Pediatric Informatics: Computer Applications in Child Health (Health ...

16 Prioritizing Pediatric Investment for IT in Smaller Practices 225
16.3.2.2 Costs to Customize Products
Small practice decision makers must decide if “commercial off-the-shelf (COTS)”
technology will meet practice needs or if customization is required. Customization
may range from “built-in” specification of forms (low cost) to changes in the
underlying data structures that require technologist intervention (high cost). In
addition, practices need to determine the frequency of customization updates and
how these will incur further costs.
16.3.2.3 Costs to Interface/Integrate Systems
In the same manner, practices must decide if “standalone” products will meet needs
of if they must connect to other systems (and on what basis). Interface/integration
considerations include the costs of interfaces (and functionalities) of an EHR to:
Practice cost centers or management system
Different office locations (and home/mobile)
Commercial laboratory and imaging services
New entities (How much will it cost to modify current interfaces)
The most useful interface is between clinical information tools (such as EHRs and
eRx) to practice management systems to integrate clinical information with billing
and scheduling functions. Interfaces that connect products from different vendors
to form value-added integrated suites are available. Challenges to practices include
decisions on how to transition from current management systems while minimizing
costs of productivity loss and retraining of staff. Transitions may require operation
of more than one system.
16.3.2.4 Upgrade Costs
Proprietary and customized systems are vulnerable to discontinuation by their
vendors. Contractual negotiations with vendors should include contingency plans
for continued service, including if needed, availability of code or interfaces for
modification. All hardware and software have a life span and upgrades may include
major changes, with accompanying costs. Tools are available that can help a provider
look at individual pieces or the cost breakdown. 11
16.4 Planning IT Adoption
16.4.1 The Steps
The steps in planning adoption for small practices may be less formal than for
larger ones. These include: