The Pitfalls of Health Care Information System Acquisitions

When a health care organization goes down the road to implementing a health care information system there are many activities and details that must be considered. Published organizational guidelines and key activities can assist in the acquisition process, and help avoid the numerous pitfalls. Wager, Lee and Gaser list the eight key activities for system acquisition as: 1) Appoint a strong leader as project manager and form a steering committee; 2) Define project objectives; 3) Screen the vendor market; 4) Determine system goals; 5) Determine system requirements; 6) Develop and distribute a request for information (RFI) or a request for proposal (RFP); 7) Evaluate vendor proposals; 8) Conduct a cost-benefit analysis on all options including software as a service through an application service provider (ASP) and build in house. Although organizational and activity guidelines are helpful, even when closely followed, there are pitfalls that can doom the project to failure.

When appointing a project manager and forming the committee, it is important to ensure the committee has the proper political clout within the organization. The committee should have a member representing the organization's leadership; even the CEO or CIO should be involved depending on the size of the organization. It is also critical the project manager have enough political clout to ensure proper participation, by committee members and the organizational leadership, in moving the project forward. It is also crucial to ensure all communication with vendors go through the defined channels within the committee. Vendor sales staff often try end-runs around the committee, directly to the organization's leadership. Aside from attempting to go directly to the organization's leadership, they often will provide “swag” in the form small office gifts or dinners. It is important the steering committee not be swayed by such tactics. But instead ensure specific criteria and requirements are followed when selecting a vendor. Not objectively following the vendor selection criteria can lead to disastrous results. Consider if the CEO forces the steering committee to use a vendor because their family got World Series tickets. The organization may end up with a system where the vendor was not properly vetted, and may not meet the needs, requirements or criteria the committee specified. Dooming the project to failure.

Ensuring all stakeholders are involved throughout the entire acquisitions process, to ensure everyone is on board and in agreement, is essential. This includes the organization's leadership and all of the end users; physicians, nurses and support staff. It is crucial they feel they have a say and are being heard, especially if they are expected to use the system. This can be accomplished by sending regular project updates, ensuring all parties attend vendor demonstrations and focus groups, and by having all parties submit questions and/or comments from these activities. This will ensure all participants are fully represented and their input properly taken into consideration.

One of the most important issues when selecting a vendor is the request for proposal (RFP) itself. If there is not enough information and detail, the vendor may not be evaluated against the criteria considered most important, and a vendor not meeting the organizations need may be selected. If there is too much information the committee may get bogged down in evaluating the responses. If the responses come back as 1500 page documents, and there are ten vendors responding, the steering committee could be overwhelmed, and could miss important information within the responses. All causing the committee to select a less than satisfactory vendor; not meeting the selection criteria or system requirements. It is important the content of the RFP be balanced with regard to quantity and quality of it’s contents, or consider using a scaled down request for information (RFI) instead.

It is also paramount cost-benefit analyses be done on each option, including for other alternatives like using an application service provider (ASP) or building in house. Although few organizations opt to build in-house, especially in smaller practices, it is good to have an idea of the costs and benefits associated with the processes. ASPs have become an ever increasing option in recent years, where the vendor provides software as a service over a network. The benefits are immense: rapid deployment, no on-site infrastructure (data center), no technical or IT staff needed for support. But there are a great many downsides to ASPs as well. Although ASPs may offer rapid deployment they usually allow limited customizations, and may only offer only standard installations. This could force an organization to conform to the system, by changing procedures or workflows. Then there may be frustration with technical support. The organization may not have technical expertise, and the vendor may not have a functional knowledge of the organization, leading to miscommunications, frustrations and dissatisfaction. Furthermore, when using an ASP vendor there may be issues with privacy, security and data ownership; all which should be clearly specified in the RFP.

Even when an organization closely follows industry guidelines for health information system acquisitions, there are a great many pitfalls that need to be avoided. Maintaining objectivity and ensuring the project team has proper political clout within the organization will help avoid selecting a vendor not meeting the organization's needs. Properly balancing the content and quality of information in an RFP or RFI is critical. Not enough detail and you may not get vital information back, too much detail and you may miss key information in the vast responses. Cost-benefit analyses can also help guide the selection committee to an optimal system by helping the committee rank requirements throughout the process. All helping to avoid the pitfalls of health information system acquisition.

Wager, K. A., Lee, F. W., Glaser, J. P. (2009). Health care information systems: A practical approach for health care management. San Francisco, CA: Jossey-Bass.