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The Technological Shift in IT Service Management

James W. Brady, CIO, Los Angeles County Department of Health Services
James W. Brady, CIO, Los Angeles County Department of Health Services

James W. Brady, CIO, Los Angeles County Department of Health Services

Technology has become an indispensable part of every industry, and the healthcare sector is no stranger to the changes that innovation has made in the health care space. The development of digitalized and network-connected medical equipment has made significant contributions to improving health and saving countless lives all around the world. The integration of technology with different areas of focus, such as disease detection and prevention, surgical procedures, and patient video visits has brought along many benefits, as well as its own set of challenges.

Understanding the trending factors

There is a transformational shift occurring in every industry with organizations adopting cloud and converged infrastructure. This evolution has enabled them to reach out to external vendors with increased interconnectedness.  In contrast to earlier practices, organizations are prepared to form alliances with vendors as they want to focus on their business efficiency and metrics when it comes to integrating their various systems and obtaining value. This development gradually progressed into the healthcare sector, where initially, we were not open to the concept of the public cloud. However, with more security maturity in the public cloud, this has enabled traditionally conservative health care organization to entrust their infrastructure and data into cloud environments. 

From an average hospital room, where there is typically an average of five medical devices, to the intensive care units, which can have as many as 22 connected medical devices, hospital rooms are inherently dependent on technology.  Since we are very focus on patient safety and positive patient outcomes, it is essential for us to focus on service management for these technologies.  I do not believe anyone would want these critical systems to be interrupted or having issues during life threatening operations or intensive medical procedures.  Therefore, it was essential that technology management in the healthcare sector evolve and remain current with other industries.

Challenges in the ITSM space

Referencing the healthcare space, it is a very complex environment with many proprietary systems, some of which were not designed to communicate with each other. This lack of integration and interoperability is a significant challenge in the healthcare sector. As we do not have a single national patient identifier system within the United States, care providers are often challenged with not knowing who their patients are from a electronic health record perspective.  This can cause patient harm.  For example, if a physician looks up the medical record of a patient, there is the danger that allergy and medication maybe incorrect. Prescribing medications could then cause patient harm.  Another challenge that we are trying to address is the lack of standards in use with systems and equipment in healthcare. With differing standards and protocols, critical patient information is often times not shared with other health care providers or payers due to the inability of systems to communicate with each other.  The government has intervened, establishing more stringent regulations and incentive programs for vendors and health care providers to move in this direction.  Open APIs and an increased focus on standards is helping in this areas. Another opportunity for health care organizations is to reduce the number of products, services, and vendors, and instead establish strategic vendor partnerships. The tradeoff here is that though we lose a little of the best of each system, we can obtain value from interconnecting the systems, monitoring and managing them.

 There is a tremendous need for more security or advanced intelligence to analyze, monitor and assess our technology capabilities 

Strategic points to be noted going forward

At the Los Angeles County Department of Health Services, we are a local government organization that is focused on fair and open vendor solicitations.  When entering into a contract with a vendor, we specify what our requirements are, and clearly delineate our responsibilities are, as well as what our vendors’ roles are.  If the demand changes later on, having a detailed Statement of Work (SOW) and contract helps to clarify obligations.  Therefore, it is important to have a contract that is amenable to both sides.

When it comes to developing software, products, and services, our outlook has changed from a waterfall approach to a more agile mindset. Hence, we have begun to look at how we can bring more functionality into the organization in a shorter period of time. 

A path to success

There is a growing digital movement happening across all industry sectors with the entry of such advanced technologies as artificial intelligence, machine learning, analytics, predictive analytics, genomics, and precision medicine in the health care environment. More emphasis is now on systems becoming software-defined, and the healthcare industry will need to adopt and virtualize their technologies accordingly, as well as manage their security.

We need to understand that traditional security perimeters are vanishing. There is a greater need for more security or advanced intelligence to analyze, monitor, and assess our systems, processes, and individual identities.  As users traverse networks between desktops and applications through access systems, we need to evaluate their activity and detect if there are any anomalies at each point along the way and take the necessary actions if required.  Only requiring security checks when a user enters the environment or logs into their system is no longer enough.

Advice to the healthcare community

With all the changes happening around, it is always good to understand what works best for your organization and develop strong relationships with strategic vendors as they have a lot to offer. Being customer-focused and over delivering, coupled with being knowledgeable and focused on the goals of your organization, is the best way to understand the best path forward.

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