Today, Rob Barras is the VP of Healthcare for CTG. The company has a division called Health Solutions which represents about 20 percent of their business. However, at the beginning of his career, Barras worked for a company that was developing what they referred to as CHIN or community health information networks. It was one of the healthcare industry’s initial forays into creating systems where interoperability would be the main idea – before EHRs. But the company was stymied by two key issues and neither were technology-based problems.

The first, as Barras explained, was a political issue. By that he meant that healthcare systems didn’t want to share data with competitors in their region. The second challenge was figuring out who would pay for the networks. A sustainability model didn’t exist back then. “And guess what? Both of those things are a problem still today,” Barras said.

“Now, those things start to go away when we focus on value-based care. Value-based care will be the mandate and should be the mandate now.”

To be successful, healthcare will need to be more proactive when it comes to adopting technology and change how it manages systems and protocol. He believes some of that change is already occurring.

“We recently conducted a CIO focus group about value-based care. Essentially, we proposed that IT needs a roadmap to determine what they prioritize, and their priorities should be tied to value-based care,” he said.

Of 12 CIOs in the room, all were in agreement. One added that his system is already sharing data with a crosstown competitor because they’re at risk for a shared population. “So now it makes sense. We can’t make decisions for a shared population with only some of the data. We need all of the data or more of it, in order to make smart decisions on how we’re managing that population. That openness is only going to increase as time goes on,” Barras said.

While there is a lot of work tied to interoperability, Barras believes that enterprise information management is the biggest challenge to address most of the issues. “We believe it’s the fundamental challenge as organizations start to understand value-based care and those requirements, not just from an IT perspective, but overall in the business.”

He said providers will want to use their data assets to address concerns, questions and problems. They’ll invest in analytic tools and platforms to answer those questions and deal with the problems. But they’re unlikely to achieve good results if they ignore a key ingredient. “The bottom line is that most organizations don’t have the established governance. Either population health governance or data governance is necessary to be successful in value-based care.”

The issues occurring due to that lack of governance are exacerbated by the steady number of mergers and acquisitions happening in healthcare. Each increases data pileup and multiplies the complexity of the untangling needed to fully benefit from the data being acquired.

Barras said that perhaps the single fundamental premise when it comes to data governance is the mentality that it’s an IT issue. “It’s not an IT issue. It’s a governance issue. IT does not own your data. You do. Your departments do. So you need to find a steward who will fit inside the data structure and make the decisions about how you will aggregate and analyze this data to solve emerging business issues. In other industries, these concepts are well-entrenched, but healthcare is still struggling with it.”

In his estimation, the creation of a data governance team shouldn’t require heavy budget commitments. A big team of full-timers isn’t needed to support it. Rather, it can be a group of people working it part time as something they do in their regular position. “Often, there are already people working on these things, so it’s more a shift in thinking than a shift in responsibilities,” he said.

For those who think they’re already on the right track, Barras offered an anecdote. “When we start talking to potential clients, we’ll typically get a response, ‘hey we do this already, and we think we’re pretty good at it.’ But once you start digging under the covers, you often find that what they think is pretty good is not good at all. What you find is that they’re cutting and pasting a lot of information, usually via spreadsheets, for example.”

That cutting and pasting can lead to redundancy and confusion and it afflicts mature and fledgling health systems alike. “So if we look at length of stay, for instance, very often we’ll see that an organization might have three or four or more definitions. They’re moving the needle by adjusting the definition behind the scenes and cutting and redefining to account for it instead of adopting a master governance plan to uniformly decide what length of stay means for the system.” That problem can be multiplied by hundreds, if not thousands, with all the other multi-definition instances within a single healthcare system. The solution? Data governance.