ORGANIZING IT SERVICES AND PERSONNEL (PART 1) Lecture 8

Introduction The IT department has been an integral part of most hospitals or health care systems since the early days of mainframe computing. If the health care facility was relatively large and complex and used a fair amount of information technology, one would find IT staff “behind the scenes” developing or enhancing applications, building system interfaces, maintaining databases, managing networks, performing system backups, and carrying out a host of other IT support activities. Today the IT department is becoming increasingly important, not only in hospitals but in all health care organizations that use IT to manage clinical and administrative data and processes.

IT Department Responsibilities 1. Ensuring that an IT plan and strategy have been developed for the organization and that the plan and strategy are kept current as the organization evolves. 2. Working with the organization to acquire or develop and implement needed new applications. 3. Providing day-to-day support for users: for example, fixing broken personal computers, responding to questions about application use, training new users, and applying vendor-supplied upgrades to existing applications. 4. Managing the IT infrastructure: for example, performing backups of databases, installing network connections for new organizational locations, monitoring system performance, and securing the infrastructure from virus attacks. 5. Examining the role and relevance of emerging information technologies.

Core Functions 1. Operations and Technical Support 2. Applications Management 3. Specialized Groups 4. IT Administration

1. Operations and Technical Support Manages the IT infrastructure, for example, the servers, networks, operating systems, database management systems, and workstations. This function installs new technology, applies upgrades, troubleshoots and repairs the infrastructure, performs “housekeeping” tasks such as backups, and responds to user problems, such as a printer that is not working.

Subgroups Data center management: manages the equipment in the organization’s computer center. Network engineers: manage the organization’s network technologies. Server engineers: oversee the installation of new servers, and perform such tasks as managing server space utilization. Database managers: add new databases, support database query tools, and respond to database problems such as file corruptions.

Subgroups Cont. Security: ensure that virus protection software is current, physical access to the computer room is constrained, disaster recovery plans are current, and processes are in place to manage application and system passwords. Help desk: provide support to users who call in with problems such as broken office equipment, trouble with operating an application, a forgotten password, or uncertainty about how to perform a specific task on the computer. Deployments: install new workstations and printers, move workstations when groups move to new buildings, and the like. Training: train organization staff on new applications and office software, such as presentation development applications.

2. Applications Management Manages the processes of acquiring new application systems, developing new application systems, implementing these new systems, providing ongoing enhancement of applications, troubleshooting application problems, and working with application suppliers to resolve these problems.

Subgroups Groups that focus on major classes of applications: for example, a financial systems group and a clinical systems group. Groups dedicated to specific applications (this is most likely in large organizations): for example, a group to support the applications in the clinical laboratory or in radiology. An applications development group (this is found in organizations that perform a significant amount of internal development). Groups that focus on specific types of internal development: for example, a Web development group.

3. Specialized Groups Groups that have very specialized functions, depending on the type of organization or the organization’s approach to IT. For example: Groups that support the needs of the research community in academic medical centers Process redesign groups in organizations that engage in a significant degree of process reengineering during application implementation Decision-support groups that help users and management perform analyses and create reports from corporate databases: for example, quality-of-care reports or financial performance reports

4. IT Administration Depending on the size of the IT department, there are groups that focus on supporting IT administrative activities. These groups perform tasks as: Overseeing the development of the IT strategic plan Managing contracts with vendors Developing and monitoring the IT budget Providing human resource support for the IT staff Providing support for the management of IT projects: for example, developing project status reports or providing project management training Managing the space occupied by an IT department or group

Typical Organizational IT Chart

Senior IT Leadership Roles Chief information officer (CIO) Chief technology officer (CTO) Chief security officer (CSO) Chief medical informatics officer (CMIO)

Chief Information Officer (CIO) The CIO manages the IT department and acts as the executive who can successfully lead the organization in its efforts to apply IT to advance its strategies. CIO, as a person, has integrity, is goal directed, is experienced with IT, and is a good consultant and communicator. Organizational excellence in IT doesn’t just happen. It is managed and led. Failure to hire and retain such talent will severely hinder the organization’s aspirations.

Responsibilities 1. Sets vision and strategy. Collaborates well with senior leaders to set organization vision and strategy and to determine how technology can best serve the organization. 2. Integrates information technology for business success. Applies knowledge of the organization’s systems, structures and functions to determine how best to advance the performance of the business with technology. 3. Makes change happen. Is able to lead the organization in making the processes changes necessary to fully capitalize on IT investments.

Responsibilities Cont. 1. Builds technological confidence. Helps the business assess the value of IT investments and the steps needed to achieve that value. 2. Partners with customers. Interacts with internal and external customers to ensure continuous customer satisfaction. 3. Ensures information technology talent. Creates a work environment and community that draws, develops and retains top IT talent. 4. Builds networks and community. Develops and maintains professional net- works with internal and external sources and effectively leverages those networks to further the effective use of IT [CHIME, 2008].

CIO Supervisor? CIOs will often argue that they should report to the chief executive officer (CEO). This argument is not wrong nor is it necessarily right. The CIO does need access to the CEO and clearly should be a member of the executive committee and actively involved in strategy discussions. However, the CIO needs a boss who is a good mentor, provides appropriate political support, and is genuinely interested in the application of IT. Chief financial officers (CFOs) and chief operating officers (COOs) can be terrific in these regards. In general about one- third of all health care provider CIOs report to the CEO, one- third report to the CFO, and one-third report to the COO.

Chief Technology Officer (CTO) The CTO must guide the definition and implementation of the organization’s technical architecture. The CTO role is not often found in smaller organizations but is increasingly common in larger ones. In smaller organizations, the CIO also wears the CTO hat.

CTO Responsibilities 1. Defining technology standards (for example, defining the operating systems and network technologies the organization will support) 2. Ensuring that the technical infrastructure is current (for example, that major vendor releases and upgrades have been applied) 3. Ensuring that all the technologies fit. The CTO’s role in ensuring fit is similar to an architect’s role in ensuring that the materials used to construct a house come together in a way that results in the desired house.

CTO Responsibilities Cont. 4. Tracking emerging technologies 5. Identifying technology that might provide value to the organization, assessing them, and when appropriate, working with the rest of the IT department and the organization to implement these technologies. For example, the CTO may be asked to investigate the possible usefulness of the new biometric security technologies.

Chief Security Officer (CSO) It is a relatively new position that has emerged as a result of the growing threats to information security and the health care organization’s need to comply with HIPAA security regulations. The primary role and functions of the CSO are: Ensure that the health care organization has an effective information security plan An appropriate technical and administrative procedures are in place to ensure that information systems are secure and safe from tampering or misuse An appropriate disaster recovery procedures exist.

Chief Medical Informatics Officer (CMIO) Is a relatively new position. The CMIO position emerged as a result of the growing interest in adopting clinical information systems and the need for physician leadership in this area. The CMIO is usually a physician, and this role may be filled through a part-time commitment by a member of the organization’s medical staff.

CMIO Responsibilities 1. Leading clinical information system initiatives such as electronic medical record (EMR) implementations 2. Serving as physician advocate for computerized provider order entry (CPOE) 3. Engaging physicians and other health care professionals in the development and use of the EMR system

CMIO Responsibilities Cont. 4. Leading the clinical informatics steering committee or other designated group that serves as the central governance forum for establishing the organization’s clinical IT priorities 5. Keeping a pulse on national efforts to develop EHR systems, and assuming a leadership role in areas where the national effort and the organization’s agenda are synergistic 6. Being highly responsive to user needs, such as training, to ensure widespread use and acceptance of clinical systems

CMIO Characteristics The CMIO should be: credible as a good clinician and not be viewed as a “techie doctor” who is only knowledgeable about computers, an effective communicator across services and disciplines, an effective consensus builder Knowledgeable of hospital operations

References “Health Care Information Systems: A Practical Approach for Health Care Management” By Karen A. Wager, Frances W. Lee, John P. Glaser “Information Systems and Healthcare Enterprises” By Roy Rada

End of Lecture 8 - 1