HIE Formation Part VIII: Who's in Charge?


By Laura Kolkman, RN, MS, FHIMSS, and Bob Brown

In this series of monthly articles, based in part on their recently published book, the authors discuss current HIE related events and leading practices within the context of forming an HIE initiative in your state, region or community. This series of articles was launched in the March 2011 issue of HIELights.

Once an HIE initiative is solidly underway, it’s important to understand who’s in charge. We’re not speaking about someone to take the blame when things go wrong (ALL projects have – and typically overcome – problems), but rather someone who can represent the HIE initiative in the larger community and who is capable of making the day to day decisions associated with any change management project with multiple concurrent activities.

Your first answer may be “the board” – if a formal board exists. If you don’t have a formally constituted board, then it’s the steering committee. Members of these groups have joined together; defined a governance approach; established the various workgroups; recruited qualified individuals to staff the workgroups; helped them define their objectives; and hopefully, helped them acquire the resources they need to accomplish their objectives.

However, the members of your board or steering committee are probably not the best people to make those day to day decisions. Nor should they. Typically, they have other responsibilities in the community; many will have full time positions. Who then is in charge?

In looking at successful HIEs, we consistently note the presence of a strong executive director or CEO. This is someone who can drive the mission of the organization and who is accountable for its success. In our book, we recommend that an executive director—the lead staff person, be brought on board as soon as possible. Based on our experience, it’s important to have someone in a full-time position that’s dedicated to coordinating the activities related to the development and operation of your HIE. The executive director may be hired at any time in the formation of the HIE—typically once there is a consistent source of funding; however, it is essential to bring someone into this position as early as possible. Initially, this might be a volunteer or someone appointed on an interim basis. But be aware that this should become a permanent, full-time, paid position.

Regardless of his or her employment status with the HIE, the person in the role of the executive director should have strong motivational skills and the ability to build a solid organization. Look for someone who has hands on experience in successfully building an organization or business. The right person in this position is critical to your success. As Laura Adams of the Rhode Island Quality Institute states: “[You] need the most talented strategic person that you can engage. Get people who are comfortable with leading among ambiguity and who won’t make small-minded mistakes.”

Recruiting and hiring an executive director is a board level issue. Look to them for assistance. They should be able to help you find the right individual. And again, based on our experience, the right individual will make all the difference in the world.

Laura Kolkman, RN, MS, FHIMSS, is the president of Mosaica Partners and Bob Brown is the vice president of Professional Services. Their book, The Health Information Exchange Formation Guide, was published by HIMSS in February. HIMSS’ companion website, where you can read chapter summaries and download select tables, figures, illustrations and checklists, is available at www.himss.org/hieformationguide.