Effective IT Governance Needed for Successful Clinical Informatics Implementations

By Roger Kropf, PhD, and Guy Scalzi, MBA

HIMSS Clinical Informatics Insights, June 2012

Not having an IT governance process, or having one that never seriously involves clinicians and other stakeholders, is a big mistake. Without a governance structure, IT at many hospitals and healthcare systems is a haphazard endeavor that typically results in late, over-budget projects and, ultimately, many disparate systems that do not function well together.

IT governance is needed because there is an almost infinite need for IT and finite resources available to the organization. CIOs and their staffs cannot set priorities by themselves. Senior executives and the clinical staff need to be involved.

What is IT Governance?
Weill and Ross define IT governance as "specifying the decision rights and accountability framework to encourage desirable behavior in using IT:"1

IT governance is not about making specific IT decisions. That is management. Rather, governance is about systematically determining who makes each type of decision (a decision right), who has input to a decision (an input right) and how these people (or groups) are held accountable for their role.2

The essential steps in creating an IT governance process are:

  • Create a Governance or Steering Committee
  • Define a Governance Charter and Process
  • Create Advisory Committees
  • Define the Role of the Board
  • Define the Role of the CEO
  • Require Project Sponsors Who Are Accountable
  • Involve the Project Management Office

What is Clinical Informatics Governance?
Clinical applications are part of the portfolio of applications that must be prioritized and finally approved by senior managers and the board. Typically, hospitals have a clinical applications advisory committee that is often given the task of prioritizing projects and advising the IT steering committee on future needs. The CMIO/CNIO often chairs this committee. A critical success factor is the ability of the CMIO, CNIO and CIO to engage physician and nurse leaders in the process either by having them serve on committees or reaching out to individuals and groups in multiple ways, including personal meetings, newsletters and email communications. Effective communication is considered a key to success. Success is defined as the active cooperation and approval of clinicians in implementation of clinical systems.


  1. Weill P, Ross JW. IT Governance: How Top Performers Manage IT Decision Rights for Superior Results. Boston: Harvard Business School Press; 2004:2.
  2. Weill P, Ross JW. Don't just lead, govern: how top performing firms manage IT. MIS Quarterly Executive. 2004; 3(1):1-17.

Related Resources

  1. IT Governance Institute. Board Briefing on IT Governance. 2nd ed. Rolling Meadows, IL: ISACA; 2003:27.
  2. ISACA. Implementing and Continually Improving IT Governance. Rolling Meadows, IL: ISACA, 2009.
  3. Kraatz A, Lyons C, Tomkinson J. Strategy and governance for successful implementation of an enterprise-wide ambulatory EMR. JHIM. Spring 2010:37.

About the Contributors
Roger Kropf and Guy Scalzi are the authors of IT Governance in Hospitals and Health Systems, published by HIMSS in February 2012. Kropf is a professor in the Health Policy and Management Program at New York University's Robert F. Wagner Graduate School of Public Service. Scalzi is a principal in Aspen Advisors, a professional services firm that works with healthcare organizations to enhance processes and streamline operations through the strategic and effective use of technology. Kropf can be reached at roger.kropf@nyu.edu and http://www.nyu.edu/classes/kropf. Scalzi can be reached at gscalzi@aspenadvisors.net.