The Institute of Medicine (IOM) views a learning organization as one that has the ability to evolve its performance by repeating the overall closed “learning loop” hundreds—and maybe thousands—of times. This process is necessary as the organization continually improves upon prior learning, alters its priorities to address new areas of improvement, and discovers new knowledge.

This view of learning as an evolutionary process has several consequences for a healthcare provider’s IT department and resources.

Implementation never stops. There may be a flurry of intense effort as the foundation for becoming a learning organization is laid. The initial introduction of the electronic health record and business intelligence is difficult work that requires great skill and significant resources. However, once the foundation has been laid, implementation continues as the foundation is built upon. In fact, it continues forever.

In a world in which implementation never stops, management and clinical mechanisms must exist to manage ongoing implementations of healthcare IT. These mechanisms must continually identify the next area to be leveraged, ensure that the requisite analyses are performed, install needed software modifications and enhancements, and reengineer relevant processes. In effect, these processes and mechanisms must continue the tasks that one typically sees prior to go-live in a traditional implementation.

Architecture becomes more important.The IT foundation must be able to support an implementation that never ends and must be able to evolve gracefully. Tools that enable rule development, the safe addition of local modifications, the incorporation of new data types and coding conventions, and efficient interoperability with other systems become essential to a healthcare learning organization. The foundation must be able to capitalize on new technologies in a manner that is both efficient and minimally disruptive.

In many ways, the architecture, technologies, and tools that enable ongoing implementation may be more important than the current functionality of the application.

Determining ROI becomes more difficult.Assessing the ROI of applications that evolve is a more difficult exercise than determining the ROI of an application that has a well-defined set of static capabilities. Although the ROI analysis should never conclude, “We can’t assess the ROI because we don’t know how we’ll evolve,” it nonetheless becomes more difficult to state the outcome of a never-ending implementation. Despite the analysis challenges posed, the organization is much more likely to see a return if it views its task as the implementation of an application that is constantly changing than if it views its task as the serial implementation of static applications.


For more information, see John Glaser and J. Marc Overhage's "Becoming a Learning Organization:The Role of Healthcare IT," hfm, February 2013.

Publication Date: Friday, February 01, 2013

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