Preparing strategic information management plans for ...

International Journal of Medical Informatics (2005) 74, 51—65

Preparing strategic information management plansfor hospitals: a practical guidelineSIM plans for hospitals: a guideline

B. Brigla,∗, E. Ammenwerthb, C. Dujatc, S. Graberd, A. Großee, A. Haberf,C. Jostesg, A. Wintera

a Institute for Medical Informatics, Statistics, and Epidemiology, University of Leipzig, Liebigstraße 27,D-04103 Leipzig, Germany
b University for Health Informatics and Technology, Tyrol, Innsbruck, Austriac Promedtheus Informationssysteme fur die Medizin AG, Aachen, Germanyd Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Hospital,Homburg, Germanye HELIOS Hospital, Leisnig, Germanyf University of Applied Sciences Zwickau, Department of Informatics, Zwickau, Germanyg DETECON International GmbH, Management and Technology Consulting, Bonn, Germany
Received 14 August 2003; received in revised form 15 September 2004; accepted 20 September 2004

KEYWORDSHospital information

systems;Information

management;Strategic planning;Guideline

SummaryObjectives: Systematic information management in hospitals demands for a strategicinformation management plan (SIM plan). As preparing a SIM plan is a considerablechallenge we provide a practical guideline that is directly applicable when a SIMplan is going to be prepared.Methods: The guideline recommends a detailed structure of a SIM plan and givesadvices about its content and the preparation process. It may be used as template,which can be adapted to the individual demands of any hospital.Results: The guideline was used in several hospitals preparing a SIM plan. Experiencesshowed that the SIM plans could be prepared very efficiently and timely using theguideline, that the proposed SIM plan structure suited well, that the guideline offersenough flexibility to meet the requirements of the individual hospitals and that thespecific recommendations of the guideline were very helpful.Conclusions: Nevertheless, we must strive for a more comprehensive theory ofstrategic information management planning which — in the sense of enterprise ar-chitecture planning — represents the intrinsic correlations of the different parts ofa SIM plan to a greater extent.© 2004 Elsevier Ireland Ltd. All rights reserved.

* Corresponding author.E-mail address: [email protected] (B. Brigl).

1386-5056/$ — see front matter © 2004 Elsevier Ireland Ltd. All rights reserved.doi:10.1016/j.ijmedinf.2004.09.002

52 B. Brigl et al.

1. Why do we need a strategicinformation management plan in ahospital

As already argued in [1] systematic informationmanagement in hospitals demands for a strategicinformation management plan (in the following:SIM plan). A SIM plan gives general guidelines forbuilding and further development of the hospitalinformation system (HIS). We consider as a HISthe socio-technical subsystem of a hospital, whichcomprises all information processing actions aswell as the associated human or technical actorsin their respective information processing role. Itsupports the information management in futurestrategic planning activities by

- defining the aims of strategic informationmanagement aligned with hospital aims,

- presenting the complete current state of hospitalinformation processing including paper-based,and computer-based information processingtools,

- assessing the current state and recognizingdeficits,

suggests a rough structure for a SIM plan in 1993[7]. Business management oriented approachesadapted for health care and theoretically moti-vated can be found in [8,9]. The latter one e.g.presents a procedure to align business strategy andinformation management strategy, the so-called‘Component Alignment Model’. Tan in [10] strivesfor the same goal, using another approach. Inhis ‘Critical Success Factor Approach to StrategicAlignment’ he proposes to identify factors criticalfor the success or unsuccessfulness of an organiza-tion, and to derive a SIM plan starting from thesecritical success factors.

Other approaches for SIM planning resultfrom the accreditation procedure of the JointCommission on Accreditation of Healthcare Or-ganizations (JCAHO). To get accredited, healthcare organizations have to comply with a set ofinformation management standards, and theyhave to prove this by SIM plans. There are a lotof papers that deal with the question of how todesign SIM plans to get the best chance to becomeaccredited [11—14]. In this context there arealso commercial software tools available (e.g.http://www.abbeyassociates.com/IMTools.html).

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- identifying the necessary call for action, anddefining the target state,

- defining a migration strategy which determinesthe tactical projects to be carried out.

So, a SIM plan is the result of enterprise archi-tecture planning (EAP; see e.g. [2—4]). As the SIMplan documents the strategic alignment of businessgoals and information management goals, it is oneof the most important references for every stake-holder interested not only in the further develop-ment of the HIS but also in the hospital’s generaldevelopment.

Preparing a SIM plan is a considerable challenge(e.g. [5]) — especially for small — andmedium-sizedhospitals. In [1], we already recommended a shal-low structure for SIM plans. The guideline suggestednow expands this structure and gives advices aboutthe content of a SIM plan and hints about thingsto pay attention to. We hope to motivate infor-mation managers to systematically and completelyplan their HIS.

2. What other approaches are there forthe preparation of a SIM plan

The demand for systematic information manage-ment planning is not new for the health carecommunity. Already in 1991, Lederer and Sethipresented principles for SIM planning [6], Spitzer

Strategic information management is essentialor enterprises of other industries as well as forublic organizations. Several approaches for SIMlanning have been proposed. These approachesre based in information management, informationystems and even business management. Zachman3] proposes in his enterprise architecture frame-ork a kind of classification of what has to beodeled but does not go into detail about how toet the information needed. Boar [4] concentratesn the description of the enterprise architecturend provides several ready-to-use blueprints anddaptable templates. In [15] the Chief Informationfficer Council in the USA as government-wideody addressing SIM planning issues of the federalgencies developed a practical guide of how to planederal enterprise architectures. Comprehensiveuidelines for SIM planning are provided by [2,5].hese books provide advanced knowledge andould complement the guideline proposed in thisaper.We decided to develop a practical guideline for

trategic information management planning in hos-itals for the following reasons:

The guideline should be complete, dealing withall aspects of SIM planning not just focus on spe-cial topics, like e.g. strategic alignment as in[8,9].The guideline should be compendious, and notas comprehensive as e.g. [2,5], and thus be di-

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Preparing strategic information management plans for hospitals 53

rectly applicable when a SIM plan is going to beprepared for a specific health care institution.

• The guideline should be concrete, and not justgive general hints like in [6,7,18] or just providea framework like in [3].

• The guideline should be uncommitted, and notproduce SIM plans answering just one purpose ase.g. [11,14].

• The guideline should be practical, i.e. readersshould not be enforced to deal primarily with the-oretical background.

• The guideline, and especially the illustrative ex-amples, should consider specifics of health careinformation systems.

• The guideline should especially support peopleinexperienced in SIM planning.

• The guideline should reflect the authors’ expe-riences with strategic information managementplanning.

Nevertheless, the core conclusions of the ap-proaches mentioned above should be integrated ifsuitable.

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3.2. Why is it necessary to adopt the SIMplan

During the phase of adopting the SIM plan, thereis opportunity to check the content of the finaldraft version and to enforce modifications. To thateffect, we need strategies to reach consensus. Inlarge hospitals there should exist an informationmanagement board, where the different pro-fessional groups are represented. This board willapprove the SIM plan, and propose it to the hospitalmanagement. If necessary, the consensus findingmay be moderated by an external consultant.The hospital management finally deliberates onthe SIM plan and adopts it. After adoption, itbecomes effective and should not be changed upto the scheduled revision. It is obligatory for allstakeholders. This adoption process ensures thatthe main decision-makers are committed to theSIM plan. It gives planning reliability to all con-cerned stakeholders, especially the IT department,and is therefore a good starting-point for a goal-oriented and successful further development of theHIS.

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. How can we prepare and use a SIMlan

n our lifecycle model a SIM plan passes throughour phases: the preparation, the adoption, the im-lementation/usage and the revision. The revisionhase initiates the rerun of the first three phasesonsidering that the SIM plan does not have to berepared from scratch. In the following we draw at-ention to some points most important within thesehases.

.1. Who is responsible for the preparationf a SIM plan

deally, the chief information officer (CIO) [16,17]s head of the IT department is responsible for thereparation of the SIM plan. If there is no CIO theospital management should choose one responsi-le person who gathers and arranges all informationrom the different stakeholders and draws up a firstersion of the SIM plan. This first version should behe basis for further discussions, which successivelyeads to a final draft version. The final draft goeshrough the adoption process. It is important thathe final draft version of the SIM plan is alreadyligned with the hospital management and with thexpectations of the various departments and differ-nt professional groups to avoid discordance andesulting delay during the adoption process.

.3. How can we implement the SIM plan

deally, the SIM plan is valid for 3—5 years. Duringhis time, it is implemented step by step. Theospital management has to provide financingnd staff necessary for the implementation. Theersons responsible for strategic information man-gement have to monitor the project portfolio ando ensure that the target state of the HIS will beeached as planned. Tactical information manage-ent is responsible for planning and carrying outhe projects given by the migration concept. Eachf the stakeholders has to act in accordance to theIM plan. If new major requirements appear theIM plan may only be adjusted in full and explicitccordance with those having adopted it, i.e. theospital’s management.

.4. When must a SIM plan be revised

he validity of a SIM plan depends on the changingmpact factors on the HIS. These may be new legalequirements (e.g. introduction of new financingules), new user requirements (e.g. introduction ofPACS) or new technical advances (e.g. introduc-ion of mobile computing). Normally, a SIM plan isalid for 3—5 years. A revision should be initiatedn sufficient time, i.e. there should be no period ofime without a valid SIM plan. Nevertheless, thereay be some major unexpected changes of the

54 B. Brigl et al.

HIS necessary (e.g. an unplanned but necessarydisplacement of a central application system). Ifit becomes clear, that the target state cannot bereached anymore, a revision of the SIM plan maybe necessary ahead of schedule.

4. What is the content of a SIM plan

In this chapter we will especially focus on thepreparation of a SIM plan. It describes the contentof a SIM plan and gives advices and best practicesof what to consider most and from where to get theinformation needed. We propose to structure a SIMplan as shown in Table 1. This structure can easilybe modified to fit the requirements of an individualhospital.

In the following, we will go into detail for eachsection of this structure.

4.1. Summary

A summary is necessary for those stakeholders whowant to get a quick overview about the most essen-tial statements of the SIM plan. Aim of the summary

risks should not be overemphasized; existing ad-vances and expected benefits should be presentedappropriately.

4.2. Introduction

Aim of the introduction is to point out, why a strate-gic plan is necessary, which facts are described andwhich goals are pursued by the strategic plan. Be-cause the preparation of a SIM plan causes great ef-forts and the plan must be accepted by all manage-ment levels, the expected benefit must be stressedprimarily.

4.3. The hospital

The HIS must support all hospital functions andfulfill the information needs of all organizationalunits and professional groups, to contribute tothe success of the hospital. Therefore, a shortdescription of the hospital itself is a must for everySIM plan. Without considering the vision, the mis-sion and the goals of the hospital, some relevanthospital characteristics and the organizationalaphm(

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is to precisely point out these essentials as basis forthe stakeholders’ decisions. It may be necessary tomake different summaries available for differentstakeholders. The style of the summary should mo-tivate the reader to support the implementation ofthe SIM plan. For this, past omissions and future

Table 1 Structure of a SIM plan

1. Summary2. Introduction3. The hospital3.1. Vision, mission and goals of the hospital3.2. Hospital characteristics3.3. Organizational structure3.4. Spatial structure

4. Information management4.1. Organization of information management4.2. Goals, principles and standards for informationprocessing

5. The current state of the hospital information system5.1. Hospital functions and information needs5.2. Information processing tools5.3. Communication infrastructure

6. Assessment6.1. Progresses made6.2. Weak points and call for action

7. The target state of the hospital information system8. Migration concept8.1. Overview8.2. Task, time and cost planning

nd spatial structure of the hospital, efficient SIMlanning is not possible. The alignment of theospital strategy and IT strategy is one of theajor goals of strategic information managementsee e.g. [8,9,18]).The hospital vision, mission and goals briefly

nd impressively fix the principal orientation ofhe hospital. The main hospital goals result fromhe vision. It includes ethical demands as wells quality requirements of the hospital to fulfillts mission. Examples are given in Table 2. It isecommended to discuss the vision and the missionf the hospital with the hospital management in aersonal dialogue, even if an appropriate documentlready exists. The personal dialogue does not onlyerve for acquiring the information needed, buts a good opportunity to illustrate the importancef strategic information management planning asell.The hospital characteristics necessary for the

IM plan should give information about the sizend the complexity of the hospital and, with it,bout the extent of information processing. Eachospital has to decide for itself which characteris-ics are important for the SIM plan. Typical hospitalharacteristics are given in Fig. 1. The characteris-ics of the hospital may lead to technical require-ents, e.g. for computer networks and computerss well as requirements concerning the number oflinical workstations, which will effect the middle-nd long-term planning of financial resources and


Table 2 Visions, missions, and goals of a hospital (examples)

Vision‘‘We strive for an international top position on clinical research and realize patient care accordant to the latest

medical knowledge.’’‘‘We see other hospitals, general practitioners and care services as our partners in an integrated healthcare

delivery system and aim for a close cooperation.’’‘‘Our hospital focuses on a patient and process optimized medical care, which requires the interdisciplinary

collaboration of all medical disciplines.’’

Mission‘‘Our mission is to provide the highest quality care, to advance care through excellence in biomedical research,

and to educate future academic and practice leaders of the health care professions.’’‘‘Our mission is to deliver compassionate, high quality, and patient-focused clinical care and health plan ser-

vices.’’

Goals‘‘We want to improve the quality of health care at our hospital without increasing the expenditures.’’‘‘We will reduce our costs of about 15% within the next 2 years.’’‘‘In the year 2004 we will have paperless hospital.’’

of personal responsible for support, maintenance,and staff training.

The organizational structure should make clear,which business areas (including the medical depart-ments) have to be taken into account, and whichbusiness functions they have to fulfill. The analysisof the current state will lead to current informationneeds of the different professional groups of thehospitals and to enterprise functions and processesmore or less supported by the HIS. The organiza-tional structure of the hospital is usually repre-sented as an organizational chart. The descriptionof the current and the target state of the HIS shouldrefer to the organizational units represented there.

The spatial structure shows which buildings haveto be taken into account when planning the HIS as akind of site plan. This is important for the physicalarchitecture of the HIS, especially if the organiza-tional units are distributed over a broader area orover several buildings.

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4.4. Information management of thehospital

4.4.1. Organization of information managementInformation management deals with strategic,tactical and operational tasks. This section of theSIM plan describes which units or persons of thehospital undertake which information managementtasks and how these units are integrated in thehospital’s organization. The organization of infor-mation management described here should not justreflect the actual state. Necessary changes shouldbe discussed in the run-up to the SIM plan, as wellas during the SIM planning process to be sure to geta well-fitting organizational structure of informa-tion management for the implementation of theSIM plan. It is recommended to bundle the overallresponsibility for information management in oneperson, the chief information officer (CIO) [16,17]

Fig. 1. Typical ho
l characteristics.

56 B. Brigl et al.

Fig. 2. Organizational positioning of the IT department.

who leads an IT department as that organizationalunit responsible for the management and operationof the HIS. Depending on the size of the hospitalit may be structured in several units. There areseveral possibilities to position the IT departmentwithin the hospital’s organizational structure (seeFig. 2), and it is the individual decision of eachhospital where to really position it. In our opinion,the CIO should directly be responsible to the hospi-tal top management. In general it is advantageousif there are clear and simple information man-agement structures. Complicated structures are asign for unclear allocation of responsibilities andcompetencies and could endanger the implemen-tation of the SIM plan because conflict resolutionis postponed to the implementation phase.

4.4.2. Information management principles,goals, and standardsThis section will define the basic conditions for in-formation management. These are general infor-mation processing principles, defaults about howinformation management tasks have to be accom-plished (e.g. the establishment of project teams orlegal regulations) as well as standards concerning

Standards (e.g. preferred hardware producers,operating systems, network protocols, communica-tion standards) are needed due to organizational oreconomic constraints. For example, the restrictionon one operating system will lead to advancesconcerning maintenance and training.

There must be a reasonable middle coursebetween a strong regimentation — which wouldunnecessarily narrow the scope of informationmanagement — and a ‘‘laissez-faire’’, where thegoals of information management get lost of sight.Examples of principles, goals and standard aregiven in Table 3.

4.5. The current state of the hospitalinformation system

This section describes the current state of the HISto facilitate the assessment of the progress made.But it equally serves as a frame of reference forthe identification of the weak points in relation tothe information management goals, and for deriv-ing suggestions for improvement (target state) anda call for action.

The current state of a HIS (see e.g. Fig. 3)ctsaTq

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the technical or organizational infrastructure of in-formation processing.

Information management principles must be for-mulated in consensus with the hospital’s top man-agement. Possibly, they can be derived from thehospital’s vision and mission, but in general find-ing information management goals and principles isthe most creative part of SIM planning. We recom-mend to initiate a meeting with hospital top man-agement representatives, the CIO, and some otherdecision-makers, to corporately develop an infor-mation management vision and the associated goalsand principles. These goals and principles will de-termine the target state most.

an most suitably be described by an architec-ural model [2,15,19]. It is reasonable to regard thetructure of the computer-supported part of the HISs well as the structure of the paper-based part.his section should give answers to the followinguestions:

Which hospital functions have to be performedand which information needs are there?For the computer-supported part of the HIS:Which computer-based information processingtools support these hospital functions? Whichhardware and software is installed in which or-ganizational units?


Table 3 Information management principles, goals, and standards (examples)

Principles‘‘Data should be entered once at the place where they appear first and should be at the disposal of all authorized

staff members of the hospital in the context of their activities.’’‘‘Information must be timely and comprehensive for the medical care as well as for administrative purposes and

quality management.’’‘‘The usage of computer-supported tools must improve hospital processes and reduce unnecessary activities.’’

Goals‘‘All digital documents in the context of patient care will be integrated to the electronic patient record and be

accessible were they are needed.’’‘‘The working places of the outpatient units will be provided with computer-supported application systems.’’

Standards‘‘For the communication between application systems the communication standard HL7 is used.

• For the paper-based part of the HIS: In whichmanner are the hospital functions supported andwhich (paper-based) tools are used?

• Which organizational units communicate, whatinformation is communicated, and how is thecommunication realized by information process-ing tools?

For the description of the hospital functions, werecommend to use reference catalogues, e.g. therequirements index for information processing inhospitals (see [20]), which just have to be adaptedto individual demands.

According to our experiences, existing SIM plansmainly consider the computer-based part of theHIS. We want to stress, that the description ofpaper-based information processing tools is just asimportant. For example, the decision of a hospi-tal to keep paper-based patient records has far-reaching consequences for the SIM planning. Ifsolely the computer-supported functions of a hospi-tal are considered, important information needs indifferent organizational units may be overlooked,and in consequence, the analysis of the currentstate will become incomplete (Fig. 3).

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4.6.1. Progress madeThis section will present the progresses made sincethe last revision of the SIM plan. If it is the initial SIMplan, the quality of the current HIS must be judgedcritically.

The information management goals of the actu-ally valid SIM plan and the measures derived fromthose goals are examined regarding their achieve-ment respectively implementation. For goals notachieved or measures not implemented, the rea-sons must be stated. These may be personnel orfinancial bottlenecks as well as changing legal re-quirements or new technological advances, whichmade some measures obsolete. It should also bedocumented if thesemeasures are still current. Thissection informs the hospital management about theprogresses made and motivates to engage in thefurther development of the HIS. Nevertheless, thepresentation of the progresses made should be briefbecause, in fact, it reflects the success of the HISbut says nothing about its future development.

4.6.2. Weak points and call for actionThis section presents the weak points of the HIS,i.e. those components which are not consistentwgtso

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.6. Assessment of the current state

he assessment of the current state should takento consideration the progress made as well as theeak points of the HIS. The assessment has to beased on criteria derived from the hospital and in-ormation management goals and — if there alreadyxists a preceding SIM plan — the call for action pre-ented there. For example, degree of availability ofealthcare professional workstations at the wards,he proportion of all medical reports stored in theigital patient record, or the quality of data rele-ant for accounting may be assessed.

ith the information management principles andoals, and describes the call for action to improvehe HIS. For each weak point it must be clearly de-cribed which principles, goals, or standards are vi-lated.Furthermore, we must consider that there may

e call for actions, which do not directly affecthe architecture of the HIS, but in particularperational information management questions.or example, the goal to introduce clinical work-tations all over the hospital may demand thestablishment of a staff training center. In this caset may be mandatory to uncover deficits concerninghe organization of information management and

58 B. Brigl et al.

Fig. 3. Part of a HIS architecture showing the computer-based application systems, their communication interfacesand communication links between them using the 3LGM2 meta model [19].

derive solutions. Necessary modification proposalsconcerning the information management organi-zation have to be prematurely arranged with thehospital management.

The formulation of the call for action should al-low to derive or to prove the target state. This is nota pure formal process, where the weak points canautomatically be derived from the current state.Rather, it is necessary to use the experiences of thewhole information management staff, who mostlyknow the weak points but do not trace them tothe HIS architecture. Examples for weak points aregiven in Table 4.

Table 4 Weak points and call for action (examples)

Weak points and call for action‘‘The heterogeneity of information processing tools is too high. Mainframes, departmental server, local networks

using different operating systems coexist in parallel. Equal hospital functions are supported by differentapplication systems. This fact contradicts to the principle usage of standards, controlled heterogeneity.’’

‘‘The hospital-wide introduction of a healthcare professional workstation (HCPW) entails increased training op-portunities, because the number of staff members working with HCPW increases and the employee turnovercauses more problems. An adequate staff training can only be guaranteed through the establishment of atraining center and the realization of a systematic training concept.’’

‘‘The access to medical knowledge at the HCPW is insufficient. Partly, the knowledge sources are provided by aknowledge server, partly by the hospital’s intranet, and the user interfaces are not standardized.’’

4.7. The target state of the hospitalinformation system

This section describes the future architecture of theHIS and is basis for the development of a migrationconcept, i.e. the way from the current state to thetarget state of the HIS.

The description of the target state of the HIS canbe similar to the description of the current state ofthe HIS. The target architecture should then showwhich changes are essential in comparison to thecurrent architecture. In this case the differencesbetween the current state and the target state have


Table 5 Problem-oriented description of the target state (examples)

Target state‘‘The healthcare professional workstation shall offer an integrated functionality for physicians and nurses at all

clinical working places, and thus support the cooperation of these healthcare groups. For the long-term, onesoftware product should be used hospital-wide.’’

‘‘The laboratory and radiological results will be presented as HTML documents using a web interface. The callof a result takes place at the healthcare professional workstation by passing patient und case identifyingcharacteristics, user identification and associated authorizations."

to be discussed in detail. We recommend a moreproblem-oriented approach, where the target stateof the HIS is described along the weak points (exam-ples see Table 5). The migration concept can thenbe derived directly from the target state.

At this planning point, central concepts deter-mining the future development of the HIS arecooperatively developed, aligned and announced.The development of these concepts is very labor-intensive and time-consuming. To get general ac-cepted solutions, it is recommended to discussthose concepts right before the actual phase ofstrategic planning activities.

4.8. Migration plan

The migration plan should concretely point outwhat has to be done to attain the target state.Result of that planning step is a project portfoliocontaining planned measures, priorities, the timeinvolved and the costs.

At first, the most important modifications haveto be formulated. Subsequently, you can derive con-crete measures to come from the current state tothe target state. The timeframe should consider thedpsqi

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This section of the SIM plan will be the one readmost attentively by the various stakeholders and,therefore, needs special diligence and realism, tosustain credibility.

It may occur that there are measures demandedwhich can not directly be derived from the infor-mation management goals, the current state of theHIS, the assessment if the HIS or the target stateof the HIS. In this case the associated goal must beformulated and — provided the goal is accepted byall decision-makers — integrated in the SIM plan. Anexample migration plan is given in Table 6.

Table 7 reflects the most essential issues ofchapter 4. For each section of the SIM plan wesummarize the aim that should be achieved bythat section, the content itself, the sources of thatcontent and/or the methods to elicit it, and thepoints that have to considered most.

Table 6 Migration plan — rough planning (example)

Measures in 2002Introduction OP planning and documentation system(closing)

Healthcare Professional Workstation, Phase 1Introduction radiological image server

ependencies between the projects and the projectriorities. Particularly, the available personal re-ources for the realization of the projects and theualification of the staff members must be takennto account.Second, the costs arising from those projectsust be estimated to allow the hospital manage-ent to prepare for the expenses. These are costsor performing the projects (staff, costs for consul-ants) as well as the costs for implementation ofhe measures. Be aware to consider not only directosts for hardware and software but also follow-uposts for operation, maintenance, support and staffraining and even (re)construction of buildings orooms.In a last step it must be made clear with which

riorities and within which timeframe the measuresill be implemented.

Replacement and extension of active net technologyFacility management, Phase 1. . .

Measures in 2003Introduction RIS/PACSHealthcare Professional Workstation (Introductionof IS-H*Med), Phase 2

Introduction Electronic healthcare record, Phase 1Facility management, Phase 2. . .

Measures in 2004Healthcare Professional Workstation (Introductionof IS-H*Med), Phase 3

Facility management, Phase 3Introduction Electronic healthcare record, Phase 2. . .

60 B. Brigl et al.

Table 7 Developing a SIM plan

Section Aim (why) Content (what) Source (S)/methods (M)

To consider

Summary Motivates thestakeholder tosupport theimplementation ofthe strategic plan

Essentials of the SIMplan

SIM plan (S) Different summariesfor differentstakeholders. Stressexisting advances andexpected benefits

Introduction Motivation for thepreparation of theSIM plan (why, what)

Content of the SIM planand motivates thereader

— Stress the expectedbenefits

The hospital Vision, mission andgoals of the hospital

Hospitalmanagement (S)

Discuss the hospital’svision, mission andgoals with the hospitaltop management

Hospitalcharacteristics,organizational andspatial structure

Hospitaladministration (S)

Informationmanagement

Describes the IMresources andresponsibilities

IM organization Organizationalcharts (M)

Don’t just describe theactual state but ratherfind a IM organizationalstructure which isparticularly suited forthe implementation ofthe strategic plan

Defines where to go Goals, principles of IM Desired stateanalysis (M),strategic alignment(M), brainstorming(M)

Align strategicinformation goals andprinciples with thehospital’s vision,mission, and goals

Defines criteria forthe assessment ofthe current state ofthe HIS

Standards of IM Find a reasonablemiddle course betweena strong regimentation— and a‘‘laissez-faire.’’

Current State Provides a survey ofthe HISarchitecture; Is basisfor the assessmentof the current stateof the HIS

Hospital functions andinformation needs;Information processingtools; Communicationinfrastructure

IT department (S);Requirementsanalysis (M);Enterprisearchitectureplanning (M),systems analysis (M)

The current stateshould give a completesurvey of informationprocessing. Don’tforget paper-basedinformation processingaspects

Assessment Assesses in whichpoints the currentstate deviates fromthe IM principles andgoals

Weak points;Progresses made

Application portfoliomanagement (M);Weak point analysis(M)

Target State Describes thearchitecture of theHIS when the SIMplan will beimplemented

Changes concerninginformation processingtools andcommunicationinfrastructure

Enterprisearchitectureplanning (M)

Consider theexpectations andreservations of thevarious hospitaldepartments andprofessional groups.Consider already knownadvanced technologiesor changing legalrequirements inadvance to assure thatthe SIM plan is valid asexpected


Table 7 (Continued )

Section Aim (why) Content (what) Source (S)/methods (M)

To consider

Migrationconcept

Describes how to getfrom the currentstate of the HIS tothe target state ofthe HIS

Project, time, andcost planning

Project planning(M); Projectportfoliomanagement

Set up a realisticproject, time and costplan; don’tunderestimate timeexposure and costs.Define clear prioritiesfor each project and aclear project sequence

5. What happens after the SIM plan isadopted?

After the SIM plan is adopted by the hospitalmanagement the plan is obligatory for all stake-holders in the hospital. Obviously, all strategicplanning principles have to be observed and allplanned projects stated in the SIM plan have to beimplemented. If necessary, minor adaptations ofthe SIM plan may be possible, but only in full andexplicit accordance with all people who adoptedit (see also Section 3.3). Major adaptations shouldlead to a complete revision of the SIM plan (seeSection 3.4). Furthermore, all changes concerningthe architecture or the infrastructure of the hos-pital information system or the organization of theinformation management must be compatible withthe SIM plan. This holds for hospital-wide projectsas well as for departmental projects.

A prerequisite for the acceptance and the imple-mentation of the SIM plan is to inform all concernedprofessional groups about how they are involvedwith the implementation of the SIM plan. Informingall concerned stakeholders broadly is decisive for asuccessful implementation of the SIM plan. Only iftan

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working together, the faculty’s Medical Informaticsdepartment acts as the hospital’s consultant in thefield of strategic information management. Thus, itorganizes the information management board andprepares the SIM plans.

The first SIM plan had been established in 1996and intended to be valid to the year 2000. Basedon this plan important steps were taken to come toan information system with more efficient supportespecially for functions in the clinical context.

In the late 2001 and the beginning of 2002 a newSIM plan has been prepared using the presentedguideline [21]. The plan resulted from an 8-months-project comprising a lot of meetings with the hos-pital’s top management and innumerable meetingswith persons responsible for information manage-ment. Finally, the plan had been adopted by thehospital’s board of directors.

The following observations can be made regard-ing the usability of the guidelines:

• The proposed structure of the strategic planproved to be well suited. The only change instructure of the SIM was to place the hospital’sgoals as top level chapter following the ‘‘The hos-

•

•

he SIM plan becomes a really used tool for planningnd implementation of projects, it fulfils its aims —ot if it disappears unread in the tray.

. Experiences

.1. University Hospital Leipzig

he University Hospital of Leipzig, Germany, is aospital with more than 1400 beds, 3830 employeesre caring for 44,400 inpatients and about 230,000utpatients a year. The ‘Information Management’epartment is supported by a committee for strate-ic information management (information manage-ent board). Since the University Hospital and theedical Faculty of Leipzig University are closely

pital’’ chapter. This was helpful in getting atten-tion from top management.There had been no vision, mission or goals in acodified form in the hospital before the projectstarted. It turned out, that strategic informationmanagement is an excellent catalyst for strategicbusiness planning. In various discussions with topmanagement important goals could be identified.They became basis for the strategy of the uni-versity hospital. One of the most important goalswas that of striving for process oriented patientcare instead of department oriented care. Thisgoal had a major impact in defining the neededchanges of the HIS. So the importance of havinggoals defined before strategically planning thehospital’s information system proved true.When discussing the organizational structure andthe responsibilities for information management,

62 B. Brigl et al.

the structure of information management as pro-posed in [1] was very helpful to define benefi-cial division of labor without forgetting importanttasks and duties.

• Although the guideline recommends, that ‘‘atfirst, the most important modifications have tobe formulated’’, that passage in our ‘‘Migration’’chapter was omitted. This turned out to be asevere mistake, because for executives and topmanagement it is now difficult to understand thevariety of different projects and to find out theirmajor aims.

• Due to shortage of time and considerable pres-sure to complete the strategic plan, the most se-rious mistake was made. This was to calculateonly investment costs concerning hard- and soft-ware for the measures to be taken. Now alsocosts for investing in server and training rooms,for tactical information management (e.g. costsfor consultant services during implementationprojects), and for operational information man-agement (e.g. costs for operational and adminis-trative personnel) have to be recalculated.

6.2. Tyrolean Federal Hospitals

nual IT plans, to derive concrete projects togetherwith the IT budget for the next years, to align the ITstrategy with the TILAK business goals, and finally,to inform all user groups on the way informationprocessing will develop in the next years.

The development of the IT strategy started inApril 2002. The draft was ready in October 2002,and after intensive and broader discussions, the 80-page IT strategy was accepted by the TILAK man-agement in December 2002 (see also [22]). Duringthe 9 months of development, two formal meetingsand seven working meeting of the committee tookplace, prepared by additional 14 meeting of the ed-itorial team.

During the development of the IT strategy, thefollowing experiences were made:

• We found the proposed structure of the IT strat-egy as given by the guideline well suited and help-ful. Only minor modifications were made. For ex-ample, we started the IT strategy with a chapteron the future development in healthcare whichform the background for the TILAK strategy andtherefore also for the TILAK IT strategy. Then,we invested some time not only to describe the

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The Tyrolean Federal Hospitals (TILAK) is a hospitalassociation, which comprises the University MedicalCenter Innsbruck (with 1500 beds) and four smallerhospitals in Tyrol (with altogether 600 beds). TheTILAK also holds shares on other Tyrolean hospi-tals as well as on several healthcare companies.TILAK was founded in 1991 to ensure the propersupply of healthcare services to the Tyrolean pop-ulation. About 7600 staff members are working forthe TILAK, the annual budget is around 350 MD ,about 4% of this being spend on IT.

To advise the TILAK management in questionsof information management, a committee forstrategic information management exists. Thiscommittee comprises a professor for medicalinformatics with strong experiences in strategicinformation management (head of the committee),the TILAK CIO, and an IT representative from theMedical Faculty of the University of Innsbruck.Further advising members are the head of ad-ministration of one of the TILAK hospitals, theTILAK vice-CIO and a second professor for medicalinformatics. In 2002, TILAK decided to develop a5-year IT strategy and gave the committee thistask. There had been experiences in preparingboth annual and long-term IT strategies.

Themotivation for preparing an updated IT strat-egy was to rise the already high quality of informa-tion processing, to create a framework for the an-

present IT architecture and infrastructure, butalso to find quantitative indices for the amountand quality of information processing such as theproportion of reports transmitted in electronicform, or the proportion of radiological imagesstored in electronic form. We also added a sub-chapter on ongoing IT projects, as they have tobe coordinated with the planned IT projects.The development of the IT strategy was startedwith a 1-day vision workshop by the committeemembers to derive the major aims of informationmanagement. We found this very useful to geta clearer picture where TILAK IT should be in 5years. The visions discussed here were structuredand later integrated into the IT strategy in thechapter describing the future state.We structured the organizational levels of infor-mation management into strategic, tactical andoperational and found this very useful.Usually, stakeholders are more interested in thefuture state (and the needed budget to go there)than in the recent state of information process-ing. However, the complete and structured de-scription of the recent state is important in ouropinion, as it is both the basis for the descrip-tion of the future steps as well as the refer-ence to describe the development of the IT inthe years to come. In our case, as TILAK al-ready had a well-organized information manage-ment for many years, the often time-consumingdescription of the state of information process-


ing could be done rather quickly. It occupies,however, together with the description of TILAK,about the half of the pages of the IT strategy.In order to reduce the dominance of those partsof the IT strategy, we included the description ofthe organization of information management andthe assessment of the recent state in the chap-ter on description of the current state, thus nowhaving four main chapters within the IT strategy:description of TILAK; description of current IT;description of future IT; description of future ITprojects.

• We only shortly described the future IT archi-tecture, but rather thoroughly described theplanned IT projects (about 70 in our case) andindicated the expected time frame. We did notadd budgetary information for the individualprojects, but for blocks of projects, and werethus able to derive the necessary budget for in-formation management for the next 5 years.

• The IT strategy had to take into account thatTILAK is an association of various hospitals, allwith their own characteristics (e.g. partly dif-ferent software in use). It is important to seethat the IT strategy must be valid for all TILAK

•

•

Overall, the guideline seems to be a good sup-port for the structured and efficient developmentof an IT strategy. However, it cannot, in our opin-ion, replace years-long experience with strategicIT management. Thus, hospitals facing this topicfor the first time are nevertheless advised to re-cruit external consulting, even when using thisguideline.

6.3. Minden Regional Hospital

In the year 2002, Minden Regional Hospital, a 1000bed hospital, authorized a healthcare consultant todevelop a SIM plan comprising an IT strategy and acorresponding action planning in view of the forth-coming move of the hospital to a new complex ofbuildings.

The development of that SIM plan required theanalysis and description of the status quo of infor-mation processing, especially the hospital functionsand their support by logical and physical informa-tion processing tools. In this regard, the organiza-tional, functional and technical weak points of theHIS where considered most. After that, the strate-gic goals for the further development of the MindenH

•••

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mescAp

stmfH

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hospitals (e.g. uniform IT infrastructure), with-out overlooking the individual qualities of eachthus. Thus, we stuck to the general structure asgiven in the guideline, and only described differ-ences in the hospitals where necessary (e.g. withregard to individual software projects).In order to ensure that the strategic IT plan isreally accepted in all TILAK hospitals and by alluser groups, we invested some time in presentingand discussing the draft of the IT strategy, asalso indicated by the guideline. For example,the draft was discussed with the managementof all TILAK hospitals, with IT representativesfrom the Medical Faculty of the University ofInnsbruck, and with representatives from theTILAK IT department. Second, the IT strategy isdistributed widely both in a printed form as wellas in the Internet.The committee which developed the IT strategydid not comprise representatives from clinicalprofessionals (in particular nurses and physi-cians). While the limited numbers of committeemembers certainly supported an efficient work,it was discussed whether this organizationmay not sufficiently integrate the clinician’spoint of view with regard to IT. We feel thatby the long-year experience of all committeemembers with clinical information processing,this was not a real problem. However, it is nowplanned to extend the committee with clinicalprofessionals.

IS where acquired:

Implementation of the IT strategy.Setup of an electronic patient record.Mapping of workflows concerning individual hos-pital units.Measures to completely reproduce performedmedical services and procedures.Measures to improve the organization.Measures to improve the IT infrastructure andMeasures to support logistics.

Starting from those goals, a precise catalogue ofeasures was developed, which describes all nec-ssary steps to reach the strategic goals. A sub-equently submitted plan of stages established ahronological connection among these measures.dditionally, the plan of stages pointed out the ex-ected costs.For the preparation of the SIM plan, the pre-

ented guideline was extensively consulted, andherefore, could be realized within less than 3onths. The content of the SIM plan is now basisor all HIS planning activities of Minden Regionalospital.The guideline used for the preparation of the

IM plan provided broad support, especially for theough planning of the strategic procedure and forhe structuring and the check for completeness ofhe SIM plan. Nevertheless, the authors of a SIM planre responsible for sufficiently adapting the content

64 B. Brigl et al.

as well as the degree of detail to the hospitals’ in-dividual specific concerns.

7. Discussion

In this paper we presented a guideline for thepreparation of SIM plans as an important instrumentfor the management of HISs. The guideline givesrecommendations about the structure and contentof a SIM plan and details about what to considermost.

The guideline was used for the preparation ofseveral SIM plans in German and Austrian hospitals.These practical experiences showed that

• the SIM plans could be prepared very efficientlyand timely using the guideline;

• the proposed SIM plan structure suited well, onlyminor modifications were necessary to accommo-date local priorities;

• the guideline offers enough flexibility to meet therequirements of the individual hospitals;

• the specific recommendations of the guidelinewere very helpful.

ture recommended by the guideline suggests thedevelopment of a software product supporting thepreparation of SIM plans. Though there are someprofessional tools available, these tools are verytargeted to answer a certain purpose, e.g. toolsfor needs assessment and development of strate-gic information management plans in the scope ofaccreditation programs like the JCAHO accredita-tion, but are not sufficient for general strategic pur-poses.

Acknowledgement

This paper results from a broad discussion betweenmembers of the GMDS (German Society for Medi-cal Informatics, Biometry, and Epidemiology) work-ing group ‘Methods and Tools for the Managementof Hospital Information Systems’. Particularly, wethank Prof. Dr. Reinhold Haux for his valuable sug-gestions, hints and critical discussion and the au-thors of the discussed SIM plans: Reinhold Haux,Georg Lechleitner, Karl-Peter Pfeiffer, ChristianTriendl, Raimund Vogl for the Tyrolean Federal Hos-pitals, Alfred Scharsky, Klaus Borner, Gabriele Her-rWSH

R

Nevertheless, the usage of the guideline holdssome risks:

• SIM plans tend to become rather general and vac-uous if the guideline is used as template or for-mula that just has to be filled out. Users must beaware that the guideline reflects general hintsand best practices whereas a SIM plan must re-flect the specific situation of the health care in-stitution.

• The guideline primarily gives hints about the con-tent of a SIM plan. It is up to the user to designa SIM plan which is concise, coherent, balancedand understandable for the different groups ofreaders, and as mentioned above specific for thehealth care institution.

• Persons totally inexperienced in SIM planning arerecommended to read advanced literature andmay need the help of external consulting even ifthey use the guideline.

The approaches cited in Section 2 of this paperare especially suited for more experienced IT man-agers who want to go into detail.

The guideline and the resulting SIM plans is afirst step striving for enterprise architecture plan-ning in hospitals. Nevertheless, we must come upto a more comprehensive theory of strategic infor-mation management planning which represents theintrinsic correlations of the different parts of a SIMplan to a greater extent. Furthermore, the struc-

mann, Anselm Schneider, Thomas Wendt, Wernerittek for the University Hospital Leipzig, Claudiachulte-Bredemeier, Jens Gerber for the Regionalospital Minden.

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