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Who Makes Your Health IT Decisions?

With the right IT governance, your organization can make better decisions about where to invest for more effective use of technology.

Over the past decade, healthcare IT has transformed. Health systems, small as well as large, are increasingly automated and dependent on information systems. But even as they have embraced IT, a divide has emerged within those organizations.

Advanced governance is allowing some front-running organizations to rationalize IT spending, achieve unprecedented automation, and use critical data to drive the organization. But others -- perhaps yours -- struggle with ineffective steering committees, budgets that slash critical IT support, and disengaged and oppositional users.

[Ready to take charge? Read Busting The Myth Of Uncontrollable Healthcare Costs.]

Which side of this sounds like your organization? Here are some ways to tell.

A favorite CIO boss of mine was once asked -- in front of the operational and clinical leaders of the organization -- "Which of your projects are you willing to cut?"

Her answer? "These aren't my projects, they belong to all of you. You tell me what organizational initiatives you want to cut and I'll tell you what IT capital can be cut."

In an organization dependent on advanced IT, the IT budget priorities absolutely must come from clinical and financial operations. Clinicians practice medicine. Revenue cycle drops bills. Finance keeps the dollars flowing. These are the people who can muster the political strength to demand increased efficiency, reduced errors, and risk reduction. In fact, they're the only ones who can.

Modern IT governance embraces this by placing key IT decisions in the hands of those clinical and operational partners. If your chief medical officer, your chief nursing officer (CNO), your director of patient financial services, and your health information management director have the final say about your IT budget, it changes the game. Now they have to understand the value of IT and choose the initiatives that make sense. Your CIO and IT staff have to translate IT arcana into language that makes operational sense and generate questions that have operationally focused answers. This isn't wasted time. It's critical engagement work that makes sure that scarce organizational dollars wind up in the right place and in the right hands to drive the mission of the health system.

So who owns your IT budget?

"Adoption" of IT is no longer the question. It's not just about using the systems any more -- now it's about ensuring that everyone uses the systems in a way that actually helps the organization. And it's increasingly obvious that operational leadership -- clinical and financial -- owns this responsibility. Active governance gives clinical operations the venue to demand that systems work, but it also demands that those same executives commit to the use of those systems for the good of the health system.

Who owns adoption in your organization?

When trouble strikes, who owns it? Who stands up, acknowledges an IT failure, and explains what's being done about it? The CIO? The CEO? Some nameless and soon-to-be-fired project manager?

Governance isn't just a way to avoid failure. Governance is also a way to handle it. If you already have the senior stakeholders meeting regularly and aware of the interdependency of the business and the technology, the occasional failure is simply grist for the mill. If everyone owns the problem, then you can get on with the process of identifying the issues, correcting them, and moving on.

You can also respond well to escalations and crises. If your chief medical information officer knows he's backed by a strong governance group, he can negotiate with angry physicians in a way that leads to better outcomes. If your CNO already knows how to find the budget to streamline nursing documentation, then the process of handling a sudden shortage becomes manageable. Governance isn't just about planning for next year, it's also about managing today.

How does your organization cope with the unexpected?

Innovation -- the organized and thoughtful evaluation and systematic adoption of new ideas, methods, and technologies -- is a hit-or-miss proposition in many organizations. Why? Frequently, it's because there's no particular rhyme or reason to the way that innovative ideas are evaluated. If you're not organized to encourage innovation, even simple advances are challenging.

To innovate, you must constantly standardize. New ideas need a solid foundation. Spreading them requires that you remove the barriers formed when you do things differently in different parts of the organization. Constant standardization and periodic innovation are hallmarks of an advanced organizational approach to IT. Even more critical is measuring innovative ideas and shutting down even the best-sounding idea if the reality is that it's not helpful. In the context of mature governance, innovation thrives.

How's it going in your organization?

Finally, consider strategy. When was the last time you formulated a comprehensive IT strategy? How did that tie to your organizational goals? Are there IT strategic elements that don't support organizational priorities? Are there organizational strategies that don't reach down to IT? Or, to boil it down, when was the last time that IT was blindsided by an acquisition, a new service line, or a new organizational focus? If there's a wince there, you have work to do.

In the end, governance is always strategic. Even when you're attending to purely tactical matters, the process itself is strategic, forming a crucial habit of cooperation that will serve you well. Practice is the key, because your operations personnel practice IT awareness even as your IT department relentlessly practices an operations-first focus. Good structures, good technology, and strategic vision are the goal.

So where are you?

The owners of electronic health records aren't necessarily the patients. How much control should they have? Get the new Who Owns Patient Data? issue of InformationWeek Healthcare today.