The Role of Organizational Strategy on Health Information Technology Implementation
Murugan Anandarajan, Ph.D., Professor of Information Systems, Drexel University
The American Recovery and Reinvestment Act provides approximately $19 billion in outlays for health-information technology, coming mostly between 2011 and 2015. In selecting such information technology, healthcare organizations should pay attention to its overall organizational strategy.
Hammer and Champy’s business diamond model provides a useful framework to understand how new information technologies align with the organizational strategy as well as to diagnose any potential problems. (For example, doctors resistance to using e-prescription software such as Allscripts) would result in misalignment between the organizational strategies and information technology.
According to the business diamond model, there are four organization strategic factors which are important in the success implementation of healthcare information technology. They are: communication structures, workflow processes, values and beliefs and measurement systems. These are discussed below.
Communication structures in hospitals have traditionally followed the command and control model. Many significant trends such as economic pressures on both hospitals and physicians, the need to collaborate to improve quality, and the implementation of electronic health records, physician shortages and the lifestyle preferences of the employees are converging. This would result in hospitals seeking more agile communication structures.
A variety of models will likely serve as the basis of future hospital communication structures Examples include networked or matrix organizational structures, where for instance physicians are empowered through physician-advisory councils and super groups.
Although focus on the development of structural models is critical, one must be mindful that these models in and of themselves do not ensure effective communication. Research has shown that factors such as physician involvement in decision making, and physician leadership development are critical in improving communication. In addition, while many hospitals utilize electronic tools to disseminate information, these tools alone do not engage physicians.
Thus, the communication structure need to consider not only the tools that they offer but also make communication a two way process, consider generational communication structural methods and work towards bridging those gaps. Software such electronic health record systems can provide substantive and useful information on quality of care and patient satisfaction which will enhance physician engagement and support.
Given the new demands of health information technology, many hospitals may realize that existing systems may not be up to the challenge. Many hospitals have begun to investing in new systems, with the hope that these replacement systems allow organizations to take advantage of new capabilities such as better integration with clinical information systems, web-enabled functionality, and online payment options.
Healthcare organizations should remember that simply implementing the technology may not help achieve the desired consequences from the system conversions. Hospitals should consider establish the optimal business process, and then implement technology that supports the redesigned processes.
Thus, prior to implementing the Electronic Health Record systems, consider critically examining all relevant work processes. These may include workflow processes such as patient scheduling, medical billing.
Values and Beliefs
Employee beliefs are the number one risk issue fueled by mistrust and apathy. This often originates from inadequate or poorly managed processes which aggravate high risk situations and increase errors. Inertia to change within an organizational culture has resulted in resistance to new improved practices. For instance, current practices with regard to patient safety tend to be reactive rather than proactive, based on a process of reflective learning through what is learned from series of incidents and medical errors.
Many research studies have found links between the values of an organization’s culture and its innovation. Furthermore hospitals which value improvements in their competitive positions are more successful in implementing new information technologies.
Implementing Electronic health record systems, AARP requirements on showing meaningful usage will drive driving hospitals to adopt more methodologically rigorous management tools in order to evoke new efficiencies from complex health care operations. In a study conducted by Per-Se Technologies, only 67 percent of hospitals indicated that they either currently use or plan to implement metric tools such as the balance scorecard programs or six sigma or internally developed metric tools.
With the move into electronic health systems arena hospitals should consider new robust metrics of both operational and financial performance will be the primary measure of success. Hospital executives will increasingly feel the need for a metrics dashboard that sits on top of this data foundation. Such a healthcare dashboards for example, Inetsoft, will allow executives to check a range of measures on a real-time basis, and receive regular alerts for immediate action .
In summary, healthcare organizations need to consider the following organization strategy questions prior to implementing information technologies.
- What are the important structures and reporting relationships within the healthcare setting?
- Who holds the decision rights to critical decisions?
- What are the characteristics, experiences, and skill levels of the people within the organization?
- What are the key workflow processes?
- What control systems are in place?
What is the overall culture of the hospital?
Caccia-Bava, M, Guimaraes, T, and Harrington, S., (2006) Hospital organization culture, capacity to innovate and success in technology adoption, Journal of Health Organization and Management, 20, 3, 194-217.