CHAPTER 13 - Health Information Systems and Strategy
3
resulted in a
improve
excellence
and
refined mission statement and a set of strategic priorities for the organization. Sun Health's mission is to
compassion; and to work with others who share their fundamental commitment to improving the human
IN PRACTICE: Sun Health Case Study
Two years ago, the senior leadership team at Sun Health Medical Center engaged in a strategic planning process that
the physical, emotional, and spiritual health of all individuals and communities they serve; to provide care with
condition. Their strategic priorities are:
1. To improve patient safety and quality
2. To foster a patient-centered environment whereby patients are actively engaged in their own care and partners in the
care process
3. To improve care coordination and efficiency
As part of the strategy discussion, the CEO, Mary Lewis, felt it was important to explore the ways in which isnt matern
help SunHealth achieve their strategic objectives. Sun Health is a nonprofit, community-based, integrated delivery system
comprised of three community hospitals in the Southeast. It also includes a large physician practice plan, a cancer
center, a women's health center, and a wide range of ancillary and rehabilitation services. Soon after the initial strategic
planning discussions took place, SunHealth recruited a new chief information officer (CIO), John Martin. John holds
an undergraduate degree in computer science, a master's in industrial engineering, and has over 15 years of experience
in working with IT and health care professionals in the selection and implementation of IS projects. John agreed with
Mary that the organization's IS plans should be well aligned with the overall strategic plans of the organization--and he
quickly found himself at the leadership table.
After many discussions and given the strategic priorities of Sun Health, the leadership team recommended moving
forward with the selection and implementation of an electronic health record (EHR) system. (Note: The leadership team
was comprised of the CEO and CIO, as well as the chief financial officer, the chief nursing officer, and the chief of the
medical staff). They felt that an EHR would improve patient safety, decrease medical errors, and help ensure that providers
were using evidence-based medicine. They also envisioned that by allowing patients to view their records through a PHR
or patient portal, the patients would become more involved in their own care. This could help them achieve their goal of
Creating a patient-centered environment and improve care coordination and efficiency.
However, the team was concerned about doing too much at once. Based upon John's prior experience, he recommended
that the EHR system be selected and implemented using a phased approach with a series of applications introduced
over time:
Stage 1: Clinical documentation for nurses and all ancillary staff members
Stage 2: Medication administration using bar coding technology
Stage 3: Computerized provider order entry (CPOE)
approach was eventually accepted and approved by the leadership team and the board. It was just the beginning of
Stage 4: Physician notes
This
a series of milestones and challenges, with the final goal of a fully implemented EHR yet to be realized.
John established a governance structure for the project. There was a senior-level Steering Committee that oversaw the
Once the EHR vendor was selected and the phased approach for implementing the various applications was determined,
entire project, and individual project managers that managed each stage of the project. An overall project manager was also
appointed. Melissa Drake was selected to serve in this role. She had been a critical care nurse for 10 years before being lured
away to work on IT-related projects. Melissa is well respected in the organization, has a sense of the big picture, and is able
ga
PART 3 . Macro Perspectives
IN PRACTICE: Sun Health Case Study (Continued)
to delegate fairly well. She is also fairly well organized, although she does tend to forget details and often laughs at herself
that she needs a full-time secretary to keep her straight. It is easy for her to overcommit
, as she also serves as the controller
for the IT department and manages all IT contracts with vendors.
Other key members of the Steering Committee include the chief medical informatics officer, medical staff director, chief
nursing officer, CIO, and director of pharmacy. The hospital is a teaching hospital and uses residents, so the expectation is
that the residents will be entering orders directly when the hospital gets to the CPOE phase of the implementation. Buyin
by the residents will be critical. The medical staff director, Dr. Paul Long, is rather quiet and reserved. He sees the value of
the EHR, but has been very busy and not able to attend many of the Steering Committee meetings. He also admits he has
not written an order in 10 years. His residents write all orders for him.
One of the main tasks of the Steering Committee was to establish an overall time frame and sequence for implementing
the various applications. As problems or major challenges arose, John or Melissa would bring these issues to the attention
of the Steering Committee for deliberation and discussion and changes would be made to the master calendar, as
appropriate. The Steering Committee also kept a pulse on how things were going in terms of training, resource allocation,
staffing, and whether too much change was occurring at once. If priorities had to shift or additional people needed to
be brought in the Steering Committee serves in this capacity.
As of this date. Sun Health has completed phases I and 2, and is currently in phase 3. They have implemented CPOE
in one of their hospitals and are in the process of rolling it out to the other two. The rollout of CPOE has been fairly
successful, although it has gone in live in the new hospital with strong physician leaders. Melissa is concerned that the
same success might not happen in the other hospitals, where the physicians are older and tend to be less engaged in the
project. The Steering Committee estimates it will take another year before this phase of the project is completed, and they
can begin work on the final phase in moving on to physician notes. As with any project, numerous requests and changes
for enhancements have been made. Only those that have patient safety implications are acted upon immediately. All others
are being prioritized and considered as time permits.
Other approaches can also link directly to an organization's which to fund later, and which will have to wait. In this way.
strategic outlook. For example, an organization may be the strategic direction of the organization is linked directly to
committed to continuous improvement, which could be reflected
the ongoing IS projects.
in an IS strategy of continuous improvement in processes and
management. Also, as suggested earlier, the development of an
IS strategy may be driven by fundamental views about the nature
of competition and the role of is in facilitating competitive
advantage (Wager, Lee, and Glaser, 2009).
In order to be successful in HIT adoption, the strategic
level questions must eventually give way to questions of
execution. In other words, an organization must move from
advantage of achieving strategic alignment is that it tends to
the "what and why" to the "how" of adopting HIT. One
which is executive-level and clinical leadership support. High
Successful strategic alignment should result in a set of IS lead to another critical factor in the success of IS projects
its strategic direction or for sustaining existing capabilities. level support for IS projects not only communicates to the
rest of the organization that they are serious about adopting
the system in question, but it also increases the chances
progress. This portfolio of IS projects should be managed by of having the necessary resources dedicated to the project
Executive leadershin can allocate the financial and humat
projects that the organization has identified as important to
This portfolio of projects typically includes pending requests,
projects approved but not begun, and projects that are in
typ-level team that includes both senior business and
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