Health Information Technology Enterprise Collaboration Group - Charter

Refer to: OIT

1. PURPOSE.  This circular establishes the Indian Health Service (IHS) Health Information Technology (IT) Enterprise Collaboration Group (ECG), a core component of the governance framework for IHS Health IT Modernization.  The ECG gathers insights from subject matter experts who are the end-users of the enterprise Electronic Health Record (EHR) solution, and provides guidance and recommendations related to system configuration and change management.  The ECG supports the IHS mission to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level, by ensuring that subject matter experts, including those from Tribes and Urban Indian organizations, are actively engaged in how the enterprise EHR and related systems are built to improve standardization and best practices in patient care.  At a minimum, activities of the ECG are to provide guidance to drive and support the following outcomes:
   1. The enterprise EHR system is configured collaboratively based upon individual input from subject matter experts who are end-users at IHS-operated health care facilities, Tribal Health Programs, and Urban Indian Organizations (I/T/U) that are participating as Tenants on the shared enterprise EHR;
   2. Health care quality and patient safety are the top priorities in decisions concerning the enterprise EHR system design, configuration, implementation, and management;
   3. The enterprise EHR is configured to optimally support achievement and maintenance of accreditation by participating organizations;
   4. Subject matter experts from the I/T/U Tenants actively contribute individual input based on their own experience, expertise, and knowledge as end-users;
   5. The IHS is transparent with decisions, including how decisions are informed and executed; and
   6. The effective performance of the ECG at the enterprise level relieves the burden on individual health care organizations for day-to-day management of EHR configuration and change management.
2. SCOPE.  The ECG provides guidance and recommendations to the Health IT Modernization Program Management Office (PMO) within the IHS Office of Information Technology for the design, configuration, implementation, and management of the enterprise EHR.  This includes, in particular, those aspects with the potential to impact clinical and business operations, such as patient care and safety, accreditation and regulatory compliance, and revenue cycle management.
3. STRUCTURE AND COMPOSITION
   1. Overview.  The ECG is led by an Executive Committee.  The Executive Committee determines the final recommendations within the scope of this Charter.  
      1. To inform this work, the Executive Committee maintains and modifies Domain Groups to ensure receipt of individual input from end-users who are subject matter experts in the specific areas of clinical and/or business operations relevant to the scope of each Domain.  Domain Groups are multidisciplinary and have a Federal Chair, informatics support, and administrative support.  
      2. End-users will be selected to provide subject matter expertise through individual input during Domain Group meetings.  This input is used as guidance to inform the design, configuration, implementation, and management of the enterprise EHR, including but not limited to, content, workflows, alerts, decision support, data collection and reporting, and prioritization.  
      3. Ad hoc subcommittees of the Executive Committee or the Domain Groups may also be created at the discretion of the relevant chair(s) to address a specific purpose or question.  
   2. Executive Committee. 
      1. Standing Membership:
         1. Chair:  The IHS Chief Medical Information Officer (CMIO) serves as Chair of the ECG.  The IHS Chief Information Officer will appoint an Acting Chair to serve in the case of absence or incapacity of the CMIO.
         2. Co-Chair:  IHS Chief Medical Officer (or designee)
         3. Member:  Deputy Director for Quality Healthcare and Enterprise Risk Management (or designee)
         4. Member:  Director, Division of Nursing Services, Office of Clinical and Preventive Services (or designee)
         5. Member:  Director, Office of Resource Access & Partnerships (or designee)
         6. Ex-Officio Member:  Director, Health IT Modernization PMO (or designee)
      2. Appointed Membership:  Domain Group Chairs.
      3. Ad Hoc Committees:  The Executive Committee may designate sub-committees composed entirely of members of the Executive Committee for the purpose of determining a final recommendation.
      4. Function:  The Executive Committee recommends enterprise EHR configuration to the PMO Director, or their designee, for Decision Points that impact I/T/U Tenants and their end-users.  The Executive Committee fulfills this function through the work it carries out directly, as well as the work carried out by the Domain Groups.  Consideration by the entire Executive Committee is most relevant for issues crossing the scope of Domain Groups or to resolve conflicting recommendations coming from the Domain Group Chairs.
      5. Executive Committee Recommendations:  Executive Committee recommendations are presented to the PMO Director, or their designee, as the final ECG recommendations for configuration or changes to the enterprise EHR.  The PMO Director, or their designee, will direct such changes for the enterprise EHR.  In most cases, ECG recommendations are accepted and executed by the PMO.  If the PMO is unable to do so for any reason, the ECG Executive Committee is advised and may have the opportunity to revise its recommendations.
         1. The Executive Committee will seek to make final recommendations by consensus; if consensus is not achieved and a quorum is present, the Chair may call for a majority vote;
         2. Quorum is achieved when at least three members of the Standing Executive Committee and Chairs of half of the Domain Groups are in attendance; and
         3. The Executive Committee Chair does not cast a vote except in the case of a tie.
   3. ECG Domain Groups.
      1. The Executive Committee will establish each Domain Group and can initiate or stand down such Groups as necessary to fulfill its functions.
      2. Domain Group Composition and Contributors:
         1. Chair:  The Standing Executive Committee members will appoint a Federal employee that is an active end-user and recognized subject matter expert within a domain to serve a two-year renewable term as Chair.  Selection will be made from nominations from I/T/U Tenants, and in concurrence with local chain of command.
         2. Co-Chair:  The CMIO will appoint a Federal informatics employee to serve as Co-Chair, renewable or replaced at the CMIO’s discretion.
         3. End-users:  Each Domain Group is multidisciplinary and will include end-users who are subject matter experts in the areas of clinical and/or business operations within the scope of the Domain Group.  End-users will be recommended to the Executive Committee by the respective Chair and Co-Chair, drawing from I/T/U Tenant nominations.  The Chair and Co-Chair will prioritize having representation from Tribal and Urban organizations.  If selected, the end-user will be asked to provide their individual input to the applicable Domain Group, as a subject matter expert, for two-year renewable terms, with the concurrence of their local chain of command.
      3. Ad Hoc Sub-groups:  The Chair of a Domain Group may create a sub-group for a specific purpose or question, when consistent with the Domain Group actions described in the following subsection of this Circular.
      4. Domain Group actions:
         1. Domain Groups will meet periodically as convened by their respective Chairs to discuss and provide individual input concerning how the enterprise EHR should be configured to best support end-users, and to consider change requests within the scope of their Domain as forwarded to them by the PMO.
         2. Domain Groups do not serve as advisory committees as defined in the Federal Advisory Committee Act (FACA) 5 U.S.C. App. § 1-16.  End-users, whether from IHS, Tribal, or Urban Indian Organization Tenants, serve on these groups due to their individual subject matter expertise and provide individual input to Federal Domain Group Chairs based on that expertise.  No votes, consensus discussions, or similar actions involving end-users are taken in or attributed to Domain Groups.  While it is not the intent of this Charter to include activities that would be subject to the FACA, any activities that do trigger the FACA must comply with the required procedures.
4. ROLES AND RESPONSIBILITIES
   1. The ECG Chair has the following responsibilities:
      1. Directs the business of the ECG to meet enterprise EHR objectives.
      2. Ensures standing members of the Executive Committee are designated.
      3. Facilitates and participates in the selection of Domain Group Chairs.
      4. Appoints Domain Group Co-Chairs.
      5. Directs the development of Standard Operating Procedures (SOP) for ECG business:
         1. Ensures appropriate accountability and transparency by specifying minimum standards for documentation, reporting, and publication of meetings, agendas, decisions, and risks for the Executive Committee, Domain Groups, and any ad-hoc committee or sub-group.
         2. Ensures acceptable representation and communication by assisting with defining relevant stakeholder groups for each Domain Group for inclusion in the PMO Communication Plan.
      6. Communicates ECG recommendations to the PMO and other responsible parties and stakeholders as appropriate.
      7. Establishes Ad Hoc subcommittees.  The Chairperson will establish and appoint committee members to Ad Hoc subcommittees as needed.
   2. The ECG Co-Chair will discharge the responsibilities of the Chair when the Chair is unavailable and an Acting Chair has not been designated.
   3. Standing Executive Committee members have the following responsibilities:
      1. Create new Domain Groups as needed to meet ECG objectives.
      2. Retire existing Domain Groups if no longer needed to meet ECG objectives.
      3. Approve Domain Group Chair nominations by consensus or majority vote.
      4. Consider Domain Group Chair recommendations that have implications for broader IHS policy, determining whether these recommendations should be referred to the appropriate Headquarters Office or other parts of the Federal government to consider for policy updates or other actions.
   4. The full Executive Committee has these additional responsibilities:
      1. Consider, discuss, and approve enterprise EHR configuration and change recommendations, in particular those recommendations that contain scope that crosses Domain Groups, via consensus or majority vote.
      2. Discuss and resolve conflicting recommendations that cross Domain Groups’ scope, as well as specific decisions referred to the Executive Committee by individual Domain Group Chairs.
      3. Delegate who will author the final recommendations within the Executive Committee to balance efficiency and representation as needed.
   5. ECG Domain Group Chairs (including Acting Chairs) have the following responsibilities:
      1. Coordinate Domain Group participation in baseline-build discussions with the enterprise EHR integrator, vendor, PMO, and other IHS-directed entities;
      2. Manage discussions of enterprise EHR configuration decision points within or relevant to their group.  Ensure that end-users are encouraged to provide individual input relevant to their subject matter expertise and not consensus advice;
      3. Participate in Executive Sub-Committees to review and integrate recommendations across Domain Groups;
      4. Provide recommendations to the full Executive Committee that take into consideration the individual input from end-users as subject matter experts; and
      5. Comply with SOP regarding documentation of meetings, activities, and actions including, but not limited to: agendas, discussions, recommendations, decisions, and risks.
   6. End-users selected as subject matter experts to ECG Domain Groups have the following responsibilities:
      1. Notify the relevant ECG Domain Group Chair if the end-user is no longer able to remain current, knowledgeable, and informed concerning their areas of subject matter expertise, as relevant to the scope of their Domain Group;
      2. Through communication of their individual input, actively participate in Domain Group and vendor/integrator-led configuration discussions to support knowledge-sharing and informed recommendations by the ECG Domain Group Chair;
      3. Strive to provide individual input that is evidence-based wherever possible; and
      4. Provide verbal and/or written individual input, as requested, to the Domain Group Chair and/or the Executive Committee.
5. DECISION-MAKING PROCESS.  The ECG provides a structured forum for subject matter experts of I/T/U Tenants to offer individual input, based on their experience, expertise, and knowledge as end-users to Domain Group Chairs and the Executive Committee regarding enterprise EHR configuration Decision Points that are assigned to a Domain Group for review.  Domain Group Chairs will utilize this individual input to ensure existing workflows, best practices, expert opinions, and end-user concerns from their Groups are included for consideration in their recommendations to the Executive Committee.  Ultimately, the ECG Executive Committee provides final recommendations and guidance to the PMO regarding enterprise EHR configuration related to the scope of the ECG. 
6. SUPPORT AND COMMUNICATION.  The ECG receives administrative support staffed by the PMO, including notices and agendas for ECG and group meetings, meeting facilitation, and documentation of proceedings and recommendations.  Informatics support will be coordinated by the CMIO as ECG Chair.  Public communication concerning ECG activities, deliberations, and recommendations is coordinated between the ECG Chair and the PMO Director, within the overall PMO Communication Plan. 
7. CHARTER REVIEW.  The Charter will be reviewed no less than annually by the CMIO, as ECG Chair, to ensure the purpose and scope are consistent with current Health IT Modernization priorities. 
8. SUPERSEDURE.  None.
9. EFFECTIVE DATE.  This charter becomes effective on the date of signature.

Distribution: IHS-wide
Date: 04/05/2024