This article was originally published on Healthcare IT News. For more on our partnership with North Country Healthcare from CIO, Darrell Bodnar:
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Healthcare chief information officers are under constant pressure to get more from their technology investments. But sometimes optimizing an existing platform is smarter than replacing it.
Knowing which path to take requires looking well beyond the technology itself. For Darrell Bodnar, CIO of North Country Healthcare, a three-hospital nonprofit health system serving New Hampshire, the decision starts with strategy.
Platform optimization versus full replacement is never an IT decision alone – the replacement of an electronic health record or another major enterprise platform is one of the most significant operational and financial decisions a healthcare organization can make.
"The discussion needs to start with where the organization is headed over the next five to ten years," Bodnar advised. "That is not always easy to predict, particularly in rural healthcare, but these platforms are long-term investments.
"You need to consider future clinical services, growth, partnerships, mergers and acquisitions, interoperability requirements, and how the organization expects care delivery to evolve," he continued.
Optimization will almost always be an easier and more financially attractive option in the short term. If the existing platform has the functionality an organization needs, has a viable development roadmap, and can support the organization's strategy, there is tremendous value to continue optimization, he added.
"Healthcare organizations frequently have more capability within their existing systems than they actually use," he noted. "I would want to understand whether we have truly exhausted the functionality that already exists and whether workflow, adoption or governance issues contribute to the perceived limitations prior to platform replacement."
This is exactly where an optimization evaluation can be extremely helpful, he said.
There is an important distinction between a platform at the end of its useful life and an organization frustrated by it, Bodnar said.
"True end of life does not necessarily mean that a vendor has ended support for a product," he noted. "It can also mean that development has slowed to the point where the platform can no longer keep pace with the organization's clinical, operational or business needs.
"There can also be significant compliance gaps that need to be considered," he continued. "If critical functionality is consistently absent, integrations are more difficult, or important capabilities are not on the vendor's future roadmap, these are meaningful indicators."
However, organizations need to be careful not to interpret poor adoption or inefficient workflows as technology failures.
"I would look very closely at system usage prior to a decision to replace a platform," he advised. "Do we use the functionality we already own? Have workflows been standardized? Have users received adequate training? Do departments use the system consistently, or have years of customization and local preferences created unnecessary complexity?"
Bodnar is a strong believer that basic process-improvement education should extend well beyond a small quality department or performance-improvement team. He encourages organizations to provide at least Yellow Belt-level training, or its equivalent, to employees across the organization.
"When people understand basic process improvement, they look at their everyday work differently," he said. "They refuse to simply accept inefficiencies because 'That is how we have always done it,' and instead ask why a process exists and whether there is a better way to accomplish the same goal.
"That changes the technology conversation significantly," he continued. "Technology is extremely effective to enhance a well-designed process, but it can also automate a poorly designed one."
If an organization has not mapped the current state, identified unnecessary steps and designed an efficient future state, the addition of technology can simply make a bad process happen faster. It can even make the workflow more complicated in some cases.
"I prefer to start with process evaluation prior to technology selection," he said. "What problem do we seek to solve? Where are the delays, handoffs, redundancies and failure points? What would the ideal future-state workflow look like if we were not constrained by how things have historically been done?
"Once those questions have been answered," he added, "technology can be evaluated against that future state."
Financial constraints are inseparable from this decision, particularly in rural healthcare. A major platform replacement involves far more than the purchase price of the technology. There are implementation costs, consultant resources, interfaces, data conversion, education, temporary personnel and the internal time required from clinical and operational leaders.
"There are also financial impacts that are harder to capture in the original project budget," Bodnar said. "Major implementations temporarily affect productivity. Documentation patterns change. Billing and charge capture workflows change. Revenue cycle processes can be disrupted, and staff who normally focus on operational work are redirected toward implementation activities.
"Even when an implementation is ultimately very successful, there is usually a period of adjustment that needs to be incorporated into financial plans," he continued. "Optimization can be extremely valuable for those reasons."
If an organization can improve schedules, documentation, charge capture, revenue cycle performance, clinician efficiency or patient access through better use of an existing platform, the return can be substantial without the cost and organizational disruption of a replacement.
Rural healthcare providers can realize a meaningful financial impact when they extend the useful life of a major technology investment by several years, he added.
"But cost alone cannot drive the decision – there is also a cost associated with a platform that no longer meets the organization's needs," he advised. "If technology limitations create inefficiency, hinder integration, impact collections, restrict growth, or require more manual processes and workarounds, the organization needs to understand those costs as well.
"The real financial analysis should compare the long-term cost and risk to retain the current platform against the total cost and organizational impact of a replacement," he said.
One of the most effective approaches is to resist the temptation to deploy these technologies broadly immediately, Bodnar stated.
"Pilot programs are extremely important, particularly with new AI tools," he said. "A focused pilot with a multidisciplinary group allows an organization to understand how the technology performs in a real clinical environment, how it fits within current workflows, and where adjustments are needed before expansion.
"That pilot also needs to involve more than IT," he continued. "Clinical leadership, providers, informatics, compliance, privacy, security and operational leaders all bring different perspectives to the implementation."
IT should certainly help establish the technical and governance framework, but operational ownership needs to be distributed, he added.
"That becomes especially important for organizations with limited IT resources because the technology cannot become another application that IT has sole responsibility to push into the organization," he concluded.