The effectiveness of an information services (IS) department is directly tied to understanding its parent organization's strategy and goals. Doing so requires clear and regular communication between the IS department and the organization's operations leadership. This becomes more crucial as the size and complexity of the organization increases.
The late management consultant Peter F. Drucker once said hospitals are the most complex human organizations yet devised. Among these institutions, the academic medical center-consisting of an accredited medical school, one or more affiliated hospitals, and affiliated faculty practice plan-represents the high point of complexity.
Penn Medicine, part of the University of Pennsylvania Health System, is a major academic medical center in Philadelphia. It includes a school of medicine, four hospitals in Philadelphia, outpatient centers throughout the region, and home care and hospice services. With such a large number of components, Penn Medicine has an intricate operational structure. Ensuring proper IS service in light of this structure requires a support organization that is centralized enough to take advantage of economies of scale and flexible enough to respond to the large number of operational strategies at the entity level.
Penn Medicine's IS division is a centralized corporate department consisting of more than 300 staff members providing support for approximately 14,000 employees and 200 information systems delivered via 20,000 devices.
EIO AS LIAISON
As is the case at many IS departments, the senior management structure at Penn Medicine consists of a chief information officer (CIO) with several direct reports who manage application systems, technical infrastructure, and project management units. This structure allows Penn Medicine to take advantage of the economies of scale noted above.
In addition to its conventional IS structure, at Penn Medicine several direct reports called entity information officers (EIOs) also report directly to the CIO.
Given the complexity of Penn Medicine, we concluded that a single, system-wide CIO would not have the capability to be fully responsive to each entity's IS needs. Therefore, we created a structure with an EIO who serves as the primary IS executive for each entity. In this role the EIO is the liaison between the entity and the central IS department and works to ensure that IS plans and activities are in place to address the entity's business objectives within the framework of the health system's overall IS goals.
Each EIO reports to both the CIO and the chief executive for his entity. In addition to addressing their own entities' IS needs, EIOs collectively also help to develop systemwide IS strategies to support consistent deployment of technology and business processes throughout the enterprise.
For EIOs to be effective, they need to be the responsive face of IS within their entities. At Penn the EIOs focus on three areas:
reliability and availability of entity-level hardware (e.g., PCs, peripheral devices, networks);
representation and advocacy for entity-level operational requirements; and
planning of systemwide IS initiatives with consideration of entity requirements.
MEETING ENTITY-LEVEL NEEDS
User satisfaction with information services starts with the PC. If a physician cannot access the enterprise EMR during a clinical round or post-surgery, or a nurse cannot check lab results electronically, patient care will suffer. Therefore, each EIO has a staff of desktop and network technicians who are housed at the entity and serve as first responders. These teams deal with all break-fix tickets and service requests for new installations.
Each EIO also has responsibility for reviewing and approving all new hardware purchases for his entity. This ensures proper equipment selection according to IS standards and helps the EIO project support needs for the entity.
How each Penn Medicine entity executes University of Pennsylvania Health System strategy varies by market niche as well as by personnel, technology, and related factors. The EIO is key to understanding entity operational plans so that common system platforms can be best designed, deployed, and supported.
For example, each of the hospital EIOs co-chairs his respective inpatient electronic medical record (EMR) committees. This role provides a perspective that is crucial for helping understand and advocate for systemwide changes in the EMR that also address the needs of their particular entities.
At the Hospital of the University of Pennsylvania, where I am EIO, the phlebotomy staff does the majority of our blood draws. However, our peer institutions-Penn Presbyterian, Pennsylvania Hospital, and Penn Medicine at Rittenhouse-handle blood draws differently. So when my hospital wanted to improve its blood collection process, I worked with the central IS support team and our peer institutions to implement new systemwide lab approaches that took my hospital's specific needs into account while still satisfying the other institutions.
At Penn Medicine enterprise-wide information systems such as electronic medical records are conceived and initiated at the central level. However, as it proceeds toward budgetary adoption, the health system needs to account for variations within its hospitals to ensure appropriate funding and staffing for each entity.
Because of their first-hand knowledge and direct reporting relationship to their entity's leadership, EIOs are able to more effectively communicate entity-level infrastructure requirements to the systemwide CIO than a single CIO could hope to learn on his own. For example, Penn Medicine has recently begun planning to install PCs in every patient room to promote increased usage of our inpatient EMR. I worked with my technician team and my hospital's nursing leadership to determine the PC, networking, and power requirements for each of our clinical units. This effort will help ensure proper system budgeting for the fiscal year.
The focus on reducing expenses and minimizing variations in care supports the practice of centralizing and consolidating information systems. But being responsive to local needs and requirements is equally crucial. While this may seem like a difficult balancing act to carry out-and it often is-we at Penn Medicine have shown that it is possible. The key has been the ability to maximize the sharing of information about IS needs and priorities with and among central administrators and local leadership and clinicians. The dual reporting structure gives EIOs credibility with their own hospital leadership and clinicians-for whom they are advocates-as well as the systemwide CIO to whom they report.
Andre Jenkins is entity information officer at the Hospital of the University of Pennsylvania. Healthcare Informatics 2010 August;27(8):28-29
