HIM 680 Module 5 Final Project Milestone Two Example

Final Project Milestone Two: One Definition, One Owner. A Governance Framework for Social Risk Data at Cedar Prairie Health

[Student Name]

Southern New Hampshire University

HIM 680: Advanced Topics in HIM I

Final Project Milestone Two

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[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Final Project Milestone Two: One Definition, One Owner. A Governance Framework for Social Risk Data at Cedar Prairie Health

Milestone One found that Cedar Prairie Health governs its social risk data hardly at all: six data elements, almost no owners, three definitions of food insecurity and quality problems at every step from screener to claim. This milestone designs the framework that will change that. It follows the DAMA body of knowledge, which describes governance as shared decision making about data, carried out through defined roles, policies and standards and supported by measurement (DAMA International, 2017). The framework is deliberately small. A system that has never governed a data domain is more likely to succeed with a few clear decisions than with an elaborate structure.

Structure and Decision Rights

A social risk data council will meet monthly for the first year. Its voting members are the population health director, who chairs as data owner, the clinic social work lead, the coding manager, the equity committee chair and the data warehouse lead, with the director of data governance as facilitator without a vote. The council has three decision rights: it approves standard definitions, it approves changes to how the data are captured or calculated and it settles disputes between users. It does not approve budgets or projects, which remain with existing leaders. The chief medical officer serves as executive sponsor and can overrule the council only in writing.

Roles

The population health director owns the domain, accountable for what each element means and for its fitness for use. Three stewards report to the owner on data matters. The clinic social work lead stewards screening data and problem list entries, training staff and answering questions about meaning. The coding manager stewards social risk codes, including coder education and audits. The data warehouse lead stewards the technical definitions, the calculations that turn captured data into measures. Information technology remains custodian of the systems. Each steward spends about two hours a week on the role, which is written into their job descriptions.

Writing the duties into job descriptions matters more than it seems. Governance roles that exist only in a committee charter tend to fade when the first busy month arrives, while roles that appear in performance reviews tend to last. The owner will review each steward's work twice a year, and the director of data governance will provide templates, training and a shared issue log so the stewards are not inventing their methods alone.

Policies

Four policies establish the framework. A definitions policy states that only council-approved definitions may be used in reports presented to leaders or external parties, and that every such report must name the definition used. A standards policy requires new social risk data elements to use a recognized terminology. A change control policy requires council approval before any screener question, calculation or report logic is changed. A data quality policy requires stewards to review quality measures monthly and report to the council.

Standard Definition of Food Insecurity

The council's first decision is a single definition of food insecurity. The proposed definition uses the two-question screen validated by Hager et al. (2010), which flags risk when a parent endorses either item at any frequency other than never; across more than 30,000 families, that rule caught nearly all food-insecure households while misclassifying fewer than one in five of the rest. Cedar Prairie's screener already contains both questions. A patient is counted as food insecure for reporting if the most recent screen within twelve months is positive, and the rate's denominator is patients screened rather than all patients, so that screening reach is reported separately. The equity committee's code-based count will be retired as a prevalence measure and kept only as a measure of coding capture.

Data Dictionary and Standards

Table 1 shows dictionary entries for five core elements. Each entry names the element, its definition, the terminology to be used and its steward. The terminology choices follow the federal core data set's social determinants classes, which expect assessments, problems and interventions to be exchangeable in standard form (Office of the National Coordinator for Health Information Technology, n.d.).

Table 1. Data Dictionary Entries for Core Social Risk Elements

Note. Entries approved by the council are published in the system's data catalog.

Quality Measures and Targets

Stewards will report four measures each month, organized by the categories of Kahn et al. (2016). For conformance, the share of screener answers stored in standard codes, with a target of 100% after remapping. For completeness, the share of eligible visits screened, from 71% to 85%, and the share of positive screens with a problem list entry, from 38% to 60%. For plausibility, any clinic whose positive rate differs from the system rate by more than ten points will be reviewed by the steward. A fourth measure, social risk codes on admissions of patients with a recent positive screen, will be tracked from under 3% toward 25% as coders gain access to screening results.

Escalation

Disputes go first to the relevant steward, then to the owner and then to the council. A dispute not settled in two council meetings goes to the executive sponsor. Every decision is recorded in the data catalog with its date and rationale, so that the next person who asks why food insecurity is counted this way can find the answer.

Conclusion

The framework gives Cedar Prairie's social risk data what Milestone One found missing: an owner, stewards, a single definition grounded in evidence, standard terminologies, quality measures and a way to settle disagreements. Milestone Three will design the data management and informatics work that delivers governed data to the people who need it.

References

DAMA International. (2017). DAMA-DMBOK: Data management body of knowledge (2nd ed.). Technics Publications.

Hager, E. R., Quigg, A. M., Black, M. M., Coleman, S. M., Heeren, T., Rose-Jacobs, R., Cook, J. T., de Cuba, S. A. E., Casey, P. H., Chilton, M., Cutts, D. B., Meyers, A. F., & Frank, D. A. (2010). Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics, 126(1), e26-e32. https://doi.org/10.1542/peds.2009-3146

Kahn, M. G., Callahan, T. J., Barnard, J., Bauck, A. E., Brown, J., Davidson, B. N., Estiri, H., Goerg, C., Holve, E., Johnson, S. G., Liaw, S.-T., Hamilton-Lopez, M., Meeker, D., Ong, T. C., Ryan, P., Shang, N., Weiskopf, N. G., Weng, C., Zozus, M. N., & Schilling, L. (2016). A harmonized data quality assessment terminology and framework for the secondary use of electronic health record data. eGEMs, 4(1), Article 1244. https://doi.org/10.13063/2327-9214.1244

Office of the National Coordinator for Health Information Technology. (n.d.). United States Core Data for Interoperability (USCDI). https://www.healthit.gov/isp/united-states-core-data-interoperability-uscdi