Beyond Medical Informatics

It’s been over a month since I last written for the blog.

My life as a CIO has been very busy. The past few weeks much more so. Some of my recent activities (I’ll write about them soon) include:

• Continuing development and design of TMC PRIME—the EMR platform we are developing.
• TMC Quality Fair Week where we had a booth that featured TMC PRIME.
• Implementation of Google Apps—Yes, TMC is now on GMail!
• Initial wrap-up of 2011 projects for Year-To-Date IT accomplishments (in preparation for budget planning).
• Initial project planning for next year’s budget.
• Initial brainstorming for restructuring of IT Department.

The last one has been in my mind for several months now—probably since I started work as CIO. I found our IT organizational structure to be rigid and unwieldy. I had a hard time responding to critical IT requirements and situations. Projects were not managed or monitored well. Some projects slip through the cracks of proper implementation.

Then it dawned on me. For several years, the main IT project was the hospital information system (SHAMAN). This system started out small but has since become the workhorse of hospital operations. And the IT department was almost exclusively organized around this application—to the detriment of other IT projects.

I shared this with my IT managers:

We have an IT department that is structured to support a single software.

That can’t be. We need to change that. We have other IT projects aside from SHAMAN, like:

• HL7 Integration Platform
• Clinical Data Repository Platform
• Clinical Documentation Platform
• Business Intelligence
• Document Management Systems

Our users also have other IT plans like:

• Improved charge capturing using mobile devices
• Improved medication management
• Online surveys and patient feedback forms
• Research and patient registries

So, I pose this challenge to my IT management team.

Let’s build an IT organization that supports the whole organization including the network of clinics and hospitals we serve.

It will not be easy. Our initial thoughts focus on the following areas:

• Strengthen the IT management team with focus on strategic planning, initiatives and relationship-building.
• Build project management and systems analysis core competencies among the staff.
• Build technical core competencies for the core technologies used.
• If possible, outsource some IT services, e.g. technical support, specialized programming.

Let’s hope we succeed.

Next year will be an exciting year!

Last Thursday, September 15, 2011, we had an IT Department (ITD) staff meeting. I wanted the IT staff to appreciate what the department accomplished for The Medical City in the past year. This was also an exercise to improve our intra-departmental communications.

After the managers of the different sections of the department—development, SQA, support and technical—shared their activities and accomplishments, I presented possible projects and activities for next year. I also expressed the need to be more focused and proactive to ensure successful implementations.

I also wanted to end the meeting with an inspiring message. So I shared the Serenity Prayer:

Grant us the serenity to accept the things we cannot change, the courage to change the things we can, and the wisdom to know the difference.

I highlighted the three concepts—serenity, courage and wisdom—and then told them that the prayer was wrong.

First off, the prayer got the order of the 3 concepts wrong. Starting with “accepting things we cannot change” is not serenity—it is surrender.

Second, it’s misleading to call it the Serenity prayer when what we need to change the world is courage. It should be the Courage prayer. I wanted my IT Department to have balls!

Lastly, the wisdom part assumed it was easy to know the difference. It is not.

So, how do we know which ones we can change and which ones we cannot?

The answer: We don’t know—and won’t know—until we try.

Therein lies the true wisdom: Going through life with the conviction to MAKE a difference is the only way to KNOW the difference.

So, I rewrote the prayer for our IT Department. I rewrote it matching the order of things we need to continually support the operations of the hospital, contribute towards better patient care and forge the way into the future.

Here it is:

Grant us the wisdom to make a difference, the courage to change the things we can change and the serenity to accept the things we cannot.

Our work in Health IT is not easy. We should first be wise enough and brave enough to challenge the status quo. Serenity should be our last resort.

Amen?

Amen.

I’m currently reading "Power: Why Some People Have It and Others Don’t" by Jeffrey Pfeffer.

Although I’ve yet to finish the whole thing, one of his points struck me. Let me paraphrase it:

The "years of work experience" is not a good gauge of competencies and skills. 20 years may just be 1 year repeated 20 times.

This made me laugh. (My wife almost woke up.)

As a CIO, I need to look into the work and project experiences of consultants and vendors. That’s just part of the vendor evaluation process.

As a Healthcare IT professional, I find it essential to keep updated with latest trends but way, way better to get involved in different projects. Here is a list of Healthcare IT projects I’ve done in the past. There’s more coming in.

So, how do you evaluate someone with 10 years experience—but handled the same project, technology and methodology in those 10 years? Is that 10 years or just 1 year repeated 10 times?

Many organizations mistake project management as nothing more than project coordination. And many IT projects fail because of this misconception.

Project management is not just an activity—it is a core skill of effective management.  Project managers (PMs) are NOT administrative clerks of meeting agendas, project calendars and schedules of deliverables. They should take on leadership roles and drive the pace of the project.

Here’s my top 3 key ingredients for effective project management:

1. Accountability for Failure.
2. Effective Decisions.
3. Management of Outside Input.

Accountability for failure

It is said that success has many fathers but failure is an orphan. Effective project managers know that true accountability is being accountable not only for project success but also for project failure.

If this is clear from the start, few would volunteer to start or manage projects just for the ‘distinction’ of becoming project managers. Effective PMs know they cannot play the blame game at the end of failed projects.

Effective decisions

Project managers should have the commensurate authority to make decisions for specific details and tasks of the project. But authority is just the beginning. PMs should also make effective decisions.

Effective decisions should be both timely and actionable. The output of every decision should be a realistic action plan that is shared with the project team. Effective PMs know that the progress of the project is not determined by activities in the Gantt chart but by decisions made for the project.

Management of outside input

Effective PMs understand that many tasks and deliverables are beyond their team’s control. The bigger the project, the more groups involved. And input from these people are prerequisites for many project activities.

The PM will have to do a lot of ‘C’s: Communicate, Coordinate, Control.

Here’s a short list of tips to help manage outside input:

• Identify deliverables as concrete as possible.
• Make deliverables or task list public. Share with project stakeholders.
• Get—and document—commitments from outside groups.
• Do quick follow-ups or reminders prior to delivery dates.
• Hold groups accountable for deadlines. Report frequent delays to group superior.
• Confirm completion of tasks and deliverables as positive feedback.

If you noticed, my top 3 ingredients tackle important management areas:

1. Self – Get a true sense of accountability
2. Internal/Project Team – Effective decisions drive effective teams
3. External Teams – Find ways to manage things beyond your control

I’m sure there are more tips out there to be more effective at project management. What tips can you share to be more effective in project management? What habits, skills or characteristics do effective project managers have?

Recent email discussions got me thinking about the challenges of implementing Healthcare IT for developing countries (HIT4Dev). The basic assumptions of HIT4Dev include the following:

• The US (and other western countries) are more advanced in HIT concepts and implementations.
• Because of this, they are models for HIT implementations.
• Compared to these models, the developing countries lag behind.
• There is a palpable gap.
• HIT for developing countries (HIT4Dev) try to bridge this gap.

Here are 5 tips to help meet the challenges of bridging the gap and implementing HIT for developing countries:

1) Know what can work for developing countries.

With so much HIT updates today, it’s challenging to identify the ones applicable for Philippine settings. Not every technological advancement is relevant. Many implementations and applications brought about by US regulations may not hold true for the Philippines.

A good example would be the US HIPAA regulations. The concepts behind HIPAA are legitimate, yes, but direct compliance does not provide immediate or relevant impact to local implementations as of yet. It would be a foolish waste of resources to work on that given other areas for improvement.

2) Know why it worked.

Don’t stop knowing the “What”. The biggest lessons from successful HIT implementations in other countries are in the “Why”. Understanding and insight are the best tools in bridging the gap.

Being a copycat is a sure recipe for failure. Know what factors and concepts made it work. Know the conditions wherein it will NOT work. Get a clear handle of the ‘because’ of HIT implementations and activities, e.g. “Let’s do this BECAUSE…”, “Let’s not do that BECAUSE…”

3) Identify relevant target results.

After a thorough study, ask yourself these questions:

• What tangible results can I get out of the implementation?
• What specific deliverables provide the most relevant impact?
• What measures of success matters to the local users and stakeholders?

Get the successful US model and break it down into workable and relevant targets. As the saying goes, “You eat a whole elephant one bite at a time.” Just make sure the bite is something you can chew and use.

4) Understand ALL the components of the gap.

Understand that the gap is not specific to Healthcare IT because clinical applications do not exist in a vacuum. There are technological advancements, organizational dynamics, societal changes and governance structures that contribute towards the gap. These other things matter.

Focusing on clinical applications without understanding the non-clinical environment in which it thrives is a big mistake. Many HIT4Dev teams make that mistake.

5) Go beyond funding as the solution.

“If we only had funding, this problem would be solved.” How many times have we heard that?

People who think that way when trying to bridge the gap are simpletons.

The simplest problems are those where funding is the solution. They are easy to solve. But many problems are not that simple. Pouring money into a problem does not solve itself.

Take money out of the picture when solving problems. And you’ll find the real solutions worth funding.

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Comments and violent reactions? Do you have other tips for HIT4Dev teams? Post them below! Thanks!

During the open forum of my talk on eHealth Project Management, I was asked to cite experiences with IT vendors from the perspective of a consultant of a major hospital. I focused my answers on two areas: working with IT vendors and tips on choosing an IT vendor. Let me elaborate further in this post.

Two General Categories

If the hospital follows the long-term strategy of "Build + Buy", IT vendors often fall under two general categories:

1. Software Development: These include companies that provide contractual employees, consultancy for in-house software development or outsourced application development. This engagement is for custom-built software such as hospital-specific clinical and research applications.
2. Product/Service Providers: These include vendors of administrative software, e.g. financial and inventory systems, and ancillary systems, e.g. PACS and laboratory information systems. Others may provide services for hardware support and software acquisitions.

Working Relationship

When working with IT vendors, I find it best for the hospital management and/or IT department to do the following:

• Treat them as partners. Make it easy for them to help you solve your problems.
• Make them accountable for their product–AND their promises. Honesty, integrity and truthfulness are essential ingredients for an excellent working relationship.
• Do not believe all their promises. Even with a good working relationship, understand that they are still in the business of selling.
• Pay on time. Help the company thrive.
• Make referrals. Help the company grow.
• Give feedback of their services. Help the company get better.
• Do not adapt their vision for your company. Come up with your own. Despite their good intentions, you know your company much better.
• Identify success and/or acceptance criteria during development or implementation. These items should be specific and measurable. This helps everyone look at the same direction.

Choosing an IT Vendor

Document and understand your hospital and project needs before going through the process of vendor evaluation. It is easy to be distracted by ‘product or service peripherals’. Come up with a standard for evaluation and stick to it.

Beyond that, here are some qualities I look for in the company and in its people:

• Excellent listening skills: They’re not only selling a product/service, they hear what you need and are sincere in helping you solve your problems.
• Experience, knowledge and skills: They should know their product and their customers. They should know what they are doing.
• Willing to learn: I admire organizations who invest in their people. They constantly strive to be better.
• Ability to walk away from a project: I like vendors who can say ‘No’ to a project. It shows honesty, integrity and an understanding of their company’s or product’s limitations and capabilities. The opposite of this would be vendors who promise to have or do everything.
• Accept defeat graciously: When other vendors are chosen, they still stick around and help with other projects. It reflects an organizational culture that wants to build relationships and not just a client base.

No healthcare organization is an island. Having the right IT partners can help the organization succeed in its process improvement, modernization and computerization efforts. The key is to choose wisely and maintain excellent working relationships.

These are just from my own limited experience. I’m sure there are more—and better—recommendations out there.

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What’s your experience with IT vendors? Are they good or bad? How do you deal with the bad ones? What are your recommendations? Let me hear from you.

Here’s a list of news, links and articles about Medical Informatics, Healthcare and IT that I found interesting this past week.

• eWeek.com – How Google, CDC, Twitter, Wikipedia Are Tracking Swine Flu: This is a Health Care IT Slideshow. It details the use of Search Engine technology and Web 2.0 Social Networking sites to track the global pandemic. The data-mining and collaborative technologies behind these non-healthcare sites open a lot of opportunities for disease surveillance. Amazing! Here’s the related article: Google Flu Trends for Mexico, Facebook Track Swine Flu.
• Economist.com – Special report on health care and technology (Medicine goes digital): A series of articles on how "the convergence of biology and engineering is turning health care into an information industry". Some article tackle bioinformatics and genomics concepts.
• NYTimes.com – Connecting the Dots of Medicine and Data: Article describes the ‘double life’ of practicing doctors who are in the biomedical informatics field. A good starter article about how these professionals are "the glue between the I.T. enterprise and the clinical leadership".

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Is there an interesting Healthcare IT-related link you’d like to share? Please post them below. Thanks!