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Hungry, Hungry HIPAA: How Health Information Professionals Appease the Appetite for Data in Healthcare Administration

Laura ShueBy Laura A. Shue, MPA, CHDA, CPHIMS, Director of Data Quality, Compliance and Operations, University of Michigan Health System

The healthcare industry is such a rapacious collector and consumer of data that an entirely new buzzword has recently crept into standard industry terminology: Big Data.  We hear this word tossed about in titles of presentations at our professional association meetings; it is a frequent contender for our continuing education topics; it appears regularly in blog posts and other professional trade journals. Other signs and symptoms include the advent of the Chief Data Officer role in many academic medical centers, integrated care delivery systems and other large networks of practices.  What conditions gave rise to “Big Data” in healthcare? And why is it critical that we harness it accordingly?

Giving Rise to Big Data

Following the Affordable Care Act, HITECH, and Meaningful Use, there was a veritable explosion in the implementation of Electronic Health Records.  Overnight, where we used to collect one structured data element on paper, we suddenly found ourselves collecting ten structured data elements and three additional unstructured fields, electronically.  Where we had separate Clinical, Financial, and Operational electronic business systems, we now had a single comprehensive electronic health record.  We now have metadata, access logs and audit trails; we even have access and audit logs for audit trails!

What is captured within these integrated systems? Volumes of free-text clinical documents, such as discharge summaries and operative reports, are translated into a series of diagnosis and procedure codes according to internationally-recognized standards.  From these codes flow Severity of Illness, Hospital Acquired Conditions and Risk of Mortality scores which are then used for quality monitoring, predictive modeling and federal programming such as Medicare. These codes also populate administrative claim forms and, combined with charge information, are used to inform insurance plan design and reimbursement.  Patients meeting specific conditions have their information abstracted to populate disease registries and/or disseminated in de-identified fashion to public health agencies or for clinical outcomes research.  Clinical trials and other research studies collect and analyze data to inform best-practice treatment protocols (i.e., low-dose ketamine infusion analgesia to reduce opioid usage). Patient medical records from multiple facilities and providers are integrated via health information exchange and interoperability technologies, and information regarding the care received is shared with the patient via electronic patient "portals".   

The Role of Health Information Management (HIM) Professionals in Big Data

A reasonable question at this point is, "Fascinating information, but why is this article in a blog for public administration students and professionals?" The answer is fourfold. First, all of above capture and usage of healthcare data is facilitated by health information and/or health informatics professionals.   Secondly, all of the structured and unstructured data relevant to the care, treatment and medical decision-making of patients comprise protected health information (PHI), governed by HIPAA, and it forms the basis for the patient medical record. Lastly, but most importantly, technology - including the collection and dissemination of PHI - must always be driven by policy.

Health information management professionals ensure the integrity of access to and transmission of PHI. They lead the development, implementation and enforcement of policies concerning the patient medical record, chart corrections and patient amendment requests. They develop standards and procedures for clinicians documenting in the medical record. They ensure patient medical records are secure and that access to them is appropriate and follows established privacy principles. Issues of privacy and security related to PHI continue to increase in scope - and complexity - as the amount of data we collect, store, search, share, transfer and analyze surges. New technologies that generate medical data (such as patient medical device output), and various electronic correspondence methods between caregivers and patients (such as text messaging, email messaging, Direct messaging) intensify the need for professionals with a firm grasp of both analytic methods and policy development practices and lifecycles. With the solid curriculum of public finance, human resources management, analytic and statistical methodologies and public policy development and analysis, MPA professionals are well-poised to take on careers in Healthcare Administration.

The Importance of Harnessing Big Data

As public administrators, we face many decisions with significant long- or intermediate-term impact upon quality of life: we make decisions on public safety funding, recruitment and training; we select between municipal water service providers; we resolve questions regarding economic development.  When these decisions go wrong, they typically go “very” wrong, in quite noticeable, public ways.  When these decisions go well, we typically don’t get that type of immediate, passionate feedback. Such is the life of a healthcare administrator. Many of you may have read recent articles about the recent hacking of patient medical records at large, reputable medical centers. The victory anthem in my department, and that of most Health Information Management departments, following any major endeavor is usually: “We didn’t hear a peep out of anyone.”  These quiet victories are part and parcel of the job of a healthcare administrator: we are not on the front lines administering care or making treatment decisions, and yet, our jobs are extremely important: we are behind the scenes orchestrating, if you will, the precise resources at the exact moment to allow our patients and clinicians maximum opportunity for success. No resource could be considered more essential to this process than information. Health Information Management professionals take data and transform it into meaningful, accurate and actionable information, in the exact format and timing required by the end user.  Remembering, ultimately, at the end of every transaction or piece of data we touch is a human life, and that medical decisions are only as good as the information they are founded on.

Laura Shue, MPA, CHDA, CPHIMS is the Director of Data Quality, Compliance and Operations at the University of Michigan Health System. A 2011 alum of the EMU MPA program, Laura is also Director of the Michigan Health Information Management Association.

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