Week 7

Health IT strategy is something that seems standard regardless of the organization discussed in our MHA program.  However, IT strategy is very different across organizations and varies much even within an organization.  For instance, the radiology department's work and platforms used is much different and influences the workflow of other departments within an organization.  With a 3-5 year strategy plan to implement new systems, many assume technology is a magical tool that resolves even the culture of an organization.  It may definitely influence a culture of an organization, but likely in a negative way when not properly balanced with meaningful change management.

A challenge I foresee for many organizations with the growth of health IT is variation.  One of the issues from variation that comes up is the lack of interoperability.  Even though many organizations are contracted with the same vendors such as EPIC and Cerner, each organization customizes everything even down to how the data is being collected.  This poses an enormous obstacle in streamlining what is necessary and valuable data and what is considered junk down the line.  This leads to another challenge with variation, the difficulty in addressing population health.  With data being collected so differently between organizations, it's hard for those who do want to address population health to even get the definition aligned as everyone has very different definitions to what to address.

I honestly take these challenges as a good thing in terms of my career in health care.  I don't think I'll ever be out of a job and because the obstacles health faces not only on the delivery side, but other aspects such as the payer, vendors, etc. I am encouraged that I will always find something that is of interest.

Week 7

Week 7- 

This week the subject of data sharing was discussed.  Data sharing can offer new ways of delivering care by allowing patient's information to follow them from one organization to another.  It allows care providers to see a full view of a patient's history without the patient having to request their chart. Perceptions must be challenged that patient data is proprietary.  Organizations should change their view regarding sharing patient data to how the data and data sharing can best benefit their patients. According to an article from The Network for Public Health Law, patient data sharing adds many benefits to patients, health care workers and public health officials, including: Earlier detection of infectious disease outbreaks, improved tracking of patients’ chronic disease management, improved coordination of care across public and private providers, reduction of adverse health care events and more accurate assessments of the amount of disease in the community and of the impact of community-wide prevention initiatives.

Week 7

By: Connor Ledbetter

 The topic for health informatics this week pertained to information exchanges and the need for the seamless flow of data from one provider or location to another, especially amongst those within the same health system.  I am not a techy (I've never even had a twitter account) nor do I claim to be, and for that reason I cannot speak to the specifics of data exchanges, or the technical difficulties that may arise. It is with that in mind, that I will reflect upon the conversation this week from a non-technical approach and some of my views as to why the need for data exchange has arisen.

First of all, I believe that the need for the smooth sharing of information from one organization to another has arisen the shift to a more consumer focus in the healthcare industry. As healthcare increasingly focuses on patients as consumers, we continue to identify pain points (no pun intended) for patients in the process of healthcare delivery and alleviate those pains. Patients being required to fill out the same paper work at every visit, or every time that they walk into a healthcare facility is one of those pain points. To make matters worse, patients often compare the healthcare industry to other industries that are far more advanced in capturing information and relaying throughout their organization to the point of completely understanding customers preferences and expectations.
Additionally, I believe the issue has arisen internally within the healthcare industry as of late due to the meaningful use funds that many healthcare organizations received through the American Recovery and Reinvestment Act. Up to that point some organizations had EMRs but many still operated with paper forms. However, through meaningful use funds, many organizations made the shift to electronics health records and for the first time, it became possible to share information from one organization to the next electronically.

I believe the need for increased retention and sharing of data through exchanges in the healthcare sector is not going away. This is something that consumers will increasingly call for and organizations will move to address.

Week 7

Strategy was our topic for the week.  Dave kept stressing to us that health IT strategy is probably the most complicated chapter in the textbook we are using.  I found this an interesting comment to make, but can certainly appreciate it.  IT strategy for a healthcare organization must be aligned with the strategic plan and the overarching goals of the organization.  In today's healthcare environment, successfully setting and implementing IT strategy is complicated because IT must support the human resources and clinical/non-clinical workflows, IT/IS investments are expensive, IT requires significant ongoing labor costs, technology continues to change year after year, and the business and technology models of the organization must be aligned.  In many situations, adding technology to a broken or bad process will only highlight and exacerbate the problems that exist, so it is important to define the function before one attempts to define or add on to the form.

I enjoyed the class activity, in which Larry and Sarah must make a decision about dealing with the requests from Placebo Domingo and Anne Nemia about replacing the old IV pumps with smart IV pumps.  Our groups talked about how senior leadership must stress the importance of thinking about strategy holistically from a higher level.  Strategic development is about setting the true north of the organization and the strategic goals to bring the organization closer to its vision.  It is important for us to think about the need for senior leadership to balance between different needs and priorities with a set budget.  Unfortunately, I'm not sure there's always a right answer?

Finally, I just want to add that I really appreciate the quote Dave shared with us on the Canvas module.  It definitely captures the essence of what strategy is at its core.  Additionally, the quote also helps us understand why having good strategy is important for an organization.

"Tactics is knowing what to do when there is something to do.
Strategy is knowing what to do when there is nothing to do."- Ksawery Tartakower

Week 7

     Working this summer on all of the clinical data registries throughout UW Medical Center gave me an appreciation for just how much data is out there and gets sent around to a variety of organizations.  However, I'd like to start with addressing the information at the beginning of the case study pertaining to filling out forms.  Before my current position I worked the front desk at an Urgent Care clinic and was responsible for collecting paperwork from individuals.  Over the course of the time I worked there we shifted from a "need to have a form filled out once a year" to "need to have a form filled out once period".  This shift prevented me from having a lot of extra stress in my job.  The argument that we need to ensure that none of your information has changed is valid but extremely frustrating for someone who has lived in the same house with the same phone number for 20 years.  The biggest problem for most of these situations is legal compliance.  Sometimes people would go to the Emergency Room and follow up with us 3 days later and have to fill out a new form because our physicians work under a different medical group and therefore need a different signature for liability protection.  It is incredible frustrating for patients to have separate billing and separate registration systems for different locations within the same organization.  Luckily, we at least had the information from visits in both places which saves trouble.
     In terms of the need for data in various locations there are less complications but still several.  The biggest problem is the lack of centralized oversight.  It might be that one department is collecting certain types of information for one registry while another is collecting the same information to send off to the DOH and neither has any idea the other one is doing it.  At least with demographic information filling out forms the patient is aware and complaints can be heard and addressed.  When it comes to things like registry data the only way to find out about the overlap is to have the two people abstracting the data to happen to talk to each other which is very unlikely.  These kinds of hidden wastes are rampant in larger systems.  We finally formed a sub-committee to look at registry participation and figure out who is collecting what data and sending it where to cut out a lot of dead weight.

Week 7

By Lili Hozakowska:

Because of last week’s detour we’ve gotten a bit behind in our class, meaning we were only able to discuss HIT strategic planning today. While I related HIT strategic planning to last week’s post-election discussion in my last reflection, this time I wanted to focus a little more on the lessons learned from the case study. During the presentations today, team Mason showed an IBM advertisement for a new health IT system. It looked like a great product! However, our class began questioning its validity just as we have been taught to do since the first day of this MHA program. How were we supposed to know if it was working accurately?

We began discussing the case study with our teams while still in this skeptic mindset. How necessary are these smart pumps? Did they truly work only half the time, or was that an exaggeration? Why do they need to come out of the IT budget? Before making any decision, it’s important that all of these questions are considered so that we are armed with all necessary information. However, we should always keep the bigger picture in mind as well. If these smart pumps are taken out of the IT budget, then we won’t be able to complete the CPOE implementation. How might that affect the organization? Would the pumps or the CPOE system be more beneficial at this time for Moyen Sante as a whole? While there are strong arguments made for the pumps, it is the job of the executives to make the best decision possible for their entire organization, rather than focusing solely on department-specific benefits.

One last question that was brought up today that I wanted to discuss was about the impact of advancing technology on IT strategic planning. How are we supposed to account for technologies that have yet to be invented when we formulate a 3 to 5 year IT strategic plan? The fear of creating a plan that will soon become obsolete should not be a deterrent, however. In my opinion, the best plan would detail the first year thoroughly and then provide more of an outline for the following years. An IT strategic plan should always be monitored and revised to keep up with the times, both internally and externally of the organization. Taking this approach should make the process of developing a comprehensive HIT strategic plan a little less daunting. Health IT will only continue growing in importance and it is vital that we, as health care students and one day health care administrators, learn how best to adapt and embrace this ever-changing environment.

Week 6

This week's class dialogue strayed from the usual informatics topic and was instead invested on the class response to the elections.  Instead of dwelling on the emotions I have towards the results of the elections, I want to stay on track with informatics.  I firmly believe information technology will never be lesser of a priority with this presidency or with any other presidency.  As we have read from this class and others, health care has invested far too much and has had bipartisan support all along.  Although our MHA community as well as the rest of the health care community has been shaken with the results of the elections, health care has historically time and time again been resilient through change and has been able to sustain because ultimately people believe health care is a human right for all.

In terms of strategy for health IT, I think one of the more larger scope strategies will be to ensure there is healthy competition between vendors.  This is something that regulators and legislators will need to get more involved with.  Over the years, large entities such as Cerner, EPIC, and McKesson have held a strong hold over health care delivery systems.  This is the case because they have contracted with delivery systems that are able to afford the services.  However, there are plenty of smaller entities that have been surviving when the larger entities refuse to invest due to smaller payments not worth the time.  I think legislators will need to work more aggressively to ensure that a few companies do not monopolize the health care industry and continue the legacy and practice of the failure of interoperability.

Chapter 6- Tactics is knowing what to do when there is something to do. Strategy is knowing what to do when there is nothing to do.

What is the relationship between IT strategy and organization wide strategy?

Strategic goals between two organizations that are in the same industry will differ. Although they may be in the business of doing, relatively, the same thing, the strategy of one hospital will be slightly different from the strategy of another hospital. Similarly, the strategy of one department within a hospital will be different from the strategy of another department within the same hospital. The difference between these two examples however is this, the strategies of two departments within in the same organization should be working toward the achievement of the same overall strategy of the organization. Two differing hospitals have no obligation to align their strategies.

The point of HIS strategy should be to build the organization’s IT structure and functionality in support of the organization’s goals. The HIT strategy will, of course, have its’ own goals and objectives. However, the specific set goals and objectives within the HIT strategy should be in pursuit of the overall strategy of the organization. In essence, the role of an HIT strategic plan should be to translate the organization’s strategic plan into HIT language, including the infrastructure, resources, capabilities, and projects needed to achieve the overarching goals. The goals and objectives should push the organization toward the overall strategic plan, and if they hinder the pursuit of the overall strategic plan in anyway, they should be rethought. When developing a strategic plan for the HIT department, it may be beneficial to think of the organization’s strategic plan as a map or compass. It is a tool that will guide the direction of the organization as well as direct the path of the HIT strategic plan.

Lastly, the argument may be made that the development of a strategic plan for HIT plays a more critical role than the development of a strategic plan for another department. This is due to the nature of the work in an HIT department. HIT projects consume a great deal of resources, are costly, and take a significant amount of planning and time to implement. Because of this, a clear direction and clarity in decision making is critical for leaders in HIT, and having a HIT strategic plan can help bring coherence to HIT leaders as they guide their department.

What are the difficulties in crafting an IT strategic plan (changing technology horizons etc…)?

Creating a good IT strategic plan is challenging for many reasons.  One of the possible challenges is a lack of strong leadership that will be accountable for proper, timely implementation.  Implementing all components of a healthcare organization’s IT strategic plan is as important, if not more important, than formulating and writing out the strategic plan.  conflicting priorities and interests among leadership on investment.  Accountability ultimately means that each leader is responsible for helping to achieve desired goals through use of the implemented IT/IS investments.  Likely, measurement of progress towards these set goals will be tracked by financial cost savings, workflow efficiencies or improved clinical outcomes.  Without strong leadership, a healthcare organization’s IT strategic plan is guaranteed to fail.     

Another challenge to crafting a good IT strategic plan is competing priorities within the healthcare organization.  Strategic planning is about consensus building.  Done appropriately, the process is meant to promote communication, participation, and collaboration.  Unfortunately, competing priorities often still exist and impede the strategic planning and implementation processes, especially in healthcare organizations that are pursuing ambitious growth or many subsidiaries, members and parties to allocate organizational resources to.  Sometimes, different members of the senior leadership team will be in direct conflict over whether or not the organization should spend money on purchasing and installing a new firewall or building out a new program.  

Finally, we must be acutely aware is that technology is always rapidly changing.  Each year, one will realize that the newest generations, editions and updates of last year are already outdated and soon to be replaced-- if not already replaced.  Understanding of the dynamic nature of technology and the healthcare environment forces IT leadership and organizational leadership to look both short term and long term when deciding what types of IT investments will be made today, as well as what to investments to hold off on.  In an rapidly changing policy landscape as well, it is important to consider stay current on hot topic issues in healthcare reform and innovations in health IT management.   

What are the key criteria that should be viewed as most important while creating an IT strategic plan?

One of the key criteria of an effective IT strategic plan is its alignment with the organization’s goals. Therefore, when formulating an IT strategic plan, the most important thing to do is to first review the overall strategic plan of the entire organization, including its mission, vision, and values. This allows for the easy identification of areas where technology could enhance processes, which often helps establish a direction for the IT strategic plan. Similarly, as various projects are being considered for the IT plan, they should be evaluated on the bases of how they could contribute to the strategic goals of the organization. Overall, however, the “plan should focus on business needs, the ability of IT to meet those needs, how to close any gaps, how decisions will be made, and how to measure progress,” according to cio.com.

It’s essential to note though that it is not the deliverable itself that is most important when developing an IT strategic plan, but the process of creating it. Stakeholders and internal staff should be surveyed, interviewed, and involved in a variety of other ways in the development of the IT strategic plan. There must be collaboration between IT and non-IT staff so that ideas can be generated, common themes extrapolated, and a direction for the plan selected. In order for the plan to be implemented at some point, this creation process must ensure that partnerships are cultivated and silos broken down so that those who perform the functions affected by the plan have some buy-in.

Additionally, as is the case with any strategic plan, metrics and a review process should be identified. These are key to developing effective IT strategic plans because an organization must be aware of the progress made toward their goals. Because strategic plans span a period of approximately three to five years, it is important to evaluate progress and review methods to ensure that everything is performing as it should. If something is wrong, the review process allows an organization to catch the error and adjust so that they do not head too far in the wrong direction.

The last key criteria of an IT strategic plan to be mentioned here will be brevity. Plans and reports often come with executive summaries because people rarely will take the time in a professional setting to read more than a few pages. Keeping this in mind, it is wise to keep an IT strategic plan brief and focused on just the most crucial elements. Additionally, “sharpening the focus allows the team to be bolder and the plan to be more actionable and visionary.” While there are numerous other criteria to be considered when developing an IT strategic plan, organizational alignment, stakeholder engagement, metrics, and brevity are a few of the most important criteria that should be considered.

How can an IT strategic plan ensure that the organization remains flexible and able to build upon their existing foundation?

The IT strategic plan must fall into step with the overall goals and plan of the organization.  The link between IT strategy and the organizational strategy involves building an IT infrastructure surrounding initiatives such as: adding or changing services,improving services, expanding services, or improving data sharing amongst entities.  The linking of the two strategies usually means an improvement in core processes and information management. An example of this would be the use of drug interaction software. Drug interaction software can quickly alert a prescriber or reviewing pharmacist or nurse about potential conflicts at the moment a medication’s name is entered. A good software program can perform the checks and make the alerts more quickly and reliably than a manual system.  This type of improvement in core processes would ensure that the number of medication errors would decrease, thus fulfilling the organization's overall goal of reducing medical errors of all kinds.  

The IT strategic plan should be a roadmap that outlines exactly what deliverables will contribute business value and where an organization can gain competitive advantage within the marketplace.  The IT strategy must be pliable enough to accommodate new business priorities and technologies that have the potential for driving growth within the organization, and the IT leadership team should look at areas where technology could enhance the overall mission and vision of the organization.  The strategic plan must not only outline timeline goals, it must be clear about its ultimate goals, including a list of technology investments that the IT department deems a priority to contribute to the organization's success.  This will create a check and balance to ensure the IT strategic plan always comes back to the overall strategy of the organization.  

Finally, since the healthcare industry is calling for a more patient centered approach, it is important to build upon this IT strategy to improve workflows. There are tools that can be implemented by IT which are patient-facing.  Patients may like the convenience of using a kiosk instead of waiting to check in with the receptionist.  Or perhaps the use of a tablet device for an online interpreter service which can be used at a moment's notice instead of trying to book an in person interpreter.  

How is IT able to provide competitive advantages for its organization?

In order to provide an organization with a competitive advantage, an IT solution must impact the way that the organization interacts with its patients in some regard. Instituting a computerized billing system can be an important organizational goal but since the patient is unlikely to know about it or have it affect them, it is not truly a form of competitive advantage. The implementation of an EHR system was viewed as a significant advantage for an organization several years ago. However, now that every hospital has some form of EHR there are less obvious opportunities for an organization to differentiate themselves from their competitors in this regard.

Other forms of technology can lead to improved patient care. On the primary care side of the organization, technology such as self-scheduling or patient portals may greatly increase user satisfaction and provide an advantage. Access to care through reduced wait times can be frustrating for many patients so any IT strategy which makes this process easier might provide an advantage. At the very least, they can prevent falling further behind even if they are unable to lead to a direct advantage themselves. For hospitals a major source of competitive advantage comes from medical devices and technology. Having a device which allows them to perform rare or difficult types of surgery can provide new revenue streams for the hospital which are unavailable to nearby organizations. Before undertaking this type of investment there must be a thorough market analysis performed in order to make sure that the capital investment, which can cost tens of millions of dollars, has a suitable return on investment within that market.

The last element that can provide a competitive advantage for a healthcare organization is quality. It becomes much more difficult to pinpoint a specific IT investment to lead to this type of advantage and instead must be viewed as a whole. Organizations which choose to differentiate themselves on the basis of quality need to look at many different IT investments to shore up areas of weakness and improve strengths. Increasing the ability to use population-level data to provide better management of care might be one way to market on the basis of quality. Strategy plays an increasingly important role in the way that an organization addresses quality in an environment moving ever closer to population health and value based payments.

How does the potential future for value based payments and population health shape the way that IT strategy should be created?

With the aftermath of the elections, many wonder and possibly worry about the future of value-based payment initiatives.  Because transparency and data for patients and providers as well as for payers were ideas of interest long before the Affordable Care Act was even drafted, there should be no real concern regarding the future of the value-based care and its influence on HIT strategy.  In fact, HIT has been on the bipartisan agenda for as long as health information has been incorporated into technology.  Both democratic and republican parties support health IT and agree that it just makes sense.   

One example that health IT strategy is not much different despite party differences lives in the inherent values of Newt Gingrich.  Gingrich advocates for “a transformed, more personally responsible, incentive-led, and information-rich system” to reduce medical errors and allow for EHR systems to be interoperable so that IT can be a backbone for healthcare to provide real-time strengths for which to make critical decisions whether it is in the hospital or for a national crisis like bioterrorism.  Ultimately this allows for care to be deliberate to minimize unnecessary expenditures and costs.   

If the ACA is repealed without an alternative that has a strong health IT focus, about 10 million Americans may lose out on health care coverage and access.  This also stampedes on the ability for health care delivery systems to make an impact on population health as a potential 10 million people will not be able to go in regularly to see a healthcare provider.  There will be less or no tracking of patients’ health status and it also challenges whether effective measures can be made regarding quality.  Care quality gaps can be identified and people who are slipping through the cracks can be identified more quickly and easily.

 

Sources:
http://library.books24x7.com.offcampus.lib.washington.edu/assetviewer.aspx?bookid=73688&chunkid=640886457&noteMenuToggle=0&leftMenuState=1
http://www.aalgroup.org/newsletter/?p=279

http://www.ihi.org/resources/Pages/Changes/UseDrugInteractionSoftware.aspx

http://searchcio.techtarget.com/definition/IT-strategic-plan-information-technology-strategic-plan

http://www.healthcareitnews.com/news/5-tips-creating-strategic-plan-it

http://www.leadingage.org/uploadedFiles/Content/About/CAST/Resources/Seven_Steps%20_IT_Strategic_Plan.pdf

http://www.cio.com/article/2437285/business-alignment/anatomy-of-an-it-strategic-plan.html

https://campustechnology.com/articles/2016/05/26/3-keys-to-creating-an-it-strategic-plan.aspx

http://www.modernhealthcare.com/article/20161111/MAGAZINE/161109907

http://www.healthcareitnews.com/news/commentary-trump-must-respect-value-health-it-us-president

Week 6

Last week, our class spent the entire session together reflecting about the election of the night before and its implications for us moving forward.  It's safe to say that we do not yet know what will happen- the future is still uncertain with regards to policy (health and otherwise).  I must say that the entire experience of classmates sharing their fears and personal thoughts to be very enlightening and emotional.  During the discussion, I had expressed myself that the power of vulnerability and personal story-telling should not be undervalued.  Instead of attacking others, we must look forward and do our best with the people we love and will work with to make this world a better place.

With regards to health informatics and health IT, we may see some changes if the ACA (or parts of it) is repealed.  However, MACRA received bipartisan support in Congress when it was passed just last year and the need for physician and physician groups to utilize interoperable health IT and data analytics will continue to play a large role in determining how clinicians are reimbursed.  I just learned last week that the meaningful use program will sunset in a matter of years as MACRA is implemented in steps.  At any rate, health informatics management will indisputably remain relevant to our work moving forward.

Week 6

Developing a robust ability for change is the ultimate strategic goal when implementing an IT project.  Many HIT projects hit barriers because there is a power struggle between what each department wants versus the strategy for the entire organization.  Many departments take their own priorities and feel compelled to make a "burning platform" case under the premise of patient safety or patient satisfaction.  Leadership must then choose which departmental priorities actually contribute to the overall strategy of the organization.

The organizational strategy must work hand in hand with IT strategy.  Strong IT strategy makes an organization more agile in order to meet changing patient demands, and changing technology.  This also looks back to the idea of adding value to the organization, therefore increasing the return on investment within a HIT project.  If an organization is increasing agile in their response to the changing marketplace, than they are more apt to survive a downturn of some kind or an adverse event.

Week 6

For this week’s HIT reflection, I’d like to stray a bit from the usual format and instead relate this week’s topic of IT strategic plans to this week’s class discussion about the election. In class we openly discussed our feelings about the outcome of the election, our fears for the future, our goals as individuals, and our hopes for society. We learned how we could support others in our cohort moving forward. We slowly came to a conclusion about what we could do outside of the classroom to combat the changes we have already begun to see. In essence, we came up with a strategic plan to help us achieve the unity we hope for despite the pending challenges of a Trump reign. If we view this plan as being similar to an organizational strategic plan, we could view our individual plans as comparative to IT strategic plans.

An IT strategic plan must align with the organizational strategic plan. Organizations have long-term plans for their future and IT can be an integral piece of achieving those goals. By creating an IT strategic plan, we are identifying the areas in which we feel that IT can enhance processes and are determining what steps we must take so that organizational goals can be realized. Similarly, after our class discussion, many of us walked away with individual plans. We recognized some of the ways that we, as individuals, may be able to contribute to broader, societal goals of unity. Having a strategic approach to overcoming obstacles is essential, but we must remember that there are a variety of tools at our disposal that should also be used strategically. Whether it is our individual contribution to societal improvement or the benefits that IT can bring to an organization, we must always use a strategic approach to ensure that proper actions are being taken to achieve our long-term goals.

Week 6

        The case study for this week emphasized further the need for change management but focused mainly on the strategy element.  A central problem for any organization is keeping the goals of the entire organization in focus over the goals of individuals or specific departments.  In this particular case, the nurses knew that they had a need and viewed that need as more important than anything else going on.  It is possible that this was true but the delay in determining whether it is true is incomprehensible from their standpoint.
        This past summer at UWMC I got to experience some of the changes put forth by management in order to re-design roles and departments for the good of the organization.  When viewed at the 30,000 foot level, all of these role changes made sense.  Some departments were working on projects that really shouldn't have fallen under their jurisdiction and it was best for the organization to arrange things differently.  However, without constant communication it is very hard for the people on the ground to understand what is happening.  It may be helpful to speak to departmental leaders but then you are relying on those leaders to accurately represent the viewpoint to their staff.  Every time the conversation gets a level removed the odds increase that things get lost in translation as if during a game of telephone.  In our case, panic in the department spread until we were able to get the new CAO to give a presentation accurately displaying the viewpoint.  This substantially calmed everyone's nerves and helped them to feel engaged with the process.
        Within the case study it sounds as if this approach is what Larry tried to take.  Including the nurses in the discussion is the proper way to increase buy-in and to allow them to understand the process that you have to go through.  However, it is still difficult for many clinical staff members to engage in any kind of strategy discussion.  Whenever someone is asked to consider the greater good over the things that directly impact their jobs on a day to day basis, there are challenges.  Hiring strong middle management who are able to go between the CIO or CMIO and the nursing staff or the physicians is the surest way to achieve success in these endeavors.  This is easier said than done in the current hiring climate but in that case putting resources into training of change management or leadership skills is likely an investment that will pay off in the long run.

Week 6

By: Connor Ledbetter

The case study this week was an interesting one for me due to the overlap that it has with a class that we have previously taken, strategic planning. This past summer I had the opportunity to work first hand on the strategic planning process and saw what it constitutes first hand. Yet, my experience with strategic planning to date has all been done at the level that focuses on the organization as a whole. This case study emphasizes the importance of developing a strategic plan for a single department, in this case the HIT department. Further, through our research on the case study and answering some of the essential questions that we developed for our main blog post this week I came to realize a couple of complimentary benefits that arise when departments conduct a strategic planning process. On one hand an HIT strategic plan will help align the goals of the department with the overall goals of the organization. On the other hand a strategic plan for the HIT department can help to enlighten the rest of the organization, specifically senior leadership, on the needs and plans for the department moving forward.

A significant take-away for me from this case study and our research this past week is the importance of planning and transparency in throughout the planning process, whether that is done at the organizational level or for a specific department. I do not have a desire to work in HIT in the future, however the lessons that this case study brought forward are applicable to any number of departments or functions within a hospital. If, in the future, I am in a position to develop a strategic plan I will remember to keep in mind how important it will be to make the plan both known to the department as well as senior leadership. I will need to ensure that the goals and objectives of the plan align and pursue the goals and objectives of the organizational strategic plan, and I will be need to ensure that the strategic planning process considers the opinions of all stakeholders involved.

Chapter 5 - A Million Here, A Million There

What Measures are Useful?

This weeks discussion centered on how to assess the value of a HIT project.  Value for this type of project does not just boil down to dollars and cents, it looks to the tangible and intangible values that make a HIT project successful...or not.  When you measure value, one must look at the increase revenue collected by an organization after the successful implementation of an EHR.  According to a study in the Journal of the American Medical Informatics Association, EHR implementation may lead to a dip in patient volume but can boost revenue in the long term.

Intangible value is very difficult to measure.  However, the are value added to the organization.  Improved decision making imparts immense value because EHRs allow care providers the ability to see the whole picture when reviewing a patients chart and determining the best course of care.  The ability to collaborate with other care providers to offer comprehensive care to a patient is hard to measure in terms of dollars yet its intangible value is understood through the improvement of care.

http://www.beckershospitalreview.com/healthcare-information-technology/study-ehrs-decrease-number-of-patients-seen-but-increase-revenue.html


How do we determine what success will look like for a given initiative?

One aspect of an IT proposal that can often be overlooked is answering “what will success for the project look like?”  This question may seem as if it does not need to be addressed until implementation but the earlier the question is asked the easier it will be to answer.  It is possible that part of an initiative may be set up in such a way that it is impossible to gain meaningful data and that a small change would rectify this problem.  The only way to make this change before it is too late is if the project is properly planned.  During this chapter we will look at a hypothetical IT initiative, in this case the implementation of a telemedicine program between urban specialists and rural primary care, and examine how to effectively manage the data which the program will provide.

The first step in determining success is to figure out what the objective is trying to achieve. By having a clear picture of what the ideal end state will be it will allow administrators to create meaningful metrics.  In the case of the telemedicine setup there are several objectives which contribute to success.  If everything works to perfection on the clinic’s side it means that rural patients will be able to get instant access to specialists who normally would require a day’s travel and a week’s wait for an appointment.  Additionally, they would have increased patient satisfaction and a better relationship with those patients.  From the specialist’s perspective, an ideal initiative would mean a better relationship with rural providers and an increased likelihood that they will refer their patients to the medical center in the future.  Now that we have an idea of what success looks like we can attempt to come up with ways to measure and sustain that success.


http://site.ebrary.com.offcampus.lib.washington.edu/lib/uwash/reader.action?docID=10734602


Can we use the data to make actionable decisions?

The data and evaluations of the overall value that a health IT investment generates should provide the very basis upon which healthcare leaders make actionable decisions.  As business value of health IT can be measured through outcome metrics such as cost reductions, time savings, workflow efficiency, utilization reduction, physician satisfaction, patient satisfaction, it is important for healthcare leaders to also recognize that health IT can generate social value.  When weighing decisions on what types of health IT investments should be made, we must always keep our organization’s mission, vision, and values in mind as we move forward with formulating strategy and, specifically, health IT strategy that should be aligned with the organization’s overall aims.  Viewing health IT as a key strategic asset instead of merely a tool to cut costs and improve patient care quality, healthcare leaders will see the need to make smart investments that are aligned with their strategic goals.

Chief Information Officers should be acutely aware of current and upcoming trends, news, and best practices in newly available health IT products and services, the latest health IT investment decisions of other healthcare organizations, health IT strategy, as well as new ways to leverage health IT and data analytics.  CIOs are responsible for collecting this information, bringing it back to the organization, and using his business acumen, expertise, and knowledge to make recommendations to the rest of the senior leaders that will need to be on-board with expensive health IT investments.  Other senior leaders, including the CEO and CFO, will assert significant influence over whether or not a health IT investment will be made, based on space in the budget for IT, competing organizational priorities, and their assessment of organizational readiness.

http://www.modernhealthcare.com/article/20150411/MAGAZINE/304119976
http://www.ajmc.com/journals/issue/2014/2014-11-vol20-sp/the-value-of-health-information-technology-filling-the-knowledge-gap/P-1


Is doing an ROI a waste of time?

Electronic Health Records are increasingly in popularity for a number of justifiable reasons. However, as of recent, the passage of MACRA has made the reporting of data and quality metrics a financially rewarded, or punitive if not reported, factor for physician reimbursement. This was the federal government’s way of mandating that all physician practices implement EHRs. Many may ask themselves then, if this is something that I have to purchase and implement, is there any point to conducting an ROI for the EHR? In the traditional sense of an ROI the answer would be no. Often times, ROIs are used to justify an investment and in many cases are the means through which the investment was approved. However, with EHRs being mandated by the federal physician reimbursement system there is no longer the need to justify the purchase, the justification has become explicit. With this understanding, it is important to realize that there are other benefits to an ROI that still validate the effort to facilitating one. These benefits and the reasons to continue the practice of ROIs will be explored a little further in the following section.

When it comes to an EHR, there is no easy way to conduct an ROI as many of the benefits are difficult to quantify such as enhanced patient satisfaction, better quality of care, and improved security over prescribed medication. Yet, that does not mean that the need for an ROI has become obsolete. Even when ROIs are not used to justify a project, there is still value in them as a tool to measure performance and make changes incrementally if the technology is not meeting expectations. In the business setting, ROIs are understood and although the reasoning behind needing to do them has changed, they should still be done as they contribute value and clarity to the implementation process.

http://medcitynews.com/2013/10/ehr-roi-vs-ehr-implementation-costs/?rf=1
http://www.acog.org/About-ACOG/ACOG-Departments/Health-Information-Technology/Electronic-Medical-Records--Return-on-Investment
http://bok.ahima.org/doc?oid=101607#.WCHpsIWcHIU


How would you perform your evaluation?

When making post-evaluations of your EHR implementation, it is important to revisit the expectations and proposals made initially when the project was being formulated.  First and foremost is to see if the implementation meets the anticipated deadline.  Once go-live begins, it is good for any organization to review where it is in terms of progress.  Second, all EHR implementations run over budget and even with the best intention and best planning, it is difficult for many organizations to budget precise costs.  An evaluation of the financial standing and assessing the budget will highlight which areas to focus on to stop financial leakage.  Third, workflows should be evaluated.  Checking to see whether staff are able to work efficiently and effectively with this new technology will help identify training needs, system interface issues, and vendor issues.  Although this may be a requirement during post-implementation, this should be woven throughout the planning and launch process.  Since EHR implementations are very costly, this gives opportunity to report back to vendors what is not working for the organization.  Last and most importantly, staff should be evaluated.  People are the best resources in many capacities in health care, but they are often overlooked by more appealing and innovative technologies.  Surveying whether staff have easily acclimated to the new system and made the new system a part of the organization’s culture is valuable.  As you can see, evaluating EHR implementations is not simply a financial review.  It requires leadership to evaluate the connections the organization has with its vendors and its staff and to make sure valuable resources are utilized to the best of its ability.


http://site.ebrary.com.offcampus.lib.washington.edu/lib/uwash/reader.action?docID=10734602&ppg=593
https://www.healthit.gov/providers-professionals/faqs/how-do-i-conduct-post-implementation-evaluation

Week 5

ROI- Do the savings and benefits outweigh the substantial costs?

In terms of tangible process improvement, yes there are substantial savings from the implementation of an EHR.  Fewer errors are one of the most important and cost saving benefits of the implementation of a new EHR. Care providers are able readily catch errors when they have a comprehensive listing of a patient's diagnosis and listing of medications. According to healthit.gov, the benefits of an EHR are:

1. A qualified EHR not only keeps a record of a patient's medications or allergies, it also automatically checks for problems whenever a new medication is prescribed and alerts the clinician to potential conflicts. 
2. Information gathered by a primary care provider and recorded in an EHR tells a clinician in the emergency department about a patient's life-threatening allergy, and emergency staff can adjust care appropriately, even if the patient is unconscious.   
3.    EHRs can expose potential safety problems when they occur, helping providers avoid more serious consequences for patients and leading to better patient outcomes.
4.     EHRs can help providers quickly and systematically identify and correct operational problems. In a paper-based setting, identifying such problems is much more difficult, and correcting them can take years.                 

Although the above may not be able to be accurately measured by tangible dollars, the return on investment from the implementation of the most updated EHR is obvious once one measures it by the errors it saves.  Therefore, patient safety is really what the ROI comes down to.

Week 5

A million here, a million there.  What a great name for this week's discussion on Health IT investments.  Healthcare leaders are making decisions with consequences on a very large scale when it comes to paying big upfront and ongoing costs towards building and maintaining health IT infrastructure and systems, as well as covering the costs of system upgrades and training and hiring new staff.  Because of this, I think this week's discussion and thinking about how to make the right strategic health IT investments was important.

A clear understanding of what we aim to achieve and the measures we will use to evaluate the success of our investments, based on the value they generate, is critical to making wise decisions.  Lots of literature has been written about the different types of value that health IT can generate if implemented and used appropriately-- such as improvements to clinical workflow and outcomes, patient and/or physician engagement, cost reductions or ability to better manage the health of populations.  Thus, it's important to weigh the various types of value that health IT investments may generate for our own organizations and ensure that they align with both financial incentives and our overall strategic plan.

Finally, I want to reflect a little bit on the CIO's role in helping other senior leaders see the importance in investing in health IT.  Even if the CIO knows for sure it's well worth it and has tons of data to support that claim, if he or she cannot get the CFO and the rest of the senior leaders to say "yes" to the investments, then CIO can only work with what is currently in place.  I've come to understand that it takes a significant amount of business acumen, tact, understanding of the organization, and good communication to be successful in managing health IT and informatics.

Week 5

          This week's topic provides an interesting follow-up to our previous Population Health chapter which also dealt with finding the proper metrics to determine success.  I consider myself to be extremely data driven but I often catch myself making the mistake of advocating metrics which aren't actionable.  I love to get in the weeds and discover intricacies about a process which makes it very easy for others to say, so what?  I will respond that it's extremely interesting and they will reply that it doesn't matter if that doesn't tell us anything actually useful.  One question this issue raises is whether or not a project should be undertaken if there's not a reliable way to measure whether it worked.  This can happy on either a small or exceptionally large scale.  In the IT space it is possible to switch to a new firewall that is supposedly safer even when the old one had never been breached.  How do you measure an improvement over a 100% success rate?  Additionally, in the case of an EMR implementation, so many aspects of the organization change that there are too many success indicators.  If you succeed in 38 metrics and fail in 35 metrics is the measure a success?  If you make a composite metric is there any way to properly weight criteria?
          It was interesting that we introduced the idea of self-plagiarism just before this unit as my topic for our research paper in Finance last year was determining the financial impact of EMR implementations.  The key takeaway was that it takes years to assess the true impact and that even so it is incredibly difficult to isolate the effect it actually has on the organization.  Many organizations have seen large increases in net income several years after putting in an EMR but how do you truly know that the increase was because of the EMR and not something else?  Even attempting to measure it doesn't really accomplish anything.  If you lose money by putting in the EMR it isn't as if you are going to just stop using it or you can sell it and recoup your losses.  That is one of the things that has made the decision frighteningly for healthcare organizations.  It is something that you clearly have to do but there is almost no ability to cut losses or change course once you set off on the path.

Week 5

By Connor Ledbetter:

    Today's discussion centered on the measurements that need to be developed when implementing change in a healthcare organization. In this specific scenario the change involves the implementation of a new HIT system or capability. There were a few key points from the discussion today that resonated with me as I tried to place myself in the position of the project manager tasked with overseeing the implementation.
    
     The first nugget of knowledge that I walked away from class with was the realization of how critical it is to establish a baseline for metrics before the project even begins. Once appropriate measures for the project are established, I would be tempted to dive right into the project and do my best to get it underway. However, if I do not take the time to step back and assess the current status, determine a baseline for the metrics, there will be nothing for me to compare my measurements with in the future to determine whether or not there are indeed the expected improvements. Additionally, a component of the conversation that stuck in my mind, was the dialogue around unintended consequences. The implementation of new IT in the healthcare setting, however perfect and process improving it may seem, will likely result in outcomes that were not planned and that do not improve the delivery of care. It is difficult to determine ahead of time what these consequences may be. We may, at best, speculate. Understanding the ambiguous nature of unintended consequences, and relating back to the class theme of measuring improvement. It may be a critical step of the change management of HIT projects to establish metric baselines and monitor measurements that are catered not to areas of improvement, but rather to areas that we suspect may possibly experience the unintended consequences. A worst case scenario approach may seem pessimistic, but it could play an instrumental role in identifying and mitigating quickly outcomes of change that are not desirable.