Buy vs. build your software, 8 things to consider

As the owner and account manager at a medical software company specializing in physician call scheduling software, I occasionally have a prospect tell us that they are "thinking about creating scheduling software in-house".  Although I highly discourage this due to the complexity, staff requirements and amount of time that would need to be invested to re-create what we have already done, I thought I would be objective and tell you when I think it’s good to build versus buy. 

After researching this topic, consensus appears to be:  Buy when you need to automate commodity business processes or to standardize; build when you’re dealing with core processes that differentiate your company or to compete.  “Everyone knows that the more standardized you are and the more you buy off-the-shelf, the more cost effective it will be for both implementation and ongoing maintenance,” says Mark Lutchen of PricewaterhouseCoopers.

Here are 8 things to consider when making your decision:

1.      Upfront Scope and Requirements costs:  what do you want the software to do and how will it look and function.  What are your expectations?

2.      Upfront development cost:  You will most likely need project manager(s), lead architects, coders and testers.  Also don’t forget the technology required to develop and test.

3.      Upfront time:  Scope and requirements can take 2-3 months full time on a project that is medium in complexity.  Development can take 6-9 months and testing another 2-3 months.

4.      Plan for the “ooh, that’s what you meant” most projects have some amount of re-work required to move forward.   This is usually greater if you decide to “off-shore” your project.

5.      Ongoing maintenance:  Software becomes outdated the moment it is released, that’s why there are patches and updates.  Not to mention that every time you update or patch something, chances are that you will break something else.

6.      Software maturity:  This is the point when you have an ultra-stable system that is virtually bug-free.  This is a moving target.

7.      Staffing:  What happened when your coder or project manager gets a better job offer or you have budget cuts and have to eliminate a key position? 

8.      Intellectual property rights:  Don’t forget about the IP that will go into this project during the development.  Although most companies have policies that state that anything that is developed on company time is property of the company, that does not preclude your employees from developing “similar software” for another industry or building on a concept that was scrapped at work.  The hardest part in this scenario is finding out that someone has a covert project going on at home.

                                                    Graphic by Bruce F. Webster

I think a good argument can be made depending on your goals and objectives.  As an example, we have developed custom on-call doctor scheduling software to sell to hospitals and clinics.  We truly feel this is core to our business.  But on the flip side we have purchased via SaaS model both CRM and Accounting software where better mousetraps had already been built. 

I think the key takeaway is to know what you’re getting yourself into and why are you deciding to build vs. buy software. 

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Justin Wampach is president of Adjuvant Technologies, developer and provider of Call Scheduler. Contact him at 320-257-7134 or justinw@call-scheduler.com

Who’s planning for the worst?

What is the cost of starting over
In the world of business, especially as a Software company there has been a push since 1999 to be sure that your company has a disaster plan in place, just-in-case something happens.  A Business Continuity Plan (BCP) or disaster plan is the least expensive insurance plan a company can have, as it costs virtually nothing to produce, if you do it yourself.  Adjuvant Technologies has spent time making sure that our company can still provide a valuable on-call scheduling and management service even if our office is not accessible.

Recently I have spoken to many prospective customers who have not given much thought to the question of “what would happen if the person or Doctor who creates and manages the providers’ on-call and work schedule was gone and the information was not available in your office?” “Do you have anyone cross-trained in creating and maintaining the physician schedule?”  ‘Do you have the process documented?”  “Do you have the complex rules documented on paper?”  “Where is all of your information located?”  “When was the last back-up?”  If the answer to any or all of these questions is “I don’t know” or “no”, you need to keep reading this.

According to website WiliHow.com, there are several steps the partners can take to be sure that your most critical items have been carefully thought through and you have an accessible plan that directs the organization in a time of chaos.  Here are the first 9 things to know.

 9 Easy steps

Step 1:  Document key personnel and backups.  These are people without which your business can function.  Doctors and other key providers would be on this list.

Step 2:  Identify who can work from home.  Find people who are capable of working from a home office.

Step 3:  Document external contacts.  Critical vendors, your attorney, banker, hospital contacts, and EMR vendor.

Step 4:  Document critical equipment.  Personal computers, back-ups, fax machines, servers, software.

Step 5:  Identify critical documents.  Articles of incorporation, HR records, lease papers, physician schedule history, on-call tally reports.

Step 6:  Identify contingency equipment options.  Where would you rent computers, a phone system, fax and copy machines, and how quickly could you have all of this set-up.

Step 7:  Identify your contingency location.  Where will you conduct business, where will you be directing patients to in a disaster?

Step 8:  Make a “how to” process book.   This should include step-by-step instructions on what to do, who should do it and how.  This should be done for every “critical process” in your organization.

Step 9:  Put this information together.  This plan is useless unless it has been assembled and can be accessed in case of an emergency.  Be sure to have extra copies.

Practice what you preach

At Adjuvant we began identifying critical systems and process that we would need if our office suddenly did not exist.  Here are some of the things we did.  1)  We used to have our accounting system, QuickBooks located on a server in our office.  We transitioned to QuickBooks online to be sure that we can access the information from anywhere.  2) We also used to have our Customer Relationship Manager (CRM) software located on a server in our office.  We quickly realized that if we did not have access to the office, we would never be able to notify our clients of any problems.  We began using salesforce.com and online company to manage this information off site for us.  3)  As an Application Service Provider (ASP) servicing clinics and hospital emergency rooms, our customers rely on us to keep our equipment up and running.  We relocated all of our production servers to large national hosting facilities that offer costal redundancy.  These are 3 examples of how we used new technology as part of our Continuity Plan.

As the owner of an ASP, I try to tell prospective customers how valuable it can be to have critical information accessible from anywhere via the Internet.  In the case of scheduling physicians, where they are or are supposed to be may be important enough to your organization to make sure it is part of your larger continuity plan. 

Please don’t wait to find out if you will ever need a BCP.  I can promise you that at some point you probably will.  Is yours done?  Ours is!

______________________________
Justin Wampach is president of Adjuvant Technologies, developer and provider of Call Scheduler. Contact him at 320-257-7134 or justinw@call-scheduler.com

What happens when one Doctor holds all of the provider scheduling knowledge?

In many provider owned medical practices it is not uncommon to see a senior physician creating and maintaining the provider on-call schedule by hand or using Excel.  It has been their pro-bono contribution to the practice for years.  With the baby boomers getting closer to retirement age, it may not be as easy as it was in the past to find the “kind hearted” doctor to take over this colossal task.  The new “generation X” Doctors are going to want to know what’s in it for them.  Not only will making the transition from one person to another difficult, but the larger question should be “is it beneficial for the group to have all of this information in a person’s head?”  We talk to medical practices almost daily who think the answer to this question should be NO.

 Hazards

Here are a few things that you need to be aware of that comes along having the same provider create the schedule by hand.

·         There is a misconception that there is only one way of doing things, the current scheduler’s way.

·         The schedule can be seen as unfair if you are not as close to the scheduler as others.

·         Scheduling nights, weekends and holidays is a lot of power for one person to have.

·         Too much of the important information, namely rules, are contained in someone’s head.

·         There is a lack of documentation of the current process.

·         Lack of a back-up process.

·         Historical data may not be present or accurate.

Person –vs- Process

According to Wikipedia, Process describes “the act of taking something through an established and usually set of routine procedures to convert it from one form to another”.  For example, milk into cheese or processing provider requests and schedule history to create an on call schedule.  Typically when using a process you are able to predict the results.  With a person, you are not.  An example of this would be if you have a provider that has been creating the call schedule for years and suddenly a new person steps in while the original person is on an extended leave.  I will guarantee you that the new person will hear “…well that’s not the way so and so did it”.  It is very difficult to produce consistent results by chance.  We also observe prospect schedulers being challenged with honoring the groups scheduling policies via “rules”.  We see this clearly when people send us a copy of their current schedule accompanied by a list of their rules or policies.  80% of the time the rules are violated and we find out they are really strong preferences.  We also observe, mainly from physician schedulers, that if there is a discrepancy or hole in the schedule, they will often sacrifice themselves to work extra days as opposed to upsetting the apple cart. 

The not-so new way

Back in 1999 I saw my first ever computer based on-call scheduling system.  Granted it was DOS based, but it did the job.  Today, web-based on-call scheduling programs exist with the intent of solving the problem of having one person hold all of this important knowledge.  Outsource the knowledge to a database and you will quickly realize the benefits.

·         According to a 2006 article in Physicians Practice Magazine by Pamela Moore, PhD, there are approximately 5 “call models”, call scheduling software can run scenarios to show you the differences?

·         Let the software choose the best candidate to work, based on your groups rules and policies.

·         Prove fairness and transparency with automated tally reports.

·         The good call-scheduling companies will document and print out your unique process for you to use and keep.

·         Historical data such as provider requests and holiday history are archived indefinitely and available at your fingertips.

Software is the answer to solving the problem of having all of the on-call information trapped in someone’s head. Making the transition takes time and a willingness to change, but it’s worth it.

Call Scheduling: A Thankless Job

 Evaluating the Costs of Your Clinic’s System.

 As a leader of a technology company focused on creating, maintaining and publishing physician on-call schedules, I hear stories almost every day from frustrated physicians who have taken on the pro-bono assignment of creating a call schedule for others in their practice.

It’s is one of the lone clinical duties still done this way. Over the years, clinics have moved other key functions like accounting to paid, in-house responsibilities to ensure accountability, quality and sustainability. In the end, the good intentions of physicians who volunteer to do the call scheduling results in the other partners not understand what it takes to provide a fair and accurate schedule.

Time’s Ticking
In practices of all sizes, I’ve seen a physician spend many hours of personal time at home or in the office after hours to help out the practice. Behind the scenes, the physician scheduler aims to simultaneously adhere to the complex rules and regulations and meet the personalized needs of the physicians. Duties range from coordinating meetings to discuss fair rotations and juggling time off requests to creating daily schedules.

A schedule is rarely finalized. Often, schedulers make countless changes and provide a series of revisions to accommodate swaps and adjustments after a schedule is published. A scheduler spends a week’s worth of work every quarter to create, maintain and publish a call schedule for a practice with 14 providers. That’s a month’s worth of time a physician could be spending with patients or doing other activities.

Evaluating Costs
When most physicians are asked what it costs their practice to do call scheduling, their response is zero -because another physician takes care of it. That’s deceiving to the practice’s bottom line, not to mention devaluing to the person doing the job.

The time spent on the call schedule may not be billed – but it could be. If a specialty physician earns $300,000 a year and works an average of 80 hours a week, their hourly rate would equal $72. Multiply that times 105 – the average hours spent on creating, publishing and maintaining a schedule a year – and the actual cost is more than $7,500 annually.

The soft costs are rarely recognized, but can be equally as important. Imagine if the physician scheduler spent 105 more hours with his wife or kids. Imagine the ability to spend more time reading medical journals, relaxing on the golf course and getting involved in the community.

No matter how long a physician volunteers to do the scheduling, eventually he or she has to hand it off. When that happens, I often receive a call from the new physician in charge asking about technology the practice can use and a free trial. They believe that Call Scheduler - or any tool for that matter - would be better than doing it by hand so they ask for pricing and presents it to the partners. But the belief that the practice currently gets the schedule for free prevents the partners from moving forward.

Getting Results
Practices cannot make informed decisions until they effectively evaluate the hard and soft costs of their current system – even if it is done by hand for free. Here are three steps partners can take to ensure the resources are optimized:

1. Keep track of each hour that a scheduler spends creating, maintain and publishing the on-call schedule. (Paid or unpaid)

2. Create invoices with the true costs. The physician scheduler can continue to no charge. This will provide a track record of the cost.

3. Give the project back. Explain to partners that the time spent and the benefit received are not equal. Perhaps a “paid” staff member within the group can pick-up the duties.

These steps have been proven to help practices better evaluate the effectiveness of their current scheduling system and make changes to better position them for the future. The creation of the call schedule for providers is no less important than the EMR, CPOE or accounting software. Physicians will see a sizable return when they take the time to ensure they have a call management system that is efficient, scalable and sustainable.

8 Steps to implement change and have it stick!

Change is difficult. You know that the change needs to happen, but you don't really know how to go about delivering it. Where do you start? Whom to you involve? How do you see it through to the end?

There are many theories on how to "do" change. A professor at Harvard Business School John Kotter introduced his eight-step change process. As an example lets look at how we can use these steps to prepare you with the tools you need to "change" the way your clinic or hospital department schedules your Doctors.

Step One: Create Urgency: The next time the wrong Doctor is called or one of the partners is upset about the on-call process, have an honest convincing dialogue with them explaining the consequences of your old system. Explain why it happened and tell them you need their help in preventing it from happening again.

Step Two: Form a Powerful Coalition: Convince the Doctors that change is necessary and ask them to help you convince others in the organization.

Step Three: Create a Vision for Change: Show the Doctors what you are trying to accomplish, why and how it benefits them personally.

Step Four: Communicate the Vision: You will be competing with other projects or systems that need change. Communicate your message frequently and powerfully.

Step Five: Remove Obstacles: Be aware of barriers and use your powerful coalition to help you. Don't tackle this part alone.

Step Six: Create Short Term Wins: Give a taste of victory early. Do a 30 day trial and show the success.

Step Seven: Build on the Change: Don't declare victory too early, change is an evolutionary process that takes time. Remind others that this change is for the long term and it will not happen over night.

Step Eight: Anchor the Changes in the Corporate Culture: Make it stick and become part of the core of your clinic or department. Share success stories of the change so far.

When you plan carefully and build the proper foundation, implementing change can be much easier and you will improve your chances of success.

More Hospitals Forced to Pay for Specialists Care

In this article "Specialist Shortage Shakes Emergency Rooms; More Hospitals Forced to Pay for Specialist Care" specialists being paid to be on call is becoming more frequent. Stipends are ranging from $100-$1000 per shift depending on the speciality.

Is your hospital paying for call shifts?

Is it for all specialities?

If you refuse to take call unless you recieve a stipend will you loose your hospital privileges?

This article can be read in its entirety at : http://findarticles.com/p/articles/mi_m0843/is_3_31/ai_n13817772.html

Missouri Court Upholds Liability For Call Coverage Issue

Do you have a contingency plan if your on-call person is unavailable? In this article a Doctor swapped call duty with an associate in his practice. The doctor did not inform the hospital of his arrangement. In addition the new on-call doctor did not have privileges at that hospital. A patient arrived that required care from the on-call physician who did not have privileges at the hospital. By the time the patient was admitted to the new hospital the patient was deteriorating. Subsequently the patient died and the family sued both doctors.

Does your organization have a plan in place to deal with a situation like this?

The entire article is located at: http://www.medlaw.com/healthlaw/HOSPITAL/6_2/missouri-court-upholds-li.shtml