Governance & Leadership – TheSupport Structure for “Meaningful Use”of Your Electronic Health Record (EHR)Charlotte Hovet, ...
Presentation Overview•   Drivers of healthcare transformation•   EHR governance and leadership•   Governance gaps, best pr...
Healthcare Transformation          • Information technology in healthcare is a means to            transformation, not the...
Value-based Healthcare    The required change has a simple formula:                     QUALITY                       ----...
To Survive,Healthcare organizations must:• Improve the health of the population served• Enhance the patient experience of ...
The Future: Integration and Clinical Alignment                                                      Quality               ...
Transforming Care Delivery and the EHR7                                        Global Marketing
EHR Clinical Decision Support  Source: MEDITECH                                Global Marketing
Physician/Clinician EHR Adoption    Critical Success Factors    •   Shared Vision    •   Committed Leadership    •   Incen...
Importance of a Vision                     A Vision…                     •   is a catalyst for organizational transformati...
EHR Physician Governance:A Sound Structure for Leadership              “Leadership is the capacity to translate           ...
Governance     Governance is the decision-making process by which leaders     achieve the organization’s shared strategic ...
Governance• In general, “Governance” is about bringing the “right” people to the     table to have the “right” conversatio...
Common Governance Gaps                •   Unclear expectations                •   No meeting agendas                •   No...
Physician Engagement Across the Organization•    What physician governance groups are in place currently?•    How is the C...
Hospital Medical Staff Governance                                   Hospital/Health System                                ...
Physician EHR Committee•    Medical Executive Committee approval and support•    Participatory committee structure and fun...
EHR Physician Leaders• Promote the EHR initiative through identified “champions” who  serve on the Physician EHR Committee...
Key EHR Decisions• Examples   – “Universal adoption” of CPOE   – No personal order sets   – Mandatory CPOE training   – No...
Physician Champion EHR Work Groups                   •   Communications                   •   Order Sets                  ...
EHR Governance Structure                         Executive Steering Committee                         Provides guidance, p...
EHR Work Group22               Global Marketing
EHR Work Group23               Global Marketing
EHR Work Group24               Global Marketing
Process Redesign                   Paper to                   Electronic Current State                  Future State      ...
EHR Work Group26               Global Marketing
EHR Work Group27               Global Marketing
Culture Can Clash with EHR Strategy EHR Healthcare                 Prevailing Culture in Transformation                 Me...
Clash Of “Promise” And Imperatives    Traditional “Promise”     Imperatives                            • Improve          ...
Keys to Culture Change                • Comprehensive consistency in words, polices,                  and actions         ...
Scenarios for Discussion• A high volume admitter is threatening to take her business to  another hospital if she is forced...
EHR Success Requires… • Executive Sponsorship and committed leadership • Shared vision • Clarified purpose and goals • Org...
The End Goal               • Successful implementation and adoption of an                 integrated, fully functional EHR...
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Governance & Leadership – The Support Structure for “Meaningful Use” of Your Electronic Health Record (EHR)

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Governance & Leadership – The Support Structure for “Meaningful Use” of Your Electronic Health Record (EHR)

  1. 1. Governance & Leadership – TheSupport Structure for “Meaningful Use”of Your Electronic Health Record (EHR)Charlotte Hovet, MD, MMM, CPEMedical Director, Clinical InformaticsMEDITECH Solutions Group within Dell Services
  2. 2. Presentation Overview• Drivers of healthcare transformation• EHR governance and leadership• Governance gaps, best practices, and challenges• Q&A2 Global Marketing
  3. 3. Healthcare Transformation • Information technology in healthcare is a means to transformation, not the end goal. • The moment an organization forgets this, it places in jeopardy the change it needs to undergo to survive. Global Marketing
  4. 4. Value-based Healthcare The required change has a simple formula: QUALITY ---------- VALUE COST Improving quality by using best practice methodologies to improve patient care, eliminating waste and reducing the overuse and misuse of care, reduces cost and creates value for the patient and the purchaser of that care. Global Marketing
  5. 5. To Survive,Healthcare organizations must:• Improve the health of the population served• Enhance the patient experience of care (including access, quality, and reliability); and• Reduce, or at least control, the per capita cost of care Global Marketing
  6. 6. The Future: Integration and Clinical Alignment Quality Align and Integration Incentives Affordable Outcomes• Continuum of care • Global Payment• EHR • P4P• Patient Experience • Physician Incentive Programs Global Marketing
  7. 7. Transforming Care Delivery and the EHR7 Global Marketing
  8. 8. EHR Clinical Decision Support Source: MEDITECH Global Marketing
  9. 9. Physician/Clinician EHR Adoption Critical Success Factors • Shared Vision • Committed Leadership • Incentives • Communication • Care Standardization • Workflow Redesign • Effective Access • Training and Support • Success Metrics • Culture Change9 Global Marketing
  10. 10. Importance of a Vision A Vision… • is a catalyst for organizational transformation using anThe vision is articulated “picture” of the ideal future state.a force in • aligns people in activities that cut across the people’s organization. hearts, a • elicits commitment and buy-in for an operating force of model. impressive • facilitates goal setting and planning. power. • supports accountability for congruent behavior and -Peter Senge actions. • is a succinct source of inspiration and guidance. • is the embodiment of the organization’s core beliefs. Global Marketing
  11. 11. EHR Physician Governance:A Sound Structure for Leadership “Leadership is the capacity to translate vision into reality. Warren G. Bennis Global Marketing
  12. 12. Governance Governance is the decision-making process by which leaders achieve the organization’s shared strategic vision by providing guidance to others, direct oversight, or primary execution of plans.12 Global Marketing
  13. 13. Governance• In general, “Governance” is about bringing the “right” people to the table to have the “right” conversation with the “right” process and best information available. • At the most pragmatic level, Governance is about making decisions and ensuring that they get implemented, this breaks down into a number of separate components: Knowing who is responsible for making decisions Knowing how decisions are made Knowing who is responsible for ensuring that decisions get implemented Ensuring that decisions actually do get implemented13 Global Marketing
  14. 14. Common Governance Gaps • Unclear expectations • No meeting agendas • No assigned responsibilities • No reporting structure • No communication plan • No defined accountability • No sense of urgency • No formal process and methodology14 Global Marketing
  15. 15. Physician Engagement Across the Organization• What physician governance groups are in place currently?• How is the CPOE project linked to these groups?• How can you get physicians engaged in design and build decisions?• What is your recruiting process for physicians?• Will there be compensation for participation?• How do you create and maintain open lines of communication?15 Global Marketing
  16. 16. Hospital Medical Staff Governance Hospital/Health System Board Executive Leadership Medical Executive Team Committee Physician EHR MEC Committees Committee •P&T Information Services •Quality •Patient Safety •Credentialing EHR Work Groups16 Global Marketing
  17. 17. Physician EHR Committee• Medical Executive Committee approval and support• Participatory committee structure and function• Defined expectations (committee charter)• Formal accountability and reporting structure• Meeting agendas and minutes17 Global Marketing
  18. 18. EHR Physician Leaders• Promote the EHR initiative through identified “champions” who serve on the Physician EHR Committee and Work Groups• Create and support designated EHR physician leadership roles – Time commitment and compensation• Recruit physicians who are willing to: – Lend their knowledge, credibility, and support – Act as a role model by trying new ideas and approaches – Influence others to support effective change• Support physician champions as visible and active decision makers18 Global Marketing
  19. 19. Key EHR Decisions• Examples – “Universal adoption” of CPOE – No personal order sets – Mandatory CPOE training – No verbal orders unless provider is “scrubbed” in or emergency situation – No batch printing of labs, medications, rounds lists – Physicians will document in the Problem and Diagnoses List19 Global Marketing
  20. 20. Physician Champion EHR Work Groups • Communications • Order Sets • Workflow & Devices • Training & Support • Metrics20 Global Marketing
  21. 21. EHR Governance Structure Executive Steering Committee Provides guidance, prioritization, and coordination of approved projects Nursing/Ancillary Collaboration Physician EHR Committee EHR Committee EHR Work Groups (Communications, Workflow & Devices, Order Sets, Training & Support, and Metrics)21 Global Marketing
  22. 22. EHR Work Group22 Global Marketing
  23. 23. EHR Work Group23 Global Marketing
  24. 24. EHR Work Group24 Global Marketing
  25. 25. Process Redesign Paper to Electronic Current State Future State Global Marketing
  26. 26. EHR Work Group26 Global Marketing
  27. 27. EHR Work Group27 Global Marketing
  28. 28. Culture Can Clash with EHR Strategy EHR Healthcare Prevailing Culture in Transformation Medical Organizations •Silos •Hierarchy •Lack of partnership Global Marketing
  29. 29. Clash Of “Promise” And Imperatives Traditional “Promise” Imperatives • Improve safety/quality • Autonomy • Provide service • Protection • Be patient- focused • Entitlement • Improve access • Improve efficiency Global Marketing
  30. 30. Keys to Culture Change • Comprehensive consistency in words, polices, and actions • Dialogue about what is changing and why accelerates support for the new deal, new behaviors, new culture.30 Global Marketing
  31. 31. Scenarios for Discussion• A high volume admitter is threatening to take her business to another hospital if she is forced to use CPOE.• A physician who doesn’t believe he needs training and wants his password to get right into the system on the day of go-live.• A physician doesn’t want to access and review lab/radiology results and medication administration in the system. She wants these elements of the charts printed for her at the beginning of the shift.• A physician doesn’t want to use the standardized order sets and wants to customize his own.• A physician who has never used a computer and doesn’t trust them wants to continue using paper orders and wants the nurse to enter all of the orders.31 Global Marketing
  32. 32. EHR Success Requires… • Executive Sponsorship and committed leadership • Shared vision • Clarified purpose and goals • Organized, productive meetings • Defined roles and responsibilities • Strong collaboration between physicians, nursing, quality, IT and other organizational leaders • Confident, meaningful decision making • Accountability for active participation and results32 Global Marketing
  33. 33. The End Goal • Successful implementation and adoption of an integrated, fully functional EHR • Transformed healthcare delivery system • Measurable improvements in patient outcomes  Optimal health and well-being of the patients, families and communities served33 Global Marketing
  34. 34. Thank you

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