As Utah-based Intermountain Healthcare moves toward its concept of shared accountability by redesigning care across all its clinical areas, its executives became increasingly convinced over the last few years that “teleservices” would be a key part of their process redesign. One key question was whether to buy a telehealth system from a vendor or build its own.
Speaking at the American Telemedicine Association annual meeting in Baltimore on May 19, Kim Henrichsen, R.N., Intermountain’s vice president of clinical operations and chief nursing officer, described why the 22-hospital system eventually chose to build its own platform.
Intermountain, which is planning to begin the transition from its homegrown EHR to Cerner in the next year, will work with Cerner on integrating the new Intermountain telehealth platform with Cerner’s tools, she added.
About three years ago Intermountain started looking more closely at providing access to members, patients and employees wherever they may be, Henrichsen explained. “We realized teleservices would play a significant role. It is something we had to move forward with.”
Intermountain recently finalized a framework that will define the types of technology it would need, and what types of services it needs to employ in the organization to achieve its overarching strategy.
The organization actually had teleservices on its IT “to-do list” for eight years, Henrichsen said, but with all the challenges IT was facing, a teleICU project just kept getting bumped. “We didn't get it prioritized until three years ago,” she said. Then the build vs. buy debate began.
“I was on the executive team. I remember asking, do we always have to build it? There are wonderful solutions on the market to tap into,” she recalled. My team knew how painful it was to build things. We asked how long it would take. Would we get enough resources? It came down to the fact that we have an EMR and decision support tools they are used to in the critical care arena. If we bought a vendor solution, we could contribute to it, but we wouldn't have ability to alter what was built in. And we wanted one platform we could use for all teleservices, rather than one for teleICU, another for mental health, another for women’s services.We did look at the two most commonly used solutions for telecritical care. Another deciding factor was the cost. We thought we could build a platform for an array of teleservices for the cost of a vendor telecritical care system.”
Intermountain did bring in an outside firm, Blue Cirrus Consulting, to assess its readiness and to help with project management during implementation of the homegrown system, which consists of a stand-alone audio-visual platform independent of clinical systems.
Dan Watterson, R.N., a senior consultant for Blue Cirrus, said Intermountain went live with the teleICU in December 2013, and expects to have 12 facilities and 260 beds live on teleICU by the fall of 2014. Beyond that, there are plans for various other programs, including behavioral health, oncology and cardiovascular health.
He stressed the importance of a governance process to project success. “Make sure you have a formal project, with clearly defined sponsorships and a clinical and IT business owner, and a project manager,” he said. He also recommended ensuring that all IT functional departments are represented on the project team.
“Do not move forward without clear business ownership,” he said. “Create a formal project charter. We spent a month to six weeks on a charter for the teleICU program. I thought that was a long time, but it came in handy.” When people would come up with suggestions outside the scope of the project, Watterson would remind them they needed to stick with what they signed off on and get it done.
As far as the pros of building your own system, Watterson said you do get lower total cost of ownership and minimal to no licensure limitations. “You can customize it to your heart’s desire,” he said.
The cons? “You own it, and this is complex stuff. You need experts, and you have to make a long-term commitment to develop, implement and support it.”
Another potential con is that enhancement requests are specific only to your system, not to the industry as a whole. “You will not get the benefit of a vendor solution getting feedback enhancement requests from across industry,” Watterson said. “You may miss out on some cool stuff.”