Health Information Management: Integrating Information Technology ...

INFORMATION STRATEGY: AN INTRODUCTION 133
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improved integrated technology management;
less management effort to achieve integrated network and systems.
Potential disadvantages are:
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missing out on more sophisticated applications offered by other vendors;
dependency in case vendor is purchased or goes out of business;
vendors may charge integration fees anyway.
Some hospitals even outsource their IT departments to the single source
supplier. Some organizations hold shared strategy sessions with their
supplier. Most single source suppliers will integrate systems from other
vendors if clients decide to choose for such a solution or they may have an
alliance with vendors of systems which they cannot provide themselves
and act as main contractors. An intermediate approach is the so-called
‘best-of-cluster’ strategy (Kelly 2002).
From the hospital strategy point of view, IT capabilities should be
aligned with process improvement or other developments in the
organization. In practice, obtaining the proper systems can be the subject
of a complicated internal negotiation process, which will also involve
external stakeholders, such as (potential) vendors and consultants, amongst
others. Given the great number of systems hospitals tend to use on the one
hand and the need for integration of information on the other, alignment of
the IT portfolio as a whole is imperative. Long term contracts may
facilitate or hamper an organization’s ability to adapt to evolving strategies.
Careful consideration of which systems may qualify for a single source
strategy is necessary.
IT infrastructures that are intended to standardize work processes on the level of
the organizations as a whole are adopted locally in many different ways.
The deployed infrastructure (i.e. as it is being used) thus has to be considered as
the outcome of interactions between ‘top-down’ design and ‘bottom-up’
adoption. Insights from the local level frequently are adopted at the top level.
Combining ‘top-down’ and ‘bottom-up’ approaches creatively will allow
organizations to harness the power of the periphery, as opposed to seeing it as a
source of resistance (ibid.).
SUMMARY
In this chapter, we have discussed strategy issues, related to integrating IT in
health care work. Building on the first part of this book, we have taken the
position that the formation and implementation of health care IT strategy has
proven to be problematic. We have set out to find out why this may be the case
and to discover approaches that may be more successful.