The Role of the Independent Consultant in HIE and HIT
Increasingly I see organizations involved in delivering HIE making the mistake of confusing the roles of consulting and delivery. This has included the burgeoning not-for-profits set up by the state as SDEs, the state government entities set up to handle the ONC and CMS grants, and the regional HIOs themselves.
Whenever I talk about this I have people challenge me and ask me why I see it as an issue. After all, many of the companies who provide HIE and HIT consulting services are staffed by people who have themselves cut their teeth delivering technology solutions. Since they have the knowledge on how to do that, what is the danger on them also being the people who design systems, or set strategy, or help write grant proposals.
The example I give is that if you were looking to buy a vehicle you would probably do research on what you purchase. There are many resources for this – car magazines, web sites, friends, industry magazines etc. What you would probably not do is go to a car retail location affiliated with a manufacturer, or two or three brands, and ask them what you should buy.
The bottom line is if you go to a Mercedes car salesperson and ask them what make of vehicle you should buy, they will probably tell you to buy a Mercedes, unless what you want is so obviously out of their sweet spot they can’t pull it off. They have a financial interest in recommending something they are able to sell.
I’m not saying that in HIT or HIE it is always this clear cut. n some cases consultant will come in as a consultant, and ensure that the work they deliver ensures they remain on as a consultant, and that is just good business sense. In other cases they will recommend a strategy, and then make recommendations on products they may not directly own, but when they have strategic relationships with the companies who do.
In some cases the relationships are even more blurred. HIT and HIE are two areas in particular where people will take positions and make recommendations with almost religious fervor. “Experts” will routinely claim there is only one way to do something, or that something is a standard that is not, or that a framework they select is definitively the model that will become the national standard. This is not done with bad intentions; it is simply the nature of the business.
The reality is also, however, that there are many cases where people will make recommendations that directly benefit themselves while couching them as independent. More than in most industries, HIE and HIT are extremely incestuous. Boards tend to cross-pollinate, the number of national experts is limited and tend to appears at meetings together again and again, and people have either direct or indirect financial interests in products they recommend.
Independent consultant tender to be harder to find, and may well charge more as they don’t get any of the downstream benefits. What you get for that higher fee structure is the knowledge that what they recommend is done so without any expectation of doing the work they are recommending. You cannot realistically ask a Microsoft, or a Medicity, or a Dell (Perot) to write your strategy independently if they can in turn bid on the solution they recommend.
That does not mean that their recommendations are invalid, in fact the more of story a company has to tell of successful implementations, the more valid the solution they propose is likely to be. Nor does it mean that to get a company in to write a proposal and strategic design and then provide the solution is an invalid approach, it is a completely valid approach. What it is not, is independent.
Know what you are paying for, understand what you are getting. Don’t let someone tell you they are making an independent recommendation when they are not. Don’t be afraid to question, or ask about their relationships with vendors and solution providers. Then make a decision based on the realities of what they provide, how they generate their work, and how they make their make money.
Whenever I talk about this I have people challenge me and ask me why I see it as an issue. After all, many of the companies who provide HIE and HIT consulting services are staffed by people who have themselves cut their teeth delivering technology solutions. Since they have the knowledge on how to do that, what is the danger on them also being the people who design systems, or set strategy, or help write grant proposals.
The example I give is that if you were looking to buy a vehicle you would probably do research on what you purchase. There are many resources for this – car magazines, web sites, friends, industry magazines etc. What you would probably not do is go to a car retail location affiliated with a manufacturer, or two or three brands, and ask them what you should buy.
The bottom line is if you go to a Mercedes car salesperson and ask them what make of vehicle you should buy, they will probably tell you to buy a Mercedes, unless what you want is so obviously out of their sweet spot they can’t pull it off. They have a financial interest in recommending something they are able to sell.
I’m not saying that in HIT or HIE it is always this clear cut. n some cases consultant will come in as a consultant, and ensure that the work they deliver ensures they remain on as a consultant, and that is just good business sense. In other cases they will recommend a strategy, and then make recommendations on products they may not directly own, but when they have strategic relationships with the companies who do.
In some cases the relationships are even more blurred. HIT and HIE are two areas in particular where people will take positions and make recommendations with almost religious fervor. “Experts” will routinely claim there is only one way to do something, or that something is a standard that is not, or that a framework they select is definitively the model that will become the national standard. This is not done with bad intentions; it is simply the nature of the business.
The reality is also, however, that there are many cases where people will make recommendations that directly benefit themselves while couching them as independent. More than in most industries, HIE and HIT are extremely incestuous. Boards tend to cross-pollinate, the number of national experts is limited and tend to appears at meetings together again and again, and people have either direct or indirect financial interests in products they recommend.
Independent consultant tender to be harder to find, and may well charge more as they don’t get any of the downstream benefits. What you get for that higher fee structure is the knowledge that what they recommend is done so without any expectation of doing the work they are recommending. You cannot realistically ask a Microsoft, or a Medicity, or a Dell (Perot) to write your strategy independently if they can in turn bid on the solution they recommend.
That does not mean that their recommendations are invalid, in fact the more of story a company has to tell of successful implementations, the more valid the solution they propose is likely to be. Nor does it mean that to get a company in to write a proposal and strategic design and then provide the solution is an invalid approach, it is a completely valid approach. What it is not, is independent.
Know what you are paying for, understand what you are getting. Don’t let someone tell you they are making an independent recommendation when they are not. Don’t be afraid to question, or ask about their relationships with vendors and solution providers. Then make a decision based on the realities of what they provide, how they generate their work, and how they make their make money.
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