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Healthcare Integration:
Total Cost of Ownership
A guide to the costs of integration based on tested
formulas and years of experience.
Build? ... Buy?
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Although a common decision in healthcare when adding integration
technology capabilities, organizations at any scale stand at the crossroad of
Build or Buy. With both creation and acquisition options, understanding the
pros and cons behind either approach is critical. In-house integration
development carries certain responsibilities, but as does purchasing any
other vendor-based solution. Once cognizant of all possible implications, the
next step becomes simpler. We know what building costs because we’ve built
it; as of July 2016 we’re running integration hardware on over 200 Docker
containers with integrations at over 40 organizations. Although there is no
substitute for firsthand experience, within this guide, the integration sherpas
at Catalyze reveal the realities to consider.
SECTIONS
1. HIT Classic Reasoning and Maturation
2. Building an Integration Solution
3. Cost of Labor for Internal Development
4. Pros & Cons of Building an Integration Solution
5. Buying an Integration Solution
Total Cost of Ownership Guide
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HIT Classic Reasoning and
Maturation
The mantra for healthcare information technology (HIT),
and in most other IT organizations, is "why build when
you can buy?"
This conventional wisdom is deemed the legacy of the
early, classic 1970s healthcare applications, and as these
novel systems aged, some rightful concerns arose.
Internally developed applications key stakeholders either
left or lost interest in application maintenance, among
other aspects. Although classic reasoning can still stand
tried and true, if an application must meet certain
specifications, a pre-packaged solution may not be the
best approach. There are important measures to evaluate
in buy-versus-build decisions, as well as both tangible
and intangible constraints that must be considered.
Building an Integration
Solution
In the last 20 years, computing technology has sufficiently
evolved to address most of the classic reasons not to
build because ‘buy’ has now become ‘buy+build.’ New
technologies have eased the formerly difficult integration
among different healthcare applications.
For example, Web services and XML (the basis for HL7
version 3) provide a mechanism for developers to design
applications that can independently utilize, and be
utilized by, other applications now or in the future. Interapplication integration is easier with custom-developed
systems, whereas integrating packaged systems can be
difficult because of their proprietary design. In addition,
custom applications can evolve as clinical practice
changes or as the hospital adds new systems.
Total Cost of Ownership Guide
In-house integration solutions are often enacted quite
successfully. The tradeoff on time, personnel, regulatory
requirements, and project management of an in-house
developed solution must be considered regardless of any
pre-existing talent or capabilities of IT and clinical
engineering teams. The availability of indigenous talent
can restrict internal development to organizations that
are either staffed suitably or have sufficient resources to
hire. As implied, large research institutions typically are
those that engage in operations such as developing or
modifying an integration solution, although not a strict
rule.
The Big Idea
Cost of Ownership methodologies stem from
1970s philosophies. Modern technology
requires us to question the formula.
Cost of Labor for Internal
Development
The question that faces modern engineering teams is not
the decision to buy and implement commercial off-theshelf vs. build your own from scratch, but rather buy and
customize (buy+build) or build and customize (build
+build). Either way, technical teams will continue to face
crossroads that drive operational and technical costs,
such as the costs of VPNs, SSL management, hardware,
custom solutions, architecture, and compliance. Perhaps
the most generally tangible, and necessary, resource for
integration implementation is the labor. The table below
outlines a generalization of necessary staff:
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Position
Integration Engineer
Details
• Backbone of any integration project
• Programmer with knowledge of healthcare IT
•
•
Ops / Network / Security
Engineer
maintaining servers and databases
• Individual with knowledge about configuring
•
Project Manager
$85-90K / year
workflows, integration workflows, web
security, and interface engines
Must get excited about healthcare
technologies, so cannot be frustrated when
exploring obscure technologies is necessitated
Effective communicator that can be client
facing
• An engineer with expertise in setting up and
•
Estimated Cost
VPN appliances or managed VPN provider data
transfer
Capability to figure out how to scale
application with an understanding of how
critical the stacks being delivered are
Effective communicator that can be client
facing
• Experienced healthcare IT professional with
multiple successful projects completed
$55-105K / year
(dependent on
market)
$80-110K / year
• Knowledgeable on integration standards
• Ability to lead the process and navigate any
obstacles faced
• World-class communicator that knows the
importance of timeliness and remaining within
budget.
Integration Strategy / Sales
Support
• Individual that has the experience of all those
listed above
• An understanding of organizational workflow
•
•
•
Total Cost of Ownership Guide
Priceless
and how integrations coincide
Empathetic to all stakeholders, from engineers
to executives
Can accurately calculate the value proposition
of the EHR integration
Always determined to close a deal and will
never quit
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Pros & Cons of Building an
Integration Solution
There are quite a few implications to building a solution
from scratch. Organizational support teams must be in
place to provide 24/7 coverage and maintenance of the
solution. There is certain data communication, such as
from medical devices, that requires hardware that will
need to be either acquired or developed and maintained.
Also, quality and regulatory management of the system,
inclusive of the necessary artifacts such as testing
documentation, will be necessary.
Healthcare stakeholder desires will most likely mandate
developers consider usability of the system and human
interaction. Such usability requirements translate into
accounting for workflow interaction requirements, as well
as visual end-user requirements. The integration solution
will also need to interoperate with existing health IT
systems. Therefore, these interface requirements will
need to be taken into additional account throughout the
development process.
Control vs. Focus
In opposition, building an integration solution internally
is essentially equivalent to creating a custom product for
medical integration within the healthcare entity. A key
benefit of this undertaking is that the organization has the
opportunity to create precisely what it needs to meet its
requirements. Additionally, this can be done unrestricted
by solution provider offerings, which, of necessity, must
be made market-generic to meet needs of various
prospects and clients. The entity can then focus solely on
integrating the most desired data on a timeline that is
beneficial to specific needs and availability of resources
including clinical, IT, and other staff.
development shop and may expose itself to the need for
quality and regulatory oversight. Nonetheless,
maintenance of a quality system and compliance with
best manufacturing practices and development
processes will need to be undertaken immediately.
If an organization has neither the experience nor the
resources available for developing and maintaining a
solution, then it becomes a challenge to overcome any
aspect of integration. For larger enterprises, this may be
acceptable and even welcome, since it ensures that
developed solutions are customized precisely to the
present needs.
Example Use Case: Patient Identification
Information (PII)
To illustrate, consider the use of patient identification
information for the purpose of patient association and
disassociation from identification information. If patient
identifiers are to be associated with medical devices and
communicated to the health IT system, then patient-tomedical device association mechanisms will need to be
acquired or fabricated, and fielded. In order to
accomplish, workflow analysis of various relations is
required, including software development to conform to
end-user workflow requirements, user validation testing,
training, implementation, and support.
Because of a vast scope of effort, involving boundless
resources, smaller entities can be discouraged from
developing their own integration solutions. Industry best
practices suggest that only larger enterprises partake in
the resource allotment necessary to meet objectives
associated with home-grown integration.
With this approach, an organization is challenged by
taking on the role of an integration solution provider
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Buying an Integration
Solution
For health systems, buying can mean the
diversification of risk
One of the benefits of purchasing a vendor-based
solution is the solution provider takes on the
development responsibility and delivers a product that, in
theory, will be as close to implementation as possible. A
key challenge is that the entity is dependent on the
solution provider for upgrades and further development.
Since customization is not often possible, this implies that
the healthcare enterprise may be required to change or
modify workflow to accommodate the operational
behavior of a system. Hence, healthcare entities may find
themselves having to make necessary changes to clinical,
IT and support workflow. For smaller healthcare entities
that do not possess extensive IT infrastructure in terms of
staff and fiscal resources, buying is an option to be
favored.
For smaller organizations, buying
integration help means freeing up resources
the integration options available, implementation
tribulations are inevitable. Catalyze is here to help
though. No matter who you are or what integration stage
you’re at, our team wants to solve your problem so you
can focus on the solution.
Have questions?
Don't hesitate to reach out.
Catalyze is assembled from veterans of the
healthcare IT world who have built or bought
cloud and integration technology for years.
The team's foundation is built from past
experience at Epic, Rackspace, NASA,
Experian, The NSA, US Oncology [McKesson],
and NantHealth.
We are happy to share specific formulas which
might address your situation.
catalyze.io/contact
Unlike the larger healthcare enterprises, smaller
organizations may not need a highly tailored and
customized solution that provides needed data for health
IT systems, data warehousing, and other recipients.
The acquisition of a solution should be conducted in a
manner similar to that of acquiring other software and
hardware systems. Integration solutions, however, can
span both hardware and software and, as such, may
require a collaboration between clinical engineering and
IT system expertise.
There is no cookie-cutter solution to integration, and
although you may now have a thorough understanding of
Total Cost of Ownership Guide
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Appendix: Build vs. Buy Comparison Summary
Build
Pros
Cons
• Specific to your needs
• Accessible data
• More control over the types of data and
• Higher infrastructure costs
• Hardware may be required
• Producing and maintaining necessary
analytics related to the product’s use
documentation
• Engineering takes away from core
resources
• 24/7 ongoing internal support and
•
•
•
•
•
Buy
Pros
•
•
•
•
•
•
•
•
maintenance
Data integrity concerns
Potentially siloed data
Difficult to add new features over time
Greater potential for error
Longer development periods
Cons
Feature-rich
Simple integrations
Interoperable capabilities
Proven expertise
Access to services, resources, and support
Easily add features
Minimal development team time needed
Reliable data
• Time consuming to find the right solution
• Less customization capabilities
• Seemingly high cost
Looking for more help? Let us handle your integration.
Meet Redpoint, your new integration sherpa. More at catalyze.io/redpoint. Connect directly with an integration expert to discover if Redpoint is a fit for
your integration challenges.
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Totalcatalyze.io
Cost of Ownership
• EmailGuide
us at hello@catalyze.io • Call us at +1 (888) 377-3184
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