Managing the Tidal Wave of Demand for
IT: The Keys to Successful IT Governance
Dr. John Lee, Jamie Nelson, Guy Scalzi
May 2014
1
Guy Scalzi
Principal
Aspen Advisors
2
Definition of Governance
Putting structure around how
organizations align IT strategy with
business strategy, ensuring they
stay on track to achieve their
strategies and goals, and
implementing good ways to
measure IT’s performance.
~
K. D. Schwartz, CIO.com
5/22/07
3
Why Governance is Important
•
•
•
•
•
•
•
Confers legitimacy on decisions
Standardizes processes
Shapes expectations
Ensures benefits are achieved
Aligns strategy
Provides input to capital budget process
Streamlines IT demand management
4
Keys to Success
•
•
•
•
•
Communicate
Meet regularly
Don’t allow gaming
Keep it simple and transparent
Ensure executive involvement
5
Jamie Nelson
VP and CIO
Hospital for Special Surgery
6
Quick Facts
About IS
• 30,000 orthopedic
surgeries/year
• 35 OR’s; 11 MRI’s; 200 beds
• 100 orthopedic surgeons
• 3 time Magnet designation
• 22 consecutive quarters
99th percentile Press Ganey
Likelihood to Recommend
question
• US News & World Report
2012-2013 America’s Best
Hospitals issue ranked HSS:
• 150 staff, many with clinical
or business backgrounds
• “Invest in IT as Enabler”
part of strategic plan
Core Initiatives
• 18 month Epic EHR and
Revenue Cycle
implementation underway
– Epic Led
– Epic Remote Hosting
• Network core replacement
– #1 in Orthopedics
– #3 in Rheumatology
7
Governance Structure
Former State
8
Linking HSS Vision to IT
Strategic Direction
Mission
1
5
Enable
growth and
extend the
brand
4
Serve
as the
most
trusted
educator
Support
and align a
world-class
medical staff
Vision
2
Patient
3
Maximize
quality and
efficiency:
Operational
excellence
Advance
through
research
and
innovation
6 Elevate employee engagement
7 Invest in information technology
Culture + Values
As an enabling strategic
priority, our vision for IT
at HSS is to:
“Provide world-class IT
systems and services aligned
with HSS strategic initiatives
and commensurate with
world-class care.”
 Easy and consistent patient
experience
 Seamless transitions of care
 Time and cost savings through
automation and optimization
 Extend reach of HSS brand
 Always available, stable
 Future focused, scalable and
aligned with industry
Operationalizing the IT Strategy
Opeartionalizing the IT strategy and tactical plan starts with effective IT governance.
IT Governance Group Members
 Lisa Goldstein, Chair
 Lou Shapiro, Stacey Malakoff, Catherine Krna,
Stephanie Goldberg, Jamie Nelson, Steven
Magid, MD, Laura Robbins, Vincent Grassia,
Marc Gould, Robin Merle and Karen Cohen
External
Facing
Systems
Steering
Committee
Goals
 Align IT expenditure with HSS strategic goals
 Increase organizational commitment to IT programs
 Insure adequate resourcing for IT projects
 Prioritize the demand for IT resources
 Align expectations across the business and IT
 Provide transparency on progress and outcomes
 Increase benefits realized from IT programs
Executive IT
Governance
Group
Research
Systems
Steering
Committee
Education
Systems
Steering
Committee
Corporate
Systems
Steering
Committee
Technology
Steering
Committee
Clinical Systems
Steering
Committee
Vincent Grassia
Laura Robbins
Marc Gould
Jamie Nelson
Stephen Magid, MD
Stephanie Goldberg
Advisory
Groups
Security/
Standards
Supply
Chain
Finance
Rev Cycle
Periop
Innovation
Ops, DR and
DC
IT Dept/
PMs
Inpatient
AMB
Surgical
Advisory
Board
IT Project Request Process Timeline
Jan
Feb
Mar
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
IT Governance committee meets 6x a year. Also meets for two rebalancing efforts 1x in March and 1x in October.
Steering Committees meet 6-12x a year. Also meet for two rebalancing efforts – 1x in March and 1x in October
Corporate & IT
Strategy
Refresh Starts
Communication to
Business that IT
Project Requests
need to be in by
May for next year.
IT Project Request
Intake for Refinement
Process Ends for
following year.
IT Portfolio Annual
Rebalancing Ends
IT Project Request
Refinement Ends
Corporate Budgeting
Process Begins
IT Project Request
Refinement Begins
Corporate & IT
Strategy
Refresh Ends
Corporate Budgeting
Process Ends
Next Year IT
Portfolio Approved
IT Portfolio Annual
Rebalancing Begins
11
Use Case Scenario
• Annual capital budget process
• IT no longer in the business of prioritizing – accountability
at the Steering Committee Level
• CIO goal (tied to incentive comp) – no project
receives capital funding unless it has gone through Steering
Committee Prioritization Process
• Steering Committees, staffed by business unit owners,
negotiate priorities amongst themselves considering:
–
–
–
–
–
–
Strategic alignment
Employee and patient impact
Organizational impact
Financial impact
Risk factors
Alignment with single vendor strategy
12
Keys to Success
• Projects requiring only operational dollars
still need to go through the IT governance process
• Transparency is important – end users are
looking for process and communication
• Don’t let perfect get in the way of the good,
(e.g., forget about weighting )
– we used:
•
•
•
•
Broken or bleeding
Strategic importance – can’t wait
Strategic importance – can wait
Can be deferred
• Figure out whether Executive IT Governance Group wants
to be part of final decision-making process or just approver
13
John Lee, MD
CMIO
Edward Elmhurst Healthcare
14
Quick Facts
About IS
• Formed July 1, 2013
• 676 beds, 3 hospitals
• Edward, Elmhurst
Memorial, Linden Oaks
• More than 50 locations
• Service area of 1.9 million
residents in western
suburbs of Chicago
• 7,600+ employees
• 1,680 medical staff
• 1,700 volunteers
Edward
• Epic Ambulatory (~120
physicians) July 2012
• Epic in Edward and Linden
Oaks Hospitals April 2013
• Share Epic with DuPage
Medical Group,
independent multi-specialty
group of ~ 400 physicians
Elmhurst
• Next Gen in physician
practices (~100 physicians)
>10 years
• Meditech in hospital >10
years
Core Initiatives
• Implementation of CPOE
and improvement of patient
safety.
15
Use Case Scenario
• Decision support
• Alert fatigue
16
Decision Support for a Driver
Use Case Scenario
• Clinical complexity
• Technical complexity
• Solution: break the blood (MD)-brain (IT)
barrier
• Agility
• Governance challenges
18
Keys to Success
•
•
•
•
Highly dependent on individual
Don’t accept out-of-the-box
Clinical focus with IT tools
Plan to scale
19
Questions?
John Lee, MD
Jamie Nelson
CMIO
Edward Elmhurst Healthcare
jlee@edward.org
(630) 527-5144
VP and CIO
Hospital for Special Surgery
nelsonj@hss.edu
(212) 606-1654
Guy Scalzi
Principal
Aspen Advisors
gscalzi@aspenadvisors.net
(646) 369-9310
20