IT governance in healthcare still evolving

Aug 4, 2005

"We're an anarcho-syndicalist commune. We take it in turns to act as a sort of executive officer for the week, but all the decisions of that officer have to be ratified at a special biweekly meeting, by a simple majority in the case of purely internal affairs, but by a two-thirds majority in the case of more major...." -- Monty Python and the Holy Grail

In theory, and in practice in most industries, the chief information officer (CIO) is accountable for directing the information, data integrity, and information service functions of the enterprise. But in U.S. healthcare, according to survey results published in April this year, the majority of CIOs do not govern all information technology (IT) resources at their institutions.

In fact, most of the CIO's surveyed didn't even identify IT governance as a critical component of success in their institutions' information systems, although in data presented from thriving implementations, IT governance was seen as one of the top factors contributing to success.

The "Changing Landscape of Healthcare IT Management and Governance" study found that 60% of the respondents had IT staff outside their purview, and only 16% believe governance is important for success.

The majority of IT staff outside the CIO's governance is to be found in the laboratory departments (pathology, histology, and such) and radiology department, 40% and 35%, respectively. Other areas with IT personnel not reporting to the CIO are pharmacy, operating room, cardiology, and telecommunications, according to the survey findings.

"There is a distinct dichotomy between what most survey respondents believe (and do) and what successful practices organizations do regarding IT governance, leadership, and the role of the CIO, according to senior executives who responded to the 'Healthcare Leaders Report' survey," the study authors wrote.

The survey was a joint venture sponsored by enterprise-application developer Lawson Software of St. Paul, MN, and conducted from February through March 2005 by the Scottsdale Institute of Minneapolis and Chicago-based HIMSS Analytics, the Healthcare Information and Management Systems Society's (HIMSS) for-profit healthcare analysis division.

Background

The results are based on responses from 235 healthcare representatives (CIOs, chief nursing officers, chief executive officers, chief financial officers, chief operating officers, and chief medical officers) that responded to an invitation to complete a Web-based questionnaire.

The respondents represented organizations with annual net revenues of $50 million or less, (11.5%) to institutions seeing net revenues of more than $1 billion a year (16.7%). The provider organizations were also broken out into facility type. The majority were identified as community hospitals (57%) while the rest comprised teaching/academic medical centers, as well as integrated delivery systems or multihospital systems.

Approximately two-thirds (63%) of the CIOS have a background in healthcare; however, only 11% of the respondents reported formal healthcare or clinical education. Nearly half, or about 40%, have a technical background in IT management.

"Given the increasing utilization of IT to support care delivery, it will be critical that either more CIOs have clinical and healthcare background or that there be greater involvement of chief medical information officers (CMIOs) and other clinicians to bridge these disciplines," the study authors wrote.

Findings

The most important factor in success for IT initiatives, as defined by 50% of survey respondents, was for executive ownership and accountability. This was closely followed by the need to align IT and business processes.

"System performance and vendor solutions were rated last in importance," wrote the authors. "Somewhat surprisingly, physician adoption was indicated as a critical success factor by only 10% of the respondents."

Interestingly, in other data from the survey, CIOs see both physician and nonphysician clinicians playing an active role in IT. Approximately 98% of the respondents reported that clinicians participate in IT system evaluation, and 94% indicated that clinicians took on the role of project champion.

"Nonphysician clinicians are most likely to play a role in supporting existing clinical applications (61%), selecting IT systems to support their department needs (64%), and in developing and implementing a clinician training program (50%)," the authors wrote.

CIOs also viewed themselves as responsible for driving the value of IT-enabled business processes, a role in which they reportedly found themselves uncomfortable. About 75% of the survey group said that they were primarily responsible for driving value; however, only 20% believe they should have that role. Roughly two-thirds of this group think that this responsibility should be shifted to other functional area leaders, such as the chief medical officer or chief nursing officer.

Vendor consolidation is becoming mandatory at more than one-third of the institutions responding in the survey. Approximately 39% of the CIOs reported that their organizations have a formal policy in place of consolidating vendors across all areas of healthcare IT. In addition 54% said that a combination of mandatory and voluntary vendor consolidation is taking place in their facilities.

"This confirms the industry trend away from best of breed toward 'best of suite' in order to achieve greater standardization, integration, and economies of scale," the authors noted.

IT governance and leadership requires more than reworking organization charts with direct- and dotted-line reporting responsibilities. It is a business and cultural shift that can and should evolve purposefully over time.

"You can't just flip a switch," said Tim Zoph, vice president of information systems and CIO of Northwestern Memorial Healthcare in Chicago. "It will take time to build the discipline and the IT capability. We've gone through an evolution from ad hoc IT committees to more formal IT governance. Now we look for opportunities for the full board to discuss IT in terms of quality, safety, and risks. We bring technology into every discussion because it's so pervasive."

By Jonathan S. Batchelor
AuntMinnie.com contributing writer
August 5, 2005

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Brailer outlines national health IT goals, challenges at HIMSS, February 18, 2005