Health information technology initiatives are assisting hospitals and health systems to improve efficiency, streamline workflows and produce better patient care outcomes. However, many of the projects, such as preparing for and meeting meaningful use, can be costly. This is especially true because many organizations address HIT implementations as enterprise-wide efforts, because doing so often leads to easier, more efficient and more successful implementations. However, what about down the road when a hospital is trying to optimize its HIT? Are enterprise-wide upgrades efficient? How do healthcare organizations guarantee that changes and upgrades will continue to add benefit and align with the enterprise's strategic goals?
"[Success in health IT initiatives] is all about alignment. Align your mission and business strategic plan with the needs of the patient, then align your technology strategic plan with your business strategic plan," says Dave Garrett, senior vice president and CIO of Novant Health in Winston-Salem, N.C. "We've spent a lot of time over the last year implementing, fine-tuning and optimizing business processes and IT processes to align within our organization. Clinical is an important part, but a system-wide business plan is also important."
Novant Health is a non-profit, integrated group of hospitals and physician practices, caring for communities in North Carolina, Virginia, South Carolina and Georgia. In order to align its IT strategy with its business strategy, Novant Health employs an IT governance council to address IT and business goal alignment on an enterprise scale.
Here, Mr. Garrett and A.J. Patefield, MD, senior vice president and CMIO of Novant Health, discuss Novant Health's governance council and the steps it follows to align IT projects with business goals.
Novant Health's governance council
Fourteen individuals who represent non-clinical and clinical areas of the organization sit on the council. Mr. Garrett is the only individual who represents IT. The governance council hears cases and makes decisions on future IT changes involving new hardware, new applications and other technological capabilities.
"The governance council makes sure we stay focused on what matters for the organization — for the IT-enabled space. Every organization has some way to manage its IT projects, and we feel confident about ours and the optimization process we use to continually refine it," says Mr. Garrett.
The governance council meets on a monthly basis to hear updates on current projects as well as to approve new ones. Once a year, the council spends two full days to completely review all project requests to reassess IT and business goal alignment and is coordinated with the annual corporate budget process.
Outcomes
As a result of the governance council, Novant Health has moved from a culture of siloed thinking to a system of collaborative thinking where the focus is the possible benefit for all from common applications, says Dr. Patefield.
"In the past, one facility's radiology department may have felt that their need for an application had priority over another facility's radiology department. Bringing representatives from those departments to the governance council has allowed them to share perspectives. Now, there is more understanding on how changes to IT in one department, facility or market cannot be made without affecting everyone," says Dr. Patefield.
The process
Here, Dr. Patefield and Mr. Garrett discuss three key steps of the governance council's process for reviewing and accepting new IT projects.
1. Build a business case. The process starts with a business case. According to Mr. Garrett, to request a particular project an individual, also known as the business case owner, creates a business case, working with constituents to outline the project definition, costs and benefits as well as to identify the appropriate category.
"We have different categories or swim lanes to classify IT projects. They are based on what the project focuses on, such as regulatory, safety, quality, sustainability, high return on investment or new IT-enabled project. Sustainability would be a project that sustains the system so it does not become outdated," says Mr. Garrett.
Project proposals may range from upgrades for radiology imaging storage systems to requests for software or new technology to interpret MRIs. "Any software application that would touch our network or the entire organization is usually pitched in a business case to the council. Proposals could also be upgrades for the hospital's financial supply chain or an IT need for a physician group," says Dr. Patefield.
"We often see patient safety business cases. Almost anything with IT contributes to patient safety. We do put higher criteria on patient safety upgrades or changes because it has priority for the entire system. We have a patient safety group of senior leaders that would have to declare it a patient safety application to the point that every facility under Novant Health would need to have it or a similar solution," says Mr. Garrett.
2. Review by subject matter experts. Since some projects fall into multiple "swim lanes," Novant Health uses subject matter experts to review the case for strength and accuracy and to determine which swim lane it fits. The SMEs may also determine something really does not meet criteria. For example, the business case owner might claim it is a regulatory requirement. The regulatory compliance SMEs may determine it is not a regulatory "requirement," but only a suggestion.
Once the business case passes subject matter review, the project is presented to the governance council.
3. Present to the governance council. The business case is presented to the council so it may be discussed, debated and compared to other projects. The governance council also decides whether the specific project aligns with Novant Health's broader strategic goals. According to Mr. Garrett, each "swim lane" mentioned earlier has a weight attached to it, assigned each year by the Novant Health executive team. Those weights assist the governance council in determining priority.
"What could happen is that we place a project currently underway on hold because a new project is designated as more important and higher priority. This is because, as the governance council meets, we match up new projects with existing projects to make sure we are working on the most important things," says Mr. Garrett.
As the healthcare industry progresses, merely implementing HIT and other technologies will not be enough. Hospitals and health systems need to continuously optimize health IT to capitalize on the benefits and produce the best outcomes for patients. Utilizing a governance council to oversee IT projects and review their alignment with overall business strategies has helped Novant Health, and may prove to be a useful guide for other hospitals and health systems.
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"[Success in health IT initiatives] is all about alignment. Align your mission and business strategic plan with the needs of the patient, then align your technology strategic plan with your business strategic plan," says Dave Garrett, senior vice president and CIO of Novant Health in Winston-Salem, N.C. "We've spent a lot of time over the last year implementing, fine-tuning and optimizing business processes and IT processes to align within our organization. Clinical is an important part, but a system-wide business plan is also important."
Novant Health is a non-profit, integrated group of hospitals and physician practices, caring for communities in North Carolina, Virginia, South Carolina and Georgia. In order to align its IT strategy with its business strategy, Novant Health employs an IT governance council to address IT and business goal alignment on an enterprise scale.
Here, Mr. Garrett and A.J. Patefield, MD, senior vice president and CMIO of Novant Health, discuss Novant Health's governance council and the steps it follows to align IT projects with business goals.
Novant Health's governance council
Fourteen individuals who represent non-clinical and clinical areas of the organization sit on the council. Mr. Garrett is the only individual who represents IT. The governance council hears cases and makes decisions on future IT changes involving new hardware, new applications and other technological capabilities.
"The governance council makes sure we stay focused on what matters for the organization — for the IT-enabled space. Every organization has some way to manage its IT projects, and we feel confident about ours and the optimization process we use to continually refine it," says Mr. Garrett.
The governance council meets on a monthly basis to hear updates on current projects as well as to approve new ones. Once a year, the council spends two full days to completely review all project requests to reassess IT and business goal alignment and is coordinated with the annual corporate budget process.
Outcomes
As a result of the governance council, Novant Health has moved from a culture of siloed thinking to a system of collaborative thinking where the focus is the possible benefit for all from common applications, says Dr. Patefield.
"In the past, one facility's radiology department may have felt that their need for an application had priority over another facility's radiology department. Bringing representatives from those departments to the governance council has allowed them to share perspectives. Now, there is more understanding on how changes to IT in one department, facility or market cannot be made without affecting everyone," says Dr. Patefield.
The process
Here, Dr. Patefield and Mr. Garrett discuss three key steps of the governance council's process for reviewing and accepting new IT projects.
1. Build a business case. The process starts with a business case. According to Mr. Garrett, to request a particular project an individual, also known as the business case owner, creates a business case, working with constituents to outline the project definition, costs and benefits as well as to identify the appropriate category.
"We have different categories or swim lanes to classify IT projects. They are based on what the project focuses on, such as regulatory, safety, quality, sustainability, high return on investment or new IT-enabled project. Sustainability would be a project that sustains the system so it does not become outdated," says Mr. Garrett.
Project proposals may range from upgrades for radiology imaging storage systems to requests for software or new technology to interpret MRIs. "Any software application that would touch our network or the entire organization is usually pitched in a business case to the council. Proposals could also be upgrades for the hospital's financial supply chain or an IT need for a physician group," says Dr. Patefield.
"We often see patient safety business cases. Almost anything with IT contributes to patient safety. We do put higher criteria on patient safety upgrades or changes because it has priority for the entire system. We have a patient safety group of senior leaders that would have to declare it a patient safety application to the point that every facility under Novant Health would need to have it or a similar solution," says Mr. Garrett.
2. Review by subject matter experts. Since some projects fall into multiple "swim lanes," Novant Health uses subject matter experts to review the case for strength and accuracy and to determine which swim lane it fits. The SMEs may also determine something really does not meet criteria. For example, the business case owner might claim it is a regulatory requirement. The regulatory compliance SMEs may determine it is not a regulatory "requirement," but only a suggestion.
Once the business case passes subject matter review, the project is presented to the governance council.
3. Present to the governance council. The business case is presented to the council so it may be discussed, debated and compared to other projects. The governance council also decides whether the specific project aligns with Novant Health's broader strategic goals. According to Mr. Garrett, each "swim lane" mentioned earlier has a weight attached to it, assigned each year by the Novant Health executive team. Those weights assist the governance council in determining priority.
"What could happen is that we place a project currently underway on hold because a new project is designated as more important and higher priority. This is because, as the governance council meets, we match up new projects with existing projects to make sure we are working on the most important things," says Mr. Garrett.
As the healthcare industry progresses, merely implementing HIT and other technologies will not be enough. Hospitals and health systems need to continuously optimize health IT to capitalize on the benefits and produce the best outcomes for patients. Utilizing a governance council to oversee IT projects and review their alignment with overall business strategies has helped Novant Health, and may prove to be a useful guide for other hospitals and health systems.
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