Governance & Leadership – The

Support Structure for “Meaningful Use”

of Your Electronic Health Record (EHR) Charlotte Hovet, MD, MMM, CPE

Medical Director, Clinical Informatics

MEDITECH Solutions Group within Dell Services

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Presentation Overview

• Drivers of healthcare transformation • EHR governance and leadership • Governance gaps, best practices, and challenges • Q&A

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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.

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QUALITY

COST

---------- VALUE

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.

Value-based Healthcare

The required change has a simple formula:

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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

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Integration Align

Incentives

Quality and

Affordable Outcomes

The Future: Integration and Clinical Alignment

• Continuum of care • EHR • Patient Experience

• Global Payment • P4P • Physician Incentive Programs

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Transforming Care Delivery and the EHR

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EHR Clinical Decision Support

Source: MEDITECH

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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 Change

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Importance of a Vision

The vision is a force in

people’s hearts, a force of

impressive power.

-Peter Senge

A Vision… • is a catalyst for organizational transformation using an

articulated “picture” of the ideal future state. • aligns people in activities that cut across the

organization. • elicits commitment and buy-in for an operating

model. • facilitates goal setting and planning. • supports accountability for congruent behavior and

actions. • is a succinct source of inspiration and guidance. • is the embodiment of the organization’s core beliefs.

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EHR Physician Governance: A Sound Structure for Leadership

“Leadership is the capacity to translate vision into reality. Warren G. Bennis

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Governance

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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.

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Governance

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• 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 implemented

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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 methodology

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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?

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Hospital Medical Staff Governance

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Medical Executive Committee

Physician EHR Committee

MEC Committees

•P&T

•Quality

•Patient Safety

•Credentialing

Executive Leadership Team

Hospital/Health System Board

EHR Work Groups

Information Services

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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 minutes

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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 makers

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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 List

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Physician Champion EHR Work Groups

• Communications • Order Sets • Workflow & Devices • Training & Support • Metrics

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EHR Governance Structure

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Provides guidance, prioritization, and coordination of approved

projects

Executive Steering Committee

Nursing/Ancillary

EHR Committee

Collaboration

EHR Work Groups

(Communications, Workflow & Devices, Order Sets,

Training & Support, and Metrics)

Physician

EHR Committee

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EHR Work Group

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EHR Work Group

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EHR Work Group

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Process Redesign

Paper to

Electronic

Current State Future State

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EHR Work Group

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EHR Work Group

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EHR Healthcare Transformation

Prevailing Culture in Medical Organizations •Silos •Hierarchy •Lack of partnership

Culture Can Clash with EHR Strategy

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• Autonomy

• Protection

• Entitlement

• Improve

safety/quality

• Provide service

• Be patient-

focused

• Improve access

• Improve

efficiency

Traditional “Promise” Imperatives

Clash Of “Promise” And Imperatives

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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.

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Scenarios for Discussion

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• 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.

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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 results

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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 served

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Thank you