IT Governance and Decision Rights

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Governance Decision rights. General issues in the theory and practice of management

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IT Governance and Decision Rights

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1. IT Governance and Decision Rights HSPM J713 Sept. 22, 2008

2. Governance Decision rights General issues in the theory and practice of management “much discussion and even some debate.” Applied here to IT management (Book says IM/IT, which means information management/information technology)

3. Learning Objectives Why strategic planning [in health care IM] become important 5 components of IM governance “the major elements of a healthcare organization’s planning elements” [sic] Elements of an IM strategic plan Systems theory and why you need it for IM

4. An “integrated governance model” Topics in the chapter: Background of IM governance and planning Purpose of planning Importance of system integration Organizing IT strategic planning Systems theory introduced Management control and decision support theory introduced

5. Information Management Information Technology What’s the difference in emphasis?

6. Background of governance and planning in IM/IT IM/IT systems evolved “piecemeal” Individual data systems for individual units of the enterprise

7. Piecemeal 14th century Middle English pecemeale Piece is related to the French word “petit,” meaning small. Meal means by a fixed measure (from Old English -mæ¯lum, at a time, from dative pl. of mæ¯l, appointed time) – answers.com

8. Problems of piecemeal development Data entered repetitively Data duplicated [Duplicated data may not match] Information hard to retrieve except for the original purpose for which it was stored

9. Integration of systems Enables: Strategic planning Clinical decision support Sharing data among departments, among facilities, and among enterprises

10. (Integrated) System Functional Scalable Flexible What do those mean?

11. Governance How things are controlled (I’m trying to think of a word to use instead of “governed.”) Centralized vs. decentralized decisions Differentiated from contingency analysis “Why and how decisions are made in an organization” [?] [What is a contingency?]

12. 5 domains of governance Quoted from study Strategic alignment Risk management Resource management Performance management Value delivery

13. IT priorities Reducing medical errors Establishing electronic medical records These are not of the same character

14. Components of Strategic Governance 1 of 5: Develop a Consistent IT Strategy Apply a plan across operating units Plan was new idea in mid-1990s. Generally implemented now. 1993 was first web browser

15. Components of Strategic Governance 2 of 5: Align IT Planning with Organizational Planning. CIO and CEO must ask together: What do we do? Whom to or for? Where? When? Why? How?

16. Components of Strategic Governance 3 of 5: Develop IT Infrastructure, Architecture, and Policies Infrastructure: Hardware “(architecture)” Network Degree of centralization/decentralization Software to support network

17. 4 technologies in current use Networks (“high-speed”) Intranets Wireless Client/server systems Chapter 6 explains

18. Components of Strategic Governance 3 of 5: Develop IT Infrastructure, Architecture, and Policies Example of policy: Data standardization Standard ways to represent data, such as dates. So all you data systems can share dates, for example. National standards organizations working on uniform ways to represent all health care-related data Medicare/Medicaid standards tend to dominate HIPAA-mandated standards

21. HITSP Healthcare Information Technology Standards Panel Developing standards, under contract with US DHHS

22. Hardware and Software Standards Uniformity of hardware and software Compatibility Ease of maintenance Site licenses often cheaper per seat the more you buy Control inappropriate use Such as people installing copied software

23. Components of Strategic Governance 4 of 5: Set IT Project Priorities and Oversee Investments Purchase what fits with the plan

24. Components of Strategic Governance 5 of 5: Be able to assess IT’s contribution Accountability of IT to the organization Value that can be demonstrated Financial Costs decreased Revenue increased More productivity [which means more revenue relative to cost?]

25. Components of Strategic Governance 5 of 5: Be able to assess IT’s contribution Accountability of IT to the organization Value that can be demonstrated Clinical Adherence to standards Better outcomes Organizational Stakeholder [what’s that?] satisfaction Risk reduction

26. Components of Strategic Governance 5 of 5: Be able to assess IT’s contribution Accountability of IT to the organization Value that can be demonstrated Getting away from reliance on “’anecdote, inference, and opinion”

27. Organizing the planning effort Board of Trustees Chief Executive Officer Info Sys Steering Committee Subcommittees New and replacement systems Infrastructure specifications Capital and operating budgeting

28. Organizing the planning effort Board of Trustees Gives responsibility to the CEO Chief Executive Officer Organizes the committees Info Sys Steering Committee Does the planning Subcommittees New and replacement systems Infrastructure specifications Capital and operating budgeting

29. Organizing the planning effort Outside consultants Often needed for technical expertise Choose carefully Independent of vendors, no conflict of interest Personality Resource for planning. Your inside people should do the planning.

30. Organizing the planning effort Serving on steering committee or subcommittee takes time Should be part of job – involves Human Resources CIO should chair the steering committee

31. What should be in the IT plan 1. Organization’s goals and objectives for the planning period (typically 3-5 years) E.g. if reducing medical errors is a goal, that should be stated at the top. E.g. if acquiring or creating more operations is a goal, that should be stated at the top Because these have implications for what IT must do

32. What should be in the IT plan 2. IT’s goals and objectives for the planning period Should flow from the organizational goals Specifics. For example: BAD GOAL: “improve the quality of care and increase efficiency” GOOD GOAL: “all records from the patient index file should be available online to our physicians”

33. By the way… What’s the difference between a goal and an objective?

34. What should be in the IT plan 3. IT’s priorities Which goals should be addressed first [This has to be done with an eye to methods and costs. Even so, that formal analysis comes later after] the plan so far is reviewed by the CEO.

35. What should be in the IT plan 4. Systems architecture and infrastructure Centralized vs. decentralized

36. Arguments for centralization Less variability [easier maintenance?] Better security Less work More flexible Less costly to invest [buy in bulk] Less costly to operate [because less variable?] More “end-user satisfaction” Better assures alignment with organizational needs

37. Arguments for decentralization More “end-user satisfaction,” because users control it Less costly because users support it More innovation Local flexibility Fewer delays from overburdening centralized programmers and support personnel

38. What should be in the IT plan 4. Systems architecture and infrastructure Network architecture Mainframe Client/server File server Distributed How applications are linked How data will be stored [and backed up] Data takes many forms, including pictures as well as words and numbers

39. What should be in the IT plan 5. Software development plan Old days: In-house programmers developed applications Nowadays: Buy applications from commercial vendors Which makes sense if data is becoming more uniform and requirements for use are becoming more uniform Applications service provider The application runs on their computer, not yours.

40. What should be in the IT plan 6. Management and staffing plan Technical staff Who Where (relates to centralization-decentralization) 7. Resources required Capital and operating budgets

41. Review and Approval Formal review and revision cycle before plan implemented Annual reviews of progress relative to goals and objectives

42. End-User Computing Allow end-runs by departments whose needs aren’t in the plan? Departmental software purchases Improvised programs by computer-savvy users How isolated is the system? Enforce data compatibility

43. Strategic Information Systems Planning for IDSs Integrated data system = IDS? “Vertically integrated organizations” Patients progress through or get treatment from clinics, surgery centers, acute care hospitals, substance abuse centers, nursing facilities The information system must meet the needs of each part and coordinate their data needs

44. Strategic Information Systems Planning for IDSs Provide comparable financial data for management Standardized coding of data across units Or else conversion methods needed Bringing in new units after merger means conversion tasks Centralization – data warehouses

45. Systems theory Systems characteristics Unity Complexity Internal hierarchy Stability and equilibrium [?] Deterministic or probabilistic

46. Simplest system

47. System with feedback

48. Cybernetic system Input, process, output Sensor measures output Monitor takes info from sensor, send signals to control unit Control unit affects process Show page 84.

50. Summary IT’s governance must fit with organization’s goals IT plan, by enterprise-wide steering committee System integration essential The plan should develop policies Systems theory can help organize thinking

51. Learning Objectives Why strategic planning [in health care IM] become important 5 components of IM governance “the major elements of a healthcare organization’s planning elements” [sic] Elements of an IM strategic plan Systems theory and why you need it for IM

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