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The Build or Buy HIT Decision

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Best of Both Worlds for Healthcare IT Systems?

By Brent Metfessel MD

An important consideration when looking at the development of new technological functionality is whether to obtain an HIT system from an outside vendor or build the system using primarily internal staff.

Three Parameters

Basically, such a build or buy decision depends on the following aspects:

  • availability of internal resources to hire the highly skilled staff needed to create a new system;
  • availability of vendors with proven expertise in the area of technology relevant to the new project; and
  • flexibility of the vendors to customize their products for hospitals with unique needs.

The temptation to use consultants rather than FTEs to develop and implement the new system needs exploring.

Both Sides and the Consultants

On the positive side, finding consultants that have highly specialized expertise relevant to the project is often less difficult than finding such expertise in people willing to come on board as FTEs.  Such expertise in clinical informatics may be critical to the success of the project.

On the negative side, the cash outlay for multiple consultants can be staggering, especially if multiple consultants come on board with long-term contracts and retainers. Specialized consultants may charge up to $150 to $200 dollars per hour, quickly draining the most robust of IT budgets. Consultants should be used for just that — consulting. They exist on the project for their expertise and transfer of knowledge to the rest of the staff. To use consultants to do the hands-on tasks of actually building the system is generally not an optimal use of the consultant’s time.

Consultants, if used at all, should typically be used on a temporary basis to share their expertise and advice during critical parts of the project.

Buy Off the Shelf

Overall, buying an application off the shelf may be favored for more sophisticated applications. For example, computerized order entry [CPOE] and EMR systems have a number of dedicated vendors that are vying to achieve market share.

For major projects, distributing request for information (RFI) packages to selected vendors enables senior management to critically evaluate the different vendors in parallel, in the end selecting finalists and ultimately the vendor of choice. A critical requirement when evaluating vendors is a strong client reference base. The best predictor of future success is past success, and thus multiple existing satisfied clients are essential for the chosen vendor. Larger academic or tertiary care systems, however, tend to have more access to expertise and more significant customization requirements. Consequently, building a home-grown system rather than outsourcing the work to a vendor may be the best strategy for such institutions.


When working with vendors, one should be strategic in price negotiations. One suggestion is to link part of the vendor compensation to the success of the implementation. This puts the vendor partially “at risk” for project success and thus provides additional incentive for vendor cooperation. Additionally, one should not purchase a system or services from the initial bid. It is critical that more than one vendor bids for the project to provide a pricing and negotiation advantage.

There is nothing that states only one vendor can be chosen for a project. Although obtaining everything from one vendor can lead to a more seamless integration and prevent the juggling of multiple vendor relationships, using more than one vendor may in some cases lead to a higher quality end product. This is known as the “best of breed” approach and is a viable option, in particular for complex projects where a single vendor does not adequately meet user needs.


For more basic administrative systems, there are also off-the-shelf products from vendors that may be applicable. Where there is less need for customization, a single vendor may work out very well. Where there are significant unique needs that require customization, once again it may be best to develop the system internally or outsource the work to multiple vendors.

There is also the issue of small or rural hospitals that have limited resources. For such institutions, investments in more complex information systems may be difficult. Consequently, many vendors offer “stripped down” versions of their systems at a more affordable price, specifically tailored to the small hospital. The ability to customize the system for unique needs, however, is significantly more limited.

More info: http://www.hitconsultant.net/2012/10/01/healthcare-it-systems-buy-vs-build-or-best-of-both


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5 Responses

  1. ONC Lays Out Health IT Safety Plan

    Acknowledging that new health information technologies can create patient-safety risks, HHS’ health IT office is inviting healthcare providers, vendors, and the public to comment on its recently issued national Health Information Technology Patient Safety Action & Surveillance Plan.

    “Just as health IT can create new opportunities to improve patient care and safety, it can also create new potentials for harm,” the plan, released by the Office of the National Coordinator for Health IT, states. The plan’s authors cited “poor user interface design or unclear information displays” as potential contributors to dangers such as physicians ordering the wrong drugs for patients.

    “Health IT will only fulfill its enormous potential to improve patient safety if the risks associated with its use are identified, if there is a coordinated effort to mitigate those risks, and if it is used to make care safer,” the authors wrote.

    Source: Joseph Conn, Modern Healthcare [12/26/12]


  2. Health System IT Initiatives

    Hospitals & Health Networks surveyed hospitals and health systems about their IT initiatives. And this is what they found:

    • 36 percent of Most Wired hospitals aggregate data from patient encounters to create a community health record.
    • 71 percent of Most Wired hospitals manage care transitions compared with 57 percent of all responding organizations.
    • 43 percent of Most Wired organizations integrate clinical and claims data so that they are accessible, searchable, and reportable across the care community.
    • 69 percent of Most Wired hospitals use tools for retrospective analysis of clinical and administrative data to identify areas for improving the quality of care and reducing the cost of care delivered.
    • 35 percent of Most Wired hospitals use social media to deliver care management messages and 40 percent provide mobile applications for secure messaging with patients

    Source: Hospitals & Health Networks


  3. 5 Steps to Building Successful Digital Health Solutions

    1. Context – Understanding the context of a piece of technology is essential for it to have any positive impact whether that’s operationally or clinically
    2. Interoperability – Healthcare is notoriously siloed and we’re not breaking out of those silos fast enough
    3. Physician Engagement – We’re working hard to get patients to engage when it comes to technology and so we should
    4. Evidence – Build your evidence base
    5. Scale – You need to have the excess capacity to deal with variables

    Source: HIT Consultant


  4. Terrifying truths about health care IT

    Brent – One would expect that in an era where smartphones are more powerful than our computers were 5 years ago, health care providers would have an arsenal of health care IT solutions to enhance patient care but also optimize their own workflow.


    But, nooooo?



  5. Physician Perspectives on Healthcare IT

    Here are some key findings from a recently released Accenture Survey on physician attitudes toward and usage of digital healthcare tools:

    • 79% of U.S. doctors are more proficient using EMR than they were two years ago.
    • The number of doctors who use digital tools has increased from 13% to 30% since 2012.
    • Over two-thirds of doctors believe that healthcare IT has decreased the amount of time spent with patients.
    • 76% of doctors believe that interoperability of the IT tools limits their ability to improve patient care quality.
    • 9 of 10 believe better functionality and easy-to-use systems are important for improving patient care quality.
    • 58% said that the electronic health record system in their organization is hard to use.
    • Those who believe EMR has improved treatment decisions decreased from 62% to 46% since 2012.
    • Fewer physicians believe EMR reduced medical errors (64 vs. 72% in 2012).
    • 46% believe EMR improved health outcomes for patients compared to 58% in 2012.

    Source: Accenture, April 13, 2015


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