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Research by Marty Stempniak

The election is long over, the courts have spoken and health care reform is inevitable. But uncertainty may remain for some hospitals when it comes to their technology needs and how to prepare for clinical integration, population health and value-based reimbursement.
Should your hospital just make do with what it has, try to upgrade the existing IT infrastructure or scrap everything and start anew? Whatever the strategy, experts say it's critical to compile an IT master plan now to prepare for the future of health care. Without one, leaders may end up with electronic health record systems that work fine individually for cardiology, orthopedics and the emergency department, but they won't "speak to each other" and will greatly limit how well physicians can coordinate, says Graham Brown, a vice president with the Camden Group consulting firm, who specializes in clinical integration and health IT strategy.

"The patients' impact is going to be that they're treated as though they're in a silo every time they come in and get care, and the amount of staff effort involved in taking their medical history and understanding their medications and their allergies has to be done every single time," he says.

To achieve the necessary coordination needed in the reform era, Brown says hospitals and health systems must have a health information exchange that allows doctors to view clinical results across an entire network, from the primary care physician to the ED. Plus, providers should have a central data repository to view a patient's history and better understand his or her needs. Risk adjustment and predictive modeling tools are also key to understanding for whom they're caring, which patients are the most acute and who is likely to become the most acute down the line.

But how do you know if your current IT systems are fine or whether they're in need of a gut job? Take an inventory of your existing technologies — analyze the gaps, find solutions, prioritize them, choose the most appropriate and strategic, and understand the costs and staff needed to keep the system running. Convincing all your partners to transition to the same system is ideal, rather than trying to interface the dozen already in place, says John P. Hoyt, executive vice president of the Healthcare Information and Management Systems Society and a former hospital CIO. But it's expensive, and some doctors may be reluctant to give up their trusty old system.

"The issue is, 'I don't have a leisurely four or five years to figure this out because the hospital board says we're going to become an ACO and we hope to do it by July 15 of next year,' " Hoyt says. "And you're the CIO and you think, 'Oh my God, we're going to go out and make partnerships with dozens of physician practices over a bunch of zip codes,' and you need the data they've got in their databases. Or if they don't have electronic health records, well, you better get one in their office."

And don't set your plan in stone. Bill Spooner, CIO for Sharp HealthCare for the past 16 years, recommends revisiting it often, at least annually, and be ready to go in a completely different direction if a new innovation emerges.

"Obviously, you have to be agile," says Spooner, who oversees a $100 million operating IT budget and a staff of 400. "It's such a changing environment and we have the opportunity to rethink our plans regularly. We're finding more and more things that we can do with our technology, so our plates get a little bit fuller every year, it seems."

This gatefold will explore hospitals' IT needs under health care reform, provide advice on how to develop a technology master plan to meet those needs, and give an example of one health system that's helping to rethink the field.

Who should join my IT strategic planning team?

Whether your hospital is developing its technology master plan as an offshoot of the organization's main roadmap, or as a stand-alone plan, experts say it's important to break IT out of its silo. Cast a wide net when figuring out whom to include in the discussion, from nurses to lab techs to the CIO. Here are some positions that John P. Hoyt, executive vice president of the Healthcare Information and Management Systems Society, suggests you involve:

• CIO: should be the leader of the multidisciplinary team.


• Medical staff

• Ancillary services (laboratory, radiology, pharmacy, etc.)

• enterprise planning (those who work on the organization's broader plan)

• Other key non-IT leaders: should have a say in the process, says Graham Brown with the Camden Group.

"Does the strategic master plan for IT investment have awareness at the board level? Is it related to the clinical goals of the organization?" Brown asks. "The call to action for the CEO — and for the CFO who's going to oversee these investments, the CIO who's going to implement these technologies and the CMO who's going to hopefully guide the quality-improvement initiatives across the clinical realm — is to be working together," he says.

Sources: John P. Hoyt, HIMSS, and Graham Brown, the Camden Group, 2012

The IT planning life cycle

Here are some examples of the possible steps in the IT life cycle, as suggested by authors George Hickman and Detlev Smaltz in their 2008 book, The Healthcare Information Technology Planning Fieldbook, along with a diagram of what the IT planning process may look like.

Phase 1 | Planning

  • Concept description
  • Business case development
  • Authorizations to proceed
  • Budget support

Phase 2 | Selection and acquisition

  • Requirements definition
  • Build vs. buy decisions
  • Vendor package fit to requirements
  • Solution agreement
  • Contracting

Phase 3 | Implementation

  • Project chartering, scope assurance, work planning and resourcing
  • Design — technical, data, functional, workflow, workplace, rules, content
  • Build
  • Test — unit, volume, integration
  • Education
  • Go live
  • Post-implementation turnover management
  • Post-implementation lessons learned

Phase 4 | Support

  • Ongoing support
  • Technology upkeep
  • Application upgrades and enhancements
  • Integration support
  • Content enhancements

Taking the pulse of the health IT field — what lies ahead?

So what do most CIOs feel is the top priority in their field? How many of them are concocting a plan to chase those priorities, and what might be some of the barriers to tackling that plan? The Healthcare Information and Management Systems Society's most recent survey of 302 IT professionals shows that the top priority for many technology leaders (about 38 percent) is achieving meaningful use of electronic health records. Focusing on clinical systems and leveraging information also were big priorities for CIOs. The vast majority of those polled said they have some sort of IT plan — whether or not it's aligned with their hospital's overall strategy — while a lack of staff resources and financial support were some of the biggest barriers to implementing those strategies.

Key IT Planning Principles

In his article, "Successful Strategic Planning: Creating Clarity," published in the Journal of Healthcare Information Management, Jim Adams, executive vice president of Healthlink Inc., suggests several key principles in the IT strategic planning process:

1. Involve key non-IT executives and managers throughout the planning process: Without them, the plan is seen as the IT function plan instead of the organization's IT strategic plan.

2. Speak the language of the business: Focus talks along the way on solving business problems, not "technospeak." Changes shouldn't be made in a "black hole."

3. Use every opportunity to educate non-IT executives about relevant IT-related issues and subjects: Education is needed when there's been an IT issue or leadership is going to have to make a decision. Students are more open-eared in these "teachable moments."

4. Define, evaluate and present alternatives: Execs, then, can make a more informed decision, and be on your side later on if objections arise after the system is implemented.

5. Have the right people making the decisions: Business people should weigh in on IT decisions with financial implications, such as how much to spend, which capabilities need to spread through the entire organization and what security risks will be accepted.

6. Communicate: A good communication plan involves an ongoing dialogue from the IT and non-IT executives with their employees, along with peers in the IT field and key people outside the IT function.

CASE STUDY:Texas Health Resources

Long before Obamacare and calls for meaningful use, Texas Health Resources had been on a journey to transform its technology and tackle population health through an integrated electronic health record system.

Since 2004, Texas Health — a system of 25 hospitals based in Arlington — has been charging forward with an ambitious effort to digitize its medical records. It has poured some $200 million into upgrading the IT infrastructure over a five-year period, and now has more than 4.7 million electronic health records, says Ed Marx, senior vice president and CIO of the system.

Key to tackling such a large endeavor was developing an IT master plan, with the help of everyone from physician groups to administrators and even patients. At Texas Health, the IT department has "converged" with their strategy arm of the system, and Marx says he regularly has to report to the chief strategy officer.

"That's the beautiful thing — IT is right in the mix," he says. "So it's not an afterthought. With some organizations, it's like, 'Hey let's build this great plan, and later on we might check in with IT.' And IT becomes kind of a laggard and a little bit behind."

Texas Health has made a big push for wellness strategically and is working to roll out mobile health tools to engage both patients and physicians. It's adding population health experts to the staff to help lead the push.

By better understanding the health of the population through technology, Texas Health was able to move the quality needle in some key areas, including reducing both urinary tract infections and venous thromboembolism by almost 30 percent in one pilot.

Texas Health is pushing to make as much of the health care experience as possible digital. He thinks hospitals eventually might resemble banks, where customers seldom need to visit a branch. Patients will browse their health records and consult with a doctor on a tablet. That push starts, Marx says, by melding IT strategic planning with the overall mindset of the organization.