June 2009

Strategic Management of Information Systems in Healthcare : By Dr. Sanjeev Sood

This book explores how healthcare organisations can utilise advanced information technology to achieve high levels of operational performance and strengthen their market position.  It considers health information systems from an organisation perspective, integrating the science of IT, medicine and nursing practice within the context of complex adaptive systems. The book provides a conceptual framework for considering how IT can be used to redesign clinical work processes and integrate the clinical and business functions to achieve a coherent organisation strategy. The frame work draws on a body of organisational and systems theory and incorporates evidence from information and clinical sciences.  The book takes an application approach, drawing on current operational and policy issues, supported with rapidly growing body of evidence on how IT can be used to transform health systems function and improve clinical and business performance.

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The book is divided into four parts. Each chapter begins with chapter outline, learning objectives, overview; key terms used and end up with conclusion, questions for discussion, references and further reading. This format makes the understanding of the subject easier, while giving more stimulus for further exploration for those interested. The book has been amply illustrated with case studies by drawing on actual situations to introduce and apply the concepts. These chapters also include a problem solving scenario that draws on the case and thereafter applies and integrates material from the chapter.

Part-I focuses on both business and clinical strategies and then considers them as an integrated organisational strategy. Part-II focuses on information strategy relating to enterprise strategy, and how organisations use information to position themselves in a competitive market and respond to environmental changes. Specific strategies are selected and discussed in some detail, including knowledge management as an organisational strategy, consumer informatics, role of e-health and web-based technologies, and the impact of genomic medicine on health behaviour and service delivery. Part-III focuses on managing information recourses. The editors feel it is necessary to provide a detailed discussion of IT from the perspectives of operations management in Part-I and strategic management in Part-II before addressing the specifics of managing information resources.  The section includes chapters on effective management of information resources, IT investments, IT structure and staffing and information security and ethics. Part-IV provides a broader context for thinking about how IT might affect health systems in the future.  It is policy oriented and includes a comparative analysis drawing on how information has been applied in other service industries and health systems in other countries.  It considers how IT in health might spawn fundamentally new ways of thinking about the industry.    Included in the discussion is an assessment of current U.S. policy initiatives to develop a national health information infrastructure.

IT is recognised as an important and one of the latest technologies to be brought into health systems. This recognition has given rise to many clinical and business applications and is reported in the literature. Information, however, is more than just latest technology to affect health systems. It is one of the few resources that increase in volume and value as it is used. Its value is its use, as with any resource, but by its use adds to resources. Traditional models to explain the economics and strategy of investing in a technology do not fit in information technology.  This book explores IT within a new paradigm applied to health organisations and systems.

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Historically, the application of IT in health institutions has been considered primarily from a technical perspective. The technology has been applied to existing decisions, work processes and system structures. Complexities of clinical and business processes have posed major technical challenges that have taken time to resolve. Part of the challenge has also been the difficultly of changing clinical processes because of conflicts between traditional professional roles. The technical focus of early IT applications primarily included nursing and medical professionals.

This book builds on the foundation work in medical informatics to explore how IT can be used to transform work processes and systems. The science and complexity of tasks are explained to include how information can be used to facilitate change in complex systems and individual behaviours.  Information enables organisations to restructure their work processes and systems. It also enables them to develop new strategic initiatives, some of which are based on information as an enterprise strategy.  Such profound change draws on the fields of medicine and nursing, informatics, systems theory, organisational psychology, organisational strategy and structure, economics and finance, law and ethics.  These are disciplines from which this book draws to understand the potential of this new technology.

The book has been authored by professionals in the faculty of the department of health management and informatics at the University of Missouri-Columbia. It primarily discusses the subject in the context of highly decentralised and privatised hospital centric healthcare system of USA. Because of its grounding in theory and research evidence, the book is well designed for use in graduate courses in health management, medical informatics, eHealth, medicine and nursing and in general all those interested in applications of ICT in healthcare. Practicing health professionals can use the book effectively as well, either as general reference or by focusing on the conceptual and applied material as a framework for solving strategy development.

With increasing adoption of ICT applications in Indian hospitals for safe, efficient, patient centric and cost effective delivery of healthcare, the book shall provide a useful study material. Further, healthcare organisations running chain of hospitals and interested in giving a strategic direction to their enterprise through adoption of technology shall find this book as an invaluable accompaniment.

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