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Foundation Members:
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CHIME Presents:
The CIO’s Guide to Implementing EHRs in the HITECH Era
CHIME Member Comments on
Chapter 4: CEOs, Senior Executives Set Vision and Lead the Change to EHRs
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Question posed to members:
From a CIO perspective, what are the best ways your CEO and/or senior executives can help
facilitate the organization’s move to an EHR? How best can they support change in your
organization’s culture while underscoring IT’s strategic importance?
Comments:
“I went to our Executive Team in early 2009 to discuss technical opportunities for acquiring new clinical system that would help us improve our goals for an integrated system ready to meet the challenges of the Healthcare Reform legislation. We agreed on a process and also on a budget. The main success was to get us “all” to agree that this objective was the # 1 priority in the System for the next 2 years. Once we had 100 agreement on that, the rest is detail.”
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“Understand the organizational commitment required to be successful with the new technology and processes that an EHR requires. It must be embraced as a clinical initiative, focused on improving quality, safety, and the patient experience. It cannot be viewed as an IS initiative. A senior clinical executive must take on the role of project sponsor. Adopt quality and safety goals tied to the initiative and measure them for success.”
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“Make it part of the organizations strategy, make executive team accountable for success, support addition of a CMIO, and champion the benefits to the board and physicians.”
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“What the CIO needs most is the unqualified support of the CEO and other Senior Executives. They absolutely must share the vision. And see where the organization wants to end up and understand why. Along the way, there are going to be groups the need to be persuaded, coaxed, cajoled or just plain told to get on the bus or get off. That must be supported all the way to the top. To do that, they must have and fully share the vision. It starts with the CEO, and then the rest of the Senior Team. If the CEO does not get it, and support it, things may end up in jeopardy.”
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“I believe the best way a CEO or senior execs can help is to set up a separate implementation organization and have it report to an executive sponsor or two in the operations side of the business. This will insure that the organization sees the implementation as a clinical transformation project not an IT project. Of course the CIO needs to give up some control with this approach but system adoption is greater which ultimately is the goal.”
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“ CEO and other executives need to communicate the importance of the implementation. They need to make it clear that the implementation isn't an IS project, but instead is a patient care improvement project supported by IS.”
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“Being visible, owning the initiative as a top driven strategic priority in partnership with clinical leadership;
Including the EHR initiative in CEO communications and connecting it back to mission and goals;
Funding it adequately; and last, but not least,
Aligning senior management compensation incentives to ensure the success of the effort.”
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“We are using our IT steering committee for this.”
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“The CEO and all of Senior Leadership along with the Medical Executive Committee must consistently enforce mandatory CPOE. The first step in underscoring IT’s strategic importance is putting the CIO on the Senior Leadership team reporting directly to the CEO and regular reports to the board.”
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“First and foremost is talking the talk. If they don’t understand what the next five years are going to bring it will not happen. Clinical transformation will be huge for some organizations and that will be to get not only the employed hospital staff to change the way they do business but also the physicians that work in the hospitals. It will be imperative the Executive Staff understand, support and back this change. Computers are just the tool, the change is by the people.”
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“This one thing is what made us successful with our implementation. The entire executive team was behind this, support the movement as senior owners of the project. The VP of Medical Affairs and Chief Nursing Officer co-chaired most of the meetings. It was made clear early on that this is not an IT implementation but an organization wide system. The CEO supported the concept of 100% CPOE and began sending the message from the beginning. We knew we would have outliers but they have been overcome and the stories I’ve heard from many physicians is that it does take a little longer to place an order but when it came to results they were pulling them up interactively.”
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“Embed the EHR strategy within the organizations overall strategic plan and have the board actively involved with monitoring progress. Have members of the senior leadership team (CNO, CMO, and CIO) chair the EHR Steering Committee and have a strong physician advisory committee plus a clinical informatics committee made up of key clinical departments that implement the EHR strategy. Planning and governance are key along with a solid communication plan.”
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“The move to an EHR does not only require the senior executive support - it requires senior leader champions for the process. They can't just support the project, they have to lead the charge or it becomes "just an IT project".”
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“First and foremost is to be an engaged member of the strategy through participation on key project activities (governance meetings, communication events etc…) Second is through recognizing that this is more about clinical process transformation than technology implementation and sponsoring/enabling the process change first will establish the foundation for success. Finally, by keeping the activities top of mind in the mission and strategy of the organization displays importance sponsorship from the top level.”
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“CEO and Senior executives have to take ownership of the EHR project and it has to be discussed at every meeting. EHR is an organization project and has to be managed as one.”
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“Address the fears of spending $ with no clear guarantee of return. Create programs to help with purchase or lease, explain MU and how achieving MU is an outcome of EHR and not the other way around.
Identify champion doctors who "get it" and draft them into your awareness campaign.”
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“Make it the organization's job 1 and recognize it is a change in culture, not just a technology project. Job 1 makes it clear that the user staff that has to be part of the project to translate what they do to the EHR are available and even transferred to the project full time, that staff is made available for training and the stupid tricks that creep into the culture are corrected in the redesign. An EHR implementation is the complicated undertaking a hospital will ever do affect staff, providers, ancillaries and patient care. If it's not job 1, don't do it!”
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“Remembering the maxim “Culture eats Strategy for Lunch”, the primary objective of the CEO and other senior leadership is to set the cultural tone. They must live the vision and position themselves as the executive sponsors, not allowing the EHR to be branded an IT initiative.”
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“Of course they must support it financially, but they also must support it culturally by framing it as a clinical transformation project, and not an I.T. project....they must review any provider compensation plans that are productivity based, and make them harmless for loss of income during the transition, but also look at the feasibility of modifying the comp plan to include metrics for quality and system usage. The adoption within the medical staff must be organic, ie., be supported by the key medical committees within the facility, and key providers...senior executives need to create the vision for where the enterprise is going, and why the ehr being implemented will increase quality and efficiency....they also have to support the team put together to implement the system, and know when to get out of its way.”
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“A few items are key her IMO. First you need Clinician champions, folks who are both enthusiastic and willing to roll up their sleeves and stay involved throughout the process. There should be more than one.
Pre-Implementation assessments – how prepared are your people (all of them) to use computers day to day. What can be done to make sure they are ready?
Plan for productivity hits and budget accordingly. Change costs. Plan for it.
Be a benevolent dictator. Direction, timelines and processes need to be clear, pervasive, and adhered to. Exceptions don’t exist and participation is mandatory.
Don’t give training the short shrift.”
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“Number one in my opinion is that they must support the decision to move to an EHR and explain why we need to move this way with some solid facts, figures and reasons for doing it. Two, they need to be involved in the meetings with key players so they can stay in the loop. Three, they need to pick champions and recognize them for their contributions.”
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“In my organization we have an Executive team made up of the COO and the key VP’s and we are at the table every month discussing this and reinforcing this IT is an important part in the overall strategies that lie ahead. The fact that we now get together monthly and they are taking the message back to their direct reports has help tremendously. Also the VP MA and the president of the Medical Staff invite me to all Medical Staff Meetings to present and we have a standing invite at the Medical Executive Committee.”
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“On the move to EHR
a. They need to demonstrate their unwavering support for the initiative and help create the sense of urgency
b. They need to ensure that the necessary resources (personnel, resources, etc.) are committed and retained to the project.
Support change
a. Investing in specialty areas of expertise such as lean, six sigma and other process improvement methods and techniques
b. Investing in educational training and job aides for clinical personnel to ensure they have received the appropriate training.
c. Investing in personal change and transition education and training for leadership such that they are able to use tools and techniques in working with clinical staff to help them embrace the new technologies and new workflows”
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“1) Proper IT governance is key, part of this governance should include an Executive level IT Steering Committee, chaired by the CIO. The Strategic Information Services Plan should have review and sign off by this committee.
In that plan we define: Change Management, Clinical Process Automation (The Clinical Application systems we utilize to deliver our business of Healthcare have grown from being an adjunct tool in the delivery of care to a vital integrated tool in the complex process of delivering care to our patients...etc)
We define Key; Strategies: "Sponsorship "IT will create a Project Management Office to manage all IT projects for the organization. Our organization will commit to a process that places business case development, justification, and benefits realization for projects with the business units that would be the primary beneficiary. Identification of an Executive Sponsor and a completed business case will be a prerequisite to consideration in the process. Executive sponsors will manage the overall delivery of projects and realizing the benefits of investment in IT."
So, it is the standard answer in every IT Value/Governance Roadmap. The key to success is to roll this out in a bureaucratic free manner, which facilitates the business, protects the assets and gains the trust that IS will be transparent and the IS agenda is an Intuitive Information System that will give "Actionable Data at the Time and Place of Care" Very important that the leader of IT has a very positive and trusting relationship with the others in the C-Suite.
All major IT initiatives (ie new Surgery and ED systems) are kicked off by the CEO, with clear direction to the organization of the importance of the project. CEO needs to be out front and supportive.”
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“1) Executive support is mandatory; and by support, I don’t just mean funds. Culture adjustment, priority shift, technology utilization, change management, communication and laying out a clear, well defined and, most important, achievable strategy all play a part in support. They are all equally important as they all address vital pieces of the overall goal.”
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“The single most critical component for the CEO and Senior Executive team, is that they set the expectation that use of the system is not optional, but rather a condition of employment and/or practicing medicine at the organization. There will be many physicians and staff who will try and avoid using the system, sighting things such as "Nearing Retirement and don't want to make this dramatic change at this time in my career…", etc… Being firm in the expectation and not allowing ANY exceptions is critical.
Provide the necessary IS and Operational resources for the implementation, training and ongoing support of the systems. Many times it is felt that once a system is live, it’s time to release the resources and get back to business as usual. With a fully implemented EHR, the daily care and feeding, updates and ongoing optimization will be the new "Business as Usual”.”
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“It needs to be part of the facilities strategic plan, it must be conveyed to all staff, this is a facility initiative, but it is not enough to just say the words, we need their support for participation and involvement, and above all hold staff accountable. Support needs to come from the top and they need to be involved in the meetings, to show their support and the importance of this project.”
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“1. Be the "executive" sponsors and be keenly interested in sign off on the projects. When there is some push-back or anxiety from clinicians it is crucial to address those issues in-synch with project charter and be willing to negotiate for the good of the organization at whole.
2. Have a grasp on what the change and culture really are. Remember that Operations (clinical) drives the project but IT is the vehicle to deliver. IT and Operations must be in synch.”
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“IMHO then need to be visible and engaged and most of the time leading the conversation. They need to be well versed in the organizational benefits of the EHR and how it fits into and support the overall strategic plan/initiatives. Being a supporter of the change and not just look a the bottom line. By holding the rest of the team accountable for their parts in the process.”
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“Senior executives can help facilitate the organization's move to an E.H.R. by having high visibility at all meetings. For example, throughout our health system, our E.H.R. journey is a standing agenda for every meeting. This has been requested by senior leadership and thus motivates those leading other meetings to make sure they have the most current information before their meeting is held. Visibility is also very important, at all shifts. This visibility and rounding reinforces to staff that yes, this is important and is not just the "project of the day" but truly a care transformation journey. Both of these strategies help with both acceptance
and compliance.”
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“Defining business sponsorship - these are NOT IT projects.
Understanding and support creative ways to overcome resource constraints
Support culture of change”
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“The CEO can make it clear in words and deeds that this is not just an IT project. Line of business execs must run the multidisciplinary teams and drive to the desired business results.”
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“CEOs support change and advocate IT’s importance by making sure that quality and patient safety are on the top of the agenda. That is really all they have to do. The EHR and IT’s importance becomes a tacit part of the strategy when CEOs tout, espouse, and drive safety and improvement goals. Everything we do from an IT standpoint is inextricably linked to our organization’s strategic plan. This plan is driven primarily by our desire to continuously improve quality and patient safety. Thus, our end-to-end integration strategy is tightly aligned with our need to facilitate important goals such as medication management. Using these integrated data, we drive patient safety initiatives with real-time clinical decision support applications that enable the enterprise caregiver to respond safely and expediently with the best data and knowledge available. No way to do this without CEO and executive support for an integrated IT/EHR strategy. We’ve been asking the wrong question for years: “How do we get organizations to support IT and an EHR?” The right question: “What are we doing to make our organizations the safest and most efficient providers of care?” The answer to that is no longer in question.”
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“Understanding what it means. If they’re just repeating what others tell them, even if they support it in principle, it doesn’t ring as true to all as if they truly understand what the EHR means, and how it is intended to accomplish more than just add features and functions and reports. They need to understand the underlying (and overlying!) purpose is improved patient care and outcomes, and that they’re sufficiently versed to answer questions about HOW the EHR will lead to that.”
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“1. An EHR/EMR implementation is as much about culture change, workflow improvements, and an overall embracing of patient quality and safety initiatives than it is about technology implementation. The CEO, therefore, needs to be visibly supportive of this change process. There needs to be a commitment to, even an embracing of, a period of chaos during and shortly following the implementation. This is a necessary step of change.”
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“Admin support is imperative – CPOE has to be mandated. Contracts for paid faculty needs to have system usage requirements. Residents must do CPOE.”
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“First, to spend time to understand the implications of HITECH and to “internalize” the value and the potential impact on patient care and safety. Second, to understand and support the significant process and culture changes brought on by HITECH. From then on, to champion the efforts and support the team that’s working to implement.”
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