E-HEALTH CARE TECHNOLOGY MANAGEMENT

A Multifactorial Model for Harnessing E-Technologies

George Eisler, Sam Sheps, Joseph Tan

I. Learning Objectives

II. Introduction

III. Multidimensionality of the E-HCTM Concept

A. The Strategic Role of E-Technology

B. E-Health Care Technology Management Strategy

IV. E-Surveying Health Executives

A. Defining Health Care Technology Management

B. Pilot Test and Field Test, Using a Delphi Approach

C. Validity and Reliability Issues and the Gap Score

D. Web-Based Survey Design

E. The National Survey

V. Research Findings with Relevance for E-Health Care Technology Management

A. Factor Analysis

B. Cluster Analysis

C. The Hay Group Study

VI. Conclusion

VII. Chapter Questions

VIII. References

IX. Evidence-Based Medicine Case

Learning Objectives

1. Conceptualize e-health care technology management

2. Recognize the benefits and challenges of e-surveying health administrators and executive team members

3. Identify the perceptions of senior health care executives on technology management issues and interpretations of expert opinions and ratings

4. Understand the relationships of HCTM research findings to the results of the Hay Group Study

5. Associate HCTM research findings with an e-HCTM context

Introduction

Human history and development have always been linked dynamically to the technology inherent in tools and means of production. The survival of individuals, clans, tribes, organizations, societies, and empires depends on the power of their technology to harness nature and their environment. The evolution of human civilization from the hunter-gatherer stage to the industrial stage took almost two million years. Amazingly, the evolution of computing and automated information processing technology has taken no more than a few decades, following the Industrial Revolution, two World Wars, the Cold War, and the race to the moon. In the last decade, this trend of accelerating change has been further fueled by instant access to worldwide information, global competition, and the pervasive power of converging advances in computing, information and telecommunication technology, and biotechnology.

The e-health paradigm shift, the topic of this text, is another revolution in the human history of technological developments. The view that e-technology is just an implementation issue or just another operational requirement vying for resources may be one of the key reasons for the current poor coupling of e-technology and e-health care. This view sees e-technology merely as a tool to implement e-health care strategies. It assesses e-technology in terms of return on investment or in terms of satisfying current e-market needs, covering such aspects as identification, selection, acquisition, exploitation, and protection of e-health product or process technologies. Although such tactical e-technology plans are useful (Gregory, Probert, and Cowell, 1996), more compelling is the potential and power of e-technology to radically change clinical and business strategies in health care, not just support e-health systems that mimic traditional systems. Indeed, e-technological innovation has already shifted the competitive balance within the health care industry and is creating more new opportunities for growth, as previous chapters of this text have discussed.

Economists such as Tapscott and Caston (1993) have pointed to technology as an important change agent in the structure of industries and competition. Andersen, Belardo, and Dawes (1994) confirm that the issues are similar in the public service sector arena: “Public expectations for the level and quality of government services were formed in better economic times. Those expectations have grown while satisfaction with their fulfillment has steadily declined. In the past few years, it has become evident that cutting fat, eliminating waste, and preventing abuse is not nearly enough. Government needs to rethink its methods and restructure its approach to public services.” Around the world, countries are recognizing that the competitiveness of their health care products and services in the global marketplace depends on their focus on e-technology management. In the e-health environment, the task of managing applications and services is particularly complex. It requires that health care executives master many different skills, including government relations, community liaison, employment of human resources in e-work, financing of e-health business initiatives, e-patient care, research on e-technologies (for example, research based on linked databases), and on-line education. E-health care technology management (e-HCTM), therefore, adds one more dimension to the challenge of harnessing IT for health care in the new economy.

In recent years, e-HCTM and mainstream health care technology management (HCTM) have been receiving attention in developed countries (for example, Japan and countries in Europe and North America) as well as in developing nations (for example, Southeast Asian countries). The World Health Organization (WHO), for example, proclaimed that there were serious shortcomings in the performance of health systems in virtually all countries (World Health Organization, 2000). In the late 1980s, the WHO admitted that its attempts to introduce components of an HCTM system around the world had not been very successful (World Health Organization, 2000). The lack of a working HCTM model or framework and a shortage of technology management skills, expertise, and knowledge among workers in those countries were identified as serious limitations. Without a functioning HCTM or e-HCTM system (incorporating, for example, technology planning, technology life cycle management, and technology assessment and evaluation), long-term support for technology applications and health initiatives is unsustainable. These deficiencies with respect to the management of technology point to the crucial need to align technology strategy and e-business strategy. In other words, the strengthening, linking, and aligning of technology planning and e-business planning in the e-health care context is the essential purpose of e-HCTM. In light of this development, the discussion of this chapter will focus on drawing lessons for e-HCTM from previous research on health care technology management in traditional health care organizations—specifically, large teaching hospitals (Eisler, Sheps, Satuglu, and Tan, 2002).

Multidimensionality of the E-HCTM Concept

Transferring lessons we have gathered from technology management in other industry sectors—particularly the concept of strategic HCTM and the importance of innovation—to health care and e-health care is the beginning step in exploring the concept of e-HCTM.

The complexity of the e-health care environment, the multitude of forces that shape technology decisions, and the uniqueness of the e-health care environment are all justifications for applying e-HCTM to overcome challenges of sustainability, cost, and quality of care. Compared with other industry sectors, such as banking and transportation, the e-health care environment is not only more complex but also more turbulent. The environment is challenging not only because of the complexities inherent in the development and maintenance of a seamless system spanning the continuum of e-health care delivery but also because of the complexity of relationships among stakeholders, including providers, vendors, payers, investors, insurers, patients, the general public (consumers), policymakers, regulators, researchers, and educators.

The Strategic Role of E-Technology

The health care industry is in transition, driven by such changing factors as economic trends, technology products and services, and population demographics. These pressures have resulted in changes in the structure and process of care, financing, and human resource management. The challenge in health care can be summarized as ensuring timely access to high-quality and cost-effective health care services. Health care systems in Canada, the United States, and other developed countries are expected to continue on the road of cost reduction and quality improvement through the growth and diffusion of e-health business models and services (see Chapter Twelve). Reforms in health care have been intended to increase efficiency, flexibility, and integration, as well as to improve health outcomes, community participation, and cost control. Given these sometimes conflicting pressures, a debate about the role of technology as the problem or as an important part of the solution is taking shape. Indeed, e-technology can play a vital strategic role in health care, as it does in other knowledge-based service industries, including banking and entertainment. This is particularly true for information and communication technologies and e-technologies, which can contribute significantly to improved management, cost-effectiveness, customer service, and support. These applications can create opportunities for new e-health services or for new delivery methods for existing services. For these reasons, some governments (for example, the government of British Columbia) have maintained information and communication technologies and e-health applications on their list of priorities even during a period of severe cost reduction (British Columbia Ministry of Health Planning, 2002). Only after a thorough economic evaluation will questions about comparative costs and benefits of various e-technologies, including the status quo, be answerable.

The emergence of e-technology as a lever of economic competitive advantage has created a demand for personnel who can help enterprises take advantage of such technological innovation (Raghupathi and Tan, 2002). In the past, many industries have seen technologies such as computer and telecommunication networks as playing a supportive role, contributing to overhead costs. In other words, these technologies are not seen as central to corporate objectives. Today, e-technologies are beginning to be recognized as significant core enabling assets with major strategic implications for an organization’s survival and success. In addition, the power of converging e-technologies is blurring the boundaries between administrative and core technology tools. Many CEOs now believe that such enabling technologies, if managed appropriately, can contribute significantly to the achievement of e-business strategy and new organizational objectives. At the same time, these e-technologies may fundamentally change the way an organization functions as well as the way it relates to its industry sector, sponsors, suppliers, and, most important, its customers or clients. For example, the availability of e-health care through the Internet and related Web services is transforming mainstream health care.

From a marketing perspective, creative and rapid technological evolution generates a volatile technology push on the input side of organizations. Many companies, including giant retailers like Sears and CVS Pharmacy are going on-line to prevent their chain stores from losing customers to a growing list of on-line competitors. On the output side, customers expect reliable, consistent, safe, effective, and efficient service. The convenience of on-line shopping means that they can change their loyalties easily and quickly. They are looking for seamless technology and applications. The challenge, then, is for executives, including health executives, to enable their organization to continually transform the turbulent technology input into a customer-focused and appropriate output in the face of increasingly difficult internal and external constraints (Tapscott, 1996).

“Where change used to occur periodically, it’s a way of life now,” said Charles Webb Edwards, executive vice president of the Technology and Operations Group at Wells Fargo and executive vice president and chief technology officer at Norwest Corporation prior to its merger with Wells Fargo. “There is real value in being able to manage . . . change.” Strategic planning horizons for most companies are shortening from ten or twenty years to five and, more recently, to three years. “The new approach to strategic planning recognizes that the New World is not predictable, linear, or deterministic. Rather, it is unpredictable, nonlinear, and full of surprises.” Rapid technological change is partly responsible for this nonlinearity (McCallum, 1996). Technology strategy is an integral strand in the strategic management fabric of an organization (Badawy, 1998; Husain and Sushil, 1997).

According to McGee and Thomas (1989), what has been missing “is a comprehensive view of how technological change can affect the rules of competition, and the ways in which technology can be the foundation of creating defensible strategies for firms.” Restructuring programs, takeover campaigns, and the unprecedented trend toward joint ventures are indications of the new way of doing business, “driven by the need to compete more aggressively and efficiently in world scale markets” (Perrino and Tipping, 1989). Studies have shown that levels of companies’ investments in technology explain international differences in productivity and in shares of world markets.

Geisler and Heller (1996) argue that because of economic pressures, our health care system is in crisis. What’s more, technology, especially medical technology, has played an increasing role in creating the crisis. They claim that proper and better management of medical technology provides some hope for dealing with the forthcoming challenges.

The World Health Organization defines health as a state of total physical, mental, and social well-being, not merely the absence of disease and infirmity. It is now recognized that population and individual health has many determinants not traditionally associated directly with the health care system—for example, air quality and socioeconomic status. Accordingly, e-HCTM includes managing applications of technology that influence the environment, information dissemination, health protection, and disease prevention. It goes beyond just applications of medical technology found in modern acute care systems or for direct medical care. In this context, the term e-health care technology applies, in the broadest sense, to more than just e-health information. It includes hardware and firmware devices, software and business processes, health products such as drugs and home care health products marketed on-line, as well as e-prescription and e-home care services. E-technologies that may contribute to quality or sustainability of health care systems (see Chapters One and Two) could be associated with virtual communities (see Chapter Three), e-clinical care (see Chapter Four), e-public health systems (see Chapter Five), e-network infrastructure (see Chapter Six), various e-health domains and applications (see Chapters Seven through Eleven) or other e-health business processes (see Chapter Twelve).

E-Health Care Technology Management Strategy

In this chapter, we review the literature across several industry sectors and combine the results of that review with the findings of our research on technology management in traditional health care organizations. This approach yields general agreement about the basis for e-HCTM strategy; the characteristics of an e-HCTM-focused business; and the responsibilities and capabilities of the e-technology officer, who is equivalent to the chief technology officer (CTO) in traditional corporate settings.

E-HCTM strategy is based on the competitive and turbulent e-health environment, the nature of the e-health business, and the state of e-technology development. Other factors in e-HCTM strategy include considerations of business-specific factors, environmental factors, and customer preferences; creation of strategic advantage and differentiation; development of e-technological expertise, e-business decisionmaking and problem-solving skills, and human resource capabilities; and readiness for a comprehensive rethinking and readjustment of job descriptions, information systems, governance structure, incentives, and decision-making processes. One of the most important issues is e-health business structure and its value propositions, as has been noted throughout this text. E-health policies hold together a decentralized, virtual workplace with rapid access to global information. In addition to flexible governance structures, management of e-health systems must emphasize seamless information flow, appropriate incentives (for example, for focusing on customers), and innovative performance assessment schemes.

E-HCTM strategy needs to be characterized by managerial vision, foresight, and entrepreneurial spirit. Strong leadership is one of the most critical aspects of success. This entails commitment to knowledge acquisition rather than just product development. Management personnel must know what they want, given the difficultto- quantify costs and benefits of newer e-technologies and the need for flexibility. Managers must set realistic goals, match the supply of products and services to market demands, and be clearly aware of resources, constraints, and risks. Decisions and attitudes of management must be based on an analysis of competitive position, market intelligence, technical preferences of e-consumers (customers), and internal capabilities. The e-HCTM strategy focuses on the customer, replacing organizationcentered approaches with an emphasis on market pull rather than e-technology push.

Management systems must focus on an internally integrated enterprise. These systems must coordinate across functional boundaries; in other words, cross-functional approaches must facilitate convergence of the historically divergent views of technically oriented and market-oriented individuals. Full and meaningful worker and customer participation in the production and delivery process is key to e-health success. Moreover, process management has to replace product management; this shift in focus to flexibility, adaptability, responsiveness, and effectiveness rather than efficiency and costs is necessary mainly because competitive advantage comes from achieving greater customer satisfaction and enterprise knowledge integration by deploying the appropriate e-HCTM strategy, not just from labor cost savings. Above all, the ability of the management team to change, adapt, and avail itself of new opportunities is critical in an environment as turbulent as the e-health marketplace.

E-consumers’, e-providers’ and the government’s expectations have increased because of advances in technological capabilities. For the e-technology officer to move e-HCTM strategy forward, he or she must demonstrate thinking and visionary leadership, the ability to create new ways of funding, and a commitment to the alignment of e-technology with clinical objectives. Thus, the e-technology officer must bridge gaps between virtual team members and engage in continual planning, active resource allocation, development of standards, rapid reorganization when necessary, and adoption and implementation of fundamental changes in the e-business system. He or she must also be a steward of networked leadership, be close to the front line, and build an invisible enabling infrastructure.

The e-technology officer must ensure that promises made on behalf of e-technology applications are kept. He or she must build a viable, productive, and flexible e-technology asset base that can deliver goods and services on time and with a competitive pricing scheme. Moreover, he or she needs to take responsibility for managing technology-driven change and act as a change champion. Overall, this individual must be able to manage in an environment of decentralized decision making with a high level of interfunctional coordination; be conversant in e-business issues and challenges; have a focused commitment, empowered with applicable technical information; and have the skills to effect and manage change. Such an individual will also need relevant technical competence and an understanding of the importance of e-technologies and systems that provide a competitive edge, as well as the need for e-technologies and systems that support the goals of the virtual enterprise.

Joseph Tan. E-Health Care Information Systems : An Introduction for Students and Professionals (2005).