EHR governance for transformation era

BOSTON—“Governance and communication go hand in hand,” said Richard Schreiber, MD, CMIO of Holy Spirit Hospital, speaking at AMIA’s iHealth 2015 Conference.

Schreiber said different governance styles product different results. For example, when stakeholders are in silos there are fractured, dissociated goals. Meanwhile, “consensus is great but typically a very slow process. Most would agree that if someone is willing to take responsibility, you will move faster but it’s hard to get accountability.”

But, he noted that both doing and not doing have costs. “It takes real time and dollars to get something done but the lack of a decision is as good as a decision to not do something and will cost time and money. If you fail to do something you will fail to get anything done. Some people don’t put that on the cost side of the equation.”

A community hospital with a good structure can keep things moving forward and while a multispecialty site will probably have a central committee, each hospital will have to weigh in on a certain level. These organizations will experience a slower approval process, he said, and the community hospital can move faster but has fewer resources.

Schreiber cited a HIMSS survey in which 21 percent said they have no EHR governance and 19 percent didn’t know. For those who don’t know, “at best that’s ineffective governance.” He pointed out that there is very little physician involvement in EHR governance as well as very little literature on the topic.

Physicians lose interest rapidly, Schreiber noted. Plus, there is frequent changeover of key personnel with medical executive leadership changes yearly and hospital leadership changing every 5.5 years on average. That doesn’t even factor in the rapid cycle change in rules and regulations and budget constraints.

Despite the challenges, Schreiber said physicians have to get involved. “Physicians don’t know or don’t want to believe they are instrumental in getting everybody else involved.”

EHR governance is harder than it was in 2005, said Ann O’Brien, RN, MSN, senior director of clinical informatics at Kaiser Permanente. That’s because the switch from silos to continuous learning is hyper complex. “This environment depends on more coordination and collaboration. That’s a big change from a system that had been pretty top down.”

High reliability organizations consist of tightly coupled teams in which members are dependent on tasks performed across their team, O’Brien explained. Moving into this highly dependent environment is relatively new. New drivers of change “are really impacting how we do the work and how we do the work together,” she said.

People used to be focused on implementation and optimization and it was all about the EHR. “Now, it’s like to so many other things.” In the past, governance was more about the build. “Now we’ve come to a point where that’s clearly not enough.” Providing the best care requires getting the right information to the right person at the right time. “That’s new and adds to the complexity of governance.”

Better care also requires shared goals, shared knowledge and mutual respect, she said. Despite all the changes, provider organizations still need executive leaders who set the expectations. O’Brien also recommended that organizations encourage pilots and sharing of best practices, bring diverse teams together and continuously update protocols and processes. "Move from optimization to transformation.”