Buying a Clinical Information Technology System

Buying a clinical information technology system challenges every organization’s senior management team. Unlike other administrative applications that help manage a facility, the clinical information technology system touches directly the lives of patients and the work flow of physicians, nurses, and other clinicians. Careers and entire organizations can be ruined by poor vendor choices and botched implementations (e.g., installation of the software and hardware) and deployments (e.g., introduction of applications to end users). Poorly chosen clinical information technology systems can drive physicians to competitor institutions, impact facility accreditation, and in some cases invite litigation due to unexpected morbidity or mortality.

As frightening as this task is, the best way to be successful is to be humble. Senior executives must accept the fact that full investigation of the features and functionality of clinical information technology systems before purchase is impossible. No individual or committee has the technical expertise and available time to effectively evaluate and fully review the capabilities of a comprehensive clinical information technology system. Therefore, organizations must base their decision to purchase systems on factors that function as surrogates for the usefulness and appropriateness of the systems in its institutions. These may include such items as the source of clinical content included with the system, list of organizations using the system, and perceived ease of use of the application.

Evaluate Live Systems

Although information technology vendors utilize demonstrations of their software to educate clients about their products, viewing working systems deployed in patient care areas offers the most valuable information. Unfortunately for both vendors and purchasers, the competitiveness of the healthcare information technology marketplace, couple with the complexity of these systems, encourages vendors to showcase software products during demonstrations that are either partially completed or are in beta version.

Therefore, often what is seen in these demonstrations does not accurately represent the features and functionality currently available. It is important to take vendors at their word when they declare that the demonstrated software is representative of features and functionality under development.

Focus on Deployed Working Systems Only

To increase the probability of purchasing a product that will satisfy the needs of an organization, institutions most focus on existing, working, deployed, and implemented versions of the applications being considered for purchase. The best way to evaluate current-state versions of applications is to visit current clients of each vendor and to witness the daily use of the various applications. Organizations must be patient and allocate adequate time to see the systems working under all conditions. This includes visiting multiple hospitals and various patient care areas throughout each hospital.

Forge Solid Vendor Relationships

For most organizations, it is more prudent to engage in relationships with vendors that have established working applications that can be immediately deployed and utilized. Although working, released software will have its inevitable share of problems, it is likely there will be fewer problems and solutions will be readily found.

In some cases, it may be advantageous to engage in relationships with vendors that are offering software that hast just been released or is under development. In these instances, organizations must enter the agreement recognizing the potential benefits from such arrangements but also the problems and delays in the software that may be associated with purchasing new, untested software. Organizations that do not have extensive information technology infrastructure and departments should be wary of entering into these types of arrangements.

The following sections outline a recommended process for choosing clinical information technology for an institution.

Review and Embrace Strategic Vision

The purchase of all clinical information technology tools must be driven by the clinical strategic vision of the organization. The strategic vision represents the views and aspirations of the board of directors, the medical staff, and other clinical professionals in the organization. Clearly, cost control is always a consideration, but the importance of patient safety and quality healthcare overwhelmingly drives decision making.

Broadly Explore Options

A high level of evaluation of your organization will quickly identify the potential suppliers of the application software required. In almost all cases, there will be a relatively small number of vendors who provide software that meets the needs of an organization. Identification of these vendors can be done through a request for information process ( RFI ), searching the Internet, and contacting colleagues at institutions similar to one’s own.

Understand the Vendor

As relationships with application vendors extend far beyond the implementation phase, a strong, open, and trusting relationship is necessary to be able to ensure that implemented software will deliver the expected results to an organization. Because problems will arise, a positive relationship is required to ensure that problems are resolved. A good relationship with a vendor, as exhibited by respectful an honest interactions with all representatives of the organization, unequivocally trumps perceived advantages in features and functionality that might be seen in other products.

Evaluate The Product

The best way to evaluate clinical information technology applications is to actually see them functioning in a real working environment. Unless an organization is working as a development partner with a vendor, various client organizations, comparable to the purchasing institution, should be available to be visited to observe the applications being used by clinical professionals.

Purchasing organizations must budget more than one day to visit these client organizations and see the applications being used at a variety of times during the day. Workloads vary, with morning physician rounds often presenting the greatest demands upon systems because of their high number of new patient orders and the need for patient care documentation. In addition, evening use represents a time when information technology staffing may be low or system maintenance may occur.

Organizations should request that their representatives be allowed to visit patient care areas unencumbered and be able to ask questions of the various users of the applications. The more institutions visited, the better the information that can be collected to evaluate the applications and the vendor.

Understand Pricing

Vendor pricing is greatly influenced by the level of ongoing maintenance payments, the strategic value of the organization to the vendor, and market forces. Therefore, in negotiating products with vendors, be sure to take a very broad and considered view of the products, services, and support being provided.

Cost of ownership includes not only the purchase price of the software but also the ongoing maintenance fee to the vendor and the cost of implementing, deploying, and maintaining the system during its life. Finally, the importance of the quality of the relationship with the vendor cannot be overemphasized, as it will have the greatest impact on the success of implementation and, eventually,clinician adoption.

Secure Adoption

Implementing clinical information technology without broad involvement and support by the clinical staff-requiring focus on all stakeholders, including physicians, nurses, pharmacists, and other health professionals-all but guarantees a failed and wasteful deployment. Clinical information technology systems alone do not fix clinical problems, advance safety, or reduce costs by themselves. These systems provide tools that can be used by clinicians to change how they deliver care. Only with clinician creativity, insight, and experience molding the implementation can new processes deployed with these tools deliver acceptable work flows and generate good outcomes.

If deployment is poor and disruptive, clinicians will create work-arounds to these failing system processes, a development that guarantees medical errors and unacceptable waste. By securing adoption, organizations can be assured of usable systems that are embraced by clinicians and that are able to deliver expected and much-needed clinical and financial outcomes.

The Importance of Information Technology Training from a Management Perspective

Information technology training for IT managers and systems analysts may seem superfluous – these folks are usually well-learned in their areas of expertise. But, do they understand how a company’s technology fits into the bigger picture from a business perspective? That’s where management training becomes important. Every manager who plays a role in researching, selecting or implementing enterprise technology needs to have a firm grasp on the basics of emerging technologies, as well as how they serve a larger business purpose, to ensure that technology is being used to the company’s best strategic advantage.

Stay Current on Revolutionary, Emerging Technology Applications

A program of continual information technology training is crucial to the success of any IT team. Technology is constantly evolving, and it seems that there is a new application released every day that is meant to simplify doing business. This can be overwhelming if you do not stay current on the high-level trends of technology and their corresponding impact on business. With the Web 2.0 revolution in full swing, management training is a useful tool for managers to become familiar with the online trends such as blogs, wikis, podcasts and RSS feeds, as well as how the trends are going to change the ways we view the Internet and communicate with each other. It is estimated that these technologies will have significant business impact in the coming years, and companies everywhere have to consider directly how it affects their business strategies.

Information technology training can help managers determine the impact of new technologies and how to adapt their business processes. Trying to envision how Web 2.0 changes traditional business models is difficult when you have no knowledge of how these new technical applications are being used from a business perspective. First and foremost, managers must take it upon themselves to become proactive by keeping abreast of emerging trends and understanding them not only from a technical standpoint, but evaluating them from a higher-level, strategic standpoint. Management training courses on technology focus specifically on the ways that emerging technologies affect businesses on a high level. This is the type of knowledge needed to make conscious and informed decisions on what aspects of new technologies will affect your organization in the next few years and transition your thoughts into strategic action and implementation.

Collaboration and information sharing, within and outside of enterprises, are two areas that have made huge strides that management training can help your organization harness to improve business strategies. The advent of user-created content sharing has transformed the way that enterprises communicate. Enterprise-class blogs and wikis boost productivity and innovation by enabling ad hoc teams to participate in complex, collaborative problem solving, and then make the results available to the rest of the organization with ease. Information technology training gives managers the high-level information about these technologies that they need to bring them effectively into your organization.

Large companies will often struggle the most with adopting new business strategies based on emerging technologies due to organizational inertia and the lag that comes from changing any integrated system. Not only do the right people need to be convinced of the value of a new application, but the proper infrastructure often needs to be developed or tweaked to implement the technology. This is where the importance of management information technology training to understand the potential impact of technology from a business perspective comes into play.

Management Training for Appropriate Technology Selection and Recommendation

Management training courses typically deal with logistics and personnel management but fail to guide managers when it comes to making decisions about technology. As a manager in today’s world, what really matters isn’t just your ability to lead and maintain technology infrastructure – it’s your ability to deliver positive business outcomes. Cutting IT costs and managing infrastructure are only part of the equation. Technology must also reduce business risk and generate new opportunities and growth. Information technology training can help managers transition their views of technology as an isolated island off the coast of a business and look at it as one working part of the whole machine that is the organization.

Finding a cool application that has all the shiny bells and whistles you dreamed of and recommending implementation based on the technology’s sheer innovation is no longer enough to make a good business case. Before presenting a recommendation, you must understand every step involved with the successful implementation of the technology. A thorough study will need to be conducted to determine what departments, processes and functions will need to be modified in order to benefit from the new technology. Management training courses focusing on information technology gives managers the tools they need to make that determination.

If you are going to make an impact on the decision makers of a business, you have to get on their level. When it comes down to making a decision, for many business people it is all about the numbers. That is why it is essential to participate in information technology training courses that help you perform your due diligence and gather the data you need to compile hard numbers around your recommendation. What is the true return on investment that the company can expect to achieve by implementing the technology? It is much easier to convince an associate of the merits of your idea if you can show a real increase in profit based on proven research instead of attempting to sway them based on opinion only.

Conclusion

Technology is rapidly changing the way that businesses communicate and function every day. It is important for managers to take a proactive role in understanding emerging technology trends and how they may affect a company’s business model by investing in an ongoing program of information technology training for all levels of staff. Management training in particular is essential for ensuring the right technologies are pursued to ensure business success. Viewing technology as a direct influencer on the business as a whole ensures consistent alignment of goals throughout the enterprise.

Data Arteries – Enabling Business Strategy Through Information Technology

Regardless of size and industry, every enterprise is dependent upon information technology, and must have a strategy for how to employ it, especially as the internet becomes more pervasive. Information technology strategy is an enabler of business strategy. Not only must an enterprise manage relationships with its constituencies, but it must be able to connect with them electronically through data arteries – information supply, value, and demand chains. The information supply and demand chains are external; the information value chains are internal.

An information technology strategy is a special case functional strategy because every function in the enterprise requires electronic information delivery capabilities, and many require electronic process control also. In very large enterprises, strategy may be formulated at both the enterprise and organizational unit levels.

As websites such as Facebook, LinkedIn, MySpace, Plaxo, and Twitter become more pervasive in business, linkages between application systems and databases and social networking websites will be more important to enable constituencies to communicate both collaboratively and cooperatively. Just as email has become a primary method of communication between enterprises and their constituencies, so will social networking sites especially for advertising and ecommerce.

Business intelligence information can be used to identify opportunities for competitive advantage. However, information technology itself can be an enabler of competitive advantage, especially when there are opportunities to digitize products or deliver information products electronically. In such cases, business strategy is inseparable from information technology strategy.

Information technology comprises the analytical and operational application systems, databases, and technical infrastructure (hardware and networks) of an enterprise. Not all computer technologies are information based. Computer technology is used for process control applications in special purpose equipment. However, connectivity is essential as applications become more integrated. As digital construction and manufacturing practices develop through such technologies as computer-aided design/computer-aided manufacturing (CAD/CAM), the processes, the control of processes, and the products and/or services delivered by processes all rely upon information technology for connectivity.

For example, in the manufacturing industry, not only can design and manufacturing work be conducted through integrated CAD/CAM processes with electronic linkages to carriers, such as FedEx and UPS, but the entire project and process management activities can be monitored electronically from ideation to product delivery.

Through technologies such as electronic data interchange and electronic funds transfer, data and both digital and information products flow through information supply and demand chains in parallel to material supply and product and/or service demand chains. Within the enterprise, data flows through information value chains from supply chains and to demand chains.

Developing an information technology strategy document is essential for describing the requirements and for educating users because:

  • The impact is enterprise or organizational unit wide and other elements of strategy cannot be implemented without it
  • Administrative activities, such as legal, finance, and human resources, and operational activities, such as research and development, procurement, manufacturing or equivalent, distribution, marketing, sales, and service depend on information technology – analytical and operational systems support both administrative and operational functions
  • The time frames, expenditures, risks, and magnitude of efforts are usually larger and more complicated than other initiatives and must be clearly understood; information technology projects have a tendency to go out of control and under deliver – therefore, contingency plans are always necessary
  • The subject matter can be complicated if not well explained

Information technology strategy is usually packaged as a separate but related document to the strategic plan. It is deployed and executed through specific programs and projects that develop new or enhance or maintain existing application systems, databases, and technical infrastructure.

Large information technology development projects are usually cross-functional, and may be part of a broader initiative sponsored by multiple functions collectively. Broader initiatives that have information technology components include:

  • Market research and development
  • Product research and development
  • Infrastructure research and development for processes and information delivery

For example – for the development of a:

  • Digital manufacturing system integrating both research and development and sales and production activities (sponsors: Manufacturing and Sales functions – impact is on Research and Development, Procurement, Manufacturing, Distribution, Sales, and Service functions)
  • Financial, managerial, and regulatory accounting and reporting system (sponsor: Finance function – impact is enterprise wide)
  • Human resource management system (sponsor: Human Resources function – impact is enterprise wide)
  • Sales tracking system (sponsor: Sales function – impact is on all salespeople enterprise wide)

Some projects can be solely for the Information Technology function, in which case it is a customer of itself.

Steering committees should be established for major programs and projects representing the various impacted functions in order to resolve cross-functional barriers. Major programs should come under the review of a planning and policy committee at the enterprise level.

Information technology strategy formulation is a project in its own right at the enterprise or organizational unit level. Very large projects are grouped as a program of inter-related components under a program manager. Projects can be stand alone also. A single project can deliver one or more application systems and related databases and technical infrastructure, or multiple projects may be required depending upon complexity.

For example, when launching a new product, it may be necessary to conduct marketing, product, and infrastructure development projects that include the delivery of new systems, and upgrades to existing systems. However, if an addition to the product line is launched at a later time, a new project or set of projects may be required to enhance or maintain the current systems, or even develop new ones.

The work breakdown structure for downstream development, enhancement, and maintenance projects decomposes into planning, analysis, design, construction, implementation, and performance measurement phases. The performance measurement phase can be conducted in parallel with the other phases, and each must end with a performance review. A feedback loop to future planning activities must be established so that lessons learned from the past can be reflected in future initiatives.

Meeting the cost and schedule requirements is always a major consideration. Hence, “meeting the date” is a frequent requirement for project success. However, after implementation, the scope of what was delivered and its quality is usually remembered more than when. In anticipation of the need to make changes after implementation, an adaption project may be necessary to tune, standardize, and integrate the deliverables.

The planning phase is conducted at the enterprise, organizational unit, or program levels for one or more projects depending upon size and complexity. However, each application system and related databases and technical infrastructure is delivered through a project with distinct analysis, design, construction, and implementation phases. Each phase always begins with a detailed planning activity to ensure that resources are allocated appropriately. The work breakdown structure does not preclude the use of iterative methodologies within each phase for rapid application development and prototyping. Development, enhancement, and maintenance of websites can be very rapid, and heavily interactive with user involvement, when the appropriate tools are used.

Key questions and deliverables by information technology strategy project and downstream phases include:

Strategy project (enterprise and organizational unit levels):

Key questions:

  • How does information technology enable business strategy?
  • What are the investment priorities?

Deliverables include:

  • Information technology architecture (applications, data and databases, and technical infrastructure)
  • High level project phasing and plans

Planning phase (enterprise, organizational unit, and program levels):

Key questions:

  • What are the administrative functions’ systems and information needs?
  • What are the operational functions’ systems and information needs?
  • What are the priorities for the candidate analytical systems?
  • What are the priorities for the candidate operational systems?

Deliverables include:

  • Process models
  • Function models
  • Data models
  • Information models
  • Economic evaluation
  • Scope of analysis projects and schedules

Analysis phase (project level):

Key questions:

  • How do processes, functions, and systems fit together?
  • How do systems processes and functions relate to enterprise processes and functions?
  • How do systems processes and functions and enterprise processes and functions fit together?

Deliverables include:

  • Functional requirements
  • Economic evaluation
  • Scope of design projects and schedules

Design phase (project level):

Key questions (by system):

  • What are the system’s functional requirements?
  • What are the system’s technical requirements?
  • What is the total cost of ownership and benefits (tangible and intangible)?

Deliverables include (by system):

  • Application system specifications
  • Data and database specifications
  • Technical infrastructure specifications
  • Scope of construction project and schedule
  • Total cost of ownership/benefit analysis

Construction phase (project level):

Key questions (by system):

  • Is the system being constructed according to design?
  • If not, what change orders are required, and why?

Deliverables include (by system):

  • Tested application system and interfaces, databases, and technical infrastructure
  • Trained users

Implementation phase (project level):

Key questions (by system):

  • What are the costs and schedule relative to plan?
  • What is the scope relative to plan?
  • What is the quality relative to plan
  • When will the benefits be realized relative to plan?
  • What adjustments for tuning, standardization, and integration are required relative to plan?
  • What are the current anticipated enhancement requests?
  • What are the current anticipated maintenance requests?
  • What are the lessons learned for the future?

Deliverables include (by system):

  • Working application system and interfaces, databases, and technical infrastructure
  • List of enhancement requests
  • List of maintenance requests
  • Performance measurement report

As enterprises become more dependent upon the internet for connectivity with constituencies, it is essential to develop, enhance, and maintain the information technology strategy on an ongoing basis. The strategy must emphasize connectivity through the data arteries as digital and information products become more pervasive.

Formulating information technology strategy is an enterpriship (entrepreneurship, leadership, and management) competency.