Health Informatics Series. Software Selection

Health Informatics Series: Software Selection1 |

Health Informatics Series

Software Selection

Mark H. Spohr, MD,Health Care Informatics IER/HIS, World Health Organization, 20, Avenue Appia, CH-1211 Geneva 27 SWITZERLAND


Why Health Informatics?Health Informatics provides

information to make decisions

Better information leads to better decisions

Health care, management, planning and policy all need good information


Enterprise Architecture


Software Industry CharacteristicsInformation Technology is a "Network

Industry" with these characteristics:– Complementarities, compatibility and standards – Consumption externalities [network effects] – Switching costs and lock-in – Significant economies of scale in production


Complementarities, compatibility and standards

IT is a System that consists of:– Complementary products (computers, monitors,

keyboards, software, operating systems)– All of these must be compatible to work together– They all must follow standards to work together

Vendors should follow these standards– Often vendors try to limit your options by producing

proprietary computers, software, operating systems, and data formats that do not follow standards and do not work well together.


Network EffectsThese are known in economics as

"consumption externalities"

One telephone is useless, two are useful, three are a network

The value of the network increases exponentially as more "nodes" are added.


Switching Costs and Lock-inUsers can be prevented from

switching by various factors:– Contracts– Training and learning– Data conversion– Search cost– Loyalty cost

Adherence to standards can help address some of these costs


Economies of ScaleSoftware is the ultimate product when

it comes to economies of scale– The first copy is very expensive (design, coding,

testing)– All subsequent copies cost nothing to produce– (Implementation, however, does have costs)


Data EconomyData is expensive to collect

The cost to copy and communicate data is very low

Must have data standards to have meaningful communication


Open Source EconomyFree Open Source Software (FOSS)

allows sharing of high development costs

The public sector can benefit greatly by sharing their contribution to software development


Now that you understand the market…

You can use your understanding of these market characteristics to your benefit when selecting software:

– The value of Standards– How to benefit from Network effects– Lock-in (and how to avoid it)– The true cost of software and data


Health Information System Life Cycle Methodology


Overview of Software SelectionDefine functional and technical

requirements

Research software vendors

Conduct vendor evaluations

Plan for the implementation of the selected software


Preliminary ConsiderationsDoes an information system plan

exist?

Is software the answer to this problem?

Does software exist or will the project require custom software or extensive modification of existing software?


Understanding the ProjectDoes everyone understand the project

in terms of cost, timeline, internal resource commitments, impact on the organization and the need to change processes?


Define the ScopeWhat functions/data are needed?

Is this within the overall information architecture vision?

What is the business case?

What are the process impacts?


Assess and PlanReview current information systems and

processes

Design the "To Be" information systems and processes

Design and document changes (how to get from "As Is" to "To Be")


Mind the Gaps

List and plan to address gaps in:– Computer hardware– Software– Communications– Business processes– Human resources– Data Standards and Interoperability


Evaluate SoftwareUsing the "To Be" system design,

create a list of software functional requirements tailored to your specific needs.

– Data elements captured– Data input screens– Data access screens– Workflow capabilities– Interoperability capabilities – functionality– Standards supported


Compare SoftwareCreate an evaluation matrix to

compare the various software options against each other.


Make or Buy?You always have the option of building

your own software

This should only be considered when you cannot find adequate software or the software is too expensive or would require extensive modifications


ModifyConsider that open source software

will be easier to modify and will give you more control of the product

All software will require some modification. Always look at how easy it is to modify the software and who will do the modifications.


Make vs. Buy… Or ModifyBuy Software

– May not be an exact fit to your needs

Build Software– Long expensive process not guaranteed to succeed.

Modify– Start with open source software that you can modify– This may meet only part of your needs but can be

modified to meet your exact requirements– Everyone benefits from your investment in the software


IT ResourcesMost organizations will need additional

IT people for new IT projects

Consider contracting with an outside specialized IT service for new projects or modifications to existing IT projects

Baseline IT needs can be staffed by in-house personnel


How and Who?Who should evaluate software?

– Persons familiar with the business processes– People who will use the information– Technology people who will implement– Experts in technology

How?– Consider a broad "landscaping" to gather all potential

solutions– First pass to eliminate weak solutions– Second pass to decide on finalists


Software Selection FactorsSoftware Capabilities

Vendor strength and capabilities– Size of vendor– Length of time in business– Experience with this application– Vendor references


Modification and SupportAlternative support options (open

source can provide the option of multiple vendors for support)

Customization and software modification capabilities


Vendor NegotiationsInitial software purchase costs – what

is included?– Definition of "users" (concurrent, named, development,

active)– Number of users or sites

Ongoing support costs– Response time– Maintenance costs– Cap on support costs


Vendor Implementation Assistance

The contract should spell out:– Number of days of configuration assistance– Number of days of user training (when, where, cost)– General technical assistance– Specific technical assistance (hardware selection and

conversion costs)– Training materials and implementation tools– Availability of vendor support hours


CostCore charges typically include:

– Per system base charge– Charges for additional modules– Per user charges ("seats)

Software, hardware and services

Implementation and training

Cost for Changes


Payment schedule:– 50% on signing– 20% on installation (after "acceptance")– 30% upon completion and ready for "go-live"


Acceptance CriteriaSystem performance levels (response

time under expected load)

Document custom work that will be done

Functional Specification

"Out clause" for non-performance


Essential Contract ElementsClear definition of objective criteria to

define a successful implementation

Contractual remedies for failure to meet acceptance criteria

Change Management Process defined


Contract ProcessTechnical people must review and

accept contract

Legal Review of Contract


Change Management ProcessNo specification is ever perfect

All software requires changes

Change management– Clear written description of the change– Cost for the change– Timeline for the change– Approvals by all parties


Health Informatics SeriesMark H. Spohr, MD

– email: [email protected]

Lectures in this series:– Introduction to Health Informatics– Enterprise Architecture– Interoperability– National Health Information Systems– Patient Identifiers– Software Selection

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Health Informatics Series. Software Selection

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