IT Governance and Decision Rights

1
IT Governance and Decision Rights

• HSPM J713
• Sept. 22, 2008

2
GovernanceDecision rights

• General issues in the theory and practice of
  management
• much discussion and even some debate.
• Applied here to IT management
• (Book says IM/IT, which means information
  management/information technology)

3
Learning Objectives

• Why strategic planning in health care IM become
  important
• 5 components of IM governance
• the major elements of a healthcare
  organizations planning elements sic
• Elements of an IM strategic plan
• Systems theory and why you need it for IM

4
An integrated governance modelTopics in the
chapter

• Background of IM governance and planning
• Purpose of planning
• Importance of system integration
• Organizing IT strategic planning
• Systems theory introduced
• Management control and decision support theory
  introduced

5
Information ManagementInformation Technology

• Whats the difference in emphasis?

6
Background of governance and planning in IM/IT

• IM/IT systems evolved piecemeal
• Individual data systems for individual units of
  the enterprise

7
Piecemeal

• 14th century Middle English pecemeale
• Piece is related to the French word petit,
  meaning small.
• Meal means by a fixed measure (from Old English
  -mælum, at a time, from dative pl. of mæl,
  appointed time)
• answers.com

8
Problems of piecemeal development

• Data entered repetitively
• Data duplicated
• Duplicated data may not match
• Information hard to retrieve except for the
  original purpose for which it was stored

9
Integration of systems

• Enables
• Strategic planning
• Clinical decision support
• Sharing data among departments, among
  facilities, and among enterprises

10
(Integrated) System

• Functional
• Scalable
• Flexible
• What do those mean?

11
Governance

• How things are controlled (Im trying to think of
  a word to use instead of governed.)
• Centralized vs. decentralized decisions
• Differentiated from contingency analysis
• Why and how decisions are made in an
  organization ?
• What is a contingency?

12
5 domains of governance

• Quoted from study
• Strategic alignment
• Risk management
• Resource management
• Performance management
• Value delivery

13
IT priorities

• Reducing medical errors
• Establishing electronic medical records
• These are not of the same character

14
Components of Strategic Governance

• 1 of 5 Develop a Consistent IT Strategy
• Apply a plan across operating units
• Plan was new idea in mid-1990s. Generally
  implemented now.
• 1993 was first web browser

15
Components of Strategic Governance

• 2 of 5 Align IT Planning with Organizational
  Planning. CIO and CEO must ask together
• What do we do?
• Whom to or for?
• Where?
• When?
• Why?
• How?

16
Components of Strategic Governance

• 3 of 5 Develop IT Infrastructure, Architecture,
  and Policies
• Infrastructure
• Hardware (architecture)
• Network
• Degree of centralization/decentralization
• Software to support network

17
4 technologies in current use

• Networks (high-speed)
• Intranets
• Wireless
• Client/server systems
• Chapter 6 explains

18
Components of Strategic Governance

• 3 of 5 Develop IT Infrastructure, Architecture,
  and Policies
• Example of policy Data standardization
• Standard ways to represent data, such as dates.
• So all you data systems can share dates, for
  example.
• National standards organizations working on
  uniform ways to represent all health care-related
  data
• Medicare/Medicaid standards tend to dominate
• HIPAA-mandated standards

19
(No Transcript)
20
(No Transcript)
21
HITSP

• Healthcare Information Technology Standards Panel
• Developing standards, under contract with US DHHS

22
Hardware and Software Standards

• Uniformity of hardware and software
• Compatibility
• Ease of maintenance
• Site licenses often cheaper per seat the more you
  buy
• Control inappropriate use
• Such as people installing copied software

23
Components of Strategic Governance

• 4 of 5 Set IT Project Priorities and Oversee
  Investments
• Purchase what fits with the plan

24
Components of Strategic Governance

• 5 of 5 Be able to assess ITs contribution
• Accountability of IT to the organization
• Value that can be demonstrated
• Financial
• Costs decreased
• Revenue increased
• More productivity which means more revenue
  relative to cost?

25
Components of Strategic Governance

• 5 of 5 Be able to assess ITs contribution
• Accountability of IT to the organization
• Value that can be demonstrated
• Clinical
• Adherence to standards
• Better outcomes
• Organizational
• Stakeholder whats that? satisfaction
• Risk reduction

26
Components of Strategic Governance

• 5 of 5 Be able to assess ITs contribution
• Accountability of IT to the organization
• Value that can be demonstrated
• Getting away from reliance on anecdote,
  inference, and opinion

27
Organizing the planning effort

• Board of Trustees
• Chief Executive Officer
• Info Sys Steering Committee
• Subcommittees
• New and replacement systems
• Infrastructure specifications
• Capital and operating budgeting

28
Organizing the planning effort

• Board of Trustees
• Gives responsibility to the CEO
• Chief Executive Officer
• Organizes the committees
• Info Sys Steering Committee
• Does the planning
• Subcommittees
• New and replacement systems
• Infrastructure specifications
• Capital and operating budgeting

29
Organizing the planning effort

• Outside consultants
• Often needed for technical expertise
• Choose carefully
• Independent of vendors, no conflict of interest
• Personality
• Resource for planning. Your inside people should
  do the planning.

30
Organizing the planning effort

• Serving on steering committee or subcommittee
  takes time
• Should be part of job involves Human Resources
• CIO should chair the steering committee

31
What should be in the IT plan

• 1. Organizations goals and objectives for the
  planning period (typically 3-5 years)
• E.g. if reducing medical errors is a goal, that
  should be stated at the top.
• E.g. if acquiring or creating more operations is
  a goal, that should be stated at the top
• Because these have implications for what IT must
  do

32
What should be in the IT plan

• 2. ITs goals and objectives for the planning
  period
• Should flow from the organizational goals
• Specifics. For example
• BAD GOAL improve the quality of care and
  increase efficiency
• GOOD GOAL all records from the patient index
  file should be available online to our
  physicians

33
By the way

• Whats the difference between a goal and an
  objective?

34
What should be in the IT plan

• 3. ITs priorities
• Which goals should be addressed first
• This has to be done with an eye to methods and
  costs. Even so, that formal analysis comes later
  after the plan so far is reviewed by the CEO.

35
What should be in the IT plan

• 4. Systems architecture and infrastructure
• Centralized vs. decentralized

36
Arguments for centralization

• Less variability easier maintenance?
• Better security
• Less work
• More flexible
• Less costly to invest buy in bulk
• Less costly to operate because less variable?
• More end-user satisfaction
• Better assures alignment with organizational
  needs

37
Arguments for decentralization

• More end-user satisfaction, because users
  control it
• Less costly because users support it
• More innovation
• Local flexibility
• Fewer delays from overburdening centralized
  programmers and support personnel

38
What should be in the IT plan

• 4. Systems architecture and infrastructure
• Network architecture
• Mainframe
• Client/server
• File server
• Distributed
• How applications are linked
• How data will be stored and backed up
• Data takes many forms, including pictures as well
  as words and numbers

39
What should be in the IT plan

• 5. Software development plan
• Old days In-house programmers developed
  applications
• Nowadays Buy applications from commercial
  vendors
• Which makes sense if data is becoming more
  uniform and requirements for use are becoming
  more uniform
• Applications service provider
• The application runs on their computer, not yours.

40
What should be in the IT plan

• 6. Management and staffing plan
• Technical staff
• Who
• Where (relates to centralization-decentralization)
  
• 7. Resources required
• Capital and operating budgets

41
Review and Approval

• Formal review and revision cycle before plan
  implemented
• Annual reviews of progress relative to goals and
  objectives

42
End-User Computing

• Allow end-runs by departments whose needs arent
  in the plan?
• Departmental software purchases
• Improvised programs by computer-savvy users
• How isolated is the system?
• Enforce data compatibility

43
Strategic Information Systems Planning for IDSs

• Integrated data system IDS?
• Vertically integrated organizations
• Patients progress through or get treatment from
  clinics, surgery centers, acute care hospitals,
  substance abuse centers, nursing facilities
• The information system must meet the needs of
  each part and coordinate their data needs

44
Strategic Information Systems Planning for IDSs

• Provide comparable financial data for management
• Standardized coding of data across units
• Or else conversion methods needed
• Bringing in new units after merger means
  conversion tasks
• Centralization data warehouses

45
Systems theory

• Systems characteristics
• Unity
• Complexity
• Internal hierarchy
• Stability and equilibrium ?
• Deterministic or probabilistic

46
Simplest system
47
System with feedback
48
Cybernetic system

• Input, process, output
• Sensor measures output
• Monitor takes info from sensor, send signals to
  control unit
• Control unit affects process
• Show page 84.

49
(No Transcript)
50
Summary

• ITs governance must fit with organizations
  goals
• IT plan, by enterprise-wide steering committee
• System integration essential
• The plan should develop policies
• Systems theory can help organize thinking

51
Learning Objectives

• Why strategic planning in health care IM become
  important
• 5 components of IM governance
• the major elements of a healthcare
  organizations planning elements sic
• Elements of an IM strategic plan
• Systems theory and why you need it for IM