Chapter 4: Developing and Gaining Support for a PHM IT Investment Road Map - Step 2 & 3
Excerpted from original article published by Population Health Management, copyright Mary Ann Liebert, Inc.
Guide for Developing an Information Technology Investment Road Map for Population Health Management
Jacquelyn Hunt, PharmD, MS, Richard Gibson, MD, PhD, John Whittington, MD, Kitty Powell, Brad Wozney, MD, Susan Knudson, MA
Many health systems recovering from a massive investment in electronic health records are now faced with the prospect of maturing into accountable care organizations. This maturation includes the need to cooperate with new partners, involve substantially new data sources, require investment in additional information technology (IT) solutions, and become proficient in managing care from a new perspective. This seven-part series, with excerpts drawn from the article originally composed by leading authorities on population health management and enabling IT, will help organizations chart their position on the population health readiness spectrum and enhance their chances for a successful transition from volume-based to value-based care.
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Developing and Gaining Supportfor a PHM IT Investment Road Map
Step 2. Clarify PHM IT governance
As a derivative of corporate governance, IT governance is critical to forging the connection between business strategy and IT for value creation. With the PHM business strategy articulated from Step 1, the role of business leaders in the governance process is that of ultimate decision maker as well as taking subsequent accountability for return on investment. IT exists to serve the clinical and business functions of the organization. In their supporting role in the governance process, IT partners provide the business with options to meet the PHM business strategy. Role clarity and a collaborative partnership are integral to the subsequent steps in the cycle.
To the extent not already accomplished, the organization should design, approve, and socialize an IT governance process that aligns investment with the PHM business strategy.28,42 To ensure an efficient and effective decision-making process, leaders should take stock of the maturity of existing IT governance processes, and proactively determine the need to expand, alter, or reinforce the process. When multiple health care delivery systems partner to manage populations, the IT governance process within a single organization may no longer serve as the vehicle for PHM IT investment decision making. In this more complicated scenario, executives across organizations will need to invest time in forming an overarching IT governance process that can comprehend the individual position and needs of each participating organization, along with their shared PHM IT needs.
Organizations may feel pressure based on signed, at-risk contracts to make rapid IT decisions. However, we have witnessed cases where failing to explicitly address this step has caused potentially avoidable strife within and between organizations, ultimately causing further delays or poor investment decisions.
Step 3. Create business requirements based on PHM stakeholders and their Jobs-to-be-Done (JTBD)
With an explicit PHM business strategy and an effective governance process, the organization is ready to consider its detailed PHM business requirements. Unfortunately, many organizations stall at this step because of an impasse between business leaders expecting their IT counterparts to describe how technology will enable PHM (ie, tell me what the technology will do for me), and IT leaders expecting business leaders to describe their PHM business needs (ie, tell me what functions you need done).
The JTBD framework43 can provide the necessary bridge between PHM business needs and potential technology solutions. In this case, the JTBD specifies the PHM problems that must be solved (ie, jobs to be hired) by IT to efficiently and effectively deliver on Triple Aim outcomes for specific populations. When constructing the JTBD categories, it is enlightening to consider who will be the primary stakeholder responsible for each PHM job. Table 2 describes 4 categories of PHM stakeholders, along with their potential roles and perspectives.
With an understanding of the PHM stakeholder perspectives and their high-level JTBD, PHM business requirements can be created to support each job. Investing the time to create ideal future state PHM business requirements enables organizations to assess current capabilities, consider build-versus-buy alternatives, communicate their future direction to vendors, and seek innovative new solutions and partners for solving their PHM challenges.
The writing and socializing of PHM business requirements can be complicated by terminology. The language that surrounds PHM finds it roots in multiple sources, including hospitals, ambulatory clinics, health insurance plans, public health, and the technology industry. Depending on the source, terms such as ‘‘case management,’’ ‘‘care coordination,’’ or ‘‘patient engagement’’ may hold different meanings depending on the historical context, user role and/ or marketing spin. These language nuances must be explicitly comprehended in the requirements to ensure astute evaluation of IT alternative solutions and, ultimately, wise investment.
Organizations’ ideal PHM business requirements may be influenced by their PHM strategy, breadth of service offerings, and specific target populations. Additionally, there is certainly more than one ‘‘right’’ way to categorize PHM JTBD and business requirements. Given that, there are advantages to creating a single internal PHM business requirements document. Primarily, the document will align internal stakeholders and enable an apples-to-apples comparison of IT alternatives. In the absence of a designated document, each vendor will propose their own format and language, creating havoc for both analysts and decision makers. Using a multidisciplinary team and an interactive process, we have created, tested, and revised a list of PHM JTBD and business requirements (Table 3). We have found that this parsimonious list has resonated with clinical, business, and IT leaders in multiple organizations. Teams might find the information in Table 3 a useful starting place or might use the information for comparison with their own current thinking.
Some organizations may find that the creation of ideal future state PHM business requirements is sufficient to support their IT road map development and subsequent product evaluation. Given limited resources, other organizations will determine that not all requirements are equally important given their current environment. Accordingly, a weighting system will assist these organizations to allocate their IT investment across short- and long-term priorities. Alternatively, teams might create a subset list of minimum or ‘‘must have’’ requirements.
Once drafted, the business requirements should be circulated with all the relevant stakeholders for feedback and revision. The circulation and sign-off on the PHM JTBD and requirements document can serve to educate, engage, and align leaders. As with any strategic document, the PHM requirements should be considered a working document that will evolve with changing market dynamics, organizational capabilities, and technology advancements.
28. Morrissey J. iGovernance. Hospitals & Health Networks. 2012;Feb:24–29.
42. Iveroth E, Fryk P, Rapp B. Information technology strategy and alignment issues in health care organizations. Health Care Manage Rev. 2013;38:188–200.
43. Christensen CM, Raynor ME. The Innovator’s Solution: Creating and Sustaining Successful Growth. Boston: Harvard Business School Press; 2003:73.