KLAS Arch Collaborative Success Pathway—EHR Shared Ownership & Governance

Establish a Clinician-Led, IT-Supported EHR Shared Ownership & Governance Foundation to Drive Trust, Efficiency & EHR Success

Assess the current state: Review self-examination questions. Assess your clinicians’ awareness and feelings about your EHR shared ownership and governance structure using the KLAS Arch Collaborative EHR Experience Survey.

Establish a clinician-led, IT-supported EHR shared ownership and governance structure with foundation councils, committees, and work groups that include multidisciplinary members (e.g., physicians, nurses, APPs, clinical operations leaders, informaticists, educators, IT analysts, revenue/regulatory partners).

Ensure that your EHR shared ownership and governance charter and decision-making model align with organizational strategic goals, EHR guiding principles, clinical needs, and regulatory requirements.

To avoid an EHR silo, determine how EHR decision-making ties to overall organization decisions and established processes for evaluating requests and reporting decisions.

Create a governance model that follows a structured change management framework (e.g., Advancing Research and Clinical Practice Through Close Collaboration model, Johns-Hopkins Evidence-Based Practice model, Star model).

Incorporate the Arch Collaborative’s four governance pillars into your foundation: decision-making, accountability, training/education oversight, and continuous improvement. For additional information, see the Arch Collaborative Learning Summit 2023 overview.

Clearly define the responsibilities of your governance councils, committees, and work groups and define the scope of decision-making authority for each group. These responsibilities should include supporting patient care, optimizing EHR system usability and clinician efficiency, implementing necessary changes and upgrades (see the Success Pathway for EHR Changes & Upgrades), gathering user feedback, monitoring system performance, and reporting outcomes to senior leadership and frontline clinicians.

Determine the number and types of committees and work groups to include in your governance structure (e.g., physician, nurse, revenue cycle), including from a variety of clinical specialty and focus areas, ensuring balanced representation across locations and roles. View examples of EHR shared ownership and governance structures in the following Arch Collaborative case studies with Dubai Health, Johns Hopkins Aramco Healthcare, and St. Jude Children’s Research Hospital.

Establish consistent standards and processes for governance councils, committees, and work groups.

Institute a defined reporting structure for each governance group, including clear principles that outline who has decision-making authority and who holds final approval at every level.

Ensure there is representative overlap in governance group membership and participation to foster collaboration and coordination (e.g., a member of the nursing advisory council should also participate in the EHR shared ownership and governance steering committee, a physician member of a work group should also participate in the physician advisory council).

To prioritize enhancements and change requests, create transparent decision-making scoring criteria (e.g., patient safety, cost, time to create/implement the change, regulatory impact, clinician efficiency, reach). Create a tool and/or process to track requests and monitor progress and decisions.

Determine the frequency and length of committee and work group meetings (e.g., every third Wednesday at 8:00 a.m. for 90 minutes, once a month for 60 minutes).

Provide a structured agenda template for meetings that includes celebrations, follow-up items, new business, and communication plans. Confirm that each action item is assigned to an individual with a follow-up reporting date.

Select and monitor KPIs to ensure EHR governance groups are effectively serving their purpose.

Select governance council and committee members intentionally using criteria such as clinical credibility, communication skills, service-line representation, and willingness to collaborate.

Include frontline workflow experts and stakeholders who can assess the organization-wide impact of EHR changes and optimizations.

Create a career development/laddering framework for participants. (See an example of EHR shared ownership and governance career laddering in the Arch Collaborative case study written in partnership with Children’s Hospital of Philadelphia.)

Establish a clear role for each participant (e.g., voting member, advisor, subject matter expert) to ensure efficient EHR use across users and proper management of EHR workflows.

Clarify term lengths and rotation schedules to maintain strong engagement across a wide user base. Monitor participation and replace inactive members.

Provide protected time for participants to engage in your EHR shared ownership and governance process.

Build a Standardized Pathway with Closed-Loop Feedback for Clinicians to Submit & Track Optimization Requests

Establish a single pathway to formally enter the governance process and educate users on the governance submission process.

Ensure the process supports requesters in creating a well-developed proposal.

Create a standardized submission form that incorporates the Phase 1 scoring criteria, outlines the requested change and its rationale, captures expected downstream impacts and/or efficiency gains, and ties to the organization’s strategic goals.

Provide an opportunity for requesters to present their idea(s) to the appropriate governance group. Identify a change sponsor to help shepherd the requester through the governance process.

Publish a simplified flow diagram for requests that can also be leveraged to show each submission’s status.

Institute response-time expectations and close-the-loop standards for all submissions (i.e., each submission receives a follow-up with next steps in 30 days). Ensure each submission is easily trackable by committee members and requesters.

Include information about whether the request is approved and will move forward and why. As applicable, set expectations around the implementation timeline.

For requests that are not approved, close the loop with the requester by explaining the rationale.

Create a Robust EHR Shared Ownership & Governance Communication Plan

Develop a robust communication plan for EHR governance decisions and changes. Identify communication owners (e.g., CMIO/CMO will communicate physician-focused messages, CNIO/CNO will communicate nursing-focused messages, service line leaders will communicate role-specific changes).

Set a consistent day and time for routine communications (e.g., every Thursday morning, every other Tuesday at noon), especially for topics like upgrades.

Create a standard communication format that translates EHR shared ownership and governance decisions into clear “what, why, and when” messages for clinicians.

Highlight clinician-proposed changes and enhancements. Include a standard “you asked, we acted” section in all EHR shared ownership and governance-related communications.

Leverage multiple communication channels (e.g., emails, townhall meetings, superuser cascades, rounding, team meetings, posters, intranet sites, EHR pop-ups) to reach diverse audiences.

Use a variety of communication formats, incorporating videos and written formats.

Tailor messages by specialty, role, and workflow impact.

Establish In-Person Support & Rounding to Continually Capture Clinician Feedback & Strengthen Relationships

Build relationships between EHR shared ownership and governance committee members and frontline clinicians through a regular rounding cadence.

Prepare team members to share tips, workflow refinements, and upcoming changes as well as to listen for pain points to gather new submissions. Equip team members with the knowledge to close the loop on concerns and questions.

Require governance leaders to regularly round in clinical settings and listen to concerns.

Display committee rosters, term lengths, and meeting schedules in an easily accessible place (i.e., your intranet) so that clinicians know who represents them in EHR shared ownership and governance decisions.

Credit clinicians when their changes or optimizations are implemented to illustrate your clinician-led EHR shared ownership and governance framework. Include relevant details (e.g., the requester’s name, role, and specialty) on tip sheets and related education materials.

Incorporate clinician quotes, survey themes, and EHR usage data into EHR shared ownership and governance agenda packets.