What’s Old is New Again: Custom Development and Integration in a Post-EHR World
The Tegria Blog Jun 18, 2021
It makes more sense to innovate not just by adding products, but by introducing new methodologies, new ideas. That’s also innovating. Taking what you have and making what you want. That’s where organizations must go.Nick Whichard, Principal, Tegria
Nick Whichard, Principal with Tegria, is a former hospital CIO who now helps healthcare organizations transform their operations. At the CHIME Fall Forum, he met with a group of healthcare IT executives to hear how these leaders are approaching challenges like budget constraints, staff shortages, physician burnout, and competitive pressures.
Welcome, Nick. We’re now ending what appears to be one of the most challenging years in recent memory for healthcare. Can you share what the healthcare IT leaders named as their key pain points in 2022?
Nick: There were several items that came up in our discussion. The first was innovation. Many organizations are asking their IT leaders to continue to innovate. They’re asking them to do more with less—less people, less money, less time, and that’s the actual pain point. There’s a need to take advantage of new, emerging technologies, but they just don’t have what they need to accomplish that task.
The next challenge was general resource constraints, and it’s more than just “we don’t have enough people.” Many of the IT executives suggest that even when they have people, they don’t have people with the required skillset. You can almost think about it like going to a cardiologist. The reason why you go to a cardiologist is because they specialize in the heart. You wouldn’t necessarily go to a general practitioner for specialized cardiology care. The same thing is true in IT. Years ago it was thought that one IT resource was just like the other, but that’s not really the case. If you’re in need of an interface engineer, that’s exactly what you need.
The third concern is this need to reduce technological footprint. What I mean by that is many organizations are in this process of adding more applications, more systems, and that increases their spend. It increases the costs to run their organization, and IT leaders are being asked to reduce that footprint. But because there are applications that may perform a niche function or have a unique feature, they are still needed. You also have challenges around the transition process and the cost of migrating data from one system to the next system. Organizations are going through this process they’re calling application rationalization to determine which applications are really needed and which can be sunset.
The fourth and final category sort of surprised me. This came up not only at the forum but also through my own research. This was the pain around mergers and acquisitions, and the technological part of that. The general sense was that there wasn’t a lot of planning for that work or thinking through what the costs and resource requirements for migrating one organization to the platform used by the other. So now organizations are scrambling to figure out how to get this work done. At the forum, we had IT leaders that were on both sides of the track. The integration was more painful, took longer, and cost more than they ever expected.
Based on your own experience leading healthcare IT as a CIO, what’s a sound approach to innovation during times like these?
Nick: Innovation is not happenstance. It’s not something you happen to find in the moment; it needs to be baked into our organizations. This approach is not limited to times like these.
Think about the word ‘innovate’. Typically, it carries with it the meaning to create change by introducing new products, and I think that’s where many people are. They’re thinking we need to go out and purchase some new emerging technology. While that’s one way of innovating, in times like these, it makes more sense to innovate not just by adding products, but by introducing new methodologies, new ideas. That’s also innovating. Taking what you have and making what you want. That’s where organizations must go.
A case in point might be a hospital’s service desk. Many of these IT executives talked a lot about service desk software specifically, because traditionally it’s been used just for the service desk or the IT help desk calls. But they’re finding it can be used in more than one space. You can use it for your HR, you can use it for workforce management and project management, so they began to broaden their view. Were they innovative? I would say yes. They used resources they already had, and in many cases, it solved many of their problems. I think organizations must think that way—what do we have, and can we use it better, or differently, to meet our challenges?
As this group of leaders shared wisdom on how they advance innovation in a challenging climate, what types of lessons could other organizations benefit from?
Nick: When I spoke to leaders who had what they considered a mature framework around innovation, many of them had some form of existing structure or strategy around innovation in place. When someone had a new idea, there was a process already established that they could go through: structure, governance, and vetting criteria.
I always say it’s necessary to establish the why. If you’re innovating, you need to figure out why you are trying to innovate. What problem are you trying to solve for? For example, in healthcare today, we recognize that physicians are suffering burnout, and if we broaden that a little bit, it’s not just physicians. It’s also other resources in other areas. Part of the reason why there’s this constraint around resources is because there is also IT burnout. So, there is this problem with what specific groups of people are experiencing. How do we fix that? Maybe we can leverage things like AI, artificial intelligence, to help with the administrative load that physicians are experiencing. Maybe we introduce clinical decision support. Maybe there’s software that will aid them to be able to see and help diagnose patients faster. That should be the mindset. We innovate with some real intention in mind to solve some real problem.
As I understand it, there was a healthy discussion around cloud technologies during your session. Can you share the high-level points? Was there a philosophical consensus?
Nick: Yeah, there was, and we got to a consensus quickly. The group generally thought that if there was a cloud offering for technology that they were interested in, they were going to pursue it. Years ago, there were a lot of questions about cloud: do you really want your critical application or your data offsite in the hands of others? What has come to fruition is that cloud technology is so much more mature. These organizations are hosting your data and hosting your application can do it better, faster, more securely and in many cases cheaper.
I remember talking to at least three IT executives about this, and they used the same example, which is fascinating. It was almost like they had an epiphany. They woke up one morning and they said, ‘Nick why are we in the data center business? We are hospitals. Our focus and business should be healthcare.’
The business of healthcare is taking care of patients, the best way we can. Let’s leverage other resources to do the work we are not necessarily experts in. If we can put our data in the cloud and let someone else handle it, someone who can do it faster, better, and cheaper, then we can free up our resources to do the things that we really want to focus on, those things that pertain to supporting a healthcare ecosystem.Nick Whichard
The business of healthcare is taking care of patients, the best way we can. Let’s leverage other resources to do the work we are not necessarily experts in. If we can put our data in the cloud and let someone else handle it, someone who can do it faster, better, and cheaper, then we can free up our resources to do the things that we really want to focus on, those things that pertain to supporting a healthcare ecosystem. That should be the motivation.
One of the other things about using cloud technology and a managed services hosting partner is that the partner takes on some of the risk around cybersecurity. They need to be good at it, because this is their business model. They have the focused attention; they can spend time making sure your data is protected. At healthcare organizations, we typically hire some security analysts, and we do the very best we can to protect the hospital data, but the hosting companies in many cases can do it better, faster, cheaper, and I think that’s what’s come to fruition for many healthcare IT executives, from small organizations and larger organizations alike.
Looking at things through the patient experience lens, how can hospitals keep patients from feeling the pinch of resource constraints and continue to offer the outstanding care and convenient experience patients need and want?
Nick: Healthcare really needs to be focused on healthcare. They need to be about that business and remain experts in that space. They can help to prevent their patients from feeling that resource pinch by leveraging companies and technologies to reduce the load off their providers and staff. There’s so much that can be done today through hosting, through third parties, through managed services agreements. You can move that stuff that you’re not necessarily an expert at to third parties, free up your resources, and let physicians, nurses, and staff do what they are really good at.
Maybe we have time for one more question…what would you consider to be the overall lessons learned?
Nick: Yes, three things. One, as I’ve said time and time again, is to let experts be experts. And believe it or not, that one statement will fix a lot of problems. If these providers that are feeling burned out are given the opportunity to just practice medicine, to operate within the scope of their practice, to do what they feel is their ‘why,’ I promise you they’re going to be much happier. It’s going to be better for the patient, because happy people approach their life and their work differently.
The second is to maximize value. The example I used earlier about application rationalization—you have all of these applications, and a lot of these applications do the same thing. Part of that process is looking at each application and trying to get the most out of it. I mentioned the service desk and thinking about how you could use it. Most organizations have mature service desk software, but they’re only using maybe twenty percent of its full functionality. Maximize that. Get the most out of that product. Not just that product, but all the products you use.
The third final element that came out was around return on investment. Traditionally, we look at return on investment through the lens of cost savings, or cost avoidance. Right now, given where healthcare is, everyone is interested in cost savings and cost avoidance. But I think that may blind us to what return on investment may really be. What I glean from my conversations is that return on investment can be things like improving the experience for all the people you’re responsible for—patients, providers, your staff. I know it’s difficult to quantify that, but I’m sure we can see the value there.
Return on investment can be the reduction of risk. If we move to the cloud and this vendor is now providing cybersecurity and meeting those requirements and standards to protect our data, then it reduces the risk we bear, and it also reduces the load that we need to carry. So as organizations are trying to calculate whether a move is good for business, they need to broaden their view on the true return on investment for the organization and the people they serve.
Thank you so much, Nick. Some great insights for Healthcare IT leaders as they head into 2023. We hope to hear more from you.
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