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Governance

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Governance


Executive leadership

Must be fully engaged in the CPOE project and provide guidance to the project management team.  This can be accomplished by an executive level steering committee. 

Note: In a smaller organization, an existing IT governance committee could be repurposed if CPOE will be the primary IT initiative.

 

Recommended membership

  1. CEO (Ideal, not essential)
  2. CMO / CMIO
  3. CNO
  4. Physician Champion (Ideally, a physician who will use the system to care for patients.)
  5. Pharmacy Director
  6. Inpatient Nursing Director
  7. CIO
  8. Others to consider – Executive(s) over key ancillary departments, Executive over quality if not one of the above

 

Key responsibilities

  1. Define the vision, guiding principles, scope, project objectives and success criteria
  2. Ensure that work is done right and the key success factors are achieved
  3. Ensure that decisions are in the best interest of the whole organization, not a particular department
  4. Ensure that organizational change is well-planned and managed proactively
  5. Ensure financial and human resources are adequate
  6. Remove barriers / resolve issues 

 

Physician Champion

 

Recommended membership

The physician leading the CPOE initiative needs to be someone who understands how decisions about the CPOE project (such as application configuration decisions)  will affect physicians.  It needs to be someone whom the medical staff can trust to represent their interests.  Because of this there are advantages if the physician champion is a practicing physician who will use the CPOE system. This role could be filled by the Chief Medical Officer - especially in a smaller organization, or by a Chief Medical Information Officer in a larger organization. Or it can be filled by another physician who is able to commit a minimum of 0.5 FTE to lead the CPOE project.    

 

Key responsibilities

  1. Represents the medical staff as owners of the CPOE / EMR system
  2. Makes the clinical nature clear and unambiguous
  3. Underlines the importance of the project in the provision of care to patients
  4. Ensures that physician requirements and needs to deliver care will be addressed
  5. Oversee all clinical aspects of the project.
  6. Chair the Physician Advisory Committee (PAC) and participate in other key committee meetings.
  7. Participate and ensure physician participation in CPOE / EMR application design decisions.
  8. Provide education to physician groups on
    1. CPOE in general
    2. Use of clinical decision support tools
    3. How physicians in other organizations are using technology to enhance practice
  9. Oversee physician adoption strategy: Collaborate with the executive and physician leadership to define principles that identify the extent to which physician use of EMR/CPOE is required
  10. Make medical staff policy, bylaws and/or rules and regulations recommendations to Clinical Executive Leadership
  11. Participate in setting agenda for clinical decision support (Order sets, rules, alerts)
  12. Reinforce communication between clinicians and administration
  13. Coordinate with clinical and quality improvement committees
  14. Monitor physician training
  15. Participate in system tests
  16. Spearhead education initiatives
  17. Identify and address areas of resistance
  18. Monitor physician utilization statistics
  19. Suggest, collect, review and prioritize system change requests
  20. Review system enhancements
  21. Review and advocate for adequate support plans
  22. Coach site (unit/service/department) champions and physician leaders
  23. Act as change agent

Note that many of these responsibilities continue after the CPOE system is in operation.

 

 

Physician Advisory Committee

Owns the CPOE project on behalf of the medical staff

Composition is reflective and representative of the medical staff - balance of specialties, practice types and patterns, computer literacy, etc

Chaired by the physician champion

Serves as final arbiter of all clinical conflicts related to project that cannot be resolved by other mechanisms

Has direct communication with the high level IT and operational committees

 

Recommended Membership:

Physicians who will provide leadership and significant input to the CPOE initiative.  This group needs to represent a cross section of medical departments.  It should include some who are enthusiasts for the application of technology to medicine, but it should include some who are not technology enthusiasts.  It should include some with previous CPOE experience. 

 

Key Responsibilities:

  1. Represent all physician interests in the CPOE project
  2. Make medical staff policy recommendations and decisions
  3. Communicate to the medical staff
  4. Oversee the development, validation, approval and maintenance of CPOE clinical content (order sets, rules and alerts, documentation tools, flow sheets, problem lists, etc.)
  5. Oversee, decide and implement project clinical policy issues
  6. Map or sign-off on physician workflow analysis
  7. Review and sign-off on future state
  8. Serve as liaison with other project work groups
  9. Delegate and coordinate tasks to physician subgroups
  10. Direct physician engagement and adoption of change
  11. Support physician champion

 

Supporting Committees

 

Recommended committees:

Medical Executive Committee, Quality Council, Clinical Quality Teams, Pharmacy and Therapeutics Committee, Medication Safety Committee, Patient Safety Committee, Nursing Informatics Committee, and the Medical Records Committee.  This list is representative.  You may have other committees that should be involved.

 

Key Responsibilities:

A number of existing hospital committees have responsibilities that are related to or will be affected by the CPOE system.  These committees need to be engaged in the CPOE project and in ongoing use of the system.  Responsibilities will vary by committee.  The following are some high-level suggestions.

  1. Medical Executive Committee: Review and ratify policy recommendations from the physician champion, CMO and PAC.  Provide direction to these and to the Medical Work Groups.
  2. Quality Council: Recommend metrics for the success of the CPOE project.  Consider the capabilities of the CPOE system to measure and improve quality, patient safety and outcomes.  Include the capabilities of the CPOE system in developing the annual performance improvement plan.  Look for and report on evidence of the success of the CPOE system in improving quality, patient safety and outcomes. 
  3. Clinical Improvement Teams: Provide input to clinical content to ensure hospital standards of care can be optimally supported by the system.  Give input on order sets content, rules and alerts.
  4. Pharmacy and Therapeutics Team: Review order sets for appropriate meds.  Give input regarding rules and alerts.
  5. Medication Safety Committee: Review order sets for appropriate meds.  Give input regarding rules and alerts.  Consider reviewing workflow and CPOE design with respect to failure modes.  Look for and report on evidence of the success of the CPOE system in improving medication safety and outcomes.  Monitor adverse drug events for aspects of the CPOE system as a root cause and direct actions to correct CPOE configuration and use as a root cause of error.
  6. Patient Safety Committee: Consider the use of CPOE order sets, rules and alerts as tools to achieve the goals of the committee.  Look for and report on evidence of the success of the CPOE system in improving quality, patient safety and outcomes.  Monitor incident reports for aspects of the CPOE system as a root cause and direct actions to correct CPOE configuration and use as a root cause of error.
  7. Nursing Informatics Committee: This group or persons appointed by it need to be very involved in all aspects of the CPOE project including workflow analysis, testing, training, development of order sets, rules and alerts.
  8. Medical Records Committee: Consider how CPOE changes the electronic medical record.  In addition they need to
    • Assure a sound medicolegal EHR/CPOE for the purposes of documenting and communicating patient care and maintenance of a sound business record that adequately represents the care that was provided to an individual.
    • Assure that the format and content of orders and order sets conforms to standards that will preserve the integrity of the medical record.
    • Assure that orders and order sets are structured in such a way that they promote appropriate payment for services rendered. 
  9.  

 

 

References


Morganstern Dan, Physician Roles in CPOE: Directing/Serving on PAC, www.masstech.org (From the CPOE University, a part of the ehealth initiative of the Massachusetts Technology Collaborative)

Morganstern Dan, Physician Roles in CPOE: Champion and Sponsor, www.masstech.org (From the CPOE University, a part of the ehealth initiative of the Massachusetts Technology Collaborative)

Adams Mitchell, et. al., CPOE Lessons Learned in Community Hospitals, pp 25-26, prepared by the First Consulting Group for the Massachusetts Technology Collaborative and the New England Healthcare Institute

 

 

Contributors:

Jeff Bell

Cecilia A. Backman