Examine the balance between defining HIT needs and applying available HIT solutions—?
How do you engage Physicians in Planning/Product Selection, when physicians generally lack the basic IT understanding to even determine what they would want from an HIT system, like an EHR..?
How do you engage Physicians in Planning/Product Selection, when each physician often has their own workflow and there is No way to implement a HIT system that meets every physician needs/wants…?
Reference
APA Format
Week 5 HIT Governance and Decision Rights
HCAD 610
1
Learning Objectives
Explain why healthcare information technology (HIT) strategic planning has become more important for healthcare organizations.
Summarize the five major components of HIT governance.
Describe the major elements of a healthcare organization’s planning effort.
Assess the major elements of an HIT strategic plan.
Describe systems theory, and explain why it is vital to HIT governance and planning.
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2
Overview
Background of HIT governance and strategic planning
Organizing an HIT strategic planning effort
The importance of system integration
The basics of systems theory
Management control and decision support systems
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Background
Governance is designed to address agency problem (separation of ownership from management).
Managers may become risk averse (to keep job). Behavior does not maximize outcomes.
Owners establish bonding contracts to align incentives or monitoring to control.
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Background: HIT Planning
As healthcare organizations become more complex, HIT must accommodate that complexity with information architecture.
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HIT Planning Domains
Strategic alignment
Risk management
Resource management
Performance measurement
Value delivery
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Components of HIT Governance
Consistently applied HIT strategy
Alignment of HIT strategy with organizational strategy
Well-developed HIT infrastructure, architecture, and policies
Well-managed HIT project priorities and investments in HIT infrastructure
Documented HIT value or benefits to enhance accountability
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Consistent HIT Strategy
Support strategic goals, objectives, and priorities of organization
35% of organizations had no HIT strategic plan in 1996
8% had no HIT strategic plan in 2002
Question not asked today
HIT plan can be part of or integrated with organization strategic plan
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Alignment of HIT and Organizational Strategy
Must address six key questions:
What does the organization do?
Who does the organization do it to or for?
Where does the organization do it?
When does the organization do it?
Why does the organization do it?
How does the organization do it?
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Well-Developed HIT Infrastructure, Architecture, and Policies
HIT development priorities 2012 (percentage of respondents):
Servers/virtual servers (19%)
Mobile devices (18%)
Desktops/virtual desktops (16%)
Security systems (16%)
Storage and backup (8%)
Wired/wireless networks (7%)
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Data Standardization
System integration vital in future
Can’t share information without data standardization
Facilitate exchange within and outside organization
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Data Standardization (cont’d)
Multiple projects underway to develop and distribute standards:
American National Standards Institute (ANSI)
Health Industry Business Communication Council
Health Level Seven (HL7)
Healthcare Information Technology Standards Panel (HITSP)
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Data Standardization (cont’d)
Health Level Seven (HL7)
Voluntary effort involving providers, vendors, government, and others
HIPAA established standards that providers are required to follow to receive Medicare, Medicaid, and other payments
Standards adoption is work in progress
Health information exchanges’ (HIEs) impediment due to failure to specify a standard structure and format of data
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Hardware and Software Standards
Steering committee and CIO standards, such as central review and approval of purchases:
Ensures compatibility with enterprise-wide data standards
Terminals and workstations use common operating systems
Cost advantages through purchase of site licenses
Eases technical support capacity
Prevents illegal use of unlicensed software
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Well-Managed HIT Project Priorities and Investments
Capitalize on specialized skills of HIT staff in selecting and purchasing hardware and software
HIT management must manage competing priorities
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Documented HIT Value or Benefits
Value of investment needs to be documented to justify ongoing organizational support
Financial
Cost reductions
Revenue enhancements
Productivity gains
Clinical
Service delivery
Outcome measures
Organizational
Risk reduction
Stakeholder satisfaction
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Organizing HIT Strategic Planning Effort
Responsibilities for HIT management:
Board delegates to CEO
CEO delegates to CIO
Important due to expanding size and complexity of healthcare organizations
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Organizing HIT Strategic Planning Effort (cont’d)
Purpose of strategic governance and HIT planning:
IT governance helps the organization make business decisions more accurately and in a more timely manner.
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Steering Committee
HIT steering committee
Designed to engage key user groups
Ensures diversity of input to governance function
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Steering Committee Membership
Executive management (CIO)
Medical staff
Nursing staff
Financial management
Clinical support services
Planning and marketing
Other major system users
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Organizing HIT Strategic Planning Effort
Steering committee assumes responsibility for HIT plan that addresses:
Priorities for new and replacement systems
Specifications for IT infrastructure
Capital and operating budget
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HIT Strategic Technology Plan
Major elements of HIT technology plan:
Statement of HIT goals and objectives aligned with the strategic goals of the organization
Priorities for the portfolio of computer applications to be developed
Specification of overall system architecture
Software development plan
HIT management and staffing plan
Resource requirements, including capital and operating budget projections
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HIT: Systems Analysis
Systems analysis is the process of collecting information about functional information system requirements and the environment in which the system will operate.
Systems analysis is needed regardless of whether the system will be developed in-house or will be implemented using vendor software.
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HIT: System Characteristics
Unity or integrity—unity of purpose
Healthcare systems are complex
Complex systems contain hierarchical structure
Most posses stability and equilibrium
Deterministic or probabilistic
Simple systems with feedback
Closed or open
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HIT Systems
Management control and decision support systems:
Inputs
Conversion process
Outputs
Sensor
Monitor (standards)
Control process (corrective action)
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Useful Management Information
Information, not data driven
Relevant and sensitive
Unbiased
Comprehensive
Timely
Action oriented
Uniform (for comparison)
Performance targeted
Cost-effective
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Web Resources
Governance
American National Standards Institute (ANSI; www.ansi.org)
Centers for Disease Control and Prevention, National Center for Health Statistics (http://healthindicators.gov/)
CharlesRiver Advisors (www.charlesriveradvisors.com/)
Dearborn Advisors (www.dearbornadvisors.com/)
Environmental Protection Agency (EPA; www.epa.gov/enviro)
Health Management Technology magazine (www.healthmgttech.com)
HL7 (www.hl7.org)
The Joint Commission (www.jointcommission.org)
Strategic Plans
Advanta Health Partners strategic plan (www.advantapartners.com/projects/project9_itsd.html)
Centers for Disease Control strategic plan (www.cdc.gov/od/ocio/docs/CDC_IT_Strategic_Plan_2012_2016.pdf)
Indiana University School of Medicine (http://technology.iusm.iu.edu/iusm-strategic-plan/)
Stanford University Medical Center (http://medstrategicplan.stanford.edu/retreat03/IRT.ppt)
University of Utah strategic plan (www.healthcare.utah.edu/technology/itsPlan/2010%20UUHC%20ITSP%20Full%20Version.pdf)
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