Will the Weight of EMRs Break IT? Reply

This post was written and contributed to the Politics of Healthcare blog at Healthcare POV:

Pulling together as a nation to overhaul an aging, often paper-based medical records system is long overdue. We can all agree it will create jobs, pump money into various industries and make managing a fast-growing patient base much easier. With great potential comes great risk — in this case, risk of stretching an ailing health care IT industry to the breaking point. Legacy systems abound, support for decade’s-old central infrastructure no longer exists, and facilities must consider increased privacy and regulatory measures.

Clearly, outsourcing is the most attractive solution within an economy of reduced IT budgets — a solution that can be greatly improved for the betterment of all involved with the planning and building of EMRs. As a theme, “risk” often starts with traditional outsourcing arrangements emphasizing getting to the lowest bid…as opposed to getting to the best business value. The health care IT industry needs this to change. In my opinion, this change should follow a few basic guidelines.

1) Outsourcing should generate a favorable return. The goal of an outsourcing investment should be achieving a specific business result — not simply buying cheaper labor. Project risks and execution should be shared responsibilities between you and your outsourcing partner. If you structure the outsourcing partnership correctly, risk reduction happens automatically — thereby reducing your costs.

2) Methodology matters. Demand that the specific methodology of outsourcing and project execution is an explicit part of your vendor’s business proposition. Project governance should be the responsibility of the vendor. Make sure that methodology and governance address the risks of project execution, as well as unique risks of distributed development.

3) Success is a joint responsibility. Success is a function of the time and effort invested into the project by the stakeholders (engineering, IT and business users). The absolute key to success is frequent and timely feedback by the all the stakeholders, particularly on the business side. Whenever possible, clearly identify the decision-making criteria in advance so that the team can work most effectively to meet your business goals.

4) Things will change. Within any project, change is inevitable. Make sure the business model and the methodology are nimble enough to absorb business change, and that the sign-off approving project change is held in the relevant hands. To ensure maximum project return, reassess and reconfirm priorities periodically during the project as part of the project execution methodology.

5) Align end to end. Because outsourced projects rely on resources who are working for a different company, there is the potential for staff changes to affect your intellectual property and project control. The best way to minimize this risk is to make sure your outsourcing business model aligns you and your outsourcing vendor all the way from overall business goals down to the staff level. Specifically, verify that the HR and compensation strategy of the vendor aligns with your project goals.

The health care technology industry has already asked IT departments to do more with less, reduce staff and stretch existing legacy systems far beyond their original life expectancy. Under the normal circumstances of a down economy this is a risk organizations are forced to take. The mandated EMR system implementation compounds this situation and will push outsourcing practices to change.