Competing priorities in healthcare IT

By Jianggan Li | 1 March 2010 | Permanent link | 2 comments

ERP is in place, financial results are presented, images are integrated into the clinical system and order entries are computerised. What’s next for a hospital’s IT journey?

There are very good metrics to measure how advanced, or competent, a hospital is in leveraging IT, such as the HIMSS EMR Adoption Model in the clinical space. However, they are not perfect. Hospitals face a problem when projects with commonly-agreeable benefits are well on schedule… What to do next?

In a recent conversation, Dr David Bates, Director of General Medicine of Brigham and Women’s Hospital and a leading researcher in Health IT, told me that his most proud recent achievement was the bar-coding of medication. This perplexed me. Given the advanced status BWH has in the health IT field (order entry was computerised in 1995 there), one would expect them to have done that long ago.

“For many years we were about to implement it. But when the funding was finally approved, it always gave way to competing priorities,” Dr Bates explained.

New healthcare IT modules do not come cheap, and the benefits are often unevenly spread. Voice recognition benefits doctors and radiologists more; nurses and pharmacists get more from bar-coding. When the benefits are spread out, sequencing the priorities becomes a jostle between different parties. Nurses and pharmacists do not, naturally, have the same bargaining power as doctors; even though bar-coding would bring more immediate benefits to the hospital and the computerisation of notes is much more difficult to do. That was why BWH’s bar-coding project had been repeatedly delayed, explains Dr Bates.

I argued a long time ago, in this column, that it is important to distinguish between what is ‘necessary’ and ‘desirable’. It is the same principle here. Competing priorities exist because people see things through the prism of their own professional goals.

IT should be actively anticipating the needs of different departments, comparing them, calculating the benefits which are normally spread out and work out a roadmap for the organisation. Of course, to do that would require hours of work: observation, consultation and - not least - persuasion.

In a recent chat, Dr Chong Yoke Sin, CEO of Integrated Health Information Systems in Singapore, pressed the importance of such hard work on the ground, with enterprise architecture and a roadmap in place. That’s how the organisation, formed after the merger of all public care providers’ IT departments, achieved so much in just two years.

While hospital managers should bestow more power to the CIO, or CMIO, to make this happen, they should also make sure the man or woman who is given that power is competent to do the job. It’s not uncommon that IT decision makers fail to serve as the integrator between business and IT.

“For a hospital to be successful in IT, you need to have a visionary,” the witty Dr Karanvir Singh, CIO of Sir Ganga Ram Hospital in Delhi, told me last year. “Unfortunately, we didn’t have one for many years.” So the old systems became terribly outdated and had to be abandoned altogether.

Before we resolve competing priorities, however, let’s not forget that for many hospitals in the region, getting the basics in place is undoubtedly the most pressing priority.