Web Hosting & Concierge IT: More Economical Paths to Meaningful Use
More organizations are turning to web hosting and concierge health IT service providers to meet their growing needs and keep up with the competition. Beyond the dollars-and-cents aspect of hosted IT is another practical consideration: less fighting with in-house systems allows clinicians more time to focus on patient care.
“What’s driving this interest in outsourcing is that the scale of the solutions is really outpacing the budgets at many hospitals,” says Bruno Nardone, vice president of healthcare transformation at Science Applications International Corp. (SAIC), which provides hosted services to healthcare and other industries.
As in any relationship, the partnership between the hospital and the service provider can go bad if the options, contracts and needs are not weighed properly. When evaluating the option of concierge health IT services, hospitals must consider the benefits against potential risks and perform a cost-benefit analysis.
Innovative Enterprises provides a range of options, from help in managing phone networks to provision of website applications, data centers or EMRs. The company provides a one-stop-shop for hospitals to get where they need to be, and do so faster than they could on their own. In fact, the time from contractual talks to go-live takes three months for physician offices and six to nine months for hospitals, says Russell P. Branzell, CIO of the Poudre Valley Health System in Fort Collins, and president and CEO of Innovation Enterprises.
For smaller, more rural hospitals, which may not be able to afford advanced technologies and IT applications, partnering with an MSO places them on an already established EMR system and provides them with long-term upgrade and IT support with the need for very little necessary infrastructure.
“The only thing the hospital or physicians office needs is a VPN and the end devices to host the EMR application,” Branzell says. “They don’t need servicers or technical staff; we provide all of that so all they need to do is to focus on providing clinical care and business operations.”
The shared server technology eliminates infrastructure, hardware and staff support, and physician practices and hospitals may see cost reductions reaching upwards of 50 percent to 75 percent, he says.
Branzell says many hospitals are scrambling to integrate an EMR or practice management system that meets these criteria and is part of a collaborative HIE. By mid-2011, Branzell says, 200 to 250 physicians will hop onto the HIE, where they can then link from their own HIE to the state HIE to exchange pertinent patient information across the three-state area.
“We have built it so patient information is accessible to the right people, at the right time,” says Branzell. “All of our physicians have access to our systems remotely through mobile devices, home computing over secure websites, whatever the case may be so they aren’t tied to an office or hospital computer we try to make that as ambiguous as possible.”
The Salem, Ore., facility hired Phoenix Health Systems to regulate and manage its infrastructure, networks and telecommunications systems and to house the infrastructure for its EMR. Hospital staff gains access to patient records and information via a web-based application. The contract also provides them with help desk and desktop support.
“I think with the government’s meaningful use criteria and requiring hospitals to move toward EMRs, there is more of an awareness of IT capabilities and quite frankly some organizations are realizing that they just don’t have the skill set to do it. Hospitals have another focus: It’s patients,” says Ken Kudla, vice president and CIO with Salem Hospital.
Under the contract, a Phoenix employee works in-house as part of Salem’s management team and reports directly to Kudla. The employee performs hospital management functions as if he were an actual hospital employee. “They are intricately involved in all of our IS implementations,” says Kudla. From calling the help desk for support, changes and upgrades to the EMR applications, the employee helps with the more than 300 applications running at Salem.
While costs are clearly a consideration when choosing these types of outsources services, an organization might not save as much as expected, says Kudla. However, the technical resources and support might still be worth the shift. Under Salem Health’s five-year contract agreement, the hospital saved $500,000, in decreased operational costs, reducing FTEs and not having to purchase millions of dollars worth of equipment outright, Kudla says.
The most important thing to remember is that “you don’t give up your hospital executive because you have an outsourcing relationship,” says Kudla. In other words, the meaningful use process is still hospital-driven and should not be driven by the vendor.
As an effort to reduce high costs and increase patient care in 1994, five hospitals in the Spokane, Wash., area—Deaconess Medical Center, Providence Holy Family Hospital, Providence Sacred Heart Medical Center & Children’s Hospital, and Valley Hospital & Medical Center—partnered to form Inland Northwest Health Services (INHS), a non-profit healthcare organization and healthcare information exchange (HIE). Today, INHS includes 34 hospitals and more than 100 medical practices.
With help from an outsourced vendor (SAIC), INHS has digitized millions of patient records to replace paper ones, and linked various entities to the HIE via EMRs, according to SAIC. Each of its 34 hospitals is now exchanging information with the Washington State Department of Health (DOH), the Social Security Administration and the U.S. Department of Health and Human Services (HHS).
The SAIC infrastructure and applications enable INHS to act as an application service provider, so physician offices and hospitals don’t have to buy their own hardware or hire IT staff. The SAIC infrastructure within the INHS platform also facilitates “syndrome surveillance,” says David Dobbs, SAIC president and principal solutions architect. This allows public health offices to gain real-time data on diseases that are occurring in the population to understand the clinical flows of information, identify disease syndromes and provide a picture of how disease outbreaks occur.
“The benefit to the hospitals and physician offices to having outsourced their EHR systems is they can better implement these types of higher-level services on top of the EHR,” says Dobbs.
“Anyone can come in and cut costs … but it goes well beyond that,” says Salem Hospital’s Kudla. “If you are really looking at outsourcing, you are really looking at it from a different perspective other than cost. You are saying ‘what’s the value we can bring to the organization?’ ”
“What’s driving this interest in outsourcing is that the scale of the solutions is really outpacing the budgets at many hospitals,” says Bruno Nardone, vice president of healthcare transformation at Science Applications International Corp. (SAIC), which provides hosted services to healthcare and other industries.
As in any relationship, the partnership between the hospital and the service provider can go bad if the options, contracts and needs are not weighed properly. When evaluating the option of concierge health IT services, hospitals must consider the benefits against potential risks and perform a cost-benefit analysis.
Health IT concierge
Hospitals and physician’s offices in northern Colorado, southwestern Nebraska and southeastern Wyoming have a “concierge” option for up-to-date health IT—Innovative Enterprises, a for-profit IS managed service organization (MSO) and an entity of the Poudre Valley Health System in Fort Collins, Colo.Innovative Enterprises provides a range of options, from help in managing phone networks to provision of website applications, data centers or EMRs. The company provides a one-stop-shop for hospitals to get where they need to be, and do so faster than they could on their own. In fact, the time from contractual talks to go-live takes three months for physician offices and six to nine months for hospitals, says Russell P. Branzell, CIO of the Poudre Valley Health System in Fort Collins, and president and CEO of Innovation Enterprises.
For smaller, more rural hospitals, which may not be able to afford advanced technologies and IT applications, partnering with an MSO places them on an already established EMR system and provides them with long-term upgrade and IT support with the need for very little necessary infrastructure.
“The only thing the hospital or physicians office needs is a VPN and the end devices to host the EMR application,” Branzell says. “They don’t need servicers or technical staff; we provide all of that so all they need to do is to focus on providing clinical care and business operations.”
The shared server technology eliminates infrastructure, hardware and staff support, and physician practices and hospitals may see cost reductions reaching upwards of 50 percent to 75 percent, he says.
Branzell says many hospitals are scrambling to integrate an EMR or practice management system that meets these criteria and is part of a collaborative HIE. By mid-2011, Branzell says, 200 to 250 physicians will hop onto the HIE, where they can then link from their own HIE to the state HIE to exchange pertinent patient information across the three-state area.
“We have built it so patient information is accessible to the right people, at the right time,” says Branzell. “All of our physicians have access to our systems remotely through mobile devices, home computing over secure websites, whatever the case may be so they aren’t tied to an office or hospital computer we try to make that as ambiguous as possible.”
Cost, quality—or both?
Salem Hospital, a 454-bed acute-care hospital within Salem Health, did not have the technical expertise to manage its IT needs, so it looked for an external partner to manage and direct its IT infrastructure and services.The Salem, Ore., facility hired Phoenix Health Systems to regulate and manage its infrastructure, networks and telecommunications systems and to house the infrastructure for its EMR. Hospital staff gains access to patient records and information via a web-based application. The contract also provides them with help desk and desktop support.
| Three outsourcing options for EMRs |
Hospitals looking to host an EMR through an outsourcer have three options, says Bruno Nardone, vice president of healthcare transformation at Science Applications International Corp.
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Under the contract, a Phoenix employee works in-house as part of Salem’s management team and reports directly to Kudla. The employee performs hospital management functions as if he were an actual hospital employee. “They are intricately involved in all of our IS implementations,” says Kudla. From calling the help desk for support, changes and upgrades to the EMR applications, the employee helps with the more than 300 applications running at Salem.
While costs are clearly a consideration when choosing these types of outsources services, an organization might not save as much as expected, says Kudla. However, the technical resources and support might still be worth the shift. Under Salem Health’s five-year contract agreement, the hospital saved $500,000, in decreased operational costs, reducing FTEs and not having to purchase millions of dollars worth of equipment outright, Kudla says.
The most important thing to remember is that “you don’t give up your hospital executive because you have an outsourcing relationship,” says Kudla. In other words, the meaningful use process is still hospital-driven and should not be driven by the vendor.
Outsourcing to HIEs?
Hospitals and outsourcing companies may face web-hosted service competition from a new source in coming years: regional or statewide HIEs. As these entities look for sustainable business models, exporting related health IT services could be one piece of the puzzle.As an effort to reduce high costs and increase patient care in 1994, five hospitals in the Spokane, Wash., area—Deaconess Medical Center, Providence Holy Family Hospital, Providence Sacred Heart Medical Center & Children’s Hospital, and Valley Hospital & Medical Center—partnered to form Inland Northwest Health Services (INHS), a non-profit healthcare organization and healthcare information exchange (HIE). Today, INHS includes 34 hospitals and more than 100 medical practices.
With help from an outsourced vendor (SAIC), INHS has digitized millions of patient records to replace paper ones, and linked various entities to the HIE via EMRs, according to SAIC. Each of its 34 hospitals is now exchanging information with the Washington State Department of Health (DOH), the Social Security Administration and the U.S. Department of Health and Human Services (HHS).
The SAIC infrastructure and applications enable INHS to act as an application service provider, so physician offices and hospitals don’t have to buy their own hardware or hire IT staff. The SAIC infrastructure within the INHS platform also facilitates “syndrome surveillance,” says David Dobbs, SAIC president and principal solutions architect. This allows public health offices to gain real-time data on diseases that are occurring in the population to understand the clinical flows of information, identify disease syndromes and provide a picture of how disease outbreaks occur.
“The benefit to the hospitals and physician offices to having outsourced their EHR systems is they can better implement these types of higher-level services on top of the EHR,” says Dobbs.
“Anyone can come in and cut costs … but it goes well beyond that,” says Salem Hospital’s Kudla. “If you are really looking at outsourcing, you are really looking at it from a different perspective other than cost. You are saying ‘what’s the value we can bring to the organization?’ ”