NURS 6412 week 11 Assignment Paper
The Stewardship of Health Information
“We are data rich and information poor.” This is a concern we hear about all the time, most often from health systems that have been collecting data for years and have terabytes of stockpiled data.
But how can an organization with terabytes of valuable data waiting to be tapped become information rich? There are two key components.NURS 6412 week 11 Assignment Paper
The first component is having ready access to the data. One of the best options is by using an enterprise data warehouse that has been specifically designed to work with a healthcare analytics system. In addition to ready access to the data, there also needs to be accountability for that data. This leads us to the second component — good healthcare data stewardship.
what Is Healthcare Data Stewardship?
Data stewardship is the aspect of healthcare data governance that focuses on providing the appropriate access to users, helping users to understand the data, and taking ownership of data quality. When there’s poor data stewardship, however, even the best infrastructures become underutilized and poorly understood by knowledge workers who could be generating value from the data every day.
Who Should Be a Healthcare Data Steward?
Can you name an organization where one person knows all the different systems in use and can speak with authority on the data within those systems? I’d be willing to bet you can’t. The point here is that, because no single person can know everything about every system, it’s best to have many data stewards — at least one for every major source of data in the organization. This may seem like a lot of data stewards, but the best person to perform this role is the person who knows the most about how and why the data is collected in each of the various source systems. One person simply can’t know all of this.NURS 6412 week 11 Assignment Paper
2 Tools a Data Stewards Needs to Be Successful
Once you’ve identified who should become a data steward, there are a few things they will need to succeed.
1. Enterprise Data Warehouse
First, make sure there’s a good data warehouse architecture. This will promote good data stewardship because it will eliminate the fragmented data systems.
In a fragmented IT environment, there are many diverse data systems and each system has different modes of access. Some may have ‘back end database access’ and some may have reporting platforms of their own. The trouble is, with so many different systems and modes of access, it is extremely challenging to manage access centrally. This is why the job usually defaults to the individual IT administrators responsible for maintaining the systems — the only ones who know how to give access. Unfortunately, these folks typically have about a billion other tasks in their work queue with higher priority than providing access to a data system to a user who they don’t even know.
A fragmented IT environment also makes it challenging to manage an organization-wide data dictionary. Some healthcare information systems do a good job of documenting metadata — the underlying data that communicates the origin and other details about data, much like a dictionary entry — while others do it very poorly. Having a centralized place to search for data elements and browse data structures is next to impossible in a fragmented IT environment.NURS 6412 week 11 Assignment Paper
A centralized enterprise data warehouse delivers a single reporting platform and a single point of entry into an organized repository of the organization’s data. The standardization of technology allows the development of more centralized access policies. Good data warehouse architecture allows a data steward to own a piece of the data warehouse that maps to their specific knowledge about a specific source system or a specific data mart created within the warehouse. This is reflected in an architecture that allows the creation of ‘source marts’ and ‘subject marts’ and allows access to be granted on the individual data mart level. The data steward is an expert in a particular data mart and is the appropriate person to decide who gets access to that area in the enterprise data warehouse.
2. Data Warehouse Tools
Once you have identified data stewards, you need good tools to let the data warehouse user community know who these data stewards are. If a user wants access to the data warehouse, how will they know who to go to for access to a particular area of the warehouse? How will a user understand what data is in a particular table, or who to go to if there is a quality issue with the data? A solid metadata tool will list data marts in the warehouse and link those data marts to data stewards. The tool will allow a data steward to share their knowledge about the data mart or marts that they are responsible for. Metadata tools that allow data stewards and users to create and edit descriptions for objects in the data warehouse provide this forum and will aid in creating a self-sufficient data warehouse user community.NURS 6412 week 11 Assignment Paper
Create Long-Term Value with Healthcare Data Stewardship
Once the data is unlocked in an enterprise data warehouse, the best way to create long-term value is to have a thriving user base. Data stewards are critical partners to the data warehouse team in creating a thriving user base. They are the data librarians who advise and guide users, and help them get the most value out of the enterprise data warehouse.
Users of the data warehouse will create value in different ways. Some may use the data to secure grant funding, others may use the data to squeeze extra dollars in savings through operational improvements, and still others may use the data to improve patient care and reduce costs. If more users translate to more value … make it easy to do the right thing and get these data-hungry analytics superstars connected to the data!
What do we mean when we talk about physician stewardship in an integrated health care system? A steward is responsible for the care and prudent use of the property of another. In this case we are talking about both of the important professional relationships we have with government and with patients.
The decisions we make account for a large percentage of health care expenditures. There is a balance between authority and accountability. Beyond the fiscal considerations, our decisions also obviously have a major impact on the health of patients. We also have a significant influence on how patients spend their time and resources, and in that sense, we could consider ourselves stewards of the property of our patients.NURS 6412 week 11 Assignment Paper
Why is this an important subject for us? It is our professional responsibility to be effective stewards over the resources we use on behalf of patients. There are also benefits for the steward in return for effective stewardship. I believe that effective stewardship is also intrinsically rewarding and is a great source of professional satisfaction and happiness. This relationship is more fully expressed as the social contract between the profession and society, which I will say more about later.
First, I will describe our relationship to the payer. In a public health care system, resources are owned by society and dispensed by government. We usually think that the only thing a doctor should consider in making decisions is the need of the patient to whom he or she is immediately attending. That must always be the primary concern, but we must also remember that, in the choices we make for one patient, there is an element of stewardship for all health resources. Physician decisions drive about 70% (or more) of the costs in the system. There is a fiscal reality to consider in health care costs. That is why stewardship is one of our professional responsibilities.
To be effective as stewards, though, certain conditions must be met. To be trustworthy, a steward must be trusted. To live within his/her means, a steward must have the authority to manage resources assigned to him/her. To manage resources, a steward must have the necessary tools, for example, current information about costs and how one’s choices compare with others across the system. There must be a mechanism for the steward to report back to the owner about how the resources have been managed. This requires exchange of information between the profession and government.NURS 6412 week 11 Assignment Paper
Stewardship is also embedded in the social contract between society and physicians. Society provides us with autonomy, trust, self-regulation, monopoly, status and rewards. In turn, we provide compassion, availability and accountability, working for the public good with altruistic service. There is an obligatory relationship between society and physicians in this regard.
If either society or physicians vary their terms in the contract, there is an unavoidable and corresponding variance by the other party. The link between these two parties in this contract can be described as professionalism. See an illustration of this concept accompanying this article.
Every time you see a patient, think of it is an opportunity to reshape the health care system. We can do this by positively shifting the social contract equation to improve the relationship, not only with that patient, but also with society in general. Ultimately, this will create a positive patient experience, provide happiness and system success. Management changes cannot do this. We can do it only through the individual choices each of us makes, every time we interact with a patient.
Integration is an approach to health care that involves a high degree of communication, collaboration and coordination among providers and patients to meet the needs of the whole person. Integration around the individual patient or a defined population creates a seamless patient experience. This is the most effective approach to prevention, acute care and chronic illness management. It also affords opportunities to address social determinants of health.NURS 6412 week 11 Assignment Paper
The need for an integrated health care system is based on changing patient attitudes and demographics, advances in technology, the increased need for chronic illness management and, importantly, on the failure over recent years to improve health outcomes by simply doing more of the same. Among Commonwealth countries, Canada ranks 5th of 11 in expenditures and 10th in performance. While the introduction of Medicare was a significant social event that has become a pillar of Canadian society, we cannot continue in the belief that yesterday’s success is sufficient to meet tomorrow’s challenges.
Instead of regarding the patient as a consumer of health services produced by providers in a system managed by the providers, we must shift our thinking toward the concept of co-production of health services by providers and patients working together to create what the patient values, in a co-managed system. We should move from viewing health care as a commodity produced by a system of providers to the view that it is a collection of services co-produced by patients and providers, based on the values of the patients. This will lead to patient-centered integration.NURS 6412 week 11 Assignment Paper