SI/HMP 661: Managing Health Informatics. Fall 2013 Syllabus

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1 SI/HMP 661: Managing Health Informatics Fall 2013 Syllabus Wednesdays 3:10-6:00 p.m. North Quad 2245 Instructor Julia Adler-Milstein Assistant Professor School of Information 4376 North Quad Phone: (734) Office Hours: Tuesdays 3:30-4:30 p.m. Course Description The course will prepare students to take on management challenges faced in health informatics leadership roles within a variety of organizational settings. It will be a highly interactive course in which students will have the opportunity to apply theory when discussing real-world health informatics scenarios from a variety of perspectives. Course Objectives (1) To equip students with the relevant theories and health informatics content knowledge to become effective leaders within health-related organizations. (2) To expose students to real-world managerial decisions in the health informatics domain. (3) To enable students to consider multiple dimensions of decisions in uncertain and ambiguous scenarios and articulate the justification for their chosen approach. Learning Outcomes After completing this course students will be able to: Page 1 of 17

2 (1) Describe key theories in four domains -- leadership, operational process control, disruptive innovation, and population ecology in order to have generalized knowledge about how to be an effective leader. (2) Apply key theories to a set of health informatics topics in which management plays a central role -- implementation & project management, IT & care transformation, big data & analytics, policy & market forces in order to assess the specific mechanisms through which the theories can facilitate managerial decision-making. (3) Be familiar with scenarios that capture real-world health informatics management decisions in order to feel comfortable making decisions under uncertain or ambiguous circumstances. Course Structure The course includes four modules. Each module will draw on a given theory to examine a specific type of managerial challenge in the health IT domain: Module 1: Module 2: Module 3: Module 4: Leadership & Leading Health IT Implementations Operational Process Control & Redesigning Care Delivery to Leverage Health IT Disruptive Innovation & Engaging Consumers and Clinicians in Using Health IT Population Ecology & Managing Environmental Factors: Health IT Policy and Market Dynamics Each module will be comprised of three lectures. The first lecture will introduce the theory and discuss its applicability to the managerial challenge. The second lecture will feature a practitioner someone whose job it is to tackle that challenge and they will speak to how well the theories work in practice. The last lecture will be case-based and give students an opportunity to wrestle with the given challenge themselves, drawing on the theory and practical experiences that they learned in the prior two lectures. Course Requirements Throughout the semester, students will be expected to complete the assigned readings, attend and actively participate during class, and prepare three cases. There will be a final project. Readings Required readings for the course include: 1) Cases 2) Articles from peer-reviewed journals 3) Reports from health informatics thought leaders The course will heavily emphasize cases. Although short, they require extensive preparation and thorough reading. We will spend the first session of the course learning how to read and prepare a case. Page 2 of 17

3 For other readings, please carefully review any additional instructions associated with a given reading. We may not review all the readings in class but you will be expected to cite them in your written assignments. Readings are available on CTools and through Harvard Business School Publishing (https://cb.hbsp.harvard.edu/cbmp/access/ ). HBSP readings will cost $ There are no books for this course. Assignments Homework Given that class participation is a critical part of the course and that successful class participation requires that you have read the assigned material, the main homework assignment is to carefully complete the required reading before each class. Case Analyses You are required to prepare three cases throughout the semester one for each of the first three modules (from the third session within each module). You will read and prepare to discuss the case in advance of the class in which it is discussed. Then, two weeks after the case is discussed, you will turn in your formal write-up. The case that will serve as the basis for the assignment will be selected from the two assigned cases and announced in-class. There will be specific questions and guidance for each case assignment. Final Paper The final paper will ask you to read an article that summarizes five key areas of promise and seven key challenges anticipated in the next five years in the health informatics domain. You will pick 2 of these areas and write about how the theories and other lessons that you learned in the course speak to how best to realize the promise or address the challenge. More details will be provided in class. Grading Criteria Grades are based on a total of 100 points. Class Participation: Case Analyses: Final Paper: 25 points 45 points (15 points each) 30 points At the end of the semester, I will translate the numerical scores to letter grades with a 97 and above being an A+, being an A, being an A-, being a B+, being a B, being a B-, and so on. Letter grades should be interpreted as follows: Page 3 of 17

4 Feedback To You. I will do my best to return assignments to you in a timely fashion and with sufficient comments for you to understand where any gaps in your understanding may lie. Feel free to follow-up with me if you can t understand (or read!) a particular comment, or if points were miscalculated. Since class participation is 25% of your grade, halfway through the semester I will individually let any students know if they are not participating at an acceptable level. Please also use it as an opportunity to let me know if there are things I can do to facilitate your participation. From You. I highly value your feedback on both the content and structure of the course. There will be two opportunities for formal evaluation. I will conduct an anonymous mid-semester evaluation and there is a formal university-sponsored evaluation at the end of the semester. Outside of these, I welcome you to share feedback with me informally and via whichever channel is most comfortable to you. Don t be shy! My goal is to teach a course that meets your needs, and I am not always able to tell if I am doing so. Original Work Policy Collaboration. I strongly encourage collaboration while discussing and interpreting the reading assignments. Active learning is effective. Collaboration will be especially valuable in summarizing the reading materials and picking out the key concepts. Plagiarism. All written submissions (cases and final project) must be your own, original work. Original work for narrative questions is not mere paraphrasing of someone else's completed answer and you are not allowed to share written answers with each other prior to submission. Largely duplicate copies of the same assignment will receive an equal division of the total point score from the one piece of work. You may incorporate selected excerpts from publications by other authors, but they must be clearly marked as quotations and must be attributed. If you build on the ideas of prior authors, you must cite their work. You may obtain copy editing assistance, and you may discuss your ideas with others, but all substantive writing and ideas must be your own, or be explicitly attributed to another. For more information, refer to the Rackham Graduate policy on Academic and Professional Integrity for the definition of plagiarism, and associated consequences: Page 4 of 17

5 integrity/. Accommodations for Students with Disabilities If you think you need an accommodation for a disability, please let me know at your earliest convenience. Some aspects of this course, the assignments, the in-class activities, and the way we teach may be modified to facilitate your participation and progress. As soon as you make me aware of your needs, we can work with the Office of Services for Students with Disabilities (SSD) to help us determine appropriate accommodations. SSD ( ; typically recommends accommodations through a Verified Individualized Services and Accommodations (VISA) form. I will treat any information you provide as private and confidential. Page 5 of 17

6 Date Number Session and Title OVERVIEW OF SESSIONS 9/4 1 A: INTRODUCTION & COURSE OBJECTIVES B: LEARNING THE CASE METHOD & MINI-CASE MODULE 1: HEALTH IT IMPLEMENTATION 9/11 2 A: THEORY: LEADERSHIP A.1 SENSEMAKING A.2 BUILDING HIGH-PERFORMANCE, RESILIENT TEAMS A.3 FRAMING FOR LEARNING B: CASE: EDMONDSON (2003) FRAMING FOR LEARNING 9/18 3 A: HEALTH INFORMATICS DOMAIN: THE CIO S GUIDE TO IMPLEMENTING EHRS IN THE HITECH ERA B: GUEST SPEAKER: MARNA FLAHERTY-ROBB, CHIEF NURSING INFORMATION OFFICER AT UNIVERSITY OF MICHIGAN HEALTH SYSTEM 9/25 4 CASES: A. MCAFEE, MACGREGOR AND BENARI (2002) MOUNT AUBURN HOSPITAL B. HAMERMESH ET AL (2011) COMPUTERIZED PROVIDER ORDER ENTRY AT EMORY HEALTHCARE WITH SPECIAL GUEST SPEAKER DR. WILLIAM BORNSTEIN, CHIEF QUALITY AND MEDICAL OFFICER, EMORY HEALTHCARE MODULE 2: REDESIGNING CARE DELIVERY TO LEVERAGE HEALTH IT 10/2 5 A: THEORY: OPERATIONAL PROCESS CONTROL B: CASE: MCCARTHY ET AL (2009) GEISINGER HEALTH SYSTEM 10/9 6 A: HEALTH INFORMATICS DOMAIN: CARE MANAGEMENT & REDESIGN 10/16 7 CASES: B: GUEST SPEAKER: PANEL LED BY DR. NEAL WEINBERG, INTEGRATED HEALTH ASSOCIATES (4-6 PM) CASE ANALYSIS 1 3 PM Page 6 of 17

7 A: BOHMER, MCFARLAN AND ADLER-MILSTEIN (2007) IT AND CLINICAL OPERATIONS AT BIDMC B: TUCKER (2013) LEARNING ABOUT REDUCING HOSPITAL MORTALITY AT KAISER PERMANENTE MODULE 3: DISRUPTIVE INNOVATION 10/23 8 A: THEORY: DISRUPTIVE INNOVATION & CONSUMER HEALTH INFORMATICS B: CASE: POPULATE YOUR OWN PHR! 10/30 9 A: HEALTH INFORMATICS DOMAIN: EHR USABILITY 11/6 10 CASES: B: GUEST SPEAKER: DR. DAVID HANAUER; ASSISTANT PROFESSOR, UNIVERSITY OF MICHIGAN MEDICAL SCHOOL (2) INNOVATIVE EHR DEVELOPER CASE ANALYSIS 2 3 PM A: QUICKMEDX B: INTEL NBI MODULE 4: MANAGING ENVIRONMENTAL FACTORS POLICY AND MARKET DYNAMICS 11/13 11 A: THEORY: POPULATION ECOLOGY B: CASE: ACOS, HIE AND HITECH 11/20 13 A: HEALTH INFORMATICS DOMAIN: INDUSTRY TRENDS AND POLICY ISSUES B: GUEST SPEAKER: (1) NANCY ROBERTS, PROVIDENCE HEALTH CARE (3:10-4:30) (2) DR. TIMOTHY A. PETERSON; MEDICAL DIRECTOR, UNIVERSITY OF MICHIGAN PIONEER ACO (5-6 PM) CASE ANALYSIS 3 3 PM 11/27 NO CLASS HAPPY THANKSGIVING! 12/4 14 CASES: ARBOR HEALTH CARE COMPANY Page 7 of 17

8 WRAP-UP CONCLUDING SESSION 12/11 15 FINAL PAPER PRESENTATIONS FINAL PAPER 3 PM Page 8 of 17

9 Session #1 Introduction & Course Objectives Learning the Case Method Topics: What is the value of using cases to learn? How do you prepare for a case? 1. Hammond, J. S. (1976). Learning by the Case Method. Harvard Business Review. Cambridge, MA. Mini-Case Topics: The athena case is written as a marketing case, but our discussion will *not* be focused on marketing. Instead we will use it to discuss the following questions: - In 2009, what was athena s core business? How did they structure their business model? What was their competitive advantage? - How does athenaclinicals compare to other EHRs on the market? From the perspective of a physician practice, what are the advantages and disadvantages of athena s EHR? From the perspective of athena, what are the advantages and disadvantages of offering an EHR? - How did the passage of HITECH change the picture from the practice perspective? How did the passage of HITECH change the picture from athena s perspective? - What is athenacommunity? What are the advantages and risks of pursuing this new service (both within the context of the case and based on what you know more broadly about what is going on with HITECH and the ACA)? 2. Chakravorti, B., L. Winig and N. Arastu (2010). athenahealth: Innovating in Response to a Crisis in Healthcare, Harvard Business School. Page 9 of 17

10 MODULE 1: LEADERSHIP AND LEADING HEALTH IT IMPLEMENTATIONS Session #2: The Role of Leaders and Leadership Topics: What are the key challenges faced by a leader in the context of HIT implementation? 1. (Optional) Nembhard, I. M., J. A. Alexander, T. J. Hoff and R. Ramanujam (2009). "Why does the quality of health care continue to lag? Insights from management research." Academy of Management Perspectives 23(1): SENSEMAKING Topics: What does it mean to make and give sense of a situation? How can you do it successfully? Why is it important? 2. Ancona, D. (2011). Sensemaking: Framing and Acting in the Unknown. The Handbook for Teaching Leadership: Knowing, Doing, and Being. S. Snook, N. Nohria and R. Khurana, SAGE Publications, Incorporated: BUILDING HIGH-PERFORMANCE, RESILIENT TEAMS Topics: What are common characteristics among successful teams? What is the leader s role in developing and maintaining effective teams? 3. Gratton, L., A. Voigt and T. Erickson (2007). "Bridging Faultlines." MIT Sloan Management Review. 4. (Skim for key points) Hackman, J. R. and R. Wageman (2004). "When and how team leaders matter." Research in organizational behavior 26: FRAMING FOR LEARNING Topics: What does it mean to be a learning organization? How can leaders create a learning orientation? 5. Senge, P. M. (1996). "Leading learning organizations." Training and development 50(12): APPLIED CASE Page 10 of 17

11 Topics: What are the different dimensions of framing for learning? What do they look like in practice? 6. Edmondson, A. C. (2002). Framing for learning: Lessons in successful technology implementation. California Management Review 45(2): Session #3: CIOs Perspectives on EHR Implementation Topics: Are current models of leading EHR implementations guided by: (1) sensemaking, (2) building high-performance teams; (3) framing for learning? Find three places where you see the theory present and three places where you feel what CHIME recommends diverges from theory. 1. College of Healthcare Information Management Executives (CHIME) (2010). The CIO's Guide to Implementing EHRs in the HITECH Era. Ann Arbor, MI. Session #4: Case Studies Topics: See specific discussion questions. 1. McAfee, A., S. MacGregor and M. Benari (2002). Mount Auburn Hospital: Physician Order Entry, Harvard Business School. 2. Hamermesh, R. G., F. W. McFarlan, M. Keil, M. Morgan, A. Katz and D. LaBorde (2011). Computerized Provider Order Entry at Emory Healthcare, Harvard Business School. Page 11 of 17

12 MODULE 2: OPERATIONAL PROCESS CONTROL & REDESIGNING CARE DELIVERY TO LEVERAGE HEALTH IT Session #5: Operational Process Control & Organizational Redesign 5.1 THE IMPACT OF IT ON ORGANIZATIONAL PERFORMANCE Topics: How might IT improve productivity in the short-term? In the long-term? What managerial factors seem most relevant to these changes in health care? (Hint: think about issues discussed in Module 1 and the types of changes discussed in Cusumano.) 1. Devaraj, S. and R. Kohli (2000). "Information technology payoff in the health-care industry: a longitudinal study." Journal of Management Information Systems 16(4): Read first 10 pages only 2. Cusumano, M. A. (1988). Manufacturing Innovation: Lessons from the Japanese Auto Industry. Sloan Management Review. Cambridge, MA, Massachusetts Institute of Technology. 30: Brynjolfsson, E. and L. M. Hitt (2000). "Beyond computation: Information technology, organizational transformation and business performance." The Journal of Economic Perspectives 14(4): USING IT TO ENABLE NEW APPROACHES TO CARE DELIVERY Topics: What types of processes are health care organizations trying to change? How can HIT support these delivery system reforms? In what way are the HIT-enabled processes different from paper processes, beyond speed/automation? How can HIT support the overall attributes Shih et al identify as crucial to a high-performing health system? 4. Shih, A., K. Davis, Stephen C. Schoenbaum, A. Gauthier, R. Nuzum and D. McCarthy (2008). How Do We Want Health Care to be Delivered? Organizing the US health care delivery system for high performance, Commonwealth Fund: McCarthy, D., K. Mueller, J. Wrenn and C. Fund (2009). Geisinger Health System: achieving the potential of system integration through innovation, leadership, measurement, and incentives, Commonwealth Fund. 6. Paulus, R. A., K. Davis and G. D. Steele (2008). "Continuous Innovation In Health Care: Implications Of The Geisinger Experience." Health Affairs 27(5): Page 12 of 17

13 Session #6: CIOs Role in Health Care Delivery Reform Topics: What can CIOs do to support CEO visions? Where can CIOs push the envelope and lead technology-driven innovation? 1. Cosgrove, D. M., M. Fisher, P. Gabow, G. Gottlieb, G. C. Halvorson, B. C. James, G. S. Kaplan, J. B. Perlin, R. Petzel, G. D. Steele and J. S. Toussaint (2013). "Ten Strategies To Lower Costs, Improve Quality, And Engage Patients: The View From Leading Health System CEOs." Health Affairs 32(2): Shehadi, R., W. Tohme and E. H. Baker (2012). IT and Healthcare: Evolving Together at the Cleveland Clinic. strategy+business. New York, NY, Booz & Company. 3. McAfee, A. and E. Brynjolfsson (2012). "Big data: the management revolution." Harvard Business Review Kleiner, A. (2010). Thought Leader: Erik Brynjolfsson. strategy+business. New York, NY, Booz & Company. Session #7: Case Studies Topics: See specific discussion questions. 1. Bohmer, R., F. W. McFarlan and R. B. F. W. McFarlan (2007). Information Technology and Clinical Operations at Beth Israel Deaconess Medical Center, Harvard Business School. 2. Tucker, A. (2013). Learning About Reducing Hospital Mortality at Kaiser Permanente, Harvard Business School. Page 13 of 17

14 MODULE 3: DISRUPTIVE INNOVATION & ENGAGING CONSUMERS AND CLINICIANS IN USING HEALTH IT Session #8: Disruptive Innovation 8.1 DISRUPTIVE INNOVATION Topics: What is disruptive innovation? What are some opportunities for disruptive innovation in health care? Why is disruptive innovation so challenging? 1. Christensen, C. M. and M. Overdorf (2000). "Meeting the challenge of disruptive change." Harvard Business Review 78(2): Hwang, J. and C. M. Christensen (2008). "Disruptive Innovation In Health Care Delivery: A Framework For Business-Model Innovation." Health Affairs 27(5): (optional) Christensen, C. M., R. Bohmer and J. Kenagy (2000). "Will disruptive innovations cure health care?" Harvard business review 78(5): PERSONAL HEALTH RECORDS Topics: First, spend ~30 minutes setting up your own PHR using any commercial vendor you like. Does the system meet your needs? Is it easy to use? What would you change about the layout? The level of detail? Then, read the assigned articles. Do these commentaries on Google/Microsoft PHRs reflect your own experience? Do the national studies identify the most important issues? 3. Set up your own PHR! 4. Gardner, B. (2011). "Google Health #failed. So, how do we make personal health records work?" Something Not Unlike Research Dolan, B. (2011). "10 Reasons why Google Health failed." MobiHealthNews Krasner, M. (2011). "The PHR School of Hard Knocks." The Health Care Blog Peters, K., M. Niebling, C. Slimmer, T. Green, J. M. Webb and R. Schumacher (2009). Usability Guidance for Improving the User Interface and Adoption of Online Personal Health Records. Oakbrook Terrace, IL, User Centric, Inc. Page 14 of 17

15 8. Patel, V., E. Abramson, A. Edwards, M. Cheung, R. Dhopeshwarkar and R. Kaushal (2011). "Consumer attitudes toward personal health records in a beacon community." The American journal of managed care 17(4): e Kahn, J. S., V. Aulakh and A. Bosworth (2009). "What it takes: characteristics of the ideal personal health record." Health Affairs 28(2): Session #9: EHR Usability and EHR Entrepreneurs Topics: Are current EHRs meeting users needs? Why or why not? What issues are innovators facing trying to disrupt this market segment? 1. Koppel, R. and D. A. Kreda (2010). "Healthcare IT usability and suitability for clinical needs: Challenges of design, workflow, and contractual relations." Stud Health Technol Inform 157: Mandl, K. D., J. C. Mandel, S. N. Murphy, E. V. Bernstam, R. L. Ramoni, D. A. Kreda, J. M. McCoy, B. Adida and I. S. Kohane (2012). "The SMART Platform: early experience enabling substitutable applications for electronic health records." Journal of the American Medical Informatics Association 19(4): Mandl, K. D. and I. S. Kohane (2012). "Escaping the EHR trap the future of health IT." New England Journal of Medicine 366(24): Herzlinger, R. (2006). "Innovating in health care-framework." Harvard Business Review: Session #10: Case Studies Topics: See specific discussion questions. 1. Bohmer, R. and J. Groberg (2003). "QuickMedx inc." HBS Case: Shih, W. and T. Thurston (2009). "Intel NBI: Vivonic." HBS Case ( ). Page 15 of 17

16 MODULE 4: POPULATION ECOLOGY & MANAGING ENVIRONMENTAL FACTORS HEALTH IT POLICY AND MARKET DYNAMICS Session #11: Managing a Changing Environment: HIT and the Relationships between Hospitals and Physicians Topics: How do organizations manage their external environments? What happens when you do nothing and the environment is nonetheless changing around you? Why might doing something be challenging? 1. Sørensen, J. B. and T. E. Stuart (2000). "Aging, obsolescence, and organizational innovation." Administrative science quarterly 45(1): Topics: Congress relaxed regulations to allow hospitals to share HIT with physicians in an effort to increase adoption in the ambulatory setting how did hospitals respond to this new opportunity? Did they perceive it as beneficial? Were they able to act in ways they thought were strategic? 2. Grossman, J. M. and G. Cohen (2008). "Despite regulatory changes, hospitals cautious in helping physicians purchase electronic medical records." Issue Brief (Center for Studying Health System Change) 123: 1-4. Topics: What are Accountable Care Organizations? What are hospitals and physicians worried about? How could each group benefit? In what ways are the interests of hospitals and physicians either complementary or competitive? 3. Rau, J., P. Galewitz and B. Vaida (2011). New ACO Rules Outline Gains and Risks for Doctors, Hospitals. Kaiser Health News. Menlo Park, CA, Kaiser Family Foundation. 4. Fisher, E. S., S. M. Shortell, S. A. Kreindler, A. D. Van Citters and B. K. Larson (2012). "A Framework For Evaluating The Formation, Implementation, And Performance Of Accountable Care Organizations." Health Affairs 31(11): Topics: How do the tensions among ACO participants affect ACOs overall ability to set up and leverage HIT? 5. Certification Commission for Health Information Technology (2013). A Health IT Framework for Accountable Care. Chicago, IL. 6. Grossman, J. M., K. L. Kushner, E. A. November and P. C. LTHPOLICY (2008). Creating sustainable local health information exchanges: can barriers to stakeholder participation be overcome?, Center for Studying Health System Change Washington, DC. Page 16 of 17

17 7. Adler-Milstein, J., C. M. DesRoches and A. K. Jha (2011). "Health information exchange among US hospitals." American Journal of Managed Care 17(11): 761. Session #12: Industry Trends and Policy Issues Topics: Read through this bundle of official notices from CMS and try to identify some of the concerns hospitals and physicians might have in forming an ACO. What questions do you have about UM s decision to withdraw from the Pioneer ACO demonstration? 1. HHS Press Office (2011). Accountable Care Organizations: Improving Care Coordination for People with Medicare. HHS News. U.S. Department of Health and Human Services. 2. CMS Office of Media Affairs (2011). Summary of proposed rule provisions for Accountable Care Organizations under the Medicare Shared Savings Program. HHS News. Centers for Medicare & Medicaid Services at the U.S. Department of Health and Human Services. 3. CMS Office of Media Affairs (2011). Federal agencies address legal issues regarding Accountable Care Organizations. HHS News. Centers for Medicare & Medicaid Services at the U.S. Department of Health and Human Services. 4. CMS Office of Media Affairs (2011). What Providers Need to Know: Accountable Care Organizations. HHS News. Centers for Medicare & Medicaid Services at the U.S. Department of Health and Human Services. Topics: How would a physician or hospital leader respond to the new opportunities presented by HITECH? What would they be worried about? How do these challenges compare to the issues raised by ACO formation? 5. Blumenthal, D. (2009). "Stimulating the adoption of health information technology." New England Journal of Medicine 360(15): Session #13: Case Studies and Wrap-Up Topics: See specific discussion questions. 1. Hart, M. and S. Dodson (1997). Arbor Health Care Company, Harvard Business School. Page 17 of 17

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