Information technology management in local health departments: Implications for emergency preparedness

In the United States, public health departments play a key role in preparing for and responding to emergency incidents affecting their community's health. As such, their ability to effectively and efficiently undertake their responsibilities has been given considerable attention by our Nation's leadership. An area of concern is the adequacy of the public health infrastructure, revealed to be inadequate to manage emergencies during the 2001 9/11 and anthrax terrorist events. Since 2001, federal resources have been allocated to strengthen the public health infrastructure, and many local health departments (LHDs) across the United States have received funding for emergency preparedness activities. This research examines one component of the public health infrastructure--information and data systems. This research examines information technology (IT) management practices within LHDs, and the implications for the management of the IT supported by emergency preparedness funding. A survey instrument was developed with indicators relevant to (1) measuring IT management practices, (2) understanding whether LHDs have effectively established IT supporting emergency preparedness, and (3) documenting LHDs directors' perceptions about the extent to which their department is emergency ready. Two respondents from each "large" LHD were targeted for inclusion in the survey--the Director of IT and Emergency Preparedness Director (EP Director). There are approximately 133 large LHDs--defined as an agency serving a health jurisdiction with a population totaling more than 500,000. Forty-three LHDs participated in the survey. A total of 63 surveys were completed--29 by an IT Director; 34 by the EP Director. The findings reveal none of the LHDs rate as high performers on all or a majority of indicators relevant to effectively managing IT--either organizationally or with respect to the IT supporting emergency preparedness--or having effectively in place the IT of relevance to emergency preparedness. Seven LHDs rated as high performers for managing their emergency preparedness IT; three LHDs rated as high performers with respect to emergency prepared. About one-fourth of the LHDs are medium performers. The survey findings highlight areas where additional attention is required to effectively establish the public health IT infrastructure LHDs need to effectively assure their community's health.Information Technology Management in Local Health Departments: Implications for Emergency Preparedness Doctoral Dissertation Submitted in Partial Fulfillment of Requirements for Doctor of Management Submitted by: Yvonne Claudio University of Maryland University College Dissertation Committee Robert P. Ouellette, PhD, MBA, Chair Paul F.G. Keller, PhD, MS Kathleen Edwards, PhD, MS External Reviewer: Janise Richards, PhD, MS, MPH Senior Advisor, National Center for Public Health Informatics, Division of Knowledge Management, CDC March 31, 2008 IT Management in LHDs ii Copyright © Copyright by Yvonne Claudio All Rights Reserved May 2008 IT Management in LHDs iii Dedication This dissertation is dedicated to my immediate family who were the reason why this challenge was important. It was each of you that motivated me as I worked to complete each milestone in my education. To my mother, Maria Isabel Torres, my father Mariano Berrios Claudio (in memory), my brothers and sisters Mario, Josephine, Sandra, Elizabeth, Shirley (in memory), Hector, Luz, and Abraham. Thank you for all your love and support. We truly do have a very special loving Puerto Rican family. my best friends, Dr. Carmen (in memory) and Raymond Mercado, who served as my personal cheerleaders for more than 30 years. Thank you for your great friendship, support, and generosity. Carmen I am very sorry that you missed my graduation by a few months. May you rest in peace. Father Roland L. Dumpson, who early in my life stressed the importance of education, and encouraged me to pursue a college, masters, and doctoral education. I finally completed the goal you set for me more than 40 years ago. my life partners. Each of you was a major inspiration and in your own way served as a role model. Thank you for all your emotional support and full encouragement as I pursued my educational goals. IT Management in LHDs iv Acknowledgements I wish to thank my committee members, for their continued support over the past years. Thank you Dr. Robert Ouellette, my committee chair, for your patience in reading through very rough drafts, and providing feedback that helped frame the research and work. Thank you Dr. Kathleen Edwards and Dr. Paul Keller for agreeing to serve on my committee, for remaining available through this long process, and for providing feedback on final drafts. I would also like to thank Dr. Janise Richards, my external reviewer on the dissertation committee. Thank you for agreeing to serve on the committee, and for the considerable time you put into reviewing, editing, and providing comments and feedback to the document. I truly appreciated the diligence with which you reviewed the drafts and the public health perspective that your participation provided. Also, thank you to all my professors at UMUC for the masters and doctoral education that you provided. I will forever cherish my years at UMUC. I also wish to acknowledge my colleagues in public health departments. Over the years, many individuals I worked with contributed considerable insight on public health operations and IT practices. My greatest appreciation goes to my colleagues and forever friends James A. Buford, Carl W. Wilson, Willis R. Bradwell, Jr. and James M. White. Finally, thank you to all the CIOs and individuals with whom I worked while at NAPHIT, and a special thank you to the LHD leadership who participated in this research and whose input made this work possible. IT Management in LHDs v Table of Contents Copyright ........................................................................................................................ii Dedication ..................................................................................................................... iii Acknowledgements ........................................................................................................iv Table of Contents ............................................................................................................v List of Tables..................................................................................................................xi List of Figures ..............................................................................................................xiv List of Abbreviations .....................................................................................................xv Title Page ........................................................................................................................1 Abstract...........................................................................................................................2 I. Introduction..................................................................................................................4 II. Research Problem .......................................................................................................9 A. Problem Statement ......................................................................................9 B. Research Questions....................................................................................10 C. Research Objectives...................................................................................11 D. Research Constraints .................................................................................12 III. Literature Review ....................................................................................................13 A. Public Health--Functions, Role in Emergency Preparedness, Infrastructure13 1. LHDs in the U.S. ................................................................................13 2. Core Public Health Functions .............................................................14 3. LHD Emergency Preparedness Functions ...........................................18 4. The Public Health Infrastructure .........................................................21 IT Management in LHDs vi B. Information Technology Infrastructure in LHDs ........................................23 1. LHD Information, Data and Communications Systems .......................23 2. The State of the Public Health IT Infrastructure ..................................26 3. Federal Action to Address the Public Health IT Infrastructure ............28 4. National IT Initiatives--Implications for LHDs IT Infrastructure.........33 5. National IT Initiatives--A Need for Strategic Action...........................35 6. A Strategy for Moving Forward..........................................................36 C. Information Technology Management .......................................................38 1. Information Technology and IT Infrastructure Defined.......................38 2. Historical Perspective .........................................................................40 3. The Relevance of Strategic Management of IT for Organizations .......43 4. Forces Impacting IT Management.......................................................46 5. The Essentials of Strategic Management of IT ....................................50 a. Governance..................................................................................50 b. Visioning/Planning ......................................................................52 c. Aligning IT Strategy with Business Unit Strategy and Functions..54 d. IT Infrastructure Development/Portfolio Identification ................55 e. Acquisition Priorities and Control ................................................59 f. Scope of IT Support Services .......................................................60 6. Frameworks for Assessing IT Management ........................................61 a. Base Firm-Wide IT Infrastructure Services Framework-- Broadbent,Weill, & St. Clair ......................................................61 IT Management in LHDs vii b. Feeny/Willcocks Framework for Core IS Capabilities..................62 c. Strategic IT Management Framework--Bergeron, Raymond & Rivard........................................................................................63 d. Information Technology Investment Management (ITIM)/GAO Framework ................................................................................66 e. IT Management Competencies for Public Health Professionals Framework--The O Carroll and Public Health Informatics Competencies Working Group...................................................69 IV. Conceptual Framework............................................................................................72 V. Research Methodology .............................................................................................79 A. Sampling Frame ........................................................................................79 B. Respondents ..............................................................................................80 C. Survey Instrument......................................................................................81 D. Limitations ................................................................................................83 VI. Findings ..................................................................................................................85 A. Survey Findings--Organizational Management of IT in LHDs ...................85 1. Overall Findings .................................................................................85 2. LHD s IT Management Practices: High and Medium Performers........96 3. Open-ended Comments Offered by Respondents ..............................100 B. Survey Findings--IT Supporting Emergency Readiness ...........................102 1. Overall Findings ...............................................................................102 IT Management in LHDs viii 2. LHD s Effectiveness in Establishing Emergency Preparedness IT: High and Medium Performers .................................................................105 3. Open-Ended Comments Offered by Respondents..............................113 C. Management of IT Supporting Emergency Preparedness .........................115 1. Overall Findings ...............................................................................115 2. LHD s Effectiveness in Managing Emergency Preparedness IT: High and Medium Performers .................................................................118 3. Open-Ended Comments Offered on Emergency Preparedness Management ...................................................................................123 D. Survey Findings--Emergency Readiness in LHDs....................................125 1. Overall Findings ...............................................................................125 2. LHD s Readiness for Emergencies: High and Medium Performers ...128 3. Open-ended Comments Offered by Respondents on Emergency Readiness .......................................................................................129 E. Summary Findings--LHD Performance....................................................131 VII. Discussion............................................................................................................136 VIII. References ..........................................................................................................145 IX. Appendices............................................................................................................157 IT Management in LHDs ix List of Appendices Appendix A. Summary of Indicators Used in LHD Survey Source and Research Topic ..............................................................................158 Appendix B. U.S. Large LHDs--Sampling Frame ........................................................173 Appendix C. Survey Instrument...................................................................................177 Appendix D. Framework of Base Firm-Wide IT Infrastructure Services Framework (Broadbent, Weill, and St. Clair, 1999)..........................................191 Appendix E. Feeny/Willcocks Framework for Core IS Capabilities (2006) ..................192 Appendix F. Measures of Strategic IT Management (Bergeron, Raymond & Rivard, 2001 ................................................................................193 Appendix G. ITIM/GAO Framework Components ......................................................195 Appendix H. IT Management Competencies for Public Health Professionals (O Carroll and Public Health Informatics Competencies Working Group, 2002) ...............206 Appendix I. Tables with Detailed Data from Survey ....................................................208 Appendix J. Checklist for Assessing IT Management Practices....................................215 Appendix K. Checklist for Evaluating the Effectiveness in Planning and Adopting IT to Support Emergency Preparedness ............................................218 Appendix L. Competencies for Strategic Management of IT and IT Projects: Suggestions for Additional Public Health Workforce Skills..............................222 IT Management in LHDs x Appendix M. IT Management Metrics for LHD Accreditation: Suggestions for Operational Definition of a Functional Health Department ......224 Appendix N. Human Subjects Research Form .............................................................235 Appendix O. Permission to Use Copyrighted Material................................................239 IT Management in LHDs xi List of Tables Table 1. LHDs by Size of Population Served (NACCHO, 2006)....................................14 Table 2. Personal Health Services Provided in LHDs, 2001 ...........................................16 Table 3: Population-Level Services Provided in LHDs, 2001.........................................17 Table 4. Sample Listing of Information Technology Supporting Public Health Programs/Services and Emergency Preparedness ...............................................24 Table 5. Enterprise Architecture--Discrete Enterprise Structural Components................58 Table 6. Base Firm-Wide IT Infrastructure Services Framework Broadbent, Weill, and St. Clair...........................................................................62 Table 7. The Feeny/Willcocks Framework for Core IS Capabilities ...............................63 Table 8. Measures of Strategic IT Management Framework Bergeron, Raymond, & Rivard...........................................................................65 Table 9. The ITIM/GAO Framework.............................................................................68 Table 10. IT Management Competencies for Public Health Professionals Framework The O Carroll and Public Health Informatics Competencies Working Group .....69 Table 11. Comparison of Survey Participants and NonParticipants ................................81 Table 12. Distribution of Participants Across Size of LHD Jurisdiction, Purview Specific ................................................................................................81 Table 13. IT Director s Rating of LHDs on IT Management Practices (N=29)...............90 Table 14. IT Director s Rating of LHDs on IT Management Practices (N=20)...............93 Table 15. LHD s IT Management Practices Across 8 Components of the Framework: Number of High and Medium Performers ..........................................................97 IT Management in LHDs xii Table 16. LHD s IT Management Practices Across Groupings of the Framework: Number of High and Medium Performers .........................................................99 Table 17. LHD s IT Management Practices for All and Strategic Indicators: Number of High and Medium Performers ..........................................................99 Table 18. Emergency Preparedness Director s Rating of LHD s Effectiveness in Establishing Emergency Preparedness IT (N=34) ...................106 Table 19. Emergency Preparedness Director s Rating of LHD s Effectiveness in Establishing Emergency Preparedness IT (N=20) ...................109 Table 20. LHD s Effectiveness in Establishing Emergency Preparedness IT: Number of High and Medium Performers ........................................................112 Table 21. LHD s Leadership Assessment of Effectiveness in Managing Emergency Preparedness IT (N=40).................................................................119 Table 22. LHD s Leadership Agreement on Effectiveness in Managing Emergency Preparedness IT (N=40).................................................................120 Table 23. LHD s Leadership Assessment of Effectiveness in Managing Emergency Preparedness IT (N=63).................................................................121 Table 24. LHD s Leadership Agreement on Effectiveness in Managing Emergency Preparedness IT (N=63).................................................................122 Table 25. LHD s Effectiveness in Managing Emergency Preparedness IT: Number of High and Medium Performers (n=40) .............................................123 Table 26. Emergency Preparedness Leadership s Assessment of LHDs Readiness for Emergencies (N=34) ..................................................................127 IT Management in LHDs xiii Table 27. Emergency Preparedness Leadership s Assessment of LHDs Readiness for Emergencies (N=20) ..................................................................128 Table 28. LHD s Readiness for Emergencies: Number of High and Medium Performers .........................................................................................129 Table 29. Distribution of High and Medium Performing LHDs Across Key Components of the Dissertation s Framework (N=63)......................................133 IT Management in LHDs xiv List of Figures Figure 1. Pyramid of Public Health System Preparedness ..............................................22 Figure 2. GAO Model for Using IT to Drive Strategic Business Change........................67 Figure 3. Information and Data Systems: Relation to Emergency Preparedness Capacity .......................................................................................73 Figure 4. IT Management Practices: Implications for LHD Readiness for Emergencies.................................................................................75 Figure 5. IT Management Practices Indicators: Organizationally & for Emergency Preparedness Initiative .......................................................................................76 Figure 6. Emergency Preparedness IT Capacity Indicators (30 Variable Construct) .......77 Figure 7. Emergency Readiness Indicators (10 Variable Construct) ...............................78 Figure 8. LHD s Public Health Infrastructure ..............................................................139 IT Management in LHDs xv List of Abbreviations AHRQ Agency for Healthcare Research and Quality CDC Centers for Disease Con