Build or buy Health IT? Some assembly required.

BuildBuyFor as long as I can remember there’s been a great debate in health IT—build or buy? Every few years the pendulum seems to swing more to one side or the other which totally defies the laws of physics in the real world. Today that pendulum is showing signs that it squarely favors the buy side of the equation. Larger hospitals and health systems have been dumping homegrown solutions and spending tens of millions and sometimes billions of dollars for hospital information systems and electronic health record solutions from major industry solution vendors. A recent example comes from the Mayo Clinic where they have announced a rip and replace initiative to switch out their long-standing homegrown solution with a solution from global ISV, Epic.

Although this is certainly the trend right now, I am beginning to see a few cracks in the strategy. In a recent article in HealthcareITNews, HIMSS Media Executive Editor, Tom Sullivan, provides examples of hospitals and health providers who are bucking the trend by building their own solutions. The article, Innovation Pulse: The bold art of build-your-own IT makes it clear that rolling your own isn’t for everybody, but does have its place for institutions confident enough to give it a try.

In my world travels I’ve often come across homegrown health IT solutions that quite frankly are far less costly and provide a much better user experience than many of the commercially available HIS/EMR solutions on the market today. Homegrown solutions, especially the newer ones, are often built using commodity development tools and contemporary commercial software from either open source providers or consumer software companies. Whereas the global health industry IT vendors may have solutions that are deep in functionality, they are frequently out of scope for small to medium-sized institutions. Often these big vendor solutions have evolved over the years from what was originally financial system software to something upon which clinical functionality was later added. These “legacy solutions” while comprehensive are sometimes not best-in-class when compared to some of the recently developed home-grown solutions I’ve seen that have been built using more contemporary enterprise framework architectures with wireless mobility, a modern user interface, and cloud-based services in mind.

I was heartened to read recently that Athenahealth and Beth Israel Deaconess Hospital have formed a partnership to develop a cloud-based, hospital HIS/EMR solution. It is clear to me that cloud-based solutions are the future of health IT. What hospitals and health systems ultimately need are solutions that are more or less “plug and play” and don’t require huge IT staffs to maintain. Around these lower-cost, highly scalable subscriber-based solutions hospitals can then add other cloud software solutions for mail, messaging, voice and video communication, care team collaboration, analytics, forecasting, project management, customer relationship management, and more. While such a plan isn’t strictly a “build your own software” kind of strategy, it is a “build-your-own” health enterprise solution made from building blocks of contemporary cloud services.

AssembleOne struggle for healthcare organizations is how to get from where they are today to where they ultimately need to go. Fortunately, there are solution providers that have positioned themselves to fill in the gaps. An example might be Infomedix from Object Consulting. Infomedix provides a path for hospitals in Australia to turn old paper records into organized files of scanned electronic documents that are fully searchable and always available. Another example might be OneView Healthcare, a company based in Dublin, Ireland, that sells a portal “platform” upon which institutions can plug in customer-facing IT services to provide patients with entertainment on-demand, patient education, communication with friends and family, attendant call services, dietary menus, satisfaction surveys and more. Using the OneView portal interface, clinical staff can access information from lab, pharmacy, and other departmental systems. Yet another example might be a solution such as the one offered by Imatis Visual Heath in Norway. It can turn an archaic electronic medical record interface into something that is not only highly intuitive, but visually stunning.

Should you build or buy? Perhaps you should be doing a little of both—what I might call the “assemble” approach. Those are the choices. For the time being and for the best results, I tend to favor a model that says, “some assembly required”.

Bill Crounse, MD Senior Director, Worldwide Health Microsoft 

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