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. Read More: http://www.rimeducation.com/videos/rimondemand.php

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
adoption
2012 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 Kohn
2012 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-
Organizational
2012 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
enterprise
2012 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 some
2012 Managing Electronic Records Conference 18.5

6. Cohasset Associates, Inc.
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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 RIM
2012 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 & Confidentiality
2012 Managing Electronic Records Conference 18.7

8. Cohasset Associates, Inc.
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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 industries
2012 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 Boards
2012 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.com
2012 Managing Electronic Records Conference 18.10