Wednesday, July 9, 2014

Crafting a Next Generation IT strategy

During my 16 years as CIO, I’ve witnessed the transition from client server to web, from desktops to
mobile, and from locally hosted to cloud.  

As Beth Israel Deaconess merges and acquires more hospitals, more practices and more care management capabilities, what are its strategic IT choices?

I will not even mention “best of breed”, because I think the industry has abandoned such a strategy as unworkable in an era when everyone needs access to everything for care coordination, population health, and patient/family engagement.

The choices are basically two

a.  Single monolithic vendor application for everyone everywhere
b.  Best of Suite - the smallest number of applications/modules that meet the need for business integration (defined in the graphic above)

It’s extremely popular among academic medical centers, ACOs, and healthcare systems to choose “A”, often at great cost.

BIDMC has a 30 year tradition of building and buying systems balancing costs, agility, and functionality.

As I plan for the next generation of IT systems, I favor “B” and believe I can achieve our business goals in shorter time, at lower cost, with less risk.

Here’s the thinking.  

1.  At BIDMC, we need a web-based, mobile friendly, cloud hosted solution that has the agility to support rapidly evolving research, education, and clinical requirements.   The culture at BIDMC is not top down, command/control, willing to compromise but bottom up, collaborative, and impatient for innovation.    We will continue to build the core clinical systems at BIDMC until there is a vendor application that meets the cultural requirements and is affordable.

2.  At all other sites, we will use cloud hosted inpatient and ambulatory vendor-based systems that are aligned with the business requirements and culture of the institutions.

3.  Our budgets are very limited to serve 22,000 users and 3000 doctors.  Operating budgets for IT are 1.9% of the total spend.   Capital is about $10 million a year.   One time capital for major IT initiatives is unlikely to ever exceed $20 million.    When I hear about expenditures of hundreds of millions for IT systems, I really wonder how the economics are sustainable.

4.  Interoperability for care coordination across a small number of applications is possible via bidirectional viewing, pushing summaries, and pulling records via the state healthcare information highway.

5.  Business intelligence/analytics across the network is supported by financial and clinical registries, populated via well described interfaces.

Over the next 90 days stakeholders from throughout the organization will complete the next generation IT plan as follows:

July - strategy complete, draft budgets submitted
August - organizational structure for unified enterprise IT proposed, budgets finalized
September - staffing plan finalized and timelines aligned for execution beginning October 1

As with any plan, change management will be the most challenging aspect, balancing time, resources, and scope.

Over the coming months, I’ll share the decisions we’ve made for a cloud of community hospital functionality and a cloud of ambulatory EHR functionality that unifies all our practices.

1 comment:

Medical Quack said...

It's nice you take the time to explain so others can see what some of the complexities are out there. It has all evolved so fast and there's so much demand for "I want it right now".

A clinical "affordable" solution, and I think that is a key word out there as I don't see how all of this is going to be sustainable as community and non profits in some areas are really having a hard time.

You're the only one out there talking about "simplifying" things, which is what is needed but you're light years ahead of most everyone else.

Sure there's new technologies all the time but I think the question all have to ask at some point is how much do I need to give good clinical care and where.

I think we have some problems out there with virtual values and real world values colliding and people not knowing how to either mix or separate for whatever the occasion is calling for. I have just never seen a time like now where everyone walks around and talks numbers, all the time and sure we need data but it needs a break. I think some of our news today is being generated at this website called "Spurious Correlations" which was put together by a Harvard student to exploit some of this and have a little fun at the same time.

I have talked quite a bit about the Zoeticx system and there may be more like it but it's the first web application I have seen built on a clarity server that connects hospitals, doctors, etc. with no synch, when you're done with the connection, it breaks off, so there's no constant connection when you don't need it to warehouse synchronized data. The founder, CEO back a few years worked at BEA and what he created ended up being the Oracle weblogic server as it was renamed from Aqualogic. I sure hope others begin talking about simplication and what is "really" needed to take care of patients as it's almost a run a way train at times.

If anyone keeps buying, the software folks do keep coming aorund to sell:)