THE STRATEGIC APPLICATION OF INFORMATION TECHNOLOGY IN HEALTH CARE ORGANIZATIONS

Y THE STRATEGIC APPLICATION OF INFORMATION TECHNOLOGY IN HEALTH CARE ORGANIZATIONS SECOND EDITION John P. Glaser

The Jossey-Bass Health Series brings together the most current information and ideas in health care from the leaders in the field. Titles from the Jossey-Bass Health Series include these essential health care resources: Beyond Managed Care: How Consumers and Technology Are Changing the Future of Health Care, Dean C.Coddington, Elizabeth A. Fischer, Keith D. Moore, Richard L. Clarke Board Work: Governing Health Care Organizations, Dennis D. Pointer, James E. Orlikoff Changing the U.S. Health Care System: Key Issues in Health Services Policy and Management, Second Edition, Ronald M. Andersen, Thomas H. Rice, Gerald F. Kominski, Editors Curing Health Care: New Strategies for Quality Improvement, Donald M. Berwick, A. Blanton Godfrey, Jane Roessner E-Health, Telehealth, and Telemedicine: A Guide to Start-Up and Success, Marlene Maheu, Pamela Whitten, Ace Allen Health Care 2010: The Forecast, The Challenge, Institute for the Future Health Care in the New Millennium: Vision, Values, and Leadership, Ian Morrison Oxymorons: The Myth of a U.S. Health Care System, J.D. Kleinke Privacy and Confidentiality of Health Information, Jill Callahan Dennis Strategies for the New Health Care Marketplace: Managing the Convergence of Consumerism and Technology, Dean C. Coddington, Elizabeth A. Fischer, Keith D. Moore Technology and the Future of Health Care: Preparing for the Next 30 Years, David Ellis The Twenty-First Century Health Care Leader, Roderick W. Gilkey, Editor, and The Center for Healthcare Leadership, Emory University School of Medicine The CEO s Guide to Health Care Information Systems, Second Edition, Joseph M. DeLuca, Rebecca Enmark

THE STRATEGIC APPLICATION OF INFORMATION TECHNOLOGY IN HEALTH CARE ORGANIZATIONS

Y THE STRATEGIC APPLICATION OF INFORMATION TECHNOLOGY IN HEALTH CARE ORGANIZATIONS SECOND EDITION John P. Glaser

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CONTENTS Tables, Figures, and Exhibits ix Acknowledgments About the Author xi xiii Introduction xv 1 An Overview of Strategy 1 Definition of Strategy 1 Competitive Strategy 5 The Need-for-IT Strategy 6 Characteristics of Strategic Thinking 11 Summary 13 2 Linkage of IT Strategy to Organizational Strategy 14 Strategic Planning Frameworks and Methodologies 14 Information Technology as a Competitive Weapon 30 Summary 51 vii

viii Contents 3 Internal IT Capabilities and Characteristics 52 Asset Composition and Overview 53 Asset Discussion 54 Asset Lessons Learned and Observations 91 IT-Centric Organizational Attributes 93 The Question of Value 100 Factors That Influence Organizational IT Asset Decisions 117 Summary 123 4 Examples of IT Strategy 125 Clinical Information Systems 127 Integration of Information Systems 151 The Internet 170 Summary 192 5 Conclusion 194 References 197 Index 201

TABLES, FIGURES, AND EXHIBITS Tables Table 3.1 Table 3.2 Table 4.1 Partners HealthCare IT Managers Ratings of Great Place to Work Factors The Impact of PACS Possible Continuum Improvements Figures Figure 2.1 Figure 2.2 Figure 2.3 Figure 2.4 Figure 2.5 Figure 2.6 Figure 2.7 Figure 3.1 Figure 3.2 Figure 3.3 Figure 3.4 Generic IT Strategic Planning Methodology Minard Model Component Alignment Model The Value Chain How the Internet Influences Industry Structure The Three E-Opportunity Domains and Their Components Developing the IT Asset: A Succession of Singles and Grand Slams Assessment of the Application Portfolio Components for Partners HealthCare s Clinical Information Systems Typical Hospital Information System Architecture Diagram Typical Integrated Delivery System Architecture Diagram ix

x Tables, Figures, and Exhibits Figure 3.5 Proposed Quality Management Organization Structure for Partners HealthCare Systems Figure 3.6 Two-Dimensional Organizational Structure Based on Function and Geography Figure 3.7 Two-Dimensional Organizational Structure Based on Function and Process Figure 3.8 The Correlation Between Excellence Rating and IT Spending Figure 3.9 Three Approaches to Eligibility Transaction Costs Figure 3.10 Cost-Benefit Analysis of the Computerized Patient Record Figure 3.11 Serious Medication Error Reduction Figure 3.12 PCHInet Knowledge Resources Figure 3.13 Reducing Days in Accounts Receivable Figure 3.14 Health Care IT Hype Cycle, 2001 Figure 4.1 Medication Order Entry Figure 4.2 Medication Allergy Warning Figure 4.3 Clinical Information Systems IT Asset Figure 4.4 Partners Network Infrastructure Figure 4.5 Knowledge Resources (Handbook) Figure 4.6 CDR Results Viewer Figure 4.7 Viewing a Medical Image Figure 4.8 Main Screen of the Computerized Ambulatory Medical Record Figure 4.9 Home Health Service Request Figure 4.10 econsult Figure 4.11 Patient Gateway Prescription Refill Figure 4.12 NEHEN Eligibility Determination Figure 4.13 Digital City Brigham and Women s Hospital Link Exhibits Exhibit 3.1 Exhibit 4.1 Narrative Description of Clinical Information Systems Workflow Clinical Integration Goals for Partners HealthCare Systems, Inc.

ACKNOWLEDGMENTS The author gratefully acknowledges the contribution of Leslie Hsu to the first edition of this book, The Strategic Application of Information Technology in Healthcare Organizations (McGraw-Hill, 1999). xi

ABOUT THE AUTHOR J ohn P. Glaser is vice president and chief information officer of Partners Health- Care System, Inc. Previously, he was vice president of Information Systems at Brigham and Women s Hospital and before that manager of the Healthcare Information Systems consulting practice at Arthur D. Little. Glaser was the founding chairman of College of Healthcare Information Management Executives (CHIME) and is a past president of the Healthcare Information and Management Systems Society (HIMSS). He is a fellow of HIMSS, CHIME, and the American College of Medical Informatics. He has been awarded the John Gall Award for health care CIO of the year. Partners HealthCare has received several industry awards for its effective and innovative use of information technology. Glaser has participated in National Academy of Sciences studies on the role of the Internet in health care and health care confidentiality and security. He is on the editorial boards of CIO Magazine, Healthcare Informatics, the Journal of Biomedical Informatics, the Journal of Healthcare Information Management, and Topics in Health Information Management. He has published more than sixty articles and a book on the strategic application of information technology in health care. He holds a Ph.D. degree in health care information systems from the University of Minnesota. xiii