EDM in a Hospital Group's EHR Upgrade
A six-hospital group with 14,000 staff and revenue of $2.1 billion is preparing a $48 million electronic health record upgrade. Its board IT committee meets for two hours each quarter; agendas are dominated by budget approvals and project status slides. The business case for the upgrade cites vendor estimates of a 20 percent efficiency gain, but no baseline benefits have been defined. Clinicians report medication-ordering workarounds and interoperability defects, and a regulator has asked for evidence that the board oversees clinical-system risk. The CIO wants approval within six weeks to secure vendor pricing. The committee chair asks you to redesign how the committee works so that it evaluates, directs, and monitors IT rather than merely approving spending. Committee members are financially literate but not technologists, and the group has no enterprise architecture function.
1. Design an EDM cadence for the committee. What should be evaluated before the EHR decision, what should be directed, and what should be monitored afterward?
Read the worked answer
Use a deliberate EDM rhythm, not a project-approval calendar.
Evaluate: before the EHR decision, require a one-page strategic case linked to clinical and operating strategy, a clinical-safety risk assessment, a benefits baseline (medication errors, order turnaround, clinician time), options including deferral and replacement, total cost and exit terms, and an independent review of vendor claims. The committee should evaluate the decision it is actually making: whether to commit $48m and on what conditions.
Direct: if it proceeds, direct stage gates, a named clinical and business benefits owner, a safety case, a data-migration and interoperability plan, and a risk appetite for go-live. Authorise negotiation and limited early spend, not unconditional commitment.
Monitor: a quarterly dashboard with benefits against baseline, safety incidents and workarounds, schedule and cost variance, vendor performance, clinician adoption, and regulatory evidence. Set escalation triggers.
The two-hour quarterly meeting should spend most time on exceptions and decisions, with detailed assurance delegated to a subcommittee or internal audit. That is governance, not project management.
2. The CIO argues that a six-week approval is essential for pricing. How should the committee respond without simply delaying?
Read the worked answer
The committee should not accept a binary choice between six weeks and delay. It can time-box evaluation without lowering the evidence bar.
Response:
- Ask management to return in two weeks with the minimum decision-grade evidence: benefits baseline, clinical-safety assessment, affordability, and the cost of not proceeding.
- Authorise only a negotiation mandate and due-diligence spend, not the full $48m, so pricing can be held without irrevocable commitment.
- Set conditions: if the baseline and safety case are absent, the decision is 'not yet', not 'yes'.
- Record the risk of vendor pricing pressure as a board-level risk and assign an owner.
- Delegate detailed technical diligence to an independent reviewer and management, with a report to the committee.
This respects the CIO's commercial constraint while preserving the board's accountability. A six-week deadline is a schedule risk, not a reason to approve an unproven business case. The committee should also ask why the pricing window is credible and whether alternatives have been tested.