Health Care Information Systems: A Practical Approach for Health Care Management

Karen A. Wager I Frances Wickham Lee I John P. Glaser

Chapter Eight
Organizing Information Technology Services
 Learning Objectives
• Describe the roles, responsibilities, and major functions of the IT
department or organization
• Discuss the role and responsibility of the CIO, CMIO, CSO, CTO, and other
key IT staff members
• Describe the different ways IT services might be organized and governed
within a health care organization
• Identify key attributes of highly effective IT organizations
• Describe the role and function of the data analytics department or unit
• Develop a plan for evaluation the effectiveness of the IT function within
an organization

Health Care Information Systems: A Practical Approach for Health Care Management, 4th edition K. Wager I F. Lee I J. Glaser 2
 Outline
• Core functions of an IT department
• IT leadership roles
– Key attributes of high-performing CIOs
• IT staff roles
– Key attributes of high-performing staff
• Centralization v. decentralization of IT services
• Agility and innovativeness
• Outsourcing
• Evaluating IT effectiveness
Health Care Information Systems: A Practical Approach for Health Care Management, 4th edition K. Wager I F. Lee I J. Glaser 3
 Core Functions
IT Department
1. Operations and technical support
– Manages the IT infrastructure (e.g., servers, networks, operating systems,
database management systems, workstations)
– Installs new technology, applies upgrades, troubleshoots and repairs the
infrastructure, performs backups, responds to user problems
2. Applications management
– Manages the process of acquiring new systems, developing and
implementing new systems, ongoing enhancement, troubleshooting, and
working with application suppliers

Health Care Information Systems: A Practical Approach for Health Care Management, 4th edition K. Wager I F. Lee I J. Glaser 4
 Core Functions
IT Department
3. Specialized groups
– Specialized functions depend on the type of organization of the
organization’s approach to IT
4. IT administration
– Oversees the development of the IT strategic plan, manages contracts with
vendors, handles the IT budget, provides HR support for IT staff members,
managing the space occupied by the IT department

Health Care Information Systems: A Practical Approach for Health Care Management, 4th edition K. Wager I F. Lee I J. Glaser 5
 IT Roles
Senior Leadership
• Chief information officer (CIO)
– Manages the IT department; the executive who can successfully lead the
organization in its efforts to apply IT to advance its strategies
• Chief technology officer (CTO)
– Defines technology standards; ensures technical infrastructure is current;
ensures all technologies fit
– Tracks emerging technology and identifies the ones that might provide value
to the organization

Health Care Information Systems: A Practical Approach for Health Care Management, 4th edition K. Wager I F. Lee I J. Glaser 6
 IT Roles
Senior Leadership
• Chief security officer (CISO)
– Ensures the organization has an effective information security plan,
appropriate procedures are in place to keep information systems secure and
safe from tampering or misuse, and appropriate disaster recovery
procedures are in place
• Chief medical information officer (CMIO)
– Emerged as a result of growing interest in adopting clinical information
systems and leveraging those systems to improve care
– Typically a physician; Filled through a part-time commitment by a member of
the medical staff

Health Care Information Systems: A Practical Approach for Health Care Management, 4th edition K. Wager I F. Lee I J. Glaser 7
 Key Attributes
High-Performing CIOs
1. Sets vision and strategy
2. Integrates information technology for business success
3. Makes change happen
4. Builds technological confidence
5. Partners with customers
6. Ensures information technology talent
7. Builds networks and community
Source: CHIME, 2008

Health Care Information Systems: A Practical Approach for Health Care Management, 4th edition K. Wager I F. Lee I J. Glaser 8
 IT Roles
Staff
• The project leader
– Manages IT projects (e.g., implementations, deployment of infrastructure)
• The systems analyst
– Works closely with managers and end user in identifying information system
needs and problems, evaluating workflow, and determining strategies for
optimizing particular systems
– Prepares cost-benefit and return-on-investment analyses

Health Care Information Systems: A Practical Approach for Health Care Management, 4th edition K. Wager I F. Lee I J. Glaser 9
 IT Roles
Staff
• The programmer
– Writes, tests, and maintains the programs that computers follow to perform
their functions; conceives, designs, and tests logical structures for solving
problems with computers
– Applications programmer: writes programs to handle specific user tasks;
revises existing packaged software; customizes generic applications
– Systems programmer: writes programs to maintain and control
infrastructure software

Health Care Information Systems: A Practical Approach for Health Care Management, 4th edition K. Wager I F. Lee I J. Glaser 10
 IT Roles
Staff
• The database administrator
– Works with database management systems software and determines ways
to organize and store data; ensures the performance of the database
systems
– Plans and coordinates security measures
• The network administrator
– Designs, tests, and evaluates systems such as LANs, wireless networks, the
Internet, intranets, and other data communication systems
– Performs network modeling; researches related products and makes
hardware and software recommendations

Health Care Information Systems: A Practical Approach for Health Care Management, 4th edition K. Wager I F. Lee I J. Glaser 11
 Key Attributes
High-Performing IT Staff
• They execute well
• They are good consultants
• They provide world-class support
• They stay current in their field of expertise

Health Care Information Systems: A Practical Approach for Health Care Management, 4th edition K. Wager I F. Lee I J. Glaser 12
 Benefits
Centralization of IT Services
• Enforcement of hardware and software standards
• Efficient administration of resources
• Better staffing
• Easier training
• Effective planning of shared systems
• Easier strategic IT planning
• Tighter control by senior management

Health Care Information Systems: A Practical Approach for Health Care Management, 4th edition K. Wager I F. Lee I J. Glaser 13
 Benefits
Decentralization of IT Services
• Better fit of IT to business needs
• Quick response time
• Encouragement of end user development of applications
• Innovative use of information systems

Health Care Information Systems: A Practical Approach for Health Care Management, 4th edition K. Wager I F. Lee I J. Glaser 14
 Core IT Competencies
• Identified by the organization
• Areas where getting an A+ from the “customers” matters
• A small number of areas should be identified

Health Care Information Systems: A Practical Approach for Health Care Management, 4th edition K. Wager I F. Lee I J. Glaser 15
 Departmental Attributes
• Agility
– The ability to form and disband teams quickly as staff members move from
project to project
– Organizational structures and reporting relationships must be flexible;
– During a project. the project manager is the [temporary] boss of the
project team members; team members may have several bosses during
the course of a year if they work on different projects
– Organized around projects, not functions

Health Care Information Systems: A Practical Approach for Health Care Management, 4th edition K. Wager I F. Lee I J. Glaser 16
 Departmental Attributes
• Innovativeness
– Reward systems that encourage new ideas and successful implementation
of innovative applications
– Create dedicated research and development groups
– Permit staff members to take sabbaticals or accept internships with other
departments in the organization in an effort to expand IT members’
awareness of organizational operations, cultures, and issues

Health Care Information Systems: A Practical Approach for Health Care Management, 4th edition K. Wager I F. Lee I J. Glaser 17
 Outsourcing
• In-house: organizations hire their own IT staff members and form their
own IT department
• Outsource: organizations ask a third party to provide the IT staff
members and be responsible for the management of IT
– Organizations may not have staff members will the skills, time, or
resources to take on new projects or provide sufficient service
– Organizations may outsource held desk services or website development
so that internal IT staff can focus on implementing or supporting
applications
– May enable organizations to better control costs
– May serve as “rescue mission” if IT has been mismanaged
Health Care Information Systems: A Practical Approach for Health Care Management, 4th edition K. Wager I F. Lee I J. Glaser 18
 Key Areas
Evaluating IT Effectiveness
• Governance
– Are IT strategies aligned with the overall strategic goals?
• Budget development and resource allocation
– Benchmark: Are we spending too much or too little on IT?
• System acquisition and system implementation
• IT service levels
– What is the quality of the every day service being delivered?
– Infrastructure, day-to-day support, consultation

Health Care Information Systems: A Practical Approach for Health Care Management, 4th edition K. Wager I F. Lee I J. Glaser 19
 Infrastructure Metrics
Evaluating IT Effectiveness
• Reliability: percentage of time that systems have unscheduled downtime
• Response time: how quickly an application moves from one screen to
the next
• Resiliency: how quickly a system can recover after it goes down
• Software bugs: the number of bugs detected in an application per line of
program code or hour of use

Health Care Information Systems: A Practical Approach for Health Care Management, 4th edition K. Wager I F. Lee I J. Glaser 20
 Core IT Processes
For an Effective IT Department
1. Human capital management
2. Platform management
3. Relationship management
4. Strategic planning
5. Financial management
6. Value innovation
7. Solutions delivery
8. Services provisioning
Source: Agarwal and Sambamurthy, 2002

Health Care Information Systems: A Practical Approach for Health Care Management, 4th edition K. Wager I F. Lee I J. Glaser 21
 Summary
• Core functions of an IT – CISO – CMIO
department
• IT staff roles
– Operations and technical support – Project leader
– Applications management – Systems analyst
– Specialized groups – Programmer
– IT administration – Database administrator
• IT leadership roles – Network administrator
– CIO – CTO

Health Care Information Systems: A Practical Approach for Health Care Management, 4th edition K. Wager I F. Lee I J. Glaser 22
 Summary
• Benefits of centralization and decentralization of IT services
• Agility and innovativeness of an IT department
• Outsourcing
• Evaluating IT effectiveness
– Governance
– Budget development and resource allocation
– System acquisition and system implementation
– IT service levels

Health Care Information Systems: A Practical Approach for Health Care Management, 4th edition K. Wager I F. Lee I J. Glaser 23
 Summary
• Infrastructure metrics • Core IT processes
– Reliability 1. Human capital management
– Response time 2. Platform management
– Resiliency 3. Relationship management
– Software bugs
4. Strategic planning
5. Financial management
6. Value innovation
7. Solutions delivery
8. Services provisioning

Health Care Information Systems: A Practical Approach for Health Care Management, 4th edition K. Wager I F. Lee I J. Glaser 24