1. Manage costs

• Managing costs is always a huge component of the IT leaders job.  In 2009, it will be absolutely critical.  State governments across the nation have deficits.  36 states are facing huge shortfalls in revenue, and you can bet that health care will be among groups to take cuts.  Cost per unit of service will be one of the major metrics you needs to obtain in 2009.  Use “Cost per unit” to determine your cost per telephone, cost per PC deployment, cost per terabyte of storage, and cost per mbps in WAN connections.  Measure religiously and make adjustments as you go.  Your CFO will love the data and it may give you a fighting chance of avoiding more budget cuts.

2. Control the storage explosion

• The storage explosion will be one of the largest challenges for health care information technology in the coming years.  PACS, EHRs, EMRs, enterprise content management, genomics, and interface capable bio-medical equipment are adding to a massive increase in storage needs.  Many of medical facilities are seeing 100%+ per year increases in storage.   This storage is extremely expensive.  iSCSI and Fiber Channel SANs (that often must be redundant and require a failover SAN) make up the bulk of this type of storage.  These systems can cost millions of dollars to implement and many thousands a year to maintain.  CIOs will need to incorpate controls on storage through both technology and administrative methods to survive this explosion.

3. Implement Demand Management

• The most common thing I hear from CIOs and CTOs throughout the medical field is simple:  “We are over burdened with demand.”  Basically, as the HIT field has burst out of its infancy and is finally starting to learn to walk, we have discovered a simple truth, there is infinite demand and we have finite resources.   If you intend on trying to serve your customer and still keep you staff from revolting against you, you must come up with a demand management system that can create an effecient way to adopt the most valuable projects for your organization, optimally use your staffing resources, and communicate effectively with all of your customers (both those that get projects approved, and those that don’t).

4. Increase service with the same FTEs

• Increasing your ability to serve your clinical customers with the same FTE count may seem like crazy talk.  However, the reality is that very few of us are going to have the ability to add staff in 2009 and 2010 and our workload will not decrease.  The secret to fighting this contradiction will be to decrease your day to day operational workload.  Things like giving managers the ability to do their own reporting (helps your programmers), restructuring super-users (helps your analysts), or starting a comprehensive training program (helps your Help Desk) are all good starts to decrease your operational workloads.  Where you decrease operations, you can re-dedicate resources to your deployment workload.

5. Ensure Information Technology is part of the overall organizational strategy

• One of the most irritating things about being an IT leader in health care is that we have to struggle endlessly to make other clinical leaders understand that we are strategic to the organization.  IT is absolutely central to the clinical practice.  Without us, Radiology can’t read images (PACS), Lab can’t process orders (LIS), and patients lives are put at risk (BMV).  Even with this central role many administrators see us as “information handlers”, basically expensive librarians for handing out data.  We need to make the other administrators understand that in reality our purpose is to be the ultimate performance improvement department while providing safety and innovation enhancements for all aspects of the clinical practice.

6. Merge Performance Improvement and Information Technology

• As I alluded to in #5, Information Technology (IT) and Performance Improvement (PI) are shadows of each other.  The two departments must live and breath as one in a clinical environment.  The Information Technology teams can implement technology and adapt it to the environments.  The Performance Improvement teams can make sure that the right technology was adopted to start with.  Before starting any technology implementation the PI teams should do a thorough process analysis of the clinical service line.  Streamlining processes before implementations will give a much better result.  Remember this:  CRAP PROCESS + TECHNOLOGY = FAST CRAP    — Make sure to fix the process first.

7. Continue EHR deployments

• The Electronic Health Record may never be done.  We must update daily for medications, regulatory considerations, process changes, new service lines, new practices, and others.  Continue those deployments with diligence.  Look at the ancillary applications that can be deployed and integrate them as tightly as possible.  Many sites will look at their finances in 2009 and contemplate stopping deployment of new EHR components.  Do what you can to keep deployments moving forward.  Refocus on operational aspects if you have to, but make sure to keep developing and deploying.  New initiatives of the Obama presidency will require the full deployment of EHRs.

8. Continue Ancillary application deployment – carefully

• The ancillary deployment of applications is very similar to that of the EHRs.  Deploy…but in the case of ancillary apps, take your time, and consider each one carefully.  PACS, EHR, Business office, Financial Accounting, Billing, etc.  These are all core components of a hospital or clinics function.  You will have upgrades and new applications to consider.  Consider them carefully in 2009.  If you have a function that can wait 1-2 more years, you may want to consider pushing your timelines back.  This seems in contrast to “deploy”, but budgets must be balanced, and resources must be considered.

9. Develop your Project Management Office (PMO)

• Project Management is very similar to PI in a health care setting.  Project Management should be tied directly to the IT leadership.  It is very difficult to deploy applications without having solid project management from all different aspects of a project.  Let us take a look at a “simple” project like Medication Therapy Management (MTM).  In this project you need representatives from the Pharmacies, Registration, Anti-Coag, IT, PI, and others.  That can be a handful for a straight IT team.  Use the PMO to its fullest to keep your projects on target while limiting the resources necessary from your IT team.

10. Consolidate equipment and use more existing features

• Consoliting equipment is a very easy way to decrease recurring costs and lower the amount of maintenance your technical teams need to perform.  Explore Virtual technologies for effective ways to decrease the hardware.  Beyond physical equipment look further at your application base.  Many facilities fail to realize the full breadth of their application base.  The installed applications can often serve features that are necessary throughout the organization without further purchases.