Enterprise Integration: Is There Life After Consolidation? - Industry Trend or Event

Health Management Technology, July, 1999 by Keith Hagen, Chris Chapman

Options, solutions, and a checklist to help achieve systems communication quickly and painlessly.

The integrated delivery network (IDN) intends to attain two goals through consolidation--share resources and save money--while at the same time improving patient satisfaction. Easier said than done.

First, let's establish who makes up an IDN. You may not think you do because you're a physician group practice who's affiliated with a 100-bed hospital around the corner in small-town USA. But you do. An IDN could be a community hospital, a clinic, and a doctor's office located within the same city block.

Or, it could be a multi-entity enterprise made up of multiple 500 plus-bed hospitals scattered over a 25-mile radius in a metropolitan area. It may be neither of those. But the trend shows that it soon will be.

Healthcare is now centered on this IDN concept: Consolidate and save money; consolidate and share resources. Since everyone's competing for market share and trying to increase the number of patient care services they offer, consolidation is a viable solution. But how can IDNs save money--or more realistically, not spend more money--when it comes to integrating their systems across the enterprise?

Patient is King

And all the while, they are trying to remember one thing. That the most important part of the healthcare enterprise is the customer--the patient. In order for healthcare enterprises to better serve these customers, they must be able to communicate among themselves--quickly, effectively, and reliably. It's not a revelation that healthcare is a very competitive market. People still have a choice of where to go. The question IDNs must answer in order to compete is: How can we improve the patient experience?

Put all the changes in administration, personnel, and supplies aside. In order to succeed and improve customer (patient) service, your systems must communicate. And that has to happen immediately after consolidation.

We all know the goal of the IDN is for facilities to integrate to save money and improve quality of care. Your IDN's IT infrastructure and foundation is a critical component to achieving your objective. We offer some tips and resources for integrating your enterprise IT after you've become affiliated with another entity--to better service your patients without alienating them.

The IDN Market

According to healthcare consultant Dorenfest, 72 percent of 1,467 IDNs profiled across the US have an installed enterprise-wide solution for at least one application. Registration and Master Person Index are the two most frequently installed applications (which are being used by an average of 63 percent of IDNs). But how long did it take those IDNs to get just one application installed enterprise-wide? Probably six to ten months per member, excluding training and ongoing updates for all members of the IDN.

So, despite the fact that many IDNs have completed enterprise-wide implementations, most of them are just starting on their journey to use the software. Few IDNs have a "complete" and fully functional solution that works enterprise-wide. Several others have parts of a solution that operate in only one or two areas of their IDN.

Today's Options for Enterprise Integration

Months before facilities join (or create) an IDN, decisions on the systems must be made. To date, IDNs have three alternative solutions, which are discussed here along with negatives and positives for each.

Solution 1. Individual members of the IDN keep the systems they have and use them exactly as they did prior to consolidation.

Negatives:

* IDN members can't share information, so they don't achieve any economies, and they don't address the continuum of care;

* Customer/patient satisfaction decreases significantly due to unnecessary repetition of information at each visit; and

* Quality of care suffers because clinicians don't have the full picture of the patient's history if the system isn't integrated.

Positives:

* The IDN doesn't have to reinvest in new systems. * For solution 1, the return on investment (ROI) tends to be low and patient satisfaction is low.

Solution 2. All members of the IDN replace their systems so they are all compatible and using the same systems.

Negatives:

* Cost prohibitive to replace all systems and train staff;

* Installation is time consuming. When new members are added to the IDN, it takes an average six to eighteen months for them to be up and running on the system, and integrated with all other members. So the IDN is forever in catch-up mode, and it takes a long time to get a ROI and value from the system. Every time you add or assimilate a new entity, you're back to square zero;

* Vendor selection is time consuming. Vendor selection for choosing a system to use enterprise-wide is not only time consuming, but can be very complicated after consolidation because of all the organizational restructuring taking place. How do you determine which vendor to select when you're not sure who is in charge of the decision?

There are multitudes of issues surrounding vendor selection already, the least of which is trying to figure out how and when to implement a new enterprise-wide HIS in the middle of the organizational chaos of "merger mania" (e.g., two hospitals merge, so there's two CIOs and two CFOs, each looking at the other to determine who'll be there at the end of the day).