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When it comes to software we ask ourselves “build it or buy it”, we should really be asking “build it or rent it?”

October 21, 2013

There’s something magical about owning your own home. When you walk through that door, you are in your kingdom. This is your domain. If you want to paint all of the walls black and go with concrete furniture (and you live alone), you are free to make those decisions. If you feel like three of the rooms should have their border walls knocked down to make one giant room, it’s all yours. It’s one of the great freedoms we can have. Right up until the furnace stops working and you have to spend thousands to get it fixed.

Owning a home ¬is wonderful as long as you have the means to keep up with the daily maintenance it demands. It’s for that reason that some people love to rent. You may not have the freedom to build your own addition or start knocking down walls, but if the dishwasher stops working you can just call the landlord. Depending on the landlord, that makes life a lot easier. So what does this have to do with software or healthcare?

Healthcare is currently having technology stuffed down its collective throat. If you aren’t pushing forward with your new EHR implementation it had better be due to the fact that you are already working on your upgrade. There are a ton of systems out there and some big players emerging in the EHR market, and they all want you to “buy” their systems. The reality is however, you don’t get to buy software. You get to rent it. Regardless of how customizable the software manufacturer purports the system to be, they are not going to make changes to their system architecture unless it supports their entire user base, and then only if the change is profitable (or least mission critical) will they make it. Software vendors will do everything they can to allow you to “configure” their software to meet your needs but they rarely allow you to make changes to it. You can look to some of the largest Hospital systems in New England in Beth Israel Deaconess, Boston Medical Center, and Partners Healthcare who are still using home grown EHR products. BMC and Partners are in the middle of making a move to Epic Systems, but Beth Israel Deaconess is holding on to their home gown system.

Why? Because they own it.

It takes a lot of work (and money) to maintain it, but they can do whatever they want to make it meet the needs of their clinical and administrative staff. As regulations and market forces drive change, their system can move easily to meet those changes. Integrating it with other hospital systems is made easier because they control all of the input and output. Most importantly, they know that the Radiology department has different needs than the Orthopaedic Surgery department and they can bend to those needs.

Let’s face it, FQHC billing is just weird.

Most of the larger software systems out there won’t provide the customization you need to automate your RCM operation. That isn’t to say that they haven’t filled their systems with great innovations and features, it only means that their focus isn’t solely on the needs of FQHCs as a whole.

Recently at PMG we started down a new path with a software partner that should help us really enhance the Revenue Cycle Management services we provide to the FQHC market. We were impressed with the functionality and polish of this system, and making the decision to rent it was good one. However as we work to implement it, the Devil has crawled out of the details. Configuring this system to meet the needs of our FQHC client base has been a challenge to the point that one of the installation managers from the vendor described the setup as “a nightmare”. We’ll have this software up in a matter of months however, from the first demo to the first pilot practice.

At the same time we have invested in building or “buying” our own internal systems to solve some of the RCM challenges our FQHC clients face. We’ve spent more time thinking about what the software would actually do than we did in all of the decision making around our new software “rental”. We’ve just finished the design; planning and architecture phase and we are excited to see the blue print of a new system that will bend to our every need (which in reality is the needs of our clients). We’ve crafted it to be open to change. All of the back-end design exists to support customization and change without a major system overhaul.

In the end, if we decide we want to tear down all of the walls and do a major overhaul we will have the ability to do that. The process takes a lot longer, and a lot more effort, but it’s refreshing on so many levels to work on a system that is 100% devoted to what we do.

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