Issues
Essays

The discussions and cursory analyses in the Harvard Business Review case Too Far Ahead of the IT Curve? (Dalcher, 2005) attempt to implement massive IT projects without considering the implications from a strategic and tactical level. There is no mention of the most critical legal considerations of any healthcare provider, and this includes compliance to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) in addition to highly specific requirements by medical practice area and discipline (Johnston, Warkentin, 2008). Second, there isn't a framework described for governance of the IT strategies as they relate to Peachtree Healthcare's overarching strategic vision and mission. The lack of focus on governance in any strategic IT implementation will eventually lead to confused roles, cost overruns and chaos relating to the long-term contribution of IT to rapidly changing business priorities (Smaltz, Carpenter, Saltz, 2007). Max Berndt is right to be concerned about agility and flexibility; because if he had standardized healthcare processes and workflows with the company's existing systems, the results would be worse. Yet Service oriented Architectures (SOA) are not the answer to this challenge, there needs to be more thorough planning and evaluation of how IT can be made a strategic platform for growth. Third, Peachtree is woefully deficient in the areas of analytics, key performance indicators (KPIs) and metrics of performance of their enterprise to the audit and performance level of each hospital, treatment center and teaching facility. It is essential for any healthcare enterprise to have a thorough methodology in place to capture HIPAA-based audit data in addition to continually monitoring the process workflow performance of its core business unit (Alhatmi, 2010). Only by having these metrics and KPIs in place can Peachtree hope to gain the full contribution of analytics and the insights available with the latest generation of enterprise applications in this rapidly changing area. Analytics is entirely separate from the decision of whether to implement a monolithic versus SOA-based architecture. It could be argued that in healthcare enterprises, analytics are the compass that explains the direction of the enterprise, giving senior management visibility into how they can best navigate to their objectives (Smaltz, Carpenter, Saltz, 2007). Peachtree lacks a solid governance architecture though, so the analytics will end to be used to build one based on an assessment of just what areas of the existing IT infrastructure are failing. Without this level of insight, Peachtree's senior management team will continue to churn with very significant IT challenges. Analytics and audit data will show Peachtree that a large scale rip-and-replace strategies may actually harm them even more than help. Without even this layer in their IT architecture today they are in some ways like a car traveling down an interstate late at night without its lights on. Fourth, the issue of change management is not discussed as a strategic once in the case study (Dalcher, 2005). There is ample evidence this is a critical issue, given the reactions of the physicians and staff at the Decatur hospital. As Max and Candace visit in the middle of a system melt-down. Yet this issue will be the single biggest source of costs and pain of changing from existing systems, even though they are clearly substandard and not doing the job. Max, Candace and the entire board of directors need to stop and think how the decision of using a monolithic versus SOA-based approach to solving these major problems in their enterprise will be implemented, and how a change management program can be successfully implemented. The fact that physicians each have a very specific approach to how they like to work and expect IT systems to meld to their way of doing things, and not the other way around, Max and his team have a big job ahead of themselves on this issue (Smaltz, Carpenter, Saltz, 2007). The apparent lack of SOA early adopters in healthcare is a warning sign that the CIO doesn't seem to take too seriously, yet demanding user references is going to be critical to the success of any partnership with an enterprise vendor. SOA implementations also challenge every aspect of an organization, from its governance architecture (Smaltz, Carpenter, Saltz, 2007) to its change management strategies (Fickenscher, Bakerman, 2011) with the need for a consistency across a very complex series of processes. Peachtree's senior management has a perceptual blindness to these issues which are the core aspects of any strategic IT implementation. Fifth and finally the budget figures in the case lack any credibility because the executive team hasn't defined the goals and objectives for this project in the context of a governance framework for Peachtree. There is no governance framework to determine relative levels of spending again, making the massive figures unbelievable. It is common knowledge that any enterprise project will be comprised of 10% of software costs, and 90% being change management-related costs including customizing the applications and systems to how employees work creation and testing of analytics and metrics, and piloting of the system itself (Fickenscher, Bakerman, 2011). None of this is included in the statement of work or in the case which further brings confusion tot eh decision making process.

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