HIT Service Strategy

HIT Service Strategy
Enabling Transformational Health Care

Creative Solutions

Forces Confronting Health Care CIOs
• Health care IT (HIT) is experiencing volatile change driven, in
part, by government incentives and mandates in the U.S., along
with a mass of economic and quality dynamics concerned with
improved patient-centered care.
– Many organizations already have existing plans for implementing
EMRs and EHRs along with growing needs to replace aging fleets
of financial systems*.
– Federal mandates accelerate project timelines and expenditures,
squeezing hospital capital budgets already under strain from
steadily rising costs, rising by approximately 10 percent
annually—and outpacing revenues.**
– Global economics and technology trends, for all IT industries, call
for further cost reductions through consolidation, virtualization,
SaaS, and cloud computing arrangements.
– CEO’s are increasingly looking for real business value metrics
from IT and not simply cost recoveries and SLA performance
measures.
*HIMSS Analytics from John Hoyt, VP Healthcare Organizational Services - HIMSS
** McKinsey Quarterly August 2010

Creative Solutions

Financial Incentives – Small Offsets
• Federal Incentive Programs
offer only about 15-20 Percent
offset of the total coast to
implement EHR within
mandated timeframes.
• The government predicts a
shortfall of about 50,000
qualified health IT workers
over the next five years.
• 8 in 10 hospital CIOs are
reportedly concerned or very
concerned they will not be able Source - 2010 HIMSS CIO Leadership Surv ey s 2005-2010
to demonstrate meaningful use
of EHRs within the federally
established deadline of 2015.
*PricewaterhouseCoopers’ Health
Research Institute.
Creative Solutions

Federal Penalties are Significant
• “An accelerated timetable means that US health care providers
have until the end of 2015 to make the investments or face fines
starting at $2,000 a bed in the first year and up to $35,000 a
bed by 2019. In addition, both revisions to the Health Insurance
Portability and Accountability Act (HIPAA) 5010 and the switch
to ICD-10 require providers to apply strict new data-coding
standards—no small task given the number of databases,
hospital systems, and clinicians affected.” *
• “To meet these various requirements, US hospitals will need to
spend approximately $120 billion, at an average cost of
$80,000 to $100,000 per bed, for the required project
planning, software, hardware, implementation, and training.”**
• The rapidly aging population of baby boomers continues to
balloon the need for more hospital beds and penalty dollars.
There is little decline in population numbers after this
generation in the U.S.
•McKinsey Quarterly August 2010
**Ibid

Creative Solutions

CIO Questions
• Health Care CIOs are looking for fresh perspectives in
advancing HIT strategy design, development, and deployment
for more effective and efficient health care delivery.
A number of important questions require immediate answers.

 Is there room to optimize service delivery capability?
 Do we effectively organize/manage/govern HIT Services to
maximize value and clinical relevancy?
 Are we sure that service performance will meet or exceed
federal and customer expectations?
 Is the budget allocated correctly?
 Is there room to optimize our spend?
 Should we prioritize or redistribute HIT spend?
 How best should we strategically source HIT skills and
services?
Creative Solutions

HIT Services Must Be Agile
Survival in Volatility Requires a HIT Organization be Able to:
• Change size, shape, scope and style as needed:
– Size: Grow/shrink at many levels and rates via flexible resource capacity
arrangements (own, rent, lease, borrow).
– Shape: Centralized, distributed, networked as needed (simultaneous
component shapes if required).
– Scope: Occupy a varying footprint(s) in its value web as the value and
service lifecycles evolve.
– Style: Integrate, collaborate, franchise, etc., depending on dynamics of
markets and offers.

• Engage “self-directed” leadership, managerial and operational
behaviors within dynamic, environmentally determined
constraints.
• Embrace an “effectiveness over efficiency” culture, while
continuing to focus on efficiency.

Creative Solutions

Challenges Will Remain Constant
• The distributed vertical nature and volatility of today’s health care
environments, the global economy, and government legislation are
underscoring increased challenges with:
– Quality of Patient Care
– Responsiveness
– Innovation
– Competitive Positioning
– Speed to Delivery
– Reach
– Reliability
– Risk
– Cost Efficiency “Insanity: doing the same thing over and over again and expecting
different results”. -Albert Einstein

• Health care organizations will need a radically new transformational
approach to HIT on the part of the CIOs, business leaders and
clinicians.
• A transformational strategy will encompass an inclusive governance
process with streamlined decision-making authority, a radically
simplified IT architecture, mega-project-management capability,
resource allocations and strategic sourcing, change and effective
communication management.
Creative Solutions

HIT Organizations Currently Strive for a
Business - Aligned, Managed Environment
Today’s best practices show that HIT value
can be maximized when enterprise HIT
investments are aligned with health care
goals and HIT execution is well managed.

The key drivers of HIT value are:
• Outlook – How organizations make
Outlook

Health Care
Aligned decisions about technology
investments
• Performance – How well organizations
Tactical
implement those decisions

Performance
Reactive Managed

Creative Solutions

But Technological-Driven Transformation of
Health Care Is Challenging this Target
Extended
Clinical/Health
Care
Employers
Home PBMs, Retail RX Processes
Laboratories

Expanded
Physician Groups Channels &
Imaging Centers
Connections

Patient

Payers Hospitals Dynamic
Community Business
Health
Services
Models

Care Centers Government Care Managers
Creative Solutions

This Requires a New Mindset and a New
Approach to Technology Execution

Environmentally
Integrated
Outlook

Health Care
Aligned

Tactical

Performance
Reactive Managed Agile

Creative Solutions

The Pressures Felt by Most HIT
Organizations Validate this Model
• Pressure on current HIT spending:
– Are we delivering maximum business value for the resources spent?
– How do we deliver more with less?
– How do we minimize capital investment?

• Scarce resources: How do we hire, retain, retrain, or obtain staff to
provide the necessary technology skills?

• HIT governance challenges: How do we coordinate HIT spending
and activities throughout the organization? With our partners?

• The need for speed: How do we support business requirements to
respond to opportunities in days vs. months vs. years?

Creative Solutions

An Agile HIT Framework Provides a
Persistent Context for the Strategy Outputs
Strategic Directions Required for Driving Agile HIT Come in Two Flavors

• Getting Aligned and Managed . . . Externalizing &
Becoming Agile
– Drive efficiency and effectiveness of HIT delivery Transitional State

and management processes Environmentally
Integrated
Agile

– Adopt an enterprise architectural view IT

– Focus on getting costs structured, understood, Getting Health
under control Aligned & Care
Health Care Managed Aligned

Outlook
– Concentrate cost optimization on efficiency issues Aligned Managed
Health
– Drive opportunity portfolio prioritization through Care
Aligned
value tradeoff Managed
Transitional State
– Align business and HIT strategies
Tactical

• Externalizing and Becoming Agile . . .
– Integrate business and HIT strategies performance
Reactive Managed Agile
– Focus on improved services and delivery through
adaptive management and delivery processes
– Expand the view of infrastructure to “extra-
Because an organization’s HIT
structure” capabilities are typically
– Create agility through a flexible services distributed across the framework,
environment leveraging internal and external their HIT Strategy embraces a mix
providers of activity types
Creative Solutions

An Agile HIT Strategy Addresses the
Shortcomings of the Traditional HIT Strategy
• HIT defines an ongoing decision tool for leveraging IT to drive a
health care organizational success in a constantly evolving
community environment
• The process is practical and scenario driven
• It recognizes that technology both enables and improves health
care strategy
• The process examines opportunities made available by other
entities in the environment as well as constraints imposed by it
• The strategy is not just about the new, but what to do with the
existing environment and current systems portfolio
• The strategy drives integrated architectures and implementations

Creative Solutions

HIT Strategy Translates Needs and
Opportunities from the Environment into Action
Technology
Health Care Environment
Environment
Visioning

IT Architectures
HIT Strategy Application
Health Care
Strategy Data
Technology
Health Care Security
Architecture Governance

What How

Transformation Services
HIT Current State
People HIT Future State
Process
Technology

Creative Solutions

What Does the HIT Strategy Produce?
A plan for leveraging the HIT capabilities of the company
and the community environment to deliver health care Clusters of tech-enabled
business capability
success --------------
Provide decision making
Environment framework

Health Care Strategy

IT Strategy

IT Systems &
Services
Health
Healthcare
Care
IT Capabilities
Institutions Success
IT Operating Model

Skills and capability that enable
Systems & Service delivery
--------------
Sourcing strategy is critical
Rules of engagement for
decision making
-------------------------
Coordinates complex
Creative Solutions
relationships, brokering

An Agile HIT Strategy Provides…
• HIT Systems and Services Directions, that
– Are the strategic technology-enabled health care capabilities stewarded by HIT
– Provide the decision-making framework for all potential HIT investment
– Recognize
• the interplay of internal capabilities with those of health care partners and customers
• the potential need to support rapid health care business and technology evolution

• HIT Capabilities & Sourcing Strategies, that
– Describe the combination of skills and knowledge with methods and tools that
support the development, deployment and management of the HIT systems &
services
– Examine sourcing options and define the critical skill sets that must be developed
and maintained within an organization

• An HIT Operating Model, that defines
– HIT management structures and processes
– HIT delivery structure and processes
– Roles, responsibilities, and interaction with partners and customers that support
the model of agile execution

Creative Solutions

The HIT Strategic Components Provide the
Basis for HIT Transformation Tools
• HIT Initiative Planning & Prioritization
– Development of a set of processes and tools to organize and prioritize HIT
initiatives
– Focus on resolving the issues around resource management and
prioritization of scare resources

• HIT Portfolio Management / Portfolio Rationalization
– Development of the disciplines and processes around managing the HIT
environment as a portfolio of assets
– Can also include an effort linked to “cost reduction” that focuses on
rationalizing an existing portfolio based on business/ health/ technical
criteria

• HIT Organization Design
– Focused on developing a new HIT organization based on changes in the
environment such as:
• Acquisition / divestiture
• Re-centralization
• A re-evaluation of the HIT strategy
Creative Solutions

This Pragmatic Approach to HIT Strategy Focuses
on Sustained Value and Significant Benefits
• Integrates with and drives health care strategy, not an after-thought or
extension
– Provides a common language for health care/HIT discussions

• Recognizes ROI, needed capabilities, and risks
– Provides an explicit linkage between HIT investments and health care
capabilities
– Enables a consistent framework for prioritizing HIT demands in an
environment of permanent volatility
– Coordinates previously fragmented HIT investments
– Resolves capability development, acquisition, and partner challenges

• Evolves an organization, as opposed to simply maintaining it:
– Plans for new assets in the form of intellectual capital and strategic
capabilities, not just salaries and depreciated hardware
– Allocates resources to the right investments while containing costs
– Determines clear roles and responsibilities for distributed HIT decision
making, enabling an organization to act quickly and with confidence

Greater “technology ROI” derives from greater agility in response and tighter integration of
technology and health care decision making

HIT Strategy Development
Steps Tasks Resources
• Extract key health care strategies • Executive management team
• Document and review with key • Division management
Confirm health care management • HIT management
strategy • Create health care strategy summary • Strategy development team
• Confirm with key management

• Identify technology infrastructure • HIT management
enablers • Strategy development team
Identify key • Identify information management • Key business subject matter experts
technology enablers enablers
• Identify application enablers

• Define required system/service • Strategy development team
characteristics • HIT management
Define HIT systems & • Identify key product capabilities
services • Identify key service capabilities
• Identify sourcing opportunities

• Identify baseline HIT competencies • Strategy development team
Identify HIT • Identify common capabilities • HIT management
capabilities • Identify specialized capabilities
• Identify appropriate sourcing

• Define the HIT governance structure • Strategy development team
• Define the HIT governance • HIT management
Define HIT processes for • Executive management team
Governance • HIT Product & Service delivery • Division management
• HIT management

• Identify product & service, • Strategy Development team
Identify Implications governance, capabilities • HIT Management, SMEs
implications

Creative Solutions

HIT Strategy and Agile Planning Approach
The approach to HIT Planning begins with the development of a well-articulated
information technology strategy driven by the strategic direction of the health care
business.
This strategy serves as the foundation for the enterprise architectures for
applications, information, technology infrastructure, and HIT management.
Finally, the strategy, using the architectures as “roadmaps”, helps to establish the
plan of what technology initiatives will be implemented.

Applications HIT Transition Plan
Information Technology

Development
Strategy Architecture
Health Care Application Portfolio
Initiatives
Strategy Information
Information
Health Care

3
Strategy

Strategy Architecture Information Repository
Initiatives

Technology Technology
Health Care Strategy Architecture Infrastructure Initiatives

Environment HIT Management
Management Initiatives
Strategy Architecture
20

HIT Planning Approach
The HIT Strategy describes an overall direction for HIT in terms of its Systems
and Services to the health care business, the competencies it will leverage to
deliver those Systems & Services, and the governance structure that must be in
place to support the delivery.
• The Application Architecture builds on the product/system direction that is set in that
strategy to define an overall direction for the portfolio of applications in use and a detailed
description of the current and future state of the elements of the portfolio.

• The Information Architecture looks at the structure for managing the key information
for the managing the health care business, who uses that information, where it’s created
and how it is managed.
• The Technology Architecture describes the enterprise direction for an enabling
infrastructure as driven by the strategic direction for applications and data.
• The Management Architecture describes the processes, tools and systems to be put in
place for the effective management of the HIT resource.

• The HIT Transition Plan defines how to get to the future state. The HIT Transition Plan
clusters potential project efforts into a series of prioritized programs or initiatives,
reflecting the interdependence all aspects of HIT and HIT management and their priorities
with respect to supporting the business strategy.
21

Characteristics of an HIT Strategy &
Architecture Methodology
• An accelerated methodology for developing a HIT Strategic
Plan has the following important characteristics:
– A process perspective that recognizes that HIT strategy &
architecture is not a one-time event but a continuous process that
will evolve as the health care environment evolves
– An iterative approach to strategic plan development; building
intermediate versions and gaining consensus
– A collaborative effort that leverages experience in strategic
planning development and the health care business and applied
technology knowledge
– Acceleration through parallel tasking and leveraging facilitated
sessions

22

The HIT Implications and Potential HIT Enablers of the Health
Care Business and Practice Strategies Drive the HIT Strategy
HIT Strategy Process Flow
Health Care
Direction
• Corporate business Corporate HIT Implications
direction as Health Care
articulated by senior
Strategies HIT Strategy
management • What is the impact of the
health care business and
practice strategies on the
Division / HIT systems and services? HIT Principles
Health Care
Functional • How does the health care
Strategy and Data
Health Unit direction and perception
Gathering of HIT affect the
Strategies HIT Systems and
management of HIT? Services
• Gather information
on future direction Direction
• Organize around Health Care
health care units and HIT Enablers
Process
care proc esses HIT Operating
• Review and confirm Direction • How can HIT support the
Model
information with key implementation of the
stakeholders Health Care health care business and
Organizational practice direction and
Perception of strategies through new or HIT Capabilities
Current State Data enhanced:
HIT
Gathering • Infrastructure services
• Applications
• Identify applications and • Information
data portfolios Current State
Management
• Document the existing of HIT
capabilities
governance model
• Document current
infrastructure

Creative Solutions

Future State HIT Design and Migration Planning –
Techniques: Identifying HIT Drivers
HIT Strategy Technology
Health Care Environment
Strategy Principles

Systems and
Services IT Architectures
Health Care HIT Operating Infrastructure Architecture
Environment Model
Application Architecture
Capabilities and
Sourcing Information Architecture

What
How

HIT Current State HIT Initiative Portfolio HIT Future State
HIT Management HIT Infrastructure Initiatives HIT Management HIT
Environment Portfolios Environment Portfolios
Processes Infrastructure Application Initiatives Processes Infrastructure
Data Initiatives
Tools Applications Tools Applications
HIT Management
Information Initiatives Information
Resources Resources
Repositories Repositories

Health Care Business and Practice Functions/Strategy Drive the Overall HIT Strategy,
Architecture and Planning Process

Approach & Deliverables (I)
HIT Process Scorecard

Health Care &
Strategy
IT Process Gather Health Care Workshop
Architecture
Strategies and Build
Functional Decomp Business
HIT
Architecture
Directions

Application Current State App
Architecture Application Strategy
Inventory

Current State Information
Information Strategy
Information
Architecture
Inventory

Infrastructure Infrastructure Technology
Architecture Current State & Architecture
Change Drivers Guidebook

Creative Solutions

Approach & Deliverables (II)
HIT Process Assessment &
Assess HIT Processes Recommendation

Develop HIT Systems, HIT Strategy Exec
Services, Capabilities Guidebook Briefings
Transition Plan
Application

Architecture Maintenance & Communication Plan
Strategy &
Architecture
Application
Application Portfolio Portfolio
Analysis Future
State
Disposition

Information
Strategy &
Architecture
Info Store
Information Portfolio Future
Analysis State
Disposition

Technology
Technology
Infrastructure
Architecture
Guidebook Transition
Plan

Creative Solutions

HIT Transformation Map
2010
Stage 1 Year 1 Year 2
Major activity/
Long
Major activity/
milestone
milestone Term
a l Solutions
ED & Clinic Major activity/
milestone Major activity/
milestone
Vision
Major activity/
Major activity/ milestone
milestone
Major activity/
milestone
nt Major activity/

e me milestone
ag Major activity/
an Major activity/ milestone
c eM milestone
a cti
Pr Major activity/
R& milestone
EH

e
Major activity/

l Us
Major activity/ Major activity/ Major activity/ milestone
milestone milestone milestone

ingfu
Major activity/
milestone Major activity/
Major activity/ Major activity/ milestone

Mean
milestone milestone

nce
a
ent orm
Major activity/
nt Major activity/
milestone & me Major activity/

e m Pe r f
milestone
le e milestone
yc ag
C n

e
ue Ma Major activity/

Ma erpris
Major activity/
en s
ev ces
milestone milestone

nag
TODAY R c Major activity/ Ent
A milestone

Creative Solutions

Appendix A: Detailed Project Approach

Creative Solutions

Detail Project Approach
Characteristics of an HIT Strategy & Architecture
Methodology
Project Approach

• Project Kickoff

• Track I – HIT Strategy Development & Accelerated Solutions Environment

• Track II – Application Architecture

• Track III – Information Architecture

• Track IV – Technology Architecture

• Track V – Management Architecture

• HIT Transition Plan

29

Strategy Project Kickoff
The key objective of the Project Kickoff is to organize team members, set direction, review
available information, agree on deliverable format and establish the remaining schedule

Activities Deliverables
• Review Project Management standards and practices • Project Charter, including project objectives, schedule, team
• Develop project charter leads and risk management strategy
• Develop an enterprise communication plan • Issue Resolution and status reporting templates
• Develop issue resolution and status reporting format and • Enterprise communication template
procedures • Deliverable templates
• Identify client participants for interview s and w orkshops. • Interview schedule
Begin to schedule appointments. • Complete project schedule
• Gather existing IT documentation
•Current system inventory
•HIT budgets
•HIT organization
• Gather existing documentation on business strategies and
current and planned business organizational structures
• Agree upon structure for final documents

30

Track I - HIT Strategy Development Process
Track I focuses on the development of the HIT Strategy. The strategy sets the direction for the
architectures and transition plan and be aligned to the enterprise business strategies

• Gather and synthesize the enterprise and business unit • HIT strategy guidebook w hich establishes the overarching
strategies HIT direction from a health care business and practice
• Interview key stake holders to confirm and refine the perspective. The follow ing w ill be addressed:
health care business and practice direction
•HIT Systems & Services - a description of IT’s
• Create an framew ork outlining the key HIT systems and contribution to the achievement of health care
services and how they support the business strategies
• Create a straw man HIT strategy . •HIT Principles - a statement of fundamental values that
•Identify the future state capabilities and characteristics provides ongoing guidance for decision making
of each of the HIT systems and services •HIT Governance mode identifying the basic structure
•Identify the key HIT principles for managing IT
•Identify a proposed HIT governance model •Key HIT capabilities required to deliver, operate,
• Conduct a facilitated session w ith representation from support and manage the HIT systems and services and
potential alternatives for sourcing
business and HIT to update, confirm and ratify the HIT
strategy.

31

Track II - Application Architecture Process
The majority of the HIT Systems & Services defined in the HIT Strategy are applications systems. The Application Architecture
– builds on the product direction set in that strategy to define an overall direction for the portfolio of applications
– defines how the applications support the business processes and what direction the this portfolio should take to
support the business strategies

The objective of Track II is to create a tool for the active management of the enterprise applications portfolio. Key activities &
deliverables to include:

• Develop an inventory of the current state applications • Application Inventory that provides
portfolio: • Application indentifier and ow ner information
• The inventory will include identifying information as • Technical platform and sizing information
well as information on the Strategic , Functional, and
Technic al quality of the application • Qualitative judgments on the functional quality
• Map each application to the corresponding functions it • Assessment of strategic alignment
supports from the systems and services model. • Application Strategy, to include
• Develop an application strategy that establishes a strategic • Application principles
direction for the systems supporting each key business • Applications mapped to key business processes
process • Strategies for application integration and interfacing
• Develop the future state application architecture • Application architecture, to include:
• recommend a disposition for each group of applications
• A mapping of the applications to the HIT systems and
• These recommendations will focus on aligning the services they support
strategic , functional, and technical quality of the
application portfolio with the direction set by the HIT • A detailed disposition report that defines a path for
strategy each major application
• Conduct a facilitated w orkshop to verify the application
architecture direction

32

Track III - Information Architecture Process
The Information Architecture is driven by both the HIT Strategy and the Application Architecture. The Information Architecture

– Looks at the structure for managing the key information for the managing the business, w ho uses that information,
w here it’s created and how it is managed.
– Will define the direction for the major enterprise information repositories.

The objective of Track III is to create a tool for the active management of the portfolio of key information repositories. Key
activities & deliverables to include:

• Generate an inventory of the data stores currently in use • Inventory of data stores, mapped to subject areas
that provides: • Information architecture , to include:
• identifiers and ow ners • an analysis of the current state and a recommended
• technical platform information future state model w ith the business
• applications associated w ith data stores • a definition of data subject areas and constituencies
• Examine the subject area mapping of the inventory to • an assessment of the limitations of current state
determine the level of redundancy and complexity of • a recommendation for a future state model for
information control information placement
• Conduct an Applications and Information Strategy • a strategy for data ow nership and management
w orkshop to determine the set of HIT directions for the process
information portfolio that are directly linked to the health
care strategy
• Conduct a facilitated w orkshop meeting w ith data ow ners
to develop the future state architecture and modeling

33

The Application & Data Architectures Define How
Applications & Information Support the Business

Chain
Value
Health Care Health Care Health Care Health Care Health Care
Process #1 Process #2 Process #3 Process #4 Process #5

Apps
Application Application Application Application Application Application Application
#1 #2 #3 #4 #5 #6 #7

DB #1 DB #2 DB #3 DB #4 DB #5

Data
Data Warehouse
Reference Data
Informational Data
Transactional Data DataMart DataMart DataMart

Understanding how applications and data support the business is key to making strategic HIT & Health
Care business and practice decisions 34

Track IV - Technology Architecture Process
The Technology Architecture provides a roadmap for the construction of an enabling infrastructure

Creation of the technology architecture occurs after the determination of the strategic direction of the applications and data

The objective of Track IV is to determine the future technology architecture that will drive the implementation of required
Infrastructure to support the healthcare business and practice activities & deliverables include:

• Identify the technology architecture drivers from the • Technology architecture guidebook outlining
strategy and application and data architectures • Framew orks
• Identify the current technology infrastructure in terms of • Models
technologies, standards and implementation • Standards
• Develop a future state direction for each of the key For each of the technology components outlined in the
technology architecture components: activities
• Application services
• Data services
• Commerce services
• Netw orks
• Netw ork based services
• Platforms
• Security
• Conduct a facilitated w orkshop to verify and confirm the
technology architecture direction

35

Components of a Technology Architecture
The technology architecture or infrastructure blueprint
is divided into distinct components
• Service (Application) Components Commun-
ications
– Commerce, Communications,
Content, Customization
Commerce Custom-
Content
• Technology Components ization
– Application Services
– Data Services Network
App. Data
and Platforms
– Platforms Services Services
Security
– Security
– Network and Communications

Each component represents a well defined set of technologies, vendors,
standards, and disciplines.

The technologies and standards selected for any one component set
may have significant influence on the others.
36

Architecture Component Classification Recognizes
the Evolutionary Nature of Infrastructure
Special-Use
Emerging – Isolated infrastructure needed to meet a
– Technology under specific and isolated business need
evaluation – “One off” solutions that are bolted onto
– Limited services the core architecture
initially available
– Competing
emerging
technologies
might replace CORE ARCHITECTURE
core or special-
use Core
EMERGING Architecture
TECHNOLOGY
EMERGING – Strategic
infrastructure
TECHNOLOGY direction
EMERGING
TECHNOLOGY – Replicated
technology
DECLINING throughout an
organization
– Full range of
infrastructure
Declining services provided
– Technologies that are not strategic for the future
– May be a candidate for immediate transition or may
be on a “sunset” path for several years 37

Track V - Management Architecture Process
The Management Architecture will define the HIT governance / HIT organizational structure required to support the HIT
strategy and managed the future state HIT environment. The management architecture will define:
– The HIT Governance structure
– The HIT Organizational structure

The Management architecture will be developed as an outcome of the HIT strategy. The HIT Strategy will set the direction
for HIT governance and the architecture will define specific governance model and organizational structure, including
roles & responsibilities

• Identify the key governance drivers from the HIT strategy • A management architecture that w ill:
• Identify all the constituencies involved in managing and • Define the governance structure for managing HIT
setting the direction for HIT • Define the constituents involved in managing HIT and
• Identify the roles and responsibilities for the constituents their roles and responsibilities
• Identify the key competencies required for delivering and • Key competencies that w ill be required for HIT
managing HIT

38

Management Architecture Can Consider a
Range of Governance Structures
· Service Level Agreements
· Knowledge, Resource Sharing
· Competitive Pricing
· Economies of Scale
· Chargeback Cost · Shareholder-driven Objectives
Recovery · Revenue Generation Potential
· Architecture Control Shared · Various Ownership Options
Service Separate
Centralized
Subsidiary
Control

· Pooling of key
Centers · Shared Risk
competencies Joint Venture · Leverages Partner
of
· Knowledge
Excellence Resources
Sharing

Outsourcing
Franchise
· Proven, Reusable · Contractual
Model Relationship
· Portable Solution · Predictable Costs
· Reduces Capital
Outlays

39

A Process For Creating Roles and
Responsibilities is Driven by the HIT Strategy
The process involves analyzing and The health care users of the HIT
synthesizing the requirements for HIT systems and services and the
systems & services and determining the roles HIT Users organizations/people that
& responsib ilities for delivering, managing influence & guide HIT
and planning those systems & services

HIT Systems HIT Health Care Business and Practices
& Services Influencers HIT

The HIT systems
and related services
that support health
care operation
Analysis & HIT Roles &
HIT Service Synthesis Responsibilities
Providers
Organizations that
develop, manage &
support HIT systems

HIT HIT Policies &
HIT Processes
Principles Procedures
Key processes for
Basic beliefs and tenets developing, supporting
concerning the and managing HIT
management of HIT driven 40
by the health care business

HIT Transition Plan Process
The Transition Plan defines the the initiatives that need to be undertaken to implement the HIT strategy and the value
proposition that will result. The plan will include:
– The initiatives that can be accomplished in the 12-24 months following the completion of the plan
– Identify the value proposition for each initiative
– Identify the estimated resources and timeframe for implementation

The objective of the transition plan is to develop a short term HIT implementation plan supported by business cases.

• Perform gap analysis and identify key initiatives • Portfolio of strategic initiatives, key aspects to include:
• Detail the initiatives in terms of: • Business cases
• Value propositions • Initiative prioritization
• Resources • Transition program including:
• Timeframes • A description of each initiative : duration,
• Prioritize and document initiatives dependencies and order of magnitude capital costs
• Program overview : capital costs estimates (if know n)
and an aggregation of timing/dependencies to provide
an order of magnitude estimate of the level of
investment required
• Timeline

41

Appendix B: Strategy Project Work Samples

Creative Solutions

Strategy Work Sample: Assessing the Current
State of HIT and its Service Agility
• Use existing organizational documentation sources, questionnaires, an HIT
Service Agility tool, and executive interviews to review and assess
capabilities in Applications, Information Management, Technology
Management, and Technology Infrastructure across dimensions of services,
all stakeholders, common industry models and standards.

• Compare current processes HIT Service Agility Framework
environments and costs with leading Infrastructure
The hardware and software that supports the
Application
Software that supports the automation of business
practices and benchmarks to Applications, Information, Processes and Users processes or functions (Purchased Packages,
Custom Developed, Systems Integration)

determine how well services compare
• Hardware/Software
• Outsourced commodities • System development lifecycle - application process
• Architectural standards • Application framework - core set of common services

to most other companies within health
• Rapid technology introduction • Buy, build, integrate
• Workstations • Portfolio rationalization process
• Scalability of services • Application implementation decisions guided by

care.
• Consistent HIT processes enterprise application architecture
• Quality of Services
• Platforms
• Networks

Information Management & Organization
• Document areas of strength, Information repositories and tools for access and Processes that support the ongoing delivery and
analysis of key business data elements (e.g., operation of HIT solutions, organization design &
weaknesses, quick hits and Customers, Products, Transactions, Documents) the roles that perform those processes

recommendations for developing the •
•
•
Data ownership
Information managed as an enterprise asset
Data quality strategy
•
•
HIT strategy and planning with business strategy
Managed portfolio of services and initiatives
• Consistent financial management of HIT costs

HIT strategy. •
•
Data warehouses
Enterprise wide data model and repositories
• Resource management process

Creative Solutions

Strategy Work Sample: Assessment Domains
and Dimensions of Services
Management Applications Information Infrastructure

le
nt ab
ne er
po eliv
om D
C le
p
m
Sa
Creative Solutions

Strategy Work Sample: Assessment Tools,
Interviews and Process Document Reviews

le
nt ab
ne er
po eliv
om D
C le
p
m
Sa
Creative Solutions

Strategy Work Sample: High Level and Detailed
Assessment Deliverables
Observations Recommendations

IS is a relatively low cost services provider. Overall IS costs are
Assess current staffing strategy for improvements in staff flexibility
below the benchmark mean for *** and % of total revenue (-
and availability.
21% variance for both benchmarks).
–Conduct a resource planning analysis to understand
–Low infrastructure costs (data center, network, PC hardware,
capacity alignment with current competency requirements.
etc.) offset high claims system costs (significantly above the
Initiate a resourc e planning process (potentially in the PMO)
benchmark range) and increased overall personnel costs (at
that will proactively plan and address future capacity
the high end of the benchmark range).
management.
–IS’s cost performance is significant considering xyz’s relative
size in the industry. Stratification of respondents in the •Resource planning and budget process should be
Gartner Study indicates that IS costs *** increases as integrated with demand management and portfolio
prioritization processes to ensure appropriate
company size increases (based on total revenue). IS resources are fully utilized throughout the year.
economies of scale are not typically realized with increased
•Research business analyst skill set match and
size.
address gaps appropriately (training, infuse
experienced resources, etc.), particularly in the area
Demand for IS services is high for an organization of xyz size. of IT.
Overall staffing levels are at the high end of the benchmark –Implement staffing management tools that allow more
range (+36% variance from the mean). effective balancing across BAU and development of
–Development and maintenance staff are both significantly strategic business capabilities.
above benchmarks. Ratio of development to maintenance –Develop an accelerated on-boarding and cross-training
staff is good, but slightly weighted toward maintenance. program that effectively organizes materials on xyz’s business
–Management, administrative, and infrastructure staff appear processes and the IS supporting applications.
well leveraged. Adjusting development and maintenance
staff to benchmark means produces an overall staffing level
le

We believe there are currently no tangible benefits in outsourcing
nt ab

that is below the benchmarks. the IS utility functions (Data Center, Network) at xyz.
ne er

–Current IS infrastructure costs are low, therefore outsourcers
po eliv

will not be able to reduce the costs enough to overcome the
om D

inherent risks of outsourcing.
C le

–Current operational services are satisfactory and improving.
p
am

–xyz mainframe environment, although mature, is a dynamic
S

environment (major development is ongoing) that normally
does not lend well to the outsourcing financial model.
Creative Solutions

Strategy Work Sample: Supporting Observations
for Ratings in Each Focus Area within the Four
Domains
These are the leading practices that
represent a perfect score – which very
few, if any, companies can attain.

This section of These observations
the scorecard support our ratings
provides the in the three
overall categories that
assessment for contribute most to
that component overall agility:
of the Domain.
Is the strategic
direction for this
component well-
defined and aligned
to the business?
le

Is this process well
nt ab

documented? How
ne er
po eliv

well is it executed?
om D
C le
p
m
Sa

Creative Solutions

Strategy Work Sample: Benchmark Detail - IS
Costs
Benchmark Name Benchmark Metric

25th % Mean 75th % 2.3%
IT Costs as a % of Total Revenue
2.0% 2.9% 3.2%

Metric Data Description
Element Data Source Value Adjustments
•IS Total Costs Budget versus Actual $135 M Data factored by Finance from actual
System costs
•Total Revenue $5,768 M
Finance

Informational Metrics
Metric Data Description Data Source Metric Comments
•Total IT Costs Budget versus Actual System 2.4% $265 MM Costs/
$10,913 MM Revenue

Observations/ Assumptions

le
• Low IT costs as a % of total revenue

nt ab
ne er
• Benchmark mean for IT Operating Budget as a % of Gross Revenue = 2.1%

po eliv
• Total Revenue includes Premium Revenue, Interest Income, and Fees and Other Income

om D
C le
• Metric variance from mean: -21%

p
am
Creative Solutions S

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