HIT Service Strategy

Creative Solutions

HIT Service StrategyEnabling Transformational Health Care

Creative Solutions

Forces Confronting Health Care CIOs• Health care IT (HIT) is experiencing volatile change driven, in

part, by government incentives and mandates in the U.S., alongwith a mass of economic and quality dynamics concerned withimproved patient-centered care.

– Many organizations already have existing plans for implementingEMRs and EHRs along with growing needs to replace aging fleetsof financial systems*.

– Federal mandates accelerate project timelines and expenditures,squeezing hospital capital budgets already under strain fromsteadily rising costs, rising by approximately 10 percentannually—and outpacing revenues.**

– Global economics and technology trends, for all IT industries, callfor further cost reductions through consolidation, virtualization,SaaS, and cloud computing arrangements.

– CEO’s are increasingly looking for real business value metricsfrom IT and not simply cost recoveries and SLA performancemeasures.

*HIMSS Analytics from John Hoyt, VP Healthcare Organizational Services - HIMSS** McKinsey Quarterly August 2010

Creative Solutions

Financial Incentives – Small Offsets

• Federal Incentive Programsoffer only about 15-20 Percentoffset of the total coast toimplement EHR withinmandated timeframes.

• The government predicts ashortfall of about 50,000qualified health IT workersover the next five years.

• 8 in 10 hospital CIOs arereportedly concerned or veryconcerned they will not be ableto demonstrate meaningful useof EHRs within the federallyestablished deadline of 2015.

*PricewaterhouseCoopers’ HealthResearch Institute.

Source - 2010 HIMSS CIO Leadership Surv ey s 2005-2010

Creative Solutions

Federal Penalties are Significant• “An accelerated timetable means that US health care providers

have until the end of 2015 to make the investments or face finesstarting at $2,000 a bed in the first year and up to $35,000 abed by 2019. In addition, both revisions to the Health InsurancePortability and Accountability Act (HIPAA) 5010 and the switchto ICD-10 require providers to apply strict new data-codingstandards—no small task given the number of databases,hospital systems, and clinicians affected.” *

• “To meet these various requirements, US hospitals will need tospend approximately $120 billion, at an average cost of$80,000 to $100,000 per bed, for the required projectplanning, software, hardware, implementation, and training.”**

• The rapidly aging population of baby boomers continues toballoon the need for more hospital beds and penalty dollars.There is little decline in population numbers after thisgeneration in the U.S.

•McKinsey Quarterly August 2010**Ibid

Creative Solutions

CIO Questions

A number of important questions require immediate answers.

Is there room to optimize service delivery capability?

Do we effectively organize/manage/govern HIT Services tomaximize value and clinical relevancy?

Are we sure that service performance will meet or exceedfederal and customer expectations?

Is the budget allocated correctly?

Is there room to optimize our spend?

Should we prioritize or redistribute HIT spend?

How best should we strategically source HIT skills andservices?

• Health Care CIOs are looking for fresh perspectives inadvancing HIT strategy design, development, and deploymentfor more effective and efficient health care delivery.

Creative Solutions

HIT Services Must Be Agile

• Change size, shape, scope and style as needed:

– Size: Grow/shrink at many levels and rates via flexible resource capacityarrangements (own, rent, lease, borrow).

– Shape: Centralized, distributed, networked as needed (simultaneouscomponent shapes if required).

– Scope: Occupy a varying footprint(s) in its value web as the value andservice lifecycles evolve.

– Style: Integrate, collaborate, franchise, etc., depending on dynamics ofmarkets and offers.

• Engage “self-directed” leadership, managerial and operationalbehaviors within dynamic, environmentally determinedconstraints.

• Embrace an “effectiveness over efficiency” culture, whilecontinuing to focus on efficiency.

Survival in Volatility Requires a HIT Organization be Able to:

Creative Solutions

Challenges Will Remain Constant• The distributed vertical nature and volatility of today’s health care

environments, the global economy, and government legislation areunderscoring increased challenges with:

– Quality of Patient Care– Responsiveness– Innovation– Competitive Positioning– Speed to Delivery– Reach– Reliability– Risk– Cost Efficiency

• Health care organizations will need a radically new transformationalapproach to HIT on the part of the CIOs, business leaders andclinicians.

• A transformational strategy will encompass an inclusive governanceprocess with streamlined decision-making authority, a radicallysimplified IT architecture, mega-project-management capability,resource allocations and strategic sourcing, change and effectivecommunication management.

“Insanity: doing the same thing over and over again and expectingdifferent results”. -Albert Einstein

Creative Solutions

HIT Organizations Currently Strive for aBusiness - Aligned, Managed Environment

Ou

tlo

ok

Performance

Health CareAligned

Tactical

Reactive Managed

Today’s best practices show that HIT valuecan be maximized when enterprise HITinvestments are aligned with health caregoals and HIT execution is well managed.

The key drivers of HIT value are:

• Outlook – How organizations makedecisions about technology

investments

• Performance – How well organizations

implement those decisions

Creative Solutions

But Technological-Driven Transformation ofHealth Care Is Challenging this Target

ExpandedChannels &

Connections

DynamicBusinessModels

ExtendedClinical/Health

CareProcesses

Patient

Government

CommunityHealthServices

Imaging Centers

Payers

Care Centers

Employers

Care Managers

Hospitals

Physician Groups

PBMs, Retail RXHomeLaboratories

Creative Solutions

This Requires a New Mindset and a NewApproach to Technology Execution

Ou

tlo

ok

Performance

Health CareAligned

Tactical

Reactive Managed Agile

EnvironmentallyIntegrated

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The Pressures Felt by Most HITOrganizations Validate this Model

• Pressure on current HIT spending:– Are we delivering maximum business value for the resources spent?

– How do we deliver more with less?

– How do we minimize capital investment?

• Scarce resources: How do we hire, retain, retrain, or obtain staff toprovide the necessary technology skills?

• HIT governance challenges: How do we coordinate HIT spendingand activities throughout the organization? With our partners?

• The need for speed: How do we support business requirements torespond to opportunities in days vs. months vs. years?

Creative Solutions

An Agile HIT Framework Provides aPersistent Context for the Strategy Outputs

• Getting Aligned and Managed . . .– Drive efficiency and effectiveness of HIT delivery

and management processes– Adopt an enterprise architectural view– Focus on getting costs structured, understood,

under control– Concentrate cost optimization on efficiency issues– Drive opportunity portfolio prioritization through

value tradeoff– Align business and HIT strategies

• Externalizing and Becoming Agile . . .– Integrate business and HIT strategies– Focus on improved services and delivery through

adaptive management and delivery processes– Expand the view of infrastructure to “extra-

structure”– Create agility through a flexible services

environment leveraging internal and externalproviders

Health CareAligned

Tactical

Reactive Managed Agile

EnvironmentallyIntegrated

Ou

tlo

ok

performance

HealthCare

AlignedManaged

GettingAligned &Managed

Externalizing &Becoming AgileTransitional State

Transitional State

Agile

IT

HealthCare

AlignedManaged

Because an organization’s HITcapabilities are typicallydistributed across the framework,their HIT Strategy embraces a mixof activity types

Strategic Directions Required for Driving Agile HIT Come in Two Flavors

Creative Solutions

An Agile HIT Strategy Addresses theShortcomings of the Traditional HIT Strategy

• HIT defines an ongoing decision tool for leveraging IT to drive ahealth care organizational success in a constantly evolvingcommunity environment

• The process is practical and scenario driven

• It recognizes that technology both enables and improves healthcare strategy

• The process examines opportunities made available by otherentities in the environment as well as constraints imposed by it

• The strategy is not just about the new, but what to do with theexisting environment and current systems portfolio

• The strategy drives integrated architectures and implementations

Creative Solutions

Health CareEnvironment

Vis

ioni

ng

HIT StrategyHealth CareStrategy

HIT Current State

Health CareArchitecture

IT ArchitecturesApplication

DataTechnology

SecurityGovernance

Transformation ServicesPeople

ProcessTechnology

TechnologyEnvironment

HIT Future State

HIT Strategy Translates Needs andOpportunities from the Environment into Action

What How

Creative Solutions

Health Care Strategy

IT Strategy

IT Operating Model

What Does the HIT Strategy Produce?

Environment

IT Systems &Services

IT CapabilitiesHealthcare Institutions

Health Care

Success

Clusters of tech-enabledbusiness capability

--------------Provide decision making

framework

Skills and capability that enableSystems & Service delivery

--------------Sourcing strategy is criticalRules of engagement for

decision making-------------------------

Coordinates complexrelationships, brokering

A plan for leveraging the HIT capabilities of the companyand the community environment to deliver health caresuccess

Creative Solutions

An Agile HIT Strategy Provides…

• HIT Systems and Services Directions, that– Are the strategic technology-enabled health care capabilities stewarded by HIT– Provide the decision-making framework for all potential HIT investment– Recognize

• the interplay of internal capabilities with those of health care partners and customers• the potential need to support rapid health care business and technology evolution

• HIT Capabilities & Sourcing Strategies, that– Describe the combination of skills and knowledge with methods and tools that

support the development, deployment and management of the HIT systems &services

– Examine sourcing options and define the critical skill sets that must be developedand maintained within an organization

• An HIT Operating Model, that defines– HIT management structures and processes– HIT delivery structure and processes– Roles, responsibilities, and interaction with partners and customers that support

the model of agile execution

Creative Solutions

The HIT Strategic Components Provide theBasis for HIT Transformation Tools

• HIT Initiative Planning & Prioritization– Development of a set of processes and tools to organize and prioritize HIT

initiatives– Focus on resolving the issues around resource management and

prioritization of scare resources

• HIT Portfolio Management / Portfolio Rationalization– Development of the disciplines and processes around managing the HIT

environment as a portfolio of assets– Can also include an effort linked to “cost reduction” that focuses on

rationalizing an existing portfolio based on business/ health/ technicalcriteria

• HIT Organization Design– Focused on developing a new HIT organization based on changes in the

environment such as:• Acquisition / divestiture• Re-centralization• A re-evaluation of the HIT strategy

This Pragmatic Approach to HIT Strategy Focuseson Sustained Value and Significant Benefits

• Integrates with and drives health care strategy, not an after-thought orextension

– Provides a common language for health care/HIT discussions

• Recognizes ROI, needed capabilities, and risks– Provides an explicit linkage between HIT investments and health care

capabilities– Enables a consistent framework for prioritizing HIT demands in an

environment of permanent volatility– Coordinates previously fragmented HIT investments– Resolves capability development, acquisition, and partner challenges

• Evolves an organization, as opposed to simply maintaining it:– Plans for new assets in the form of intellectual capital and strategic

capabilities, not just salaries and depreciated hardware– Allocates resources to the right investments while containing costs– Determines clear roles and responsibilities for distributed HIT decision

making, enabling an organization to act quickly and with confidence

Greater “technology ROI” derives from greater agility in response and tighter integration oftechnology and health care decision making

Creative Solutions

HIT Strategy Development

Confirm health carestrategy

Identify keytechnology enablers

Define HIT systems &services

Identify HITcapabilities

Define HITGovernance

• Extract key health care strategies• Document and review with key

management• Create health care strategy summary• Confirm with key management

• Identify technology infrastructureenablers

• Identify information managementenablers

• Identify application enablers

• Define required system/servicecharacteristics

• Identify key product capabilities• Identify key service capabilities• Identify sourcing opportunities

• Identify baseline HIT competencies• Identify common capabilities• Identify specialized capabilities• Identify appropriate sourcing

• Define the HIT governance structure• Define the HIT governance

processes for• HIT Product & Service delivery• HIT management

• Executive management team• Division management• HIT management• Strategy development team

Steps Tasks Resources

• HIT management• Strategy development team• Key business subject matter experts

• Strategy development team• HIT management

• Strategy development team• HIT management

• Strategy development team• HIT management• Executive management team• Division management

Identify Implications• Identify product & service,

governance, capabilitiesimplications

• Strategy Development team• HIT Management, SMEs

20

HIT Strategy and Agile Planning ApproachThe approach to HIT Planning begins with the development of a well-articulatedinformation technology strategy driven by the strategic direction of the health carebusiness.

This strategy serves as the foundation for the enterprise architectures forapplications, information, technology infrastructure, and HIT management.

Finally, the strategy, using the architectures as “roadmaps”, helps to establish theplan of what technology initiatives will be implemented.


StrategyApplications

Architecture

InformationStrategy Architecture

Technology

Architecture

ManagementArchitecture

Hea

lth

Car

eIn

form

atio

n T

ech

no

log

yS

trat

egy

HIT Transition Plan Development

HIT ManagementInitiatives

3

Health CareStrategy

TechnologyInfrastructure Initiatives

Information RepositoryInitiatives

Application PortfolioInitiatives

InformationStrategy

Strategy

Strategy

Architecture

21

HIT Planning ApproachThe HIT Strategy describes an overall direction for HIT in terms of its Systemsand Services to the health care business, the competencies it will leverage todeliver those Systems & Services, and the governance structure that must be inplace to support the delivery.

• The Application Architecture builds on the product/system direction that is set in thatstrategy to define an overall direction for the portfolio of applications in use and a detaileddescription of the current and future state of the elements of the portfolio.

• The Information Architecture looks at the structure for managing the key informationfor the managing the health care business, who uses that information, where it’s createdand how it is managed.

• The Technology Architecture describes the enterprise direction for an enablinginfrastructure as driven by the strategic direction for applications and data.

• The Management Architecture describes the processes, tools and systems to be put inplace for the effective management of the HIT resource.

• The HIT Transition Plan defines how to get to the future state. The HIT Transition Planclusters potential project efforts into a series of prioritized programs or initiatives,reflecting the interdependence all aspects of HIT and HIT management and their prioritieswith respect to supporting the business strategy.

22

Characteristics of an HIT Strategy &Architecture Methodology

• An accelerated methodology for developing a HIT StrategicPlan has the following important characteristics:

– A process perspective that recognizes that HIT strategy &architecture is not a one-time event but a continuous process thatwill evolve as the health care environment evolves

– An iterative approach to strategic plan development; buildingintermediate versions and gaining consensus

– A collaborative effort that leverages experience in strategicplanning development and the health care business and appliedtechnology knowledge

– Acceleration through parallel tasking and leveraging facilitatedsessions

Creative Solutions

The HIT Implications and Potential HIT Enablers of the HealthCare Business and Practice Strategies Drive the HIT Strategy

HIT Strategy Process Flow

Division /FunctionalHealth UnitStrategies

HIT Implications

• What is the impact of thehealth care business andpractice strategies on theHIT systems and services?

• How does the health caredirection and perceptionof HIT affect themanagement of HIT?

Health CareStrategy and DataGathering

• Gather informationon future direction

• Organize aroundhealth care units andcare processes

• Review and confirminformation with keystakeholders

Current State DataGathering

• Identify applications anddata portfolios

• Document the existinggovernance model

• Document currentinfrastructure

HIT Principles

HIT Systems andServicesDirection

HIT Capabilities

HIT Strategy

HIT OperatingModel

CorporateHealth CareStrategies

Health CareOrganizationalPerception of

HIT

HIT Enablers

• How can HIT support theimplementation of thehealth care business andpractice direction andstrategies through new orenhanced:

• Infrastructure services• Applications• Information

Managementcapabilities

Health CareDirection

• Corporate businessdirection asarticulated by seniormanagement

Current Stateof HIT

Health CareProcessDirection

Health Care Business and Practice Functions/Strategy Drive the Overall HIT Strategy,Architecture and Planning Process

Future State HIT Design and Migration Planning –Techniques: Identifying HIT Drivers

HIT StrategyHealth Care

Strategy


Systems andServices

HIT OperatingModel

Capabilities andSourcing

Principles

IT Architectures

Infrastructure Architecture

Application Architecture

Information Architecture

HIT Initiative Portfolio

Infrastructure Initiatives

Application Initiatives

Data Initiatives

HIT ManagementInitiatives

HIT ManagementEnvironment

HITPortfolios

Processes

Tools Applications

ResourcesInformation

Repositories

Infrastructure

HIT Current State

HIT ManagementEnvironment

HITPortfolios

Processes

Tools Applications

ResourcesInformation

Repositories

Infrastructure

HIT Future State

TechnologyEnvironment

What How

Creative Solutions

Technology ArchitectureGuidebook

StrategyWorkshop

Health Care &IT Process Architecture

ApplicationArchitecture

InformationArchitecture

InfrastructureArchitecture

Approach & Deliverables (I)

Gather Health CareStrategies and BuildFunctional Decomp

Current StateApplicationInventory

Current StateInformationInventory

InfrastructureCurrent State &Change Drivers

HITDirections

HIT Process Scorecard

BusinessArchitecture

AppStrategy

Information Strategy

Creative Solutions

ApplicationStrategy &

Architecture

InformationStrategy &

Architecture

TechnologyArchitectureGuidebook

ApplicationPortfolioFutureState

Disposition

Info StoreFutureState

Disposition

TechnologyInfrastructure

TransitionPlan

Transition Plan

Approach & Deliverables (II)

Develop HIT Systems,Services, Capabilities

Assess HIT Processes

HIT StrategyGuidebook

Application PortfolioAnalysis

Information PortfolioAnalysis

Exec Briefings

HIT Process Assessment &Recommendation

Arc

hit

ectu

re M

ain

ten

ance

& C

om

mu

nic

atio

n P

lan

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ED & Clinical Solutions

EHR & Practice Management

Revenue C

ycle

&

Access M

anagement

Ente

rpri

se P

erfo

rman

ce

Man

agem

ent

Me

an

ing

ful U

se

Stage 1 Year 22010

Year 1

TODAY

HIT Transformation Map

Long Term

VisionMajor activity/

milestone

Major activity/milestone






Major activity/milestone Major activity/

milestone

















Creative Solutions

Appendix A: Detailed Project Approach

29

Detail Project ApproachCharacteristics of an HIT Strategy & Architecture

Methodology

Project Approach

• Project Kickoff

• Track I – HIT Strategy Development & Accelerated Solutions Environment

• Track II – Application Architecture

• Track III – Information Architecture

• Track IV – Technology Architecture

• Track V – Management Architecture

• HIT Transition Plan

30

• Review Project Management standards and practices

• Develop project charter

• Develop an enterprise communication plan

• Develop issue resolution and status reporting format andprocedures

• Identify client participants for interview s and w orkshops.Begin to schedule appointments.

• Gather existing IT documentation

•Current system inventory

•HIT budgets

•HIT organization

• Gather existing documentation on business strategies andcurrent and planned business organizational structures

• Agree upon structure for f inal documents

Activities

• Project Charter, including project objectives, schedule, teamleads and risk management strategy

• Issue Resolution and status reporting templates

• Enterprise communication template

• Deliverable templates

• Interview schedule

• Complete project schedule

Deliverables

The key objective of the Project Kickoff is to organize team members, set direction, reviewavailable information, agree on deliverable format and establish the remaining schedule

Strategy Project Kickoff

31

• Gather and synthesize the enterprise and business unitstrategies

• Interview key stake holders to confirm and refine thehealth care business and practice direction

• Create an framew ork outlining the key HIT systems andservices and how they support the business

• Create a straw man HIT strategy .•Identify the future state capabilities and characteristicsof each of the HIT systems and services

•Identify the key HIT principles

•Identify a proposed HIT governance model

• Conduct a facilitated session w ith representation frombusiness and HIT to update, confirm and ratify the HITstrategy.

Activities

• HIT strategy guidebook w hich establishes the overarchingHIT direction from a health care business and practiceperspective. The follow ing w ill be addressed:

•HIT Systems & Services - a description of IT’scontribution to the achievement of health carestrategies

•HIT Principles - a statement of fundamental values thatprovides ongoing guidance for decision making

•HIT Governance mode identifying the basic structurefor managing IT

•Key HIT capabilities required to deliver, operate,support and manage the HIT systems and services andpotential alternatives for sourcing

Deliverables

Track I focuses on the development of the HIT Strategy. The strategy sets the direction for thearchitectures and transition plan and be aligned to the enterprise business strategies

Track I - HIT Strategy Development Process

32

• Develop an inventory of the current state applicationsportfolio:

• The inventory will include identifying information aswell as information on the Strategic, Functional, andTechnical quality of the application

• Map each application to the corresponding functions itsupports from the systems and services model.

• Develop an application strategy that establishes a strategicdirection for the systems supporting each key businessprocess

• Develop the future state application architecture• recommend a disposition for each group of applications

• These recommendations will focus on aligning thestrategic, functional, and technical quality of theapplication portfolio with the direction set by the HITstrategy

• Conduct a facilitated w orkshop to verify the applicationarchitecture direction

Activities

• Application Inventory that provides

• Application indentif ier and ow ner information

• Technical platform and sizing information

• Qualitative judgments on the functional quality

• Assessment of strategic alignment

• Application Strategy, to include

• Application principles

• Applications mapped to key business processes

• Strategies for application integration and interfacing

• Application architecture, to include:

• A mapping of the applications to the HIT systems andservices they support

• A detailed disposition report that defines a path foreach major application

Deliverables

The majority of the HIT Systems & Services defined in the HIT Strategy are applications systems. The Application Architecture

– builds on the product direction set in that strategy to define an overall direction for the portfolio of applications

– defines how the applications support the business processes and what direction the this portfolio should take to

support the business strategies

The objective of Track II is to create a tool for the active management of the enterprise applications portfolio. Key activities &deliverables to include:

Track II - Application Architecture Process

33

Activities Deliverables

The Information Architecture is driven by both the HIT Strategy and the Application Architecture. The Information Architecture

– Looks at the structure for managing the key information for the managing the business, w ho uses that information,

w here it’s created and how it is managed.

– Will define the direction for the major enterprise information repositories.

The objective of Track III is to create a tool for the active management of the portfolio of key information repositories. Keyactivities & deliverables to include:

Track III - Information Architecture Process

• Generate an inventory of the data stores currently in usethat provides:

• identif iers and ow ners

• technical platform information

• applications associated w ith data stores

• Examine the subject area mapping of the inventory todetermine the level of redundancy and complexity ofinformation control

• Conduct an Applications and Information Strategyw orkshop to determine the set of HIT directions for theinformation portfolio that are directly linked to the healthcare strategy

• Conduct a facilitated w orkshop meeting w ith data ow nersto develop the future state architecture and modeling

• Inventory of data stores, mapped to subject areas

• Information architecture , to include:

• an analysis of the current state and a recommendedfuture state model w ith the business

• a definition of data subject areas and constituencies

• an assessment of the limitations of current state

• a recommendation for a future state model forinformation placement

• a strategy for data ow nership and managementprocess

34

DB #1 DB #2 DB #3 DB #4 DB #5

Application#1

Application#2

Application#3

Application#4

Application#5

Application#6

Application#7

Health CareProcess #1





Reference DataInformational DataTransactional Data

Val

ue

Ch

ain

Ap

ps

Dat

a

Understanding how applications and data support the business is key to making strategic HIT & HealthCare business and practice decisions

Data Warehouse

DataMart DataMart DataMart

The Application & Data Architectures Define HowApplications & Information Support the Business

35

• Identify the technology architecture drivers from thestrategy and application and data architectures

• Identify the current technology infrastructure in terms oftechnologies, standards and implementation

• Develop a future state direction for each of the keytechnology architecture components:

• Application services

• Data services

• Commerce services

• Netw orks

• Netw ork based services

• Platforms

• Security

• Conduct a facilitated w orkshop to verify and confirm thetechnology architecture direction

Activities

• Technology architecture guidebook outlining

•Framew orks

•Models

•Standards

For each of the technology components outlined in theactivities

Deliverables

The Technology Architecture provides a roadmap for the construction of an enabling infrastructure

Creation of the technology architecture occurs after the determination of the strategic direction of the applications and data

The objective of Track IV is to determine the future technology architecture that will drive the implementation of requiredInfrastructure to support the healthcare business and practice activities & deliverables include:

Track IV - Technology Architecture Process

36

Components of a Technology Architecture

The technology architecture or infrastructure blueprintis divided into distinct components

• Service (Application) Components– Commerce, Communications,

Content, Customization

• Technology Components– Application Services– Data Services– Platforms– Security– Network and Communications

Each component represents a well defined set of technologies, vendors,standards, and disciplines.

The technologies and standards selected for any one component setmay have significant influence on the others.

App. Services

Network and

Security

DataServices

Platforms

Commerce ContentCustom-ization

Commun-ications

37

Architecture Component Classification Recognizesthe Evolutionary Nature of Infrastructure

EMERGING TECHNOLOGY

CORE ARCHITECTURECORE ARCHITECTURE

CoreArchitecture

– Strategicinfrastructuredirection

– Replicatedtechnologythroughout anorganization

– Full range ofinfrastructureservices provided

Special-Use– Isolated infrastructure needed to meet a

specific and isolated business need– “One off” solutions that are bolted onto

the core architecture

Declining– Technologies that are not strategic for the future– May be a candidate for immediate transition or may

be on a “sunset” path for several years

DECLININGDECLINING

Emerging– Technology under

evaluation– Limited services

initially available– Competing

emergingtechnologiesmight replacecore or special-use

EMERGING EMERGING TECHNOLOGYTECHNOLOGY

EMERGING TECHNOLOGY

38

• Identify the key governance drivers from the HIT strategy

• Identify all the constituencies involved in managing andsetting the direction for HIT

• Identify the roles and responsibilities for the constituents

• Identify the key competencies required for delivering andmanaging HIT

Activities

• A management architecture that w ill:

• Define the governance structure for managing HIT

• Define the constituents involved in managing HIT andtheir roles and responsibilities

• Key competencies that w ill be required for HIT

Deliverables

The Management Architecture will define the HIT governance / HIT organizational structure required to support the HITstrategy and managed the future state HIT environment. The management architecture will define:

– The HIT Governance structure

– The HIT Organizational structure

The Management architecture will be developed as an outcome of the HIT strategy. The HIT Strategy will set the directionfor HIT governance and the architecture will define specific governance model and organizational structure, includingroles & responsibilities

Track V - Management Architecture Process

39

· Service Level Agreements· Knowledge, Resource Sharing· Competitive Pricing

Franchise

Centersof

Excellence

CentralizedControl

SeparateSubsidiary

Joint Venture

Outsourcing

· Economies of Scale· Chargeback Cost

Recovery· Architecture Control

· Pooling of keycompetencies

· KnowledgeSharing

· Proven, ReusableModel

· Portable Solution

· Shareholder-driven Objectives· Revenue Generation Potential· Various Ownership Options

· Shared Risk· Leverages Partner

Resources

· ContractualRelationship

· Predictable Costs· Reduces Capital

Outlays

SharedService

Management Architecture Can Consider aRange of Governance Structures

40

Analysis &

Synthesis

HIT Systems& Services

HIT Roles &Responsibilities

The HIT systemsand related servicesthat support healthcare operation

HIT ServiceProviders

Organizations thatdevelop, manage &support HIT systems

HITProcesses

Key processes fordeveloping, supportingand managing HIT

A Process For Creating Roles andResponsibilities is Driven by the HIT Strategy

HIT Users

HITInfluencers

The health care users of the HITsystems and services and theorganizations/people thatinfluence & guide HIT

Health Care Business and Practices

HIT

HITPrinciples

Basic beliefs and tenetsconcerning themanagement of HIT drivenby the health care business

HIT Policies &Procedures

The process involves analyzing andsynthesizing the requirements for HITsystems & services and determining the roles& responsib ilities for delivering, managingand planning those systems & services

41

• Perform gap analysis and identify key initiatives

• Detail the initiatives in terms of:

• Value propositions

• Resources

• Timeframes

• Prioritize and document initiatives

Activities

• Portfolio of strategic initiatives, key aspects to include:

• Business cases

• Initiative prioritization

• Transition program including:

• A description of each initiative : duration,dependencies and order of magnitude capital costs

• Program overview : capital costs estimates (if know n)and an aggregation of timing/dependencies to providean order of magnitude estimate of the level ofinvestment required

• Timeline

Deliverables

The Transition Plan defines the the initiatives that need to be undertaken to implement the HIT strategy and the valueproposition that will result. The plan will include:

– The initiatives that can be accomplished in the 12-24 months following the completion of the plan

– Identify the value proposition for each initiative

– Identify the estimated resources and timeframe for implementation

The objective of the transition plan is to develop a short term HIT implementation plan supported by business cases.

HIT Transition Plan Process

Creative Solutions

ED & Clinical Solutions

EHR & Practice Management

Revenue C

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&

Access M

anagement

Ente

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Man

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Me

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Stage 1 Year 22010

Year 1

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HIT Transformation Map

Long Term

VisionMajor activity/

milestone







Major activity/milestone Major activity/

milestone

















Creative Solutions

Appendix B: Strategy Project Work Samples

Creative Solutions

Strategy Work Sample: Assessing the CurrentState of HIT and its Service Agility

• Use existing organizational documentation sources, questionnaires, an HITService Agility tool, and executive interviews to review and assesscapabilities in Applications, Information Management, TechnologyManagement, and Technology Infrastructure across dimensions of services,all stakeholders, common industry models and standards.

• Compare current processesenvironments and costs with leadingpractices and benchmarks todetermine how well services compareto most other companies within healthcare.

• Document areas of strength,weaknesses, quick hits andrecommendations for developing theHIT strategy.

HIT Service Agility FrameworkInfrastructure Application

Management & OrganizationInformation

The hardware and software that supports theApplications, Information, Processes and Users

Software that supports the automation of businessprocesses or functions (Purchased Packages,Custom Developed, Systems Integration)

Processes that support the ongoing delivery andoperation of HIT solutions, organization design &the roles that perform those processes

Information repositories and tools for access andanalysis of key business data elements (e.g.,Customers, Products, Transactions, Documents)

• Data ownership• Information managed as an enterprise asset• Data quality strategy• Data warehouses• Enterprise wide data model and repositories

• Hardware/Software• Outsourced commodities• Architectural standards• Rapid technology introduction• Workstations• Scalability of services• Consistent HIT processes• Quality of Services• Platforms• Networks

• System development lifecycle - application process• Application framework - core set of common services• Buy, build, integrate• Portfolio rationalization process• Application implementation decisions guided by enterprise application architecture

• HIT strategy and planning with business strategy• Managed portfolio of services and initiatives• Consistent financial management of HIT costs• Resource management process

Creative Solutions

Strategy Work Sample: Assessment Domainsand Dimensions of Services

Management Applications Information Infrastructure

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Strategy Work Sample: Assessment Tools,Interviews and Process Document Reviews

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IS is a relatively low cost services provider. Overall IS costs arebelow the benchmark mean for *** and % of total revenue (-21% variance for both benchmarks).

–Low infrastructure costs (data center, network, PC hardware,etc.) offset high c laims system costs (significantly above thebenchmark range) and increased overall personnel costs (atthe high end of the benchmark range).

–IS’s cost performance is significant considering xyz’s relativesize in the industry. Stratification of respondents in theGartner Study indicates that IS costs *** increases ascompany size increases (based on total revenue). ISeconomies of scale are not typically realized with increasedsize.

Demand for IS services is high for an organization of xyz size.Overall staffing levels are at the high end of the benchmarkrange (+36% variance from the mean).

–Development and maintenance staff are both significantlyabove benchmarks. Ratio of development to maintenancestaff is good, but slightly weighted toward maintenance.

–Management, administrative, and infrastructure staff appearwell leveraged. Adjusting development and maintenancestaff to benchmark means produces an overall staffing levelthat is below the benchmarks.

Observations Recommendations

Assess current staffing strategy for improvements in staff flexibil ityand availabil ity.

–Conduct a resource planning analysis to understandcapacity alignment with current competency requirements.Initiate a resource planning process (potentially in the PMO)that will proactively plan and address future capacitymanagement.

•Resource planning and budget process should beintegrated with demand management and portfolioprioritization processes to ensure appropriateresources are fully uti l ized throughout the year.

•Research business analyst skil l set match andaddress gaps appropriately (training, infuseexperienced resources, etc.), particularly in the areaof IT.

–Implement staffing management tools that allow moreeffective balancing across BAU and development ofstrategic business capabilities.

–Develop an accelerated on-boarding and cross-trainingprogram that effectively organizes materials on xyz’s businessprocesses and the IS supporting applications.

We believe there are currently no tangible benefits in outsourcingthe IS util i ty functions (Data Center, Network) at xyz.

–Current IS infrastructure costs are low, therefore outsourcerswill not be able to reduce the costs enough to overcome theinherent risks of outsourcing.–Current operational services are satisfactory and improving.–xyz mainframe environment, although mature, is a dynamicenvironment (major development is ongoing) that normallydoes not lend well to the outsourcing financial model.

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Strategy Work Sample: High Level and DetailedAssessment Deliverables

Creative Solutions

Strategy Work Sample: Supporting Observationsfor Ratings in Each Focus Area within the Four

Domains

This section ofthe scorecard

provides theoverall

assessment forthat component

of the Domain.

These observationssupport our ratingsin the threecategories thatcontribute most tooverall agility:

Is the strategicdirection for thiscomponent well-defined and alignedto the business?Is this process welldocumented? Howwell is it executed?

These are the leading practices thatrepresent a perfect score – which very

few, if any, companies can attain.

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IT Costs as a % of Total Revenue

2.0% 2.9% 3.2%

•IS Total Costs

•Total Revenue

Budget versus ActualSystem

$135 M

$5,768 MFinance

•Total IT Costs

2.3%

• Low IT costs as a % of total revenue

• Benchmark mean for IT Operating Budget as a % of Gross Revenue = 2.1%

• Total Revenue includes Premium Revenue, Interest Income, and Fees and Other Income

• Metric variance from mean: -21%

Strategy Work Sample: Benchmark Detail - ISCosts

Data factored by Finance from actualcosts

2.4% $265 MM Costs/

$10,913 MM Revenue

Budget versus Actual System

AdjustmentsValueData SourceElement

CommentsMetricData SourceMetric Data Description

Informational Metrics

Observations/ Assumptions

Metric Data Description

Benchmark Name Benchmark Metric

75th %Mean25th %

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Strategy Work Sample: HIT Systems &Services Model Current & Future State

Financial Reporting Systems - Current & Future State

Informational reporting and access for financial dataDescription

Current State Future State

! Multiple point systems, primarily composed of productivity tools that process output from operational applications

! Primarily used for ad hoc analysis

! Hyperion and Clarus

! Shared analysis capabilities for accessing financial systems for ad hoc analysis

! Management and Financial Analysts across EEEE

! Management and Financial Analysts across EEEE

! Business day availability (hours of outage)

! Business day availability (hours of outage)

! Primarily manual Interfaces between financial applications and productivity environment

! Some users have database views defined in Access for retrieving financial data

! Automated, direct interface to operational financial data, with download capabilities for local analysis

Portfolio/ Usage

Users

Availability/ Performance

Integration/ Interfacing

! Functionality limited to what a user can program in the MSOffice environment

! Direct access to financial information

! Variety of reporting formats: fixed, variable and multi -dimensional

! Access to centralized financial data that has consistent metadata definitions

Capabilities

3. Current & futurecharacteristics ofeach HIT system orservice are reviewedbased on businessdrivers.

2. Mapping of each HIT system to service on the left isreviewed.

1. The entire HIT environment (applications, databases,infrastructure) is reviewed as represented in businessservice terms shown below.

4. The systems & services modelis also used to structure otherreviews, e. g., HIT spending (notshown).

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Marketing

•Advertising•Marketing

•Research

•Communications

•Strategic Planning

•Direct Customer

Communication

Marketing


•Research

•Communications


•Direct Customer

Communication

Financial

•Accounting Corporate &

General

•Credit

•Financial Planning & Analysis

•Inventory Accounting

•Payables

•Product Accounting

•Tax

•Treasury•Imaging

Financial


General

•Credit



•Payables


•Tax


Logistics

•Logistics Support•Forecast &

Replenishment

•Transportation

Logistics


Replenishment

•Transportation

Store

Operations

•Specialty Sales

•Store Planning

•Support

•Store Operations•Loss Prevention

•Contractor Yard

•Point of Sale

•Sales Reporting

Store

Operations

•Specialty Sales

•Store Planning

•Support


•Contractor Yard

•Point of Sale

•Sales Reporting

Administration

•Legal•Audit

•Fleet

•Travel

•Maintenance/Repair

•Real Estate

•Aviation•Facilities

•Procurement/Supply

•Time Reporting

Administration

•Legal•Audit

•Fleet

•Travel


•Real Estate



•Time Reporting

Human Resources

•Payroll

•Human Resources

•EEO

•Garnishment•Share Wealth

•Stock Options

Human Resources

•Payroll

•Human Resources

•EEO


•Stock Options

Merchandising

•Item

•Item Management

•Pricing•Bookmarking

•Stocking

•Vendor/Merchant

Program

•Assortment Planning

•Store Ranging

Merchandising

•Item

•Item Management


•Stocking

•Vendor/Merchant

Program


•Store Ranging

Electronic

Commerce

•eLink

•abc.com

•eProcurement

•Collaborative Planning

•EDI/XML Portal

Electronic

Commerce

•eLink

•abc.com

•eProcurement


•EDI/XML Portal

Distribution Center

•Warehouse Management•Warehouse Planning

•Labor Management

•Productivity Planning

•Yard Management

•Fleet Management

Distribution Center


•Labor Management


•Yard Management

•Fleet Management

Sample IT Systems Model

Marketing


•Research

•Communications


•Direct Customer

Communication

Marketing


•Research

•Communications


•Direct Customer

Communication

Financial


General

•Credit



•Payables


•Tax


Financial


General

•Credit



•Payables


•Tax


Logistics


Replenishment

•Transportation

Logistics


Replenishment

•Transportation

Store

Operations

•Specialty Sales

•Store Planning

•Support


•Contractor Yard

•Point of Sale

•Sales Reporting

Store

Operations

•Specialty Sales

•Store Planning

•Support


•Contractor Yard

•Point of Sale

•Sales Reporting

Administration

•Legal•Audit

•Fleet

•Travel


•Real Estate



•Time Reporting

Administration

•Legal•Audit

•Fleet

•Travel


•Real Estate



•Time Reporting

Human Resources

•Payroll

•Human Resources

•EEO


•Stock Options

Human Resources

•Payroll

•Human Resources

•EEO


•Stock Options

Merchandising

•Item

•Item Management


•Stocking

•Vendor/Merchant

Program


•Store Ranging

Merchandising

•Item

•Item Management


•Stocking

•Vendor/Merchant

Program


•Store Ranging

Electronic

Commerce

•eLink

•abc.com

•eProcurement


•EDI/XML Portal

Electronic

Commerce

•eLink

•abc.com

•eProcurement


•EDI/XML Portal

Distribution Center


•Labor Management


•Yard Management

•Fleet Management

Distribution Center


•Labor Management


•Yard Management

•Fleet Management

Sample IT Systems Model

Sample IT Services ModelIT Strategy &

Planning

• Def ine an IT Strategy A ligned to

the Business

• Establish IT Direction

• Establish IT Strategy and

Priorities

• Approve (Disapprove) Proposed

Init iatives

• Determine the IT Initiat ive/

Investment Portfolio

• Schedule IT Service Delivery

• Manage the IT Resources

• Create Customer Support

Strategy

• Manage Business/IT Liaisons

• Def ine and Manage IT

Communication Strategy and

Plan

• Manage Financial Plans and

Budgets

• Manage IT Relat ionships

• Manage IT Costs and Benef its

• Manage the IT Asset Portfolio

• Manage the IT Relat ionship

Portfolio

• Manage IT Supplier

Relationships

• Manage Problem Resolution

IT Strategy &

Planning

• Def ine an IT Strategy A ligned to

the Business

• Establish IT Direction

• Establish IT Strategy and

Priorities

• Approve (Disapprove) Proposed

Init iatives

• Determine the IT Initiat ive/

Investment Portfolio


• Manage the IT Resources

• Create Customer Support

Strategy

• Manage Business/IT Liaisons

• Def ine and Manage IT

Communication Strategy and

Plan

• Manage Financial Plans and

Budgets

• Manage IT Relat ionships

• Manage IT Costs and Benef its

• Manage the IT Asset Portfolio

• Manage the IT Relat ionship

Portfolio

• Manage IT Supplier

Relationships


Communications

Infrastructure

• Provide Telecommunication

Services

• Provide Connectiv ity Services

• Provide Collaboration Services

• Fix and Correct Problems


Communications

Infrastructure

• Provide Telecommunication

Services

• Provide Connectiv ity Services

• Provide Collaboration Services



Solution Delivery

• Def ine Component Projects

• Analyze Business Requirements

• Buy/Build Business Components

• Deliver/Deploy Components

• Manage Component Projects

• Manage the IT Delivery Process


• Maintain Legacy Systems

• Maintain Sof tware Components

• Maintain Other Components



Solution Delivery

• Def ine Component Projects

• Analyze Business Requirements

• Buy/Build Business Components

• Deliver/Deploy Components

• Manage Component Projects

• Manage the IT Delivery Process







Operations

Infrastructure

• Provide Operational IT

Environment

• Provide IT Controls

• Manage IT Environment

• IT Inventory Management

• Conf iguration Management

• Disaster Recovery

• Acquire Technology

• Monitor and Measure IT

Environment Performance

• Set Service Level Agreements

(SLAs)

• Provide Customer Support


• Maintain Hardw are Components




• Provide Help w ith IT

Environment

• Provide Customer Training

• Provide Information About IT

Environment


Operations

Infrastructure

• Provide Operational IT

Environment

• Provide IT Controls

• Manage IT Environment

• IT Inventory Management

• Conf iguration Management

• Disaster Recovery

• Acquire Technology

• Monitor and Measure IT

Environment Performance

• Set Service Level Agreements

(SLAs)

• Provide Customer Support


• Maintain Hardw are Components




• Provide Help w ith IT

Environment

• Provide Customer Training

• Provide Information About IT

Environment


Information

Management

• Develop Know ledgebase/

Repository

• Provide Business Information

Services

• Provide Data Administration

Services

• Provide Database

Administration Services






Information

Management

• Develop Know ledgebase/

Repository

• Provide Business Information

Services

• Provide Data Administration

Services

• Provide Database

Administration Services






IT Research,

Architecture & Engineering

• Explore Emerging IT

Capabilities

• Monitor Industry Activ ity

• Conduct Research and

Development

• Products

• Packages

• Hardw are

• Technology

• Business Processes

• Identif y and Develop Concepts

• Determine Feasibility of

Concepts

• Def ine and Evolve IT

A rchitectures

• Technology

• Data

• Applications


IT Research,

Architecture & Engineering

• Explore Emerging IT

Capabilities

• Monitor Industry Activ ity

• Conduct Research and

Development

• Products

• Packages

• Hardw are

• Technology

• Business Processes

• Identif y and Develop Concepts

• Determine Feasibility of

Concepts

• Def ine and Evolve IT

A rchitectures

• Technology

• Data

• Applications


IT Consulting

• Def ine IT Principles

• Develop Standards, Methods

and Techniques

• Provide Project -based

Consulting


Training

• Def ine IT Performance

Metrics/ Measures

• Measure and Monitor IT

Performance

• Develop Business Process

Benchmarks

• Provide Quality Assessment

Services

• Provide Business Process

Improvement Services

• Manage problem resolution

• Def ine & Maintain IT

Processes and Procedures

•Product management

•Asset management

•IT inventory management

•Conf iguration

management

•Version management

•Program/project

management

• Scope management

• Risk management

• Issues management

• Change management

•Organization change

management

•Disaster recovery

•Strategic planning

•Resource management

•IT portfolio management

•Product portfolio

management

•Customer support

IT Consulting

• Def ine IT Principles

• Develop Standards, Methods

and Techniques


Consulting


Training

• Def ine IT Performance

Metrics/ Measures

• Measure and Monitor IT

Performance

• Develop Business Process

Benchmarks

• Provide Quality Assessment

Services

• Provide Business Process

Improvement Services

• Manage problem resolution

• Def ine & Maintain IT

Processes and Procedures

•Product management

•Asset management

•IT inventory management

•Conf iguration

management

•Version management

•Program/project

management

• Scope management

• Risk management

• Issues management

• Change management

•Organization change

management

•Disaster recovery

•Strategic planning

•Resource management

•IT portfolio management

•Product portfolio

management

•Customer support

Business Products

• Perform Product Management

Processes

• Product Ow nership

• Product Responsibility

• Product Accountability

• Init iative Def inition/

Prioritization

• Manage Product Portfolio

(Strategic/Tactical)

• Full Product Life Cycle

• Product/Portfolio

Interdependencies

• Related Init iatives (Training,

Business Processes)

• Manage Product Delivery

Process

• Development/ Deployment

Management

• Manage Business/IT A lignment

• Develop Business/IT Awareness

• Manage IT Customer/End -user

Relationship


Business Products

• Perform Product Management

Processes

• Product Ow nership

• Product Responsibility

• Product Accountability

• Init iative Def inition/

Prioritization

• Manage Product Portfolio

(Strategic/Tactical)

• Full Product Life Cycle

• Product/Portfolio

Interdependencies

• Related Init iatives (Training,

Business Processes)

• Manage Product Delivery

Process

• Development/ Deployment

Management

• Manage Business/IT A lignment

• Develop Business/IT Awareness

• Manage IT Customer/End -user

Relationship


Professional

Development

• Establish MIS Human Resources

Strategy

• Def ine Roles and

Responsibilities

• Def ine Personnel Resource

Requirements

• Perform Recruiting Activ ities

• Develop and Monitor

Performance Management

Process

• Def ine and Maintain Education

Curriculum

• Provide Ongoing Training


Professional

Development

• Establish MIS Human Resources

Strategy

• Def ine Roles and

Responsibilities

• Def ine Personnel Resource

Requirements

• Perform Recruiting Activ ities

• Develop and Monitor

Performance Management

Process

• Def ine and Maintain Education

Curriculum

• Provide Ongoing Training


Creative Solutions

Strategy Work Sample: HIT Capabilities andSourcing

Range of IT Capabilities

• Supplier / Vendor Management• Partner Management

• Relationship Management• Help Desk

• IT Training

• End-User Training Development• End-User Training Delivery

• Documentation & Communication

• Governance• IT Value Management

• Strategic Planning• IT Architecture Definition & Refresh

• Project Management

• Lifecycle/Portfolio Management• Business Analysis

• Security Administration

Common Capabilities

• Operations

• Infrastructure Engineering• Infrastructure Implementation

• Information Management

• Data Analysis

• Package / Service Selection• Package Implementation &

Integration

• Application Development• Software Product Development

• Application Maintenance

Infrastructure EnvironmentInformation EnvironmentApplications Environment

• Supplier / Vendor Management• Partner Management

• Relationship Management• Help Desk

• IT Training

• End-User Training Development• End-User Training Delivery

• Documentation & Communication

• Governance• IT Value Management

• Strategic Planning• IT Architecture Definition & Refresh

• Project Management

• Lifecycle/Portfolio Management• Business Analysis

• Security Administration

Common Capabilities

• Operations

• Infrastructure Engineering• Infrastructure Implementation

• Information Management

• Data Analysis

• Package / Service Selection• Package Implementation &

Integration

• Application Development• Software Product Development

• Application Maintenance

Infrastructure EnvironmentInformation EnvironmentApplications Environment

IT Capability Description – Application Environment

• System Design

• Application Developm ent

• Software Development for

Integration

• Data Migration

• Database Development

• New System Development

• Major Enhancem ent

The ability to provide custom applications that will be

software products to be sold to external customers.

Software Product

Development

• Minor Enhancem ents

• Bug Fixes

• Integration Support

• User Administration

The ability to maintain and enhance existing system

functionality.

Application Maintenance

• System Design



Integration

• Data Migration




The ability to provide custom applications to fulfill

customer facing services. Includes the delivery of the right information in the right format (Palm, Wireless, etc.)

Application Development

• System Design

• Package Configuration


Integration

• Data Migration


The ability to install and configure applications and integrate them with existing systems.

Package Implementation & Integration

• RFP Development

• Technical E valuation

• Functional E valuation

• Verify Business Requirements

• Proof of Concept

The ability to provide applications which fully support

business needs and conform to IT system standards.

Package Selection

CharacteristicsDescriptionIT Capability

• System Design



Integration

• Data Migration




The ability to provide custom applications that will be

software products to be sold to external customers.

Software Product

Development

• Minor Enhancem ents

• Bug Fixes

• Integration Support

• User Administration

The ability to maintain and enhance existing system

functionality.

Application Maintenance

• System Design



Integration

• Data Migration




The ability to provide custom applications to fulfill

customer facing services. Includes the delivery of the right information in the right format (Palm, Wireless, etc.)

Application Development

• System Design

• Package Configuration


Integration

• Data Migration


The ability to install and configure applications and integrate them with existing systems.

Package Implementation & Integration

• RFP Development

• Technical E valuation

• Functional E valuation

• Verify Business Requirements

• Proof of Concept

The ability to provide applications which fully support

business needs and conform to IT system standards.

Package Selection

CharacteristicsDescriptionIT Capability

1. HIT capabilities are the combination of skills and knowledge with methods and tools thatsupport the development, deployment and management of the HIT systems & services.

2. The full set of HIT Capabilities maps are determined as shown in the example modelbelow.

Str

ate

gic

Im

po

rtan

ce

Ability to Meet Future Enterprise Needs

Core (differentiates

XY Z from

competition)

Necessity (required

capability to

compete in the

industry)

Support (base capability

requi red to

operate)

Weak(does not

support business need)

Sufficient(supports basic business need)

Strong(exceeds

business needs)

Invest to Create and

Maintain Systems

Reduce Investment

if Possible

Consider Buying for

Competitive Parity

Consider

Outsourcing

IT Capability Sourcing Evaluation Framework

3. .. and sourcing options analyzed &determined

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Creative Solutions

Strategy Work Sample: Organization andGovernance

OpportunityArea

Evaluation

Project

Concept

Assessmentand Scope

IdentificationImplementation Maintenance

Business CaseDevelopment

Project Portfolio Management

Methodology Development

Resource Allocation

II III IV

Strategic Plan Refresh

ImplementStart Under-stand

Design Build ImplementStart Under-stand

Design Build

Project ManagementProject

ApprovalBusiness Case Development

Architecture Guidance

Architecture Compliance


Project AuditProject

Approval


IT Measurement

IT R&D Management

IT Management Processes

RE

VIE

W

PR

OC

ES

SE

S

LIF

E C

YC

LE

PR

OC

ES

SE

SD

IRE

CT

ION

SE

TT

ING

PR

OC

ES

SE

S

Communication Education

Communication Education

This diagram illustrates how each IT Management processes intera ct with each other:

Governance Structure

Investment Council

(CFO, CIO, COO, Corporate Development)

Investment Council

(CFO, CIO, COO, Corporate Development)

Application

Delivery

Managers

Application

Delivery

Managers

IT Business

Steering Committee

IT Business

Steering Committee

• Coordinate IT activity for single business unit

• Promote projects

• Delivery of projects, maintenance activities and small enhancements

• Responsible for people/staff management• Determine level of required maintenance• Production support and maintenance

XYZ Executive ManagementXYZ Executive Management

• Set business strategy• Approve capital funding• Charters IT roles and authorities

• Overall direction setting for IT future• Enterprise investment priorities• Major project approval

Project

Office

Project

Office

IT

Relationship

Managers

Relationship

Managers

• Work with business/staff groups to develop prioritized list of projects and requested level of capped small enhancements

• Single point of contact for business groups• Liaison to business strategy• Business initiatives formation

• Common processes (chargeback, budgeting,

resource planning, etc.)• Recommend aggregate demand• Manage major projects at the enterprise level

Technology

Planning &

Infrastructure

Technology

Planning &

Infrastructure

• Strategy, standards & architectures

• Enterprise infrastructure

Outsourcing

Management

Outsourcing

Management

• Coordinate activities of outsourcing partners (CSC, Acxiom )

• Manage financial relationship with partners and

Service Level Agreements • Coordinate planning for disaster recovery and

business resumption

IT Governance

Council

IT Governance Functions

ITCommunity

BusinessCommunity

IT Investment

Portfolio

IT Strategy

IT Projects

Business

IT

Sponsor Owner

Project

Manager

Project Management Portfolio Management

IT Projects IT Portfolio

Steward

IT Strategy

Business Mgmt

Strategic Planning

IT Mgmt

Business

IT

Sponsor Owner

Project

Manager

Project Management Portfolio Management

IT Projects IT Portfolio

Steward

IT Strategy

Business Mgmt

Strategic Planning

IT Mgmt

Appropriate Roles & Responsibilities

Represent processes that involve joint Business / IT participati on

Database Systems

Administration

Server Support

Desktop Support

Asset Management

First Level Network Support

First Level Application Support

Application Integration

Infrastructure Support

Security Administration

Operations Infrastructure

Network Services

Network Security Services

Data Interchange Services

Internet E-mail Services

Communications Infrastructure

Data Administration

Information Reporting,Analysis,

& Discovery

Data Movement Services

Imaging Services

Metadata Management

Information Management

Research

Architecture

Engineering

IT Research, Architecture & Engineering

Management Information SystemsIT Organization Model

Determining the processes formanaging HIT and making decisionsabout HIT investments on anenvironmental basis.

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Creative Solutions

Strategy Work Sample: HIT Principles

IT Principles

• IT will partner with the business units to enable them to make use of the full power of technology to meet our commitment to be a “best of class” company

• XYZ’s approach to managing technology and information will address the enterprise requirements as a whole, not isolated business units

! XYZ will accommodate business unit specialized solutions when required for competitive advantage

! XYZ will prefer shared services, resources and technologies that address multiple business needs, as a first choice

• XYZ will follow a disciplined approach to making IT investment decisions. This approach will be characterized by:

! Targeting a balance of investments that are required to remain competitive, that meet acceptable ROI thresholds, and that create options for the future

! Employing a consistent and efficient process to initiate and evaluate investment decisions and manage and measure IT investment success

• XYZ will provide centralized support of technology --Business units will be responsible for project sponsorship and full participation and support of technology initiatives

• XYZ will strive to be a close follower in adopting emerging technologies

• Applications & Information

! XYZ will first reuse, then buy, then build new application and information solutions

! XYZ will manage, define and share data at the enterprise level

! Target an 80% solution, understanding that a bias toward action supersedes a “perfect world”

• Technology Infrastructure

! All technology investments will be made consistent with the three -year IT strategic plan

! XYZ will select open standards and technologies that are current and market -centric

! XYZ’s technology architecture will be service -based and will minimize redundant products and technologies

! XYZ will enable cross -business unit integration and shared or reusable processing

• They are developed jointlywith all HIT stakeholders.

• They address the entire HITlandscape: - Applications - Information & Knowledge - Infrastructure - HIT Management

• Principles are high level guidelines and constraints which help directthe actions of the HIT organizations throughout the enterprise.

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Capability A

Strategy Work Sample: CompetencyAlignments with Tools and Processes to Deliver

HIT Capabilities

1 62 3

Are HIT competencies grouped to deliverflexible HIT capabilities that candynamically be sourced from across thebusiness environment?

Internal SharedExternal

KEY

ExampleCapability: Solution DevelopmentCompetencies: Business Analysis, Architecture, Development, …Tools: Rational Rose, ERWIN, …Processes: Rational Unified Process

Capability B

2 83 7

Capability C

7 108 9

External ITCapability

Shared ITCapability

Internal ITCapability

Sample

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Creative Solutions55

Strategy Work Sample: HIT Resource Allocation

Creating HealthCare Capabilities Operations &

Support

Ongoing Health Care Support

Maintenance

System/Service#1

$Headcount

$Headcount

$Headcount

. . .$

Headcount$

Headcount$

Headcount

Product/Service #n$

Headcount$

Headcount$

Headcount

HIT System & Service Delivery

HIT Initiative portfolioHIT Asset portfolio +those HIT Initiativesthat are focused solelyon operating &maintaining the HITAsset portfolio

Resources allocatedto Planning andManaging HIT

HIT Planning and Management

HIT Planning and Management

$Headcount

Sample

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Strategy Work Sample: Strategy InitiativesIT Strategy - App & Data

Initiative Summary

Initiative Information

Initiative Name Current or Future Initiative

Develop Enterprise Data Warehouse - product Current Future

Description

The critical success factor for this initiative is the creation of an IRM function (Initiative One from this sub team.)

Priority Ranking w ithin Your Sub-Team Sub-Team Name

High Medium Low

Est. Duration IT Strategy (linked to)

< 6 mths 6 - 12 mths 1 - 2yrs > 2 yrs 1, 2, 3, 4, 5, 6

Est. Annual Financial Benefit Upfront / One-Time Investment Confidence LevelConfidence of Dollar Estimates

1 ) < 500k 1 ) < 500k 1 ) 100%

2 ) 500k - 1m 2 ) 500k - 1m 2 ) 80%

3 ) 1m - 5m 3 ) 1m - 5m X 3 ) 60%

4 ) 5m - 10m X 4 ) 5m - 10m 4 ) 40%

5 ) 10m - 20m 5 ) 10m - 20m 5 ) 20%

6 ) > 20m 6 ) > 20m 6 ) 5%

Benefits / Business Value / Rationale

1. Savings derived from:

a.) Better management of our product lines, franchises, analysis for new products, acquisitions, etc.

b.) Business based trending, ability to look at all products and find all information about a single product or category

c.) Immediate access to enterprise-wide business intelligence for initiatives requiring consistent view of our products (e.g. e-Commerce, exchanges, etc.)

d.) Improved decision making based on comprehensive, integrated views of market, channels, customers, etc.

e.) Consistent source of information, quality controlled environment for reporting, analysis, management review, . . .

f.) Leverage information and resources; improve responsiveness

Risks

Dependencies

a) Creation of Data Stewardship position and related policies and procedures.

b) Creation of Data Architecture & Decision Support Function to enable the creation of the models behind the ODS.

c) Creation and continued operation of the enterprise ODS

d) Information must be recognized as a business asset, and must be developed and managed separately from applications

Develop and implement an architecture and Enterprise Data Warehouse (EDW) to support business intelligence across the enterprise. The

resource will include multiple subject areas, be shared by multiple functions, and will feed division and functional area data marts and

warehouses. Implement the initial product subject area within the data warehouse. Assess and coordinate related current division projects.

Product Information

1. Data Architecture groups not appropriately established - (includes authority, organization, resources) - operational implementation will fail

without the proper organizational support.

2. Lack of Divisional Commitment - Divisions will need to be directed to cooperate.

3. Enterprise Data Sources Too Strict - Results in stifling organizational / marketplace growth with too restrictive policies.

4. Historical data may be poorly utilized.

5. Data quality and value limited if operational data stores not adequately implemented

Sample: Application Portfolio Initiatives

Information Repository InitiativesTechnology Infrastructure Initiatives

IT Management InitiativesOne for each selected initiative

Sample

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Strategy Work Sample: Transformation Maps• Transformation maps and the required actions from all sections of the HIT

Strategy are developed.

• They determine how the organization establishes clear priorities and set majorobjectives / milestones to be achieved in each area over time.

• Transformation maps are useful for communication across the enterprise andfostering alignment with health care business and practice areas.

Systems Roadmap: Supply Chain Management Systems

Systems ProjectsSystems Projects Prev.Spend

Prev.

Spend2000

Q1 Q2 Q3 Q4

2001

Q1 Q2 Q3 Q4

2002

Q1 Q2 Q3 Q4

2003

Q1 Q2 Q3 Q4

2004

Q1 Q2 Q3 Q4

2005

Q1 Q2 Q3 Q4

Supply Chain Managem ent

MMP Process Improvements

DRS II

Top 10,000

MTM Local Fill

SWS Reclass Efficiencies

SDS Reengineering

Matl . Flow Dec Tree - mand.

Low Vol. / Seasonal Forecast.

Parts & Customer Segmentation

in Supply Chain Mgmt (SCM)

Mechanized Promise Info Sys

US Matl . Flow Renewal

SCM Continuous Improvement

Supply Chain Managem ent

MMP Process Improvements

DRS II

Top 10,000

MTM Local Fill

SWS Reclass Efficiencies

SDS Reengineering

Matl . Flow Dec Tree - mand .

Low Vol. / Seasonal Forecast.

Parts & Customer Segmentation

in Supply Chain Mgmt (SCM)

Mechanized Promise Info Sys

US Matl . Flow Renewal

SCM Continuous Improvement

Value Delivered

$170k

$4,541k

$3,200k (see Assumptions)

$700k

$3,500k

$1,600k

$1,690k

$TBDk

$20,000

$650k $650k $650k $650k $650k

$200k

Supplier Direct Ship improvementsSupplier Direct Ship improvements

MMP improvements for forecasting completeMMP improvements for forecasting complete

Complete renew al of US Supply Chain management systems using technology proven in EuropeComplete renew al of US Supply Chain management systems using technology proven in Europe

Incremental material f low improvements completeIncremental material f low improvements complete

$TBDk

$236k

Total Benefits: TBD

Total Benefits: $26m

Total Benefits: TBD

Total Benefits: $675k

Total Benefits: $2,000k

Total Benefits: $1,9b -- Revenue Enhancement



Total Benefits: TBD

Total Benefits: TBD

Total Benefits: TBD

Cost and benefit figures from

Systems Plan 2000 -2004

Transformation Map – Worldwide IT

Infrastructure

ManagementData Management

Systems and Services

(New and Existing)

2002 2004 2005

Governance

IM

Capabilities

Business Capabilities &

Processes

MovingTargetMovingTarget

2003

2001 2002 2003

IM Organization Measures

InvestmentPortfolio is a Competitive

Advantage for XYZ

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Po

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• Identify portfolio owners at executive level

• Conduct focused investment discussions w/ business leads

• Set direction, make high level resource allocations, and appoint process owners

• Coordinate business case development

• Charter projects within key investment areas

• Rationalize new and ongoing project efforts – from consolidated timeline for initial efforts

• Kick -off conceptual design for initial efforts

• Coordinate rev iew sessions –prepare options for 2002 budget

• Fine-tune process

20

03

20

02

20

01

• Establish metrics and targets around key investment areas and portfolio decisions

• Merge metrics into decision models for investments and alternatives

• Conduct capability audit for ex isting IM organization

• Establish integrated processes that align people, processes, measures, and decision making

• Optimize investment decisions based on measures/metrics

• Executemature

decisionprocesses

• Revisit strategic intent and integrate with maturedecision processes

• Measure performance

• Plan the next wave

• Complete migration to Program Management Office for all Investments

• Integrate delivery metrics and value into decision processes

• Solidifygovernance processes

• Establish global IM leadership team, including new positions forarchitecture, Europe and Research & Development

• Establish program management structure and teams

• Establish communications, and logis tical processes

• Establish leadership roles

• Review ex isting project management and implementation methods

• Introduce common delivery structure and methods for all projects

• Introduce common project methodology terms, tools, and templates (process modeling, implementation approach…)

• Introduce project accounting and reporting tools and techniques

• Manage change to effectively introduce new processes and roles

• Align resources behind s trategic investments and critical deliverables

• Agree measures andtargets

• Create high -performance teams throughout the organization

• Finalize migration to newroles and responsibilities

• Optimizeorganization

• MeasurePerformance

• Identify key indiv iduals to support program management teams

• Ensure soundness of structures, systems, and processes

Transformation Map – IT Management

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For More Information Contact:

John [email protected]://www.linkedin.com/in/johnxe22

Creative Solutions LLC6009 Buffalo Ridge RdEarlysville, VA 22936U.S.A.

01-815-354-7456

HIT Service Strategy

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Transcript of HIT Service Strategy