HIT Service Strategy

Enabling Transformational Health Care

CEO/CIO Questions
Healthcare CEO/CIOs are looking for fresh perspectives in advancing Healthcare Information Technology (HIT) strategy design, development, and deployment for more effective and efficient healthcare delivery. A number of important questions require immediate answers. Is there room to optimize service delivery capability? Do we effectively organize/manage/govern HIT Services to maximize value and clinical relevancy? Are we sure that service performance will meet or exceed federal and customer expectations? Is the budget allocated correctly? Is there room to optimize our spend?

Should we prioritize or redistribute HIT spend?

How best should we strategically source HIT skills and services?

HIT Services Must Be Agile

Survival in Volatility Requires a HIT Organization be Able to:
Change size, shape, scope and style as needed:
Size: Grow/shrink at many levels and rates via flexible resource capacity arrangements (own, rent, lease, borrow). Shape: Centralized, distributed, networked as needed (simultaneous component shapes if required). Scope: Occupy a varying footprint(s) in its value web as the value and service lifecycles evolve. Style: Integrate, collaborate, franchise, etc., depending on dynamics of markets and offers.

Engage self-directed leadership, managerial and operational behaviors within dynamic, environmentally determined constraints.
Embrace an effectiveness over efficiency culture, while continuing to focus on efficiency.

Challenges Will Remain Constant

The distributed vertical nature and volatility of todays healthcare environments, the global economy, and government legislation are underscoring increased challenges with:

Quality of Patient Care Responsiveness Innovation Competitive Positioning Speed to Delivery Reach Reliability Risk Cost Efficiency

We can't solve problems by using the same kind of thinking we used when we created them.-Albert Einstein

Healthcare organizations will need a radically new transformational approach to HIT on the part of the CIOs, business leaders and clinicians.
A transformational strategy will encompass an inclusive governance process with streamlined decision-making authority, a radically simplified IT architecture, mega-project-management capability, resource allocations and strategic sourcing, change and effective communication management.

HIT Organizations Currently Strive for a Business - Aligned, Managed Environment

Todays best practices show that HIT value can be maximized when enterprise HIT investments are aligned with healthcare goals and HIT execution is well managed.

The key drivers of HIT value are:

Health Care Aligned

Tactical

Outlook How organizations make decisions about technology investments Performance How well organizations implement those decisions
Performance
Reactive Managed

Outlook

But Technological-Driven Transformation of Health Care Is Challenging this Target

Extended Clinical/Health Care Processes

Employers

Home Laboratories

PBMs, Retail RX

Physician Groups Imaging Centers

Expanded Channels & Connections

Patient Payers Community Health Services Hospitals

Dynamic Business Models

Care Managers

Care Centers

Government

This Requires a New Mindset and a New Approach to Technology Execution

Environmentally Integrated

Health Care Aligned

Tactical

Outlook

Performance
Reactive Managed Agile

The Pressures Felt by Most HIT Organizations Validate this Model

Pressure on current HIT spending:
Are we delivering maximum business value for the resources spent? How do we deliver more with less? How do we minimize capital investment?

Scarce resources: How do we hire, retain, retrain, or obtain staff to provide the necessary technology skills? HIT governance challenges: How do we coordinate HIT spending and activities throughout the organization? With our partners? The need for speed: How do we support business requirements to respond to opportunities in days vs. months vs. years?

An Agile HIT Framework Provides a Persistent Context for the Strategy Outputs
Strategic Directions Required for Driving Agile HIT Come in Two Flavors Getting Aligned and Managed . . .

Externalizing & Becoming Agile Agile IT Getting Aligned & Managed
Outlook

Drive efficiency and effectiveness of HIT delivery Environmentally and management processes Integrated Adopt an enterprise architectural view Focus on getting costs structured, understood, under control Health Care Aligned Concentrate cost optimization on efficiency issues Drive opportunity portfolio prioritization through value tradeoff Align business and HIT strategies
Tactical

Transitional State

Health Care Aligned Managed

Health Care Aligned Managed Transitional State

Externalizing and Becoming Agile . . .

Integrate business and HIT strategies Focus on improved services and delivery through adaptive management and delivery processes Expand the view of infrastructure to extrastructure Create agility through a flexible services environment leveraging internal and external providers
performance Reactive Managed Agile

Because an organizations HIT capabilities are typically distributed across the framework, their HIT Strategy embraces a mix of activity types

An Agile HIT Strategy Addresses the Shortcomings of the Traditional HIT Strategy
HIT defines an ongoing decision tool for leveraging IT to drive a healthcare organizational success in a constantly evolving community environment
The process is practical and scenario driven It recognizes that technology both enables and improves healthcare strategy The process examines opportunities made available by other entities in the environment as well as constraints imposed by it The strategy is not just about the new, but what to do with the existing environment and current systems portfolio

The strategy drives integrated architectures and implementations

An Agile HIT Strategy Translates Needs and Opportunities from the Environment into Action
Health Care Environment Technology Environment

Visioning

IT Architectures
Health Care Strategy Health Care Architecture What

HIT Strategy

Application Data Technology Security Governance

How

Transformation Services
HIT Current State

People Process Technology

HIT Future State

What Does an Agile HIT Strategy Produce?

A plan for leveraging the HIT capabilities of the company and the community environment to deliver healthcare success

Environment
Health Care Strategy IT Strategy
IT Systems & Services

Clusters of tech-enabled business capability -------------Provide decision making framework

Healthcare Institutions

IT Capabilities IT Operating Model

Health Care Success

Rules of engagement for decision making ------------------------Coordinates complex Creative Solutions relationships, brokering

Skills and capability that enable Systems & Service delivery -------------Sourcing strategy is critical

An Agile HIT Strategy Provides

HIT Systems and Services Directions, that
Are strategic technology-enabled healthcare capabilities stewarded by HIT Provide the decision-making framework for all potential HIT investment Recognize
the interplay of internal capabilities with those of healthcare partners and customers the potential need to support rapid healthcare business and technology evolution

HIT Capabilities & Sourcing Strategies, that

Describe the combination of skills and knowledge with methods and tools that support the development, deployment and management of the HIT systems & services Examine sourcing options and define the critical skill sets that must be developed and maintained within an organization

An HIT Operating Model, that defines

HIT management structures and processes HIT delivery structure and processes Roles, responsibilities, and interaction with partners and customers that support the model of agile execution

The HIT Strategic Components Provide the Basis for HIT Transformation Tools
HIT Initiative Planning & Prioritization
Development of a set of processes and tools to organize and prioritize HIT initiatives Focus on resolving the issues around resource management and prioritization of scare resources

HIT Portfolio Management / Portfolio Rationalization

Development of the disciplines and processes around managing the HIT environment as a portfolio of assets Can also include an effort linked to cost reduction that focuses on rationalizing an existing portfolio based on business/ health/ technical criteria

HIT Organization Design

Focused on developing a new HIT organization based on changes in the environment such as: Acquisition / divestiture Re-centralization A re-evaluation of the HIT strategy

This Pragmatic Approach to HIT Strategy Focuses on Sustained Value and Significant Benefits
Integrates with and drives healthcare strategy, not an after-thought or extension
Provides a common language for healthcare/HIT discussions

Recognizes ROI, needed capabilities, and risks

Provides an explicit linkage between HIT investments and healthcare capabilities Enables a consistent framework for prioritizing HIT demands in an environment of permanent volatility Coordinates previously fragmented HIT investments Resolves capability development, acquisition, and partner challenges

Evolves an organization, as opposed to simply maintaining it:

Plans for new assets in the form of intellectual capital and strategic capabilities, not just salaries and depreciated hardware Allocates resources to the right investments while containing costs Determines clear roles and responsibilities for distributed HIT decision making, enabling an organization to act quickly and with confidence Greater technology ROI derives from greater agility in response to and tighter integration of technology and healthcare decision making

Appendix A: Agile HIT Strategy and Planning Approach

Agile HIT Strategy Development

Steps
Confirm healthcare strategy

Tasks
Extract key healthcare strategies Document and review with key management Create healthcare strategy summary Confirm with key management Identify technology infrastructure enablers Identify information management enablers Identify application enablers Define required system/service characteristics Identify key product capabilities Identify key service capabilities Identify sourcing opportunities Identify baseline HIT competencies Identify common capabilities Identify specialized capabilities Identify appropriate sourcing Define the HIT governance structure Define the HIT governance processes for HIT Product & Service delivery HIT management Identify product & service, governance, capabilities implications

Resources
Executive management team Division management HIT management Strategy development team

Identify key technology enablers

HIT management Strategy development team Key business subject matter experts

Define HIT systems & services

Strategy development team HIT management

Identify HIT capabilities

Strategy development team HIT management

Define HIT Governance

Strategy development team HIT management Executive management team Division management

Identify Implications

Strategy Development team HIT Management, SMEs

Agile HIT Strategy and Planning Approach

The approach to HIT Planning begins with the development of a well-articulated information technology strategy driven by the strategic direction of the healthcare business. This strategy serves as the foundation for the enterprise architectures for applications, information, technology infrastructure, and HIT management. Finally, the strategy, using the architectures as roadmaps, helps to establish the plan of what technology initiatives will be implemented. Health Care Information Technology Strategy
Applications Strategy Architecture
3
HIT Transition Plan Development
Application Portfolio Initiatives Information Repository Initiatives Technology Infrastructure Initiatives

Health Care Strategy

Information Information Strategy Architecture Technology Strategy Architecture Management Architecture Strategy

Health Care Environment

HIT Management Initiatives

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HIT Planning Approach

The HIT Strategy describes an overall direction for HIT in terms of its Systems and Services to the healthcare business, the competencies it will leverage to deliver those Systems & Services, and the governance structure that must be in place to support the delivery. The Application Architecture builds on the product/system direction that is set in that
strategy to define an overall direction for the portfolio of applications in use and a detailed description of the current and future state of the elements of the portfolio.

The Information Architecture looks at the structure for managing the key information

for managing the healthcare business, who uses that information, where its created and how it is managed. The Technology Architecture describes the enterprise direction for an enabling infrastructure as driven by the strategic direction for applications and data. The Management Architecture describes the processes, tools and systems to be put in place for the effective management of the HIT resource.

The HIT Transition Plan defines how to get to the future state. The HIT Transition Plan
clusters potential project efforts into a series of prioritized programs or initiatives, reflecting the interdependence all aspects of HIT and HIT management and their priorities with respect to supporting the business strategy.
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HIT Transformation Map

2010

Stage 1
Major activity/ milestone

Year 1

Year 2
Major activity/ milestone

Major activity/ milestone Major activity/ milestone Major activity/ milestone Major activity/ milestone

Major activity/ milestone

Long Term Vision

Major activity/ milestone Major activity/ milestone Major activity/ milestone Major activity/ milestone Major activity/ milestone Major activity/ milestone Major activity/ milestone Major activity/ milestone Major activity/ milestone Major activity/ milestone Major activity/ milestone Major activity/ milestone

Major activity/ milestone

Major activity/ milestone

Major activity/ milestone Major activity/ milestone

Major activity/ milestone

TODAY

Major activity/ milestone

For More Information Contact:

John Anderson creative@jpranderson.com Innovative Solutions, LLC 52 Sandia Lane Placitas, NM 87043 U.S.A. 01-815-354-7456