Managing the Tidal Wave of Demand for IT: The Keys to Successful IT Governance

Dr. John Lee, Jamie Nelson, Guy Scalzi

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May 2014

Guy ScalziPrincipal

Aspen Advisors

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Definition of Governance

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Putting structure around how organizations align IT strategy with business strategy, ensuring they stay on track to achieve their strategies and goals, and implementing good ways to measure IT’s performance.

~ K. D. Schwartz, CIO.com

5/22/07

Why Governance is Important

• Confers legitimacy on decisions• Standardizes processes• Shapes expectations• Ensures benefits are achieved• Aligns strategy• Provides input to capital budget process• Streamlines IT demand management

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Keys to Success

• Communicate• Meet regularly• Don’t allow gaming• Keep it simple and transparent• Ensure executive involvement

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Jamie NelsonVP and CIO

Hospital for Special Surgery

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Quick Facts

About IS Core Initiatives

• 30,000 orthopedic surgeries/year

• 35 OR’s; 11 MRI’s; 200 beds• 100 orthopedic surgeons • 3 time Magnet designation • 22 consecutive quarters

99th percentile Press Ganey Likelihood to Recommend question

• US News & World Report 2012-2013 America’s Best Hospitals issue ranked HSS:– #1 in Orthopedics– #3 in Rheumatology

• 18 month Epic EHR and Revenue Cycle implementation underway– Epic Led– Epic Remote Hosting

• Network core replacement

• 150 staff, many with clinical or business backgrounds

• “Invest in IT as Enabler” part of strategic plan

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Governance Structure

Former State

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Linking HSS Vision to ITStrategic Direction

Culture + Values

Patient

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Support and align a world-classmedical staff

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Advance through research and innovation

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Serve as the most trusted educator

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Enablegrowth andextend the brand

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Maximize quality and efficiency: Operational excellence

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6 Elevate employee engagement

Invest in information technology

VisionMission As an enabling strategic priority, our vision for IT

at HSS is to:“Provide world-class IT

systems and services aligned with HSS strategic initiatives

and commensurate with world-class care.”

Easy and consistent patient experience

Seamless transitions of care Time and cost savings through

automation and optimization Extend reach of HSS brand Always available, stable Future focused, scalable and

aligned with industry

Operationalizing the IT Strategy

IT Governance Group Members Lisa Goldstein, Chair Lou Shapiro, Stacey Malakoff, Catherine Krna,

Stephanie Goldberg, Jamie Nelson, Steven Magid, MD, Laura Robbins, Vincent Grassia,Marc Gould, Robin Merle and Karen Cohen

Goals Align IT expenditure with HSS strategic goals Increase organizational commitment to IT programs Insure adequate resourcing for IT projects Prioritize the demand for IT resources Align expectations across the business and IT Provide transparency on progress and outcomes Increase benefits realized from IT programs

Surgical Advisory

Board

Security/ Standards

Innovation

Supply Chain Periop

Executive IT Governance

Group

Advisory Groups

IT Dept/PMs

Finance

InpatientOps, DR and DC

AMB

Rev Cycle

External Facing SystemsSteering

Committee

Corporate Systems Steering

Committee

Technology Steering

Committee

Clinical Systems Steering

Committee

Research SystemsSteering

Committee

Education Systems Steering

Committee

Vincent Grassia Laura Robbins Marc Gould Jamie NelsonStephen Magid, MDStephanie Goldberg

Opeartionalizing the IT strategy and tactical plan starts with effective IT governance.

IT Project Request Process Timeline

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Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

IT Project Request Refinement Ends

IT Portfolio Annual Rebalancing Begins

Next Year IT Portfolio Approved

Corporate Budgeting Process Begins

Corporate & IT Strategy

Refresh Starts

IT Portfolio Annual Rebalancing Ends

IT Project Request Refinement Begins

Corporate & IT Strategy

Refresh Ends

Corporate Budgeting Process Ends

IT Governance committee meets 6x a year. Also meets for two rebalancing efforts 1x in March and 1x in October.

Steering Committees meet 6-12x a year. Also meet for two rebalancing efforts – 1x in March and 1x in October

IT Project Request Intake for Refinement

Process Ends for following year.

Communication to Business that IT Project Requests need to be in by

May for next year.

Use Case Scenario

• Annual capital budget process• IT no longer in the business of prioritizing – accountability at the

Steering Committee Level• CIO goal (tied to incentive comp) – no project

receives capital funding unless it has gone through Steering Committee Prioritization Process

• Steering Committees, staffed by business unit owners,negotiate priorities amongst themselves considering:– Strategic alignment– Employee and patient impact– Organizational impact– Financial impact– Risk factors– Alignment with single vendor strategy

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Keys to Success

• Projects requiring only operational dollarsstill need to go through the IT governance process

• Transparency is important – end users arelooking for process and communication

• Don’t let perfect get in the way of the good,(e.g., forget about weighting )– we used:

• Broken or bleeding• Strategic importance – can’t wait• Strategic importance – can wait• Can be deferred

• Figure out whether Executive IT Governance Group wants to be part of final decision-making process or just approver

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John Lee, MDCMIO

Edward Elmhurst Healthcare

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Quick Facts

About IS Core Initiatives

• Formed July 1, 2013• 676 beds, 3 hospitals• Edward, Elmhurst

Memorial, Linden Oaks• More than 50 locations• Service area of 1.9 million

residents in western suburbs of Chicago

• 7,600+ employees• 1,680 medical staff• 1,700 volunteers

• Implementation of CPOE and improvement of patient safety.

Edward• Epic Ambulatory (~120

physicians) July 2012• Epic in Edward and Linden

Oaks Hospitals April 2013• Share Epic with DuPage

Medical Group, independent multi-specialty group of ~ 400 physicians

Elmhurst• Next Gen in physician

practices (~100 physicians) >10 years

• Meditech in hospital >10 years

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Use Case Scenario

• Decision support• Alert fatigue

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Decision Support for a Driver

Use Case Scenario

• Clinical complexity• Technical complexity• Solution: break the blood (MD)-brain (IT)

barrier• Agility• Governance challenges

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Keys to Success

• Highly dependent on individual• Don’t accept out-of-the-box• Clinical focus with IT tools• Plan to scale

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Questions?

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Jamie NelsonVP and CIO

Hospital for Special Surgerynelsonj@hss.edu

(212) 606-1654

John Lee, MDCMIO

Edward Elmhurst Healthcarejlee@edward.org

(630) 527-5144

Guy ScalziPrincipal

Aspen Advisorsgscalzi@aspenadvisors.net

(646) 369-9310