IT Choice Points

Choice Points. No matter what role one plays in an organization, everyone has Choice Points that arise from time-to-time to which he or she must respond. A Choice Point is one of those critical strategic decisions to make on behalf of the organization. These decisions can become career-impacting in that, if the outcome goes well, the individual will likely earn high praise and may even receive more responsibility or a promotion. Conversely, if the result of a Choice Point decision falls short of expectations or completely fails, that employee may have to look for another job unexpectedly.

Choice Points commonly have the following characteristics:

• The consequences of being wrong are severe. For example:
  1. A software company’s strategy ignored the Internet and security and went out of business.
  2. A hospital failed to execute a provider network strategy and lost money and market share.
• These decisions have major impact on other determinations. For example:
  1. A move to protocol-driven care.
  2. A move to protocol-driven care.
• How will it get provider buy-in and sustained support?
• What governance structure needs to be established?
• How do we measure and report progress and to whom?
• These decisions have a significant impact and changes to the business. For example:
  1. Taking on contractual risk arrangements.
  2. Implementing a true continuum-of-care strategy.
  3. Pursuing an acquisition or joint venture

In the world of Information Technology (IT), Chief Information Officers (CIOs) also face their own high risk, high cost, and highly visible Choice Points. The extent to which these Choice Points are assessed, understood, communicated, and executed have a critical effect upon the upstream and downstream operations throughout the organization. Decisions involving IT often touch many or all aspects of an organization.Following are a few IT Choice Point examples that many CIOs with whom we interact are currently facing:

• Cloud-Based Electronic Medical Record (EMR) Architecture: Deciding to move one’s EMR to or from a cloud-based strategy (either in-house or another cloud-based environment) is one of the most critical Choice Points that a CIO can make. Such a decision sets a course for at least the next 5 to 7 years.

• Clinical Decision Support (CDS): Many organizations are investing in CDS systems to help providers make higher quality, more timely, and cost-effective decisions with less variability. Such a move leads to other critical determinations to address, such as who and how will decision rules be developed? How will medications, labs, procedures, problems, etc., be coded and by whom? Who and how will the providers be trained and supported? Without addressing these and related questions, providers have revolted against such initiatives, causing these projects to fall far short or fail.

• IT Health and Wellness Check-Up: Before embarking on a major IT system implementation, a CIO needs to decide if the organization’s physical IT infrastructure and operations, including data networking, cabling, in-house file servers, software, backup and recovery, data security and confidentiality, virtualization, and cloud adaptability are ready for such an endeavor.

• Program Management, System Conversion, and Implementation: CIOs must develop and implement a strategy to convert complex core application systems to a set of new application systems (e.g., EMR, revenue cycle) including mapping, testing, and migrating data from the old to the new IT systems and training users effectively. Today’s broad and complex IT implementation undertakings require a more comprehensive program management approach to manage several related projects simultaneously to ensure that the result improves an organization's performance and effectiveness.

• Legacy System Support and Retirement Strategy: CIOs must also develop and implement an approach to support and decommission older IT systems and data that are superseded by new systems and/or inherited as a result of mergers or acquisitions. Ensuring data integrity, security, and archiving is a fundamental responsibility of the CIO, without which the organization cannot function in our digital society.

• IT Leadership and Staff Development: CIOs must continually evaluate the strengths and weaknesses of their IT organizational structure, including staff roles and responsibilities, knowledge, skills, processes, governance, and current and planned IT portfolio to help justify the value provided from the current IT spend. The development of IT leadership, communication, customer service, technical, and team-building skills must precede or be commensurate with the progress and need of the organization.

How well CIOs handle their Choice Points directly facilitates or impedes the contribution IT makes to the progress or success of an organization. Astute CIOs anticipate and recognize their Choice Points along the way. They also know when they may need a second or third opinion from a trusted fellow CIO, advisor, or another third party.