HIMSS24: A Newly Modernized Infrastructure Adoption Model for Healthcare

HEALTHTECH: In which areas of healthcare IT do you think organizations currently need the most support?

BRADLEY: Staffing is probably one of the most challenging areas. It's difficult to find the people that you need and to retain them. The other problem is the growing expectations of everyone with technical devices. The expectations are going up, particularly with the younger generations who do almost everything with a smartphone, and healthcare is struggling to keep up with those expectations. That’s an infrastructure challenge.

Organizations are also struggling to justify investments needed to meet those expectations. Budgets are small; margins are smaller. It's important to be able to communicate funding requests, not in technical terms but in terms of value to the organization. It’s about sustainability, not in the environmental sense, but sustainability to ensure that the investments made today will continue to meet the organization’s needs going forward.

HEALTHTECH: What would you say are the top catalysts for modernizing INFRAM and offering it to health systems now? How does this model best respond to current and future healthcare concerns?

BRADLEY: The biggest driver is to help organizations build the infrastructure to drive clinicians and patients to become much more digitally enabled consumers. Healthcare is becoming more outcome-focused. We have to make sure that what we do supports positive patient outcomes. That's a big reason for why we modernized INFRAM. Like the other models that we've already modernized, we're moving away from “How do you build it?” to “What value are you getting from your investments?” There's still a heavy IT component, but the focus is on what value the infrastructure provides. That's the biggest shift, as we see it, in what’s going to help organizations move into the future as budgets continue to be squeezed.

HEALTHTECH: Why is cybersecurity highlighted in this model?

BRADLEY: Unfortunately, cybersecurity is a growing problem. It can affect healthcare organizations’ bottom lines. We can't get the risk down to zero, but we can do our best to get it to an acceptable level. We need to make sure organizations realize it's not just the tools that we need for cybersecurity but also the governance around it, an understanding of what those tools are remediating, and being able to respond when or if an incident occurs.

The INFRAM advisory group strongly suggested HIMSS not build a new cybersecurity framework. With that in mind, HIMSS leveraged existing frameworks as well as national standards across the globe to ensure international relevance. Your cybersecurity staff should recognize much of the INFRAM cybersecurity requirements.

READ MORE: Healthcare leaders remain focused on cybersecurity and efficiency.

HEALTHTECH: Another domain covers sustainability. How does this HIMSS model address sustainability differently compared with other models?

BRADLEY: We’re referring to sustainability in two ways: sustainability as in building the infrastructure for the long run, helping the business sustain itself, and the other as in the organization’s carbon impact.

There is long-term sustainability built into the other focus areas, including cybersecurity and IT performance management, that helps organizations decide where their dollars need to go and why, and how they can track the benefits of those investments over time. It's easy for organizations to roll out technologies being used by clinicians or patients and have that usage taper off over time. We have built a model that makes sure that the organization is tracking the use of those technologies, the investments, and that if usage does start tapering off, they’ll have enough data to understand why and adjust accordingly.

On the carbon impact side, we are starting to collect data so that we have a better understanding of where healthcare is. We're going way beyond just the carbon impact of IT, not just power consumption and the recycling of retired technologies, but other areas such as lighting, environmental controls in the building, the building management system itself, recycling of plastics that are used, so that we can have a good measure, we can compare and help organizations understand where they are on their curve toward being carbon neutral.

HEALTHTECH: Healthcare organizations may be intimidated to hear that few health systems in the world attain INFRAM Stage 7 so far. What advice do you have for organizations that may feel overwhelmed to start an assessment?

BRADLEY: We want our models to be aspirational but achievable. Maybe the previous version was a bit too aspirational because it was so technically focused. If you didn't do it the technical way, it was challenging to get to Stage 6 and 7. Our recommendation now is not to let that intimidate you, look at the survey, get started and create a baseline for yourself. Stage 7 is the highest level that a health system can achieve, but understanding where you are today and working to get to the highest level with a roadmap to get you there is the value.

We aren't an organization that would give you a survey and then say, “Sorry, you didn't make it.” We work with organizations to help them understand the next steps. If you're at Stage 4, how do you get to Stage 5? What does it take to get to Stage 6? It's a progression. It may take organizations years to go from where they are to where they want to be as we work with them.

It's not that daunting of a survey. It takes a few hours to complete, and we really encourage organizations to get the right people around the table so you end up with a meaningful survey. We really want it to be mindful so that it can be a useful tool for leadership to say, “This is where our investments need to go next.”

EXPLORE: Navigate the balancing act of tight budgets and healthcare innovation.

HEALTHTECH: Where would you say most U.S. health systems are in their assessments? What are some common questions you've received from leaders who are early in their maturity journey?

BRADLEY: The U.S. healthcare market is doing well in two of the focus areas: cybersecurity and IT management and performance, which means that they manage their IT infrastructure fairly well. They have good change management processes; they're not letting their infrastructure get too outdated or out of maintenance.

Where they're struggling is in the adoption and outcomes focus areas. Adoption is where we want to be able to assess how well the technology that we're putting out is actually being used. They're not doing that badly, but they're not achieving Stage 7 mostly because they don't have a proactive way of gaining insights into adoption. They're still reliant on help desk surveys: You open a ticket, you close it, we send you a survey. That's just not good enough. It needs to be more real time. You see things today where you just give a thumbs up, thumbs down, smiley face or frowny face to rate the interaction. Was the online scheduling experience easy to do? Something quick and easy to share feedback. That's the aspirational part of the model.

And the area that they're struggling the most with is outcomes. How do we tie technology investments to outcomes? You can't do it by saying, “We're going to upgrade our Wi-Fi because of these technical improvements.” It has to be associated with a business objective. “We're upgrading Wi-Fi because we want to do these things,” and successes are measured by performance indicators, whether it's improving the scanning of specimens collected at bedside or whatever it might be. What are the process improvements that we expect, and are they defined up front? Do we define them over time as the project wraps up and matures? What we see in U.S. is they do the first part of that really well; they define, but then they don't go back and assess. They usually close that project and move on to the next one. We're encouraging them to step back and say, “Here are the performance improvements that you saw in those investments,” so that the rest of the executive leadership team understands why.

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