Healthcare's relentless pace is accelerating as new technologies and organizational advancements further enable patient care.
But the break-neck speed and adoption of Electronic Healthcare Records (EHR's) has created an environment in which crucial healthcare business strategy, sound deployment and integration methodology was trumped by the need for rapid adoption; and the disruption is still reverberating. As healthcare takes a moment to recalibrate and determine next steps, focus will return to business fundamentals and on clinical departments that facilitate enterprise-wide benefits and returns. Transformation and promotion of departments that are historically profitable, critical to strategic growth (catchment or M&A) and provide platforms for cross company, cross region, interstate exchange of data/digital patient assets and care will be targets for for healthcare investment. As such, imaging is positioned to be a primary candidate for innovation and adoption.
Flip that House
Television shows (and even entire channels) are dedicated to scenarios where investors attempt to flip a house. The formula for success is to know the market and be intimately aware of the house's conditions from roof to basement. Similarly, the key to any successful enterprise initiative is a comprehensive Discovery Phase. It is critical to evaluate and mapthe current core and peripheral technologies, operational and organizational nuances and realistic assessment of the organizations willingness and capability to absorb change. The results of this activity should be an executive report that provides a clear and comprehensive picture of the "as-is" environment across enterprise service lines that receive and utilize patient imaging data (Cardio, Radiology, Pathology, Ophthalmology, etc.). This discovery and analysis encompasses a full inventory of systems utilized at each site including clinical systems, modalities, reporting and the user experience. In addition, workflow observation and documentation should verify "actual" workflow for all departmental staff to determine the true needs and requirements of any replacement systems.
By surveying key users and stakeholders across your organization, you will be able to provide a picture of the gaps, inefficiencies, and frustrations that impede workflow, data accuracy, and patient care. This will prompt the organization to identify opportunities for replacement technologies or workflows that improve outcomes. Enterprise imaging transformation will require full analysis of data flow to determine where gaps and silos exist within the organization so that an organization can move to the next steps 'informed'.
Strategy and its Close Cousin 'Governance'
An effective enterprise imaging transformative process will require an innovative strategy followed by an iterative adoption in phased activities. Former imaging initiatives including PACS, PACS replacement, and peripheral system implementations do not provide an effective roadmap for your enterprise imaging initiative. The complexity of enterprise imaging is much deeper and convoluted than departmental project work. Challenges related to system replacement, cross-specialty stakeholder buy-in, cost and budget models, chronology and project planning and ultimately program and data governance require a detailed and thoughtful strategy. This strategy or "roadmap" should project out 5 years for resourcing, budgeting, system decision-making, and data management planning.
Strategy is imperative, but just as important is the governance model adopted within the organization to carry out the strategy. This governance body is not just a figurehead committee that meets periodically to discuss updates. Effective deployment of an enterprise imaging initiative requires an engaged, informed, and empowered governance structure. There will be important decisions throughout the entire project lifecycle and many of these decisions will encounter conflict that requires negotiation and compromise. Departmental priority, workflow optimization, integration models and interoperability are just a few of the challenges organizations will face. The best way to ensure success is to build a governance team with broad representation of key stakeholders from clinical, operations, technical and financial groups.
Healthcare's 'Angies List'
The vendors of healthcare are constantly developing features and functions designed to benefit business and patient care capabilities. When designing, building and implementing enterprise-scale systems, an organization must have a comprehensive and objective knowledge of existing technologies and how their respective development roadmaps and support correlate with the organizations vision. It requires not only the technical evaluation, but also the clinical and business components on a continual basis. A complete and effective summary of one's options and short list key vendors will include the following objectives:
- Establish Stakeholders and Governance Requirements
- Engage both Healthcare Consultancies and Vendors for Education
- Research Comparison Charts and Industry Analysts Reports
- Develop Detailed Criteria to Shake Out Ambiguous Claims and/or Vaporware
- Evaluate each Vendor's R&D Roadmap
- Seek Industry Peer Reviews and Lessons Learned
- Leverage Conferences/Expos for Ease of Access and Time Efficiency
- Determine Potential Disruption Based on Market Consolidation and M&A
- The Market is Hungry so Negotiate for 'Win – Win' Deals
- Neutralize the Political Agenda's as much as Possible
Golden Rule: Engaged, Managed and Rapid Implementation
Healthcare must get use to the rapid nature of innovation and how quickly a previously enjoyed advantage (loyalty, technology, brand, capabilities, etc.) can dissipate or be neutralized. One of the biggest values that an organization will retain from an enterprise imaging effort is the ability to codify the processes and activities. Building your organizations ability to rapidly adopt and leverage enterprise solutions across the continuum of patient care is invaluable and necessary.
Top management must be involved by not only supporting the implementation, but at times driving the process. If the enterprise imaging initiative is just another HIT or software/hardware project rather than a business project, top management will have little interest in participating as a key stakeholder and driving force in the ongoing project. The implementation team will not get the important feedback, financing or resources required. The clinical user's involvement is also necessary to implement changes as they are more likely to have insight into the people within the department and what they can handle if significant workflow change is involved.
Experienced consultants can be used to analyze, design and deploy as they bring significant insight to the initiative which will increase the speed of adoption and reduce disruption. Within the organizations team their maybe gaps in knowledge, experience, or lack of current training. Consultants can add tremendous value to implementation team during the project.
Conclusion
A rapid and successful implementation of an enterprise imaging solution is possible with the right goals, the right people\governance, and the right company. The long held philosophy of the "rule of thirds" still exists, even thrives, in healthcare organizations: One-third of organizations will be widely successful regarding cost and benefits, one-third will muddle through with some advantages being captured, and one-third will fail miserably. It's up to leadership and execution to determine which category every organization will fall into.
Jef Williams is the Chief Operating Officer at Ascendian Healthcare Consulting. He is a frequent speaker and writer on Enterprise Imaging Transformation and healthcare technology topics spanning people, process, strategy and technology. You can review his articles on Ascendian's website at www.ascendian.com or contact him directly at jwilliams@ascendian.com.
Hjalmer Danielson is a VP at Ascendian Healthcare Consulting and a frequent contributor to the subject of Health Information Technology. You may contact him directly athdanielson@ascendian.com or visit the Ascendian website for more information at www.ascendian.com.
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