Careful planning is needed to ensure rewards outweigh risks as IT moves off-site.
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| John Glaser | |
For many years, organizations have talked about their applications using their data running on their infrastructure in their data center supported by their information technology staff and used by their employees and medical staff.
"Their" encompassed management oversight of the direction and use of IT assets, control over organizational capital and operating investments in the assets, ownership of the assets, and the assets being located on-site.
But the reality of "their" has been changing.
Minicomputers, followed by personal computers, led to departments and individuals engaging in IT acquisitions and use that were barely or not at all controlled by the organization. Meanwhile, some provider organizations have been running applications on hardware located off-site through a shared service arrangement. More recently, software as a service and cloud computing enable organizations to function using someone else's applications and infrastructure.
Outsourcing provides the organization with the ability to leverage someone else's IT staff.
This erosion in the boundaries around the organization's IT assets provides value. Organizations can share capital costs with others and turn over the routine management of infrastructure to vendors that are more efficient and skilled. Individuals using personal computers have been able to improve productivity and data analysis capacity. Obtaining staff through outsourcing has enabled health care organizations to access scarce talent and ease the challenge of flexible staffing needs.
At the same time, this trend has created risks. The use of software as a service potentially exposes the organization to external infrastructure management and application development limitations. Individual use of personal computers can lead to undisciplined and difficult-to-support software development. Outsourcing arrangements can turn sour.
As the boundaries wear away, the pursuit of potential value has had to be accompanied by a mature appreciation of risks and the development of sufficient contractual arrangements, knowledgeable assessment of service or resource provider's capabilities, organizational policies and management mechanisms to assess and enforce controls.
The weakening of IT boundaries is continuing. The two most significant contributors to this erosion are Web 2.0 technologies and consumer computing devices, which are becoming integral components of the organization's IT assets.
Web 2.0 technologies include social networking sites such as Facebook, Sermo and MySpace. They also include sites that support shared knowledge development, such as Wikipedia. Both types of sites have exploded in recent years; there are more than 50 million users of Facebook in the United States, and more than half are older than 25. Wikipedia has more than 3 million articles in English.
Many clinicians and staff use these technologies, which provide personal and professional value. Social networking sites help staff members locate others with common professional interests, engage with communities that are important to the organization and identify professionals or companies that can provide needed information, services or products. Physicians and other clinicians use social networking sites to seek the advice of other clinicians and to learn more about issues and challenges related to living with a chronic disease.
Knowledge sites, such as Wikipedia, are an easy way to access current and accurate information. Clinicians and staff also contribute to these sites, advancing the ability of others to deliver care and manage organizations and departments.
Consumer computing devices, such as the iPhone and the Blackberry, include a range of very potent technologies. These are powerful computers, and they have led to a stunning array of applications that are very inexpensive. Moreover, these devices offer full access to resources available through the Internet. They also support the user's ability to work from almost anywhere and often extend the organization's electronic health record by providing access to knowledge resources, image viewers and integration with medical devices.
As with other boundary-eroding technologies and services, risks are introduced. Staff members may view their contributions to social networking sites as a form of backyard conversation. The informality of these sites may lead a user to forget that he or she may be seen as a representative of the organization rather than a friendly neighbor. Staff members may not understand that a response to one individual may have been seen by many and, unlike a remark over the back fence, remains online long after the conversation ends. Social networking sites often bring a false sense of anonymity, resulting in individuals behaving in ways that they would find embarrassing in a meeting with colleagues.
Consumer computing devices pose a different form of risk. Clinicians and staff members often store patient data or sensitive organization information on these devices, not realizing the increasing legal and regulatory consequences if the device is lost or stolen. Users often will assume that all of the organization's applications should work on the device and that device problems are the IT department's responsibility.
Health care and other industries are struggling to find the right balance between reaping the benefits of Web 2.0 technologies and consumer computing devices, while protecting the organization from the incipient risks.
This struggle occurs every time a new boundary-eroding technology or service arrives. Decades ago, organizations established "microcomputer" committees to control personal computer acquisition and develop microcomputer use policies. In the last decade, countless articles and conferences were held to help organizations understand the benefits and challenges of outsourcing.
There is no quick and easy path to a mature understanding of the balance. Time is needed to gain experience and perspective. Thoughtful review of early efforts at use and control are needed to separate overly optimistic hype and unnecessarily gloomy projections of grave risk from the realities of use.
Health care organizations also should avoid taking an extreme position on these types of technologies. Boundary erosion is an underlying, unalterable trend in information technology. It will not reverse itself. Neither an unbridled embrace nor blanket dismissal of these technologies has ever been the eventual outcome. A careful balance of risk and reward is far more likely.
John Glaser is a vice president and the CIO of Partners HealthCare in Boston and a regular contributor to H&HN Weekly.
This article 1st appeared on January 11, 2010 in HHN Magazine online site.
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