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February 2014

Data Governance 101
By Sandra Nunn, MA, RHIA, CHP
For The Record
Vol. 26 No. 2 P. 18

Designed to reflect an evolving workforce, AHIMA’s curriculum maps help educators move the HIM industry forward. The 2014 version addresses many, but not all, of the changes taking place in data governance.

Recently, AHIMA updated its associate, baccalaureate, and graduate HIM curricula. HIM professionals, both official and voluntary, spent months refining the guidelines that will influence HIM educators in terms of creating course objectives for those entering the profession. Although the guidelines are new, they are very much an expansion of the areas AHIMA always has emphasized.

At one of the organization’s 2013 gatherings, an HIM professional commented that HIM always has handled information governance. This is both true and false. AHIMA has gained a national reputation for its role in stressing data integrity and the protection of health information. However, the ability to carry out information governance on an enterprise level for structured, semistructured, and unstructured information is in the exploratory stage at many health care organizations.

The new AHIMA curricula guidelines are encouraging in that they address the rapid changes taking place as information moves from being recorded on paper to living in databases that can be managed field by field. AHIMA has examined the role of data stewards from the operational, tactical, and strategic levels. Indeed, the data steward’s responsibilities are the foundation on which information management and data governance structures can become a reality.

AHIMA has recognized that data stewards, who are responsible for the definition, creation, management, and use of the data in their particular business units, both clinical and nonclinical, already exist at the operational level. According to the guidelines, HIM professionals graduating from an associate program (RHITs) may be tasked with the following job responsibilities:

• applying policies and procedures to ensure health data accuracy;

• collecting and maintaining health data;

• validating the reliability and accuracy of secondary data sources;

• explaining analytics and decision support; and

• applying report generation technologies to facilitate decision making.

The potential for a larger, more interdepartmental role for data stewards appears in the curricula guidelines for bachelor-level HIM professionals and beyond. Completing the course work at these levels should prepare HIM baccalaureate or graduate professionals to jump to tactical- or even strategic-level work in governance.

In the March 2013 DM Radio forum “New Roles, New Challenges for Information Managers,” Dan Everett, senior director of marketing enterprise information management at SAP, discussed an expansion of the role traditionally thought of as the data steward: “These jobs sit between two worlds: business and IT. They must be able to talk to both: 60% business knowledge and 40% IT. The toolsets are getting there. It is now easier to do data profiling, data quality monitoring, and metadata management.”

Everett predicted that some data stewards will rise from the departmental ranks and noted the importance of having someone with “people skills” in the role. “This person must be a good negotiator and must be able to do the internal marketing it takes when putting in a governance program—that is, getting people to buy in, getting people to budge from their positions,” he said. “This person cannot be a newbie but someone who understands the business value of the data.”

The AHIMA curricula guidelines take into account the technical aspects of such skills, especially at the baccalaureate and graduate levels. In the data governance and data management subdomains, concepts such as data integration needs, data interoperability, and the ability to maintain the standardization of data dictionaries to meet the needs of the enterprise require pending HIM professionals to graduate equipped not only with the ability to wield technical tools but also the political skills to carry out data governance.

The informatics, analytics, and data use domain covers an array of terms, including data architecture, interface considerations, data modeling, analytics and decision support, data quality, trend analysis, and data visualization techniques. Universities are incorporating aspects of these guidelines and customizing them to the particular profiles of their HIM programs.

Susan White, PhD, CHDA, an associate professor at Ohio State University, says its HIM program emphasizes statistics, database development and implementation, and analytical skills such as those that would allow graduates to contrast hospital financial ratios. “Only one-quarter of the graduates from the HIM program at Ohio State go into traditional HIM roles, while as many as half enter nontraditional roles in quality or revenue management,” she notes. “The remainder moves on to grad school.”

While the Ohio State program teaches students to use data management tools such as data modeling and profiling, the emphasis is on data management. For example, part of the curriculum focuses on how to collect and use high integrity data.

Taking education away from the classroom, the College of St Scholastica in Duluth, Minnesota, offers one of the first HIM-focused massive open online courses. “Health Data Analytics,” taught by adjunct faculty member David Marc, MBS, has the support of AHIMA, which grants 12 CE credits to any HIM professional who completes the coursework. These types of courses allow HIM professionals in data steward positions to take advantage of new opportunities involving higher data analytical skills.

“Copious amounts of health care data are collected daily, offering an opportunity to conduct large-scale analyses for a multitude of purposes, including hypothesis testing and predictive data mining,” Marc says. “However, there is a general need for training professionals in health informatics and information management on the methods of data retrieval and analysis.”

Valerie Watzlaf, PhD, RHIA, FAHIMA, an associate professor in the HIM department at the University of Pittsburgh, has helped chart new pathways for HIM students. In an effort to prepare future HIM professionals for the enormous amount of EHR-generated data to come, she participated in a grant from the National Science Foundation to build a four-part genomics module into her HIM quality management course. “I wanted to show the students how genomics is linked to quality and how such information could be mined,” says Watzlaf, who worked with Bailee Ludwig, a senior HIM student at the time of the grant, and Leming Zhou, PhD, DSc, a colleague in the HIM department, to set up “labs around pulling genomic information out of databases” for hands-on exercises.

With the help of Zhou and the computer science department, she has integrated computational thinking into statistical courses, including some knowledge of Python programming, which “aids in doing statistical analysis.”

Beyond the Data Steward
In the DM Radio forum, Loretta Mahon Smith, CCP, CBIP, CDMP, of DAMA International, said that “the Bureau of Labor Statistics only has a DBA [database administrator] as an IT job category.” Quoting the World Bank’s Eileen Morse, who said during a DAMA International meeting that “the big I needs to be put back into IT,” Smith noted that information management, not technology, needs to be the industry’s focus.

In the same forum, Forrester Research’s Leslie Owens said that “organizations need high-quality data and robust governance.” In fact, numerous speakers during the forum touted the potential growth of data management positions, such as business architects, data scientists, and other high-paying, highly visible roles.

There is no reason that HIM professionals can’t eventually gravitate to such highly skilled positions. However, in the immediate future, HIM can facilitate the work of such specialists by creating the necessary infrastructure in which data scientists can thrive. According to Smith, academics need to teach “the use of data in the real world” and “hardware is becoming a commodity; it’s understanding the data that matters.”

Data vs. Information Governance
The new AHIMA curricula maps emphasize creating the needed infrastructure for optimum data governance. Registry management, which typically focuses on cancer, trauma, and immunizations, significantly impacts data integrity and research efforts. HIM professionals who elect to pursue this field may apply research principles and clinical literature evaluation to improve outcomes, while others may exercise data extraction methodologies to create business intelligence through data analytics. All the entries in the new curricula guides provide pathways for rookie and veteran HIM professionals to take their careers in different directions, including roles in business intelligence, data quality, and metadata management.

At AHIMA’s fall 2013 Health Information Integrity Summit in Alexandria, Virginia, an expert panel discussed the distinction between data and information governance, a topic that has been generating interest throughout the profession. The panel, featuring White; Michele O’Connor, MPA, RHIA, FAHIMA, chief privacy officer at IBM Initiate Systems; and Kathleen Addison, vice president of HIM for Alberta Health Services in Canada, seemed to agree that data governance occurs at the operational level and is more of a nuts-and-bolts operation involving data integrity. On the other hand, information governance concentrates on data management at the enterprise level, where it is treated as an asset.

When considering what job types may emerge, the panel’s thoughts on information governance could just as easily be applied to data governance, including the following:

• “The business analytics: What are the data telling us, and are we interpreting them correctly? In other words, keeping the garbage out.”

• “How are you securing those data? What systems are you going to use to retain the information? How long is it relevant?”

Those comments illustrate the marketplace’s confusion regarding the differences between data and information governance. Data governance involves data integrity and analytics, while information governance implies an expansion of roles into other domains, including standards development.

Chart a Course to Mapping
There is burgeoning interest in data mapping, a field promoted in the new AHIMA curricula guidelines. Students in this arena will learn how to interpret terminologies, vocabularies, and classification systems; identify the functions and relationships between health care classification systems; and map clinical vocabularies and terminologies to their appropriate classification systems.

According to the February 2007 Journal of AHIMA article “Translation, Please,” mapping involves deciding whether a concept in the source data is an exact or similar match to one or more concepts in the target data set. By this definition, mapping takes on a larger role as data and information governance become crucial to interoperability, which supports reimbursement, decision support, and data reuse for multiple purposes.

With all these factors and benefits in play, it’s easy to understand why there is a growing demand for professionals with a data mapping background.

Protecting Data
Safeguarding protected health information is one of the bedrocks of the HIM profession. From ensuring proper access to patient information to maintaining data integrity and securing archived records, HIM professionals have always played a major role in data protection.

AHIMA’s new curricula support traditional roles such as HIPAA privacy officer and release of information manager while exploring possible new career paths centered on data security management. For example, increases in identity theft and the misuse of patient information led AHIMA to create opportunities for students to learn how to develop forensic models for fraud surveillance and improvement measures. Other classes focus on how to use data monitoring and metrics to spot information security issues and fraudulent behavior, in-demand skills that should lead to either part-time or full-time employment for those HIM professionals.

The Missing Elephant in the Room
Although the new curricula maps include an enterprise information management subdomain, there is little substance in this section. However, it does note that two-year HIM professionals should be able to “apply knowledge of database architecture and design.” It will be interesting to see how community college instructors manifest this directive in their classes.

What is included in the new guidelines is less astonishing than what is missing. While the guidelines are a resounding testament to HIM’s longstanding strengths, such as managing structured information, they fail to address unstructured information management, which continues to be the dominant type of information found in EHR and clinical care systems. No discussion of information governance or enterprise information management can realistically take place without the inclusion of semistructured and unstructured information management.

According to Everett, an information manager “must understand there are different practices and methodologies for data management and enterprise content and records management [and] must also understand document management. eDiscovery, extraction of threads, and the move back to knowledge management.” As a result, he says HIM programs must consider adding another layer to the current curriculum.

Because unstructured content must be managed in the same manner as structured information, AHIMA must determine the exact skills necessary to carry out information governance and enterprise information management and then address them in the curriculum maps.

AHIMA also may want to consider how such courses are taught in other programs. At Kent State University in Ohio, the online class “Foundations of Document Management” teaches students how to manage documents, records, and content, including the metadata associated with this information. This type of course can provide an excellent foundation for any HIM professional looking to advance into an enterprise information management role.

Kent State’s School of Digital Sciences also offers a course on digital information management and processing. Educational offerings of this sort, which cover information governance, principles, and methods, could be stepping-stones for HIM professionals interested in pursuing a career in a governance-related field.

Final Thoughts
Much work went into AHIMA’s efforts to update its curriculum maps, which promise to increase the requirements of becoming an HIM professional and boost the chances of meeting the market demand for more skilled data practitioners. The maps examine information management learning from a career ladder perspective, constructing steps from associate to graduate levels in specialized HIM areas.

It is hoped that AHIMA eventually will grasp the golden opportunity at hand and begin to teach unstructured information management skills. Adopting such an approach would further the chances of HIM professionals looking to land important positions in that booming domain.

— Sandra Nunn, MA, RHIA, CHP, is a contributing editor at For The Record and principal of KAMC Consulting in Albuquerque, New Mexico.