Monday, December 31, 2007

My New Year's resolutions

It's the time of year to synthesize the lessons learned from the past year and think about new approaches for the coming year. Remember - the definition of "insanity" is doing the same thing in the same way and expecting a different result. Here are my 2008 New Year's resolutions:

We're implementing a $4 million hosted electronic health record solution for our non-owned doctors, subsidizing 85% of the start-up costs for clinician offices. The effort involves collaborating with several vendor and implementation partners (I'll provide all the details in an upcoming post). Only by subsidizing costs, providing the resources to transform practices from paper to electronic workflow, and supporting clinicians post go live can we reduce the barriers to adopting electronic health records. My resolution is to reduce the total cost of implementing an EHR for private doctor's offices from the historical average of $40,000-60,000 to $25,000 per physician.

Over the past 10 years, I've been able to centralize all infrastructure purchases and support, phasing out most departmental IT spending. Currently we have just a few applications that are managed by departments. Over the next year I want to align the change management and communications processes for all applications, including those maintained by departments, with IT standard processes. My resolution is to create an ecosystem of change management processes followed by all.

Although we have strong governance processes, there are occasional projects that engage IT at the 11th hour, imposing unrealistic deadlines for phone, network, and desktop support. My resolution is to develop and widely communicate guidelines to all stakeholders imposing a 90 day notification period on opening new locations needing network, telecom, and desktop support.

The Dean's strategic planning process is likely to create a demand for more collaboration tools. We'll migrate from Web 1.0 tools that focused on content management to Web 2.0 tools that focus on collaboration among users from many Harvard affiliated organizations. Another aspect of this is providing the tools to locate people, equipment and knowledge - call it a matchmaking service for 18,000 faculty. Maybe Harvard's version of for science? My resolution is evolve our web frameworks to meet the needs of next generation collaboration.

My IT budget administrator is transitioning to another HMS position on January 4 and I would like to recast the position as the Business Manager of IT, producing all the data needed to make most IT purchases an annuity i.e. a desktop with a 4 year life results in operating budgets to replace 1/4 of all desktops each year. Even new FTEs can be algorithmically linked to growth in demand for support, storage, and high performance computing. My resolution is to create a highly predictable, data driven annual budget process.

The current scope of IT services at Harvard is infrastructure support (desktop, server, network, storage) and enterprise applications. However, we do not have the staff to support ad hoc web design, assist researchers with database creation or coordinate niche application programming in support of grants. My resolution is to extend the scope of IT services to include the application support that will empower researchers to get new grants which include innovative IT methods.

The Massachusetts Regional Health Information Organization (RHIO) provides Health Information Exchange services for e-Prescribing and secure clinical data sharing in Massachusetts. My resolution is to expand the number of hospitals, clinicians, and payers connected to this infrastructure.

The New England Health EDI Network, a regional financial data exchange, connects payers and providers with 100 million transactions per year. Over the the past year we've worked to make this advanced IT system available to every doctor in the state, even small solo practitioner offices. My resolution is to increase the number of small community practices using this technology.

The Healthcare Information Technology Standards Panel has harmonized electronic data standards for 3 use cases in 2006, 5 use cases in 2007 and has been assigned 6 use cases for 2008. My resolution is to harmonize standards for consumer healthcare devices, remote consultation, referral management, the genome/family history, public health case reporting and immunizations by October 2008.

Since a blog can be a personal glimpse into the life of the author, here are my personal resolutions:
  • Donate 10% of my income to fund technology for those on the other side of the digital divide
  • Continue to reduce my carbon footprint by
    1. Eating regionally grown vegan foods, freshly prepared each day, eliminating the need for wasteful packaging
    2. Reducing my airline travel by 20%
    3. Consuming less by reusing, recycling, and renewing - the end result being less churn of my belongings
  • Take walks with my wife and daughter (the picture above) through a local forest three times per week
  • Play a Japanese flute concert on the top of Eichorn Pinnacle in Yosemite
I look forward to a great 2008 with all my staff, my customers, and the industry. A toast to all of you!