The hospital medical records department is evolving from a paper-based repository to a digital knowledge base giving rise to more compliance and data-mining requirements. Specifically, the accountable care organization (ACO) model and a growing number of other quality-based payer incentive programs require data mining. Compliance with HIPAA privacy requirements, not to mention legal e-discovery requests, point to the need for more than just a CIO to implement and secure IT infrastructure.
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All these tasks add up to what other service sectors and industries call knowledge management, headed by the chief knowledge officer (CKO). Health care organizations have been slow to embrace the hospital CKO position, but ACOs and other emerging data initiatives point toward the need for it, said Cindy Zak, health information management (HIM) director and privacy officer at Milford (Conn.) Hospital. She made her case for the chief knowledge officer in a presentation at the American Health Information Managers Association's 83rd AHIMA Convention and Exhibit.
"[CKO] is an emerging role that we are starting to see talked about in newsletters and literature in health care because -- as hospitals and providers and health care organizations become more information-based -- there's a need to do something with this abundance of information," Zak said. "Someone to champion the use and application of the information within the [electronic health record] EHR and within databases within health care organizations."
The CKO, in her vision, reports to the CEO and is a logical evolution of the HIM manager's present position, just like HIM managers evolved from paper record librarians to their present position that includes coding staff, interacting with IT, managing HIPAA compliance and assembling legal EHRs.
Leaping from data to information to knowledge
Zak differentiated raw data an organization collects from information, which is raw data sorted with analytics. Knowledge is the combining of information with employee expertise for business advantage.
The transition from traditional to knowledge-based organizations has been happening for three decades in other sectors, Zak said, citing the examples of Hallmark Cards Inc., Dow Chemical Co. and Royal Dutch Shell PLC. Such firms take knowledge projects and, instead of making them one-time programs combining technology, people and processes, they turn them into continually improving initiatives. The constant sharing of knowledge between departments, Zak said, breeds constant innovation.
Hospitals are good at disseminating information, Zak said, but not necessarily at merging it into knowledge to create new treatments and workflows for improving outcomes, creating efficiencies and cutting costs. One such example would be examining several surgeons performing the same procedure, analyzing why one has better outcomes than the others and then sharing that information among all. Evolving into a knowledge-based organization, led by the CKO, will help affect those types of innovations.
Proliferation of health IT creates need for chief knowledge officer
Providers have spent significantly on health IT in the last year, Zak said. It's not just meaningful use requirements that are driving the investment; hospitals are also sinking resources into social media, patient portals and ICD-10 implementation.
The information explosion isn't just clinical, either. Payers are demanding additional documentation for claims as well as group metrics in pay-for-performance programs, Zak noted. Because of health care reform, they also have to change their business models with an eye toward administrative simplification and increased collaboration with providers to share financial risks -- and, providers hope, rewards.
"It's a fiercely competitive environment," Zak said. "I'm in a community hospital surrounded by tertiary care hospitals. We have to find our niche. We have to use our information to constantly be coming up with new ideas to compete."
Making a health care provider a knowledge-based organization
Knowledge workers in hospital HIM departments will evaluate and establish the value of various information in the enterprise, en route to creating "incredible databases for research moving forward," said co-presenter Sandra Nunn, principal at KAMC Consulting and former HIM manager for Presbyterian Healthcare Services in New Mexico. She predicted that increasingly rich patient genomics data will become a more significant part of the CKO's domain.
The EHR data repository will become an increasingly important well for health care improvement and innovation, Nunn said. As traditional clinical trials becomes more and more cost-prohibitive in the current economy, they could very well be replaced -- partially, in the near term of the next few years -- with research through data mining. IT staffs will enable these initiatives, collaborating closely with knowledge workers to implement the applications, as well as highly complex data storage systems larger than today's.
We have to use our information to constantly be coming up with new ideas to compete.
Cindy Zak, HIM director and privacy officer, Milford Hospital
Another large data initiative on the three- to five year horizon is incorporating genomic data in electronic records in order to customize care and medication to a particular patient's gene set. This isn't just a futuristic technology idea, Nunn said, but a part of some systems currently under development and a requirement that could potentially make it into the final stages of meaningful use.
When this idea gets implemented, Nunn said, it will be incumbent upon HIM managers to get data -- not only about the patient, but his family history as well -- into the system as fast as possible. Accuracy from the start will be imperative.
"Think of what that means in terms of the need for data integrity," Nunn said. "It means that your data has to be right the very first time, because it's going to be used real-time. It's not going to go into a decision support system that someone might access retrospectively, it's going to be there the minute it's put in."
Let us know what you think about the story; email Don Fluckinger, Features Writer.