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Tips for improving health care hospital governance

Getting physicians, nursing and pharmacy staff, and other peers together makes for effective IT problem-solving in clinical environments. This and more tips for health care IT governance.

ORLANDO, Fla. -- Here at HIMSS 2011, attendees are not just interested in the vendor bling of the exhibit hall. They want ways to implement effectively all the sexy new tech back at the ranch. In a session on best practices for IT governance, two multi-hospital informatics leaders offered their best ideas for successfully steering a health care provider's IT initiatives.

Not surprisingly, job one is getting physicians to participate in the IT governance committee. To accomplish that -- although the speakers acknowledged it might be a controversial idea in some circles -- the hospitals pay them. Not peanuts, either:  $105 to $125 an hour.

"Membership on this group wasn't enough of a reward -- so we had to have a remuneration model to pay them for their time," said Dr. Mrunal Shah, vice president of physician technology services for OhioHealth, a Columbus-based group of eight hospitals and physicians' offices. "In a lot of venues, that's a little controversial, but I thought I'd throw that out there…We have to respect the fact that physicians are willing to spend time either earlier than their clinical day, or at the end of their clinical day. They're taking time away from something -- their families, their personal time, whatever it might be -- and there should be some model to tell them we appreciate the fact they're taking a couple of hours to [meet with IT]."

The next priority for IT leaders is to add representatives to the committee from all the departments in a health care facility that use IT heavily  -- including pharmacy, nursing and patient registration at a minimum, said Shah and co-presenter Dr. Matthew Sprunger, medical director of clinical informatics for Dupont Hospital in Fort Wayne, Ind., a group of eight hospitals and an urgent care facility.

We have to respect the fact that physicians are willing to spend time either earlier than their clinical day, or at the end of their clinical day.

Dr. Mrunal Shah, vice president, physician technology services, OhioHealth

Beyond that, Shah and Sprunger offered the following recommendations for making IT work better through a governance committee's efforts:

  1. Set an overall mission for the committee -- probably starting with something along the lines of "oversee the design of software,"  "integrate the electronic medical records systems" and so forth -- and remind the members constantly of it. (Sprunger, for example, prints his committee's mission on the cover sheet of every meeting agenda.)
  2. Set objectives for the clinicians on the governance committee using a metaphor familiar to them: outcomes. Others' lists  might be different, but Shah's includes things like maintaining patient safety at all times throughout the organization's IT endeavors, seeking regulatory compliance, and always leading with best practices and evidence-based medicine.
  3. Set timing expectations. It might take the IT staff four months to implement and test an idea that the governance committee settles upon as a worthy goal. "For physicians, that's a really long time," Shah said. By then they will have forgotten they asked for it and perhaps not even notice it's been done. Be up-front about how long the development cycle takes when the committee signs on to tackle an idea, and give them notice when it goes live.
  4. Be clear that the committee is providing guidance, which the IT staff can -- but isn't necessarily compelled to -- act on.
  5. Let the governance committee tackle four or five goals at a time, no more. In a comment to after the session, Shah added that these goals can be large or small, as long as they include actionable items for the IT staff, not just vague, sweeping ideas like "improve workflow."
  6. Avoid projects that are simply digitizing paper processes. If the governance committee submits such a plan, send it back and have the members analyze which steps in the process can be removed, as well as what is the fastest way to do the process, regardless of how things are done now.
  7. Prioritize requests. Realistically, Shah said, while he might get 500 requests for IT fixes each month, many of them are so similar that they can be boiled down to 30 or 40 actual problems. See which problems seem to affect the most people, or which ones provide the most significant payback if solved. Then toss them to the governance committee.

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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