By: John Smaling, Executive Vice President
As the final definition of various ARRA related requirements take shape, financial incentives and impending penalties will most assuredly lead to an upswing in ambulatory software implementations. A number of those initiatives, sponsored by acute care organizations, will be large-scale implementations that involve large numbers of practices, and lots of physicians, spanning multiple specialties. With heavy participation by the acute care IT organization, these types of initiatives will introduce a number of complexities that I believe will challenge both vendors and customers, while exposing the differences in approach adopted by the ambulatory software vendors, and those typically employed during acute care implementations.
Historically, ambulatory software vendors have dealt with physician practices ranging from single practitioners, to large, multi-specialty group practices. In the course of deploying their solutions to this customer base, vendors have developed planning, implementation and support strategies that have worked for this profile of clients. I believe that this dynamic will oftentimes differ from the typical hospital customer in many ways, among them:
1. Acute care customers will have different goals and objectives than the typical physician practice in the areas of standardization, data normalization, reporting, and outcomes. For example, a common goal of the acute care organization is to achieve a comprehensive medical record that encompasses both practice and hospital based episodes and the level of integration required to accomplish this will likely be atypical for many ambulatory vendors.
2. Acute care enterprises will generally have larger and more experienced IT teams who have stronger views on infrastructure, security, project management, process and systems management than that found in physician practices.
3. There will be differing views from the acute care customer with respect to the level of individuality required from practice to practice. Many acute care organizations will feel that one physician practice operates essentially like every other practice, and their vision of standard workflows, process, and customization may be far different than the desires and perceptions of their constituent practice groups. The ambulatory vendor needs to understand this potential conflict in views and understand how to arbitrate these differences to meet their customer’s goals and objectives.
4. Acute care software vendors generally hold similar views with respect to the transition from install mode to support mode, and the manner in which they structure their support arrangements with customers. Ambulatory vendors, given their physician practice orientation, oftentimes adopt vastly different approaches than acute care vendors.
5. Decision-making and dealing with complex organizational dynamics, even in a relatively large physician practice is far different than can be found in an acute care organization. The importance of well defined governance, change control, and related process is not something that ambulatory software vendors have had to address to the extent that they will encounter in the future as they engage more acute care organizations.
While this listing is by no means comprehensive, it amplifies some of the key areas that will require adjustment by both parties. Taking the time to dialogue during the sales cycle to understand the many key elements of such initiatives is warranted. Understanding differences such as those mentioned above early in the relationship will help to either promote mutual respect and workable solutions, or to avoid an unproductive relationship and ill fated technology investment.
