Facing health IT's varied, multiplying demands

I spoke to a colleague recently at an all-day event that featured networking and industry updates. We observed that these events—where we receive relevant information through a fire hose—are actually respites from our daily schedules.

As healthcare chief information officers, in addition to dealing with required meetings, policy review, preparations for regulators and other routine duties and responsibilities, we juggle an ever-growing list of strategic rapid-implementation projects that offer financial incentives and competitive opportunities critical to our organizations' continued success. Between regular work, project planning, staff development and augmentation, we scan 500 daily e-mails and text messages, respond to voice messages and take mobile calls. I do not recall the last time I had one hour of uninterrupted office time.

We all are going after meaningful-use incentives that require no less than a transformation of healthcare delivery, demanding a fundamental shift in our workforce's traditional roles and responsibilities. We are dependent on vendors to deliver certified applications that perform as expected. In reality, we accept ultimately that vendors are spread as thinly as we are and that we must get in line for upgrades and support. Every upgrade now requires prolonged rigorous testing, post-implementation troubleshooting and a level of vendor management that would not have been acceptable in the recent past.

Many community healthcare providers want to redirect their energy to patient care rather than continue to worry about how to cover office expenses, given unfavorable reimbursement changes. When providers make the difficult decision to join a larger entity, health systems must respond as quickly as possible. Much more than establishing connectivity is required. In mergers and acquisitions of all sorts, new staff members are likely to resist adapting to different security measures, workflow and technology. IT is challenged to make "it look like ours but perform as yours."

Few health systems have the capital resources for new construction, but facilities must be maintained. In light of the 24/7 nature of healthcare, the heavy traffic of equipment and people takes a toll on facilities. We continually modernized patient rooms to appear more like an inviting spa than a sterile institution. Also, surgical units and diagnostic imaging departments' new technologies demand physical accommodation, more power and emergency backup and square footage. Renovations of any sort require infrastructure redesign and a small IT army to redeploy equipment in the short window between the completion of construction and occupancy.

While renovations are ongoing in the core facilities, health systems are expanding the outer ring, offering outreach strategies to meet their busy and aging customers' demands for new services, convenient locations and extended hours. IT coordinates with telecommunications providers (with lead times of as much as four months in our area) to establish required bandwidths to satellite locations, often working around natural disasters and labor issues. Our outer-ring locations send and receive large images, yet they need to operate as though they are located down the hallway from the core services on the main campus.

As staff members become more computer-literate and comfortable with technology, a new world of automation opens for them. They look for new tools that provide better information and increase productivity. Although there is enthusiasm for the new applications at the outset, there remains some degree of naivete with regard to the initial and ongoing investment of time and attention required to produce the intended value from the new system.

Life-cycle planning and resource allocation is increasingly more significant as more areas depend on technology. In addition to the life-cycle replacement of software and equipment, regulators, auditors and payers continue to require software changes and upgrades. These maintenance projects now include the magnitude of the ICD-10 conversion project.

Aside from continual application upgrades, corporate equipment must also remain compliant with security patches while IT staff addresses security-audit remediation. IT must maintain the infrastructure to achieve peak performance—that infrastructure now includes the wireless network, single sign-on and other utilities to meet growing demand while protecting the organization against malware and sabotage.

As more areas go paperless, securing these investments becomes a priority. Data center location and design in most organizations was established when the only systems accommodated were batch, rather than real-time systems that supported workflow and clinical decision support. Locations typically were spaces that had no useful clinical purpose such as basements. However, today we are not willing to accept the risk of a basement flood.

While finalizing our new data center design, I asked a room of leaders to identify the systems requiring 100% availability. Finance was first to answer and did not believe that it was important to maintain 100% availability for the electronic medical records but contended that e-mail needed to be available at all times. Engineering added that the data center houses our security card access server that controls building, office and parking-lot access. It was not necessary to continue around the table, as it was apparent that when we use technology, we depend on its availability. Therefore, to accommodate the rapid growth and demand, a data-center strategy ensures not only sufficient power, cooling and rack space but also sub-second fail-over design to mitigate points of failure approaching U.S. Defense Department requirements. Disaster recovery is unacceptable; the business must continue without interruption.

I have never worked in an organization that believed that IT offered too many services or that the department responded too quickly. However, today, the volume and complexity of health IT initiatives challenge even the most seasoned health IT executive.

Edith Dees

Chief information officerHoly Spirit Health SystemCamp Hill, Pa.