HINF 500 Week 4 Roles and Responsibilities in the Information Systems Department Example

Who Owns the Record? Mapping the Roles, Reporting Lines and Gaps in a Community Hospital's 64-Person Information Systems Department

[Student Name]

University of Phoenix

HINF/500: Informatics for Health Administration

Week 4 Assignment

[Instructor Name]

[Date]

The hospital, its department, staffing and decisions are composites written for a model paper; research findings come from the sources listed.

At a medical staff meeting, a hospitalist at a composite 310-bed community hospital said that no one in information systems understood clinical work. The chief information officer replied that clinicians never told the department what they needed until something broke. The vice president of operations, who oversees the information systems budget, asked for a map of the department: who does what, who reports to whom and where the gaps are. This paper presents that map.

Why Structure Matters

Clinicians spend much of their day in the electronic record. In a time-and-motion study of 57 physicians in four specialties, physicians spent 27.0% of their office day in direct face time with patients and 49.2% on record and desk work, and those who kept diaries reported one to two more hours of record work each night (Sinsky et al., 2016). How the information systems department is organized, and whether clinicians have a real voice in it, affects that burden directly.

Leadership

The chief information officer answers directly to the chief executive and holds a seat among the senior leaders. He sets technology strategy, manages a $14 million annual operating budget and major vendor contracts and chairs the technical side of governance. Reporting to him are the directors of applications, infrastructure and service, a manager of data and analytics, a project management office and the information security officer.

The Department by Team

Applications (22 staff): analysts who build and maintain the electronic record, including clinical documentation, orders, pharmacy, laboratory, radiology, revenue cycle and scheduling modules, organized by module with some staff certified by the vendor.

Infrastructure (12 staff): network, servers, cloud services, storage, backups and end-user devices, including 2,100 workstations and mobile devices.

Information security (5 staff): the information security officer and analysts who manage access controls, threat monitoring, vulnerability scanning, incident response and phishing training.

Service desk (11 staff): the round-the-clock help line and on-site support for password resets, device problems and first-level application questions.

Data and analytics (6 staff): the data warehouse, dashboards and reports, including the operational and quality reports used in earlier papers.

Project management office (4 staff): planning and tracking of projects such as upgrades and new modules.

Integration (4 staff): interfaces that move data between the record and outside systems, including laboratories, the state immunization registry and health information exchange.

How Work Flows Through the Department

Tracing a single request shows how the teams connect. When the emergency department asked for a sepsis alert, the request went to the project management office, which logged it and brought it to the steering committee for priority. An applications analyst built the alert with the chief medical information officer's clinical input, the integration team connected laboratory results, infrastructure confirmed the servers could handle the added load, the analytics team built a report to monitor alert firing and response and the service desk prepared for questions after go-live. The request took five months, partly because it waited eight weeks for the next council meeting. Every team did its part, but no one tracked the request from the clinician's point of view.

Vendors and Outsourcing

Much of the hospital's technology is supplied by vendors. The electronic record is hosted by its vendor in a remote data center, a model that shifts server maintenance and some security work to the vendor but makes the hospital dependent on contracts and service levels. The department manages about 140 vendor relationships, from the record company to small software firms serving single departments. Contract management sits with the chief information officer's office, but no one regularly reviewed whether all those systems were still used, which is how the duplicate licenses were found.

Clinical Informatics Roles

The bridge between clinicians and technology is clinical informatics. Clinical informatics has been a recognized medical subspecialty, with defined core content ranging from clinical decision support to the design of health information systems and leadership of change (Gardner et al., 2009). The hospital has a chief medical information officer, an internist who spends 20% of her time in the role and reports to the chief medical officer, with an informal connection to the chief information officer. There is no nurse informatics leader, although nurses log more hours in the record than any other group.

A Growing Leadership Role

A national task force report described the chief clinical informatics officer as a senior leader responsible for making clinical information systems useful, safe and effective, and called for defined skills and formal training for the role (Sengstack et al., 2016). A physician with one day a week cannot fill that role at a hospital this size. The department had people who understood servers and people who understood patients, but almost no one whose job was to understand both.

Governance

Two committees govern information systems. The information technology steering committee, chaired by the vice president of operations, approves projects and budgets. A clinical informatics council, chaired by the chief medical information officer, reviews changes to clinical content and decision support but meets only when a project needs it and has no nursing representation.

Privacy and Compliance

The privacy officer reports to the compliance department, not to information systems, which provides independence. Privacy and security staff meet monthly to review access audits and incidents.

Gaps in the Chart

The map revealed five gaps. Clinical informatics leadership was part-time and lacked a nursing counterpart. The clinical informatics council met irregularly. No one owned data definitions across the organization, so departments reported different numbers for the same measure. Clinicians had no easy way to request changes or see their status. And the security team, at five people, had grown more slowly than the threat.

Five Changes

The vice president recommended five changes. First, expand the chief medical information officer role to half time and create a chief nursing information officer at half time, both with dotted-line reporting to the chief information officer. Second, make the clinical informatics council a standing monthly body with nursing, pharmacy and physician members. Third, appoint a data governance lead in the analytics team to own definitions and a data dictionary. Fourth, launch a clinician request portal with visible status and quarterly reports on what changed. Fifth, add two security analysts, funded partly by reducing duplicate software licenses the map uncovered.

Measuring the Effect

The department will track clinician satisfaction with the record through an annual survey, time spent in the record after hours from vendor usage data, request turnaround time, project delivery on time and budget and security measures such as phishing click rates.

Conclusion

The information systems department had capable technical teams, but the map showed that the clinical side of the record had no full-time owner, data had no steward and governance gave clinicians only an occasional voice. The five changes add clinical informatics leadership, regular governance, data ownership, a request portal and security capacity, aligning the structure with the work clinicians do in the record every day.

References

Gardner, R. M., Overhage, J. M., Steen, E. B., Munger, B. S., Holmes, J. H., Williamson, J. J., & Detmer, D. E. (2009). Core content for the subspecialty of clinical informatics. Journal of the American Medical Informatics Association, 16(2), 153-157. https://doi.org/10.1197/jamia.M3045

Sengstack, P., Thyvalikakath, T., Poikonen, J., Middleton, B., Payne, T., Lehmann, C., & Kannry, J. (2016). The chief clinical informatics officer (CCIO): AMIA task force report on CCIO knowledge, education, and skillset requirements. Applied Clinical Informatics, 7(1), 143-176. https://doi.org/10.4338/ACI-2015-12-R-0174

Sinsky, C., Colligan, L., Li, L., Prgomet, M., Reynolds, S., Goeders, L., Westbrook, J., Tutty, M., & Blike, G. (2016). Allocation of physician time in ambulatory practice: A time and motion study in 4 specialties. Annals of Internal Medicine, 165(11), 753-760. https://doi.org/10.7326/M16-0961