title: Lessons learned for collaborative clinical content development.
abstract: BACKGROUND
  Site-specific content configuration of vendor-based Electronic Health Records (EHRs) is a vital step in the development of standardized and interoperable content that can be used for clinical decision-support, reporting, care coordination, and information exchange. The multi-site, multi-stakeholder Acute Care Documentation (ACD) project at Partners Healthcare Systems (PHS) aimed to develop highly structured clinical content with adequate breadth and depth to meet the needs of all types of acute care clinicians at two academic medical centers. The Knowledge Management (KM) team at PHS led the informatics and knowledge management effort for the project.
  
  
  OBJECTIVE
  We aimed to evaluate the role, governance, and project management processes and resources for the KM team's effort as part of the standardized clinical content creation.
  
  
  METHODS
  We employed the Center for Disease Control's six step Program Evaluation Framework to guide our evaluation steps. We administered a forty-four question, open-ended, semi-structured voluntary survey to gather focused, credible evidence from members of the KM team. Qualitative open-coding was performed to identify themes for lessons learned and concluding recommendations.
  
  
  RESULTS
  Six surveys were completed. Qualitative data analysis informed five lessons learned and thirty specific recommendations associated with the lessons learned. The five lessons learned are: 1) Assess and meet knowledge needs and set expectations at the start of the project; 2) Define an accountable decision-making process; 3) Increase team meeting moderation skills; 4) Ensure adequate resources and competency training with online asynchronous collaboration tools; 5) Develop focused, goal-oriented teams and supportive, consultative service based teams.
  
  
  CONCLUSIONS
  Knowledge management requirements for the development of standardized clinical content within a vendor-based EHR among multi-stakeholder teams and sites include: 1) assessing and meeting informatics knowledge needs, 2) setting expectations and standardizing the process for decision-making, and 3) ensuring the availability of adequate resources and competency training.
authors.affiliation: Partners Healthcare Systems, 93 Worcester St.Wellesley, MA 02481, USA. sacollins@partners.org
authors.forename: S A
authors.initials: SA
authors.lastname: Collins
authors.forename: K
authors.initials: K
authors.lastname: Bavuso
authors.forename: G
authors.initials: G
authors.lastname: Zuccotti
authors.forename: R A
authors.initials: RA
authors.lastname: Rocha
mesh_terms: D003299:Cooperative Behavior; D004282:Documentation; D057286:Electronic Health Records / Q000592:standards; D005069:Evaluation Studies as Topic; D006801:Humans; D005791:Patient Care; D012015:Reference Standards
keywords: Knowledge management; content development; governance; program evaluation; standardization