[MUSIC] Welcome to module three which focuses on strategic planning. We'll be covering some strategic planning tools that you should be familiar with, SWOT and scenario planning, you'll be hearing about terms such as total cost of ownership. Return on investment, and you'll have the opportunity to learn about vendor evaluation what goes into a decision on build versus buy. And you'll be hearing about a variety of terms such as RFI, RFQ, RFP. Peter, I think we should start off by talking a bit about what goes into a decision on build versus buy in health information systems and your experience with that. >> It's a great issue and one that is certainly can get very complex. We try wherever we possibly can to not build our own things. I don't think that Hopkins' medicine is primarily software development shop. So we really try to figure out what is available in the market, especially try to figure out what have we purchased already? So we've purchased major platforms that have capabilities in them, we try very hard to adopt what those systems are. And that frustrates people who have a brand new vision and really want to create something or people that like creating things themselves. But to the most part, we try to do that only in select areas where we really are in the new space. And even as we're thinking of building something, we're going to think about okay, if we think we're building something a novel, does it make sense to do it alone? Does it make sense to have a partner? Should we partner early on with one of our existing vendors or with potentially a start up company? And this has changed a lot. I think over the time I've been here, in the first few years of deploying electronic record systems we built everything internally as did a lot of academic medical centers. And increasingly we're seeing that that's probably not an ideal process. But I'll get back and I can describe a little bit what might be a way of being more innovative in that process. >> Yeah, there certainly have been challenges with some of the legacy, home-grown systems, and like you talked about, sometimes there is a niche though where the market's not there and the opportunity to build. Someone has a fantastic idea. Are there any that are on your plate right now where a build decision has been made and you're supporting that? >> Well one case that we've been working on for a while has been secure communication systems. And that's a space where at this point, there probably are maybe 30 or 40 different products in the marketplace. But very few products had captured some legacy capabilities that we've had here, including just seamless interfacing with beepers, which unfortunately, we have not done away with. We still have thousands of beepers in this enterprise. So we still have some unique legacy requirements in the system that we haven't been able to get rid of entirely. But what we've done, and you're going to learn a lot in this module about having a more formalized process and following some discipline process in selecting a system. And we have certainly tried very hard to understand where is the market going and how could we take better advantage of what is commercially available? >> Sure, and then when it comes to the buy decision, there's the lengthy vendor evaluation process. Can you speak a bit to something that you're involved with perhaps now when it comes to vendor evaluation, and your role as a CMIO in the In that process? >> I guess my role, is first of all, back to sort of earlier strategic thinking of, are we working on the most important things? That's the most important process, to make sure you are really working on things that the organization cares about. And then secondly it's to follow a discipline process, to define what that process is and follow some discipline around selecting it. So this module may not be the most fun in that regard, but it's important that this be referenced. And you may be a leader or asked to do this inside some organization that has a very structured process, and you have to understand what that process is. You might be trying to speed it up or make a quick decision, but if you don't understand your organizational process for acquiring you can't get things done. And- >> Right, so what happens with a large health system can certainly vary from a governmental agency can certainly- >> Yes. >> Vary from private sector, whether one chooses the pathway of going for the RFI, going straight to RFQ, or going to the full blown RFP really varies. >> Yeah, and that depends a lot on what the problem is that what the kind of system is we're looking for, what the market looks like. In some cases, the market, there might be a very dominant leader in the process. And so I mean, candidly, we do try to make sure we're not just negotiating with one vendor in a process, because that puts us in a bad position. So we try as much as possible to have a fair process and bring more than one into any kind of review. The full RFP process is often overkill for a lot of the systems that we're trying to select. But you're not doing your organizational any favor if you let your group too quickly jump to deciding that one system is the right solution. We just want a little bit more measured and careful process. And so I spent a lot of time coaching colleagues to make sure that we don't indicate to the vendor that we've selected them. To rule in the process, and make sure that we put the people that are going to do the negotiating in a strong position when we actually go to try to close the deal. >> Yeah, not showing the cards too early. When it comes to the vendor evaluation, one of the things I wanted to ask you about is the role of benchmarking, and what you hear from colleagues of yours at other institutions, and what role that can play sometimes in helping to make a decision. >> It is enormously important, and honestly, I get such better information from my colleagues at other institutions. And we do that with one another. And we always answer honestly. I know who I can reach out to around the country that can tell me what it's really like to use this particular tool. We're trying to create good partnerships with vendors, and I tell them early on that, please, please, don't oversell anything that you've got. Tell me exactly. Be very, very accurate. We've got a great network of people that we're going to verify your answers. And please don't lose credibility as you answer the RFI or the RFP because we all going to be double checking what you've got, and that's a really important process. >> Yeah and when it comes to some of the financial matrix and those calculations can you just touch on at the students another place where it's really important to have the subject matter experts and their teams involved in calculating all of that. >> it is important, and you'll hear a lot of important information about that, about what kinds of costs can really be attributed to this system. And again, it's important that we all be thoughtful about whether we can trust claims being made by vendors in systems. It's very helpful if they can find a very conservative, or a line analysis for an institution. But unfortunately, many of them don't have that discipline themselves, or they get very excited about sort of overhyping what benefits are. So it's important for you from a project standpoint, because you want to be able to move from the RFI, RFP, RFQ process to getting buy-in. And to your point, if you've gotten the people from your organization that do a disciplined return on investment analysis, that have been involved in this phase, then they are your partner when you go to say, hey, we need to make this investment. >> Yeah, strategic planning with health information systems, an ongoing process and something that those of you with an interest in health informatics certainly need to be familiar with.