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When Hospital and Ambulatory IT - CLASH

November 6, 2012
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If you have been in Healthcare Information Technology long enough, you know that things often come full circle. This is the case of Ambulatory Physician Group acquisitions. We are now seeing ACO’s and HIE’s driving physician acquisitions and the corresponding pain points associated with these mergers and shotgun weddings.


 Information Technology (IT) is always one of those things that are often taken for granted during mergers. From an operational view, it’s all just “computers,” right? This could not be further from the truth! The best way to compare Hospital IT and Ambulatory IT is to walk through their support spaces. When you walk through a hospital IT shop, you will find long rows of cube space, each with some niche’ product name or subcategory of application. The Radiology Scanning guru is sitting next to the PACS application person, but they are one floor above the PACS storage ninja. They all email each other and maybe have not even met. On the Ambulatory side the IT shop looks like the circus person spinning plates on a stick. They are responsible for multiple systems, applications and have to keep an eye on each one to make sure it’s “spinning” in the right direction.

 Change management on the ambulatory side is like turning a yacht in a harbor. It’s careful, but quick. Change Management in a hospital is like moving an oil supertanker in a harbor. It will eventually happen; you just can’t perceive it with the naked eye. I can give a number of reasons why each organization has to operate the way it does, but that is not what is important. After an acquisition the most important resource that you have are the people that have been working in the trenches. They have an in depth knowledge of all the nuances and how to navigate through all operational requirements. On the ambulatory side they have learned the hard way that even when it comes to billing, there are some major differences in episodes of care, how you retain demographics, and professional versus facility billing. There is a downstream effect with interfaces, and how users capture the data.

Having been involved with various mergers and acquisitions it is always very frustrating to see the focus on systems and not the people. When I was a Navy Corpsman I would always take an x-ray of a potential fracture first and then talk to the patient. That is until an old orthopedic surgeon told me, “We treat the patient not the x-ray.” It put things in perspective for me and I never forgot that. We have to be sensitive to the lives of the people that are being impacted and changed as part of the merger. We have to look at each individual and understand what unique issue they will have with accepting change and how we can facilitate that change. Tap into our Human Resources experts and allow them to help us navigate questions concerning reporting, pay scales, benefits, etc. This has to be done just like we approach any project. You have to have a resource plan, a communication plan, reporting structures, new job descriptions and a timeline for executing each.

Once you are done with the plan for your employees, then (and only then) you can plan your system changes. How a hospital approaches systems is different than ambulatory. For one thing the approach tends to be that Operations needs to fit the system requirement. The question becomes, “How do we change the workflow to capture the data?” The ambulatory approach is a belief that there are NO system requirements, just operational requirements. Information Technology is the tail and it does not wag the dog. So the question becomes, “How do I change my system to capture data in the operational workflow?”

  Many physician groups will experience the transition to a Health System within the next few years. The successful transitions will make sure they retain the nimbleness and creativity of the physicians while creating ways to leverage large IT systems, and share information across the continuum of care. But change comes with stress. How you manage that stress for your employees will determine the success or failure of your merge. If you are not careful, you will merge your employee’s right out the door to your competitor. Merge your employees first; the systems will come on their own pace.