To design or not to design?
By Patrice Spath, ART
Consultant in Health Care Quality and Resource Management
Forest Grove, OR
Computerization is an important component of today’s quality management program. A question that often arises is, "Should we design our own system or purchase a ready-made system?"
One of the major considerations when purchasing a ready-made software package is the cost. Many systems cost more than $10,000. This purchase price, together with annual license fees, can bankrupt the capital budget of many quality management departments.
For this reason, many health care organizations design their own in-house quality management system for medical staff credentialing and/or performance measurement. Before undertaking this project, however, each facility should understand what is involved and then decide whether the cost, resource allocation, and time commitment are justified. To explore whether building your own in-house system is feasible, there are several issues that must be addressed:
• Do we have the in-house expertise of PC-based technology, database software, word processing, and printers to tackle such a project. If not, how much time will we invest in securing this expertise?
• Do the in-house data processing staff or the quality management professionals have the knowledge required to build an automated, integrated information system?
• Can people dedicate their time for an extended period to build a software application for credentialing and quality management?
• Do we have staff who can provide ongoing documentation, training, support, and maintenance to the system? If so, will changing priorities interfere with the timeliness of their support?
• What happens if the person who designed the computerized program leaves our facility for another position? Will we still be able to maintain the system?
• Do we have enough expertise to build the system with the broad picture in mind? Do we truly understand the future data demands of the Joint Commission on Accreditation of Healthcare Organizations, Health Care Financing Administration (HCFA), third-party payers, employers, and other outsiders?
• Can we provide the resources to keep the program up-to-date in our ever-changing environment?
• What do we lose by not being part of an established vendor network or user group that addresses the needs of credentialing and quality management?
• Is it more cost-effective to develop such applications in-house or would we better serve the facility by purchasing software dedicated to these needs?
The significant issues are listed below, along with the factors that must be considered before embarking on in-house development of a quality management automated system.
Do you have the hardware/software expertise?
To begin an in-house computer project, someone must be identified who is knowledgeable about the technology involved. The data processing department may be able to provide that person, although sometimes they do not have a thorough understanding of PC-based systems the hardware most often used for quality management applications. If data processing staff do not have the time or commitment, most often the responsibility falls to the quality management coordinator.
Quality management coordinators must make time in their busy schedules to gain the necessary technical expertise to build the system. Because working with new software requires a great deal of concentration, often these people find themselves putting in late-night or weekend hours to get the job done.
A software application cannot be developed in isolation from all the components of the process being automated. Each part of the process must be thoroughly understood by the developer to achieve a satisfactory "fit" at the end of the development project. Credentialing and privileging physicians and allied health professionals requires a detailed understanding of the process of training and licensure verification, medical staff bylaws requirements, continuing education requirements for board certification, malpractice issues, delineation of privileges, and other issues. The quality management process has similar details, such as accreditation and state reporting. Even managers with a thorough understanding of all the processes involved may not have the necessary statistical background to design meaningful computerized trend or summary reports.
Dealing with turnover
Once an application is designed and implemented, the work of maintenance is important. What happens when the in-house developer leaves the organization? Most often if data processing personnel have done the work, their department must find time to train new personnel. If the program design was left to the quality management coordinator, sometimes the program simply stops being used. If the only person who understands the system has gone, and there is nowhere to turn to for help, the retraining process falls on the shoulders of the new quality manager.
Looking at the broad picture
There is more to a quality management software application than just what is needed internally by the facility. The Joint Commission, HCFA, the National Practitioner Data Bank, insurers, employers, and many other external groups are asking questions your quality management department must be prepared to answer. Vendors have access to information about future data requirements because their representatives sit on key national groups and committees. The hospital-based quality management professional may not have this opportunity.
What are the time requirements for system maintenance? While someone in the organization may find the time to design and implement the system, continued updating will be necessary. New report formats will be needed, or new requirements such as reporting to and accessing the National Practitioner Data Bank may require program changes. Who will take the time to respond to these necessities?
Time constraints pressure programmers
Once the programmer has been selected, you would think the project would proceed smoothly, but this is seldom the situation. Time constraints, changes in priorities, and unexpected workload increases leave no time for continued programming or enhancements in this ever-changing environment. For quality management coordinators, the time for system development usually comes from their personal hours. This creates added stress because their regular jobs are increasingly complex.
One of the greatest benefits to users of vendor-designed software applications is a network or user group. These groups provide ideas that all the participants can benefit from, thereby reducing the need for everyone to "reinvent the wheel." One of the most gratifying benefits of involvement in a user group associated with a particular software vendor is that good ideas can be passed along to the vendor, who can incorporate these suggestions into future product enhancements. The vendor makes software refinements without interrupting the work flow of the coordinators.
The bottom line for software programs usually revolves around cost. In-house development of a credentialing/quality management program is not free nor is it limited to the spreadsheet or database program cost. Whether the development is accomplished by data processing personnel or department coordinators, time spent must be accounted for. Calculate this cost by multiplying the total in-house hours required for program design, documentation, training, enhancements, maintenance, and retraining by the average hourly salary for those individuals involved. The cost may prove much higher than a predesigned system. And of course, if the in-house person who designed the program leaves, the investment may well be lost.
Strong commitment brings desired results
Remember, building an application for any or all of the medical staff credentialing and/or quality management processes requires a good deal of investment by whoever undertakes the project. Program design and maintenance require the dedication of a team that can bring to the process all the expertise, knowledge, and commitment needed to ensure a dynamic solution for managing information. To get the best return on this investment, quality management professionals must carefully consider the issues of in-house development vs. the purchase of a predesigned automated system.
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