Reflections on Health IT Strategic Planning and Budgeting

I recieved the following email this morning:

“My business partner and I are presenting at the 2012 PCPA Technology Conference in a couple of weeks. Our topic surrounds funding, or finding funding, for EHR/HIT acquisition and implementation. Most of the content is focused on identifying new and unique sources and approaches for financing these purchases; however, we also want to emphasize the importance of having a long-range strategic HIT plan and budgeting appropriately. Might I ask your opinion as to what you believe to be the most essential elements of an HIT strategic plan and what percentage of budget you recommend for IT investment and operations?”

What follows is my response to my friend. I hope it is helpful for others.

  • Behavioral health providers – most of whom do not have adequate staffing expertise and depth in IT - are lagging in their adoption of HIT, and have the steepest curve ahead of them in terms of integration with the rest of the healthcare field both clinically and in terms of HIE/EDI/HIPAA5010, etc.  These providers should view the next 3 years as “very unique strategic times and circumstances” where their planning is concerned
  • Consequently, they should view IT budgets in terms of three strategic milestones: a) mandatory adoption and implementation in the immediate term (certified EHR, MU cert., HIE, etc.), b)  strongly advised IT (eRx, clinical messaging, data warehousing, analytical tools, etc.) in the near-term (1-3 years) to accommodate new business relationships and models that are built atop care coordination, the patient-centered medical home and accountable care organization models, and c) longer term planning  to spur innovation over the next 3-5 years (virtual services, registries, clinical decision support systems, etc.)
  • Budgets need to be developed to reflect the Total Cost of Ownership. This includes often overlooked items like consultants, new IT facilities, business analysts, informaticists, trainers, training time for professional staff (estimated at between 80-120 hours over the course of 6-12 months to be effective), privacy and security officers, disaster recovery and business continuity plans, desk-top support staff, hardware, software, networking (LAN/WAN), data warehousing, reporting tools, and a host of other considerations. Providers also need to anticipate that the cost of implementation is often much, much higher than they expect. That’s normal and they should make their peace with it.
  • One of the most important staffing considerations is the role of Chief Technology Officer and/or Chief Information Officer. Somebody on the executive team needs to stay ahead of the curve and understand better where the rest of the medical and healthcare fields are headed. I say “and/or” because managing technology is very different from managing information. This distinction is lost on most lay-people and providers.
  • As for a share of the budget to allocate to IT, I would estimate somewhere between 5% and 20% in the immediate term (1-2 years) for a lot of providers, depending largely upon where they are along the adoption and implementation continuum. The “very late adopters” will have to spend more to catch up than the early adopters. That’s not news to anyone. Providers who are further along should be looking to dedicate between 5% and 10% of their budget on IT while the most advanced providers will want to target between 3% and 5%
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