Nursing domain of CI governance: recommendations for health IT adoption and optimization

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This article shows the importance of organizational leaders and how they can make implementation and adoption better. [1]


There is a lack of recommended models for clinical informatics clinical informatics (CI) governance that can facilitate successful health information technology implementation. The objective is to understand existing CI governance structures and provide a model with recommended roles, partnerships, and councils based on perspectives of nursing informatics leaders. For this study, clinical informatics is referenced directly to Detmer and Shortlife (2014) definition as "body of knowledge, methods, and theories that focus on effective use of information and knowledge to improve the quality, safety, and cost-effectiveness of patient care as well as the health of both individuals and populations" [2]


They conducted a cross-sectional study through administering a survey via telephone to facilitate semistructured interviews from June 2012 through November 2012. They interviewed 12 nursing informatics leaders, across the United States, currently serving in executive- or director-level CI roles at integrated health care systems that have pioneered electronic health records implementation projects.


They found the following 4 themes emerge:

(1) Interprofessional partnerships are essential.
(2) Critical role-based levels of practice and competencies need to be defined.
(3) Integration into existing clinical infrastructure facilitates success.
(4) CI governance is an evolving process.


Applied clinical informatics work is highly interprofessional with patient safety implications that heighten the need for best practice models for governance structures, adequate resource allocation, and role-based competencies. Overall, there is a notable lack of a centralized CI group comprised of formally trained informaticians to provide expertise and promote adherence to informatics principles within EHR implementation governance structures.


It is very important that organizations that have successfully implemented EHR share their strategies and lessons learned to others who are implementing their own. We should not only learn from our mistakes but also from the mistakes of others. This is the only way we can make our health systems better.

Here are some points worth paying attention, from the experience of a community based hospital that managed to have a decent level of CPOE system adoption rate over eight months period since system go-live.

  • Continuous monitoring of the system through quantifying alerts and quantifying physicians' response to the alert.
  • Making changes and adjustments on the system based on feedbacks from the monitoring.
  • Letting the system monitoring and adjustment process stay long after the system is deployed. [3]

Related Read:Using special people in a computerized physician order entry system implementation: Removing barriers to success


  1. Collins, S. A., Alexander, D., & Moss, J. (2015). Nursing domain of CI governance: recommendations for health IT adoption and optimization. Journal of the American Medical Informatics Association, ocu001.
  2. Detmer DE, Shortliffe EH. Clinical informatics [published online ahead of print May 13, 2014]. JAMA. 2014;311(20): 2067–2068. doi:10.1001/jama.2014.3514.
  3. Stutman, H. R., Fineman, R., Meyer, K., & Jones, D. (2007). Optimizing the acceptance of medication-based alerts by physicians during CPOE implementation in a community hospital environment. In AMIA Annual Symposium Proceedings (Vol. 2007, p. 701). American Medical Informatics Association.