You will propose how the particular health information system used in your selected case would be applicable in a health care organization of your choice. 2 pages in length, 3 resources in the past 5 years.
Evaluate the needs that are present within your selected case study as it applies to your “ABC Health Care” organization.
Examine the practices from your selected case study that confirm or contradict that data is complete, accurate, consistent, timely, secure, and fit for use.
IT Alignment and Strategic Planning
Learning Objectives
•
To be able to understand the importance of an IT strategic plan.
•
To review the components of the IT strategic plan.
•
To be able to understand the processes for developing an IT strategy.
•
•
To be able to discuss the challenges of developing an IT strategy.
To describe the Gartner Hype Cycle recognizing the wide range of emerging technologies
at various stages of maturity.
Information technology (IT) investments serve to advance organizational
performance. These investments should enable the organization to reduce
costs, improve service, enhance the quality of care, and, in general, achieve
its strategic objectives. The goal of IT alignment and strategic planning is to
ensure a strong and clear relationship between IT investment decisions and
the health care organization’s overall strategies, goals, and objectives. For
example, an organization’s decision to invest in a new claims adjudication
system should be the clear result of a goal of improving the effectiveness of its
claims processing process. An organization’s decision to implement a care
coordination application should be a consequence of its population health
management strategy.
Developing a sound alignment can be very important for one simple reason—
if you define the IT agenda incorrectly or even partially correctly, you run the
risk that significant organizational resources will be misdirected; the resources
will not be put to furthering strategically important areas. This risk has nothing
to do with how well you execute the IT direction you choose. Being on time,
on budget, and on specification is of little value to the organization if it is doing
the wrong thing!
IT Planning Objectives
The IT strategic planning process has several objectives:
•
To ensure that information technology plans and activities align with the plans and
activities of the organization; in other words, the IT needs of each aspect of
organizational strategy are clear, and the portfolio of IT plans and activities can be
mapped to organizational strategies and operational needs
•
To ensure that the alignment is comprehensive; in other words, each aspect of strategy
has been addressed from an IT perspective that recognizes not all aspects of strategy have
an IT component, and not all components will be funded
•
To identify non-IT organizational initiatives needed to ensure maximum leverage of the
IT initiative (for example, process reengineering)
•
To ensure that the organization has not missed a strategic IT opportunity, such as those
that might result from new technologies
•
To develop a tactical plan that details approved project descriptions, timetables, budgets,
staffing plans, and plan risk factors
To create a communication tool that can inform the organization of the IT initiatives that
will and will not be undertaken
•
•
To establish a political process that helps ensure the plan results have sufficient
organizational support
At the end of the alignment and strategic-planning process, an organization should have an
outline that at a high level resembles Table 12.1. With this outline, leadership can see the IT
investments needed to advance each of the organization’s strategies. For example, the goal of
improving the quality of patient care may lead the organization to invest in databases to measure
and report quality, predictive algorithms to identify patients at risk of readmission, and the EHR.
Table 12.1 IT initiatives linked to organizational goals
Goal
IT Initiatives
Research and education
Research patient data registry
Genetics and genomics platform
Grants management
Patient care: quality improvement
Quality measurement databases
Order entry
Electronic health record
Patient care: sharing data across the system Enterprise master person index
Clinical data repository
Common infrastructure
Patient care: non-acute services
Nursing documentation
Transition of care
Financial stability
Revenue system enhancements
Payroll-personnel system
Cost accounting
In many ways the content of Table 12.1 is deceiving. It presents a tidy, orderly linkage between
the IT agenda and the strategies of the organization. One might assume this linkage is established
through a linear, rational, and straightforward series of steps. But the process of arriving at a
series of connections similar to those in Table 12.1 is complex, iterative, and at times driven by
politics and instincts.
The development of well-aligned IT strategies has been notoriously difficult for many years, and
there appears to be no reason such an alignment will become significantly easier over time.
Overview of Strategy
Strategy is the determination of the basic long-term goals and objectives of an organization, the
adoption of the course of action, and the allocation of resources necessary to carry out those
actions (Chandler, 1962). Strategy seeks to answer questions such as, where does this
organization need to go, and how will it get there? Where should the organization focus its
management attention and expenditures?
The development of an organization’s strategy has two major components: formulation and
implementation (Henderson & Venkatraman, 1993).
Formulation
Formulation involves making decisions about the mission and goals of the organization and the
activities and initiatives it will undertake to achieve them. Formulation could involve
determining the following:
•
Our mission is to provide high-quality medical care.
•
We have a goal of reducing the cost of care while at least preserving the quality of that care.
•
One of our greatest leverage points lies in reducing inappropriate and unnecessary care.
•
To achieve this goal, we will emphasize reducing the number of inappropriate radiology
procedures.
•
We will carry out initiatives that enable us to intervene at the time of procedure ordering if we
need to suggest a more cost-effective modality.
We can imagine other goals directed toward achieving this mission. For each goal, we can
envision multiple leverage points, and for each leverage point, we may see multiple initiatives.
The result is an inverted tree that cascades from our mission to a series of initiatives.
Formulation involves understanding competing ideas and choosing between them. In our
example, we could have arrived at a different set of goals and initiatives.
We could have decided to improve quality with less emphasis on care costs. We could have
decided to focus on reducing the cost per procedure. We could have decided to produce
retrospective reports of radiology use by provider and used this feedback to lead to ordering
behavior change rather than intervening at the time of ordering.
In IT, we also have a need for formulation. In keeping with an IT mission to use the technology
to support improvement of the quality of care, we may have a goal to integrate our clinical
application systems. To achieve this goal, we may decide to follow any of the following
initiatives:
•
Provide a common way to access all systems (single sign-on).
•
Interface existing heterogeneous systems.
•
Require that all applications use a common database.
•
Implement a common suite of clinical applications from one vendor.
Implementation
Implementation involves making decisions about how we structure ourselves, acquire skills,
establish organizational capabilities, and alter organizational processes to achieve the goals and
carry out the activities we have defined during formulation of our strategy. For example, if we
have decided to reduce care costs by reducing inappropriate procedure use, we may need to
implement one or more of the following:
•
An organizational unit of providers with health services research training to analyze care
practices and identify deficiencies
•
A steering committee of clinical leadership to guide these efforts and provide political support
•
A provider order entry system to provide real-time feedback on order appropriateness
•
Data warehouse technologies to support analyses of utilization
Using our clinical applications integration example, we may come to one of the following
determinations:
•
•
We need to acquire interface engine technology, adopt HL7 standards, and form an information
systems department that manages the technology and interfaces applications.
We need to engage external consulting assistance for the selection of a clinical application suite
and hire a group to implement the suite.
The implementation component of strategy development is not the development of project plans
and budgets. Rather, it is the identification of the capabilities, capacities, and competencies the
organization will need if it is to carry out the results of the formulation component of strategy.
Vectors for Arriving at IT Strategy
The IT strategy is developed using some combination of four IT strategy vectors:
•
Organizational strategies
•
Continuous improvement of core processes and information management
•
Examination of the role of new information technologies
•
Assessment of strategic trajectories
By a vector we mean the choice of perspectives and approaches through which an organization
determines its IT investment decisions. For example, the first vector (derived from organization
strategies) involves answering a question such as, “Given our strategy of improving patient
safety, what IT applications will we need?” However, the third vector (determined by examining
the role of new information technologies) involves answering a question such as, “There is a
great deal of discussion about cloud-based applications. Does this approach to delivering
applications provide us with ways to be more effective at addressing some of our organization
challenges?” Figure 12.1 illustrates the convergence of these four vectors into a series of iterative
leadership discussions and debates. These debates lead to an IT agenda.
IT Strategies Derived from Organizational Strategies
The first vector involves deriving the IT agenda directly from the organization’s goals and plans.
For example, an organization may decide it intends to become the low-cost provider of care. It
may decide to achieve this goal through implementation of disease management programs, the
reengineering of inpatient care, and the reduction of unit costs for certain tests and procedures it
believes are inordinately expensive.
The IT strategy development then centers on answering questions such as, “How do we apply IT
to support disease management?” The answers might involve web-based publication of disease
management protocols for use by providers, business intelligence technology to assess the
conformance of care practice to the protocols, provider documentation systems based on disease
guidelines, and CPOE systems that employ the disease guidelines to influence ordering
decisions. An organization may choose all or some of these responses and develop various
sequences of implementation. Nonetheless, it has developed an answer to the question of how to
apply IT in support of disease management.
Most of the time the linkage between organizational strategy and IT strategy involves developing
the IT ramifications of organizational initiatives, such as adding or changing services and
products, growing market share, improving service, streamlining processes, or reducing costs. At
times, however, an organization may decide it needs to change or add to its core characteristics
or culture. The organization may decide it needs its staff members to be more care-quality or
service-delivery or bottom-line oriented. It may decide it needs to decentralize or recentralize
decision making. It may decide to improve its ability to manage knowledge, or it may not. These
characteristics (and there are many others) can point to initiatives for IT.
In cases in which characteristics are to be changed, IT strategies must be developed to answer
questions such as, “What is our basic IT approach to supporting a decentralized decision-making
structure?” The organization might answer this question by permitting decentralized choices of
applications as long as those applications meet certain standards. (For example, they may run on
a common infrastructure or support common data standards.) It might answer the question of
how IT supports an emphasis on knowledge management by developing an intranet service that
provides access to preferred treatment guidelines.
IT Strategies to Continuously Improve Core Processes and Information
Management
All organizations have a small number of core processes and information management tasks that
are essential for the effective and efficient functioningof the organization. For a hospital these
processes might include ensuring patient access to care, ordering tests and procedures, and
managing the revenue cycle. For a restaurant these processes might include menu design, food
preparation, and dining room service. For a health plan, information management needs might
point to a requirement to understand the costs of care or the degree to which care practices vary
by physician.
Using the vector of continuous improvement of core processes and information management to
determine IT strategies involves defining the organization’s core processes and information
management needs. The organization measures the performance of core processes and uses the
resulting data to develop plans to improve its performance. The organization defines core
information needs, identifies the gap between the current status and its needs, and develops plans
to close those gaps. These plans will often point to an IT agenda. This vector may be a result of a
strategy discussion, although this is not always the case. An organization may make ongoing
efforts to improve processes regardless of the specifics of its strategic plan. For example, every
year it may establish initiatives designed to reduce costs or improve services. The organization
has decided that, regardless of a specific strategy, it will not thrive if core processes and
information management are something other than excellent.
Table 12.2 illustrates a process orientation. It provides an organization with data on the
magnitude of some problems that plague the delivery of outpatient care. These problems afflict
the processes of referral, results management, and test ordering. The organization may decide to
make IT investments in an effort to reduce or eliminate these problems. For example,
strengthening the decision support for e-prescribing could reduce the prevalence of adverse drug
events (ADEs). Abnormal test results could be highlighted in the EHR to help ensure patient
follow-up.
Table 12.2 Summary of the scope of outpatient care problems
For every:
There appear to be:
1,000 patients coming in for outpatient care
14 patients with life-threatening or serious ADEs
1,000 outpatients who are taking a
prescription drug
90 patients who seek medical attention because of
drug complications
1,000 prescriptions written
40 prescriptions with medical errors
1,000 women with a marginally abnormal
mammogram
360 who will not receive appropriate follow-up care
1,000 referrals
250 referring physicians who have not received followup information four weeks later
1,000 patients who qualified for secondary
prevention of high cholesterol
380 will not have an LDL-C on record within three
years
When this vector is used, the IT agenda is driven at least in part by a relentless year-in, year-out
focus on improving core processes and information management needs.
IT Strategies That Rely on New IT Capabilities
The third vector involves considering how new IT capabilities may enable a new IT agenda or
significantly alter the current agenda. For example, telemedicine capabilities may enable the
organization to consider a strategy of extending the reach of its specialists across its catchment
area to improve its population health efforts. Data-mining algorithm advances might enable an
organization to assess different treatment approaches to determine which approaches lead to the
best outcomes.
In this vector, the organization examines new applications and new base technologies and tries to
answer the question, “Does this application or technology enable us to advance our strategies or
improve our core processes in new ways?” For example, advances in sensors and mobile
applications might lead the organization to think of new approaches to providing feedback to the
chronically ill patient. Holding new technologies up to the spotlight of organizational interest can
lead to decisions to invest in a new technology.
An extreme form of this mechanism occurs when a new technology or application suggests that
fundamental strategies (or even the organization’s existence) may be called into question or may
need to undergo significant transformation. In general these strategies lead to a decision to adopt
a new business model. A business model is the combination of an organization’s decisions about
what it will do, how it will do it, and why “the what and how” are of such value that customers
will pay them.
For example, Uber’s business model is that it will get you from point A to point B (the what) but
it will do so in a way that involves “renting” capacity from drivers already on the road and
making the process of ordering a ride and paying for a ride very easy (the how). The what for
Uber is no different than that for a traditional taxi company but the how is very different. Uber’s
superior business model was made possible by new information technologies—the web, mobile
devices, and advanced analytics.
Strategic thinking may center on the form and rigor of the justification process for new
applications. Formal return on investment analyses may be emphasized so that all application
decisions will emphasize cost reduction or revenue gain. Or the organization may decide to have
a decision process that takes a more holistic approach to acquisition decisions, so that factors
such as improving quality of care must also be considered.
In general, strategy discussions surrounding the application asset as a whole focus on, in addition
to the application inventory, a few key areas:
•
Sourcing. What are the sources for our applications? And what criteria determine the source to
be used for an application? Should we get all applications from the same vendor or will we use a
small number of approved vendors?
•
Application uniformity. For large organizations with many subsidiaries or locations, to what
degree should our applications be the same at all locations? If some have to be the same but
some can be different, how do we decide where we allow autonomy? This discussion often
involves a trade-off between local autonomy and the central desire for efficiency and
consistency.
Application acquisition. What processes and steps should we use when we acquire
applications? Should we subject all acquisitions to rigorous analyses? Should we use a request
for proposal for all application acquisitions? This discussion is generally an assessment of the
extent to which the IT acquisition process should follow the degree of rigor applied to non-IT
acquisitions (of diagnostic equipment, for example).
•
Infrastructure
Infrastructure needs may arise from the strategic-planning process. An organization desiring to
extend its IT systems to community physicians will need to ensure that it can deliver low-cost
and secure network connections. Organizations placing significant emphasis on clinical
information systems must ensure very high reliability of their infrastructure; computerized
provider order entry systems cannot go down.
In addition to initiatives designed to add specific components to the infrastructure—for example,
new software to monitor network utilization—architecture strategies will focus on the addition or
enhancement of broad infrastructure capabilities and characteristics.
Capabilities are defined by completing this sentence: “We want our applications to be able to
…” Organizations might complete that sentence with phrases such as “be accessed from home,”
“have logic that guides clinical decision making,” or “share a pool of consistently defined data.”
Characteristics refer to broad properties of the infrastructure, such as reliability, security, agility,
supportability, integratability, and potency. An organization may be heading into the
implementation of mission-critical systems and hence must ensure very high degrees of
reliability in its applications and infrastructure. The organization may be concerned about the
threats posed by ransomware and denial of service attacks and decide to strengthen the security
of its infrastructure. The asset plans in these cases involve discussions and analyses that are
intended to answer the question, What steps do we need to take to significantly improve the
reliability of our systems or improve security?
Data
Data and information were discussed in Chapter Two. Strategies concerning data may center on
the degree of data standardization across the organization, accountability for data quality and
stewardship, data sources, and determination of database management and analyses technologies.
Data strategy conversations may originate with questions such as, We need to better understand
the costs of our care. How do we improve the linkage between our clinical data and our financial
data? Or, we have to develop a much quicker response to outbreaks of epidemics. How do we
link into the city’s emergency rooms and quickly get data on chief complaints?
In general, strategies surrounding data focus on acquiring new types of data, defining the
meaning of data, determining the organizational function responsible for maintaining that
meaning, integrating existing sets of data, and obtaining technologies used to manage, analyze,
and report data.
IT Staff Members
IT staff members are the analysts, programmers, and computer operators who, day in and day
out, manage and advance information systems in an organization. IT staff members were
discussed in Chapter Eight. IT strategy discussions may highlight the need to add IT staff
members with specific skills, such as mobile application developers and population health
implementation staff members. Organizations may decide that they need to explore outsourcing
the IT function in an effort to improve IT performance or obtain difficult-to-find skills. The
service orientation of the IT group may need to be improved.
In general, the IT staff member strategies focus on the acquisition of new skills, the organization
of the IT staff, the sourcing of the IT staff, and the characteristics of the IT department—is it, for
example, innovative, service oriented, and efficient?
A Normative Approach to Developing Alignment and IT
Strategy
You may now be asking yourself, how do I bring all of this together? In other words, is there a
suggested approach an organization can take to develop its IT strategy that takes into account
these various vectors? And by the way, what does an IT strategic plan look like?
Across health care organizations the approaches taken to developing, documenting, and
managing an IT strategy are quite varied. Some organizations have well-developed, formal
approaches that rely on the deliberations of multiple committees and leadership retreats. Other
organizations have remarkably informal processes. A small number of medical staff members
and administrative leaders meet in informal conversations to define the organization’s IT
strategy. In some cases the strategy is developed during a specific time in the year, often
preceding development of the annual budget. In other organizations, IT strategic planning goes
on all the time and permeates a wide range of formal and informal discussions.
There is no single right way to develop an IT strategy and to ensure alignment. However, the
process of developing IT strategy should be similar in approach and nature to the process used
for overall strategic planning. If the organization’s core approach to strategy development is
informal, its approach to IT strategy development should also be informal.
Recognizing this variability, a normative approach to the development of IT strategy can be
described.
Strategy Discussion Linkage
Organizational strategy is generally discussed in senior leadership meetings. These meetings may
focus specifically on strategy, or strategy may be a regular agenda item. These meetings may be
supplemented with retreats centered on strategy development and with task forces and
committees that are asked to develop recommendations for specific aspects of the strategy. (For
example, a committee of clinical leadership members might be asked to develop
recommendations for improving patient safety.) These discussions will examine the
organization’s external environment—such as changes in reimbursement and competitive
position—and internal environment—such as operational efficiency, financial health, and
clinical strengths. This examination invariably results in the identification of gaps between the
organization’s desired position and role and its current status. This examination usually includes
a review of the status and capabilities of the organization’s IT capabilities and application
portfolio.
Regardless of their form, the organization’s CIO should be present at such meetings or kept
informed of the discussion and its conclusions. If task forces and committees supplement
strategy development, an IT manager should be asked to be a member. The CIO (or the IT
member of a task force) should be expected to develop an assessment of the IT ramifications of
strategic options and to identify areas where IT can enable new approaches to carrying out the
strategy.
The CIO will not be the only member of the leadership team who will perform this role. Chief
financial officers (CFOs), for example, will frequently identify the IT ramifications of plans to
improve the revenue cycle. However, the CIO should be held accountable for ensuring the
linkage does occur.
As strategy discussions proceed, the CIO must be able to summarize and critique the IT agenda
that should be put in place to carry out the various aspects of the strategy. Exhibit 12.1 displays
an IT agenda that might emerge. Exhibit 12.2 displays a health plan IT agenda that could result
from a strategy designed to improve patient access to health information and self-service
administrative tasks for a health plan.
Exhibit 12.1 IT Initiatives Necessary to Support a Strategic Goal for a Provider
Article I. Strategic Goal
Improve service to outpatients
Article II. Problem
•
Patients have to call many locations to schedule a series of appointments and services.
•
The quality of the response at these locations is highly variable.
•
Locations inconsistently capture necessary registration and insurance information.
•
Some locations are over capacity, whereas others are underutilized.
Article III. IT Solution
•
Common scheduling system for all locations
•
A call center for “one-stop” access to all outpatient services
•
Development of master schedules for common service groups such as preoperative testing
•
Integration of scheduling system with electronic data interchange connection to payers for
eligibility determination, referral authorization, and copay information
•
Patient support material, such as maps and instructions, to be mailed to patients
Exhibit 12.2 IT Initiatives Necessary to Support a Strategic Goal for a Health Plan
Article IV. Strategic Goal
•
Improve service to subscribers
•
Reduce costs
Article V. Problem
•
Subscribers have difficulty finding high-quality health information.
•
The costs of performing routine administrative transactions such as change of address and
responding to benefits questions is increasing.
•
Subscriber perceptions of the quality of service in performing these transactions is low.
Article VI. IT Solution
•
A plan portal that provides:
•
Health content from high-quality sources
•
Access to chronic disease services and discussion groups
•
•
Subscriber ability to use self-service to perform routine administrative
transactions
•
Subscriber access to benefit information
•
Functions that enable subscribers to ask questions
•
Plan ratings of provider quality
A plan-sponsored provider portal that enables:
•
Subscribers to conduct routine transactions with their provider, such as requesting
an appointment or renewing a prescription
•
Electronic visits for certain conditions such as back pain
•
Subscribers to ask care questions of their provider
IT Liaisons
All major departments and functions (for example, finance, nursing, and medical staff
administration) should have a senior IT staff person who serves as the function’s point of contact.
Because these functions examine ways to address their needs (for example, lower their costs and
improve their services), the IT staff person can work with them to identify IT activities necessary
to carry out their endeavors. This identification often emerges with recommendations to
implement new applications that advance the performance of a function, such as a medication
administration record application to improve the nursing workflow. Exhibit 12.3 provides an
example of output from a nursing leadership discussion on improving patient safety through the
use of a nursing documentation system.
New Technology Review
The CIO should be asked to discuss, as part of the strategy discussion or in a periodic
presentation in senior leadership forums, new technologies and their possible contributions to the
goals and plans of the organization. These presentations may lead to suggestions that the
organization form a task force to closely examine a new technology. For example, a
multidisciplinary task force could be formed to examine the ability of telehealth to support the
organization’s strategies. Table 12.3 provides an overview of different types of telehealth and an
overall assessment of strategic importance.
Table 12.3 Assessment of telehealth strategic opportunities
Type of
Telehealth
Potential Strategic Value
Level of Support of
Organization’s Strategy
Semi-urgent care Enables patients to reach a clinician at any time to get
advice on addressing low acuity health issues, for
example, a modest fever of a child
Moderate
Remote patient
monitoring
Supports efforts to manage patient’s with a chronic
disease
High
Fitness
monitoring
Provides information on a patient’s exercise program
Low
Visit substitution Supports conducting visits, for example, surgery followup through video rather than requiring a face-to-face
visit
High
Clinician
consultation
High
Enables clinicians to seek a consult from a remote
specialist
Type of
Telehealth
Potential Strategic Value
Level of Support of
Organization’s Strategy
Critical care
Provides ability to perform remote stroke assessments
and ICU monitoring
Moderate
Exhibit 12.3 System Support of Nursing Documentation
Section 6.1. Problem Statement
•
Both the admitting physician(s) and nurse document medication history in their admission note.
•
Points of failure have been noted:
•
•
Incompleteness due to time or recall constraints, lack of knowledge, or lack of
clear documentation requirements
•
Incorrectness due to errors in memory, transcription between documents, and
illegibility
•
Multiple inconsistent records due to failure to resolve conflicting accounts by
different caregivers
Most of the clinical information required to support appropriate clinician decision making is
obtained during the history-taking process.
Section 6.2. Technology Interventions and Goals
•
•
A core set of clinical data should be made available to the clinician at the point of decision
making:
•
Demographics
•
Principle diagnoses and other medical conditions
•
Drug allergies
•
Current and previous relevant medications
•
Laboratory and radiology reports
Required information should be gathered only once:
•
•
Multidisciplinary system of structured, templated documentation
Clinical decision support rules, associated to specific disciplines, should guide
gathering
•
•
Workflow should support the mobile care giver with integrated wireless access to
clinical information
Needed applications could be implemented in phases:
•
Nursing admission assessment
•
Multidisciplinary admission assessment
•
Planning and progress
•
Nursing discharge plan
•
Multidisciplinary discharge plan
Overall, a core role of the organization’s CIO is to work with the rest of the leadership team to
develop the process that leads to alignment and strategic linkage.
Once all is said and done, the alignment process should produce these results:
•
An inventory of the IT initiatives that will be undertaken (These initiatives may include new
applications and projects designed to improve the IT asset.)
•
A diagram or chart that illustrates the linkage between the initiatives and the organization’s
strategy and goals
•
An overview of the timeline and the major interdependencies between initiatives
•
A high-level analysis of the budget needed to carry out these initiatives
•
An assessment of any material risks to carrying out the IT agenda and a review of the strategies
needed to reduce those risks
It is important to recognize the amount and level of discussion, compromise, and negotiation that
go into the strategic alignment process. Producing these results without going through the
preceding thoughtful process will be of little real benefit.
IT Strategy and Alignment Challenges
Creating IT strategy and alignment is a complicated and critical organizational process. The
following sections present a series of observations about that process.
Planning Methodologies
Formal processes and methodologies that help organizations develop IT plans, whether based on
derived linkage or the examination of more fundamental characteristics of organizations, can be
very helpful. If well executed, they can do all of the following:
•
Lead to the identification of a portfolio of IT applications and initiatives that are well linked to
the organization’s strategy.
•
Identify alternatives and approaches that might not have been understood without the process.
•
Contribute to a more thorough analysis of the major aspects of the plan.
•
•
Enhance and ensure necessary leadership participation and support.
Help the organization be more decisive.
•
Ensure the allocation of resources among competing alternatives is rational and politically
defensible.
•
Enhance communication of the developed plan.
In addition to formal IT strategic planning methodologies, organizations will often use strategy
frameworks that help them frame issues and opportunities. For example, Porter’s Competitive
Forces Model (Porter, 1980) identifies strategic options such as competing on cost,
differentiating based on quality, and attempting to raise barriers to the entry of other competitors.
By using this model, the organization will make choices about its overall competitive position.
Models such as these help the leadership engage in a broader and more conceptual approach to
strategy development.
Persistence of the Alignment Problem
Despite the apparent simplicity of the normative process we have described and the many
examinations of the topic by academics and consultants, achieving IT alignment has been a top
concern of senior organizational leadership for several decades. For example, a survey of CIOs
from across multiple industries found improving IT alignment with business objectives to be the
number one IT top management priority in 2007 (Alter, 2007). A survey of CIOs in 2015
(Information Management, 2016) found alignment to be, once again, the top concern. There are
several reasons for the persistent difficulty of achieving alignment (Bensaou & Earl, 1998):
•
Business strategies are often not clear or are volatile.
•
IT opportunities are poorly understood and new technologies emerge constantly.
•
The organization is unable to resolve the different priorities of different parts of the
organization.
Weill and Broadbent (1998) note that effective IT alignment requires organizational leadership to
clearly understand and strategically and tactically integrate (1) the organization’s strategic
context (its strategies and market position), (2) the organization’s environment, (3) the IT
strategy, and (4) the IT portfolio (for example, the current applications, technologies, and staff
skills). Understanding and integrating these four continuously evolving and complex areas is
exceptionally difficult.
At least two more reasons can be added to this listing of factors that make alignment difficult.
First, the organization may find it has not achieved the gains apparently achieved by others it has
heard or read about, nor have the vendors’ promises of the technologies materialized. Second, the
value of IT, particularly infrastructure, is often difficult to quantify, and the value proposition is
fuzzy and uncertain; for example, what is the value of improved security of applications?
In both these cases the organization is unsure whether the IT investment will lead to the desired
strategic gain or value. This is not strictly an alignment problem. However, alignment does
assume the organization believes it has a reasonable ability to achieve desired IT gains.
The Limitations of Alignment
Although alignment is important, it will not guarantee effective application of IT. Planning
methodologies and effective use of vectors cannot, by themselves, overcome weaknesses in other
factors that can significantly diminish the likelihood that IT investments will lead to improved
organization performance. These weaknesses include poor relationships between IT staff
members and the rest of the organization, incompetent leadership, weak financial conditions, and
ill-conceived IT governance mechanisms. IT strategy also cannot overcome unclear overall
strategies and cannot necessarily compensate for material competitive weaknesses.
If one has mediocre painting skills, a class on painting technique will make one a better painter
but will not turn one into Picasso. Similarly, superb alignment techniques will not turn an
organization limited in its ability to implement IT effectively into one brilliant at IT use. Perhaps
this reason, more than any other, is why the alignment issue persists as a top-ranked IT issue.
Organizations are searching for IT excellence in the wrong place; it cannot be delivered purely
by alignment prowess.
Alignment at Maturity
Organizations that have a history of IT excellence appear to evolve to a state in which their
alignment process has become deeply intertwined with the normal management strategy and
operations discussions. A study by Earl (1993) of organizations in the United Kingdom with a
history of IT excellence found that their IT planning processes had several characteristics.
IT Planning Was Not a Separate Process
IT planning and the strategic discussion of IT occurred as an integral part of the organization’s
strategic planning processes and management discussions.
In these organizations, management did not think of separating out an IT discussion during the
course of strategy development any more than it would run separate finance or human resource
planning processes. IT planning was an unseverable, intertwined component of the usual
management conversation. This would suggest not having a separate IT steering committee.
IT Planning Had Neither a Beginning nor an End
In many organizations, IT planning processes start in a particular month every year and are
completed within a more or less set period. In the studied organizations, the IT planning and
strategy conversation went on all the time. This does not mean that an organization doesn’t have
to have a temporally demarked, annual budget process. Rather, it means that IT planning is a
continuous process that reflects the continuous change in the environment.
IT Planning Involved Shared Decision Making and Shared Learning
IT leadership informed organizational leadership of the potential contribution of new
technologies and the constraints of current technologies. Organizational leadership ensured that
IT leadership understood the business plans, strategies, and their constraints. The IT budget and
annual tactical plan resulted from shared analyses of IT opportunities and a set of IT priorities.
The IT Plan Emphasized Themes
A provider organization may have themes of improving care quality, reducing costs, and
improving patient service. During the course of any given year, IT will have initiatives that are
intended to advance the organization along these themes. The mixture of initiatives will change
from year to year, but the themes endure for many years. Because themes endure year after year,
organizations develop competence in these themes. They become, for example, progressively
better at managing costs and improving patient service. This growing prowess extends into IT.
Organizations become more skilled at understanding which IT opportunities hold the most
promise and at managing implementation of these applications. And the IT staff members
become more skilled at knowing how to apply IT to support such themes as improving care
quality and at helping leadership assess the value of new technologies and applications.
IT Strategy Is Not Always Necessary
There are many times in IT activities when the goal, or the core approach to achieving the goal,
is not particularly strategic, and strategy formulation and strategy implementation are not
needed. Replacing an inpatient pharmacy system, enhancing help desk support, and upgrading
the network, although requiring well-executed projects, do not always require leadership to
engage in conversations about organizational goals or to take a strategic look at organizational
capabilities and skills.
There are many times when it is unlikely that the way an organization achieves a goal will create
a distinct competitive advantage. For example, an organization may decide it needs to provide
personal health records to patients, but it does not expect that that application, or its
implementation, will be so superior to a competitor’s personal health record that an advantage
accrues to the organization.
Much of what IT does is not strategic, nor does it require strategic thinking. Many IT projects do
not require thoughtful discussions of fundamental approaches to achieving organizational goals
or significant changes in the IT asset.
The Challenge of Emerging Technology
The information technology industry in general and the health information technology industry
in particular are ever-changing and evolving. New technologies are being introduced every day.
How does a health care executive know when to support the adoption of the “latest and greatest”
technologies? When does the organization acknowledge its current technologies are out-of-date
and need upgrading? How much of the current literature about new technologies is “hype”?
Which new technologies are likely to survive to become industry standards?
In this textbook we cover specific methods for selecting health care information systems to meet
the health care organizations’ operational needs. The questions posed here are more general in
nature and relate to the technologies on which these systems are built. Take, for example, the use
of smartphones and tablets by health care providers.
Individuals adopted those technologies for personal use with significant spillover into the work
environment. Now hospitals and other health care organizations are purchasing these devices as a
part of their overall information system infrastructure and are facing the challenges associated
with incorporating these devices into their overall systems. At what point should the health care
executives have known that these technologies were here to stay and were something to be
managed? Do the early adopters of the technologies have an advantage or a disadvantage in the
market?
There are no easy answers to these questions, but Gartner, Inc., has developed a useful
framework for health care executives to think about when considering adopting new
technologies. The hype cycle presents a view of how a technology will evolve over time. The
stated purpose is to “provide a sound source of insight to manage its deployment within the
context of . . . specific business goals.” The hype cycle (Figure 12.4) supports organizations in
their decisions to adopt the technology early or wait for further maturation. There are five key
phases to the cycle:
1. Technology trigger. A potential technology breakthrough kicks things off. Early proof-ofconcept stories and media interest trigger significant publicity. Often no usable products exist
and commercial viability is unproven.
2. Peak of inflated expectations. Early publicity by proponents of the technology reaches a
crescendo; often with little practical experience using the technology. Some companies take
action; many do not.
3. Trough of disillusionment. Interest wanes as experiments and implementations fail to deliver
on the hype of the peak. The technology is often immature and users of the technology are just
beginning to learn how to apply the technology to further organizational goals. Producers of the
technology shake out or fail. Investments continue only if the surviving vendors improve their
products to the satisfaction of early adopters.
4. Slope of enlightenment. More instances of how the technology can benefit the enterprise start
to crystallize and become more widely understood. Second- and third-generation mature
products appear from technology providers. More enterprises fund pilots; conservative
companies remain cautious. The real value of the technology begins to emerge.
5. Plateau of productivity. Mainstream adoption starts to take off. Criteria for assessing vendor
and product viability are more clearly defined. The technology’s broad market applicability and
relevance are clearly paying off.
Figure 12.4 Hype cycle for emerging technologies, 2014
Source: Gartner (2014). Used with permission.
In the strategic discussion of new technologies it is prudent to identify where the technology sits
on the hype cycle. It may be premature to invest at scale in technologies that are the peak of
inflated expectations. The organization may be well served to let the market evolve and the
products mature before it initiates significant investment.
However, the organization may decide that the technology, although immature and cloaked in a
fog of hype, has significant potential and that there is merit to conducting pilots so that the
organization begins to understand the potential of the technology and develop prowess in its use.
For example, the Internet of Things mentioned previously is solidly at the peak of inflated
expectations. However, the organization’s strategy may identify this class of technologies as a
potentially very important contributor to its goal of monitoring the health of people with a
chronic disease. Hence the organization will pilot the technology to better understand the impact
of the technology in improving disease management.
Summary
The development of IT alignment and strategic linkage is a complex
undertaking. Four vectors, each complex, must converge. The difficulty of this
undertaking is manifest in the frequent citing of IT alignment in surveys of
major organizational issues and problems. There are no simple answers to
this problem. At the end of the day, good alignment requires talented leaders
(including the CIO) who have effective debates and discussions regarding
strategies and who have very good instincts and understandings about the
organization’s strategy and the potential contribution of IT.
Perspective
Hype Cycle for Healthcare Provider Technologies and Standards
On the Rise
•
FHIR
•
Blue Button+
•
Real-time health care system
•
Voice user interface
At the Peak
•
Natural-language processing (clinical enterprise)
•
E-prescribing of controlled substances
•
Logical data warehouse
•
C-CDA
•
Clinical communications and collaboration
•
Consent management
•
Enterprise file synchronization and sharing
•
Enterprise fraud and misuse management
•
Secure text messaging
•
Health care master data management
•
IT GRCM
Sliding into the Trough
•
Continua
•
Business continuity management planning
•
Unified communications
•
Semantic interoperability/healthcare
•
Legacy decommissioning
•
End-user experience monitoring
•
ICD-10 (US)
•
Direct messaging
•
HIE
•
GS1 Healthcare (GDSN)
•
HL7 Infobutton
Climbing the Slope
•
Desktop virtualization
•
Patient self-service kiosks
•
Positive patient identification
•
Vendor-neutral archive
•
Enterprise mobility services
•
Information life cycle management
•
IHE XDS.b
•
Location- and condition-sensing technologies
•
User administration/provisioning
•
Enterprise content management
•
Patient portals
Entering the Plateau
•
Strong authentication for enterprise access
•
Medical device connectivity
Source: Gartner (2015). Used with permission.
It appears that organizations that are mature in their IT use have evolved
these IT alignment processes to the point at which they are no longer
distinguishable as separate processes. This observation should not be
construed as advice to cease using planning approaches or disband effective
IT steering committees. Such an evolution, to the degree that it is normative,
may occur naturally, just as kids will eventually grow up (at least most of them
will).
QUALITY IMPROVEMENT STUDENT PROJECT PROPOSAL: TYPE YOUR SPECIFIC
TITLE HERE
Fill-in the details below between the brackets
1. BACKGROUND
Setting: Here, describe the place that you will focus on for this proposal and the specific of
that place.
[
].
Health Care Service: In this section, share the specific health care service that you are
proposing a quality improvement for.
[
].
Problem: In this section, describe the specific problem you have found. Be sure to include
evidence from sources that support this is a problem.
[
].
Barriers to Quality: Here, share any barriers that exist that hinder the quality that is needed.
Be sure to provide evidence from sources to support your claims.
[
].
1
2. THE INTERVENTION
In this section, discuss the intervention or solution you are proposing to improve the quality of
the problem you have identified. Provide evidence from sources to support your suggestions.
[
].
Process Defect: Here, include the overall process that will be used to implement the
proposed solution.
[
].
Aim (Objective): Here, state the objective of the proposed intervention.
[
].
3. STRATEGY FOR IMPLEMENTATION
Here, identify and describe the steps or the strategy that will be taken to implement the
intervention.
[
].
Measures: In this space, share what will be used to measure the implementation of the
intervention or how the results of the implementation will be measured.
[
].
2
Barriers to Change: Here, include a discussion of any barriers that could get in the way of the
proposed change. Include any evidence from sources that can support your claims.
[
].
Simple Rules: Here, include the rule that will be satisfied by your proposed intervention.
[
].
Cost Implications: Here, include any costs associated with the proposed intervention.
[
].
3
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