The EHR Secret Sauce: Governance
Those of you reading this may ask, “What do electronic health records (EHRs) have to do with governance?” I say “Everything!” Now let me tell you why.
- Governance is the way decisions are made and the subsequent actions structured, sustained and held accountable. In the dental education and research community governance is important because it creates confidence in the EHR, and it improves the trust that the community has in its decision-making process.
The Collaboration for Health IT has a simple governance model. It is an Advisory Board that consists of representatives from the three founding schools (universities of Michigan, North Carolina and Pittsburgh), up to six Early Adopter schools, ICE Health Systems and Internet2. The Advisory Board meets weekly via web conferencing and face-to-face twice each year. The Advisory Board organizes and charges Working Groups to set specifications for new ICE functions, give feedback to developed functions, and in other ways guide the development process. The Advisory Board hosts a face-to-face meeting of the entire Collaboration as well as other interested schools once each year. At the annual Collaboration works together to brainstorm innovative improvements to the ICE Health System and then prioritize those ideas.
As of the writing of this blog the tables below lists the Working Groups that have either completed their charges, are currently in progress, or are emerging as needed. Currently, Working Groups for Oral Pathology, Referrals and e-prescriptions are being organized, and discussions about training, implementation, patient portal, grading, treatment codes and future technologies are under discussion.
Status of Working Groups (April 2017)
|Diagnosis Code Standards||Treatment Planning||Oral Pathology|
|Security: Phrase 1 (CCM*)||Billing||Referrals|
|Legal: Enterprise Customer Agreement & Business Associates Agreement||Security: Phrase 2 (SOC2)||e-Prescription|
|Single Sign-On||Data Migration: U-M||Patient Portal|
|Perio Chart||Caries Charting||Implementation: U-M|
|Hard Tissue Chart||Patient Management||Grading|
|Data Migration Standards||Implementation Framework||Treatment Codes|
Why should the Collaboration invest so much energy and effort into such an extraordinary and unusual system of governance for an EHR service? The norm is to purchase an existing EHR and then use the product that is delivered. The Collaboration for Health IT has chosen this new route because of its belief that collaborative governance will create the EHR that meets the needs of dental education and research and has the following benefits.
Promotes Confidence in the ICE EHR: We feel that dental educators and researchers have confidence in the EHR service if, through the Advisory Board, and Collaboration meetings that they are continually “at the table” for decision making and have a input into those decisions in a transparent and accountable way. Through the Working Groups, the dental education and research community is creating the EHR that meets their needs.
Encourages Confidence in the Advisory Board Members: The Advisory Board, knowing that they will need to report to the Collaboration at least annually, acts in the Collaboration’s overall interest, regardless of differing opinions. The Advisory Board feels comfortable in having frank and fearless discussions knowing that they are respected by the other Advisory Board members. The views of each Advisory Board member are sought, considered and respected, even if everyone doesn’t agree with them. This makes the Advisory Board is a safe place for debate and decision making.
Leads to Better Decisions: The Collaboration for Health IT has as a core value that decisions are best guided by good information, member views, and open and honest debate that reflects the interests of the Collaboration. The Collaboration feels that the most difficult and controversial decisions are more likely to stick if the discussion has been open and transparent.