Research Results: Impact of Payment Reform on HIM Professional

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 • 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 Customer Loyalty: Providers and Patients High Quality Health Care Cost Efficiency Primary HIT Requirements to Support Accountable Care Strong Privacy and Security protections 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 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