Evolving Healthcare, Evolving Infrastructure

Providers must constantly assess and advance their IT infrastructure to support new medical technologies, treatments and healthcare reform efforts. This “behind-the-scenes” nature of the beast poses its own challenges, beyond the ever-present concerns about costs.

Clinical Innovation + Technology spoke with John Vitalis, managing director of Vitalis & Company, a Chicago-area health IT consultant who has worked at Mercy Health, Alexian Brothers and Gartner, about the state of health IT infrastructure.

Are hospitals looking to the cloud to achieve downward scalability?

Hospitals are looking at it from two perspectives. One is a more traditional remote-hosting environment. A couple of years ago, a large EHR vendor said they found that approximately 90 percent of their new clients were opting for the remote-hosting option. The other option is software-as-a-service application, or cloud-based environment.

Is that decision being driven purely by economics?

There’s more to it than that. One of the major benefits with the remote hosting is that it often includes a refresh of the hardware after five years. You have to look at not only the initial cost but the total cost over seven to 10 years. Another major factor is resourcing, or staffing. Do I, the CIO, have the technical staff to support these applications? In an environment where it’s extremely difficult to add staff, remote hosting or cloud-based technologies become a more viable option. If the vendor provides the support, and the CIO doesn’t need to add new burdens to a staff that is probably already stretched—and they may not be able to get approval to hire additional FTEs—that’s another driver.

Even if you could get the approval for the FTEs, can you find them? Can you find people with the right skill sets in an environment that has always been competitive and becoming more so?

Even highly skilled IT people can take up to one year to acclimate to the hospital culture and healthcare-technology environment, correct?

That is very true. I worked with a pretty large healthcare system last year, and several of their infrastructure support staff. They were very good technically but they came from financial services or another industry, so they really didn’t understand the culture of working with clinicians. They were trying to force a technical solution on the organization and it was not going well, especially with the clinicians. The IT staff was basically blaming the clinicians saying they don’t know how to use the technology. It really was more of a technical issue than a user issue. Eventually they solved it as a technical issue, but people with very good technical skills don’t always understand the culture and the type of user.

Could any infrastructure jobs be phased out if use of the cloud increases?

I don’t think so, because if you’re buying the service, you still need people who understand the technical side and can be a liaison between the organization—the organization’s application support staff, clinical users and business users—and the vendor. Organizations won’t eliminate those people, because they’re also likely to continue to have internally hosted applications. This depends on the size of the organization. A fairly good-sized hospital isn’t going to turn everything over to a software-as-a-service or cloud-based solution. Or, at least not any time soon. Some smaller hospitals or physician organizations will be more likely to outsource or run everything as a service.

What other issues are in play for IT infrastructure decision-makers in 2013?

Data ownership is a big issue. A key question is will I have access to my data without needing to pay my vendor to get it, and how will I be able to access my data? And on support, the viability of the vendor’s security, concerns with HIPAA and patient information.

CIOs are going to be thinking about this movement of bring your own device and supporting PDAs, iPhones, iPads and Android-type devices. There’s the complexity of the environment in adding those devices and supporting them on your network and getting them to play with the applications—your EHRs. There are issues around security and patient confidentiality, obviously.

From a customer-support perspective, now you’ve potentially got a physician bringing his or her own iPhone in, having a problem with it and calling the help desk. The capability to support those devices is a huge issue for IT organizations, particularly in hospitals. Also, leaders should consider whether their network is capable of handling the volume of traffic. Are there dead spots in the network? The wireless infrastructure is a big issue.

With the evolution of healthcare in the U.S., accountable care organizations (ACOs) are a growing topic of interest. The big issue is “big data”—business intelligence and the capability to gather financial and clinical data from a provider network and to consolidate and understand all this from a clinical perspective. In terms of the services you’re providing, are you achieving the outcome, quality and cost goals that you need, from an ACO perspective? This is a growing business driver in 2013 and beyond. As more and more providers, whether physicians or physician organizations or health systems, grow in their capability to manage those data, they will be looking to use it to manage their ACO.

The recognition of the need to invest in IT continues to grow. Top executives realize that information and technology are critical to the success of the healthcare organization. But, there is still a lot of competition for financial resources. You only have so many capital dollars to spend, so there are some tough decisions to be made—invest in upgrading facilities, replacing facilities, adding facilities or spend on IT.

How can organizations avoid rate creep—the vendor driving up prices once a relationship has been built?

You always need to look very carefully at the service contract before you sign it. You need to make sure you have performance guarantees and penalties, and make sure you understand what’s included in the price. A lot of organizations don’t do that before they sign the contract. They don’t do appropriate due diligence to clearly define business objectives and match service requirements to those objectives.

There’s no question it’s a cost of doing business, and you can’t cost justify every IT expenditure. More organizations and more senior executives—CEOs, CFOs, COOs—understand that. They recognize that they can’t look at IT solely from a cost perspective, that it really is critical to the success of the organization. As with Meaningful Use, if you don’t do it, you’re going to lose money or lose out on revenue, and everyone understands this now, or at least the concept.  
In the 30 years I’ve been in the business of healthcare IT, I see people adjusting to constant change in the industry.