CPOE Adoptions Series - Part 5

Physician Governance in CPOE Projects

The last two articles here have focused on the numerous significant and important roles that CPOE projects call upon physicians to play. These include, inter alia, the Physician Champion, serving on a
Physician Advisory Committee (PAC), acting as a Subject Matter Expert (SME), becoming a physician trainer and participating in the various design, testing, validation, go‐live and support activities.
However, these and other roles represent only the building blocks in the CPOE physician edifice. How they fit together and interact with each other and other stakeholder roles, how they are organized
temporally, how the members deal with each other and the executive and project team members, essentially what is the blueprint for the assembly of these building blocks – that is the province of
project governance. Let’s explore this crucial topic a bit.

 Governance is the set of policies, roles, responsibilities and processes that are established to guide, direct and control how the organization or endeavor uses technology, people and resources accomplish the goal in question. A central component of governance is decision‐making. Project governance answers two vital questions associated with any project – in this case your CPOE project:

1. Who is accountable for the required work results?
2. Who is responsible for performing work processes that will yield those results?

Governance makes it very clear, in advance of the work, who is accountable to ensure that work follows the methodology, standards and processes. As such, it is one of the three essential legs on which all projects stand: the methodology and its components delineate what will be done (workflow analysis, content build, policy and procedure development, etc.); the career path and job definitions describe who will do it (nurses, doctors, pharmacists, IT, executives, etc.) The governance plan specifies who will do what:

– Who reports to whom
– Who sits on what committee
– Who has what task and deliverable
– Who has what responsibility and authority
– Who sets timelines and allocates resources

Clearly any flaw in methodology will yield poor results. Likewise, putting the wrong individuals in the
wrong positions (i.e. people to job description mismatch) does not bode well. Finally, poorly defining
task scope, reporting structure etc. will adversely affect even the finest people using the best
methodology. The importance of physician governance in CPOE now becomes apparent. Recall the impressive list of physician tasks we discussed in the last article, as well as the large and important stakeholder community for CPOE. How all this fits together, how reporting structures, responsibilities, resource allocation, lines of communication, decision‐making authority all function is absolutely crucial to the success of your project. While this may seem arcane and foreign to many doctors, in reality it is not. In fact we are intimately familiar with this – but in a different sphere of endeavor. For in reality, this is how we organize ourselves when taking care of a complex patient.

<<<Click here to read more on Dr. Morgenstern's thoughts on the adoption of CPOE>>>


Click here if you missed one of the previous installments of Dr. Morgenstern's CPOE Adoption Strategies.