Anticlue

Let's talk about an absolute project schedule and execution killer in an EHR implementation, the lack of good governance. In my experience if you don't get the governance structure of an EHR Implementation right, the first time. You will be blessed with rework and trying again and again until effective governance is in place.

First step is to identify and charter an EHR Steering Committee. The goal of this cross-functional team should be to ascertain the needs, select the solution, contract, implement the program, and then fine tune. This EHR Steering Committee should be the place the buck stops, with the empowerment from the executive C-suite. The CIO should just not be the chair. After all clinical transformation isn't about what software package you just made live it is about the digitizing of information from paper, this really needs an empowered operations and qualify driven clinical chair. The EHR steering committee members should be limited to under 15 participants, empowered to be the catalysts of transformation, and govern the transformation.

In all likelihood, this Steering Committee will develop sub-committees which report into the EHR steering committee. The key is to assure the sub-committees have a way to work collaboratively, when touch points are clarified for upstream and downstream effects. An escalation of decision rights is clear to all sub-committees. Finally, not to have a wealth of committees engaged in analysis paralysis.

So let's talk off our rose colored glasses, and take a frank look at our organizational risk for our Governance Practice.

• Red Flag - The C-Suite is way too far down in the weeds. The key project of the week, is the pet project here and there. Organizational Priorities are not clear, Everything is a Priority. Priorities are constantly changing. A strategy is the opening of the clinic, not the being the best service, which is enabled by growing our operations. Welcome to the all you can eat bad governance risk. If you don't have business governance, in all likelihood you won't have good program governance either. Time to put a stake in the ground! Facilitate the implementation of an enterprise wide capital planning process, which traverses at least two-years.


• Yellow Flag - An enterprise wide planning process exists, and is followed. However, it is still shaking sticking to the process. There are more than a few emergency capital requests. Honestly, is a discharge charge planning system an emergency capital request? If so, welcome to the yellow flag zone


• Green Flag - Most historical large scale change efforts have included a planning phase laying out the program structure and clarifying roles and responsibilities. All in all if this practice is in place, you are probably already checking the physician electronic orders rate.

If you enjoyed this article, you may also like other entries in our Getting Ready for the Meaningful Use EHR Series:



• Spread the EHR Fever!


• Accessing your nursing organization's capacity for change


• Assessing your current infrastructure


• Using Rules to support clinical decision support


• Assessing your vendor management skillset


• Assessing your project execution ability


• Discovering the organization's perception of an EHR


• Getting your physician leadership engaged


• The 5 levels of healthcare IT Credibility


• Understanding the refinement of meaningful use

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