The document discusses strategic planning for health IT. It defines strategic planning and differentiates it from tactical planning. It describes the purpose and scope of health IT strategic planning, governance of the planning process, and maturity models to assess health IT adoption. The strategic planning process and documentation are outlined. Critical success factors include creating a vision, gaining agreement on the plan, developing financial and implementation strategies, and assessing benefits realization. Strategic planning for health IT is important but not always valued in organizations.

1. © 2017 American Health Information Management Association© 2017 American Health Information Management Association
Health IT and EHRs:
Principles and Practice, Sixth Edition
Chapter 3: Strategic Planning for
Health IT

2. © 2017 American Health Information Management Association
Strategic Planning Defined
• Process conducted by senior management
that describes the organization’s future
state
o Strategic planning is long term and covers 3-5
years; ideally 10 years
o Tactical planning is short term for the duration
of a project; generally not more than 12-18
months

3. © 2017 American Health Information Management Association
Purpose and Scope of Strategic
Planning for Health IT
• To determine how health IT can support the
organization’s overall strategic plan
(considering broad goals and general
directions, such as whether to acquire,
merge, create a center of excellence, buy
physician practices)
• A systems perspective to health IT strategic
planning that follows the SDLC ensures the
broadest possible scope for planning

4. © 2017 American Health Information Management Association
Governance of Health IT Strategic Planning
• Governance is establishment of policies for effective and efficient
management of organization’s assets and continual monitoring of
how policies are working to achieve their stated goals
• Health IT strategic planning is performed by representatives of
the organization’s leadership in:
Finance (such as CFO) Clinical areas (such as CMO, CNO)
Operations (such as COO) Information technology (such as CIO, CTO)
• Others also play a role in strategic planning and governance by
supplying domain expertise:
o Chief medical informatics officer (CMIO) and other informaticians
o Enterprise health information management professionals
o Key IT staff; such as clinical data analysts, database administrators,
data administrator, information security analysts

5. © 2017 American Health Information Management Association
Strategic Planning Process & Documentation
• Process may be enhanced with adoption of a strategic
planning model, that may depend on the size of
organization, its planning experience, level of change
anticipated, and organizational culture
• The planning process:
o Includes identifying who, when, where, why, and how strategic
planning will be conducted
o Draws on an environmental scan and SWOT analysis
o Charts strategic direction, including review and reaffirmation of
mission, vision, and values; strategic goals, strategic initiatives, and
action plans
o Includes evaluation of the planning process and plan; and
acknowledgment of completion and celebration of results
• Strategic planning must be conducted without personal bias

6. © 2017 American Health Information Management Association
Maturity Models for Health IT
• Strategic planning for health IT benefits from
an understanding of the maturity of each
form of health IT, such as:
o Ancillary/specialty systems, EHR components,
infrastructure, and connectivity or interoperability
o Status of their adoption or plans to promote
adoption

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Gartner Generations Criteria for EHR Adoption

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HIMSS Analytics Adoption Model for Hospitals
• Stage 0: Not all ancillary systems installed
• Stage 1: Lab, radiology, and pharmacy systems installed
• Stage 2: Major ancillary systems feed data to a central data repository that
feeds rudimentary conflict checking
• Stage 3: Nursing or clinical documentation (including E-MAR) is used, and first
level of CDS is used
• Stage 4: CPOE is used in at least one service area and second level CDS
relating to evidence-based medicine protocols
• Stage 5: Closed-loop medication administration (BC-MAR)
• Stage 6: Full physician charting uses structured templates in at least one
service area. Level 3 CDS provides guidance and compliance alerts. PACS
replaces film
• Stage 7: Hospital no longer uses paper charts and has a mixture of discrete
data, document images, and medical images. A clinical data warehouse
supports data analytics. There is summary data continuity across inpatient, ED,
and outpatient areas

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HIMSS Analytics Adoption Model for Physician Practices
• Stage 0: Paper-chart based
• Stage 1: Some intraoffice messaging and desktop access to
unstructured clinical information
• Stage 2: Beginning of a clinical data repository for orders and results;
access to external lab test results
• Stage 3: Computers replace paper; practice uses electronic messaging,
clinical documentation at the point of care, and clinical decision support
• Stage 4: CPOE and structured data accessible from EHR for internal
and external sharing
• Stage 5: Practice has a personal health record or tethered patient portal
• Stage 6: Advance clinical decision support aids proactive care
management and structure messaging
• Stage 7: Practice is HIE-capable and shares data between its EHR and
a community-based EHR; generates business and clinical intelligence

10. © 2017 American Health Information Management Association
Federal Meaningful Use Maturity Models
• MU incentive program stages represents
plans for maturing EHR (see figure 1.3)

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Shared Nationwide Interoperability Roadmap
• As the MU incentive program winds down,
the federal government focuses on
interoperability:

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Health IT Migration Path
• Each organization can plot its own health IT
maturity through using a health IT migration
path
o Migration path is a strategic plan for health IT. It is a
30,000 foot view of health IT systems that are in place
and planned for over time. Various formats exist to
describe a migration path
o The migration path is in contrast to an implementation
plan that is a tactical plan that provides detailed steps
associated with selecting, installing, customizing,
testing, and rolling out each separate component of an
EHR and other health IT

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Constructing a Migration Path
• The migration path should include the following key components:
o Time frame
o Goals
o Applications
o Technology
o Operations
o Dependencies
• Frequently a diagram of some type is used to depict the overarching
migration path, then documentation for each of the components provides
more detail:
o A diagram may identify a Time Frame of Phase 2 (2015 – 2020) and
Goal of earning Stage 3 MU and recognition as a HIMSS Stage 6
hospital
o Chapter 2 of the documentation may fully identify what of the MU
criteria remain to be met and what HIMSS components must be in
place for Stage 6. The specific, detailed goals associated with each of
these would be documented as SMART and STRETCH goals (see
chapter 4)

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Sample Matrix Diagram of Migration Path for the EHR
Figure 3.3 Sample matrix diagram of migration path toward the EHR
Copyright © 2016 Margret/A Consulting, LLC. Reprinted with permission.

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Template for the Matrix Format for Migration Path

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Critical Success Factors for Health IT Strategic Planning
• Creating the vision
• Identifying the planning horizon
• Gaining agreement
• Developing a financing and acquisition strategy
• Mapping workflows and processes
• Developing functional, data, and technical
strategies
• Carrying out a vendor selection process
• Planning the implementation
• Conducting benefits realization

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Scenario
• Health IT can represent an immense change in an organization. Even when an organization
already has considerable health IT, each new phase of health IT comes with its own set of
concerns. Consider Hospital A:
A leader in EHR implementation, there remains pockets of
resistance among physicians in a multi-specialty physician
practice. As value-based payment methodologies are forcing
physicians to adopt new financial strategies, such as bundled
payments for common orthopedic procedures, such as hip and
knee replacements, the practice wants all orthopods to use the
EHR and (all physicians) to monitor analytics on variations in
practice that are causing payment outliers that will ultimately
reduce revenue to the practice, and hence physician income.

18. © 2017 American Health Information Management Association
Creating the Vision
• Each organization is best served when it creates its own
vision for its next steps in health IT
• Visioning exercises can help consider what a future state
might be like. Using a scenario, participants may be asked
to describe one or more of the following
o Achieving an award for most success in health IT
o Typical day with health IT
o Worst day without health IT

19. © 2017 American Health Information Management Association
Identifying the Planning Horizon
• Health IT cannot be implemented
overnight and often takes considerably
longer than anticipated, especially to
achieve optimal use
• Superimposing federal planning horizons
with the organization’s own history of
health IT implementation can help create a
realistic planning time frame

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Gaining Agreement on the Strategic Plan
• Agreement on the health IT strategic plan
must consider capacity to carry out the
plan’s elements
o People resources
o Financial resources
o Technology resources
o External preparedness
• Consensus must be reached before
proceeding with a health IT strategic plan

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Financing and Acquisition
• How will health IT be paid for?
o Purchase
o Partnering/Co-development
o Lease
o Other: incentives, discounts, etc.
• How will health IT be acquired?

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Workflow and Process Mapping
• Understand current workflows and processes to
identify what stays, what goes, and what needs
to change in order to achieve program goals
• Plot planned workflows and processes
considering new health IT to ensure it
addresses the goals of the program
• Monitor workflows and process in the new
health IT environment to make any necessary
adjustments

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Functional Strategy
• Specific functions of the health IT planning determine how the system
will perform with respect to its users and in relationship to its boundaries
with other systems. For example:
A primary care clinic has decided it wants to implement a personal health
record (PHR) for its patients. Its EHR vendor offers a portal through
which the patient can view lab results and certain other information in the
EHR, as well as book appointments and pay bills.
However, the clinic wants the PHR to be interoperable with other PHRs
in the community, especially those maintained by the specialists to
whom they frequently refer patients. Such interoperability is not common
as yet, but there are a few ways to achieve such a goal. The clinic needs
to carefully describe the functionality desired by specifying desired
workflows and processes, studying vendor offerings, conferring with
other clinics who have implemented such a PHR, and engaging the
specialists and patients in identifying potential barriers.

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Data Strategy
• Data strategy refers to the manner in which the
organization plans to use data standards and build
its infrastructure
• Some of the issues to be considered include:
o What standards?
o How much structured versus unstructured data?
o Who will maintain a clinical data warehouse?
o Who will perform data analytics?

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Technical Strategy
• Technology that supports health IT can
include legacy, current mainstream, leading-
edge
• Technology considerations are impacted by
staff capabilities, vendor capabilities, risk
position of leadership, cost, and other factors
• Flexibility to accommodate the pace of
change in health IT is important

26. © 2017 American Health Information Management Association
Vendor Selection Strategy
• Most healthcare organizations have considerable
technology today, but
o Niche systems are still being added, such as:
• Clinical data warehouse
• Advanced analytics
• New security technology to thwart new threats
• Health information exchange structures
o Systems are being replaced
• Vendor sunsets a product
• Organization unhappy with present capabilities
o Upgrades and enhancements are inevitable

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Implementation Strategy
• A strategic plan does not provide the level of
detail needed for implementing each and
every new, upgraded, enhanced, or replaced
system component
• However, the philosophy of change,
expectations for new users, cutover
strategies, and other considerations are
strategic in nature

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Benefits Realization
• Formal benefits realization studies are not the norm
because they are difficult to conduct, the timeframe in which
implementation occurs is long, there is often no clear-cut
definition of what success means, and there are many
confounding variables that must be considered
• However, a critical success factor in health IT strategic
planning is to establish if goals are met.
o Specifying SMART goals is key to determining if goals are being
met
o A measurement philosophy and strategy establishes the expectation
that goals are important and expected to be achieved, albeit with the
support of the organization for proper training, monitoring, feedback,
and assistance

29. © 2017 American Health Information Management Association
Current Status of Health IT Strategic Planning
• Planning is not always easy, and sometimes is not
valued.
• It is found that with respect to health IT:
o Lack of physician support is the primary cause of failure
o Executive management support is the most critical to
success
• Strategic planning for health IT is vital, and
executive management must understand its
accountability or find that lack of success often
leads to change in leadership