Snapshot

When clinical and information technologies are implemented in the service of an enterprisewide strategy, they can unify newly merged organizations.

In the same way “It’s the economy, stupid,” took hold during the 1992 presidential campaign, “It’s the system, stupid,” has become conventional wisdom in health care. As in: “Our provider network will now become a truly integrated health care system” or “Our health care system must undergo a shift to patient-centeredness.”

The ongoing consolidation of hospitals into ever-larger systems presents an opportunity to improve care by managing technology more effectively. To achieve these improvements in care, ECRI Institute proposes that an area of “systemness” that should get more attention is what we refer to as “technology systemness.”

Contrary to initial impressions, technology systemness does not refer simply to connecting technology to interconnected systems, though that goal remains critical. Instead, it represents a larger context. In essence, it promotes the consideration of technology issues in the context of the overall enterprise systems of care and how they are used within the organization. While the idea of perfectly interconnected technology has huge value, true technology systemness has even greater potential.

Why is this? Simply, health care technology, both clinical and informational, has the potential to act as an integrating force for all of the people and processes within health care organizations. Too often, technology is more of a balkanizing, rather than integrating force. For example, clinical technology requests as expressed in the capital budgeting process typically pit the needs of one department against another in a battle of who needs what most urgently. Likewise, in a multihospital system, capital budget needs frequently pit one hospital’s needs against another.

In our experience, this aggressive, disconnected advocacy often distorts the best prioritization of capital needs. The right mindset, for boards and executives alike, seeks to view technology not simply as pieces of equipment or computer servers that departments use to do their jobs. Rather, it reflects an attitude that the entire enterprise must adopt an enterprise technology “system” that first prioritizes, manages and understands needs at a global level and second at a department or individual hospital level.

Tenets of System Thinking

This new way of thinking requires adoption of two basic tenets of technology systemness. First, organizations should always attempt to standardize technology where possible. Standardization must become a critical component of enterprise technology planning. Unfortunately, the primary objective of technology standardization often has the wrong goal in mind — that of short-term acquisition cost saving.

Standardizing for the sake of price discounts misses the larger opportunity to use technology to help drive more efficient and higher quality care. If your organization standardizes to fewer or even one supplier and increases volume, it likely will get a better price — whether it is buying pacemakers or pickup trucks. But more importantly, it will reduce technology variation across hospital systems, which has the potential to reduce errors, create standardized training on the technology for the entire system of locations, improve reliability and improve service options. Just imagine consistent use and maintenance of physiologic monitoring systems across multiple facilities and the advantages that would provide.

Now, some believe that standardization stifles innovation. How can your organization avoid getting trapped by a bad technology decision or falling behind the new technology curve? Use small, well-defined pilot technology innovation projects to test different opportunities. The solution to the innovation quandary is not to have a constant supply of different technologies at every location. It is to do targeted technology experiments to keep new ideas on the forefront.

The second tenet is to implement proactive technology planning on a system level. If health care technology is important to the future of health care, it is important to the future of every health care system. Thus, boards and system executives must understand the technology needs at an enterprise level in the same way they understand the enterprise finances. This is critical to creating a link between technology acquisition and enterprise system strategy. Though perhaps an overused word, strategy matters to success. Yet, in systems everywhere, corporate strategy underplays the role of technology in success. This should not be confused with using technology as strategy — which generally will not work — but, rather linking capital budgets, resource allocation, technology directions and choices, as well as people’s time and energy, more closely with overall strategic organizational objectives.

Every manager should have a technology plan within his or her area’s strategic plan. Priorities for technology procurement should align with the strategic imperatives of the system. Every health care strategic plan should address and include how information and clinical technology will enable and advance strategy. If a plan barely mentions technology or focuses only on electronic health records, it should raise a red flag. Is the organization missing an opportunity to build its technology platform to advance its cause more effectively? Is the organization missing an opportunity to improve care by improving its investment in and deployment of all of its clinical and information technology?

Choosing a Solution

How will boards and leaders know if they are on the right track? Reflect on a slight variation in the trite old line we often say to each other: If you are not part of the solution, you are part of the problem. The board’s job should always be to check technology decisions in the same way. When faced with a decision, first ask: Are these technology choices consistent with our systemness mindset? If not, well, they will be part of the problem.

The opportunity at health care systems large and small to use technology systemness as a basic principle of improving overall quality and productivity has become low-hanging fruit. But even low-hanging fruit requires picking. So, when it comes to those next big technology choices, pick well. 

Anthony J. Montagnolo, M.S. (amontagnolo@ecri.org), is executive vice president and chief operating officer of ECRI Institute, Plymouth Meeting, Pa.