DHIS 2019 Keynote – Strategy Defines Structure
KLAS’ Digital Health Investment Symposium featured a very insightful keynote presentation from Eduardo Conrado, Executive Vice President and Chief Officer of Strategy and Innovation at Ascension. He very graciously shared the elements that help him drive success in Ascension’s HIT development. Conrado has overseen development for a massive scope: over 100 hospitals, 2,600 clinics, 25 million patient encounters per year, and 20 million patient records across 44 states, all being worked on by 6,000 IT professionals across the country. What allows such a large effort to be successful at deploying useful HIT solutions? The key phrase for Conrado is, “strategy defines structure.”
Organize people in line with strategy
While provider organizations are concerned primarily with the effective delivery of healthcare, dedicated IT folks are likely to be spread around the organization, and governance among these professionals can be lacking. Conrado made it clear that the first key in making sure that a solid strategy can drive real change is organizing the tech resources of an organization.
There needs to be a defined, singular leader who can establish a vision and move HIT development in the right direction. Committees made up of various executives, each with only a part of the total tech authority or conflicting visions, cannot match the focus and clarity of a single head. There needs to be a defined role for the person leading a provider’s tech efforts and not just a collection of interested parties. This same structure can be used further down the organizational chain. Wherever committees are found, replace them with singular decision makers who understand the total vision and can direct their teams to complete it.
Round up all of the tech people into one organization with a clear structure, leadership, and mission. Everyone in this structure needs a clearly defined role. If there is a responsibility, such as patient engagement direction, that simultaneously belongs to no one and everyone, determine who should have authority and governance over that role and aspect of the strategy.
Once the structure of the tech people is formalized and aligned with the strategy, vision, and goals of the tech executive, then the organization of systems can be considered.
Aligning systems with strategy and structure
Once people are correctly organized with a commonly understood vision, then the real work of developing HIT solutions for clinician problems can begin. These solutions are built on common ground. Data is the most critical piece to any HIT solution’s architecture, and it plays at the center of any system built by a tech team. There is a high quantity of data that is accessed by multiple platforms, and that increases the complexity of gaining correct insights from the data. Conrado stated, “The best solutions in reading data held captive by EHR systems are the ones that can deliver correct, actionable insights upon request. Any system that does not perform this task is not needed.”
These kinds of solutions require modern infrastructure to perform their tasks well. The best solution for a data access problem is unlikely to be getting another app; the solution would be to modernize data storage. Organizations need to move away from static data centers and toward secure cloud storage. This will make access more feasible and easier to implement without building more custom apps and tools purely for access purposes.
The data architecture needs to be considered and arranged strategically in order to match the desired output.
What does the team look like?
Conrado described the appropriate roles for these teams. The structure of the teams that execute this work will look more like a tech company than a clinician team. There will be researchers, designers, and product managers reporting to heads over consumer experience and clinician experience. These end-to-end managers will report to the leaders in order to determine how well the vision and goals of HIT development are being met.
These teams will work in a data-driven manner. Instead of implementing features determined by the strong opinions of the few, they will look at the available data on how users interact with their solutions, create new tools, and refine existing ones based on the interaction data. Users tell researchers what the project mangers and designers need to build based on how the users use the solution and what features they struggle to use.
The organized and holistic approach to HIT development will quell the hundreds of apps built to solve a single problem. Instead, there will be a continuous development cycle of building and refining a smaller number of tools in meaningful ways. Companies in industries outside of healthcare have tackled and overcome the structural challenges that HIT is trying to solve. Benchmarking from those other solutions and structures will lead to more rapid success. There is no need for HIT to reinvent wheels that were already built and tested outside of the industry.
Closing remarks
When a provider’s tech resources can come in line under a singular organization and work as a single unit instead of as thousands of unaligned hands, real progress and solutions are the results. A strategic approach to HIT development requires providers to think like tech developers with the exclusive clientele of clinicians and patients. This discipline and structure will lead HIT to greater success and gain in an industry that desperately needs innovation to solve modern problems.
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