i have spent many years thinking about the issue that I will refer to here as decentralized versus centralized control of IT in hospitals. In the following excerpt from HIStalk, a reader comments on what are called "mini-IT departments." Mr. HIStalk responds with a hint that the would prefer that they not be tampered with.
(Comment from reader) "Re: mini-IT departments. I disagree with what I think this means. In healthcare IT the needs of specialized areas is often better served by IT personnel who have some degree of separation from the Central IT Commissar. The analogy makes the assumption of a symmetry' between IT personnel and clinicians, while there is a great asymmetry. Clinicians enable healthcare; IT personnel facilitate it; clinicians are accountable for patient harm and death; IT personnel are not. When IT personnel move away their control mentality and become part of the clinical team, everyone (including the poor patients) will be better off."
(Mr. HIStalk response) I editorialized this week in Inside Healthcare Computing about that topic, which I called "Rogue IT Shops: Provide Rules, but Leave Them There." Darn, now I've given away my conclusion. Well, my arguments were equally fun.
I have personally managed an LIS unit embedded within a department of pathology (a mini-IT department) and also served served as an IT director for "ancillary systems" with a large portion of my salary coming from the health system CIO. I am thus familiar with the issues on both sides of the fence. It will probably come as no surprise to the readers of Lab Soft News that I strongly believe that "min-IT shops" in pathology and radiology should be allowed to operate semi-autonomously. I use this adjective cautiously because there is sometimes value in directives from higher management echelons.
Central IT personnel strive for uniformity across departments. For ease of management, they like to work with a small number of name-brand vendors for both software and hardware. They work with large numbers: large numbers of users and large hardware and software vendor contracts. The complaints of physicians are considered minor irritants that can be dealt with. Their primary concern is keeping the CIO and CEO of the health system happy.
IT personnel working in an "ancillary department" such as pathology, clinical labs, radiology, and pharmacy work side-by-side with the personnel who are delivering direct patient care. In such "mini-shops," system functionality trumps all other issues. The nameplate on the hardware or software is not a major concern. Harmonization/integration with other hospital software is agreeable but also not a driving force. As noted above, Mr. HIStalk says that "rules" need to come from above. I would stipulate that the "rules" coming from above need to have some rational basis and they must result in greater efficiency and effectiveness of those clinical units in hospitals that are affected by the rules.