The past few years have seen many changes in the healthcare industry, including new business models such as the Accountable Care Organization (ACO). The fundamental aim of an ACO is to create a coordinated care process across the patient continuum. Information technology (IT) must transition to this and other new paradigms, which impacts strategy and leadership. Information Technology is no longer a passenger but a fluent navigator in the healthcare transition.
IT has, in the past, focused on clinical engagement. Clinical systems were designed to assist nurses, physicians and medical staff to reduce errors and provide more coordinated care. This did not, unfortunately, improve quality or lower expenditure because the patient was missing from the equation.
Today, IT is tasked with ensuring that strategic vision includes IT solutions for both clinicians and patients. Patient-facing IT is the new norm. It engages patients and delivers real-time solutions in managing their health by using social media, mobile platforms and patient portals. Patients are consumers who expect better coordination of care among providers, as well as appropriate access to health knowledge and technological innovation.
To meet the new platform requirements, Broward Health architecture includes Big Data and Cloud Computing among hundreds of other services and data elements. This increasingly makes IT a broker for services and knowledge. Both these trends can be assets as they bring transformation and competitive advantage. At the same time, it is a liability, because they create security and regulatory compliance concerns.
Big Data and Cloud Computing are the most challenging because they require a 360-degree view of governance and data stewardship. Governance structure includes clinicians, business, vendors, risk and security teams, and IT. Leadership must also factor lifecycle management. Data stewardship must be an enabler of business outcomes and competitive strategy and be void of any market hype. Most importantly, IT should champion usage of data, rather than just focusing on availability. Data stewardship must factor performance auditing for different classes of data. Ignoring these requirements would severely hamper the journey.
Big data requires IT to acquire and apply tools, techniques and architectures for analyzing, visualizing, linking and managing big, complex datasets. Business value is derived from analytics and not by data in the raw form. Data is required for staying informed, collaboration and practice, disease management and sharing data for research. Data is also mandated for reduced diagnostic errors, improved quality and costs by integrating evidence-based medicine to assist clinicians with decision making.
As data moves between structured and unstructured data silos, from internal to external sources and from legacy systems, incoherent data policies and uncoordinated implementation became obvious. Data in the cloud, data from federated sources and Big Data silos add layers of complexity.
Dialogue to manage Big Data is now around information trust models—data supplied for analytics has to be trustworthy. This can be achieved by a comprehensive approach of data governance for all data ecosystems—not just Big Data. Data governance must deal with security, compliance, risk and quality. You must also include meta data management and master data management to cover all aspects of data governance.
Most healthcare systems will use a combination of vendors, products and services. Architecture and planning to support this context requires a transformed approach to information infrastructure. Big Data will shift the way we look at data. Focus is now on data mining and modeling, and less on metrics and reporting.
The shift to cloud computing will not be radical, but more of an evolutionary change. Industry predictions indicate Cloud Computing will not exceed 50 percent of the total IT portfolio. However, pushback due to concerns about total cost ownership is real.
Cloud computing provides elasticity to spin new services in an agile and nimble way. IT can focus on business innovation and vendor engagement rather than deploying or maintaining technology infrastructure. Cloud Computing Infrastructure market realities are maturing, but healthcare is slow to react. This is due to the applications in healthcare being tightly coupled and requiring customization and integration sometimes across legacy and systems.
“Cloud Computing and Big Data are some of the resources that IT will have to manage as healthcare grows”
In addition, SaaS vendors are, in some instances, adding applications in an uncontrolled way by bypassing IT and approaching business units to deploy cloud solutions specific to departmental business needs. Instead, Broward Health’s approach is to have a decentralized process that provides a balance between tactical and strategic objectives. Collaboration protocol is clearly defined.
If IT is not involved in SaaS applications, interoperability issues can occur, as a service may be composed of multiple services. Jurisdiction over data privacy and protection, infrastructure for managing provisioning and access, security, and integration framework are best managed by IT. Risks associated with contracts, billing, performance and availability are better managed by IT than the business units.
Cloud Computing and Big Data are some of the resources that IT will have to manage as healthcare grows. A governance framework where processes, procedures, people and technology are articulated will create the advantage for adoption of emerging technologies, innovation and calculated risks.
Courtney Fisher-Lewis, Associate CIO, Saint Luke’s Health System & Ex-Sr. Director, IS Program Management, Children’s Mercy Hospital David Chou, SVP & CIO, Harris Health System & Ex-Chief Information & Digital Officer, Children’s Mercy Hospital
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