Keep Your Eye on the IT Prize
Fulfilling the transformative promise of healthcare IT requires collaboration among stakeholders and organizational rigor.
By Mary Kelly
You can't open a professional magazine, attend a trade show, or even read your e–mail without being deluged by the latest and greatest information technology “solution.” With all of these IT promises fighting for attention, how can you avoid adding to your collection of horror stories about IT investments that have run over budget and behind schedule, and that haven’t come close to achieving the promised solution? More important, how can you ensure that you’re investing in the IT that truly furthers your organization’s strategic goals?
Bringing the right stakeholders together in a truly collaborative effort can ensure that you harness the transformational possibilities of IT, focus your investment on key organizational goals, and address the key issues of ownership, oversight, capital planning, and measures of success.
Don't Pave the Cow Paths
IT initiatives provide an opportunity to bring the key stakeholders together and allow them to transform clinical processes, according to Kenneth W. Kizer, MD, MPH, president, CEO and Chairman of Medsphere Systems Corporation, Aliso Viejo, Ca.; former founding president and CEO of the National Quality Forum; and the chief architect behind the IT-based transformation of health care within the U.S. Department of Veterans Affairs.
Kizer says that IT initiatives provide the opportunity to rethink what you’re doing, whether it’s important and how you’re doing it. “What concerns me about a lot of the discussion I hear today is that an IT initiative, such as implementing an electronic health records [EHR] initiative, is viewed as an end in itself or that some new technology will miraculously solve problems,” he says. “If used correctly, IT can be a really powerful and helpful tool; if it is not used wisely, it may not be helpful at all. Putting in an EHR is an opportunity to re-look at all processes and improve upon them. If you just put in the IT tool with lousy processes, then you end up just automating lousy processes.”
Marilyn Marchant, MS, vice president of foundation enterprise systems and health services at Siemens Medical Solutions, in Malvern, Pa., concurs. “If you install a new IT system with the expectation that you’re changing something, and then you try to make it match your current process, you end up with a very expensive project, and it usually fails to meet the organization’s needs.”
In addition to recognizing the scope of change, healthcare leaders need to communicate the level of transformation the organization will need to go through as part of a clinical IT initiative. Clinicians, administration and staff all need education about the depth and scope of change so they'll be able to understand the need for change, and anticipate and respond to changes in a positive manner.
“Even big, sophisticated organizations can be naïve about the change that is coming,” says Jay Eisenberg, MD, director physician executive for Cerner Corporation in Kansas City, Mo. “The high-level leaders need to paint the vision so people know this is where we are going. They don’t have to be detailed, but they need to share that a big change is coming and set the expectation for change.”
Eisenberg says key messages should include that the organization understands and supports high-level leaders, the leaders have a great team in place, and they expect the transformation to be a success. “The next level of leadership can provide more details regarding the time line and specific plans,” he says. “The deeper you go into the organizational levels, the more focused and specific you need to become.”
Focus on the Business of Caring
Kizer cautions healthcare leaders to stay focused on their core business. “Sometimes people get wrapped up in IT initiatives and get confused about what business they are in. They start thinking they are in the IT business instead of the healthcare business,” he says. “I think we always have to stay focused on the fact that we are in the healthcare business and IT is just a tool that can help us to do a better job of providing health care.”
John Halamka, MD, CIO of CareGroup Health System and Harvard Medical School, agrees. He says there is no need for a separate high-level IT operating plan. “IT is simply the tactic necessary to execute the business strategy as prioritized by the business owners,” Halamka says. “The IT department should be a strategic asset to the organization, not just a provider.”
John Glaser, CIO of Partners HealthCare in Boston, encourages healthcare leaders to ensure that the IT plan is intrinsically tied to the organization’s strategic plan. “[Leaders should] hesitate to make the IT investment until there is fine-grain mapping from the IT initiatives to the corporate strategic goals,” he says. “They need to identify who is going to be in charge of an IT initiative and correctly resource it with talent and funds.”
Ensure the Project Has the Right Owner
Ownership of IT initiatives has evolved over the years. According to Eisenberg, the nature of IT initiatives has shifted from an administrative focus to a clinical one. Whereas IT leaders used to present projects to physicians and nurse leaders, he says, now the physicians and nurse leaders pave the way on new IT projects.
Glaser sees IT as a tool that is intended to improve some aspect of an organization’s performance, which then affects whom should own the initiative. “Wherever the initiative is targeted, the owner needs to be accountable and ensure appropriate project leadership. This should rarely be an IT person,” he says. “IT should engage the initiative leaders, advise them on what is technically possible, evaluate vendors, and guide initiative leaders through implementation issues.”
Assign Oversight
Healthcare organizations also need an oversight function to keep an IT project on track, help get buy in, set expectations and resolve conflicts. Although the IT department should ultimately drive the project, a cross-functional team needs to take ownership and oversight, says Loren Buysman, vice president, Revenue Cycle Solutions / EIG, for McKesson Provide Technologies.
“All areas of the organization should be involved to make the initiative successful,” Buysman said. “At a basic level, the IT department should still implement and drive the project; however, all areas that are being impacted should provide guidance and assurance that things are moving as planned.”
Steering committees are one type of cross-functional group that can be an effective method of IT governance and oversight. At CareGroup Health System, steering committees form a governance structure that applies to all IT initiatives. “There are IT steering committees for inpatient, outpatient, the emergency department and ancillary services,” Halamka says. The steering committees, made up of physicians, nurses and administrators, prioritize needs and initiatives within their area. These committees ensure that the priorities of the business owners become the work of IT. Business owners become invested in the success of the projects and the team approach to prioritization ensures buy in from all stakeholders.
“Then we have a clinical information steering committee, which is made up of the individual steering committee chairs to deal with issues that cross different areas of the organization,” Halamka says.
According to Eisenberg, if an organization's current steering committee or oversight structure has been successful with previous IT projects, then it may work with minor adjustments for new IT initiatives. However, many organizations have not yet initiated major clinical projects and do not have experience managing this type of project, he says.
“A red flag would be an existing oversight structure that has not been successful with previous IT initiatives,” Eisenberg says. “Clients need to be brutally honest about the skill sets they have and recognize those skills sets they need to acquire on a temporary or permanent basis.”
Employ Rigorous Capital Planning
When it comes to capital planning, some healthcare organizations prefer to approve capital funding on a case–by–case basis, while other organizations take an annual approach to approving projects. Regardless of the approach, organizations should follow a consistent and rigorous corporate finance planning and approval process.
At CareGroup Health Systems, a Resource Allocation Committee (RAC) manages the capital allocation process for the organization. The stakeholders and the CIO present the project to the RAC, which is made up of 30 individuals across all aspects of the hospital. “They grade the project based on information presented and on how it relates to the organization’s strategic goals and other pre-established criteria,” Halamka says. “The projects receiving the highest grades receive capital funding approval.”
In addition to following the organization’s capital planning processes, Glaser emphasizes the need for the CIO to communicate with the CFO about key IT initiatives, current capital plans and where they are likely to go. “Larger projects, such as EHR, require many conversations with several members of the leadership team,” he says. “However, it is the CEO who needs to make the final call on projects that impact the whole organization.”
Measure Success
One area in which healthcare organizations continue to struggle is how to measure IT success. Eisenberg recommends that quantifiable metrics be established as part of the initial project planning process. He encourages healthcare executives to answer the question, “How are you going to know if your project is successful?” Organizations should look at areas where they are having problems, determine how the problems can be addressed, and identify how to measure them, he says. Measurement tool sources include the IT vendors, professional societies, internal organization measures, and partnering with others to create a new measure of success.
Once the organization has moved from planning to implementation, Halamka says that the ultimate measure of success is adoption. Although he relies on reports and matrices that address reliability, return on investment, and work flow improvements, he values adoption data above all others.
Kizer likes to focus on whether or not the organization has reached its strategic goals. In this, he encourages organizations to use quantitative measures of success. “If you can’t measure your progress toward a goal, then you should seriously question why you’re going in that direction.”
Ultimately, health leaders need to remember that success can’t be measured just once; it needs to be reevaluated over the long term, Buysman says. “The complexity of systems today makes it imperative that short-term goals are met as well as where they are in a year, two years, etcetera,” he says. “Most IT initiatives are not short-term commitments anymore—they are partnerships.”