Rural Health Network*	Local Health Information Infrastructure**
Organizing and development time (forming and storming)	Time needed for getting acquainted, getting organized, discussing issues, setting goals, and making and revising plans before they any substantive action taken. Can consume time when it may appear that nothing is really happening. Process of working through real issues to reach a consensus for action HMS p 53 Important for maintaining trust between members	Formation of a philosophical base. Discussion and decision on philosophical issues. Collaboration achieved through consensus built on sharing and trust Shared vision by members L p 13 Useful change management strategies L p 13
Legal agreement between members	Memorandum of Understanding Alliance Agreement,	Formal agreement to outline: · Policies & procedures · Practices, · Data sharing.
Commitment of Leaders in Member Organizations	Local commitment, leadership and the capacity to assign priority to multi-organizational efforts. HMS p 62	Strong sense of ownership and participation in the process. Local government support and/or involvement.
Clear Mission and Objectives	Clear program objectives Expectations Time frames Outcomes/deliverables HMS p 65	Establish clear objectives Mobilized around focused concepts There is a shared vision, mission and the benefits for participation in the LHII
Members maintain autonomy	Functions determined by the needs of each organization rather than the converse = network exists for its participants and is designed to meet their needs. The participants don’t exist for the good of the network. p. 55	The LHII must be structured so that participation does not mean the loss of power, control and/or status. L p 15 Members feel valued
Organizational structure	Bylaws describing responsibilities of members Roles of each member are clearly outlined. Members do not need to have equivalent roles.	Clearly define roles and responsibilities for everyone connected to the LHII. Cclear agreement on what participation in the LHII means
Management & Leadership	Preferred leader that is not a leader of one of the members Conflict in priorities Seen as having a hidden agenda Directed by a Board of individuals representing each membership organization	Neutral managing partner Champions of the system identified in each organization A strong leader. (A strong physician champion/ strong entrepreneurial guide who was not a physician.) Leadership groups/committees/task force
Outside consultant	Neutral third party	Technical Expert
Fulfills a need	Compelling need · Survival of providers is at stake · Community left without vital services HMS p 55	Demonstrated importance of project to the community and member providers Community consensus on the need for an LHII.
Funding	Sustain funding once grants run out by revenue from services provided HMS p. 62	Attention to financing the system—both initially and the future—to ensure success
Clinical Leadership		Strong physician involvement. (Physician users drive the clinical information decisions.)
Communication and reporting		Accurate Timely Involves all parties
Assessment/evaluation	Clear milestones with identifying responsible party Include steps on: · Organizational development · Needs assessment and planning · Service development Performance review Prescribe data collection Measures of performance to show objectives being met · Expand services · Cut costs · Improve quality · Required for continued support	Improved quality of care and safety Efficient work flow Utilization Financial return on investment Decreasing cost of health care services

* HMS, A. (1995). Rural health network development: Experiences, lessons learned, and strategies. Getzville, NY: HMS Associates.

** Lorenzi, N. M. (2003). Strategies for creating successful local health information infrastructure initiatives (Analysis). Nashville, TN: Vanderbilt University, Department of Biomedical Informatics.