An IT roadmap for hospitals: one size does not fit all

Digital technologies have become indispensable in the healthcare sector. They help to achieve better and cheaper healthcare. Policymakers are focusing strongly on eHealth and collaboration between the various players in the healthcare ecosystem. Belgian hospitals have already spent too long using IT purely as a support tool, however, with all the associated consequences. It is essential for them not to miss the boat. Professor Brecht Cardoen and professor Bjorn Cumps explain how a tool which was developed in collaboration with hospitals and their stakeholders can help.

“The plan was to present a uniform IT roadmap which could then help to put the further digitalisation of the hospital sector on the right track”, says Brecht. “In order to get a better picture of the IT challenges, we first consulted various external parties – parties which work with and for hospitals or which specialise in IT for the healthcare sector. The results of these interviews, along with insights from the literature, were then validated and supplemented during a workshop with hospital directors.”

A patient-centric approach requires standardisation and integration

In for-profit organisations, digitalisation revolves around customer centricity. In hospitals, the equivalent concept is patient centricity. How can we ensure that patients are given control, have access to all their information and can make and reschedule appointments themselves, whilst enabling them to be monitored at every stage in the journey? “So besides information about their passage through a particular hospital, we need to know about all their hospital admissions and/or tests, wherever they may be”, explains Brecht. “The government is encouraging hospitals to form networks, so the exchange of information between hospitals in a network and between the various networks is crucial. In the future, we also wish to work on prevention: preventing people from becoming ill again. This means exchanging the information required for the further follow-up of the patient once they have been discharged from the hospital. That involves all kinds of external parties: GPs, physiotherapists, home care teams, residential care centres etc. Information can only be exchanged efficiently if it is standardised and the relevant processes and systems are integrated.”

A long way to go

“Currently, IT in hospitals tends to be relatively unstructured, highly fragmented, insufficiently integrated and standardised. What is more, there has not been enough investment over the years”, says Bjorn. “A silo mentality is also more of an issue in hospitals than in other sectors: each department in the hospital has its own IT infrastructure and its own way of doing things. Our interviews reveal a major mismatch between the ambitions of our policymakers and hospital management and what the current IT infrastructure can support.”

What do we want to do?

“This brings us to my specialist area, enterprise architecture”, he smiles. “Enterprise architecture maps the business and IT architecture and ensures synchronicity between them. One tool we use for this is the capability map. We don't look at processes, i.e. how something happens, but rather at capabilities, at what a hospital needs and/or wants to do. We also distinguish between what we call ‘key capabilities’, such as internal care orchestration, and the accompanying ‘sub-capabilities’ such as admission planning, discharge planning etc. and these are then represented schematically in a capability map. Synchronising the business and IT architecture means setting up the data, devices, applications and infrastructure in such a way as to facilitate the business capabilities. These IT capabilities are represented in the map in the same way.”

Capability map Belgian hospitals

Figure 1: Capability map for Belgian hospitals. The dark-grey blocks are the key capabilities and the light-grey blocks are the sub-capabilities.

Is the resulting capability map sufficiently representative? Brecht nods. “Based on our experiences with the Belgian hospital landscape and that of other researchers, we came up with the initial impulse. The map was then refined in several iterations, working with external parties and hospital managers, CEOs and CIOs. It has also been tested and validated on the basis of four case studies. It may not yet be entirely complete, but it is sufficiently generic to ensure that hospitals which were not involved in the exercise can use it.”

Not all hospitals are the same

So how exactly do you use these capability maps? Bjorn explains: “You can use them to find out which capabilities you score well on, which you score less well on, which ones you wish to focus on and what that actually means: which capabilities are in need of refinement, which are not, and which IT capabilities require investment? If you use different colours to represent the various scores, you get a clearly arranged heat map which you can use as a basis for developing an IT roadmap, an action plan.

“This is also the exercise we went through with four hospitals”, adds Brecht. “It showed another mismatch between what the businesses would like to do and what IT can currently support. But although there are similarities – fragmentation, a lack of integration, silo mentalities – there were also significant differences, not just in terms of capabilities but also in terms of ambitions. While some hospitals are already working on external integration with the hospital network, other hospitals are still having trouble exchanging internal data. All four stated that there was room for improvement in terms of patient engagement, but the interviews revealed that this is only a strategic priority for two hospitals, i.e. one that has with an impact on their IT roadmap.”

“Various capabilities are interlinked and the tool helps to clarify this”, continues Bjorn. “For example, if you wish to improve the orchestration of your external care, which other capabilities do you inevitably need to involve? What needs to happen with them? Which investments in data, equipment, applications and/or infrastructure will be required? Colouring in the relevant blocks allows you to see the impact of your strategic choice at a glance.”

Electronic patient records

Not all hospitals have made the same progress and not all hospitals have the same priorities. However, one project which all hospitals are working on is the EPR or Electronic Patient Record1. They have no choice in the matter, as it is one of the most important 20 action points in government minister Maggie De Block's eHealth Plan.

“If there is one project which illustrates the added value of a capability map, this is it”, Brecht emphasises. “It touches on more different elements of the business and IT architecture than anything else. It supports virtually all the identified business capabilities. A properly implemented EPR is mainly important for putting the external care orchestration on the right track. And if we truly to wish to evolve towards an integrated healthcare ecosystem, this is absolutely essential.”

Getting started

“We dropped the original plan – a uniform IT roadmap for all hospitals – because there turned out to be so many differences between the various establishments. In addition, rigid roadmaps which describe a transition process covering a period of 10 years, which were previously the norm, are no longer workable”, says Bjorn.

“Indeed,” nods Brecht, “in a rapidly changing environment with countless uncertainties and unknown factors, it is important for the organisation to remain robust, resilient and agile and to make the right choices in both the short and long term.  The IT roadmap can also be regarded as an action plan for expanding or refining the strategically important capabilities and supporting them through the necessary IT investments, in such a way that the hospital is flexible enough to deal with changes and unexpected developments. The plan will therefore be different for every hospital.”

1 An EPR is the electronic version of a medical file which contains the patient's complete medical and care history, tests, treatments and hospital admissions, including prescribed medication.

 

Do you want to find out more? Download the full paper ‘Towards an IT Roadmap for Belgian Hospitals. It contains a detailed description of the IT challenges facing hospitals, the various capabilities and the four case studies. The use of the capability map is illustrated on the basis of the EPR project. This study was partly made possible by an unconditional financial contribution from Xperthis on behalf of the Belgian Association of Hospital Directors (ABDH/BVZD).

About the authors
Brecht Cardoen is an associate professor of Technology & Operations Management at Vlerick Business School and the Faculty of Business and Economics at the University of Leuven. He also manages various initiatives of the Vlerick Healthcare Management Centre, including the MINOZ research centre. Bjorn Cumps is a professor of Management Practice in Technology & Operations Management, where he is developing the Enterprise Architecture knowledge domain. He is also a member of the Vlerick Centre for Financial Services, where he is responsible for research into Financial Services Operations. Mathias Boënne is a doctoral researcher in the innovation cluster at Vlerick Business School.

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