Getting Organized: Actions

As you organize your health information exchange (HIE) effort, there are a number of strategies and actions you can take, including: exploring opportunities and barriers, creating a mission and vision, developing a communication plan, and identifying stakeholders. Specific strategies and actions are outlined below.

Step 1: Explore Opportunities and Barriers

As you begin to think about starting an HIE initiative, you may want to obtain a better understanding of existing state health and IT initiatives and begin to explore opportunities and barriers within the state, region and community. There are two ways that you can heighten your awareness and begin to understand initial challenges: (1) interview key stakeholders; and (2) research state law and legal issues that may influence the use of health care information technology.

a) Interview Process

The purpose of this interview is to get better understanding of how a targeted group of healthcare and business leaders view HIT adoption as a priority in the state. Specifically, the interviews will reveal:

How health care leaders view recent federal developments in the context of your state's health care system;
Potential barriers to HIE;
Any HIE initiatives already underway in your state; and
What can or should be done to develop a state HIT policy agenda.

The interviews should include hospital executives and other leading health providers, business leaders, key elected and appointed officials, and consumer advocates. The purpose of the interviews is to gauge the local understanding of the issues, gather information about existing state initiatives, and begin to explore opportunities and barriers within the state. The feedback gathered in the interviews also will be helpful in planning the structure and content of your initial meeting agenda, tailoring accompanying materials to meet local needs, and ensuring a comprehensive list of invited participants. Click here for an interview template by type of stakeholder.

b) State Law and Legal Issues That Influence the Effective use of Health Care Information Technology.

State law can be a help or a hindrance to local health information technology initiatives. Laws passed with consumer privacy or other worthy goals in mind can serve as roadblocks to technology that would provide consumers with better and more cost effective care. Engaging local health policy and legal resources to help state stakeholders understand the legal landscape as they design and implement local initiatives will equip them to become actively engaged in ensuring that state laws do not unnecessarily impede, but instead facilitate health information technology implementation. Click here for a template of topics that have been researched by state health policy / legal resources.

You may also want to pull together all this information, including national and other state HIE initiatives and an inventory of your state's or region's HIT or HIE initiatives discovered during the interview process into a briefing paper to inform your constituents about your state's HIE landscape, potential challenges, and HIT and HIE initiatives that can be leveraged. Click here for an example of a briefing paper and inventory that was conducted in Arizona.

Step 2: Create a Mission and Vision

A mission describes the initiative that is being undertaken. It is likely to cover the customer groups that are being served, as well as the customer needs that are being met. A vision is a compelling description or statement of what will be accomplished. It involves seeing the future for the initiative and vividly describing this future. Without an agreed upon mission and vision, the initiative will lack direction, and yield limited accomplishments for the community. You may want to use the interview process to begin crafting a mission and vision to discuss at your inaugural meeting and have a break out session to further refine these.

Not all health information exchange initiatives will have both a mission and vision, such as states where the Governor issued an Executive Order for a statewide exchange initiative. In this case, the mission may be part of the Executive Order and be aimed at the work to be accomplished by the appointed structure. A mission is usually two or three concise statements. Visions can be depicted in an abbreviated, compelling series of statements, or scenario. Click here for example of missions and visions from several health information exchange initiatives.

Step 3: Develop Communication Plan for Project

Project communication is essential and should be assigned to a dedicated resource. The purpose of a communication plan is to manage the communications for the project and ensure that information is conveyed in a timely, effective, and accurate manner across all constituencies. Effective communication is evidenced by decreased resistance to change, buy-in and commitment, and decreased fear and anxiety. The strategy for a Communication Plan ensures that the initiative:

Conveys accurate and useful information
Uses existing communication channels and creates new channels as needed
Presents information in a timely and effective manner
Provides practical feedback channels
Encourages communication to replace rumors
Fosters commitment to the project by creating informed stakeholders
Conveys information about impacts and changes to roles

A successful communication plan must have a clearly defined strategy. Time, commitment, and resources are required for effective communication. The components of a communication plan include:

Senders – The individual or group initiating the communication
Receivers – The internal and external audiences at whom the message targets
Key messages – The meaning and content of the information being communicated
Communication vehicle – The tools used to deliver the message
Frequency – When the communication will occur

Communication guidelines are as follows:

Identify what needs to be communicated during the various stages of the project
Communicate before, during and after all major parts of the project - you can't communicate too much
Segment the various constituencies or audiences and determine:

– What they need to hear (staff, physicians, volunteers and community)?
– What form they need to hear within (open forums, newsletters, etc)?

Educate all constituencies on what the project is and what it is not
Be honest about how the project is going to progress and possible outcomes – do not make unrealistic promises
Establish a regular schedule for communicating and stick to it
Recognize the efforts and achievements of all individuals involved in the project
Strive for consistency in what is communicated -- everyone is saying the same thing. Use scripts to get the same message communicated.
Do not forget to LISTEN to your various constituencies
Build an open, honest communicative culture within the project

Step 4: Identify Stakeholders

Identifying participants is critical to the initiative's success. The challenge is too have the right participants "at the table" but you must carefully manage the size of the initial, founding structure. You may prefer to limit stakeholders to the founding structure and develop an Advisory or Work Group role for additional participation. Therefore, the structure of your initiative becomes critical - some questions to help you plan for identifying stakeholders is included here. It is critical to define terminology as you begin to identify stakeholders – what is a member, stakeholder, or participant? One example of definitions can be found at the Volunteer eHealth Initiative, http://www.volunteer-ehealth.org/AHRQ/framework.htm. Below is a depicition of types of roles for HIE initiatives.