4 Case Study Questions: MGSC6204 Managing Information Resources

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Question Description

Week 3 Case Study Questions.docx

PARTNERS HEALTHCARE SYSTEM (PHS).PDF

Question 1

  1. The two core enabling information systems featured in the Partners Healthcare case are the Longitudinal Medical Records System (LMR) and the Computerized Physician Order Entry System (CPOE). How did these two systems demonstrate effective alignment in the selection of IT investments, facilitate integration of enterprise information management, and enable innovation in the delivery of health care services to patients? Explain your choices.

Effective Alignment:

Explain Your Answers:

the Longitudinal Medical Records (LMR) System

o  e.g. ensured the best possible medical solution while taking into account the type of insurance coverage help by the patient.

o 

o 

o  (add more bullets as needed)

the Computerized Physician Order Entry (CPOE) System

o  e.g. allows for the prioritization of care based on the needs of the patient and the capabilities of the hospital and its staff.

o 

o 

o  (add more bullets as needed)

Facilitated Integration:

Explain Your Answers:

the Longitudinal Medical Records (LMR) System

o 

o 

o  (add more bullets as needed)

the Computerized Physician Order Entry (CPOE) System

o 

o 

o  (add more bullets as needed)

Enabled Innovation:

Explain Your Answers:

the Longitudinal Medical Records (LMR) System

o 

o 

o  (add more bullets as needed)

the Computerized Physician Order Entry (CPOE) System

o 

o 

o  (add more bullets as needed)

Question 2

  1. The CPOE System may be characterized as both a decision support system and a knowledge management system. How might the CPOE system be employed to make operational, managerial, and strategic (a.k.a. competitive) decisions? Where do knowledge management processes enter into the use of the CPOE system?

Application

Explanation

operational decision support

o  e.g. what medicines or other medical therapies to apply to a particular patient

o 

o 

o  (add more bullets as needed)

management and control decision support

o  staffing levels by skill, day and shift based on projections of patient need

o 

o 

o  (add more bullets as needed)

strategic decision support

o 

o 

o  (add more bullets as needed)

medical knowledge management

o 

o 

o  (add more bullets as needed)

Question 3

  1. One of the hot topics in the business literature today is so-called “big data.” It may be argued that the Partners Healthcare Case is a study in big data management and business analytics.  Do you agree with this statement? Defend your position:
    • Yes/No:_____
    • Your reasoning:
      1. (add as many bullets as needed.)

Question 4

  1. Going forward, how can IM and IT ensure the ongoing agility of Partners Healthcare?  Is this important?
    • Important, Yes/No?_____
    • Agility:
      1. e.g. focus on the highest priorities for IT investment, get the systems in quickly, drive the value from them.
      2. (add more as necessary)
    • the strategic importance of IM and IT to Partners Healthcare?
      1. e.g. help create a more innovative mindset across the organization’s leadership.
      2. (add more as necessary)

Unformatted Attachment Preview

Week 3: Case Study Questions Instructions Description This set of questions concerns the Partners Healthcare for Week 3. Question 1 1. The two core enabling information systems featured in the Partners Healthcare case are the Longitudinal Medical Records System (LMR) and the Computerized Physician Order Entry System (CPOE). How did these two systems demonstrate effective alignment in the selection of IT investments, facilitate integration of enterprise information management, and enable innovation in the delivery of health care services to patients? Explain your choices. Effective Alignment: the Longitudinal Medical Records (LMR) System o o o o the Computerized Physician Order Entry (CPOE) System Facilitated Integration: the Longitudinal Medical Records (LMR) System the Computerized Physician Order Entry (CPOE) System Enabled Innovation: the Longitudinal Medical Records (LMR) System o o o o Explain Your Answers: e.g. ensured the best possible medical solution while taking into account the type of insurance coverage help by the patient. (add more bullets as needed) e.g. allows for the prioritization of care based on the needs of the patient and the capabilities of the hospital and its staff. (add more bullets as needed) Explain Your Answers: o o o (add more bullets as needed) o o o (add more bullets as needed) Explain Your Answers: o o the Computerized Physician Order Entry (CPOE) System o (add more bullets as needed) o o o (add more bullets as needed) Question 2 1. The CPOE System may be characterized as both a decision support system and a knowledge management system. How might the CPOE system be employed to make operational, managerial, and strategic (a.k.a. competitive) decisions? Where do knowledge management processes enter into the use of the CPOE system? Application operational decision support o o o o management and control decision support strategic decision support medical knowledge management o Explanation e.g. what medicines or other medical therapies to apply to a particular patient (add more bullets as needed) staffing levels by skill, day and shift based on projections of patient need o o o (add more bullets as needed) o o o (add more bullets as needed) o o o (add more bullets as needed) Question 3 1. One of the hot topics in the business literature today is so-called “big data.” It may be argued that the Partners Healthcare Case is a study in big data management and business analytics. Do you agree with this statement? Defend your position: o Yes/No:_____ o Your reasoning: o i. ii. iii. iv. (add as many bullets as needed.) Question 4 1. Going forward, how can IM and IT ensure the ongoing agility of Partners Healthcare? Is this important? o Important, Yes/No?_____ o Agility: o i. o o e.g. focus on the highest priorities for IT investment, get the systems in quickly, drive the value from them. ii. iii. iv. v. (add more as necessary) the strategic importance of IM and IT to Partners Healthcare? i. ii. iii. iv. v. e.g. help create a more innovative mindset across the organization’s leadership. (add more as necessary) H 9B09E023 PARTNERS HEALTHCARE SYSTEM (PHS): TRANSFORMING HEALTH CARE SERVICES DELIVERY THROUGH INFORMATION MANAGEMENT Professor Richard Kesner wrote this case solely to provide material for class discussion. The author does not intend to illustrate either effective or ineffective handling of a managerial situation. The author may have disguised certain names and other identifying information to protect confidentiality. Ivey Management Services is the exclusive representative of the copyright holder and prohibits any form of reproduction, storage or transmittal without its written permission. Reproduction of this material is not covered under authorization by any reproduction rights organization. To order copies or request permission to reproduce materials, contact Ivey Publishing, Ivey Management Services, c/o Richard Ivey School of Business, The University of Western Ontario, London, Ontario, Canada, N6A 3K7; phone (519) 6613208; fax (519) 661-3882; e-mail cases@ivey.uwo.ca. Copyright © 2009, Northeastern University, College of Business Administration Version: (A) 2010-02-26 INTRODUCTION According to government sources, U.S. expenditures on health care in 2009 reached nearly $2.4 trillion (expected to reach $2.7 trillion in 2010).1 Despite this vaunting national level of expenditure on medical treatment, death rates due to preventable errors in the delivery of health services rose to approximately 98,000 deaths in 2009.2 To address the dual challenges of cost control and quality improvement, some have argued that the U.S. health care system needs an integrated electronic medical record (EMR) system and associated information technology-enabled processes.3 Although the information systems currently available may meet the needs of the industry, the question remains regarding the requirements both within and by the health care services organization to achieve a satisfactory response to these dual challenges. Partners Healthcare System (PHS) maintained a centralized digital records library on more than 4.6 million patients, augmented in real time by data, textual comments and artifacts (i.e. X-rays, MRIs [magnetic resonance imagings], EKGs [electrocardiograms], etc.) as these patients visited doctor offices, received hospital-based or home care services, and obtained prescription medications and other therapies. Procedures were in place to ensure the data quality and integrity of these patient files. Going forward, any health care professional across the network could access a patient’s complete record, ensuring accurate, timely and comprehensive information sharing about that patient’s medical history, allergies, current treatments and other related information. In and of itself, the investment in this electronic medical records (EMR) system was expected to reduce delays in service delivery, mistakes in treating the patient and overall health care costs. When coupled with a computerized patient order entry (CPOE) system to inform 1 Plunkett Research, Ltd., “U.S. Healthcare Industry Overview,” 2008, www.plunkettresearch.com/Industries/HealthCare/tabid/205/Default.aspx. 2 Lucian L. Leape and Donald M. Berwick, “Five Years after to Err Is Human: What Have We Learned?” Journal of the American Medical Association, May 18, 2005, pp. 2384–2390. 3 William W. Stead and Herbert S. Lin, editors, Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions, National Academy of Sciences, National Academies Press, Washington, DC, 2009. Page 2 9B09E023 the selection of drugs and appropriate treatment, PHS health care professionals were now positioned to target more specific therapies for their patients, to identify the most effective, low-cost options among potential treatment strategies and to draw on a vast body of experience-based knowledge across the network to inform patient care. BACKGROUND: THE CHALLENGES FACING THE HEALTH CARE INDUSTRY U.S. expenditures on health care in 2008 exceeded $2 trillion. Of that amount, approximately $747 billion was spent on hospital services, $502 billion on physician and clinical services, $199 billion on nursing home and home health care services, and $247 billion on prescription drugs.4 The cost of health care was expected to spiral even further out of control as the 1950s baby-boomer population became elderly. Alongside the growing furor over escalating costs, the health care industry also faced persistent questions about the quality of the services it provided. Although the quality debate had persisted for some time,5 recent studies estimated that preventable medical errors led to as many as 98,000 deaths per year in the United States,6 clearly suggesting that better informed and more knowledgeable health care practices could not only save money for the government, insurance companies and individual-paying patients but could also save lives. In its most recent and comprehensive statement to date on the need to transform health care delivery in the United States through better information management, a study sponsored by the National Academy of Sciences observed: Health care is an information- and knowledge-intensive enterprise. In the future, health care providers will need to rely increasingly on information technology (IT) to acquire, manage, analyze, and disseminate health care information and knowledge. Many studies have identified deficiencies in the current health care system, including inadequate care, superfluous or incorrect care, immense inefficiencies and hence high costs, and inequities in access to care. In response, federal policy makers have tended to focus on the creation and interchange of electronic health information and the use of IT as critical infrastructural improvements whose deployments help to address some (but by no means all) of these deficiencies.7 The authors of this report determined that the crisis in health care delivery was not just a matter of the cost of these services but also a matter of quality.8 Even within the typical medical practice or hospital, information about the patient was not integrated nor was it effectively leveraged to prescribe cost-effective therapies. 4 Plunkett Research, Ltd., “U.S. Healthcare Industry Overview,” 2008, www.plunkettresearch.com/Industries/HealthCare/tabid/205/Default.aspx. Institute of Medicine, Medicare: A Strategy for Quality Assurance, National Academy of Sciences, The National Academies Press, Washington, DC, 1990. 6 Institute of Medicine, To Err Is Human: Building a Safer Health System. National Academy of Sciences, The National Academies Press, Washington, DC, 2000; Lucian L. Leape and Donald M. Berwick, “Five Years after to Err Is Human: What Have We Learned?” Journal of the American Medical Association, May 18, 2005, pp. 2384–2390. 7 William W. Stead and Herbert S. Lin, , Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions, Academy of Sciences, National Academies Press, Washington, D. C., 2000, p. 1. 8 Institute of Medicine, Crossing the Quality Chasm: A New Health System for the 21st Century, National Academy of Sciences, The National Academies Press, Washington, DC, 2005. 5 Page 3 9B09E023 Over the last two decades, a growing consensus has emerged that health care institutions fail to deliver the “most [cost] effective care and suffer substantially as a result of medical errors.” The National Academy of Sciences study observed that: These persistent problems do not reflect incompetence on the part of health care professionals — rather, they are a consequence of the inherent intellectual complexity of health care taken as a whole and a medical care environment that has not been adequately structured to help clinicians avoid mistakes or to systematically improve their decision making and practice. Administrative and organizational fragmentation, together with complex, distributed, and unclear authority and responsibility, further complicates the health care environment.9 The current state of health care industry performance could be considered from both a cost and quality standpoint, as a consequence of three sets of intersecting factors: 1. First, the nature of health care decisions were fraught with uncertainty about the patient’s current state of health and past medical history, the patient’s genetic predisposition (or lack thereof) to particular medical therapies and the actual effectiveness of past and future treatments for that particular patient. 2. Second, the economic structure of health care delivery in the United States was extremely complex and could be argued to be counter-intuitive to the encouragement of low-cost options. Instead, the system actively encouraged high-cost procedures under the guise of promoting risk-avoiding, “better” medicine. 3. Third and finally, the very information systems and standards that could afford better integrated service delivery, the identification of lower-cost medical options and the avoidance of mistakes in the prescription of medications and other therapies were implemented in such ways as to throw up significant barriers to information sharing and data-driven decision support.10 Despite the many very real barriers to the improvement of health care services delivery, the U.S. Federal government, health care services organizations, medical practitioners, health insurance companies and information technology companies that serviced this industry were coming together to help address these concerns. This effort required a significant investment of resources over an extended period of time, perhaps a decade or more.11 Major U.S. research hospitals and their affiliated service delivery arms were transforming health care delivery in ways that could serve as a blueprint for industry-wide change. Among these institutions, Partners HealthCare System (PHS) illustrated the potential opportunities and the ongoing challenges in achieving more integrated, higher-quality and less expensive health care services delivery. AN INTRODUCTION TO PARTNERS HEALTHCARE SYSTEM (PHS) Partners HealthCare (PHS) was founded in 1994 by the partnering of Brigham and Women’s Hospital and Massachusetts General Hospital to become an integrated health care delivery system that offered patients a continuum of coordinated high-quality care. As of 2009, the system included 6,300 primary care and specialty physicians; 11 hospitals, including its two founding academic medical centers, specialty facilities, community health centers and other health care-related entities; and an ongoing affiliation with Harvard 9 William W. Stead and Herbert S. Lin, editors, Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions, National Academy of Sciences, National Academies Press, Washington, DC, 2009, p. 3. 10 Ibid. 11 Rainu Kaushal et al., “The Costs of a National Health Information Network,” Annals of Internal Medicine, August 2, 2005, pp. 165–73. Page 4 9B09E023 Medical School. In 2008, Partners HealthCare serviced approximately 2.9 million outpatient visits and 149,000 hospital admissions. Its facilities at that time included 3,500 licensed hospital beds, serviced by 40,000 full-time equivalent (FTE) employees across its network of affiliates. For fiscal year 2008, PHS generated more than $7 billion in revenue and conducted approximately $1 billion worth of biomedical research. PHS also pursued joint ventures with the Center for Integration of Medicine and Innovative Technology, Dana-Farber/Partners CancerCare, the Harvard Clinical Research Institute and The Partners Center for Personalized Genetic Medicine (see Exhibit 1 for an overview of the PHS organization). Over the years, PHS had come to exemplify the large, complex, successful and highly regarded metropolitan health care provider, closely linked with academic medicine and medical research. Its affiliation with Harvard Medical School and its exploration of leading-edge medical practices garnered PHS substantial federal and private medical industry funding to support a rich portfolio of research projects. PHS held information on more than 4.6 million patients, augmenting these records in 2009 through 2.9 million office visits, 149,000 hospital stays and the processing of 20 million prescription drug orders. From its inception, Partners focused both on keeping the costs of its services under control and continuously improving the quality of service delivery and overall patient outcomes. To this end, the organization’s leadership extended the electronic medical record integration achieved at both the Brigham and Women’s Hospital and Massachusetts General Hospital across its entire network. This investment improved the quality of decision making both by individual doctors and medical teams concerning prescription drugs and other medical therapies. It also leveraged medical practice knowledge to improve the preventive and therapeutic treatments that the PHS network offered its patients. These aggressive efforts to improve the quality, safety and efficiency of care were the centerpiece of the so-called “High Performance Medicine Initiative” at PHS, which concluded in 2009. In reviewing the serious and capitalintensive efforts made by PHS on all of these fronts, Dr. James J. Mongan, president and chief executive officer of Partners HealthCare observed: Partners HealthCare is playing a leadership role in each area, and in fact, Partners is demonstrating how organized systems can lead to solutions. Only organized systems — as opposed to the very fragmented, disorganized non-systems that make up much of American medicine — only organized systems can implement reimbursement reform, thoroughly disseminate electronic medical records, and establish sophisticated disease management programs.12 AN INTRODUCTION TO PARTNERS HEALTHCARE SYSTEM’S INFORMATION SYSTEMS (IS) ORGANIZATION PHS maintained a substantial information management arm. The 2009 Information Systems (IS) team comprised 1,500 employees operating out of 19 locations in the greater Boston metropolitan area. With an operating budget of $196 million in fiscal year 2009 and a capital budget of $68 million, IS supported 80,000 end-users and 82,000 networked computer devices running in 140 PHS locations. In an average month in 2009, the IS organization answered 18,000 calls; and over the course of 2009, it managed 250 major information technology (IT) projects for the enterprise. To realize its information management objectives, PHS had invested heavily in information technology over the years and had hired some of the best information management professionals in the industry. 12 James J. Mongan, “Comments to the Greater Boston Chamber of Commerce — Health Care Costs,” Partners HealthCare, Boston, 2009. Page 5 9B09E023 John Glaser, the chief information officer (CIO) at PHS, had served in the same capacity at Brigham and Women’s Hospital prior to the establishment of PHS. His first hire was Mary Finlay, who later became his deputy CIO. Together they had served PHS since its inception, focusing on a strategic approach toward IS unit staffing, planning and research, and the deployment of an overall IT architecture across the greater PHS organization of end-users. Key personnel across the IS unit had, in addition to medical credentials, either IT or business management credentials. Among the distinguishing features of the PHS Information Systems organization were the following: • • • • Stability in executive management and consistency in the articulation and pursuit of a common strategic vision for the role of IT within PHS. Top-flight talent recruited and retained in key positions across the organization. The placement of executive level (i.e. CIO) positions within major business units to ensure an ongoing C-level presence and thus alignment of IT within the business. The development, adoption and maintenance of an enterprise-level architectural approach to IT selection and acquisition. Given the intense and in some ways unique use of IT in the various member hospitals and medical services units of PHS, each major business unit had its own customer-facing CIO, including Partners Community Healthcare, Inc., which supported the 6,000-plus general and specialist physician groups affiliated with PHS’s constellation of hospitals. John Glaser’s intent was to ensure that each key business unit within PHS had a strong IS advocate to focus on the particular information systems and technology needs of that constituency’s health care practitioners (see Exhibit 2 for an overview of the PHS IS organization). As part of IS’ commitment to research and development (R&D), Glaser commissioned organizational units to investigate the ...
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