IT 101

It's rather interesting what passes for IT these days. "Healthcare IT" seems to refer to Microsoft Azyxxi, EMR's, health information exchange certifications, and telemonitoring from patients' homes all in the same breath.

So far, I think people think "healthcare IT" means a "monolithic on-premises application, derived most likely from MUMPS, that's HL7 compliant and too expensive to port to physicians' offices unless it's Vista in which case it's probably free but has shall-we-say a learning curve." Somewhat like the situation not too long ago with products and vendors such as SAP for ERP in the manufacturing field.

In manufacturing, market forces and the steady progression of real IT shaped the acceptance and use of a wide variety of products and systems to manage business processes. And still the major players came out ahead -- primarily because they were agile and because the business of IT supporting business is serious business.

Insofar as healthcare IT is at a crossroads today similar to that when mainframes went client/server, and again when client/server went web (and now that portals are going Web 2.0), it's probably a good idea to review the basics -- IT 101, as it were -- of what constitutes information technology, its adoption, and its evolution for a particular industry. For now, we see, the business of IT supporting the business of healthcare is serious, serious business.

Here's my hierarchy of information technology support levels for an organization:

• Infrastructure
• Applications
• Processes
• Technology
• Customer Service

Infrastructure support provides the "basal metabolism," as it were, for IT functions that are pretty much common across all industries.

Support for Applications addresses the differentiators that are important to healthcare to serve functions for service delivery (electronic medical record, imaging systems, patient bedside monitoring, CPOE, the standard stuff).

Support for Processes refers to the true purpose of IT implementation -- namely, effective use of technology and evolution of that effectiveness to help ensure that business processes succeed in their intended goals. (What is the business of a provider organization? What processes serve the business? What IT applications, and sequencing of those applications, ensure the success of those porcesses in serving the business?)

Technology support paves the way for agile, innovative "invocations" of the organization's fundamental business processes. As the technology grows and matures, so do the processes and their results improve. (What's the measure of improvement? Cost? Quality? Profitability?)

And finally, Customer Service rests at the pinnacle -- that is the true business of healthcare, is it not? and the true target of IT support for healthcare business processes.

There's a particular reason I find this hierarchy really helpful: when you look at IT this way, you can start to identify separate metrics for the different levels that let you assess the performance of your IT implementation choices based on the business performance they target. For example, try these measures for analyzing your IT systems, and for analyzing how they associate with measures of your business systems' performance:

• Infrastructure: Reliability, Efficiency
• Applications: Cost, ROI, Availability
• Processes: Effectiveness, Efficiency
• Technology: Cost-of-Conversion, Earned Value
• Customer Service: Responsiveness, Quality-of-Service

This way you can begin to understand the components of your IT installations, and begin to compare accurately the value and effectiveness of different implementations (systems, technologies, processes) that the IT organization serves. Now there's a way to measure business performance...