Applications
Applications are the systems that users interact with: for example, scheduling, billing, and EHR systems. In addition to developing an inventory of applica tions, the organization may need to develop strategies regarding properties of the overall portfolio of applications.
For example, if the organization is an integrated delivery system, deci sions will need to be made about the degree to which applications should be the same across the organization. E-mail systems ought to be the same, but is there a strategic reason to have the same pharmacy system across all hospitals? Should an organization buy or build its applications? Building applications is risky and often requires skills that most health care organiza tions do not possess. However, internally developed applications can be less expensive and can be tailored to an organization’s needs.
Strategic thinking may center on the form and rigor of the justifi cation process for new applications. Formal return on investment analyses may be emphasized so that all application decisions will emphasize cost reduction or revenue gain. Or the organization may decide to have a decision process that takes a more holistic approach to acquisition decisions, so that factors such as improving quality of care must also be considered.
In general, strategy discussions surrounding the application asset as a whole focus on, in addition to the application inventory, a few key areas:
• Sourcing. What are the sources for our applications? And what criteria determine the source to be used for an application? Should we get all applications from the same vendor or will we use a small number of approved vendors?
• Application uniformity. For large organizations with many subsidiaries or locations, to what degree should our applications be the same at all locations? If some have to be the same but some can be different, how do we decide where we allow autonomy? This discussion often involves a trade-off between local autonomy and the central desire for effi ciency and consistency.
• Application acquisition. What processes and steps should we use when we acquire applications? Should we subject all acquisitions to rigorous analyses? Should we use a request for proposal for all application acquisitions? This discussion is generally an assessment of the extent to which the IT acquisition process should follow the degree of rigor applied to non-IT acquisitions
