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Foundation Members:
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CHIME Presents:
The CIOs Guide to Implementing EHRs in the HITECH Era
CHIME Member Comments on
Chapter 3: Assessing the Organizations Current State in IT, Charting a New Course
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Question posed to members:
Most organizations have a wide variety of IT applications in place, yet may be an indeterminate distance from being able
to qualify as a meaningful user. Are you working with your CEO and other senior executives to determine your current state
of IT readiness, and to develop a roadmap to an ideal future state? If this is your task alone, how do you communicate needs to your CEO?
Comments:
It is a combination effort between me and the CFO because as a critical access hospital there are numerous questions about timing and access to funds. We regularly communicate our findings to the CEO.
Yes to the first question. We've formed a steering committee to provide administrative guidance and oversight to our compliance efforts. I've attached the charge to the committee, which includes its membership. As you can see, the CEO is part of this committee, which is our primary means of communicating with him on this topic.
As the CIO for a health system consisting of one hospital and about 100 physicians in an owned clinic, we spent about six months in early 2009 discussing our IT plans. We came to the conclusion that we needed the functionality of a system of a specific vendor to ensure that our facility could be successful in meeting the evolving requirements of our region. Our executive team has been very supportive of my efforts to make this IT project (a conversion to our chosen vendor in the next 24 months) the number one priority for the entire health system. That decision was the defining moment for this organizations ability to meet the developing requirements for National Healthcare Reform. I work closely with the CEO and the rest of the executive team (since I report directly to the CEO and am a member of the senior leadership team) on all of the communications to the medical staff and employees related to this initiative. Being part of the executive team is necessary to enable this type of success.
IT is far from the only attention grabber in our organization. IT readiness, as it relates to MU, has been mine to address. I am addressing by trying to influence operations that they need to take the point on this. My systems and applications can get us to the threshold, but operations have to leverage the tools in order to demonstrate use. This is not clean one for one of course. System security and HIE remain mine almost exclusively. But operations and patient safety and quality have to take more prominent roles. We communicate to the CEO directly and we also bring it up to his cabinet level executives.
Yes, I am working with the CEO and the senior executive Reform Readiness Task Force to communicate our current state of MU readiness. The first step is to map the IT solutions required at the foundation of each of the MU criteria. Second is to determine the state of those solutions and their MU system certification. Third is to make sure our IT solutions implementation plan is well understood - with the associated resource costs. Lastly, is to assess the people/process readiness to answer the do you USE the tools to meet the defined measures? - that is a question that needs quality management and operational leadership involvement.
The short answer is yes, of course I working with the CEO. The next most involved is the CNO. I am for the most part the one charged with developing that road map, the budget estimates, and relative timeline. I meet with the CEO face to face at least once a month on a routine basis. I am not considered one of the executive team but the next level down of the leadership team with other directors.
The organization maintains, what is called, an Information Systems Management Partnership with a consulting firm that helps with the strategic planning, requirements development, vender selection, implementation assistance, and operational assessments aimed at getting the most out of our existing software. They also provide, what I call, a reach back capability. This is someone (to include their client base) to go to and bounce ideas off of, share lessons learned, and outline best practices.
We have a group that has evaluated our status and put together a road map. This is communicated to senior leadership, the board and all hospital staff.
My CEO has been a key partner for the past nine years. We and the senior management team work together with board and medical staff leadership on the direction being taken. If this is my task alone, I lay out a plan at a high level first with expected costs and resources that will be needed. The plan takes into account whatever strategic initiatives and goals that are in play. Some may need to change. The quicker the change needed, the more resources from all levels that will be needed. Governance is a common term being used today as it relates to IT implementation, maintenance and management. What will governance be? What is the capacity for change? Each organization is different. Every need and political landscape is also different. The perception of, history of successes/accomplishments/failures, relationships in place/not in place and skills within IT are all important components in the plan.
We keep our CEO informed on a monthly basis with a face-to-face meeting. Also presented our HITECH strategy (and commitment to achieve ALL the money available to us) to our Board. We have developed a scorecard to track how we are doing on each measure and who is responsible for that measure.
This will be monitored by our IT Steering Committee. Were in the final stages of selecting a replacement Clinical system which we intend to get us to the desired future state. It has also been determined that we will need a cross functional team with input from the quality department.
I prepared and presented a gap analysis to my Steering Committee and then asked our HIS supplier to quote any products needed to close the gap. These items then became projects to be considered within our normal capital budget process. The key is get in line early with your supplier.
CIO educated senior management, Board and a core hospital Meaningful Use Steering Committee that was formed in December 2009. The Steering Committee in early January completed the first pass at a gap analysis for the Stage 1 Criteria. From this we have prioritized the items not currently in place - the biggest one CPOE. Senior management has been updated on the gap analysis outcomes and have put many of the items we need to comply with in our strategic plan.
Our Organization in collaboration with our HIS vendor performed a gap analysis and roadmap to achieve meaningful use. The executive team has been involved and updated on a regular basis, at least monthly. In our case the CNO is the executive sponsor for the MU project.
This task is reporting to the IS Steering Committee. As the CIO, this is primarily my responsibility to gather the reporting on it. Summary info is communicated to the IS Steering Committee at monthly meetings.
We handle this in several ways: within IT, we have a specific road map, a strategic plan and have or will conduct a number of assessments and gap analysis for ARRA and/or MU. Within the organization, we have a strategic team and incorporate, as needed, the IT direction in the hospitals goals and objectives. I am the director; my boss, the VP, communicates with the CEO both in public, at the executive team meetings, as well as in private.
MU is a joint responsibility of the CIO and CMIO and an assessment was completed and communicated. Communication includes the different IT Business Councils which include operating VPs the IT Strategic Council which is C-suite and several Board Committees including Planning, Technology, Finance, and Audit.
We have developed preliminary roadmaps based on our understanding of the MU rules (draft), but until the rules are finalized, we arent going to deviate from our current IT investment plan. Needs are communicated through briefings to IS governance committees, senior executives, and one-on-ones with the CEO.
It is my task alone. However, I will be pulling in the other executives for buy in, input, feedback, etc. The needs are communicated during our annual budgeting process. If we find that we have a funding gap then we will need to request funding which first must be approved by the COO/CFO and other VPs and then is brought to the CEO for his concurrence.
Yes, we have completed an IT readiness assessment with a consultant and a vendor review with another consultant to prepare to select a new hospital information system. A clinically-driven evaluation team, along with our executive team, have worked through this process including demos, site visits, and review meetings. We have a roadmap and are prepared now to select our vendor of choice to move us forward with achieving MU.
Yes, I am working with senior management and I/S Steering Committee to plan out our roadmap to obtain MU.
The task is my responsibility to spearhead but is communicated to the CEO and other leaders on a frequent basis. Our roadmap is to replace many of the current vendor products with a more integrated system. The process is already underway but the resource allocation is minimal given the current economic condition.
Yes, we have been working on this roadmap for over 18 months. MU has just become an additional part of that roadmap. Our CEO has me leading this effort. We have an IT Steering Committee that allows me to bring strategic issues and plans foreword. This committee has the entire C-leadership on it. I also have one-on-one with our CEO specifically to discuss our roadmap.
Yes, Im working with the senior team at the facility. Ive done presentations for our department managers so that everyone is aware of the needs. Communicate verbally and in email (short and to the point).
Per the request of our executive team, our CMIO and I provide MU readiness reports quarterly in our IT governance forum. We indentified three weak areas and associated costs to be included in capital budget process.
We have been working with our primary vendor to determine any gaps and additional purchases required to align timeframe with MU. Also have reached out to other vendors we use for components of meaningful use like eligibility, electronic claims submission and e-prescribing to determine if these companies are pursuing certification for MU. I communicate with both the CFO and CEO on our status.
As a member of the senior leadership team, I brief the team on a regular basis regarding our status and needs. I engage members as needed for their support when needed.
Yes our senior executive Core Steering Committee comprised of VPs and Senior VPs of which the CIO is a member has been reviewing the requirements and has seen the initial gap analysis. A subgroup of our executive team has been formed to begin the process of putting project plans and timelines in place to bridge the gaps. In addition to demonstrate that this is a collective effort on the part of senior leadership we included a goal related to meaningful use as part of our critical success factors that the senior team is evaluated against.
Providing updates to Executive Management including the CEO. A gap analysis has been completed and our Roadmaps have been updated to address a few new items and revised timing of existing items to be more in line with Stage 1.This work is done through our governance structure which includes any specific needs being expressed to CEO.
As an inpatient acute rehab facility, we are not allowed to participate in the incentive payments that rely on MU definitions. We wish this were different. We are, however, assuming that we will have to abide by meaningful use definitions to avoid payment penalties in future years. We also know that the interoperability components of meaningful use will become a necessity for us in future regardless of IT-specific incentives that may come our way. And perhaps a miracle will occur at federal level that will allow us to participate in incentive payments before then, since we truly are part of the care continuum for patients needing physical rehabilitative medicine. To this end, I am working with our CEO and other senior executives to implement our plan for, and implement, a new integrated clinical system that will allow us to meet any reasonable MU definition in future years. We are in process of installing that system right now, and plan to be finished by around end of 2012. Our roadmap is a collaborative effort between me, the CEO, and our Information Council, which is an internal IT board of directors so to speak, populated by senior managers from clinical and administrative areas, and chaired by the CFO. The CEO and CMO are both active participants in the Information Council.
I have been tasked to assure that we will qualify for and meet meaningful criteria. I work with C-level executives as a group, provide them with a monthly status, keep them informed of progress and with whom in their areas I will need assistance. I, and my staff, work with the appropriate clinical and administrative/financial staff to address the individual criteria. I also present a monthly report to our Board of Trustees regarding our status and progress towards meeting MU criteria.
The initial assessment of readiness and determining possible roadmap to meaningful use is primarily assigned to IS to determine. Communication to the CEO occurs through the CFO and Associate CFO.
Yes, I developed a gap analysis and plan to meet MU and clearly identified the timeline and $s to meet MU. Our plan was developed to meet MU in the first phase not the second. Did numerous presentations to senior management and Board on the subject.
I am working with the CEO and relevant senior execs to identify our gaps and plan remediation, especially as it relates to the necessary process changes.
We have a team in place reviewing requirements and identifying readiness for each and/or what we have to get in place technically and procedurally. For instance, our ROI is now five days where MU asks for 72 hours. That will change processes as well as technology. Also, with the new eligibility of docs, we have to add those requirements to our matrix.
I have provided the CEO and other members of the Executive Team with a chart of which applications we have and which ones we need to implement as part of MU. The team is engaged and understands that this is not an IS Initiative, but a Health System Initiative.
Our IT Subcommittee to the Board of Directors includes the CEO, CMO, CNO, and CFO. They expect me to present my road map and readiness assessment to them for their input. Likewise, if I identify risks in readiness or other barriers, they collaborate with me to develop a risk mitigation plan. The sense of ownership is very broad, including the Chairman of the Board. Everyone is engaged in the success of the EHR, particularly the development of the road map for an ideal state.
The senior operations team at our hospital discusses IT strategy on a weekly basis and updates its HIT plans every year. The senior operations team made a conscious decision to proactively upgrade the hospitals system during 2010 (and therefore, delay other projects) in order to prepare to meet the MU requirements.
Yes, we are working with the senior executive teams. We intend to build our roadmap, then, jointly with our vendors, have them review our roadmap for what they feel are omissions or changes. Currently I am the one leading the task, but have given the senior executives a presentation on the need to broaden the responsibility for achieving MU. I meet at least monthly with the CEO to cover progress, plans and concerns.
This is a task for IT. We are charged with developing a 5 year EMR plan. I have monthly status updates to both CEO and CFO on progress. I am slated to propose the strategy to the BOD later this year.
Our CEO is heading this initiative and has his entire executive staff on board (including the Board of Directors). This is something that is discussed monthly as we progress foreword installing our EMR with a goal of having 100% CPOE by June 20, 2010. The MU will be a by-product of the solution we purchased since it has all of the current known requirements met. He understands there is going to be implementation time but everyone including the physicians are on board.
We do not focus on the MU requirements as a separate initiative. We have merged those requirements into our larger Advanced Clinical Systems Strategy and simply highlighted those areas that address MU. The MU requirements are the low watermark for advanced clinical systems.
I am working with our CMIO. I have developed a roadmap and I have presented the roadmap to our CEO. I am responsible for identifying our needs and leading all stakeholders necessary for achieving MU.
Yes. We review and update the IT strategic plan annually and share it with the executive team. Last year, it was updated after the release of the final ONC MU matrix. Following this a series of MU workshops were conducted, a MU scorecard was put together showing our current status for Stage 1, and we scoped out and signed an add on contract with our current EMR vendor to achieve all MU stages.
This is my task alone. I identify needs, plug them in to a roadmap, and establish a total cost. This is presented to the CEO in one of our standing meetings.
Yes. I have presented our current state of readiness and have proposed to the CEO and executive staff the course of action needed to achieve MU requirements (as well as HIMSS Stage 6). The CEO and executive staff have adopted my recommendations and have provided the funding to achieve our goals. Our process began before the ARRA legislation. We had implemented a five-year IT strategic plan which weve adapted to also include MU.
My staff has developed a readiness matrix that we continually update. I update the Executive Team (including CEO) quarterly on where we are at. The EMR Steering Committee is also provided with regular updates. Missing components have and/or will be added to the IT Strategic Plan which in turn is incorporated into the overall strategic plan for the organization.
We have formed an internal committee to do the review and follow up. Weve also engaged both our vendors and outside consulting to provide a very good view of where we are and where we need to go. The difficulty is that we are currently shooting with a blindfold on until the final MU requirements are solidified. The needs have been communicated verbally, in red-light green-light fashion, and formal report.
We have an IT Vision Map (rolling three-year road map) that articulates (at a high level) current state, future state, and the general sequence of projects to get from here to there, along a timeline. Weve communicated this Vision Map to the senior team, including the CEO, and we try to get (at least quarterly) time on the executive team agenda for this (the IT Vision Map), and/or related topics to funding key strategies.
We communicate needs to the CEO via executive team meetings, via CEO/CIO one-on-ones, via email updates, via Operations Management Team meetings, and via Capital Committee meetings. Our CEO is also welcome to attend our monthly IT Steering Committee (IT Governance) meetings; and, although he has delegated this function to his COO, it is well-attended by other member of the C-suite and senior leadership team. IT Steering is where we develop and/or align IT vision with the business strategies, prioritize IT requests and resource allocations, report performance to goals/metrics, and engage our senior business leaders (operational VPs) in overall governance of the IT function. IT Steering is principally where IT needs are identified, prioritized, and planned.
While I am leading this project, it has been blended into our Strategic Plan. Hence all of hospital management and the Board have endorsed the project and participate as required.
I have been tasked as the ARRA expert in positioning our organization to qualify for stimulus dollars. I communicate the status of projects, our timeline, and future needs to the Information Management Steering Council (IMSC) made up of all Senior Managers plus three physicians.
Developed a dashboard to focus on systems involved, code levels required to meet code, responsibility parties, task to do (both vendor,IT or implementation (impact outside of IT). Use this dashboard to
communicate complexity and needs with leadership. Use the MU Stage 1, 2 and 3 to provide the goals. Must relate IT selections, expenditures, etc to ability to meet MU, not just to reap the stimulus but to avoid the penalties.
Our HITECH committee worked through a gap assessment using the IFR and developed both project level and high level change recommendations. We are now sizing/costing the efforts. We have charged clinical and business sponsors for some key delivery items. We are also contemplating a progress dashboard. Our vendors' involvement will be another key to success.
We have determined our current state of IT readiness and our roadmap for the technologies we need to implement and when we will implement them is complete. We have these discussed as part of our senior management meetings which are attended by all C-suite members. The measurement of our adoption and utilization process and change acceleration methods is our next phase and we plan to tackle this once the meaningful use madness is finalized.
Yes, we have a cross-functional team responsible for readiness and roadmap. We communicate needs to our Senior Leadership Team.
Yes, I communicate with the CEO directly. We have an IT governance committee structure that I work with to evaluate readiness and projects needed to reach MU.
From the beginning, we have interfaced with required systems so that we are EMR-centric. They find what they need in the EMR. We would not be successful without the support of our leadership.
We are in very good shape to meet MU by December 31. We began the EMR journey in 2004. When the NPRM came out, I presented the proposed MU criteria to Senior Management and the Board. We then formed a task force our of our EMR Steering Committee to perform a MU Gap Analysis. We completed that April 1 for both the Inpatient side and Ambulatory side. Once the task force approved the report it went to the full EMR Steering committee for review. It was presented then to Sr. Management, and last week to our board. All along we have added two caveats:
1) The NPRM could change, but it is not likely to change radically. A second review may be required.
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2) We cannot afford to waste time.
As a result of the gap analysis, we installed various systems. We already had CPOE (two years) and all of the other requirements for MU on the Inpatient Side. Our independent clinics started their journey in 2001. They too are in great shape. Our employed physicians will be going on either the independent physicians system that the hospital supports or the physician module of our primary EMR partner for the hospital. As departments of the hospital today, the employed physicians have the hospital EMR, but really need better office documentation.
We also focused on a gap analysis for the new privacy and security requirements as well as PCI DSS. These are completed, and will be independently audited early July.
Yes other senior executives we created a MU czar and a team dedicated to only this task. The team reports thru IT steer to the CEO and other execs.
We are just in the midst of re-structuring our committees that will be guiding and monitoring our progress in this regard. Communication with the CEO should be pretty straightforward
he has decided to chair the Steering Committee for this initiative.
I am working with my supervisor, Senior VP/Quality and Information to formulate a work plan with action steps plus a methodology for each of the 23 regs to validate compliance. We will be meeting with the CFO in June to share that plan.
Working on this as a system initiative with entire healthcare system.
CEO has given overall direction be compliant for 2011 and I'm left to see if it's doable and plan accordingly. I provide periodic updates on progress so in case we're not ready it won't be a shock.
As CIO, I reviewed the MU grid and determined our status which was reported to the CEO. We then turned to our HIS vendor who helped us determine what products would satisfy MU. We signed an agreement with them to implement these modules.
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