HCA 360 Lecture 6
Critical Success Factors & Uniform Standards
Introduction
According to Tan & Payton (2010), there are three critical success factors (CSFs) that must be considered
to achieve successful HMIS implementation. These critical success factors involve gaining an
understanding of user characteristics, systems design characteristics, and organizational characteristics.
These CSFs, when combined with thorough organizational planning and management, set the stage for
HMIS implementation activities that have the greatest likelihood to be effective, comprehensive,
manageable, and result in success.
CSF: Understanding Organizational Characteristics
In the Module 1 lecture, we discussed the important role that executive staff must play in preparing the
organization for HMIS and in piloting projects from conceptualization through to post-implementation.
The HMIS project must be designed to achieve the strategic business goals of the healthcare
organization, but this first necessitates a deep understanding of the organization's structure, culture,
and resources. Always remember that HMIS should be designed to meet stated, accepted, and
achievable business objectives. Of course, there should be a sound business case for the project.
Management must carefully evaluate business risks and benefits. Short-term business risks potentially
encompasssuch issues as business continuity interruptions, inability to access files, unauthorized access
to confidential information, an increased need for duplication and storage of electronic records and
hardcopy files, and increased staff hours due to additional work and shifting priorities. A long-term
business risk might include deletion or destruction of old records, which could prove to be necessary at
a later date. Long-term business benefits might include faster access to information across business
units, improved productivity, reduced compliance costs, decreased storage costs, etc.
Not to be overlooked are alignment issues related to legal and ethical imperatives, such as how the
HMIS project can effectively support the organization's mission, and how systems will ensure rapid and
timely compliance with HIPAA and other regulatory bodies.
Other questions that planners should ask include: What are the growth factors, emerging trends, and
regulations for which we must provide? How can HMIS enable us to more rapidly adapt and respond to
a dynamic competitive environment? What are our projected costs, and over what time frame? Can we
affect the changeover ourselves? If so, at what cost? Or, would it be more cost-effective to hire outside
consultants? What are the implications to work processes and to staff? What is a reasonable time frame
for each set of deliverables?
CSF − Understanding Systems Design Characteristics
When we think about systems design characteristics, we need to consider the elements of hardware,
software, firmware, and middleware that must be selected and properly configured to ensure that
organizational objectives can be met. However, before making these decisions, planners must decide
what data must be provided, how it will be organized, how it will be distributed, which decision-support
tools should be given to which users, and, finally, which systems interface characteristics will be
required.
HCA 360 Lecture 6
Other key decisions in systems planning are how data will be defined and how it will be distributed. Data
can be distributed through a centralized data warehouse, via a decentralized network where each
organizational area maintains its own database, or through a combination of approaches (Austin &
Boxerman, 2003). Therefore, the process of identifying requirements and selecting hardware, software,
firmware, and middleware is enabled once a data distribution plan has been developed, which also acts
to define the network architecture required by the organization.
"The Vocabulary Problem"
In Module 3, we discussed Health Level-Seven (HL-7), which provides the industry with a set of
standards to be used for messages, component interfaces, and documents. "HL-7 handles clinical
information communication such as diagnostic results, scheduling information, clinical trials data, and
master file records" (Tan & Payton, 2010, p. 270).
Adoption of universal standards (including common codes and data definitions) both within the
healthcare organization and across healthcare enterprises, health insurance companies, equipment
vendors, health information exchanges, and governmental entities, will dramatically simplify HMIS
planning efforts, facilitate data exchange, and support a host of other healthcare IS needs. According to
Austin and Boxerman (2003), other healthcare standards projects include:
·
The American Standards Institute (ANSI) X.12 Group (specifications for health insurance claims
processing)
·
Health Industry Bar Code Supplier Labeling Standard (HIBC) (common coding of supplies,
materials, and equipment)
·
MEDIX (the Institute of Electrical and Electronics Engineers Committee for Medical Data
Interchange)
An expanded list of healthcare standards organizations can be found at:
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_023149.hcsp?dDocName=bok1
_023149
CSF − Understanding User Characteristics
When planning for HMIS, communicating the anticipated value of the system to staff is critical to
promote end-user buy-in and support for the process. In the Module 3 lecture, it was stated that
information needs assessment is one of the most important elements of systems analysis. However,
information needs assessment has another consequence aside from discovering current process issues:
it has the very real potential to reveal user frustrations relating to information systems. Typical staff
complaints include too much time spent managing priorities, finding needed information, and difficulties
encountered in information handling. If staff members feel that HMIS may remove barriers, reduce
redundancies, and streamline their jobs, they will be inclined to view change more positively.
However, assuming that "change" will be universally embraced at the outset would be a mistake. We
are all familiar with the maxim, "Better the devil you know than the devil you don't." In spite of the
benefits that may be expected to result from HMIS, addressing staff resistance that can arise from fears
of job loss, loss of authority, loss of established relationships, territoriality, etc., is often necessary. Or, if
the project involves inconvenience or interruption in workflows, some may not support the project
HCA 360 Lecture 6
unless they think it will ultimately result in benefit to them. These reactions are understandable and
should be expected. A realistic strategy is to address and allay staff fears, but not to over- promise or
over-commit. Employees should be made to understand that "they will be better off (or at least not
worse off) if they support the change," which should be explained in the context of overall benefits to
the organization (Golden, 2006). As noted in Module 4, an in-depth "preparation for change" training
session for ALL affected personnel adds exponentially to the acceptance and effectiveness of a systems
changeover. Unfortunately, such an important success factor is usually overlooked or performed
inadequately.
While HMIS should be portrayed as a positive opportunity for all, it should not be promoted as a magic
bullet that will solve every problem. For that reason, it is critical that leadership work to manage
expectations. A useful way to build support is to appoint steering committees to work within
departments. According to Golden (2006), these change leaders should be respected, connected, skilled
within their areas, prepared to respond to questions as they arise, and sufficiently influential to be able
to liaise with others across departments.
Communications to staff that are consistent in terms of frequency and content (and transparent
whenever possible), "user orientation, training, education, and participating," are all methods used to
keep staff informed and more amenable to change (Tan & Payton, 2010, p. 236).
Conclusion
When healthcare organizations approach systems implementation with a commitment to understand
and thoroughly address critical success factors (user characteristics, systems design characteristics, and
organizational characteristics), utilize effective planning and management processes, apply guidelines
and standard protocols to development, and facilitate legal and ethical compliance, they are best
positioned to enjoy successful HMIS implementation.
References
Austin, C. J. & Boxerman, S. B. (2003). Information systems for healthcare management (6th ed.).
Chicago, IL: AUPHA/Health Administration Press.
Golden, B. (2006). Transforming Healthcare Organizations. Healthcare Quarterly, 10(Sp), 10-19.
Retrieved November 3, 2009, from http://www.longwoods.com/product.php?productid=18490
Tan, J. & Payton F. C. (2010). Adaptive Health Management Information Systems: Concepts, Cases, and
Practical Applications (3rd ed.). Sudbury, MA: Jones and Bartlett Publishers, LLC.
CHAPTER 11
Managing Health Management Information System Projects: System Implementation and Information
Technology Services Management
Joseph Tan
Scenario: Louisiana Rural Health Information Exchange1
Louisiana Rural Health Information Exchange (LARHIX) is a pilot project championed by Louisiana
Senate President Don Hines and Representative Francis Thompson as a means of servicing the state’s
rural residents with better healthcare delivery, the need for which was made even more evident
following Hurricane Katrina. The initiative aims at demonstrating the possibility of, and potential
benefits of, exchanging patient information electronically between Delhi Hospital, a small hospital in
rural Delhi, Louisiana, and a major health sciences center such as the Louisiana State University (LSU)
Health Sciences Center in Shreveport. According to Michael Carroll, Delhi Hospital’s CEO and
administrator, success of the LARHIX project will permit patients in underserved rural areas, especially
those suffering from chronic ailments and mental diseases, to be treated regularly by physicians situated
in a major health sciences center. “We treated hundreds of people . . . (at LSU) . . . that didn’t have any
medical records at all after the hurricane,” McCarroll noted. “We were starting from scratch and at that
point, we realized that we needed portable, transferrable medical records in order to avoid this kind of
situation in the future.”
Interestingly, the project started with a physician at the LSU Health Sciences Center in
Shreveport showing how he could remotely instruct a Delhi clinician to perform a simulated, but
complete, evaluation of a surrogate patient—checking and collecting vital statistics on the patient. Flatscreen 50-inch monitors, advanced cameras, and other equipment were used in each examination room
located at the two sites to transmit a live telecast of the remote physician– patient interactive session.
In addition to EHR solutions, LARHIX utilizes Fusion, a clinical portal from Carefx (Scottsdale,
Arizona) to aggregate patient information from the various sources. Brenna Guice, Delhi Hospital’s
information systems (IS) head, notes that real-time Delhi patient care to be delivered by LSU physicians
will begin only when laboratory IS, pharmacy IS, and radiology IS are all implemented and integrated
into the health information exchange (HIE) system. Other vendors participating in the project included
Chicago-based Initiate Systems, which offered the software for the HIE’s enterprise master person index
(MPI) numbers, and EHR vendor Dairyland Healthcare Solutions—even though the requirements for
LARHIX are independent of any HIE and EHR vendor products, so long as these software solutions are
interoperable with those of other hospitals.
While Delhi was among the first of seven facilities to be piloted in the LARHIX initiative, the
longer-term vision is actually an extended project inclusive of all 44 members of the Louisiana Rural
Hospital Coalition following an approved five-year proposed funding. According to a representative in
charge of rolling out the five-year project: “Not all facilities will need a brand new system, and some
may only need an upgrade. The ultimate goal is, at the end of that five-year period, to have everyone on
a state-of-the-art system that can communicate with the hospital in Shreveport.”
Imagine you have lost everything following Katrina, except for your identity papers, the
prescriptions you were taking just before Katrina, and a disk drive containing some of your personal
health records, which you happened to have downloaded from your personal computer with other
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important information prior to Katrina. How do you perceive something like the LARHIX project could be
of any help to you as you go about reconstructing your life and your personal health information? Why
might it be important to keep good records of your personal health information, and what kind of a
system would you trust your family physician to implement for the safekeeping of your personal health
records?
I. Introduction
Systems implementation (SI) in healthcare services organizations entails a process whose
success is dependent on the fulfillment of a number of key activities. These may include strategic
planning, a thorough preliminary systems analysis, broad and detailed systems design specifications,
user training and education, and hardware–software vendor selection. Health information systems
analysts and professionals are among the best people overseeing such projects due to the project
management skills that are needed to ensure a well-managed project that is completed on time and
within budget.
In practice, certain critical factors can influence the success of health management information
systems (HMIS) implementation. For example, two broad areas have played key roles: (1) the application
of well-tested guidelines and standard protocols and (2) the enforcement of ethical and legal concerns.
Our focus here is on the HMIS implementation process; some of these factors and challenges are
addressed in the chapter on standards, which is also accompanied by a policy brief included in Part IV of
this text. Figure 11.1 shows that once HMIS planning is fine-tuned to address success factors for HMIS
implementation on the one hand, and organizational planning and management considerations on the
other, the actual steps including specific activities for HMIS implementation can be specified, directed,
monitored, and controlled by project planning and management directives.
This chapter highlights the steps necessary to achieve HMIS implementation success within a
healthcare services organizational setting. It draws from previous parts of the book, in particular
Chapters 8 through 10, to show how HMIS implementation is no more than an outgrowth of strategic
planning, systems development, and data stewardship. Even so, with the growing complexity of HMIS
applications and the increased investments placed on HMIS projects, all (or most) healthcare services
organizations today require that success be a prime criterion in any HMIS implementation effort. We
begin with a look at the critical success factors (CSFs) underscoring HMIS implementation.
II. Critical Success Factors for Systems Implementation
Many critical factors have been found to affect the success of HMIS implementation in
healthcare services organizations. Top management should focus undue attention on these CSFs before
any major HMIS implementation exercise is undertaken. Generally, management should position the
organization for HMIS technology adoption. More particularly, management must pay special attention
to those factors that are likely barriers or constraints to the implementation process. Minor issues that
do not warrant top management consideration can be delegated to middle managers, who can oversee
these issues or control them with inputs from top management on an ad hoc basis during the actual
implementation. However, there may be times when minor issues are truly major issues in disguise, and
if so, these should then be flagged for top management intervention.
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In general, the CSFs for HMIS implementation fall into one of three broad categories: user
characteristics, systems design characteristics, and organizational characteristics. Figure 11.2 shows
specific examples of factors from each of the three categories that contribute to successful or
unsuccessful HMIS implementation.
User Characteristics
Among the factors believed to influence HMIS success, user characteristics (i.e., the “people
problem”) are by far the most extensively studied.2,3 Examples include individual differences such as
learning style, cognitive behavior, user attitudes, and user expectations of what the HMIS can do for
them.
HMIS implementation often carries with it great expectations. It is not unusual, for instance, to
find that many end-users who have little or no direct involvement with system development become
disappointed with the final results of HMIS implementation because the end-product does not match
their expectations. Indeed, the argument that HMIS applications are a “mirage” is familiar.4 Clearly, the
HMIS solutions are not a panacea, in and of themselves, but the HMIS, if developed properly, will
certainly help managers make better choices as well as speed up processes that were previously
handled manually. Adopting an attitude that HMIS applications are the ends and not the means sets up
impossible goals and expectations that can only result in unfulfilled expectations. Consequently, this is
another reason to involve personnel from across all organizational units in HMIS planning and
implementation right from the beginning. In so doing, we can generate positive attitudes and feelings
among end-users, with realistic expectations that can only enhance successful HMIS implementation.
Further, the adoption of a comprehensive user education program can serve to increase the likelihood
of meeting operational objectives sought in initial HMIS planning.
Among various personal reactions to HMIS, resistance is the most destructive behavior related
to HMIS implementation. Dickson and Simmons noted five factors relating to resistance. 5 First, the
greater operating efficiency of HMIS often implies a change in departmental or divisional boundaries
and a high potential to eliminate duplicating functions. This can create a sense of fear of job loss among
operational and clerical workers. Second, HMIS can affect the informal organizational structure as much
as the formal one by creating behavioral disturbances such as doing away with informal interactions.
Third, whether individuals will react favorably to HMIS implementation depends on their overall
personalities (e.g., younger, inexperienced workers are less likely to resist than older, more experienced
ones) and cultural background (e.g., the replacement of interpersonal contacts with human–computer
interface). Fourth, the presence of peer pressure and previous experiences with HMIS implementation
can also influence the organizational climate for success. Finally, the management techniques used to
implement HMIS (e.g., the use of project planning and scheduling methodologies) directly affect user
perception of the system.
The recognition of potential dysfunctional user behaviors is a first step toward successful HMIS
implementation. User orientation, training, education, and participation are ways to minimize the
behavioral problems that may follow the introduction of HMIS in healthcare services organizations.
Systems Design Characteristics
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Aside from user characteristics, systems design characteristics also play an important role in
determining the eventual HMIS acceptability. Examples here include hardware–software performance,
the characteristics of information and decision-making support provided to the user, and systems
interface characteristics, such as the availability or incorporation of easy-to-use and easy-to-learn
features into the HMIS. The essential ingredients of any computer-based HMIS are the hardware,
software, firmware, and middleware. Common sense dictates that configuration of wares be applicable
to the organizational performance and strategies. For an organization’s information needs to be
satisfied from a systems design perspective, they need to be articulated and documented during the
early planning stages and acted upon using tailored implementation techniques. Further, the reliability
of hardware, software, and middleware is critical to HMIS performance. It is important to acknowledge,
for example, that most information needs demand a certain amount of flexibility, notwithstanding the
needs for completeness, accuracy, validity, reliability, frequency, and currency (timeliness) of
information to be supplied to the user.6 Flexibility necessitates an ability to cope with growth and
variability in an ever-changing healthcare services environment.
Systems interface is a subject that could fill an entire chapter of its own and has been briefly
discussed earlier in one of the Technology Briefs. To relate this topic to HMIS implementation, examples
are provided. First, HMIS should be designed in the way end-users such as nurses organize themselves.
For example, many nurses organize their thoughts about patients by using patient room numbers as a
constant frame of reference.7 Inevitably, when a dietetics system in a hospital uses the alphabet as an
organizing scheme, the systems interface becomes inadequate to support the nurses in performing their
routines. This has happened in real life, where a group of nurses and clerks who were exposed to the
system complained about the time it took to enter diet orders and changes into the HMIS. They became
less efficient and increasingly anxious, frustrated, and dissatisfied with the system. The result was to
abandon the system unless software would be redesigned to follow through with the patient room
number organizing scheme.
Second, HMIS interface design should incorporate favorable factors, such as the proper use of
graphics and color.8 One patient registration system used bright primary colors that were “hard on the
eyes” and thus distracting during prolonged use. The system also produced graphics that were difficult
to read and interpret. The system was almost abandoned until it was discovered that both the graphics
and colors were changeable.
Third, the design of HMIS should consider the users’ previous knowledge. For instance, in a longterm care facility, nurses who, for years, had used large desktop screens to register new patient
information have found the smaller screen-size bedside monitoring and tracking system extremely
cumbersome for entering this information. In that case, the incorporation of a coded identification
bracelet placed around the wrists of the patients along with an automated remote scanning device
resolved the problem. Nurses quickly embraced the new bedside tracking system in place of the old
desktop system.
These cases illustrate the significance of human–computer interface in HMIS implementation
success.
Organizational Characteristics
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Organizational characteristics can also influence HMIS implementation success. Examples of
variables include organizational structure and power, organizational culture, and other managerial
factors, such as top management support, commitment, and involvement. One of the key areas
affecting implementation success is the influence of top management. Exercising sound project control,
resolving issues in a timely manner, allocating resources accurately, and avoiding short-lived changes in
critical areas are all serious management considerations. 9 The strategic alignment of corporate HMIS
planning and the application of proper project planning and scheduling can together serve to prevent
costly delays in HMIS implementation. Such an alignment also ensures that the organization is not
forced into a reactive as opposed to a proactive role.10 Here, a proactive strategy anticipates industry
trends and instills innovative processes for competitive advantages and operational efficiencies,
whereas a reactive strategy takes into account current industry trends and chooses to adopt a known
process developed elsewhere.
Key strategies to achieve successful HMIS implementation include a realistic situational
assessment, accurate identification of necessary resources, and development of an action plan.11 It is
therefore critical to encourage top management involvement in many areas, and there should be a CIO
or another knowledgeable senior member of the management team taking charge of HMIS
implementation.
HMIS implementation in healthcare services organizations is no different than in business
organizations. The degree of commitment and involvement of all end-users and especially the support,
commitment, and involvement of top management affect long-term success. All users need to invest
their energy in HMIS planning and implementation in order to create a system that is going to be
accepted and adopted. Top managers in particular must provide support and act as role models to their
subordinates. Potential heavy users, such as middle managers, physicians, nurses, and support staff, also
need to be committed and involved in the HMIS implementation process in order to improve the
likelihood of its long-term success.12,13 In short, HMIS success requires inputs that come directly from
all users, not just systems professionals.
III. Strategic Planning and Management Issues
Our analysis of CSFs for HMIS implementation reveals a number of critical considerations
involved
in HMIS planning and management. Often, careful attention to these details in the
early planning stages can facilitate the creation of strategies that will enhance HMIS success.
Figure 11.3 shows the various types of planning and management issues that will influence
the process and the strategy chosen to optimize HMIS implementation for healthcare services
organizations. The key issues to be addressed are staffing issues, organizational project management,
reengineering considerations, end-user involvement, and vendor involvement, as well as
other additional considerations.
Staffing Issues
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HMIS staffing issues can be addressed by first simply asking the question: “Do we have the
adequate
human resources and HMIS expertise to carry out a successful implementation project?”
The answer to this question was articulated in previous discussions, which essentially advocate
the use of an internal audit of the current HMIS staffing situation.
For new organizations, HMIS development is relatively straightforward; that is, all individuals
with the needed skills are simply to be recruited externally. However, once beyond that, it is
a more complicated process. It becomes necessary to identify potential knowledge gaps in
HMIS staff that need to be filled. The following are more specific questions that need to be
answered.
● Are the current staff members already working at capacity?
● What level of knowledge and skills does the current staff have, and how does this affect recruitment
and training?
● How many new staff members will be needed, and when will they be needed?
The answers to these questions enable the planning of staffing strategies to be layered into an
HMIS implementation plan. It is critical that these considerations be addressed so that arrangements
can be made well in advance to hire the necessary staff or to plan for the needed training.
For instance, carrying through with an implementation schedule requires data on the availability
of staff members with HMIS expertise for certain periods. Conversely, the training of staff
members and the scheduling of recruitment depends on the overall implementation schedule.
Clearly, a lack of needed expertise among existing personnel can slow the process of HMIS
implementation,
often leading to increased pressure and frustration among the existing staff members
and possibly resulting in missed opportunities associated with on-time and “seamless”
project completion. A projection of future staffing needs is also warranted if the project has a
long-term focus.
Although the staffing issues can be resolved at the systems implementation stage, management
of healthcare services organizations must establish clear reward policies to encourage the
retention of experienced staff members. Gray documented that the demand for new systems
personnel of all types grows at a rate of 15 percent per year, whereas the turnover of information
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systems personnel averages about 20 percent per year.14 Reducing this high turnover rate can
immediately improve productivity and reduce operation costs.
To reward good technical HMIS personnel, health organizations can use a dual career path or
a professional stage model.15–18 In the former, a pathway of promotions in the technical level is
created to parallel the managerial path in rank and salary. For example, a technical staff member
would be promoted from programmer to systems analyst, then to systems specialist, and finally
to senior analyst and technical specialist. In the latter, the path for promotions can be from apprentice
to colleague to mentor to project sponsor.19 Both models provide significant incentives
for the return of experienced staff members past the initial stage of HMIS implementation,
thereby sowing the seed for long-term success.
After examining various staffing issues at the system level, an important issue at the individual
level—user knowledge—must be briefly examined. HMIS implementation in health
organizations requires an assessment of in-house systems and expert knowledge. This assessment
should take into account future user needs. Together with staffing needs assessments,
management can ascertain the educational requirements of the organization. By doing so,
the organization also avoids heavily diverting its resources to educating and training users
during and after the online implementation. Thus, educational planning—including general
training for managers, technical training for HMIS professionals, and specific end-user
training to satisfy the needs of various user groups—helps ensure a smooth and timely
HMIS implementation.20
Numerous difficulties, both expected and unexpected, associated with the initial three
months of online operations can be prevented through proper orientation and HMIS staffing
and training. In certain cases, this responsibility can even be off-loaded to software vendors.
This approach may be particularly desirable for “turnkey” systems prepackaged and serviced by
a single vendor. However, the costs in the long run can be significant.
Alternatively, if the organizational structure is capable of supporting this role with an internal
training department and knowledgeable personnel, it may be more cost-effective to provide
the staff education in-house. If in-house training is to be conducted, the training personnel
should be able to distinguish between two levels of training—holistic training and technical
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training. Holistic (or ideological) training here refers to training modules focused on the systems,
and not the operational, perspective. Systems goals and benefits, systems constraints and limitations,
organizational effects, and functional implications are sample topics for this level of training.
In short, holistic training intends to bring the entire system into view and to analyze its
relationship with its surrounding elements (the macro view). This kind of training should be directed
primarily to managerial staff, who need to view HMIS in its entirety, and secondarily to
operational staff, who are more concerned with the day-to-day operations (the micro view).
Technical (or operational) training is aimed at familiarizing the appropriate personnel with
the operational aspects of HMIS that pertain to their tasks. This level of training may encapsulate
such topics as completing forms, report abstracting, data-coding standards, data validation,
standard data input or update procedures, and introduction of routine tasks. This kind of training
is directed primarily to technical or operational staff, who are concerned with daily use of
HMIS, and secondarily to managerial staff, who also need to know the procedures of their
subordinates.
In any event, it should be recognized that the use of a team approach in-house does have the
added benefit of increasing user acceptance and reducing resistance in the long run. Regardless
of how a healthcare services organization is planning to conduct the needed staff training, the
quality of the training should be stressed, because well-managed training for HMIS operations
has the potential to reduce anxiety and potential user resistance and to promote an organizational
climate toward HMIS implementation success.
Organizational Project Management
The style of project management is extremely dependent on the organizational culture and on
the depth of experienced personnel who are available to manage such a process. In many instances,
experienced project managers with both technical and application knowledge are difficult
to find. Consequently, outside consultants are often used. However, time is needed to
educate these consultants on specific situational and historical characteristics, both internally
and externally, that can at times be significant enough to make outside consultation counterproductive.
As within the healthcare services organization, there is often a trade-off. Although
team or committee management of the implementation process provides the benefits of internal
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knowledge, user acceptance, and overall effectiveness of implementation,21 the need for a
fresh look from an external, unbiased perspective should not be overlooked.
Although it is difficult to make specific recommendations with respect to HMIS implementation,
certain techniques are useful in project management. Here, a brief examination is given
to some of the commonly used techniques for project scheduling and program coding. To ensure
that the system implementation is completed by a certain date, a detailed and realistic
schedule needs to be prepared and followed at the initial and subsequent planning stages. At the
same time, the schedule should be flexible enough to accommodate some unexpected delays.
Moreover, a detailed timetable for implementation is often essential to inspire management
confidence in the installation plan. Here, two techniques to assist project scheduling are discussed—
the critical path method (CPM) and Gantt charts.
When using the CPM, the duration of all the tasks involved and the sequence (indicated by
arrows) of all tasks need to be compiled in a network representation, as shown in Figure 11.4.
In the figure, the numbers in circles represent different stages of implementation, the letters
represent different tasks involved, and the numbers beside the letters represent the number of
days needed to complete the task.
After translating the implementation schedule into a network representation, the critical
path of the network can then be determined. The critical path is the sequence of activities that
will take the longest period to complete. The time needed to complete all the activities on this
critical path is the minimum period required to complete the entire project. Figure 11.5 lists all
the possible paths (activities in sequence) and the time needed to complete each. In this example,
the path through activities A-B-F-J-K is the longest, requiring 15 days for completion. This
is therefore the critical path of the project. In other words, the project cannot be completed in
less than 15 days unless certain tasks are started early or shortened.
Another way of representing the details in Figures 11.4 and 11.5 is to use Gantt charts,
which represent project tasks with bar charts. They are often easier to construct and understand
than CPM but may capture and generate less information. Figure 11.6 shows a Gantt
chart for the same project described. It is worth mentioning that the exact start and end dates of
certain noncritical tasks can be moved without causing delay to the overall schedule. For instance,
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if every other task in Figure 11.5 commences and finishes on time, task L can be postponed for
a day without delaying the final completion date.
Program coding, or simply programming, refers to the process of writing instructions that the
computer system can execute directly. This is usually a very labor-intensive task, and as a result,
coordination among programmers needs to be emphasized. Here, two useful coordination techniques—
data dictionaries and walkthroughs—are introduced.
Data dictionaries, containing definitions and proper uses of entities that are in alphabetical
order, can be computerized or manually compiled. Data dictionaries should also have the identities
of database programs used; the names of all the data fields found in the database, along
with the names of the programmers that use them; and descriptions of the data and the personnel
responsible for the data. Just like regular dictionaries, data dictionaries are useful in program
coding coordination, because they allow the names of data elements to be cross-referenced, help
programmers locate blocks of codes that are reusable in new applications rapidly, and ensure
that all codes are consistent with the overall application.
Another very useful tool in program coding is conducting a walkthrough (or review). A
walkthrough
can take place at various stages of program design and development. It is essentially
peer evaluation and testing of a programmer’s work, with the primary objective of soliciting
constructive feedback. In other words, walkthroughs act as control points in programming,
making sure that what is programmed is in line with specific goals and objectives and other operational
constraints. It is not in any way directed personally at the programmer.
Reengineering Considerations
Often when new HMIS applications are implemented, work flows and processes may also
change drastically because of the inherent differences of daily operations with the computerization.
Even without the changes as a result of computerization, users may still find changes to daily
operations as their tasks at work gradually change from time to time. Whereas adequate training
initially helps better prepare end-users for some of these changes, end-user involvement in
the reengineering process can greatly enhance satisfaction with computerization. This again relates
to the importance of the “people aspect” in HMIS.
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To gain maximum benefit from HMIS implementation, all operations must be redesigned
periodically to accommodate environmental changes and maximize operational benefits, while
still maintaining the necessary controls in the process. If the delivery systems are not reengineered
to meet new organizational needs, the increase in efficiency brought about by the HMIS
implementation may be offset by the unmet demands in the environment.
Often, it is inefficient simply to automate old systems processes, because computerization
lends itself to a new workflow, thus demanding extra personnel and resources. A good example
of this is the attempt to automate patient charts to mimic paper-based systems currently in
place. This document is primarily a legal document on paper, but once captured in HMIS, it
can become a much more versatile tool. Very often, healthcare services organizations are reluctant
to rely totally on HMIS and therefore opt to keep the paper copy for backup. Therefore,
health professionals are required to continue filling out these forms manually, which essentially
is a duplication of effort, thus creating an unnecessary workload.
To decide how HMIS operations (or parts thereof ) are to be reengineered, it is useful to solicit
inputs from the staff already acquainted with existing procedures. Team or committee forums
on system-supported group decision settings are excellent means to decide what should or
should not be modified. This leads us to the topic of end-user involvement.
End-User Involvement
In healthcare services organizations, HMIS planning and development are recognized to be
slow compared with the rapid pace of change in the business world. However, lessons learned in
the business sector have been found especially useful; one such lesson is the empowerment of
end-users through their involvement in systems planning and design.
HMIS planning and development require active (not passive) end-user involvement
throughout the entire process in order for implementation to be truly successful. It has been
recognized that unless HMIS staff, physicians, and nurses are involved in systems planning
and ongoing evaluation, HMIS success will be short-lived.22 In fact, in the healthcare
services system, which consists of a much broader group of individuals representing many
technical and professional groups, it seems wise to extend this to users of all the different
modules or areas of HMIS. For this to materialize, adequate time and resources need to
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be allotted, and critical committees and internal and external liaisons have to be established
such that all aspects of HMIS can be optimized while generating organization wide user
acceptance.
Specific considerations with respect to acceptance of end-users include the effect of the
change on the need satisfaction of the affected personnel, the position of those affected, and the
leadership style of those managing the change. Furthermore, direct involvement of application
program vendors, which is the next topic of discussion, is often of critical importance.
Vendor Involvement
The traditional view that vendors specialize only in sales of equipment or computer software is
fast giving way to the realities of the vendors of today. Although the primary function of computer
systems vendors is and will continue to be the actual equipment sale, there is rapidly increasing
emphasis on the sale of “services” beyond the realm of equipment maintenance. In
other words, vendors can be—and in fact very often are—involved in some degree of systems
development and implementation, including HMIS implementation. IBM is a prime example
of such a vendor.
The options with respect to the roles of vendors vary between two extremes. Here the term
vendor usually refers only to software vendors because they dictate much of the implementation.
However, the hardware vendor is also important when considering outsourcing HMIS
services. On the one hand, there can be complete turnkey implementation by the software vendor
(turnkey systems are prepackaged, ready-to-go application programs that are often products
supplied by a single vendor). On the other hand, there is the option of exercising complete inhouse
organizational control. Between these extremes lies the most used option, a blend of vendor
and organizational responsibilities, with each performing in areas of specialty to tailor the
process to the needs of the HMIS implementation.
Depending on the strengths of the organization and the vendor, areas of responsibility that
can be shared include analyst support, project management, user training, hardware and facilities
planning, software modification, interface development, conversion assistance, procedure
development, and implementation audits. The means through which vendors can be involved
vary from one organization to another. In some cases, a single vendor acts as the sole handling
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agent for all technical problems and even some user training; in others, several vendors may
have to cooperate to deal with systems problems.
Nevertheless, there are generally six steps through which a healthcare services organization
can solicit and apply useful inputs from vendors.
1. Initial conceptualization.
2. Strategic planning.
3. Feasibility study.
4. Request for proposals.
5. Proposal evaluation and selection.
6. Physical implementation.
These, as well as post-implementation upkeep issues, are outlined later in the chapter.
Additional Considerations
A few other considerations that are not often described in the literature can help ensure smooth
HMIS implementation. The first of these is related to the concept of quality. Several methodologies
can be adapted to address quality in the healthcare services delivery industry. The methodology
continuum consists of quality control, quality assurance, continuous quality improvement,
total quality management, Six Sigma, and reengineering. Depending on the organization’s
information status, implementation may be facilitated by the inclusion of any one of these
principles.
Another consideration that needs to be taken into account pertains to the manner in which
healthcare services organizations have been changing the way they measure performance. Many
organizations are progressing from an efficiency and throughput approach to an effectiveness
and outcome measurement approach. Experiencing the economic pressure perceived by many
businesses, healthcare services organizations are also increasingly being pressured to link the utilization
of various healthcare resources to their level of outcome and demand and, in many
cases, to justify the utilization with the outcome produced.
Although almost all organizations are run differently with respect to performance
measurements,
management styles can directly affect HMIS implementation. For example, the structure
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of management within organizations—such as departmental organization, program
management, matrix design, hierarchical design, and circular design—can influence HMIS
implementation.
In keeping with the changing priorities in the healthcare services delivery system,
there has been a demonstrated need for more highly integrated and interoperable HMIS.23
Thus, it is critical to keep these considerations in mind when making decisions regarding any
HMIS implementation project.
It is also crucial to keep in mind that leadership roles exhibited by the CEO and the CIO
can affect the success of HMIS implementation. Information technology, therefore, needs to be
integrated from the cultural perspective of an organization. For this to occur, both the CEO
and CIO must leverage HMIS in achieving the goals and objectives of the organization and
communicate this effectively within the organization.
In particular, Austin has called attention to several areas that should be addressed when
monitoring and evaluating HMIS implementation: productivity, user utility, value chain, competitive
performance, business alignment, investment targeting, and management vision.24
Although it is recognized that these criteria suit profit-oriented organizations, several seem
equally applicable to nonprofit healthcare services organizations.
IV. Systems Implementation
Regardless of the strategies utilized in HMIS implementation, there are several steps most
healthcare services organizations should take in order to optimize internal and external
processes in a manner that ensures an efficient and effective outcome. In general, these steps fall
into two broad stages: pre-implementation preparation and post-implementation upkeep, each
of which is now discussed in greater detail.
Pre-Implementation Preparation
The stage of pre-implementation preparation begins with the initial HMIS conceptualization
and ends with the initial online operation of the system. The major steps included are initial
conceptualization, strategic planning, feasibility study, request for proposal, proposal evaluation
and selection, and physical implementation.
Initial conceptualization can take place in a variety of ways. For instance, the CEO of a longterm
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care facility may be impressed by another healthcare services organization’s HMIS in the
same community or regional area; the board of directors of a health facility may have discussed
HMIS in their 10-year plan; staff members of a health maintenance organization (HMO) may
complain about their aging islands of technological applications. In short, the initial conceptualization
represents a genuine wish to consolidate and improve the information flows, data storage,
and information exchange capabilities in a healthcare services organization.
As stated previously, incorporating organizational strategic planning into HMIS strategic
plans is a desirable milestone in any HMIS implementation. HMIS development must be
based on a strategic information plan that is aligned with the organization’s mission, vision,
goals, and objectives. Adopting a strategic approach helps focus measurable goals and objectives
for IS/IT implementation that best suit internal and external information needs. Only in this
way can the necessary factors and considerations (such as outcome measurement, future technological
change, networking, and process reengineering) be included.
Once strategic information planning is completed, a feasibility study can be carried out. In
general, this study aims to determine the extent to which the implementation and the HMIS
upkeeps are feasible. It includes results from various meetings with the board, middle management,
and even staff members who are likely to be affected (user involvement) to solicit their
input. It also incorporates financial (how much is available) and physical (whether the facility is
too crowded for extra equipment) feasibility research. Moreover, the feasibility study can also
make recommendations on the schedule of implementation, its speed, and other issues of concern.
In many healthcare services organizations, the reports for the feasibility study need to be
approved or endorsed by the board of trustees. In these cases, the feasibility study report also
acts as project proposals subject to extensive inquiries. The study reports should always be produced
professionally and should be subjected to peer review.
Following the feasibility study, the detailed goals and objectives for the HMIS project can be
outlined on the basis of an internal and external needs assessment. Needs assessment makes it
possible to formulate a request for proposal (RFP) for the various hardware and/or software vendors
to submit bids. The RFP can include details on the organization, its information needs,
and the specifics of the organization’s goals and objectives that the system is expected to fulfill.
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When vendor replies are received, it is then possible to correlate proposals on the basis of such
internal objectives as budget and infrastructure compatibility issues in terms of existing hardware
and software. This leads to the next stage of proposal evaluation and selection, which is
followed by physical implementation. Separate discussion sections are dedicated to each of
these important steps.
Proposal Evaluation and Selection
As soon as all the proposals have been submitted, it is time to evaluate them to make a
selection.
In the proposal evaluation and selection process, two methods commonly used are benchmark
tests and the vendor rating system. In a benchmark test, the healthcare services organization
provides the vendors with a set of mock data. This set of data then acts as inputs in a prototype
of the proposed system. The prototype system then simulates the performance of the real system
using this list of computations. The actual performance of the prototypes is then compared
with the prespecified standards for evaluation.
Benchmark testing attempts to create an environment that is as close to the real clinical setting
as possible. As the prototypes are being tested, it is not uncommon to find that the real,
constructed system may, in fact, perform at a lower level due to the heavy load of information
to be processed in real life. Nevertheless, benchmark testing gives the organization a “concrete”
feel for what the system would look like and how it would function (to some extent) in the clinical
setting. In comparison, the vendor rating system is simply one in which the vendors are
quantitatively scored as to how well their proposed systems perform against a list of weighted
criteria. Commonly used criteria include user friendliness, data management, graphical and reporting
capabilities, forecasting and statistical analysis capabilities, modeling, hardware and operating
system considerations, vendor support, and cost factors.
The importance of the “people” aspect to the success of HMIS implementation cannot
be overemphasized. As a direct consequence, user friendliness should be a prime concern
when evaluating system proposals from vendors. User friendliness can be manifested in a variety
of ways. The consistency of language command, the use of natural language and touch
screens, automatic grammar checker and spelling correction, and the availability of the
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“Help” and “Undo” commands are examples of user-friendly hardware and software features.
Moreover, menus and prompts, novice and expert modes, spreadsheet display of data
and results, as well as what-you-see-is-what-you-get features also contribute to the user
friendliness of the system.
Designed as advanced “data-processing” facilities, HMIS should have adequate data
management tools to handle the massive volumes of data to be processed in the day-to-day
operation of a healthcare services organization. Such features as a common database manager,
data security measures (log-in password, etc.), simultaneous access (without significant
trade-off in performance), data selection, data dictionaries, and data validation should be
supported and included. The primary HMIS function is to produce timely and accurate information
for making intelligent healthcare decisions. Accordingly, HMIS should have the
capability to generate standard and custom reports; to generate basic graphical plots and
three-dimensional charts; to allow multicolor support and the integration of graphical
and text files; and to allow compatibility and interoperability with existing graphics devices,
the legacy systems, the Internet, new organizational IS/IT applications, or other electronic
devices.
An important theme emphasized throughout this latest edition of our HMIS text is systems
integration and interoperability. The selection of HMIS should take this matter into consideration.
In practice, this can be viewed in terms of hardware and operating system considerations.
Compatibility with various operating systems (icon-based versus command-based), microcomputer
support, compatibility with workstation requirements, and printer and plotter support, as
well as server and network compatibility, should also be considered when selecting HMIS. Even
so, the interoperability most likely is a matter of software or middleware capabilities. As noted
in previous chapters, Web services and open-source systems provide interoperable solutions to
many islands of HMIS and legacy systems.
Finally, vendor involvement can positively influence HMIS implementation. In selecting
HMIS, the amount of vendor support can definitely be a valid selection criterion. Vendor
support can be provided in a variety of ways: consultation, training, active research and development,
maintenance of local branch offices, technical support personnel, and continuing enhancements.
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Also, the financial stability and credibility of the vendor should be confirmed
before reaching a final decision.
Probably the most important factor for all health organizations is the cost. In evaluating
HMIS proposals, it would be very helpful to bear in mind how the costs are calculated and
which items are or are not included. A modular pricing approach combined with some form
of “packaged offer” is one of the more common approaches. In this case, the management
should pay particular attention to the initial license fees, license renewal fees, maintenance
arrangements, documentation, and resource utilization, as well as to hidden conversion
costs. Certainly, the cost of training and staffing has to be estimated by the management
itself.
Figure 11.7 presents a sample evaluation sheet used in a vendor rating system. Note that
although
these criteria are generally applicable to all healthcare services organizations, specific criteria
are more important to each organization by virtue of its unique environment. These
should be specified separately and weighted accordingly.
Physical Implementation
Once the vendors are chosen, a contract is signed, thereby beginning the physical
implementation
stage—the stage when the most “action” takes place. This stage actually consists of
several steps, including recruitment of personnel, training of staff, acquisition of equipment,
installation of equipment, uploading of initial data, system testing, documentation, and online
implementation.
All these steps are performed in a logical progression (some carried out simultaneously),
depending
on the needs of the organization and how these are reflected in decisions based on the
described factors and considerations. The keys to a smooth implementation process are effective
planning and project management. Some variations may be necessary, depending on the differences
in each organization, but some common steps (including some earlier steps) in initial
HMIS implementation are shown in Figure 11.8.
Among these steps, the recruitment of HMIS personnel and training of existing staff members
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have already been discussed. The modes of acquisition and installation of the equipment
are highly dependent on the characteristics of each health organization, as well as on the contract
between the vendor and the management. In addition, whether the equipment is acquired
over some period or at the same time ultimately depends on the payment scheme agreed upon
by the vendors and the management.
The uploading of initial data and systems testing are sometimes conducted simultaneously.
The initial sets of data are used to test whether the system is functioning at the desired level. If
there are any significant discrepancies between the predesignated level of performance and the
actual level, the system may have to be modified. Accordingly, there should be ample time allotted
to these two steps.
Very often, documentation can proceed simultaneously with systems testing because the
structural layout of the system is already fixed. Any additional modifications along the way can
then be documented as updates or memos. Ideally, there should be at least one copy of the master
documentation with details on how to operate the system at the technical level and on how
to manage the system at the tactical and strategic levels. The distributing copies as well as the
master copy should be updated periodically, incorporating the ad hoc updates or memos.
Online implementation involves four common approaches:
1. Parallel approach.
2. Phased approach.
3. Pilot approach.
4. Cutover approach.
In the parallel approach, systems activities are duplicated; the old system and the new system
are both operated simultaneously for a time so that their results can be compared. In the phased
approach, different functional parts of the new system become operative one after another. This
approach is relatively safe and less expensive than the parallel approach because the systems are
not duplicated. The pilot approach requires the installation of the new system in sites that are
representative of the complete system (e.g., in a small geographical area). This means that certain
locations or departments are to serve as “alpha” pilot test sites first, followed by other “beta”
pilot sites or departments until all sites operate under the new system. The cutover approach is
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also called the “cold turkey” or “burned bridges” approach. Essentially, this approach requires
the organization to “flip the switch” to the new system all at once. If the results are not satisfactory,
the system can be revised and activated again.
Figure 11.9 gives a diagrammatic representation of the four common approaches to online
implementation. As to which approach is most suitable, it depends directly on the specific
environment of each health service organization. For instance, the general level of HMIS
knowledge in the staff, the availability of resources for systems implementation, and the
amount of data handled per day will and should all affect the choice of online implementation
approach.
Post-Implementation Upkeep
Although full, online HMIS implementation is a prominent milestone, it is definitely not the
end of the story. Once the HMIS become operational, ongoing maintenance kicks in—good
maintenance is essential to achieve implementation success in the long run.
In general, ongoing upkeep is required because of problems within the system and changes in
the environment. Problems within the system may be errors that have not been discovered by
previous tests or may develop primarily because of an unexpectedly heavy workload. Changes in
the environment include those in related systems, such as in inventory order systems, and those
in the organization of human resources. In many cases, simply because of the length of time it
takes to develop HMIS, there are some deviations between the initial planning and final production;
these deviations also contribute to the need for close post-implementation monitoring.
Regardless of why the system needs to be maintained and modified, the maintenance cycle
depicted in Figure 11.10 captures the major steps involved.
Problems are usually discovered in either unexpected events or periodic systems evaluations.
Post-audits (or post-evaluations) are intended to evaluate the operational characteristics
of the system, thereby acting as control points throughout the operation of the system.
Once the problem is defined, a maintenance project can be initiated. Very often, because
of creativity and the uncertainty involved, this type of project is relatively unstructured,
characterized by numerous attempts to search for the ultimate “ideal” solution. Here, the
concepts of IT services management, which are highlighted in the next section, are very useful.
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After a feasible solution is found, it is then implemented and tested. If the problem
is still not completely solved, it may need to be redefined. Attempts to search for an acceptable
solution are then resumed. If the problem is solved, the project can be completed by
making notations on maintenance logs and by producing the appropriate documentation
for circulation.
It is also worth noting that documentation does not just take place at the end of the
maintenance
cycle. Rather, it occurs throughout the entire cycle in the form of documentation of
problems, written requests for change, and memos on possible sources of problems and solutions.
The documentation at the end of the cycle therefore emphasizes the incorporation of all
these forms and memos into a mini-report that can be used for future reference or for incorporation
into the system manual.
Figure 11.11 recaptures the main steps of the overall schema of HMIS implementation.
Throughout the entire implementation process (both pre-implementation preparation and
post-implementation upkeep), active involvement of both the users and the managers cannot
be overemphasized, for reasons described earlier.
V. IT Services Management Concepts
After examining the various steps of HMIS implementation, we now turn to an emerging field
relating to the upkeep of HMIS products after these have been implemented: IT services management
concepts.
At present, a growing number of governmental bodies in the United Kingdom and nonprofit
organizations around the world have been formed to assist in the establishment of best
practices in IT services management based on core principles of ITIL® standards and guidelines.
ITIL, a registered community trademark of the Office of Government Commerce
(OGC) that stands for IT Infrastructure Library, is essentially a set of publications that together
offers a framework of “best practices” management guidance for all aspects of IT services.
Major categories include guidance for planning to implement service management, the business
perspective, IT infrastructure management, application management, service delivery, service
support, and security management.
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In this text, concepts of HMIS strategic planning and implementation have been covered
primarily
from a general organizational and management perspective, but not specifically along
the IT service management perspective, which emphasizes a continuous service quality improvement
process. Nonetheless, key processes underpinning IT services planning, implementation,
and management are akin to those of HMIS planning, implementation, and review—beginning
with a vision; assessing the external marketplace and scouting the environments to surmise
the best and most appropriate strategies that should be considered to improve expected outcomes;
providing strong leadership support and directions to subordinates whenever possible
and practical to do so; striking a balance among the different roles played by human resources,
technology, and culture within the boundaries of an organization; setting goals; deciding on
measurable targets; conducting process improvement cycles; and achieving goals based on specific
predetermined measures and metrics.
The business perspective essentially conveys the message of the need for aligning IT goals and
objectives with the broader corporate goals and objectives. To achieve a well-knitted alignment,
the processes emphasized by ITIL include: (1) building long-term business relationships and recognizing
the value chain as part of the business partnership management; (2) enhancing supplier
relationships, including supply chain management; (3) reviewing, planning, and developing IT
applications as these applications relate to the business goals and objectives; and (4) providing liaison,
education, and communication on IT services so as to influence, gain support, and
achieve changes through IT services for greater business competitive advantage. Many of these
concepts have also been covered throughout parts of this new edition of the text.
In the domain of IT infrastructure management, IT managers are challenged to managing
appropriately
the people, products, processes, and partners (4 Ps) associated with IT services
throughout the different HMIS life cycle stages. The key steps include, but are not limited to,
feasibility analysis, systems requirements, design specifications, software development, testing,
implementation, operation, review, and retirement. All aspects of infrastructure management
and administration, design and planning, technical support, and operational deployment are
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covered. The IT infrastructure manager coordinates among the different players to ensure that
all necessary support processes are in place to aid service efficiencies and the effective use of IT
services throughout daily operations, during periods of change management, and when in crisis
management situations. Various aspects of these concepts relating to HMIS planning and management
have been discussed and illustrated in earlier sections of this and the previous few
chapters.
In the domain of application management, it is important to relate service management
concepts
to application development and management in that all deployed applications should be
designed for services. In this sense, all applications have to be more flexible, scalable,
interoperationable,
available, reliable, maintainable, manageable, usable, and in compliance with design
specifications and organizational requirements. Service management is concerned with the activities
relating to the release, delivery, support, and optimization of the application. Again, a critical theme
emphasized throughout this text has been the interoperability of HMIS applications
and the management of systems that do not support interoperability.
In the domain of service delivery, various forward-looking delivery aspects of IT servicing are
covered, including availability management, capacity management, financial management for
IT services, IT service continuity management, and service-level management. Availability ensures
that IT services are reliable, available, secure, serviceable, and able to be maintained. It is
the key to quality servicing in IT service management. Capacity management ensures that employee
requests for capacity to meet business needs and goals are given priority consideration at
all times. Financial management sees IT servicing run as a business within the larger corporate
business operation. In other words, employees and technicians are both cost-conscious about
IT services and will minimize future expenditures by trying to take care of problems in the best
way possible to the extent that these problems can be eliminated once and for all. IT service
continuity management entails setting in place a recovery plan for crisis situations management
and ensuring that a certain level of servicing be made available within an agreed-upon work
schedule to minimize any unnecessary work disruption. Finally, service-level management
(SLM) refers to the satisfactory delivery of services on a daily operational level based on the
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service-level agreement (SLA) acceptable to the organization.
In the domain of service support, daily maintenance and support services are covered, including
(1) incident management, where incident reports are filed with the support personnel manning
the computer help line or help desk; (2) problem management, where a proactive
approach is taken to reduce the adverse impacts from the same problem or persistent incidents;
(3) change management, where a more centralized approach is taken at a higher level to control
persistent problems; (4) release management, in which new releases are being considered due to
major changes so as to reduce work discontinuity and improve business processes; and (5) configuration
management, where IT assets such as the centralized or enterprisewide databases are
being managed for the successful running of the enterprise.
In the domain of security management, the IT services management must institute a security
policy to ensure all personnel are aware of the significance of protecting IT assets and information
resources and conduct risk analyses from time to time throughout the life cycle of the IT
servicing, including planning and implementation, operation, evaluation, and auditing.
Topics on regulatory policies related to the release and protection of health information and
HMIS resources have also been covered separately in the Policy Brief accompanying Chapter 12
of this text.
VI. Conclusion
In summary, successful HMIS implementation and the continual evolution of HMIS as the
information
backbone of healthcare services organizations are the ultimate objectives of the
healthcare services delivery field. Among the various steps along the path from initial conceptualization
to physical implementation to operation, the stage wherein HMIS acceptance resides
in the spotlight of organizationwide attention seems to be the post-implementation stage. This
is when the employees of the organization are truly milking HMIS to perform key task activities
and achieving the goals of the corporation. But it is also here that IT services management concepts
play a most critical role to determine if HMIS will be of value to assist the healthcare services
organization attain the goals of high-quality healthcare services delivery.
This chapter has discussed various concerns to be addressed in HMIS implementation and
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some general steps involved. It is, however, not expected that managers of all healthcare services
organizations follow the same steps and address the same concerns in an identical fashion. Rather,
it is hoped that the chapter has provided the “essentials” for healthcare managers and planners
as well as health administration students interested in HMIS implementation or expansion to
oversee new projects in HMIS such as an integration of new systems with legacy systems. With
the lessons learned, the students will then be able to adapt this global knowledge to schemes
suitable to the special environment of each healthcare services organization.
Electronic Resource for Week 6 Assignment
Electronic Resource
1. Transforming Healthcare Organizations
Read "Transforming Healthcare Organizations," by Golden, from Healthcare Quarterly (2006).
http://www.longwoods.com/product.php?productid=18490
Website
1. Optional: American National Standards Institute For additional information, the following is
recommended: American National Standards Institute website.
http://www.ansi.org/
2. Optional: Health Industry Business Communications Council For additional information, the following
is recommended: Health Industry Business Communications Council website.
http://www.hibcc.org/
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