Clinical Executives' Crucial Role in Health IT Implementation

When St. Joseph, Mich.-based Lakeland HealthCare began its electronic health record implementation in March 2011, President and CEO Loren Hamel, MD, ensured full involvement and ownership of the project from non-technical leaders.


All of the health system's leadership was involved in deciding the process and ultimate goals for the EHR implementation. As the process moved forward, Dr. Hamel realized the important role Chief Nursing Executive Elleen Willits was playing and would continue to play in making the transition smooth and efficient for the system's nurses. During the most critical months of the implementation process, Dr. Hamel asked Ms. Willits to dedicate herself full-time to the EHR. "We backfilled her position with an in-house temp so she could be 100-percent devoted to coordinating the interactions between the clinicians and the folks tasked with building the EHR," he says.

This leadership approach has paid off — Lakeland recently achieved their goal of reaching HIMSS Analytics Stage 7, placing the system in the top 2.2 percent of all hospitals and health systems nationwide in terms of EHR implementation and utilization.

Quickly achieving Stage 7 was so important to Lakeland because "before that level, we’re not fully realizing the benefits of a tool that ultimately can make our care safer and can help us save more lives," says Dr. Hamel. "That's why it was so important to me, to our vice president of IT and CIO, Norma Tirado, and to our entire EHR team. That's why the full engagement of clinical leadership was mission critical.”

Lakeland's reliance on clinical leadership and subsequent success would not surprise Kevin Larsen, MD, medical director of meaningful use at the Office of the National Coordinator for Health IT, a strong proponent of engaging CMOs, CNOs and other medical executives in major IT projects.

To the IT department, a major implementation like an EHR is a large undertaking and requires significant leadership to ensure the system is functioning correctly and is the best choice for the organization, but it does not affect the IT department's workflow structure or processes, says Dr. Larsen. The same cannot be said for the clinical side of the hospital.

"IT is a catalyst, it is a set of tools," says Dr. Larsen. "But they're tools to do something, and that something is not IT but often the clinical work of the hospital." Therefore the clinical staff, and the respective leadership, should be deeply involved in the implementation process. The leaders whose departments are most affected by the day-to-day changes know what the new technology needs to be able to do, and will be able to make strategic decisions that will allow the technology to best fulfill the hospital's needs. "The IT department is not able to do that," he says.

At Sarasota (Fla.) Memorial Health Care System, Director of Nursing Resources Janet Steves, RN, has been a central figure in the development and deployment of several IT projects. In 2009, the hospital entered into a collaboration with Voalte to developa smartphone application that allows nurses and other clinicians to send and receive secure text messages, make voice calls and receive patient care alarms on hospital-issued smartphones. The app was developed and tested in collaboration with the system's nurses, and the project was jointly overseen by Ms. Steves and Sarasota Memorial CIO Denis Baker. Since the successful launch and deployment of the smartphones, Ms. Steves has been an integral part of two more IT projects at the hospital.

She credits Mr. Baker for making a point to include her and other clinical leaders in IT projects. "He doesn’t think IT knows it all," she says, explaining Mr. Baker often runs projects by her and recruits her and a group of interested nurses to pilot new ideas or products. "He has always known the clinical staff needs to be the key people involved."

The working relationship Ms. Steves enjoys with IT leadership may be in part due to EHR implementation more than 15 years ago. “IT learned early on how much smoother it can be when involving the end user. We have a long track record showing the greater the clinical involvement, the better the end result” during technology development and implementation, she says. “It’s why we have the relationship we have now. We have an entire team of clinical systems specialists who either work as — or consult with — bedside nurses daily.”

Many leadership teams have seen large IT projects at other hospitals deteriorate due to a lack of leadership from all executives, and today, more non-CIO executives are stepping up, or being recruited, into leadership roles on IT projects than 10 years ago, says Dr. Larsen. The result of non-CIOs taking on these tech-related leadership roles is an executive team, and by extension a hospital or health system, that is all on the same page and working toward the same goal.

Dr. Larsen has seen this firsthand. Prior to assuming his current position with ONC, he served as CMIO and associate medical director at Hennepin County Medical Center in Minneapolis. All the executive leadership worked together on the hospital's 2007 EHR implementation, he says, creating a clear and consistent message throughout every department that the EHR should be everyone's top priority. "Not having that unified message would not have ensured success," he says.

While some executive teams across the country have come together like this, Dr. Larsen still sees room for improvement. When faced with a small IT project, he has seen some hospitals rely on a tech-savvy leader who can implement the smaller project without issue but who doesn't have the background to be able to make the necessary organization-wide decisions when the project is scaled out.

"I really hope that’s not the case at many hospitals," he says. The leaders involved in technology implementations should be the ones able to "manage the risks and opportunities that come with bringing these 21st century tools into a hospital."

More Articles on Health IT Implementations:

Why an MU2 Extension Isn't Enough
WEDI: 10 Health IT Recommendations
Dedicated Observation Units Could Streamline Capacity, Improve Care 

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