DNP 825 Module 1 Data Governance for a Nursing Project Example

Whose Data Are These? Governing Social Needs Screening Data From the Bedside to the Quality Report

Student Name

Doctor of Nursing Practice Program, Aspen University

DNP 825: Health Information Management and Informatics

Instructor Name

Month Day, Year

Whose Data Are These? Governing Social Needs Screening Data From the Bedside to the Quality Report

Health systems increasingly ask patients about social needs such as food, housing, transportation and safety, and nurses usually ask the questions. The answers can guide referrals and help leaders understand the populations they serve, but they are sensitive, can be misused and are often recorded in ways that make them hard to use. Data governance, the process by which an organization assigns responsibility for data and sets rules for its collection, quality, access and use, determines whether such data help patients. This paper examines the information systems that carry social needs data in a composite regional health system, identifies the governance problems a doctoral nurse leading a screening project encountered, and proposes a governance framework.

Why Social Needs Data Matter

Screening followed by action can improve outcomes. One randomized trial, involving 1,809 families seen in children's primary care and urgent care clinics, compared screening plus a navigator who helped families in person with screening plus written resource information. Four months later, the navigator group reported fewer remaining needs and caregivers rated their children's health as better (Gottlieb et al., 2016). Aggregated social needs data also allow organizations to plan services, target partnerships and adjust quality comparisons for patient populations.

Yet structured recording is rare. In an analysis of hospital admissions, only 1.9% included the diagnosis codes designed to capture social determinants of health, and their use concentrated among admissions for mental health and substance use conditions, suggesting that coding greatly understates the burden of social needs among hospitalized patients (Truong et al., 2020). Data that are not recorded in structured form cannot be counted, compared or used to evaluate programs.

How the Data Flow

In the composite system, nurses ask ten screening questions at every inpatient admission and primary care annual visit. Answers are entered in a questionnaire within the electronic health record. Positive answers generate a referral task for social workers. At that point, the data fork. Clinical staff see the answers in the record; social workers document referrals in a separate community referral platform operated by a vendor; coders may add social determinant diagnosis codes if the information appears in physician notes; and the quality department extracts screening rates for reports. Each path has different definitions, different users and different controls, and nobody owns the data from end to end.

Governance Problems Identified

The doctoral nurse leading an effort to improve food insecurity referrals found four problems. First, ownership was unclear: nursing, social work, quality and information technology each assumed another group was responsible for the data's accuracy. Second, definitions conflicted: the quality report counted a patient as screened if any question was answered, while the nursing policy required all ten. Third, access was loosely controlled: screening answers, including questions about safety at home, were visible to anyone with access to the chart, and data were shared with the referral vendor without a clear review of what was necessary. Fourth, patients were not told how their answers would be used beyond their own care.

A Governance Framework

Data stewardship implies a trust-level responsibility toward data, especially data that can identify individuals, and data governance is the process by which those responsibilities are defined and carried out (Rosenbaum, 2010). The proposed framework assigns three roles. A data owner, the chief nursing officer, is accountable for the screening data set, approves its definitions and decides on uses beyond direct care. Data stewards, a nurse informaticist and a social work leader, maintain definitions, monitor quality and approve requests for access. Data custodians in information technology manage the systems, security and extracts.

The framework sets rules for each stage. Collection: standard questions, a single definition of complete screening and training for nurses on asking sensitive questions privately. Quality: monthly checks of completion and of agreement between screening answers and referrals. Access: questions about safety at home restricted to clinicians directly involved in care, with an audit trail. Sharing: only the minimum necessary information sent to the referral vendor, under a business associate agreement reviewed by privacy staff. Secondary use: requests to use the data for research, analytics or payment reviewed by a data governance committee that includes a patient representative, with a prohibition on using social needs data to deny services or coverage.

Transparency With Patients

Patients should know why they are being asked and how their answers will be used. The system adds a one-sentence statement read before the questions, explaining that answers help connect patients with resources, are part of the medical record and may be counted, without names, to plan services. Patients may decline any question, and nurses document declines separately from negative answers so that data remain accurate.

Implementing the Framework

Governance frameworks fail when they exist only on paper. The system will implement this one in stages. In the first quarter, the chief nursing officer charters the governance committee, the stewards publish a data dictionary defining each screening item and the rule for a complete screen, and the informatics team fixes the quality report to use that rule. In the second quarter, access restrictions for sensitive items go live, the vendor contract is reviewed, and nurses complete a short training on asking the questions and documenting declines. In the third quarter, the committee reviews the first requests for secondary use and publishes its decisions internally, so that staff see how the rules work in practice.

Success will be judged by measures the committee reviews quarterly: the proportion of admissions with a complete screen, agreement between positive screens and referrals, the number of access audit exceptions, and the time taken to decide on data requests. A doctoral nurse leading the work also tracks whether social determinant codes appear more often on claims, since better structured data are one of the framework's goals.

Conclusion

Social needs data collected by nurses can improve care and planning, but only if they are recorded consistently, protected appropriately and used for the purposes patients expect. In the composite health system, unclear ownership, conflicting definitions, loose access and limited transparency undermined the data's value and risked patients' trust. A governance framework that names owners, stewards and custodians, and sets rules for collection, quality, access, sharing and secondary use, makes social needs data a reliable basis for decisions.

References

Gottlieb, L. M., Hessler, D., Long, D., Laves, E., Burns, A. R., Amaya, A., Sweeney, P., Schudel, C., & Adler, N. E. (2016). Effects of social needs screening and in-person service navigation on child health: A randomized clinical trial. JAMA Pediatrics, 170(11), Article e162521. https://doi.org/10.1001/jamapediatrics.2016.2521

Rosenbaum, S. (2010). Data governance and stewardship: Designing data stewardship entities and advancing data access. Health Services Research, 45(5, Pt. 2), 1442-1455. https://doi.org/10.1111/j.1475-6773.2010.01140.x

Truong, H. P., Luke, A. A., Hammond, G., Wadhera, R. K., Reidhead, M., & Joynt Maddox, K. E. (2020). Utilization of social determinants of health ICD-10 Z-codes among hospitalized patients in the United States, 2016-2017. Medical Care, 58(12), 1037-1043. https://doi.org/10.1097/MLR.0000000000001418