The challenge of digitalization in healthcare
IT Governance, an indispensable tool in emerging and developing countries
From IT practitioners’ point of view, governance is often seen as an unnecessary evil that limits creativity and productivity because it is often thought to be managed by rigorous rules, standards, and policies. However, regulation is only one facet of general IT governance. Contrary to belief, good IT governance is vital in establishing a good strategic and economic foundation for all stakeholders in the healthcare field. In order to make it work and be successful, it is critical that it is accepted by everyone within the healthcare system. This new strategic way of thinking is pushing the boundaries of traditional IT in the healthcare sector.
This new way of thinking is extremely beneficial for all stakeholders involved, as it creates a well-structured and transparent strategy. This strategy leads to more streamlined processes, better forward thinking in network planning and developing the necessary IT architecture that allows healthcare professionals to deliver the best service to their patients. IT Governance has additional benefits resulting in being able to measure the overall success and efficiency of the entire healthcare system, including managing financial investments and ongoing costs.
Without a doubt, the importance of information technology’s role in the healthcare sector is undisputed. In the 21st century, there are hardly any tasks that can be handled efficiently without IT solutions. Even the smallest sub-processes cannot be managed or changed without the decisions of stakeholders with specialized expertise. For instance, systems used in pre- and post-processing, diagnostics, identification and clarification of facts or the documentation and communication of decisions are governed by highly complex workflows (e.g. HIS systems, PACS, tele medicine systems, etc.).
As the complexity of these processes evolve so do the expectations for execution of these tasks and processes. The needs of the healthcare practitioners are growing and becoming more complex. Therefore, a variety of different software solutions have been developed for the various departments within hospitals, other healthcare facilities and institutes to meet these challenges. As the result of this, the challenges to get all of these systems to work together have increased dramatically. To further complicate the situation, medical institutions and other health care facilities can no longer meet their mandate of treating their patients in a timely manner due to shortages in medical professionals. As a result of this, hospitals are turning more and more to IT systems and tools to aid them in these challenges.
These complexities and the growing number of proprietary and off the shelf software has led to a never-ending hodgepodge of software and solutions, a “blackhole” of costs leading to the unsolvable and impossible Gordian Knot syndrome. Now, how are healthcare professionals to meet these growing challenges without a structured “roadmap” and wasting their money and resources? In order to accomplish these tasks economically and effectively, we need innovative solutions and seamless communication between all health care stakeholders so that all of these individual systems can be planned organizationally and strategically. The solution to this problem is the integration of IT Governance within the Healthcare field.
Structurally is it primarily about the distribution of decision-making rights, tasks, responsibilities and resources, as well as the processes and mechanisms of decision-making for IT use in healthcare. Governance also ensures that Best Practices are created and followed by all parties involved in order to ensure that the organization’s processes are designed and executed in the most effective way. This is done by effective communication by all parties in establishing the processes needed and ensuring that there is enough space for future requirements, innovations, etc.
Once these aims and processes are defined, these must be communicated to all stakeholders involved in order to achieve a uniform execution of the plan with the support of the appropriate IT systems. In addition, IT governance provides risk assessments, acceptance assurance measures and evaluation of the effectiveness of IT deployment.
In the past, the two traditional parties (IT and Purchasing) viewed their roles and tasks individually instead of working together to find the best and most economical solution. For example, the Purchasing Department was only concerned with purchasing the most economical solution, while IT was only interested in the technical scope of the project. This often lead to a system that was technically acceptable, but the stakeholders were often not satisfied because the overall goals had not been achieved and the most critical part of acceptance was missing, i.e. the desired workflow and necessary communications standards were missing. This approach typically leads to additional and unnecessary cost-intensive investments. This maybe acceptable for some, as long as there was budgeting leftover to fill these additional missing needs. However, it left no room for future innovations because their resources were spent fulfilling these missing requirements.
To remedy these problems, the need for governance becomes more critical and necessary. It is paramount that all stakeholders in the health care system work closely together to develop a systematic eHealth strategy and systems in order to implement cost-effective, innovative projects that meets the needs of all parties involved. To reach this goal, the following assurances must be given:
develop a general policy, which is sub-divided into the different organization sectors
create an agreement for clustered-organizational eHealth projects, such as electronic medical folders or seamless online media services, etc.
obtain binding agreements between public and private medical institutions, social insurance companies, pharmacies and other service providers in order to create concrete action plans for the introduction of eHealth systems in a timely manner
agree on inter-organizational cooperation between all stakeholders that everyone is on the “same page” to successfully execute the project
implement a steering committee with representatives from all involved organizations (to ensure seamless communication within the project),
By implementing these above stated measures, stakeholders within a project can be sure of:
results in higher savings potential for IT procurement measures (greater than 20%)
creates higher savings potential for running costs (greater than 20%)
establishes centrally organized structures
integrates new jobs within the local economy
builds the engine for innovation
Generally, one of the biggest roadblocks to achieving these goals is that public IT service providers have a deficit in designing and optimizing their operational structures, which results in hindering the implementation of eHealth projects and poses particular challenges to the overall structure of healthcare IT solutions. Based on these results, we must develop strategies and institutional forms with the appropriate tools of cooperation for all stakeholders in the health sector. The goal of the cooperation is to achieve economic synergies for the different health care organizations. The bundling and specialization of competencies and services to increase the quality and acceleration of all IT projects is another essential aspect.
For the introduction and implementation of IT governance in HealthCare, there needs to be a comprehensive economic analysis done with all of these institutions (e.g. social insurances, hospitals, pharmacies, etc.) in order to understand the current situation within the local healthcare system (i.e. how many running projects, processes, etc. are available). Once a general SWOT analysis had been completed, then several proposals can be created to develop eHealth strategies that fit the local healthcare system’s economic needs. These proposals include organizational consulting and feasibility studies as well as the calculation of costs. In addition, the process support and the introduction of new hardware and software, their installation, configuration and administration, testing, documentation, presentation, handover and training of employees can be created and implemented.
The key to implementing a successful project is based on the above 24-month roadmap. The recipe for success is ensuring that the necessary planning time is absolutely critical. This ensures that the proper execution of the overall project goals and stakeholder’s needs are met.
It is essential that a homogeneous IT infrastructure can be set up with IT-Governance in the healthcare sector. This will result in overall cost savings and reduced operating costs of at least 20% These synergies are a direct result of all stakeholders working “on the same page” of established goals of the project. In addition, these synergies create the opportunity for future pilot projects based on IT governance rules, as well as new jobs and innovation.
It is becoming clear that the roadmap to successfully economically viable projects, where everyone is a winner, is the implementation of “IT Governance in Healthcare”.
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