As with any organizational undertaking, information technology initiatives should support and advance the organization's goals and plans.
But often, providers view the IT strategy as simply identifying a list of applications to be implemented and creating a timeline to do so. However, the scope of the IT strategy is much broader. The IT strategy should encompass:
- An IT agenda that is connected to organizational goals and initiatives. This agenda will define needs in four areas: applications; technical infrastructure; data; and IT staff, processes and organization. These four areas collectively are referred to as the IT asset.
- Initiatives designed to improve internal organizational attributes that enhance the overall ability to apply IT effectively—for example, improving change-management competencies.
The IT Asset
An organization can develop its IT agenda through the following pathways:
Understanding organizational strategies. For example, efforts to improve patient safety can lead to an IT strategy to implement CPOE and medication administration record applications.
Continuously improving core operational processes and information management. For example, efforts to continuously improve productivity can lead to the implementation of data warehouses that enable the labor cost analysis.
Reviewing new information technologies. A review can identify opportunities to advance strategies and improve operations. For example, smart phones can enable patients to manage a chronic disease better.
Assessing strategic trajectories. An assessment can point out the need to take some preliminary strategic steps. For example, an organization may decide that accountable care organizations will be a strategic centerpiece, but it is unsure of the mature form or importance of the ACO. Hence, it decides to take some initial steps and begin the learning process. These initial steps may point out such IT needs as interoperability with affiliated physician practices.
IT Strategy Elements
Most organizations focus on an inventory of application systems, such as the electronic health record, as the centerpiece of the IT strategy. However, the strategy should be more diverse than applications; it also should include:
- technical infrastructure consisting of the base technologies—for example, networks, operating systems and workstations—that are needed to ensure that systems are reliable, secure and agile and support such features as extending the reach of applications into a patient's home;
- data—all the organization's data and analysis and access technologies; and
- IT staff—the analysts, programmers and computer operators who, day in and day out, manage and advance information systems, along with the IT organization structure, core competencies and such characteristics as innovation ability.
Each element of the organization's overall strategy may call for new applications, extensions of the infrastructure or creation of such new IT departments as quality analysis. In addition, there is often a need to develop strategies for the IT asset that cuts across several organizational activities. For example, strategies may be developed as a response to such questions as:
- What is our approach to ensure that our infrastructure is more agile?
- What is our approach to attract and retain superb IT talent?
- Is there a way we significantly can improve the impact of our clinical information systems on our care processes?
IT-Centric Organizational Attributes
A variety of studies have identified IT-centric organizational attributes that appear to have a significant influence on the effectiveness of applying IT. These factors include:
- the relationship between the IT group and the rest of the organization;
- the presence of top managerial support for IT and the quality of the leadership;
- the organization's comfort with visionary IT applications and experimenting with new technologies; and
- the organization's experience with IT.
If the IT department has a poor working relationship with the clinical staff, it is hard to imagine that the organization would be effective in implementing an electronic health record. If the organization's leaders believe that IT is a necessary but barely tolerated expense, it will be difficult to invest in IT initiatives that push a strategic envelope. If the organization has a troubled history with IT implementations, it will hesitate to take on another strategic IT initiative that suggests another expensive disappointment.
Two other characteristics of the organization impact its effectiveness: IT governance and change management. IT governance consists of the organizational mechanisms by which priorities are set, policies and procedures are developed, and management responsibility is distributed. The effectiveness, transparency and inclusive of governance can make a material contribution to the ability of IT to support organizational goals.
Change-management skills enable the organization to evolve its direction, identity, processes and structures as required by its strategy. An IT initiative often is used as a catalyst for change just as it is used to enable and support change. Even if material change is not envisioned, the implementation of an application system will require some change in workflow and information provision. Organizations that are poor at managing change will be less effective in applying IT.
These attributes, which are different from the IT asset, can be created or changed. The IT strategy development must encompass both the IT asset and these attributes.
IT Strategy Considerations
While changes to the IT asset and IT-centric organizational attributes are the result of an IT strategy development process, experiences by several industries over many years have led to considerations or conclusions that should guide strategy development.
Complementary strategies.It may be necessary to devise complementary strategies—organizational initiatives that do not involve IT per se, but are needed for the IT strategy to succeed. For example, the federal government's goal of accelerating the adoption of electronic health records is greatly facilitated by the complementary strategy of meaningful use financial incentives.
The realization of IT-enabled value. As the organization develops its IT strategy, it must understand that the acquisition and implementation of an application does not necessarily lead to value, streamlined processes, improved decision-making capabilities or reduced medical errors. This is evident in the wide variety of health care experiences with IT; at times the implementation of an electronic health record clearly improves care, and at other times it has resulted in no significant improvements. Application implementation must be well-managed, changes in processes must be considered thoughtfully, and ongoing efforts to leverage the IT investment must be put in place.
The necessity for IT strategies to evolve. IT strategies must evolve. An application system that provides a competitive advantage today becomes an industry commodity tomorrow. The use of ATMs by banks is an example. At one time ATMs gave banks an advantage. Today they are a "stay-in-business" expense borne by all banks and distinguishing none of them. In health care, an organization in the process of implementing an electronic health record must understand that there will be a day when that implementation is done and when most organizations have an electronic health record. What then?
More Than a List
The scope of an IT strategy is much broader than a list of applications to be implemented. The IT strategy also must examine the IT asset, which includes applications and data, technical infrastructure, and the IT staff. In addition, the strategy may need to identify improvements to IT-centric organizational attributes that support the organization's ability to be effective in IT. Finally, as the IT strategy is developed, provider organizations should consider lessons learned over the years by organizations striving to advance their strategies through the use of IT.
John Glaser, Ph.D., is the CEO of Siemens Healthcare Health Services in Malvern, Pa. He is also a regular contributor to H&HN Daily.