IT Governance and its Impact on National Healthcare Service

Information is a key resource for National Healthcare Service, and from the time that information is created to the moment that it is destroyed, technology plays a significant role. Information technology has become pervasive and the healthcare industry is at the forefront of technology adoption for providing highest level of patient care and safety; for effective delivery of healthcare; and for providing quality information to patients, external partners, and the rest of the ecosystem.

As all public and private healthcare information is in silos and the dependency on information systems is high, it is all the more important for NHS to have a unified view of the system to be able to create impact.

Current Situation

• Programs, directorates, and states have their own IT solutions for program reporting needs.

• All systems function in silos, information is fragmented, coordination is lacking. There is no common objective about providing quality information that improves decision making.

• Standards are lacking for information architecture, data interoperability, national disease, and service codes.

• Applications are developed for program or enterprise, not as products of utility for National Healthcare Service. Central approach in designing such architecture is to focus on information exchange, which then becomes common theme across various programs, initiatives and systems that comprise healthcare service.

• Capacity building, particularly for Healthcare IT change management is limited.

• IT processes improvement and transformation are either done in a limited way or not done at all.

These shortcomings in the current system and a few additional requirements shape the IT agenda for health service organizations. Key objectives include:

• Maintain high-quality information to support healthcare delivery decisions.

• Generate healthcare delivery value from IT-enabled investments, ie, achieve strategic goals and realize healthcare delivery benefits through effective and innovative use of IT.

• Achieve operational excellence through the reliable and efficient application of technology.

• Maintain IT-related risk at an acceptable level.

• Optimize the cost of IT services and technology.

• Comply with ever-increasing relevant laws, regulations, contractual agreements and policies.

There is need to ensure that National Health Service objectives are achieved by evaluating stakeholder needs, conditions, and options; setting direction through prioritization and decision making; and monitoring performance, compliance and progress against agreed-on direction and objectives. Key to getting effective and efficient in these initiatives should with defining, establishing, and maintaining a central framework for information and technology, supported by leadership, organizational structures and processes to:

• Ensure alignment with overall national-level governance
• Control healthcare information and information technology environment through implementation of good practices
• Assure compliance with external requirements
  With planning, delivering, and managing IT enablement becoming critical, it has yielded many best practices, standards and frameworks. It proves the growing maturity and proliferation of use of IT.

Effective control over the entire healthcare lifecycle is essential to manage IT to deliver expectations and execute strategies. ISACA has developed and published the CoBIT 5 framework, which gives end-to-end coverage of IT related processes from business perspective and is being continuously updated and revised. This is in adoption for quite many years in other countries like in US (Sunnybrook Health Sciences Centre), UK (for Maturity Assessment and Continual e-Health Governance Improvement at NHS Fife) and Japan (Takeda General Hospital, Fukushima Prefecture). NHS Fife understood that COBIT provides a higher-level framework that allows for working with a process vision, encompassing it's IT governance processes , such as strategic planning, risk management, quality management and internal control, over their existing best practices.

This single comprehensive framework is assisting healthcare delivery organizations in achieving their objectives and deliver value through effective governance and management of enterprise IT.

• Governance- ensures that enterprise objectives are achieved by evaluating stakeholder needs, conditions and options; setting direction through prioritization and decision making; and monitoring performance, compliance and progress against agreed-on direction and objectives.

• Management- plans, builds, runs, and monitors activities in alignment with the direction set by the governance body to achieve the enterprise objectives.

COBIT 5 brings together the five principles (meeting stakeholder needs, covering the enterprise end-to-end, applying a single integrated framework, enabling a holistic approach, separating governance from management) that allow the enterprise to build an effective governance and management framework based on a holistic set of seven enablers (principles, policies and frameworks; processes; organizational structures; culture, ethics and behavior; information; services, infrastructure and applications; people, skills and competencies) optimises information and technology investment and use for the benefit of stakeholders.

Not having an IT governance process, or having one that never seriously involves clinicians and other stakeholders, is a big mistake.
Without a governance structure, IT at many hospitals and healthcare systems is a haphazard endeavor that typically results in late, over-budget projects and, ultimately, many disparate systems that do not function well together.