What I Wish I’d Known Before … Creating, Defending, or Managing a Hospital IT Budget

How your organization views IS/IT should be well understood. For example, are you viewed as just a cost center or are you tied to the organization’s strategic goals? If your organization leans more to the former, focus on telling the story of cost management. For the latter, focus more on capabilities and deliverables. And find ways to build in realistic contingency. This lesson stuck from one of my college professors – "Budgets are a guess. And what do we know about guesses? They are almost always wrong!"

That doctors are not luddites but they won’t fall for the next new shiny object either.

That at any time you can and will have your budget re-allocated for the " good of the health system." Meaning, that a pet project by a key physician leader needs to get funded before they jump ship.

How much the executives were really making.

That IT is viewed as a cost center, and as such it is subject to constant downward pressure as the CEO and CFO continually chase margin. Given that IT budgets have only one real variable cost, labor, you are constantly trying to defend your staff. You have to be ruthless in squeezing your vendors – they are not your friends no matter how many dinners they buy or how much fun at HIMSS they provide. The real challenge comes after you’ve implemented your EMR and the CFO is looking for the vendor-promised 10-percent efficiency gains, never mind that you’ve implemented 6X the amount of functionality and support complexity, and BTW, those legacy systems are going to have to hang around for another six years. Best strategy I came up with was appealing to the CEO’s ego by putting him out front as a "strategy leader" in "technology driven quality healthcare," got his picture in a few trade rags with quotes, kept us safe for a couple of budget cycles.

After a go-live, be real clear with the CFO on the difference between remediation and optimization. Twenty percent on top of the original TCO for optimization in ok, but if a buzz starts that the 20 percent is just to deliver things originally promised, that’s a problem.

That a boss at a previous employer was more concerned about giving his buddy some business he would move around project priorities based on which vendors got the bid rather than actual need. Which is how we ended up buying a metric crapload of servers and networking gear but no racks or power distribution to actually install them.

That leadership would not stick to the budget and would always find a way to fund special projects without any considerations of the resource planning that had already taken place. Especially when leadership bends the budget for non-IT departments to purchase new IT-dependent products without allowing for any increase in the IT budget for implementation and support.

That finance sets the rules and will let you know when you are not following them but do not necessarily tell you what the rules are. Always add a minimum of 10 percent to your best-guess cost projection to cover the unknown.

Previous budget data, operational metrics, and how more/less efficient the proposed budget is.