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180 Section IV. Economics2. What parameters should he measure to assess its impact?3. What data collected prior to implementation would you want for an analysis?AnalysisMain IssuesAs Dr. Lawler contemplates his next move, a large number of factors come into play.A brief discussion of the more significant factors follows.Weak IT Governance Structure• There is no central IT chain of command to set policy for all the IT groups and centrallydetermine funding priorities and asset allocation.• LUG has no formal authority to mandate changes. There has been no mandate fromthe executive level for the LUG to promote standardization and shared decisionmaking.• The user group (LUG) is not organized in such a fashion as to speak with one authoritativevoice to the organization and to the vendor.• The VMG IT department has developed largely independently of any input fromany other physician groups or the corporate IT department.• There is a lack of trust among IT departments.Fragmented Organizational Culture• There is a fragmented organizational culture at VHS. The focus is on individual performanceand advancement and competition among the divisions. There is virtuallyno identification with the larger VHS organization. Collaboration is difficult in thisenvironment.• There is a relative lack of respect among physician groups. One group fails to seethe necessity for involving other divisions, while some are afraid of losing a voice inthe decision-making process.• There is no real cooperation or communication among the units.• The different divisions have differing levels of influence on corporate governance.• The Med Ed clinics are particularly fragmented, having neither one leader, an ITdepartment, or a central administration.• Individual ambitions are at play in evaluating options that may be in their personalbest interests but not in those of the organization.Different Core Missions Among Physician Groups• There is a different core mission for each of the physician groups. These core missionsare at odds with each other in some ways.• The health system does not support each mission equally, which is at odds with theirpurported mission.• There is a discrepancy between short-term goals (making more money) and longtermgoals (developing a sustainable quality improvement model).Disparity in Resources Among Physician Groups• There is a large disparity in resources among the divisions. Only VMG has thecurrent funding to support a new disease management software endeavor.