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State of Information Governance in Healthcare Case Study – Four Hospital Integrated Delivery

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State of Information Governance in Healthcare
Case Study – Four Hospital Integrated Delivery System

By: Lesley Kadlec MA RHIA

In an effort to begin to answer basic questions related to the state of information governance (IG) in healthcare, and to showcase some existing information governance models in practice, several organizations across the country were invited to participate in case studies. An analysis of the results of the IG case study from a four hospital integrated delivery system is the basis for this document.

Executive Sponsor
President/CEO.

Program Managers
CIO and Chief Quality Officer

Organizational Description
This organization an integrated health care system and the region’s largest health care provider. As a …show more content…

HIM staff had participated in the implementation of the electronic health record, but they did not have a voice in how the data was being used. HIM leadership recognized that a framework was needed.

Physicians were complaining of there being too much clutter in the EHR. They wanted to have a mechanism to understand the patient’s story. There were complaints of too much “garbage” in the record and physicians could not get to the heart of the patient’s complaints. Some physicians wanted to use “progress notes” for everything without entering any discreet data. There was a dependence on scanned documentation, both clinical notes as well as business documents. Scanned documents could not be found in the “notes activity” within the electronic record, meaning physicians had to search multiple tabs to find information while providing patient care. Information Governance Drivers
The program was started to meet reporting requirements for core measures and quality initiatives. The data that was being pulled was felt to be inaccurate or incomplete, and the lack of data integrity was leading to concerns for patient safety.

Physicians could not tell the patient’s story with the amount of clutter in the EHR. Filters were not usable and problem lists were not being maintained. After 8-9 years post implementation, HIM was being bombarded with scanned documents, both

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