leveraging agility in governing health it compliance

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Leveraging Agility In Governing Health IT Compliance


Key Takeaways

• Discover the significance of having an Agile & Scalable Compliance program for your Health IT

• Learn Governance Best Practices for your Health IT Compliance


Agenda• Introduction• What is Health IT Compliance?• What is the current state of Governance of Health IT

Compliance ?• Components of Health IT Compliance• Governance of Health IT Compliance – Why ?• Governance of Health IT Compliance – How ?• Governance Best Practices• Concluding Note• Thank You !


What is Health IT Compliance?


What is Health IT Compliance?

Compliance programs for your Health IT Organization

• Ensures your Organization meets strict Industry mandates

• Reduces Audit costs and improves program Scalability by leveraging Automation and removing redundancy

• Allows the management of Risks in real-time


What is the current state of Governance of Health IT Compliance ?


• Dynamic Business environment

Health IT Compliance : Current State Of Governance


• Compliance Challenges



• Obstacles to change

• Emerging trends in the Industry that present Healthcare Organizations with Opportunities and Risks.



• Board members need a reference in answering Compliance-oriented questions.



Components of Health IT Compliance


Components of Health IT Compliance

• Standards• Code Sets• Operating Rules• Legislation and Regulation• Advisory Organizations• Certification• Trade Associations & Professional Societies• Government Entities


Standards• Standards enable interoperable exchange of

Information• 3 Types of Standards

– Function– Syntax – Purpose

• Standards are developed by a variety of Standards Development Organizations


Code Sets

• Various organizations manage code sets (function specific/category specific) as required in Health IT regulations issued by the Department of Health and Human Services.

• LOINC is a code set which identifies Laboratory and Clinical observations


Operating Rules

• Operating rules make Electronic Transactions – more predictable and consistent

• Increase Administrative efficiencies• Foster commonality among participants.• Most common operating rules • Electronic Funds Transfer (EFT) & • Electronic Remittance Advice (ERA)


Legislation

• Legislation related to ONC’s work includes– Health Insurance Portability &

Accountability Act (HIPAA),– the Affordable Care Act (ACA), and – FDA Safety and Innovation Act (FDISA).

• ONC authors Regulations that set the Standards and Certification criteria


Certifications• Certifications

– International Organization for Standardization (ISO)

– American National Standards Institute (ANSI)– (American Society for Testing and Materials) ASTM

International– Capability Maturity Model Integration (CMMI)


Trade Associations And Professional Societies• Trade Associations & Professional Societies,

such as HIMSS or AHIMA, teach how to use existing standards to support solutions to specific use cases in implementation guides (or profiles).


Governance of Health IT Compliance -Why ?



• Alignment of various departments within the Organization responsible of Health IT Compliance, such as Compliance, Legal, Internal Audit, Human Resources and Quality Improvement• Evaluating the adequacy, independence and performance of these Departments



• Ensuring smooth functioning of Compliance processes for issue-reporting within an Organization• Identifying and tackling Regulatory Risks• Ensuring Compliance goals and objectives are achieved


Governance of Health IT Compliance -How ?



• Coordinating Internal Departments

• Evaluating the role of each Department in identifying Compliance Risks

• Investigating Compliance Risks

• Avoiding duplication of effort



• Identifying and implementing appropriate corrective actions and decision-making

• Giving Information access to the departments/employees while maintaining attorney-client privilege

• Departmental Reporting to the Board


Governance Best Practices


Governing Health IT Compliance – MobilityAnytime, Any Device, Anywhere Reporting


Governing Health IT Compliance – Robust Collaboration Tools


Executive Dashboard for ERM Reporting


Governing Health IT Compliance – Risk Reporting


Robust Reporting – Various Compliance Frameworks


Reporting to the Board

• Board must have access to all Compliance related information.

• Good Governance is ensured when Board sets and enforces expectations for receiving specific Compliance-related Reports/Dashboards from various members of Management.

• Departments need to independently report to the Board.

• Conducting periodic Sessions with leadership from the Compliance, Legal, Internal Audit and Quality Functions encourages effective Communication


Identifying and Auditing Potential Risk Areas

• Identifying “Risk areas.” • To determine what level of Risk is acceptable to take on. • Ensure that Management conducts Audits in these Risk areas

and Develops, Implements & Monitors corrective action plans.

• To be up-to-date with the Emerging trends, such as Big Data, Cloud Computing, etc..

The Role of the Board


Encouraging Accountability and Compliance

• Create a culture of Compliance throughout the Organization


• Foster an environment which encourages employees to raise Compliance concerns fearlessly

Encouraging Accountability and Compliance


On a concluding note• Every Board is responsible for ensuring that its Organization

complies with relevant Federal State and local laws.

• Implementing Agile Governance depends largely on the Organization’s departmental structure, current policies and procedures, personnel and financial resources.

• Hence Agile Governance has to evolve from being a task for the Board to an Organization wide culture


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