HIT Service Strategy

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A Point of View on how Health Care Providers can best meet the pressures they now face in their industry through the use of an effective and agile HIT Strategy Process.

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HIT Service Strategy

  1. 1. HIT Service Strategy Enabling Transformational Health Care Creative Solutions
  2. 2. Forces Confronting Health Care CIOs • Health care IT (HIT) is experiencing volatile change driven, in part, by government incentives and mandates in the U.S., along with a mass of economic and quality dynamics concerned with improved patient-centered care. – Many organizations already have existing plans for implementing EMRs and EHRs along with growing needs to replace aging fleets of financial systems*. – Federal mandates accelerate project timelines and expenditures, squeezing hospital capital budgets already under strain from steadily rising costs, rising by approximately 10 percent annually—and outpacing revenues.** – Global economics and technology trends, for all IT industries, call for further cost reductions through consolidation, virtualization, SaaS, and cloud computing arrangements. – CEO’s are increasingly looking for real business value metrics from IT and not simply cost recoveries and SLA performance measures. *HIMSS Analytics from John Hoyt, VP Healthcare Organizational Services - HIMSS ** McKinsey Quarterly August 2010 Creative Solutions
  3. 3. Financial Incentives – Small Offsets • Federal Incentive Programs offer only about 15-20 Percent offset of the total coast to implement EHR within mandated timeframes. • The government predicts a shortfall of about 50,000 qualified health IT workers over the next five years. • 8 in 10 hospital CIOs are reportedly concerned or very concerned they will not be able Source - 2010 HIMSS CIO Leadership Surv ey s 2005-2010 to demonstrate meaningful use of EHRs within the federally established deadline of 2015. *PricewaterhouseCoopers’ Health Research Institute. Creative Solutions
  4. 4. Federal Penalties are Significant • “An accelerated timetable means that US health care providers have until the end of 2015 to make the investments or face fines starting at $2,000 a bed in the first year and up to $35,000 a bed by 2019. In addition, both revisions to the Health Insurance Portability and Accountability Act (HIPAA) 5010 and the switch to ICD-10 require providers to apply strict new data-coding standards—no small task given the number of databases, hospital systems, and clinicians affected.” * • “To meet these various requirements, US hospitals will need to spend approximately $120 billion, at an average cost of $80,000 to $100,000 per bed, for the required project planning, software, hardware, implementation, and training.”** • The rapidly aging population of baby boomers continues to balloon the need for more hospital beds and penalty dollars. There is little decline in population numbers after this generation in the U.S. •McKinsey Quarterly August 2010 **Ibid Creative Solutions
  5. 5. CIO Questions • Health Care CIOs are looking for fresh perspectives in advancing HIT strategy design, development, and deployment for more effective and efficient health care 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? Creative Solutions
  6. 6. 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. Creative Solutions
  7. 7. Challenges Will Remain Constant • The distributed vertical nature and volatility of today’s health care 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 “Insanity: doing the same thing over and over again and expecting different results”. -Albert Einstein • Health care 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. Creative Solutions
  8. 8. HIT Organizations Currently Strive for a Business - Aligned, Managed Environment Today’s best practices show that HIT value can be maximized when enterprise HIT investments are aligned with health care goals and HIT execution is well managed. The key drivers of HIT value are: • Outlook – How organizations make Outlook Health Care Aligned decisions about technology investments • Performance – How well organizations Tactical implement those decisions Performance Reactive Managed Creative Solutions
  9. 9. But Technological-Driven Transformation of Health Care Is Challenging this Target Extended Clinical/Health Care Employers Home PBMs, Retail RX Processes Laboratories Expanded Physician Groups Channels & Imaging Centers Connections Patient Payers Hospitals Dynamic Community Business Health Services Models Care Centers Government Care Managers Creative Solutions
  10. 10. This Requires a New Mindset and a New Approach to Technology Execution Environmentally Integrated Outlook Health Care Aligned Tactical Performance Reactive Managed Agile Creative Solutions
  11. 11. 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? Creative Solutions
  12. 12. 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 – Drive efficiency and effectiveness of HIT delivery Transitional State and management processes Environmentally Integrated Agile – Adopt an enterprise architectural view IT – Focus on getting costs structured, understood, Getting Health under control Aligned & Care Health Care Managed Aligned Outlook – Concentrate cost optimization on efficiency issues Aligned Managed Health – Drive opportunity portfolio prioritization through Care Aligned value tradeoff Managed Transitional State – Align business and HIT strategies Tactical • Externalizing and Becoming Agile . . . – Integrate business and HIT strategies performance Reactive Managed Agile – Focus on improved services and delivery through adaptive management and delivery processes – Expand the view of infrastructure to “extra- Because an organization’s HIT structure” capabilities are typically – Create agility through a flexible services distributed across the framework, environment leveraging internal and external their HIT Strategy embraces a mix providers of activity types Creative Solutions
  13. 13. An Agile HIT Strategy Addresses the Shortcomings of the Traditional HIT Strategy • HIT defines an ongoing decision tool for leveraging IT to drive a health care organizational success in a constantly evolving community environment • The process is practical and scenario driven • It recognizes that technology both enables and improves health care 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 Creative Solutions
  14. 14. HIT Strategy Translates Needs and Opportunities from the Environment into Action Technology Health Care Environment Environment Visioning IT Architectures HIT Strategy Application Health Care Strategy Data Technology Health Care Security Architecture Governance What How Transformation Services HIT Current State People HIT Future State Process Technology Creative Solutions
  15. 15. What Does the HIT Strategy Produce? A plan for leveraging the HIT capabilities of the company and the community environment to deliver health care Clusters of tech-enabled business capability success -------------- Provide decision making Environment framework Health Care Strategy IT Strategy IT Systems & Services Health Healthcare Care IT Capabilities Institutions Success IT Operating Model Skills and capability that enable Systems & Service delivery -------------- Sourcing strategy is critical Rules of engagement for decision making ------------------------- Coordinates complex Creative Solutions relationships, brokering
  16. 16. An Agile HIT Strategy Provides… • HIT Systems and Services Directions, that – Are the strategic technology-enabled health care capabilities stewarded by HIT – Provide the decision-making framework for all potential HIT investment – Recognize • the interplay of internal capabilities with those of health care partners and customers • the potential need to support rapid health care 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 Creative Solutions
  17. 17. 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 Creative Solutions
  18. 18. This Pragmatic Approach to HIT Strategy Focuses on Sustained Value and Significant Benefits • Integrates with and drives health care strategy, not an after-thought or extension – Provides a common language for health care/HIT discussions • Recognizes ROI, needed capabilities, and risks – Provides an explicit linkage between HIT investments and health care 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 and tighter integration of technology and health care decision making
  19. 19. HIT Strategy Development Steps Tasks Resources • Extract key health care strategies • Executive management team • Document and review with key • Division management Confirm health care management • HIT management strategy • Create health care strategy summary • Strategy development team • Confirm with key management • Identify technology infrastructure • HIT management enablers • Strategy development team Identify key • Identify information management • Key business subject matter experts technology enablers enablers • Identify application enablers • Define required system/service • Strategy development team characteristics • HIT management Define HIT systems & • Identify key product capabilities services • Identify key service capabilities • Identify sourcing opportunities • Identify baseline HIT competencies • Strategy development team Identify HIT • Identify common capabilities • HIT management capabilities • Identify specialized capabilities • Identify appropriate sourcing • Define the HIT governance structure • Strategy development team • Define the HIT governance • HIT management Define HIT processes for • Executive management team Governance • HIT Product & Service delivery • Division management • HIT management • Identify product & service, • Strategy Development team Identify Implications governance, capabilities • HIT Management, SMEs implications Creative Solutions
  20. 20. HIT Strategy and Agile 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 health care 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. Applications HIT Transition Plan Information Technology Development Strategy Architecture Health Care Application Portfolio Initiatives Strategy Information Information Health Care 3 Strategy Strategy Architecture Information Repository Initiatives Technology Technology Health Care Strategy Architecture Infrastructure Initiatives Environment HIT Management Management Initiatives Strategy Architecture 20
  21. 21. HIT Planning Approach The HIT Strategy describes an overall direction for HIT in terms of its Systems and Services to the health care 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 the managing the health care business, who uses that information, where it’s 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. 21
  22. 22. Characteristics of an HIT Strategy & Architecture Methodology • An accelerated methodology for developing a HIT Strategic Plan has the following important characteristics: – A process perspective that recognizes that HIT strategy & architecture is not a one-time event but a continuous process that will evolve as the health care environment evolves – An iterative approach to strategic plan development; building intermediate versions and gaining consensus – A collaborative effort that leverages experience in strategic planning development and the health care business and applied technology knowledge – Acceleration through parallel tasking and leveraging facilitated sessions 22
  23. 23. The HIT Implications and Potential HIT Enablers of the Health Care Business and Practice Strategies Drive the HIT Strategy HIT Strategy Process Flow Health Care Direction • Corporate business Corporate HIT Implications direction as Health Care articulated by senior Strategies HIT Strategy management • What is the impact of the health care business and practice strategies on the Division / HIT systems and services? HIT Principles Health Care Functional • How does the health care Strategy and Data Health Unit direction and perception Gathering of HIT affect the Strategies HIT Systems and management of HIT? Services • Gather information on future direction Direction • Organize around Health Care health care units and HIT Enablers Process care proc esses HIT Operating • Review and confirm Direction • How can HIT support the Model information with key implementation of the stakeholders Health Care health care business and Organizational practice direction and Perception of strategies through new or HIT Capabilities Current State Data enhanced: HIT Gathering • Infrastructure services • Applications • Identify applications and • Information data portfolios Current State Management • Document the existing of HIT capabilities governance model • Document current infrastructure Creative Solutions
  24. 24. Future State HIT Design and Migration Planning – Techniques: Identifying HIT Drivers HIT Strategy Technology Health Care Environment Strategy Principles Systems and Services IT Architectures Health Care HIT Operating Infrastructure Architecture Environment Model Application Architecture Capabilities and Sourcing Information Architecture What How HIT Current State HIT Initiative Portfolio HIT Future State HIT Management HIT Infrastructure Initiatives HIT Management HIT Environment Portfolios Environment Portfolios Processes Infrastructure Application Initiatives Processes Infrastructure Data Initiatives Tools Applications Tools Applications HIT Management Information Initiatives Information Resources Resources Repositories Repositories Health Care Business and Practice Functions/Strategy Drive the Overall HIT Strategy, Architecture and Planning Process
  25. 25. Approach & Deliverables (I) HIT Process Scorecard Health Care & Strategy IT Process Gather Health Care Workshop Architecture Strategies and Build Functional Decomp Business HIT Architecture Directions Application Current State App Architecture Application Strategy Inventory Current State Information Information Strategy Information Architecture Inventory Infrastructure Infrastructure Technology Architecture Current State & Architecture Change Drivers Guidebook Creative Solutions
  26. 26. Approach & Deliverables (II) HIT Process Assessment & Assess HIT Processes Recommendation Develop HIT Systems, HIT Strategy Exec Services, Capabilities Guidebook Briefings Transition Plan Application Architecture Maintenance & Communication Plan Strategy & Architecture Application Application Portfolio Portfolio Analysis Future State Disposition Information Strategy & Architecture Info Store Information Portfolio Future Analysis State Disposition Technology Technology Infrastructure Architecture Guidebook Transition Plan Creative Solutions
  27. 27. HIT Transformation Map 2010 Stage 1 Year 1 Year 2 Major activity/ Long Major activity/ milestone milestone Term a l Solutions ED & Clinic Major activity/ milestone Major activity/ milestone Vision Major activity/ Major activity/ milestone milestone Major activity/ milestone nt Major activity/ e me milestone ag Major activity/ an Major activity/ milestone c eM milestone a cti Pr Major activity/ R& milestone EH e Major activity/ l Us Major activity/ Major activity/ Major activity/ milestone milestone milestone milestone ingfu Major activity/ milestone Major activity/ Major activity/ Major activity/ milestone Mean milestone milestone nce a ent orm Major activity/ nt Major activity/ milestone & me Major activity/ e m Pe r f milestone le e milestone yc ag C n e ue Ma Major activity/ Ma erpris Major activity/ en s ev ces milestone milestone nag TODAY R c Major activity/ Ent A milestone Creative Solutions
  28. 28. Appendix A: Detailed Project Approach Creative Solutions
  29. 29. Detail Project Approach Characteristics of an HIT Strategy & Architecture Methodology Project Approach • Project Kickoff • Track I – HIT Strategy Development & Accelerated Solutions Environment • Track II – Application Architecture • Track III – Information Architecture • Track IV – Technology Architecture • Track V – Management Architecture • HIT Transition Plan 29
  30. 30. Strategy Project Kickoff The key objective of the Project Kickoff is to organize team members, set direction, review available information, agree on deliverable format and establish the remaining schedule Activities Deliverables • Review Project Management standards and practices • Project Charter, including project objectives, schedule, team • Develop project charter leads and risk management strategy • Develop an enterprise communication plan • Issue Resolution and status reporting templates • Develop issue resolution and status reporting format and • Enterprise communication template procedures • Deliverable templates • Identify client participants for interview s and w orkshops. • Interview schedule Begin to schedule appointments. • Complete project schedule • Gather existing IT documentation •Current system inventory •HIT budgets •HIT organization • Gather existing documentation on business strategies and current and planned business organizational structures • Agree upon structure for final documents 30
  31. 31. Track I - HIT Strategy Development Process Track I focuses on the development of the HIT Strategy. The strategy sets the direction for the architectures and transition plan and be aligned to the enterprise business strategies Activities Deliverables • Gather and synthesize the enterprise and business unit • HIT strategy guidebook w hich establishes the overarching strategies HIT direction from a health care business and practice • Interview key stake holders to confirm and refine the perspective. The follow ing w ill be addressed: health care business and practice direction •HIT Systems & Services - a description of IT’s • Create an framew ork outlining the key HIT systems and contribution to the achievement of health care services and how they support the business strategies • Create a straw man HIT strategy . •HIT Principles - a statement of fundamental values that •Identify the future state capabilities and characteristics provides ongoing guidance for decision making of each of the HIT systems and services •HIT Governance mode identifying the basic structure •Identify the key HIT principles for managing IT •Identify a proposed HIT governance model •Key HIT capabilities required to deliver, operate, • Conduct a facilitated session w ith representation from support and manage the HIT systems and services and potential alternatives for sourcing business and HIT to update, confirm and ratify the HIT strategy. 31
  32. 32. Track II - Application Architecture Process The majority of the HIT Systems & Services defined in the HIT Strategy are applications systems. The Application Architecture – builds on the product direction set in that strategy to define an overall direction for the portfolio of applications – defines how the applications support the business processes and what direction the this portfolio should take to support the business strategies The objective of Track II is to create a tool for the active management of the enterprise applications portfolio. Key activities & deliverables to include: Activities Deliverables • Develop an inventory of the current state applications • Application Inventory that provides portfolio: • Application indentifier and ow ner information • The inventory will include identifying information as • Technical platform and sizing information well as information on the Strategic , Functional, and Technic al quality of the application • Qualitative judgments on the functional quality • Map each application to the corresponding functions it • Assessment of strategic alignment supports from the systems and services model. • Application Strategy, to include • Develop an application strategy that establishes a strategic • Application principles direction for the systems supporting each key business • Applications mapped to key business processes process • Strategies for application integration and interfacing • Develop the future state application architecture • Application architecture, to include: • recommend a disposition for each group of applications • A mapping of the applications to the HIT systems and • These recommendations will focus on aligning the services they support strategic , functional, and technical quality of the application portfolio with the direction set by the HIT • A detailed disposition report that defines a path for strategy each major application • Conduct a facilitated w orkshop to verify the application architecture direction 32
  33. 33. Track III - Information Architecture Process The Information Architecture is driven by both the HIT Strategy and the Application Architecture. The Information Architecture – Looks at the structure for managing the key information for the managing the business, w ho uses that information, w here it’s created and how it is managed. – Will define the direction for the major enterprise information repositories. The objective of Track III is to create a tool for the active management of the portfolio of key information repositories. Key activities & deliverables to include: Activities Deliverables • Generate an inventory of the data stores currently in use • Inventory of data stores, mapped to subject areas that provides: • Information architecture , to include: • identifiers and ow ners • an analysis of the current state and a recommended • technical platform information future state model w ith the business • applications associated w ith data stores • a definition of data subject areas and constituencies • Examine the subject area mapping of the inventory to • an assessment of the limitations of current state determine the level of redundancy and complexity of • a recommendation for a future state model for information control information placement • Conduct an Applications and Information Strategy • a strategy for data ow nership and management w orkshop to determine the set of HIT directions for the process information portfolio that are directly linked to the health care strategy • Conduct a facilitated w orkshop meeting w ith data ow ners to develop the future state architecture and modeling 33
  34. 34. The Application & Data Architectures Define How Applications & Information Support the Business Chain Value Health Care Health Care Health Care Health Care Health Care Process #1 Process #2 Process #3 Process #4 Process #5 Apps Application Application Application Application Application Application Application #1 #2 #3 #4 #5 #6 #7 DB #1 DB #2 DB #3 DB #4 DB #5 Data Data Warehouse Reference Data Informational Data Transactional Data DataMart DataMart DataMart Understanding how applications and data support the business is key to making strategic HIT & Health Care business and practice decisions 34
  35. 35. Track IV - Technology Architecture Process The Technology Architecture provides a roadmap for the construction of an enabling infrastructure Creation of the technology architecture occurs after the determination of the strategic direction of the applications and data The objective of Track IV is to determine the future technology architecture that will drive the implementation of required Infrastructure to support the healthcare business and practice activities & deliverables include: Activities Deliverables • Identify the technology architecture drivers from the • Technology architecture guidebook outlining strategy and application and data architectures • Framew orks • Identify the current technology infrastructure in terms of • Models technologies, standards and implementation • Standards • Develop a future state direction for each of the key For each of the technology components outlined in the technology architecture components: activities • Application services • Data services • Commerce services • Netw orks • Netw ork based services • Platforms • Security • Conduct a facilitated w orkshop to verify and confirm the technology architecture direction 35
  36. 36. Components of a Technology Architecture The technology architecture or infrastructure blueprint is divided into distinct components • Service (Application) Components Commun- ications – Commerce, Communications, Content, Customization Commerce Custom- Content • Technology Components ization – Application Services – Data Services Network App. Data and Platforms – Platforms Services Services Security – Security – Network and Communications Each component represents a well defined set of technologies, vendors, standards, and disciplines. The technologies and standards selected for any one component set may have significant influence on the others. 36
  37. 37. Architecture Component Classification Recognizes the Evolutionary Nature of Infrastructure Special-Use Emerging – Isolated infrastructure needed to meet a – Technology under specific and isolated business need evaluation – “One off” solutions that are bolted onto – Limited services the core architecture initially available – Competing emerging technologies might replace CORE ARCHITECTURE core or special- use Core EMERGING Architecture TECHNOLOGY EMERGING – Strategic infrastructure TECHNOLOGY direction EMERGING TECHNOLOGY – Replicated technology DECLINING throughout an organization – Full range of infrastructure Declining services provided – Technologies that are not strategic for the future – May be a candidate for immediate transition or may be on a “sunset” path for several years 37
  38. 38. Track V - Management Architecture Process The Management Architecture will define the HIT governance / HIT organizational structure required to support the HIT strategy and managed the future state HIT environment. The management architecture will define: – The HIT Governance structure – The HIT Organizational structure The Management architecture will be developed as an outcome of the HIT strategy. The HIT Strategy will set the direction for HIT governance and the architecture will define specific governance model and organizational structure, including roles & responsibilities Activities Deliverables • Identify the key governance drivers from the HIT strategy • A management architecture that w ill: • Identify all the constituencies involved in managing and • Define the governance structure for managing HIT setting the direction for HIT • Define the constituents involved in managing HIT and • Identify the roles and responsibilities for the constituents their roles and responsibilities • Identify the key competencies required for delivering and • Key competencies that w ill be required for HIT managing HIT 38
  39. 39. Management Architecture Can Consider a Range of Governance Structures · Service Level Agreements · Knowledge, Resource Sharing · Competitive Pricing · Economies of Scale · Chargeback Cost · Shareholder-driven Objectives Recovery · Revenue Generation Potential · Architecture Control Shared · Various Ownership Options Service Separate Centralized Subsidiary Control · Pooling of key Centers · Shared Risk competencies Joint Venture · Leverages Partner of · Knowledge Excellence Resources Sharing Outsourcing Franchise · Proven, Reusable · Contractual Model Relationship · Portable Solution · Predictable Costs · Reduces Capital Outlays 39
  40. 40. A Process For Creating Roles and Responsibilities is Driven by the HIT Strategy The process involves analyzing and The health care users of the HIT synthesizing the requirements for HIT systems and services and the systems & services and determining the roles HIT Users organizations/people that & responsib ilities for delivering, managing influence & guide HIT and planning those systems & services HIT Systems HIT Health Care Business and Practices & Services Influencers HIT The HIT systems and related services that support health care operation Analysis & HIT Roles & HIT Service Synthesis Responsibilities Providers Organizations that develop, manage & support HIT systems HIT HIT Policies & HIT Processes Principles Procedures Key processes for Basic beliefs and tenets developing, supporting concerning the and managing HIT management of HIT driven 40 by the health care business
  41. 41. HIT Transition Plan Process The Transition Plan defines the the initiatives that need to be undertaken to implement the HIT strategy and the value proposition that will result. The plan will include: – The initiatives that can be accomplished in the 12-24 months following the completion of the plan – Identify the value proposition for each initiative – Identify the estimated resources and timeframe for implementation The objective of the transition plan is to develop a short term HIT implementation plan supported by business cases. Activities Deliverables • Perform gap analysis and identify key initiatives • Portfolio of strategic initiatives, key aspects to include: • Detail the initiatives in terms of: • Business cases • Value propositions • Initiative prioritization • Resources • Transition program including: • Timeframes • A description of each initiative : duration, • Prioritize and document initiatives dependencies and order of magnitude capital costs • Program overview : capital costs estimates (if know n) and an aggregation of timing/dependencies to provide an order of magnitude estimate of the level of investment required • Timeline 41
  42. 42. HIT Transformation Map 2010 Stage 1 Year 1 Year 2 Major activity/ Long Major activity/ milestone milestone Term a l Solutions ED & Clinic Major activity/ milestone Major activity/ milestone Vision Major activity/ Major activity/ milestone milestone Major activity/ milestone nt Major activity/ e me milestone ag Major activity/ an Major activity/ milestone c eM milestone a cti Pr Major activity/ R& milestone EH e Major activity/ l Us Major activity/ Major activity/ Major activity/ milestone milestone milestone milestone ingfu Major activity/ milestone Major activity/ Major activity/ Major activity/ milestone Mean milestone milestone nce a ent orm Major activity/ nt Major activity/ milestone & me Major activity/ e m Pe r f milestone le e milestone yc ag C n e ue Ma Major activity/ Ma erpris Major activity/ en s ev ces milestone milestone nag TODAY R c Major activity/ Ent A milestone Creative Solutions
  43. 43. Appendix B: Strategy Project Work Samples Creative Solutions
  44. 44. Strategy Work Sample: Assessing the Current State of HIT and its Service Agility • Use existing organizational documentation sources, questionnaires, an HIT Service Agility tool, and executive interviews to review and assess capabilities in Applications, Information Management, Technology Management, and Technology Infrastructure across dimensions of services, all stakeholders, common industry models and standards. • Compare current processes HIT Service Agility Framework environments and costs with leading Infrastructure The hardware and software that supports the Application Software that supports the automation of business practices and benchmarks to Applications, Information, Processes and Users processes or functions (Purchased Packages, Custom Developed, Systems Integration) determine how well services compare • Hardware/Software • Outsourced commodities • System development lifecycle - application process • Architectural standards • Application framework - core set of common services to most other companies within health • Rapid technology introduction • Buy, build, integrate • Workstations • Portfolio rationalization process • Scalability of services • Application implementation decisions guided by care. • Consistent HIT processes enterprise application architecture • Quality of Services • Platforms • Networks Information Management & Organization • Document areas of strength, Information repositories and tools for access and Processes that support the ongoing delivery and analysis of key business data elements (e.g., operation of HIT solutions, organization design & weaknesses, quick hits and Customers, Products, Transactions, Documents) the roles that perform those processes recommendations for developing the • • • Data ownership Information managed as an enterprise asset Data quality strategy • • HIT strategy and planning with business strategy Managed portfolio of services and initiatives • Consistent financial management of HIT costs HIT strategy. • • Data warehouses Enterprise wide data model and repositories • Resource management process Creative Solutions
  45. 45. Strategy Work Sample: Assessment Domains and Dimensions of Services Management Applications Information Infrastructure le nt ab ne er po eliv om D C le p m Sa Creative Solutions
  46. 46. Strategy Work Sample: Assessment Tools, Interviews and Process Document Reviews le nt ab ne er po eliv om D C le p m Sa Creative Solutions
  47. 47. Strategy Work Sample: High Level and Detailed Assessment Deliverables Observations Recommendations IS is a relatively low cost services provider. Overall IS costs are Assess current staffing strategy for improvements in staff flexibility below the benchmark mean for *** and % of total revenue (- and availability. 21% variance for both benchmarks). –Conduct a resource planning analysis to understand –Low infrastructure costs (data center, network, PC hardware, capacity alignment with current competency requirements. etc.) offset high claims system costs (significantly above the Initiate a resourc e planning process (potentially in the PMO) benchmark range) and increased overall personnel costs (at that will proactively plan and address future capacity the high end of the benchmark range). management. –IS’s cost performance is significant considering xyz’s relative size in the industry. Stratification of respondents in the •Resource planning and budget process should be Gartner Study indicates that IS costs *** increases as integrated with demand management and portfolio prioritization processes to ensure appropriate company size increases (based on total revenue). IS resources are fully utilized throughout the year. economies of scale are not typically realized with increased •Research business analyst skill set match and size. address gaps appropriately (training, infuse experienced resources, etc.), particularly in the area Demand for IS services is high for an organization of xyz size. of IT. Overall staffing levels are at the high end of the benchmark –Implement staffing management tools that allow more range (+36% variance from the mean). effective balancing across BAU and development of –Development and maintenance staff are both significantly strategic business capabilities. above benchmarks. Ratio of development to maintenance –Develop an accelerated on-boarding and cross-training staff is good, but slightly weighted toward maintenance. program that effectively organizes materials on xyz’s business –Management, administrative, and infrastructure staff appear processes and the IS supporting applications. well leveraged. Adjusting development and maintenance staff to benchmark means produces an overall staffing level le We believe there are currently no tangible benefits in outsourcing nt ab that is below the benchmarks. the IS utility functions (Data Center, Network) at xyz. ne er –Current IS infrastructure costs are low, therefore outsourcers po eliv will not be able to reduce the costs enough to overcome the om D inherent risks of outsourcing. C le –Current operational services are satisfactory and improving. p am –xyz mainframe environment, although mature, is a dynamic S environment (major development is ongoing) that normally does not lend well to the outsourcing financial model. Creative Solutions
  48. 48. Strategy Work Sample: Supporting Observations for Ratings in Each Focus Area within the Four Domains These are the leading practices that represent a perfect score – which very few, if any, companies can attain. This section of These observations the scorecard support our ratings provides the in the three overall categories that assessment for contribute most to that component overall agility: of the Domain. Is the strategic direction for this component well- defined and aligned to the business? le Is this process well nt ab documented? How ne er po eliv well is it executed? om D C le p m Sa Creative Solutions
  49. 49. Strategy Work Sample: Benchmark Detail - IS Costs Benchmark Name Benchmark Metric 25th % Mean 75th % 2.3% IT Costs as a % of Total Revenue 2.0% 2.9% 3.2% Metric Data Description Element Data Source Value Adjustments •IS Total Costs Budget versus Actual $135 M Data factored by Finance from actual System costs •Total Revenue $5,768 M Finance Informational Metrics Metric Data Description Data Source Metric Comments •Total IT Costs Budget versus Actual System 2.4% $265 MM Costs/ $10,913 MM Revenue Observations/ Assumptions le • Low IT costs as a % of total revenue nt ab ne er • Benchmark mean for IT Operating Budget as a % of Gross Revenue = 2.1% po eliv • Total Revenue includes Premium Revenue, Interest Income, and Fees and Other Income om D C le • Metric variance from mean: -21% p am Creative Solutions S

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