Getting to the bottom of the IT list
When the trade publication Computers In Healthcare debuted in 1980, hospitals and other healthcare facilities already were hip deep in information technology – albeit with closet-sized, clunky mainframes from pioneering companies largely out of the business today.
With the advent of diagnosis-related groups (DRGs), managed care and two healthcare reformations roughly two decades apart, that publication, now known as Health Management Technology, has chronicled business and clinical operations by desktop personal computers, laptops, notebooks, hand-held personal digital assistants and now smartphones and tablet PCs.
During the meteoric rise and global acceptance and adoption of IT in that more than three-decade span of development, healthcare organizations, by and large, had to perform the same, if not similar, due diligence in evaluating, selecting and purchasing IT products.
In fact, in healthcare these days IT is just about as ubiquitous as, say, air.
To keep pace with performance improvement initiatives, provider IT professionals must know what’s needed, make fast but detailed decisions and avoid mistakes.
But is there a reliable formula for purchasing IT success? The variables can resemble some of the parameters Supply Chain faces when purchasing products for the entire organization. They include such components and considerations as product price, ongoing maintenance and service, updates and upgrades, interfacing and integration with existing or new systems, overall ease of use and nimbleness to operations and, finally, relevance to the organization’s mission, vision, finances and operations.
Yet each facility may stress all of these variables in a different order. As a result, HMT posed to nearly a dozen healthcare IT executives fundamental questions about the basics of purchasing IT effectively.
What do you believe should be the top consideration for effective IT purchasing?
- Stein: [What you list] are all important considerations, but their priority may vary by organizations depending on particular circumstances. For example, some providers may be migrating [electronic medical record] systems and are attuned to consolidation of multiple systems. Others that are embarking on a data warehouse strategy will have very data-centric priorities. Others may be sensitive to the availability of professional services that can tailor and maintain their deployments
Regardless of the relative differences, substantial thought must go into how well the solution addresses organizational needs over time, and how well can it overcome the various barriers to adoption that any new technology must face. Another important consideration will be industry-specific components that can significantly reduce the amount of professional services required to achieve the business objectives.
- Blitch: Overall ease of use and nimbleness is certainly a top consideration for effective IT purchasing. Consider this: Budget season is over. The hospital board has asked you, once again, to do more with less. The department needs to produce 20 percent more with 15 percent less resources to do so. Does this sound familiar?
With this type of consideration at the top of everyone’s minds, it’s important to have a non-disruptive solution to help with the workflow. Cloud-based technology platforms oftentimes offer these types of advantages – for example, they can be easily turned on or off by the simple way the technology stack is built. Healthcare executives should keep overall ease of use at the front of mind so that their teams will be grateful, the board will be satisfied and you can sleep better at night.
- Saffarian: There are a multitude of considerations to effective IT deployments, from integration into existing systems to identifying the right partner(s) to ensure ongoing maintenance and support. We encourage providers to look carefully at total cost of ownership (TCO) and alignment with their overarching enterprise architecture strategy and direction in selecting any new products and services. TCO encompasses price, integration and maintenance, while extended enterprise architecture ensures compliance with new health IT policies and initiatives within hospitals and clinics in addition to a growing number of merger and acquisitions of practices and clinics with different systems. Given the variable levels of technology expertise among users, ease of use should also be a top criterion in choosing the right products and software selections, but it is often overlooked.
- Glaser: The top priority should be relevance to mission, vision, finances and operations, because that will then drive the other decision-making criteria. An HIT system investment is just that – an investment in the organization’s infrastructure.
Additionally, working with a vendor that is committed to helping your organization achieve its goals and that will work with you as those goals – driven by market demands, environmental dynamics, regulatory and legislative requirements – evolve.
- Chaiken: IT purchasing needs to be based upon relevance to mission, vision, finances and operations. Purchasing IT to keep up with current trends does nothing to address the needs of an organization. In addition, it can lead to a poorly implemented IT solution that fails to meet the needs of the organization. A clear vision of organizational goals produces a clear view of what software is required to meet those goals. This allows high-quality vendors to guide an IT implementation that provides value early and throughout the product life cycle. Although pricing may be important in the short term, software costs are just a fraction of the total cost of a product, and therefore must be evaluated on the value provided. Reworking implementations can be very disruptive to operations, and very expensive.
- Kent Rowe: The overall value and return on investment. Price matters, as do ongoing maintenance and service costs, but you have to view those in the context of other savings and benefits. Interfacing and integrating with existing/new systems often gets overlooked, especially for future-proofing. Is the new product you’re thinking about purchasing vendor-neutral and interoperable? What if, a year from now, a vendor sunsets one of your current core systems? Are the services you’re purchasing dependent upon that system?
- Baumgartner: Relevance to mission, vision, finances and operations is key. With the increased pressures of both regulatory and financial constraints being placed on healthcare environments, it becomes critical that they ensure that any and all IT expenditures facilitate their efforts to achieve their mission. Facilities that do not focus on this area will continue the siloed and inefficient disparate network of data within their healthcare environment. And with the ongoing consolidation within the market, IT will be tasked more than ever to ensure the future systems are open to support the greater mission of the facility: Reduced costs with higher quality outcomes.
What are some of the essential questions that must be answered by IT departments to determine the optimal IT products and services they need?
- Lougheed: IT departments need to make sure they not only understand the needs of the business units they serve, but also make sure they understand the market trends and the approach that their peers are taking to solve these challenges. It’s also important to observe the signals of the venture capital community, particularly in the rapidly evolving healthcare IT space. There is a lot of investment capital flowing into this market. Understanding where and why that money is flowing can help IT leaders see where others are placing their bets.
- Byers: IT departments must ask themselves the following:
- How quickly could our infrastructure capacity requirements increase? Decrease?
- To what extent? And, what are the most likely scenarios?
- How rapidly are key technologies changing and evolving?
- Where in their lifecycles are the products we’re considering?
- What’s on the horizon?
- What are our current and future service level requirements for uptime and availability?
- Beyond readily available, online resources, what potential business capabilities will have the greatest positive impact on revenue generation and operational effectiveness?
- Who is the end-user and how do they interact with the customer and other IT systems?
- McMillan: Approaching this from a “privacy and security” perspective, the questions that are important fall into three basic categories: Those related to development, those related to maintenance and administration, and those related to compliance. Some examples for each:
What platform is the product developed on?
Does the product require any third-party external resource to be secure?
Was the product coded following security best practices?
Has the product gone through any third-party testing/certification?
- Maintenance and administration
Can the product be readily patched or upgraded as necessary?
Does the system require backup?
Can access to the system be controlled?
Does the system have the necessary functionality to meet compliance requirements?
If appropriate, can the system be audited?
The list here is much longer and may also include questions of the vendor and other aspects of their business if the system in question involves ePHI.
While it sounds basic and fundamental, it starts at the top with the organization’s strategy. The IT department, as well as other departments, is there to execute the strategy of the senior leadership.
- Helt: Does it impact in a positive way the mission of our organization to improve the continuum of care? If we procure this technology, what other item may not make the budget cut, and what is the impact to our organization? Have we assessed the internal skill sets to handle the implementation and rollout, the ongoing support to be handled internally/0externally,the cost associated with support (internal/external) and the future of this offering via upgrades, refresh, etc.?
- Glaser: No healthcare organization physical structure would be built without a design and blueprint that reflects what care services will be delivered and how the building must function to meet the needs of caregivers and patients alike. The same holds true for building an HIT infrastructure. It begins with the most essential question of what the organization’s strategy is and how an HIT system will support this. Fundamentally, the organization must define what it wants to accomplish with an HIT system, such as support and improve existing processes or create new, more efficient processes underpinned by HIT. Then it must define what functional capabilities are required. The key is understanding the functions that the HIT system must support and what the primary users need in a system from the vantage point of understanding the workflow and processes in the various departments. How the accounting office functions is very different from how the maternity department works. And that is very different from the workflow in the oncology department.
- Stein: Provider IT departments must take a critical look at new IT products and services to understand:
- Where does this technology fit into my organization-specific technology stack? How will it work with our existing and emerging data sources and formats?
- Who are the intended users? How will they transition from their current process to using this product? What level of training is required to achieve the productivity goal within the target time window?
- Does this technology fill a current need? How can I demonstrate ROI over time? Is it also forward looking enough to address future needs in the same space? Will we require additional components? Are they available?
- Does the technology vendor have the breadth and depth to meet our business and technology needs, even as they evolve? How does the vendor address my data life cycle?
- Does this technology satisfy our industry regulatory compliance requirements?
- Kent Rowe: What’s the cost of doing nothing, of maintaining the status quo? Quantify the opportunity cost as much as possible. Nail down prospective vendors on what they can deliver and what improvements their existing customers have seen.
Second, what’s the cost of failure? If a product or service doesn’t work out, how much time and resources will you have spent implementing it? How immediately will you be able to tell whether it’s working as intended, and what’s the impact of it potentially not working for that period of time?
- Baumgartner: First and foremost, the facility must develop a vision for the role of any and all IT within the organization. Without this vision, their decision-making will be limited to a case-by-case solution and not as likely to support the overall mission of the entity. With that in place, it is possible to answer the following essential questions:
- How will this new product or service support our vision?
- Will this new product improve our operational performance or provide additional detail for the use of quality outcome tracking?
- Is this new product simply a departmental solution or is it a solution that meets not only the unique departmental needs, but also support the greater requirement to disseminate the information appropriately across the enterprise?
- Is the new product based on standards with an open interface for integration or is it simply proprietary and require extensive one-off interfaces that will be expensive to maintain?
- What is the long-term viability of the company? Will they be around for five to 10 years or are they offering such a low price that they will not be around for support and upgrades?
- Does the vision of the company support our vision?
- Chaiken: Organizations that do not communicate a clear strategic objective with related goals are unlikely to achieve IT products and services that deliver value. Once goals are clear, IT departments must thoroughly understand the impact of various IT products and services on the ability of employees using those products and services to meet the organizational goals. In addition, IT departments must understand what each department they serve needs to accomplish and guide them on how IT can help. IT departments that see those throughout the organization as clients will most likely succeed, while others that see themselves as IT purchase and delivery organizations only will not.
- Blitch: IT departments should ask themselves three essential questions to determine the optimal IT products and services needed:
- How does the product/service integrate with our current platforms?
- Is the product/service focused on results that are measurable?
- Does the product/service support the vision of our facility?
Firstly, integration is a word that tends to scare us all. If you’ve invested a lot of time and money into an existing platform and your new product doesn’t “play nicely” with the existing infrastructure, then it falls on the IT department’s shoulders to bridge that gap. Proactively consider this in advance to avoid later complications.
Secondly, what cannot be measured cannot be improved. Though many solutions say they are results oriented, it’s up to the vendors to hold themselves accountable as well. Ask third parties these hard questions during the selection process; those who know the answers and can give solid examples will likely be the ones with whom you’ll have the most success.
Now more than ever, it is crucial that everyone is driving toward the same outcomes, both clinically and financially. It’s important to ensure that the technology vendors you choose each understand and support your short-term and long-term goals. Great vendors are more like partners who not only provide great products that make you better, but also provide great service, support and feedback to help you continually improve.
- Saffarian: It is essential that providers begin by developing a short- and long-term EMR strategy, as this must eventually drive compatibility and interoperability with and among various devices and applications inside and outside the walls for care providers, plan providers and patients. Once this is established, conducting a needs assessment for individual users or groups of users is a valuable exercise. Highly portable tablets equipped with a stylus can unlock greater efficiencies for physicians and nurses on the move, for example, while zero-client desktop solutions provide the comfort and ergonomics to enable more stationary employees to be productive. Importantly, virtual desktop infrastructure (VDI) enables both of these employees to access the same information systems with a similar user interface and experience.