Seven durable ideas
This article is a summary of the 7 guiding principles that the Partners IS group has relied on to provide the management framework for implementing application technology in their multiple institutions. These are summarized below.
Contents
Centrality of Processes
Delivering quality health care is a process, and improving that process should guide all IT efforts. Computer applications add value only to the degree that they enable processes of care delivery, such as by integrating useful decision support at the point of care. The ability to track and measure processes is necessary to assess the value derived from adding IT to a process.
Organizational Partnerships
To successfully use IT, a partnership based on trust and cooperation must exist between the IS department and the rest of an organization. This permits creation of an agenda that identifies top clinical priorities to improve health care delivery. It also requires successful project management skills and the ability to implement workflow changes when necessary to realize the benefits of IT in improving care.
Progressive Incrementalism
In large health care organizations, change is often best achieved via small steps that change processes and workflow over time. This minimizes risk and permits modification of technology when needed to better meet clinician workflow needs as users adapt to new processes.
Agility
Both technology and health care regulations can evolve rapidly today. The ability to respond in quickly to change is essential to organizational success. Glaser lists 3 types of agility to consider, and ways to succeed in each: a. Infrastructure Agility == i. Leverage Industry Standards to maximize “plug & play opportunities ii. Core Technology Assessment processes to evaluate the value of new technologies. b. Application Agility == i. Internal Development to permit organizational software customization. ii. Rapid Feedback from users to guide the process of customization. iii. Utilize the benefits of Service Oriented Architecture (SOA) to shorten the time to implementation of new technology. c. Organizational Agility == i. Streamline Decision Processes to avoid losing momentum. ii. Chunks – break projects into manageable phases.
Architecture
IT must enable clinician workflow, not disable it. To succeed: a. Use Great Architects – IT staff must be knowledgeable and committed. b. Processes, Rules & Standards – If you expect clinicians to standardize workflow, then lead by example in the IS department. c. Ability to recognize and leverage major technology advances – concepts such as SOA offer opportunities to an organization, strong IS departments must know when to pursue and when to wait.
Embedded Research
Research offers an opportunity to stay on the leading edge of quality medical care. There are two components essential to this process: a. Physician Leadership – physicians that both practice medicine and formally work for the IS department help bridge the gap between the two. b. Embedded in Operations – the research support team is involved in operations and shares in the management and budget decisions.
Engage the Field
Encourage leaders to be involved outside the organization in professional organizations to promote medical informatics. The organization must do two things: a. Create Capacity - budget resources and time to travel or to do research and publish. b. Incentives – recognize and reward individuals who do contribute outside the organization in a professional capacity.
In summary, Glaser lists four things that a good CIO must understand and do:
- Recognize the value and the limitations of the above guiding principles.
- Create and sell the vision – be able to see the big picture when setting the agenda, and be able to motivate others to achieve the vision.
- Engineering – be able to move the organization in ways that permit better care via new workflows.
- Staff – your most valuable resource is your people, so choose them wisely.
References
- Glaser JP. Seven Durable Ideas. J Am Med Inform Assoc. 2008 May–Jun; 15(3):267–271 [1]
