EHR Governance: A Practical Guide to User Centric, Consensus Driven Optimization

248 Pages·2023·26.549 MB·English

by  Paula Scariati

EHR Governance
Organizations spend large amounts of money to purchase, deploy, and opti-
mize their Electronic Health Records (EHRs). They are not plug-n-play sys-
tems so a commitment to an ongoing improvement cycle is necessary. When
done well, this responds to the people, the process, and the technology.
When not done well, complete failure of the system could result in costing
the organization thousands of dollars.
Based on the foundational premise that EHR governance done right
speeds up change and leads to a positive user experience, this book draws
upon more than a decade of work with government, academic, and non-
profit organizations using Epic, Allscripts, McKesson, Meditech, and Cerner.
Designed to be practical and pragmatic, it outlines a strategic process that
can scale to small and large organizations alike. It begins with how to artic-
ulate a clear vision to organizational leaders so they can champion strong
EHR governance both theoretically and financially. It then walks through
each step required for leading successful change, calling out critical lessons
learned to help the reader avoid pitfalls and achieve measurable improve-
ment more rapidly. It concludes with a commitment to ongoing growth and
refinement through benchmarked metrics, innovation, and out-of-the-box
thinking.

EHR Governance
A Practical Guide to User Centric,
Consensus Driven Optimization
Paula Scariati
Routledge/a Productivity Press Book
First published 2023
by Routledge
605 Third Avenue, New York, NY 10158
and by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2023 Paula Scariati
The right of Paula Scariati to be identified as author of this work has been asserted by her in accordance with sections
77 and 78 of the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic,
mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any infor-
mation storage or retrieval system, without permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for
identification and explanation without intent to infringe.
ISBN: 978-0-367-44225-5 (hbk)
ISBN: 978-0-367-40392-8 (pbk)
ISBN: 978-1-003-00840-8 (ebk)
DOI: 10.4324/9781003008408
Typeset in Garamond
by Deanta Global Publishing Services, Chennai, India
In Service, With Love

Contents
Preface ........................................................................................................xi
Acknowledgements .................................................................................xiii
About the Author .....................................................................................xv
SeCtion 1 ConteXt
1 Why Governance ..........................................................................3
EHRs Are Not Plug-n-Play Systems ............................................................3
Make It Easy to Do the Right Thing ..........................................................8
Burnout and Moral Injury .........................................................................12
Chapter Summary .....................................................................................16
Chapter Exercises ......................................................................................17
2 When Governance ......................................................................19
Earlier Is Better .........................................................................................19
Setting Expectations and Priorities ...........................................................21
Voice of the Customer ..............................................................................27
Chapter Summary ....................................................................................31
Chapter Exercises.....................................................................................32
3 How Governance ........................................................................33
Governance Dependencies .......................................................................33
Software Needs for EHR Governance ......................................................41
A Roadmap for Leading Change ...............................................................43
Chapter Summary .....................................................................................48
Chapter Exercises ......................................................................................49
vii
viii ◾ Contents
SeCtion 2 CHAnGe
4 Create Urgency ...........................................................................53
The Eisenhower Box.................................................................................53
Solution Jumping .......................................................................................56
The Case for a Good Business Case ........................................................58
Chapter Summary .....................................................................................64
Chapter Exercises ......................................................................................65
5 Form a Powerful Coalition .........................................................67
It’s a Team Sport .......................................................................................67
We’re in This Together ..............................................................................71
Try To See It My Way ...............................................................................75
Chapter Summary .....................................................................................78
Chapter Exercises ......................................................................................79
6 Create a Vision and a Strategy ...................................................81
Core Values ...............................................................................................81
Governance Framework ...........................................................................84
Decision-Making Bodies ...........................................................................90
Design Standards ......................................................................................94
Chapter Summary ...................................................................................101
Chapter Exercises ....................................................................................102
7 Communicate the Vision ..........................................................103
Assumptions Are the Termites of Communication ................................103
Communication Skills and Traditions.....................................................105
Who Told You That? ...............................................................................109
Chapter Summary ...................................................................................113
Chapter Exercises ....................................................................................114
8 Remove Obstacles ....................................................................115
The Allure of Inertia ...............................................................................115
Change is the Only Constant in Life ......................................................117
Resistance is Futile ..................................................................................120
Confusion over Decision Rights .............................................................123
Chapter Summary ...................................................................................125
Chapter Exercises ....................................................................................126
9 Generate Short-Term Wins .......................................................127
One Size Doesn’t Fit All ..........................................................................127
The Pain of Documentation ...................................................................130
Tell a Story with the Data .......................................................................133
Contents ◾ ix
Chapter Summary ...................................................................................137
Chapter Exercises ....................................................................................138
10 Consolidate Gains and Produce More Wins .............................139
Automate .................................................................................................139
Scale.........................................................................................................140
Virtual Governance .................................................................................146
Chapter Summary ...................................................................................151
Chapter Exercises ....................................................................................152
11 Anchor New Approaches in the Culture ..................................153
Culture Eats Strategy for Breakfast .........................................................153
Culture Styles ..........................................................................................156
The Way We Do Things around Here ...................................................159
Chapter Summary ...................................................................................164
Chapter Exercises ....................................................................................165
SeCtion 3 CoMMitMent
12 User Experience .......................................................................169
People, Process, and Technology ...........................................................169
The KLAS Arch Collaborative .................................................................172
Onboarding New Physicians ..................................................................178
Chapter Summary ...................................................................................182
Chapter Exercises ....................................................................................183
13 Accelerating Change through Innovation ................................185
Intrapreneurship and Entrepreneurship .................................................185
Design Thinking .....................................................................................188
Never Waste a Good Crisis .....................................................................192
Chapter Summary ...................................................................................195
Chapter Exercises ....................................................................................196
14 It’s a Journey Not a Destination ..............................................197
Order Set Management ...........................................................................197
Legal and Ethical Considerations ...........................................................203
Land and Expand ....................................................................................206
Chapter Summary ...................................................................................214
Chapter Exercises ....................................................................................215
Epilogue .........................................................................................217
Notes ...............................................................................................219
Index ..............................................................................................225