UC Davis Health uses AI to ensure compliance on patient privacy, drug diversion

Photo: Al David Sacks/Getty Images

Ensuring compliance on a number of initiatives can be a tricky proposition for a hospital or health system.

The academic medical center University of California Davis Health has just one group responsible for maintaining that compliance. But the UC Davis Compliance Office team believes it has found the best way forward, in part through use of artificial intelligence in the EHR to detect anomalies in users' activity.

The UC Davis Compliance Office is responsible for conducting investigations on a variety of compliance issues, including patient privacy, conflict of interest, scope of practice and drug diversion. 

To ensure a culture of compliance, executives needed to determine how to best leverage industry best practices to manage privacy and diversion programs and to gain efficiencies from a centralized approach to proactive monitoring. 

The compliance team was looking to implement a program that would proactively identify risk across their organization, while leveraging artificial intelligence to better identify a wider variety of compliance concerns – all while saving costs and expanding the capabilities of their team. 

Due to numerous compliance issues the office was identifying and investigating, the compliance team needed to customize their investigation workflows and achieve the highest level of efficiency possible, said Alessia Shahrokh, compliance investigations manager at UC Davis. 

Shahrokh and Protenus cofounder Nick Culbertson will speak on the issue at the HIMSS21 global conference in Las Vegas on August 10 at 10 a.m., in Caesars Forum 123, in a session entitled "Health Compliance Analytics in Practice."

"There are several functions and subjects housed within our compliance office, like with most academic medical centers," said Shahrokh. "Currently, there are four distinct teams, each led by subject matter experts. The privacy program is one of the functions within compliance, led by a privacy program manager who reports to the chief compliance officer/privacy officer. The privacy program receives all substantiated breach cases, focuses on case analyses, and federal/state reporting requirements."

Formed in 1998, the compliance program serves the medical center, the outpatient clinics (on-campus and off-campus), the School of Medicine, School of Nursing, and the UC Davis Health research programs.

The program provides education and training, privacy audits and consultations, she said. The investigations team conducts reviews for all units of the compliance office, including privacy investigations, while the privacy program and investigations team works together on privacy-related matters. This structure allowing for better streamlining of the system's strengths.

Since 2017, the investigations team has conducted all drug diversion investigations. In that time, UC Davis has augmented its program by increasing the scope from the already established focus areas.

"For example, we developed an in-house billing- and privacy-oriented regulatory team that complements other compliance initiatives but applies it to the research setting," said Shahrokh. "Having split privacy and investigations has allowed us to better focus on these individual areas. We are able to increase our capacity to manage incidents and be more proactive with audits, education and system-wide initiatives."

Since moving to an electronic health record-surveillance system that uses artificial intelligence to detect anomalies in users' activity, the health system has greatly increased the number of investigations identifying improper access or opportunities for process improvement and user education, she said.

"It is fair to equate the increase in questions and consultation requests we have received from our staff with our proactive monitoring, as people who know they are being watched are being more careful and conscientious about their use of and activity within our electronic system," said Shahrokh.

Ultimately, it's the sophisticated IT technology that has allowed for the compliance units to achieve more efficient workflows and procure tailored information critical to conducting their work.
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com