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Hospital Executives' Leadership Critical to EHR Implementation

By The College of Healthcare Information Management Executives for HealthLeaders Media  
   September 13, 2010

This excerpt fromThe CIO's Guide to Implementing EHRs in the HITECH Era covers the senior executive's role in implementing an electronic health records system. Those in the C-suite who must lead this change are best prepared if they understand that it may indeed be profound. The guide is published by CHIME, The College of Healthcare Information Management Executives.

The CEO and the senior executive team must fully support the organization's efforts to implement an electronic health record. This support must be tangible, public and sincere. The CEO puts forth the organization's vision for improving quality and patient safety and positions IT as a key strategy for achieving the outcome.

While there is no exact formula to follow in implementing an EHR system, one ingredient to success appears to be the complete and unqualified support of the senior executive team, beginning with the CEO of the organization.

An informal survey of CHIME members found that the vast majority saw full senior executive support for an EHR implementation as a key factor to success.

It is crucial for the CEO and other senior executives to demonstrate that an EHR initiative is not an IT project, and it is not like most other hospital projects. The implementation of an EHR is a transformational initiative, and if its potential is to be realized, the organization will need to undergo foundational change to achieve mission-supporting objectives that include specific improvements to patient care and safety, often requiring that the organization restructure care delivery to meet the changing requirements of a reforming healthcare system.

Despite the many competing voices that call out for each senior executive's attention, an EHR implementation will demand significant involvement and participation. That is because electronic records will affect nearly all of the diverse constituents in the care delivery process; they will change work processes and content, individual workflows and the very culture of the organization. Those in the C-suite who must lead this change are best prepared if they understand that it may indeed be profound.

"The move to an EHR does not only require senior executive support—it requires senior leader champions for the process," says Kim Ligon, director of information services and CIO at DCH Health System. "They can't just support the project; they have to lead the charge or it becomes 'just an IT project.' "

Lack of full support for the implementation change effort will lead to a solution that does not see meaningful adoption by clinicians.

Caregivers whose jobs will be affected by an EHR must see active involvement by senior executives, particularly the CEO, COO, CMO, CNO and chief quality officer (CQO), in the planning and conversion to a digital system. Without a high level of participation and leadership, front-line workers may perceive EHRs as an "of-the-moment" program and resent the change and increased workload it represents. A successful transition requires a workforce that participates in design and knows what to anticipate; those expectations must be set forth by the executive team.

"Remembering the maxim, 'Culture eats strategy for lunch,' the primary objective of the CEO and other senior leadership is to set the cultural tone," said Bill Spooner, CIO at Sharp Healthcare. "They must live the vision and position themselves as the executive sponsors."

To prepare the organization to work through the implementation process, the CEO and other senior executives must get involved in the early planning for EHRs, including the obvious steps of agreeing to a timeline, process and budget for the transition. In most organizations, the CIO takes the lead in developing these plans, with input from other executives.

For instance, budget projections should encompass all expenses that will be involved in the total cost of the project, including hardware, EHR and third-party software products, maintenance support, implementation build support, internal people resourcing, third-party medical vocabulary content, implementation build tools, training content and support, implementation go-live support, loss of productivity during the rollout, and technology infrastructure changes.

With approval from the full executive team, the CEO and other senior executives then need to get involved in the implementation process and otherwise reiterate support for the effort. A member of the executive team, or the team as a whole, can take on the role of project sponsor and assume responsibility for the success of the project, perhaps aligning senior management compensation incentives to ensure the success of the effort. Senior executives particularly need to enlist the support of CMOs and CNOs, and/or create CMIO and CNIO positions to interact with clinicians and gain their support.

Throughout the process, the CEO and other executive team members can best develop support by demonstrating that the EHR process has sufficient financial support, and that digital records symbolize a clinical transformation process that hospital leadership plans to follow from this point forward.

While support for the adoption of EHRs needs to be supported by key providers and medical committees within the facility, senior executives need to create the vision for where the enterprise is going, and the need to increase quality and efficiency.  Specific improvement metrics to track progress and outcomes should be targeted and, at this stage, should include HITECH measures.

CIOs need to have positive and trusting relationships with other senior executives in the organization. All executives need to work together, sending a clear message that the use of an EHR system is not optional but will become a condition of employment or practicing medicine at the organization.

Executive Guidance

  • The EHR-enabled transformation should be a thread that runs through the organization's overall strategic fabric, and it should be documented in its strategic plan. The organization's board must also be actively involved in monitoring progress to an appropriate level of assurance.
  • Senior executives, led by the CEO, should agree on the transformational scope, the approaches to organizational change, and resourcing the effort. They need to agree that the EHR implementation is a top priority for the organization for the next few years.
  • The CEO needs to set the vision for the implementation, truly understanding how EHRs will help an organization achieve clinical transformation to greatly improve quality, safety and the patient experience. IT efforts then support these goals.
  • A senior executive, preferably a clinical executive, should take on the role of the project sponsor, and have full support from, and access to, the CEO. The project should be viewed as a top-driven strategic priority.
  • As executives move from planning to communication, they need to emphasize the importance of the project to the organization, connecting the EHR back to the organization's missions and goals. They need to be in a visible leading role and be supportive of the initiative by "leading the conversation."
  • Beyond words alone, executives need to commit funding and additional staffing as needed, as well as their own efforts. They should participate in key transformational activities, including governance meetings and communication events.
  • Executives should endorse governance structures that guide and build support for IT initiatives surrounding EHR implementations. For example, an executive-level IT steering committee can bear responsibility for a strategic information services plan.

  • Executives, and the CEO in particular, need to demonstrate the commitment of the organization to invest in efforts to increase efficiency in tandem with IT usage. This can include Lean, Six Sigma and other process improvement methods and techniques, investments in personal change assimilation, clinical use and other forms of workforce education.

Remarks

"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."
Stephen M. Stewart, MBA, FACHE, CPHIMS, CHCIO
CIO
Henry County Health Center

"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 that the executive staff understand, support and back this change. Computers are just the tool; the change is by the people."
Mary Jo Nimmo
Director of MIS
Lenoir Memorial Hospital

"Make it the organization's Job 1 and recognize it is a change in culture, not just a technology project. An EHR implementation is the most complicated undertaking a hospital will ever do ? it will affect staff, providers, ancillaries and patient care. If it's not Job 1, don't do it!"
Jack Kowitt
Senior VP and CIO
Parkland Health & Hospital System

 

"Senior executives can help facilitate the organization's move to an EHR by having high visibility at all meetings. For example, throughout our health system, our EHR journey is a standing agenda item 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, on 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."
Mike Hibbard, RN, MHSA, PMP

CIO
Central Division, Mercy Health Partners/CHP

 

"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?We've been asking the wrong question for years: 'How do we get organizations to support IT and an EHR?' Instead, the right question is, '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."
Richard Lang, EdD
Vice President and CIO
Doylestown Hospital

To download The CIO's Guide to Implementing EHRs in the HITECH Era in its entirety, click here.

The College of Healthcare Information Management Executives (CHIME) Foundation has been established to enable providers of H.I.S. products and services to support the educational initiatives of the CHIME organization. The Foundation also serves to educate its member organizations, enabling them to better address the needs of CIOs and the healthcare industry.

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