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- 1. HHeeaalltthh IInnffoorrmmaattiiccss OOvveerrvviieeww IIAAKKMM 6600440011 HHeeaalltthh IInnffoorrmmaattiiccss MMaannaaggeemmeenntt MMiicchhaaeell OO.. BBiiccee
- 2. HHeeaalltthh IInnffoorrmmaattiiccss ((HHII)) DDeeffiinniittiioonn:: HHeeaalltthh IInnffoorrmmaattiiccss ((HHII)) iiss aa sscciieennccee tthhaatt ddeeffiinneess hhooww hheeaalltthh iinnffoorrmmaattiioonn iiss tteecchhnniiccaallllyy ccaappttuurreedd,, ttrraannssmmiitttteedd aanndd uuttiilliizzeedd.. HHeeaalltthh iinnffoorrmmaattiiccss ccaann bbee ccoonnssiiddeerreedd ““ttrraannss-- ddiisscciipplliinnaarryy”” aanndd ffooccuusseess oonn iinnffoorrmmaattiioonn ssyysstteemmss,, iinnffoorrmmaattiiccss pprriinncciipplleess,, aanndd iinnffoorrmmaattiioonn tteecchhnnoollooggyy aass iitt iiss aapppplliieedd ttoo tthhee ccoonnttiinnuuuumm ooff hheeaalltthhccaarree ddeelliivveerryy..
- 3. HHeeaalltthh IInnffoorrmmaattiiccss ((HHII)) HHeeaalltthh IInnffoorrmmaattiiccss iiss aa ddiisscciipplliinnee wwiitthh tthhrreeee ddoommaaiinnss.. – IInnffoorrmmaattiioonn SSyysstteemmss ddoommaaiinn ffooccuusseess oonn ssuucchh iissssuueess aass iinnffoorrmmaattiioonn ssyysstteemmss aannaallyyssiiss,, ddeessiiggnn,, iimmpplleemmeennttaattiioonn,, mmaannaaggeemmeenntt aanndd lleeaaddeerrsshhiipp..
- 4. HHeeaalltthh IInnffoorrmmaattiiccss ((HHII)) – IInnffoorrmmaattiiccss ddoommaaiinn iiss ccoonncceerrnneedd wwiitthh tthhee ssttuuddyy ooff ssttrruuccttuurree,, ffuunnccttiioonn aanndd ttrraannssffeerr ooff iinnffoorrmmaattiioonn,, ssoocciioo-- tteecchhnniiccaall aassppeeccttss ooff hheeaalltthh ccoommppuuttiinngg,, aanndd hhuummaann--ccoommppuutteerr iinntteerraaccttiioonn..
- 5. HHeeaalltthh IInnffoorrmmaattiiccss ((HHII)) – IInnffoorrmmaattiioonn TTeecchhnnoollooggyy ddoommaaiinn ffooccuusseess oonn:: CCoommppuutteerr nneettwwoorrkkss DDaattaabbaassee aanndd ssyysstteemmss aaddmmiinniissttrraattiioonn,, SSeeccuurriittyy PPrrooggrraammmmiinngg
- 6. WWhhaatt WWee NNeeeedd iinn PPllaaiinn EEnngglliisshh WWee nneeeedd ttoo ttuurrnn ppaappeerr pprroocceesssseess iinn hhoossppiittaallss,, cclliinniiccss,, llaabbss aanndd pphhyyssiicciiaann ooffffiicceess iinnttoo eelleeccttrroonniicc ttrraannssaaccttiioonnss WWee nneeeedd ttoo bbee aabbllee ttoo sshhaarree mmeeddiiccaall rreeccoorrddss wwhheenn aa ppaattiieenntt ttrraavveellss oouuttssiiddee ooff aa rreeggiioonn,, wwhhiillee pprrootteeccttiinngg ppaattiieenntt pprriivvaaccyy WWee nneeeedd aa wweebb--bbaasseedd ssyysstteemm ffoorr pprroommuullggaattiinngg eevviiddeennccee--bbaasseedd mmeeddiiccaall ttrreeaattmmeennttss iinnttoo eevveerryyddaayy cclliinniiccaall pprraaccttiiccee
- 7. OObbsseerrvvaattiioonnss SSiiggnniiffiiccaanntt cchhaalllleennggeess ttoo lloonnggssttaannddiinngg aassssuummppttiioonnss,, pprraaccttiicceess,, aanndd vveesstteedd iinntteerreessttss.. TThhee ttrraannssiittiioonn ffrroomm aa ppaappeerr ccuullttuurree ttoo aa ddiiggiittaall ccuullttuurree wwiillll bbee ddiiffffiiccuulltt,, ccoossttllyy,, aanndd ddiissrruuppttiivvee.. TThhee pprriivvaattee hheeaalltthhccaarree sseeccttoorr,, lleefftt ttoo iittss oowwnn ddeevviicceess,, wwiillll nneevveerr ffuullllyy eemmbbrraaccee HHII
- 8. OObbsseerrvvaattiioonnss LLaarrggee mmuullttii ssppeecciiaallttyy pphhyyssiicciiaann ggrroouuppss aarree mmoorree lliikkeellyy ttoo ppuurrssuuee eevviiddeennccee,, aaddoopptt gguuiiddeelliinneess aanndd mmaannaaggee vvaarriiaattiioonn aaggggrreessssiivveellyy,, tthhaann ssmmaalllleerr ggrroouuppss oorr ssoolloo pprraaccttiittiioonneerrss ((DDiiggiittaall DDiivviiddee)) TThhee eenndd ggaammee ffoorr HHII iiss rreedduucceedd ccoossttss,, bbeetttteerr ccaarree,, bbeetttteerr hheeaalltthh,, aanndd iimmpprroovveedd aacccceessss
- 9. OObbsseerrvvaattiioonnss FFrreeqquueennccyy aanndd SSeevveerriittyy ooff HHIITT RReellaatteedd RRiisskkss aarree IInnccrreeaassiinngg IITT PPrroodduuccttss aanndd SSeerrvviicceess HHaavvee bbeeeenn OOvveerrssoolldd aanndd NNoott WWeellll UUnnddeerrssttoooodd WWhheenn hhoossppiittaallss ppuurrcchhaassee aa mmaajjoorr IITT ssoolluuttiioonn,, tthheeyy aarree nnoott mmeerreellyy bbuuyyiinngg tteecchhnnoollooggyy.. TThheeyy aarree bbuuyyiinngg cclliinniiccaall ttrraannssffoorrmmaattiioonn..
- 10. OObbsseerrvvaattiioonnss TThhee UU..SS.. llaaggss ootthheerr iinndduussttrriiaalliizzeedd ccoouunnttrriieess iinn IITT aaddooppttiioonn AA mmaajjoorr bbaarrrriieerr ttoo wwiiddeesspprreeaadd IITT aaddooppttiioonn iiss tthhaatt ccoossttss aarree ggeenneerraallllyy iinnccuurrrreedd bbyy aa ffeeww eennttiittiieess,, wwhhiillee bbeenneeffiittss aaccccrruuee ttoo mmaannyy iinntteerreesstteedd ppaarrttiieess ((PPuubblliicc vveerrssuuss PPrriivvaattee GGoooodd??))
- 11. OObbsseerrvvaattiioonnss CCoonnnneeccttiinngg ppaattiieennttss aaccrroossss aa ffrraaggmmeenntteedd ddeelliivveerryy ssyysstteemm——ffrroomm MMDD ooffffiiccee ttoo hhoossppiittaall ttoo sskkiilllleedd nnuurrssiinngg ffaacciilliittyy——sseeeemmss ddeessiirraabbllee,, bbuutt wwiillll iitt eevveerr bbee rreeaalliizzeedd?? MMooddeerrnn tteecchhnnoollooggyy iissnn’’tt ffoooollpprrooooff.. IItt ccaann mmaaggnniiffyy pprriivvaaccyy pprroobblleemmss,, tthheerreebbyy wweeaakkeenniinngg tthhee ccaassee ffoorr ppuubblliicc ssuuppppoorrtt..
- 12. OObbsseerrvvaattiioonnss SSeeeemmiinnggllyy iinnttrraaccttaabbllee pprroobblleemmss ooff pprriivvaaccyy,, sseeccuurriittyy,, aanndd iinntteerrooppeerraabbiilliittyy HHIITT iiss aa ““ffrreeee ffoorr aallll”” iinn wwhhiicchh eevveerryy ppaarrttiicciippaanntt –– hheeaalltthh ppllaann,, pprroovviiddeerr,, vveennddoorr -- iiss ppuurrssuuiinngg tthheeiirr oowwnn aaggeennddaa HHeeaalltthhccaarree iiss aa ccoommpplleexx,, ffrraaggmmeenntteedd,, iinnffoorrmmaattiioonn--ddeeppeennddeenntt iinndduussttrryy tthhaatt llaacckkss aa uunniiffyyiinngg tteecchhnnoollooggyy
- 13. What AArree TThhee BBuussiinneessss RRiisskkss ooff HHII?? TThhee OOppeenn NNaattuurree ooff IInntteerrnneett TTeecchhnnoollooggiieess IInnccrreeaasseess VVuullnneerraabbiilliittyy ttoo:: – WWeebb OOuuttaaggeess aanndd DDiissrruuppttiioonnss – SSeeccuurriittyy BBrreeaacchheess – IInnttrroodduuccttiioonn ooff CCoommppuutteerr VViirruusseess – PPrriivvaaccyy VViioollaattiioonnss – CCoonntteenntt aanndd AAddvveerrttiissiinngg OOffffeennsseess
- 14. What AArree TThhee BBuussiinneessss RRiisskkss ooff HHII?? – IInntteelllleeccttuuaall PPrrooppeerrttyy IInnffrriinnggeemmeenntt – PPrrooggrraammmmiinngg EErrrroorrss – EElleeccttrroonniicc IInnffoorrmmaattiioonn TThheefftt,, DDaammaaggee,, oorr DDiisscclloossuurree AAllll IInnddiiccaattiioonnss aarree TThheessee IInncciiddeennttss aanndd tthhee RReessuullttaanntt TTaannggiibbllee aanndd IInnttaannggiibbllee LLoosssseess aarree oonn tthhee RRiissee
- 15. PPaauussee aanndd RReefflleecctt IIff yyoouu wweerree aa sseenniioorr hheeaalltthhccaarree eexxeeccuuttiivvee,, wwhhaatt wwoouulldd bbee yyoouurr pprriimmaarryy ccoonncceerrnnss aabboouutt iinnssttaalllliinngg aanndd mmaaiinnttaaiinniinngg eexxppeennssiivvee aanndd ssoopphhiissttiiccaatteedd IITT ssyysstteemmss?? AAss aa hheeaalltthhccaarree ccoonnssuummeerr,, wwhhaatt aarree yyoouurr pprriimmaarryy ccoonncceerrnnss aabboouutt eelleeccttrroonniicc hheeaalltthh rreeccoorrddss??
- 16. FFeeddeerraall GGoovveerrnnmmeenntt SSttrraatteeggyy ((22000044--22001144)) TThhee DDeeccaaddee ooff HHeeaalltthh IInnffoorrmmaattiioonn TTeecchhnnoollooggyy:: DDeelliivveerriinngg CCoonnssuummeerr--cceennttrriicc aanndd IInnffoorrmmaattiioonn--rriicchh HHeeaalltthh CCaarree PPrriivvaattee SSeeccttoorr CCeerrttiiffiiccaattiioonn ooff EE HH RR:: CCoommmmiissssiioonn ffoorr CCeerrttiiffiiccaattiioonn ooff HHIITT ((CCCCHHIITT)) – FFuunnccttiioonnaalliittyy – IInntteerrooppeerraabbiilliittyy – SSeeccuurriittyy
- 17. FFeeddeerraall GGoovveerrnnmmeenntt SSttrraatteeggyy ((22000044--22001144)) FFoouurr SSttrraatteeggiicc GGooaallss – IInnffoorrmm CClliinniiccaall PPrraaccttiiccee – IInntteerrccoonnnneecctt PPhhyyssiicciiaannss – PPeerrssoonnaalliizzee CCaarree – IImmpprroovvee PPooppuullaattiioonn HHeeaalltthh
- 18. Federal HHIITT SSttrraatteeggiicc PPllaann 22000088 -- 22001122 TTwwoo GGooaallss –Patient-focused Health Care –Population Health
- 19. Federal HHIITT SSttrraatteeggiicc PPllaann 22000088 -- 22001122 FFoouurr CCrroossss CCuuttttiinngg TThheemmeess –PPrriivvaaccyy aanndd SSeeccuurriittyy –IInntteerrooppeerraabbiilliittyy –AAddooppttiioonn –CCoollllaabboorraattiivvee GGoovveerrnnaannccee
- 20. Federal HHIITT SSttrraatteeggiicc PPllaann 22000088 -- 22001122 SSuucccceessss MMeeaassuurreess – Health IT becomes common and expected in health care delivery nationwide for all communities – Your health information is available to you and those caring for you so that you receive safe, high quality, and efficient care – You will be able to use information to better determine what choices are right for you with respect to your health and care – You trust your health information can be used, in a secure environment, without compromising your privacy
- 21. Costs && BBeenneeffiittss ooff HHIITT ((CCBBOO JJuullyy ’’0088)) HHIITT iiss nneecceessssaarryy bbuutt nnoott ssuuffffiicciieenntt ttoo iimmpprroovvee qquuaalliittyy aanndd ccoonnttrrooll ccoossttss CChhaalllleennggeess ttoo RRaanndd aanndd CCIITTLL SSttuuddiieess ooff HHIITT ssaavviinnggss ((PPoossssiibbllee,, bbuutt nnoott pprroobbaabbllee)) CCaann tthhee ffeeddeerraall ggoovveerrnnmmeenntt,, sshhoorrtt ooff mmaajjoorr rreeffoorrmm ttoo tthhee hheeaalltthhccaarree ssyysstteemm,, pprroovviiddee iinncceennttiivveess,, ppeennaallttiieess oorr mmaannddaatteess tthhaatt wwiillll ssuubbssttaannttiiaallllyy iinnccrreeaassee tthhee rraattee ooff HHIITT aaddooppttiioonn??
- 22. Costs && BBeenneeffiittss ooff HHIITT ((CCBBOO JJuullyy ’’0088)) TToottaall CCoossttss ffoorr aa HHIITT SSyysstteemm – The initial fixed cost of the hardware, software, and technical assistance necessary to install the system – Licensing fees – Expense of maintaining the system – Opportunity costs
- 23. Costs && BBeenneeffiittss ooff HHIITT ((CCBBOO JJuullyy ’’0088)) Evidence on Improvements in Efficiency from Adoption of HIT – Eliminating Paper Medical Records – Avoiding Duplicated or Inappropriate Diagnostic Tests – Promoting the Cost-Effective Use of Prescription Drugs – Improving the Productivity of Nurses and Physicians
- 24. Costs && BBeenneeffiittss ooff HHIITT ((CCBBOO JJuullyy ’’0088)) Low Rates of Adoption of HIT: Why? – Challenges in Implementing Health IT Systems – Providers’ Inability to Capture Financial Returns from Health IT – Competition Among Health Insurance Plans – Regulatory Impediments
- 25. PPaauussee aanndd RReefflleecctt AAss aa hheeaalltthhccaarree eexxeeccuuttiivvee,, wwhhaatt sseett ooff aarrgguummeennttss wwoouulldd yyoouu ppuutt ffoorrtthh ttoo yyoouurr BBooaarrdd ooff DDiirreeccttoorrss ttoo hhaavvee tthheemm eennddoorrssee aa mmaajjoorr,, mmuullttiippllee yyeeaarr iinnvveessttmmeenntt iinn HHeeaalltthh IITT??
- 26. SSeevveenn DDuurraabbllee IIddeeaass ((GGllaasseerr ’’0088) CCeennttrraalliittyy ooff PPrroocceesssseess – AApppplliiccaattiioonn PPrroojjeecctt aanndd SSuuppppoorrtt – IInntteelllliiggeennccee – AAsssseessssmmeenntt aanndd MMeeaassuurreemmeenntt ooff PPrroocceesssseess OOrrggaanniizzaattiioonnaall PPaarrttnneerrsshhiipp – AAggeennddaa DDeevveellooppmmeenntt – PPrroojjeecctt MMaannaaggeemmeenntt
- 27. SSeevveenn DDuurraabbllee IIddeeaass ((GGllaasseerr ’’0088) PPrrooggrreessssiivvee IInnccrreemmeennttaalliissmm – BBrreeaakk IItt IInnttoo PPiieecceess – IIddeennttiiffyyiinngg RReeaaddiinneessss AAggiilliittyy – IInnffrraassttrruuccttuurree AAggiilliittyy LLeevveerraaggee SSttaannddaarrddss CCoorree TTeecchhnnoollooggyy AAsssseessssmmeenntt
- 28. SSeevveenn DDuurraabbllee IIddeeaass ((GGllaasseerr ’’0088) AAggiilliittyy – AApppplliiccaattiioonn AAggiilliittyy IInntteerrnnaall DDeevveellooppmmeenntt RRaappiidd FFeeeeddbbaacckk SSeerrvviiccee--oorriieenntteedd AArrcchhiitteeccttuurree – OOrrggaanniizzaattiioonnaall AAggiilliittyy SSttrreeaammlliinnee DDeecciissiioonn PPrroocceessss CChhuunnkkss
- 29. SSeevveenn DDuurraabbllee IIddeeaass ((GGllaasseerr ’’0088) AArrcchhiitteeccttuurree – GGrreeaatt AArrcchhiitteeccttss – PPrroocceesssseess,, RRuulleess,, aanndd SSttaannddaarrddss – AAbbiilliittyy ttoo RReeccooggnniizzee aanndd LLeevveerraaggee MMaajjoorr TTeecchhnnoollooggyy AAddvvaanncceess EEmmbbeeddddeedd RReesseeaarrcchh – PPhhyyssiicciiaann LLeeaaddeerrsshhiipp – EEmmbbeeddddiinngg RReesseeaarrcchh iinn OOppeerraattiioonnss
- 30. SSeevveenn DDuurraabbllee IIddeeaass ((GGllaasseerr ’’0088) EEnnggaaggee tthhee BBrrooaaddeerr HHeeaalltthh CCaarree IInndduussttrryy – CCrreeaattee CCaappaacciittyy//TTiimmee ffoorr EExxtteerrnnaall PPuurrssuuiittss – IInncceennttiivveess ffoorr AAccaaddeemmiicc oorr MMaannaaggeemmeenntt PPrroommoottiioonn
- 31. What IITT LLeeaaddeerrsshhiipp NNeeeeddss ((GGllaasseerr ’’0088) VVaalluuee aanndd LLiimmiittaattiioonnss ooff DDuurraabbllee IIddeeaass VViissiioonn EEnnggiinneeeerriinngg SSttaaffff
- 32. PPaauussee aanndd RReefflleecctt AAssssuummee tthhaatt yyoouu aarree aa hhoossppiittaall CCEEOO aabboouutt ttoo llaauunncchh aa sseeaarrcchh ffoorr aa nneeww CCIIOO.. WWhhaatt wwiillll bbee tthhee ccrriittiiccaall ccoommppeetteenncciieess tthhaatt wwiillll yyoouu bbee llooookkiinngg ffoorr iinn tthhee ssuucccceessssffuull CCIIOO ccaannddiiddaattee??
Editor's Notes
- Preamble: There are 700,000 physicians and 5700 hospitals in the United States. Each piece of the delivery system collects data in its own way, and for the most part, existing information systems don’t talk with each other. More than 90% of the 30 billion annual health care transactions occur via phone, fax or paper. Bringing pen and ink patient records and prescriptions into the digital age is seen as a vital step in transforming the delivery of care. Agenda HI Defined HI Observations from the trenches Federal Government Policy 2004-2014 Congressional Budget Office Paper 2008 Glaser’s Seven Durable Ideas
- Commission on Accreditation of Health Informatics and Information Management Education (CAHIIM) 2010 Accreditation Manual
- Source: http://www.cahiim.org/applyaccred_HI_grad.html
- (MHC Editorial 5.29.06)
- CEO observations, for you to consider
- From my Marsh & McLennan Days………
- Businesses are also expected to spend on security, especially as the number of computer viruses and other malicious software hit an all-time high in 2008. TECHNOLOGY DECEMBER 23, 2008 Tech Chiefs See Bright Pockets Online Software, Mobile, Security Expected to Buck Downward Trend in '09 WSJ
- The Certification Commission has certified a total of 136 ambulatory products from 93 health IT vendors since 2006, representing nearly 50 percent of the estimated vendors in the ambulatory EHR market . In its first year of certifying inpatient products, CCHIT certified an estimated 58 percent of vendors in the marketplace. With more than half of the certified products in 2007 coming from new vendors – even though the criteria were significantly more rigorous this year – any concerns about creating barriers to innovation have been put to rest. Http://www.cchit.org/about/news/releases/index.asp Functionality = capable of serving a purpose well; "software with greater functionality“ ; The ability to perform a task or function
- Incentives for E H R adoption; reduce the risk of HIT investment; promote E H R diffusion in rural areas Foster regional and national HIE’s Encourage consumers to use PHRs; promote use of telehealth in rural areas; quality metrics available to consumers Public health surveillance architecture; health status monitoring; accelerating dissemination of evidence-based medicine
- Assertion that the nation will approach the tipping point in adoption of paperless records Enable the transformation to higher quality, more cost-efficient, patient-focused health care through electronic health information access and use by care providers, and by patients and their designees. Enable the appropriate, authorized, and timely access and use of electronic health information to benefit public health, biomedical research, quality improvement, and emergency preparedness.
- Privacy and Security: The success of a nationwide, interoperable health IT architecture in the United States will require a high degree of public confidence and trust. Interoperability: To effectively exchange health information, health IT systems and products must use consistent, specific data and technical standards. Adoption: Standards and policies that will enable the widespread adoption and ongoing use of health IT must be developed. Collaborative Governance: It is essential that collaborative governance occurs across the public and private sectors and involves all individuals and organizations with a stake in health-related activities.
- Statement of Peter R. Orszag CBO Director Evidence on the Costs and Benefits of Health Information Technology before the Subcommittee on Health Committee on Ways and Means U.S. House of Representatives July 24, 2008 A highpoint of HIMSS Summit 08 was the presentation of the Congressional Budget Office (CBO) paper, “Evidence on the Costs and Benefits of Health Information Technology” given by its director, Peter Orszag. Arguably this is the most important analysis to come out of Washington since the initial ONC strategic framework. It makes the case that health IT is necessary but not sufficient to improve quality and control costs. The CBO paper challenges the two major economic studies used to support more health IT investment: RAND and the Center for Information Technology Leadership (CITL) reports, which present possible but not probable savings. It questions whether the federal government, short of major reform to the healthcare system, can provide incentives, penalties or mandates that will substantially increase the rate of health IT adoption. (HIMSS Standards Insight Summary July 2008)
- The “opportunity cost” of the time that health care providers could have spent seeing patients but instead must devote to learning how to use the new system and how to adjust their work practices accordingly.
- Major, multi-year organizational commitment 2. Many of those benefits accrue to others rather than to the providers who purchase the health IT system (Value of HIE, improvements in Quality) 3. Plan A pays 1% + for every e-script; plan B benefits too; can’t quickly capture quality of care improvements 4. Privacy and security issues; safe harbors for hospitals helping MDs with HIT acquisitions
- One of the major thought leaders in HIT ! John Glaser, Journal of the American Medical Informatics Association Volume 15 Number 3 May / June 2008 A durable idea can be a philosophy, a belief, or a value. A specific idea guides a wide range of management decisions. For example, the idea of agility is based on the belief that it is important to be able to quickly and efficiently respond to change. This idea can guide decisions regarding architecture, application sourcing strategies, and the design of the IS organization. At a high level, the 7 durable ideas have undergone little change over the course of 20 years. The strategies and tactics adopted to implement these ideas have changed, at times significantly. In addition, the organization’s understanding of the power and nuance of the ideas has deepened. 1.Applications are only relevant to the degree that they enable improvements in core processes. Processes are central. Applications are not. In health care, clinical processes have an unusually high dependence on information and knowledge. A critical objective of virtually all clinical applications is the delivery of decision support that enable processes to be intelligent. This support requires infrastructure such as event and rules engines. It requires well-structured data for critical data types such as medications. 2. Applying information technology to improve care requires a multifaceted partnership between the IS group and the rest of the organization. There is an abundance of literature, and our own experience that suggests that the quality of the partnership has an impact that is greater than any other variable on the ability of an organization to be successful in applying information technology.
- 3. This idea is based on two considerations. First, big bang implementations are inherently risky. Second, it is very difficult to fully understand the important features of an application or the nature of the process changes needed by large-scale projects. A series of smaller projects enables the organization to progressively learn. This progressive implementation is a form of organizational evolution. It requires very good instincts about readiness and the ability to frame an initiative that takes steps that are not too far ahead of the organization and are not too timid. 4. The application and infrastructure response to change needs to be as efficient and rapid as possible and to enable reasonably quick recovery from responses that were mistakes. HL7's Vision To create the best and most widely used standards in healthcare. HL7's Mission HL7 provides standards for interoperability that improve care delivery, optimize workflow, reduce ambiguity and enhance knowledge transfer among all of our stakeholders, including healthcare providers, government agencies, the vendor community, fellow SDOs and patients. In all of our processes we exhibit timeliness, scientific rigor and technical expertise without compromising transparency, accountability, practicality, or our willingness to put the needs of our stakeholders first. http://www.hl7.org/
- Glaser: Any IS strategy that shortens the time required to deliver an application or reduces the cost of application acquisition and implementation enhances agility. Service Oriented Architecture (SOA) is an approach to integrating IT resources that can enable you to leverage existing assets, while at the same time building an infrastructure that can rapidly respond to new organizational challenges and deliver new dynamic applications. The SOA approach can help free application functionality from its underlying IT architecture, and make existing and new services available for consumption over the network. (http://www.microsoft.com/biztalk/solutions/soa/healthcare.mspx) Glaser: More recently, the growth in the capabilities of service-oriented architecture infrastructure and applications has led to the prospect of composite applications. Composite applications will introduce agility because the significant re-use of services enables the quicker and more efficient crafting of new applications. Chunks To the degree possible, all projects should be structured such that they have reasonably independent phases that can each be implemented within relatively short time intervals.
- Poorly architected systems can be the great disabler. If systems are inflexible, prone to obsolescence, difficult to integrate, or too expensive, they can damage the organization. On the other hand, systems that are fast, reliable, efficient, and capable of reasonably gracefully capitalizing on technology advances can be great enablers. Technology advances Networked personal computers, clinical decision support, the Web, and service-oriented architectures are examples of major technology advances. Med Informatics Programs have been established, over the years, in core medical informatics, bioinformatics, connected care (also known as telemedicine), evaluation, and medical imaging.
- The IS group overall, but in particular the research groups, are expected to engage the broader health care industry. Engaging the field means that they are encouraged and expected to publish, present at conferences, serve in leadership roles in professional associations, and become members of commissions and task forces that are addressing critical topics in the field. Recap of Seven Durable Ideas Centrality of Processes Organizational Partnership Progressive Incrementalism Agility Architecture Embedded Research Engage the Broader Health Care Industry
- The ideas have not prevented us from making mistakes. For example, in some cases, we were too aggressive with centralization of some IS functions, leading to service degradation and increased expense. In addition to realizing that ideas will not prevent mistakes, I have come to appreciate that the IT leadership, particularly the role of CIO, must understand four things…. 1. Appreciate the value as well as the limitations of the 7 durable ideas 2. The IS leadership must have the vision and perspective to see broad opportunities and challenges. Communicate that vision to stakeholders 3. The IS leadership should understand that improving care through the use of IT is a different form of engineering. Often one views engineering as the design and construction of tangible, highly specifiable outputs. Engineering complex organizationsengineered organizational surroundings will result in the actions of many individuals generally moving in the desired direction. 4. The IS leadership must appreciate that the most significant asset that they have is talented, motivated, organized, and resourced staff.