2 Clinical IT Leadership

Section 2.1 Plan

Section 2 Plan—IT Leadership - 1

IT Leadership

Use this tool to determine roles and specific activities for clinicians and others as you plan the implementation of your local public health (LPH) department’s HIT projects.

Time needed: 2 hours
Suggested other tools: NA

Introduction

Successful electronic health record (EHR), health information exchange (HIE), and other health information technology (HIT) projects require leadership from the clinicians who will use them. Administrative and financial staff members also play key roles.

How to Use

Review the information about roles of clinicians and other staff members and apply it in ways that best fit your department’s structure and specific HIT projects and needs.

Nurse Roles in HIT

Nurses are the primary users of EHR and HIE in LPH departments. EHRs provide many benefits to nurses, including:

· Streamlining and reducing documentation errors by eliminating repetitive transcription of lab and other diagnostic study results, medications, and other information.

· Improving outcomes through use of standard terminology and adherence to guidelines and protocols.

· Minimizing inefficiencies in workflow due to paper processing.

· Reduce risk of medical and other errors that result from having to remember many details required to coordinate care and services for clients.

· Improve data analysis for continuous quality improvement initiatives.

For these reasons, nurses should be at the forefront in evaluating EHRs, HIE services, and other HIT that they will use. They should be asked to play a leading role in workflow and process improvement, implementation, training, and system maintenance. Specific roles that are a good fit for nurses include workflow analysts, super users (individuals who have experience and/or aptitude with technology and have learned how to use it), trainers, and nurse informaticists (individuals who analyze and translate data into information to achieve quality, efficient and safe clinical outcomes).

· A workflow analyst supports all users by describing current workflows, identifying opportunities for improvement (with or without automation), redesigning workflows, and supporting users as improvements are adopted.

· A super user continues to perform existing duties but is provided release time during the implementation and adoption phases of EHR to assist in system design, testing, workflow and process improvement, and support during go-live.

· Trainers will learn the system—including tips on optimal workflows and processes—conduct initial training with users, provide continual support, reinforce positive habits, overcome negative workarounds, and train new staff.

· Nurse informaticists may serve as EHR project managers, clinical domain experts, or both. Clinical domain experts keep up to date on care guidelines and protocols, help manage the integrity of data entered into the EHR, help customize screen designs, help create documentation templates; and ensure that data meets reporting requirements. The nurse informaticist assists in quality improvement benchmarking and works with a multi-disciplinary team to ensure timely and accurate data entry.

LPH departments usually are not able to hire a trained nurse informaticist or health informaticist solely to support HIT. However, an informaticist can support several LPH departments as a consultant. The person who fills this role needs release time to perform informatics duties, especially during the implementation and adoption phases and when major system upgrades take place, such as those related to changes in regulatory requirements and when new HIT modules are added.

Other Clinician Roles in HIT

You may find that laboratory staff members, pharmacists, medical social workers, behavioral health specialists, or physicians are interested in becoming more directly involved in HIT—especially EHR. These professionals often play the role of champions and/or steering committee members.

Other Roles in HIT

Administrative/financial staff members also play key roles in elements of HIT strategic planning, selection, implementation, and use. Receptionists, who are often a client’s first point of contact with the LPH department, can take on consumer advocate or client ombudsman roles as they engage clients in using patient portals and signing up for secure email. While a client waits for an appointment, the receptionist may have them complete health forms or questionnaires on mobile or stationary kiosks. They may instruct clients calling for appointments or to report information how to access the LPH department electronically. Receptionists may provide similar help to health care providers and community service agencies

Health information management (HIM) professionals may play similar roles, as well as support clients in obtaining authorizations and consents for release of information, explaining opt-in and opt-out arrangements for HIE, and assist in other aspects of HIE. HIM professionals are also knowledgeable about electronic document management, terminologies and coding, and data stewardship and analytics.

Involving representatives from different end user groups in HIT planning can accomplish the following:

· Educate them about what is broadly possible with the HIT, and how

· EHR and HIE can help in their individual work.

· Gather end users’ specific requirements for the HIT.

· Ensure that proper attention is given to workflow and process improvement.

· Begin the change management process, building desire for HIT.

· Set expectations for success.

Additional Resources

A number of professional associations and other organizations provide excellent resources on the topic of clinical leadership in HIT planning. They include bodies of knowledge, distance learning programs, Web seminars, blogs, and newsletters. The following organizations provide a start for your exploration.

National Organizations / Minnesota Chapters
Public Health Informatics Institute (www.phii.org)
National Association of County & City Health Officials (www.naccho.org)
Centers for Disease Control and Prevention (www.cdc.gov) / Minnesota http://www.health.state.mn.us/e-health/mnphin/
Minnesota Public Health Association (www.mpha.net)
The Minnesota Omaha System Users Group (http://omahasystemmn.org/index.php)
American Health Information Management Association
www.ahima.org / Minnesota Information Management Association
http://www.mnhima.org/
American Medical Informatics Association
www.amia.org
American Nursing Informatics Association
https://www.ania.org/ / Minnesota Nursing Informatics Group
http://www.miningonline.org/
Healthcare Information Management and Systems Society (HIMSS)
www.himss.org / HIMSS Minnesota chapter
http://www.himss-mn.org/

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