HIMSS News

Clinical Informatics Governance: The Future Rooted in the Structures of Today

By Mary Lawrence Staley-Sirois

HIMSS Clinical Informatics Insights, June 2012

The urgency to implement certified electronic health record (EHR) tools has taken on a new focus for the entire healthcare industry, providing opportunities not only for the realization of quality of care improvements by becoming “meaningful users” but also the receipt of significant federal incentive monies provided by the HITECH Act. The effort to implement evidence-based order sets, improve order communication and collect quality reporting data elements will require medical, nursing, clinical, IT and operational leadership and collaboration at all levels.

Organizations face a challenge in aligning clinical, medical, financial, technical and strategic operations with the changing landscape that meaningful EHR utilization brings. The use of health IT in all processes involving the patient, including not only the traditional areas related to revenue cycle and diagnostics but also clinical documentation processes in physician practices, hospitals, and ancillary environments; evidence-based standardization across the continuum of care; and information obtained directly through a patient health record, create the need for organization to examine its current governance structure.

All of the activities that are done today, albeit possibly using paper, technology, or some combination of tools, remain the same in the future, provided the importance of data and informatics is tightly woven into them. An organization should look at today’s activities to define how clinical informatics can support the future, but recognize that this level of alignment represents significant cultural change.  Examples of questions for today and suggestions for the future, in a manner that aligns operations with informatics and leverages the data collected during this industry-revolutionizing time, are included in the table below:

Today

Future Considerations Leveraging HIT

Medical Executive Committee (MEC) approval of clinical protocols and care standards

Basic:  MEC leadership of evidence-based order set development as well as CPOE and documentation design and adoption

Advanced:  Champion organizational priorities to leverage EHR tools to proactively provide alerts to care intervention needs such as patient condition deterioration in an ICU, proactive alerts to evolving public health needs, or medical home dashboards

Senior Leadership Team creation of annual organizational performance goals

Basic:  Including EHR implementation efforts as a singular goal in the overall organizational plan, and related compensation plans.  Organizational senior leaders involved in EHR design and implementation plans with appreciation of operational ownership implications

Advanced:  Utilization of data available from clinical and financial technologies to quantify expected performance standards proactively, and measure outcomes along the way to adjust performance to ensure success.  Each organizational senior leader can describe data and reporting needs for strategic planning and performance measurement.

Nursing Education involvement in nursing staff training for new hires or just-in-time paper-based documentation changes

Basic:  Nursing Education involvement in staff training for new hires and just-in-time training for upgrades related to screen, content, functionality and process changes

Advanced:  Nursing Education proactively involved in designing processes and reports needed to ensure quality of care standards and related documentation expectations.

Departmental reports generated via a complex request process with basic level of data complexity understanding

Basic:  Compiled from data contained in the system or application

Advanced:  Utilization of data extracted from multiple applications

Impact of managing change acknowledged without a plan for adoption of change

Basic:  Recognition of the impact of process and data changes with limited resource alignment for planning and communication of change.  Resourcing for change management may exist at the project level with little to no alignment with other organizational messages or areas.

Advanced:  Recognition of the impact of change with resources and activities proactively planned and in place as part of the overall organizational commitment to managing change.  This commitment would include communication planning that aligns with the organization’s goals and key messages for all staff members and patients.

Essentially clinical informatics should be considered an integral part of the organization’s overall governance model. Clinical informatics is the bridge between clinical and medical operations and IT, providing valuable and necessary input to data standardization, collection, and utilization.  Because the scope of this clinical and cultural transformation is so profound and all-inclusive, organizations must create new governance and organizational structures that ensure collaboration across clinical and technical areas, but align with the operational structures of today. To succeed, organizational change structures, committees and teams should ensure:

  • Aligned leadership at the senior executive level, with board level support as well
  • Multi-disciplinary work teams at the end-user level
  • Sponsorship by clinical, operational and physician leaders
  • Facilitation from IT personnel

About the Contributor
Mary Lawrence Staley-Sirois has nearly 20 years of healthcare operational and strategic planning experience across a wide spectrum of provider environments. As a physical therapist by clinical background, Mary has worked with large and small healthcare systems on the planning necessary for clinical transformation as a result of an EHR deployment.  Her work includes organizational governance and change management, medical and clinical staff collaboration on best practice processes and evidence-based practice, organizational budget development and related benefits realization, and detailed project planning.  Mary’s work is focused on leveraging the skills of teams within healthcare organizations to better develop the deployment of any strategic initiative, from product development to transformation of clinical process and practice, to EHR adoption, with a recent focus on achieving Meaningful Use.