Monday, February 4, 2008

Electronic Records for Non-Owned Doctors - Governance

As promised last week, I will blog each week about the 10 critical aspects of our project to provide a hosted electronic health record solution for non-owned clinicians, one of the most challenging projects facing hospitals nationwide. This week's entry describes our project governance.

The needs of many stakeholders must be balanced to ensure the success of this project. The hospital wants to support as many clinicians as possible using its capital budgets most efficiently. Community clinicians want to minimize the financial and operational impact of the project on their practice. IT staff must manage their hospital-based projects and infrastructure while expanding their scope to new offsite locations.

Governance is critical to establish priorities, align stakeholders, and set expectations. To support this project we created two governance committees - a steering committee and an advisory committee.

The steering committee is comprised of senior executives from the hospital and physicians' organization, since it is truly a joint effort of Beth Israel Deaconess Medical Center (BIDMC) and the Beth Israel Deaconess Physicians' Organization (BIDPO). BIDMC representatives include the CFO, the CIO, the SVP of Network Development and the IT project manager. Physicians' organization members include the President, the Executive Director, and the Chief Medical Officer of BIDPO. This committee provides oversight of legal agreements, financial expenditures, project scope, timelines, and resources. It is co-chared by the CIO and Executive Director of BIDPO, who jointly sign off on all expenditures. The BIDMC and BIDPO boards provide additional oversight of the committee chairs.

The advisory committee is comprised of prospective community physician users of the electronic health record system. Since our community network is comprised of 300 non-owned Boston-based physicians, clinicians in the western suburbs and clinicians in the southern part of the state, we have representatives of each group sitting on the committee. The committee focuses on making the project really work for the practices, but also to meet the needs of the physician organization's clinically integrated network model. The role of the committee is to review our "model" office templates, help us prioritize the implementation order of practices, and make recommendations on policies. As with every project, we use our standard project management tools including a charter for each committee.

Since this project is so challenging and requires a precise blend of economics, information technology and politics, the governance committees are the place to ask permission, beg forgiveness, and communicate progress on every milestone. This is especially true to the complex cost model which shares expenditures equally between the hospital and physician's organization for implementation, subsidizing private clinician costs to the extent we are able based on Stark safe harbors. As you'll see in next week's EHR blog entry, the costs are diverse and deciding who pays/how much they pay cannot be done alone by IT, the hospital, or the physicians. It's truly a role for transparent, multi-disciplinary governance committees.

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