Top 10 lessons for planning enterprise imaging strategy

By Erik L. Ridley, AuntMinnie staff writer

November 21, 2016 -- It can be tough to allot time for strategic planning in today's busy world. But it's definitely worth the effort to develop a detailed and meaningful strategic plan for enterprise imaging, according to a November 17 webinar sponsored by the Society for Imaging Informatics in Medicine (SIIM).

For example, an enterprise imaging plan can bring key stakeholders together and facilitate prioritization and better decision-making, according to Dr. Christopher Roth, vice chair of radiology informatics at Duke University Medical Center.

"It's focused our attention on the highest-yield, longest-term wins that our organization is going to be involved with," he said. "We're not focused as much on building widespread interfaces or buying things that are redundant or building in inconsistent workflows. We're actually focusing our money, our energy, and our time on going upward, rather than building outward and sideways."

There are two ways to go about developing a strategic plan for enterprise imaging. One is through brainstorming and creating an informed draft, while the other starts with interviewing stakeholders. For a variety of reasons, Duke elected to go with the brainstorming approach.

"It gave us -- the IT side -- ownership of the strategic conversation," Roth said. "We wanted to lead the business, we wanted to lead the stakeholders in the right direction from a very early stage."

Roth said that Duke learned 10 key lessons as it progressed in its strategic planning process for enterprise imaging.

1. Force forward thinking

A strategic plan for enterprise imaging should force forward thinking, Roth said.

"As we built out these varied plans and built on them and refined them and improved them, it started forcing forward thinking amongst finance, IT, the clinical business, and other stakeholders," he said. "It became clear that the current state was not acceptable and we should be doing a lot better."

2. Have a living document

The strategic plan has to be a living document that is consulted frequently, according to Roth.

"We kept iterating all the time," he said. "And it was very helpful, because we kept using it in different settings and educating and culture-changing as best we can across a very large organization."

If your institution has an overall strategic plan, that should also inform your enterprise imaging plan, Roth said.

"Not having a stakeholder plan should motivate you to write your own enterprise imaging plan anyway," he said.

3. Bring everyone together

Duke's enterprise imaging process is owned by an imaging governance committee, which consists of 27 faculty physicians from 17 different specialties, as well as IT, finance, administration, and patient safety staff.

"It's realistically a physician-driven governance group, where the physicians are making many of the decisions about what direction that we need to go next," Roth said. "In doing so, [it has] brought everyone together. In some cases it has been easy, and in some cases the bringing together has been a little challenging."

Some specialties are moving faster than others, he added.

"But that's OK as long as everybody lands in the right place," he said. "It's been very helpful for us to have not just a plan to bring everybody together, but the governance body to do so too."

Duke's enterprise imaging framework includes strategy, initiatives to implement the strategy, outcomes, and prediction of future states (the plan for the next three to five years), as well as information on what is driving the pursuit of these outcomes.

Roth emphasized that enterprise imaging is not an end unto itself.

"A new application being installed is not an outcome, a new process being put in place is not an outcome -- those are initiatives," he said. "The outcome has to be something that is a quantifiable gain. It has to be something that has a target number and a target time, and it has to be obvious what that benefit is."

4. Be concise

An enterprise imaging plan should be easily understood by a wide variety of hospital personnel.

"Your plan is going to get shown all over your organization when it's mature enough, and in many cases you won't be there," Roth said. "The entry-level analysts in IT should understand it and the highest-level executives who don't have a whole lot of time should be able to look at your plan very quickly and understand the message."

5. Quantify outcomes

In many cases, the initiative itself is not that interesting to the finance people or the C-suite executives; they just want to know the point of it, according to Roth.

They want to know "the return on investment, return on health, or return on security that you would expect if [they] were to give you the funds that would allow you to move forward with this initiative," he said.

Roth noted that Duke Health categorized its enterprise imaging strategies into a number of different categories:

  • Imaging governance
  • Electronic health record image enablement
  • Imaging decision support
  • Imaging exchange
  • Radiology interpretation workflow
  • Imaging viewing and manipulation
  • Imaging report quality
  • Community engagement in imaging
  • Imaging business intelligence and analytics
  • Global imaging
  • Imaging research
  • Imaging education

"I hope you would be able to take a look at this list, and start breaking down the needs that you have within your organization and tying them to categories like this," he said.

6. Answer stakeholder needs

A strategic plan for enterprise imaging should answer stakeholder needs.

"If you're thinking ahead enough, you should also be able to suggest other things to guide their plan," Roth said.

For example, Duke's board of trustees recently told the chief information officer (CIO) that their most important priority was cybersecurity. As the CIO reached out to the organization, an initiative began to take shape "around what are we doing with CDs, thumb drives, mobile device photography, and identifying and anonymizing research DICOM studies, and how we are patching our systems," Roth said.

Operational stakeholders are primarily interested in outcomes and future states -- the plans for the next three to five years, he said.

7. Communicate

The strategic plan should communicate the current state, provide a rallying point, be a presentation tool, show forward thinking, and offer an entry point for discussion.

"As we went through the imaging governance committee here at Duke, what we learned was that a lot of specialties -- even the most informatics-savvy folks within those specialties -- didn't know what was happening outside of their specialties," Roth said.

In December, a strategy review town hall meeting will be held at Duke, bringing together operational stakeholders and IT staff to review the plan and make sure everybody is on the same page.

"They're going to be looking at the strategy maps, learning about where we are, learning about what direction we're going to be headed, and be able to ask questions of each other," he said.

8. Provoke lots of questions

The strategic plan should elicit questions and make a lot of people who review it uncomfortable, Roth said.

"It should make them ask a lot of questions to learn about our own current state and make people want to know more," he said.

9. Demand uncomfortable choices

Changes in workflow can be uncomfortable and lead to awkward conversations, he said. Tough questions will need to be asked.

"Questions like, are we going to prioritize IT security or are we going to prioritize education? Or are we going to commit employee hiring dollars to this project -- are we going to choose to hire some people, or are we going to spend money on an application?" Roth said.

Having a plan with a road map for the next three to five years makes it easier to tell folks that their project will have to wait in favor of other higher priorities, he said.

"At least they see their needs on the plan somewhere and know that it's going to get addressed eventually," he said.

10. Turn the gears of resource, project planning

"This is the most important lesson of all," Roth said. "Your strategic plan must turn the gears of your resource planning and project planning. When you have a strategic plan, you do not want to turn it into something you put on a shelf. ... To execute, to turn it into something that actually matters, it has to be something that ... is a living, breathing thing in whatever your project management tool of choice is, within your resource planning applications, and whatever you're using to manage tickets or projects within your IT organization."

The strategic plan for enterprise imaging at Duke comprises 90 outcomes planned for the next three to five years and 57 initiatives. The plan is also linked to effort, resource, and financial planning as of 2017, he said.


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