Business plans drive systems plans.
Your critical technology needs are determined by the business direction you set for your organization. Linking your information systems plans to your business plans is the easiest way to minimize frustration and help you to avoid buying a system that does not support critical business functions or that has features that you do not need.
For example, if your business strategy over the next three years includes diversifying into hospice or private duty and increasing the percentage of revenue derived from non-Medicare sources, you need a system (or multiple systems) capable of supporting all of those business lines. You also need systems that can handle the variety of contracts you can expect to encounter working with a non-Medicare population.
“systems planning is a hierarchical process requiring formulation of strategies, goals, objectives, operating plans, etc. ”
On the other hand, if you operate a standalone agency serving the Medicare population, and your long-term plan is to remain independent and focused solely on this market segment, your challenge is to avoid the temptation to over-buy. You will have little use for features and functions associated with other business lines.
Like business planning, systems planning is a hierarchical process requiring formulation of strategies, goals, objectives, operating plans, etc. The product of this process will be the foundation for evaluating and ultimately selecting potential technology products and vendors.
We assume that most home care organizations have had some experience working with information technology. Our planning approach, however, addresses the needs of both first-time and experienced systems users.
If you are planning to replace an existing information system, you are doing so for one or more of the following reasons:
a) your present system does not meet your needs,
b) your vendor does not meet your needs,
c) your system is too expensive to operate and maintain,
d) the term of your license agreement is about to expire, or
e) you need to begin using newer technology (your vendor may be withdrawing support for an old product).
Addressing perceived deficiencies is a key consideration when planning system changes. You want to benefit from your experience – good or bad. Consider this caution, however, particularly if your replacement decision is based on an assessment that your current system or vendor is not meeting your needs:
- For every agency dissatisfied with one particular system, there are other users who think the same system and its vendor are “just wonderful.”
- Focusing on current system deficiencies can blind one to the absence of features you rely on that are not present in some flashy new system.
In many situations, dissatisfaction may be warranted – the system is not adequate for any agency’s needs. Two customers seeing the same product’s capabilities differently may merely reflect one agency having taken the time to learn to use all of a system’s features and the other making an insufficient effort to do so.
Replacing an information system is a significant undertaking. Through the years, the best advice has always been to first assess the level of effort they have put into working with their current information system and its vendor. Replacement is warranted if you know you have “given it your best shot” and conclude that your system and/or vendor is not likely to meet your future needs regardless of any additional effort you may invest.
New agency exception: If this is the first time you are considering use of technology in your home care organization, you are most likely just entering the market. Your challenge is different. You must choose an information system that can accommodate a rapidly growing and changing enterprise. You should pay particular attention to vendor support and look for a clearly defined approach to accommodating your need for expanded capabilities over time. Approach “bells and whistles” cautiously, and avoid the temptation to over-buy.
There are many solutions available today that target startups with small budgets for technology purchases. Most of these deploy under the “Software-as-a Service” hosted model instead of installing software on servers located in your space. Many of them use pay-as-you-go pricing instead of requiring large, up-front deposits. While revenues may be tightening, affordable options for small agencies are actually expanding.
As the business of home care becomes more complex, your information system becomes an increasingly important strategic asset. In the strategic portions of your business plan you laid out broad goals and statements of long-term direction. As a starting point for your systems plan, you should develop similar statements of information system goals and direction to support your long-term business goals.
When considering your potential systems investment from a strategic perspective, think about ways to use technology to create competitive advantage. Ask yourself the following questions:
- Can we use technology to differentiate ourselves from our competitors? Your information system may help you differentiate the cost or quality of your services. It should certainly help you to achieve efficiencies and improve service delivery.
- Can we use technology to foster relationships with key entities (payers, other health care providers) in our marketplace? If your system can exchange data easily with other organizations, you may be able to develop unique relationships with key referral sources or contracting organizations. Once electronic linkages are established, they are difficult to do without. With federal dollars earmarked to encourage hospitals and physicians to deploy Electronic Medical Records, the ability to electronically interact with them is more crucial than ever from a competitive standpoint.
- Can we use technology to create new services or revenue sources? Identify areas where use of technology can add value to your services (probably in clinical or telehealth applications). The added value may be sufficient to warrant charging payers a premium for these services (e.g. case management).
If these opportunities are consistent with your business direction, include them in your long-term systems strategy.
Your business plan should span three to five years. During this time, your system requirements will change to reflect changes in your organization or marketplace. Capacity planning, addressing your need for specific systems capabilities at appropriate points in time, should address critical business applications, hardware and communications requirements.
To begin capacity planning, first develop a timeline of significant events that you have forecast in your business plan. These should include major changes in business direction, expansion into new markets, etc., anticipated during the timeframe covered by your plan.
Next, develop a list of major system requirements based on these events. For example, if the third year of your plan includes establishing a hospice program, you will need hospice-specific software prior to starting operation. You may also need additional computing capacity, telecommunications capabilities, and perhaps additional software licenses. As you develop these plans, schedule sufficient lead time to acquire and install necessary systems, train staff, etc.
At this point, you will have developed only a general picture of additional system capabilities required. The next step is to review your plans in discussions with potential vendors to more accurately define your future requirements.
Attach cost estimates to the additional capabilities required to accommodate expected business changes. Your goal is to avoid major surprises that will impede your ability to follow through on your business plan or that will significantly add to total system cost.
Develop specific objectives that will help you meet long-term system goals. Objectives should have a more immediate focus, addressing major accomplishments you expect over the next one to two years. Include objectives directly related to the operational parts of your business plan and objectives developed specifically for your systems acquisition effort.
Operational objectives should focus on aspects of your operation that you want to improve through use of technology, a key consideration during what we have identified as PPS Phase Three, the continually falling payment rate phase. These could include, for example, increasing productivity with a point-of-care clinical system, extending clinical reach with remote electronic monitoring or reducing staff training costs through online education.
Objectives should be measurable and should identify the individuals accountable for their achievement. Then, evaluate performance continuously, because these objectives measure short-term return on your system investment.
We also suggest that you develop project-level objectives specifically related to the system acquisition and implementation process. At this level you are doing tactical planning – developing schedules and specifying deliverables.
Acquiring and implementing new technologies can be a significant undertaking – developing objectives will keep management’s attention appropriately focused.
The last component of our suggested planning process is assessing your organization’s capacity and readiness to accommodate new technologies. This assessment should include:
- Risk tolerance. Acquisition of any new technology carries some risk. Many of the technology vendors serving home care are relatively small, young companies. Their products may have only been used in a few locations so far. The greater your agency’s aversion to risk, the fewer available options you have.
- Staff skills/experience. Evaluate your staff’s attitude toward automation. Use a formal test to evaluate their experience with systems and their readiness to embark on vendor software training. When necessary, do not hesitate to provide a basic computer training course.
- Computing capacity. Inventory your agency’s present hardware and software. Compatibility with newer applications may be an acquisition issue. When there are two or three Windows OS versions in use nationwide, as is the case as this article is written, compatibility and standardization efforts and policies are worth the trouble.
- Financial resources. Determine what you can afford and how you want to finance your purchase. Prices and licensing arrangements vary widely and are often negotiable.
The breadth of your search for appropriate technologies will be based, in large measure, on your assessment of these factors.
You must determine your information system priorities in order to solicit proposals from vendors and ultimately evaluate proposed systems. The priority-setting process involves both your business and systems plans. It results in a clear statement of your application-level priorities and identifies other important considerations to which potential vendors should address their proposals.
You can use this process to acquire either a comprehensive management information system or specialized software or technology products addressing a specific application. For this discussion, we describe the methodology from the perspective of an agency acquiring a comprehensive system.
If you are using The Visible Home Care Technology Selection Guide to identify likely vendors online, it will help you think about and identify most common software features and functions. This is a team task. Distribute the list of features to get input from those who will be using them before making your final checkmarks and arriving at your final prospective vendor list.
Involve as many people in the priority-setting process as reasonable. Your objective at this point is twofold – to get staff insight and buy-in. Take into account the agency’s size and complexity. At a minimum, involve key administrative and clinical staff.
To begin, compile a list of your business and systems strategies. Review each one and make note of the applications and business processes you expect to have the greatest impact on your long term goals. Impact statements can be expressed both positively and negatively – positive statements describe an application’s contribution to accomplishment of a goal, and negative statements identify barriers created by the absence of a particular feature or function.
Once you have completed this process, we suggest that you repeat it, focusing on your shorter-term business and system objectives. What should emerge is a picture of the application features and functions that are most important to achievement of both your long-term goals and more immediate objectives. These represent your most critical application requirements.
As you go through this process, make note of features and functions that are “desirable” but, if pressed, you realize you can live without them. No software package or technology product will have everything you want. These desirable features will become points of potential compromise as you move through the evaluation process.
A number of other considerations must be addressed when establishing acquisition priorities and developing criteria to evaluate vendor proposals. They include:
- Hardware (compatibility, expandability)
- Software (operating system, navigation, security)
- Support (training, operations manuals)
- Business (contract terms)
- Financial (cost, arrangements)
- Vendor (reputation, stability)
Evaluate the relative importance of each of these to your selection decision. While these should have some weight in your product and vendor selection, they are seldom the key determinant of your technology investment.
As you can see, the process of selecting the right systems solution is detailed and involved, As home care reimbursement methodologies evolve, certainly for Medicare providers but also for those with other payer business relationships, planning before purchasing is not only our recommendation but may well determine if your agency goes through the coming home care “winter” as one of the secure ants or the starving, begging grasshopper.