The Devil is in the Paperwork: Healthcare Data Governance Issues

You probably already know about all the paperwork that medical personnel has to deal with. Well, a huge reason for that is because of all the Healthcare Data Governance Issues that are plaguing the healthcare industry. When you are visiting a hospital or healthcare facility, there are some things you need to know like what documents to bring and how to fill out the forms. Before you go to a hospital (except in an emergency) there is some paperwork that you need to bring with you. Different members of the administrative department of a hospital will need different documents from you. Some of these documents needed are:

  • personal information, such as next-of-kin details
  • Insurance card or insurance information
  • funding details (for example, private health insurance, WorkCover)
  • pharmacy or government entitlement discount cards
  • list of your current medication and dosage
  • specialist’s contact details
  • completed admissions forms (when it’s not an emergency)
  • Any current test results, such as x-rays, scans and pathology.

After you are admitted into a hospital or after you’ve been attended to, you have to fill out more paperwork and when you have been discharged, there’s more paperwork you should fill out. So it’s best to be prepared. There is a lot of paperwork required to help keep track of your journey through the hospital system. When doctors, nurses, administration staff and other healthcare professionals see you, they need to know what stage you are at with your diagnosis, treatment or recovery. Some of the document you would need to complete are

  • an admission form in the emergency department  
  • an outpatient admission form
  • an in-patient admission form (for an overnight stay)
  • a consent to treatment form
  • a discharge from
  • a power of attorney form.
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  • Your health records

It’s very helpful to you and to the hospital staff if you keep proper health records of yourself and your family members. It helps medical staff provide the best service and helps with their diagnostic and medical decisions.

Patient Health Records

Now you might be wondering what health records are and why healthcare data needs governance. Put simply, the best way to answer that question is to point out that health records are meant to be extremely private. Can you imagine doctor disclosing private medical information of patients? That’s totally unacceptable. This is why healthcare data and health records need governance.

Your health record is the document that details your medical history and medical care over a period of time. When you visit hospital doctors, nurses and other health professionals make notes in your health record on everything from illnesses, symptoms and the results of medical tests to the types of medication that have been prescribed to you.

All patients are permitted by law to have access to their health records regardless of if the healthcare organization is privately owned or a public institution. Patients can request a copy of their records or the original or even the summary of your records. What you need to do to access this record could change from organization to organization so you need to find out from your healthcare organization what is required before you request your health records.

Sometimes people need others to access their records and doing this requires permission because of the healthcare data governance acts. Hospitals are required by law to protect the privacy of their patients’ medical information and also to keep their records on file. This ensures they can be accessed at a later date by your doctor or healthcare provider, in case you need further treatment. IN order for a third party to access a patient’s information, they have to have a written and signed permission like power of attorney.

However, researchers can sometimes have access to patient information for research purposes and public health initiatives. In cases like that, the information is de-identified so personal details are removed. However, these days of increased technology, companies have access to customer data which a lot of times include health data because individuals use health apps that track and record information about their health that they choose. SO who knows who has access to what these days.

The Rise of the Nurse Practitioners and Physicians Assistants

There are different specialties in medicine such as surgery, cardiology, neuroscience etc and one of the specialties is general medicine. General medicine, or the focus on treating the whole patient and not just a single organ, is in decline. In addition to general medicine doctors, hospital systems across the nation are relying more on nurse practitioners for routine visits with patients, reducing the need for and filling in the gaps for the lack of physicians.

Health Analytics


Data shows that the U.S. faces a shortage of between 46,000 and 90,000 physicians by 2025, there are an estimated additional 47,600 nurse practitioners needed by 2022, according to projections by the Bureau of Labor Statistics (BLS). Filling in the shortages are nurses with more advanced degrees and experience. While available duties vary from state to state, nurse practitioners — those with master’s degrees and board certification — can perform many of the same key duties as a doctor, such as prescribe medicine and order tests.

Since advanced practice registered nurses (APRN) on average are paid less than half than the average family physician, hospital systems are leveraging them as the person patients will see more often. (The average family physician makes $227,541 a year, according to data from more than 18,000 physicians. APRNs average $96,460.). So hospitals actually save money by using more nurses to do doctor duties. It makes one wonder the ethics of it though.