the HIM, CDI, and physician staff. This is a physician who’s still practicing medicine, but devotes some of his or her time to this position. It’s critical to have this buy-in. That’s what really sells HIM and CDI to the clinicians.”
At the core of these partnerships must be a strong framework of information governance, said Deborah Green, MBA, RHIA, Executive Vice President and Chief Operating Officer of AHIMA.
“Sometimes we feel like we’re drowning in data, but the challenge isn’t just the volume. It’s the integrity and the quality of that data,” Green said. “We need information governance to enable trust. What will that buy us? Each organization will be able to trust their data for key decision making and be confident enough to leverage that information to promote themselves. Most importantly, it’ll enable safer use of health IT.
“It’ll ensure we have the right info with the right patient. It’ll help us improve the quality of care and lower costs - two parts of the Triple Aim - and it’ll help us prove the value of value-based reimbursement,” she continued. “It’ll enable more robust data analytics, and the learning health system, and a move towards population health management. And finally, it’ll enable safe and proven interoperability. We’re not there yet, but we are moving in the right direction.”
Fridsma agreed that a collaborative approach to big data management, coupled with a robust and comprehensive strategy for information governance, will help to bridge ideological and process gaps between physicians and the HIM department.
“I think that health informatics and HIM have a lot of partnerships to develop,” he said. “There’s a need within the informatics community to have governance. That’s an area that we can work very synergistically so make sure we have good quality and good analytics so we can be good partners.”
“There is an opportunity for us to recognize that if what we do is focused on the patient - if we use the patient as our north star, we will always chart the right path. So if we can think about how patients can improve the quality of the data and make sure they have access to the patient - because who cares more than the patient that this data is complete and accurate?”
Patient-generated health data (PGHD) and pilot programs that allow open access to clinical notes have produced encouraging results for patient engagement, but the healthcare system must move far beyond the collection of basic clinical information if providers are to make meaningful headway with population health management.
“The social determinants of healthcare drive an incredible amount of costs,” stated Stack. “The people who come back to the emergency department over and over do have health problems, but so much of the overutilization we’re seeing is due to primarily to social problems. The patients don’t have transportation or support; they don’t have social networks. They suffer from stigma against mental health issues.”
“The problems they have aren’t about slipping and falling and having surgery and then getting better. They have very different challenges. To the extent that the HIM can document what’s really happening, that would really help us to address these problems and potentially try to solve them.”
Stack, a practicing emergency department physician in Kentucky, noted that physicians can certainly be resistant to new rules that change the way they have always produced documentation, but CDI specialists and clinicians don’t have to default to adversarial roles.
“I’m proud to be a physician,” he said. “I don’t need to tear you or anyone else down to be proud of what I do. I don’t need to be the arrogant, disruptive physician to do what I do well. And that’s a much better way to do things. I think we can work together, but we have to understand that people have reasonable, human responses to being under stress. There’s a lot of frustrated people. and that’s not just doctors, but nurses and other members of the care team.”
For its part, the American Medical Association has committed to three major goals to try to ameliorate some of the roadblocks that are preventing big data analytics, population health management, and value-based care from truly taking off.
“Be big and bold and honest with yourselves about what contribution your community can make,” Stack said. “We’re going to do three big things. We’re going to improve health outcomes by reducing hypertension and preventing pre-diabetics from becoming diabetics, we’re going to create the medical school of the future, and we’re going to restore joy to the practice of medicine,” he said, prompting a strong round of applause from the audience.
“It’s really about bringing back the joy of medicine,” agreed Murphy. “How can you do it in HIM? You can really reward doctors for doing their jobs in a personal way - reward them visibly. Remind doctors that when they’re adding documentation that getting that full length of stay is going to help the patient get the treatment they need. It’s providing the hospital with the technology it needs to improve the practice of medicine. Don’t just work in isolation. Work with the physician and work across various groups. If we can get that accomplished in 2016, we’ll be on the right track.”
The industry seem to be making progress towards these goals, Green said, with information governance firmly in mind. Citing a recent survey of healthcare providers, she noted that forty-four percent of providers had established oversight bodies for information governance as the importance of big data analytics for achieving strategic clinical and business goals becomes increasingly apparent. The same number said that they had seen “modest or significant progress” with their information governance programs so far.
Sixty-nine percent added that they were familiar with the AHIMA definition of information governance, and thirty-eight percent said that they had incorporated these principles into their strategic plans. A similar number have appointed senior-level leaders to drive their information governance programs.
“That’s huge,” Green noted. “That means that 38 percent of organizations recognize that information is a strategic asset that drives business.”
Big data can also provide clinicians with the tools they need to make smarter decisions, deliver tailored treatments, predict adverse events, improve patient safety, and even lighten their workload - if clear, robust, and ethical information guidelines are put in place and all stakeholders adhere to them.
Value-based care may hold the potential for improving care coordination and reducing unnecessary services, but its reliance on clinical quality measures and outcome metrics could be a weakness instead of a strength if HIM specialists and physicians try to cut corners.
“We’re seeing a gray area in this confluence between the coding and clinical spheres, said Murphy. “There are pressures now to not report certain things. A coder might ask a question to a physician would trigger a PSI and ding a surgeon’s publicly reported measure. What if they ask a query that lowers the risk and mortality score? It’s very important to have a code of ethics that encourages transparency and accuracy.”
Ultimately, as information governance smooths out some of the wrinkles of big data analytics and provides a strong foundation for complete, accurate, and high-quality information, providers may once again start to feel equipped with the tools and drive to leverage healthcare technology for the good of patient care.
Keeping patients at the center of data governance and organizational strategy is vital to ensuring that providers and HIM professionals alike are focused on the same goals: creating a coordinated, effective healthcare ecosystem that promotes wellness and satisfaction for staff and consumers equally.
“If we judge our policies and governance based on what’s best for the patient,” said Fridsma, “that’s the way to get joy back into medicine.”