Merger-and-acquisition deals among healthcare providers continue unabated. Assuming bigger means better, health systems are merging, acquiring or affiliating with other hospitals and medical groups, forming larger integrated delivery networks. To maximize value and minimize risk from these transactions, calibration of information technology strategy needs adequate attention from management and governing boards.
Updated information technology plans must align squarely with business initiatives for organization transformation, clinical integration, financial sustainability and growth. One strategic IT-related question on the M&A planning agenda of growing IDNs is whether to maintain separate electronic health-record systems or consolidate into a single enterprisewide EHR platform. The best answer might not be obvious.
The preferred approach among many leading healthcare institutions is implementation of a single instance of an enterprise EHR system. A fully integrated and highly standardized EHR enables sharing of IT assets, including a centralized database, application software code, technology infrastructure and support personnel. With a common IT foundation, care managers and clinicians can efficiently specify, design, instantiate, and continuously improve a standard set of data elements, work flows and clinical content across the care continuum. Consolidation into one EHR might seem a no-brainer, but the staggering upfront capital commitment typically and appropriately triggers hard-nosed questions among business-savvy board members.
Another, less capital-intensive option is to maintain legacy EHR systems and share data through an interoperable health information exchange. The concept is to connect each organization's existing computer application systems using an interface framework that facilitates bi-directional flows of data most relevant to business, clinical, compliance and patient information requirements. Data, software, technology and support resources remain decentralized; yet confidential information is reliable and fluid, organizational policies are consistently applied and processes are orchestrated seamlessly across organizational, geographic and technological boundaries. An HIE leverages previous investments in software, hardware and implementation, preserving scarce capital that can fuel an IDN's ongoing business expansion and other mission-critical initiatives.
An HIE sounds highly appealing, considering the large avoidance of upfront costs. However, executives should be careful not to jump to a conclusion based on the initial price tag. Purchase price alone does not equate to total cost of ownership; cost alone does not determine value. Before formulating an IDN's IT strategy, top leaders have a fiduciary duty first to define and articulate clearly the business problems being solved and opportunities created by the evolving IDN. Managers must identify essential business objectives and consider not only costs but also strategic fit, resources, benefits and risks of alternative approaches. CIOs must be at the decision-making table, consulting with stakeholders, translating business requirements into IT-enabled solutions and communicating options and recommendations in a manner that is comprehensible to their non-technical colleagues. Benchmarking against and learning from other IDNs could yield valuable insights. Reputable, industry-experienced professional services advisors can can assist management in its due diligence to better inform final decisions.
The right answer might be adopting one consolidated EHR, maintaining separate EHRs and connecting them via an HIE or perhaps a blend of the two. For an IDN aiming to achieve maximum clinical integration, a fully integrated EHR seems ideal. For an HIE to perform equally and deliver the same value as a single EHR would be no small task. On the other hand, an HIE strategy, although not optimal, might be good enough, at least for a while. Ultimately, picking the right IT strategy might be guided by asking a question of what is best for the community and patients, and perhaps grounded by a follow-up question as to what is possible.
Robert Slepin, a former CIO at John C. Lincoln Health Network in Arizona, is director of electronic health records at Johns Hopkins Aramco Healthcare, part of a joint venture between Saudi Aramco and Johns Hopkins Medicine that provides integrated care to Saudi Aramco's employees and beneficiaries.