Build vs. Buy: Digital Patient Engagement Platforms

According to a 2022 research, more than 85% health system leaders indicated their organization is likely to invest in patient access technology, while 76% of healthcare providers surveyed in a Forrester research believe that digital customer engagement is important to their business.

With the shift toward value-based, consumer-focused care, health systems are accelerating their digital front door strategy timelines, and digital patient engagement is becoming a popular option to help meet the increasingly high expectations of the healthcare consumer as well as improve access to care and operational efficiencies for both care teams and patients. 

Digital patient engagement solutions like Digital Care Journey platforms act as a virtual care companion, wherein patients can access these app-based platforms on their own everyday devices to get condition-specific just-in-time, interactive patient education, follow care plan protocols, and stay connected to their care team. Meanwhile providers can remotely monitor patients and get updates via alerts and dashboards, as well as send automated patient reminders, to-do-lists and health status checks, collect survey responses and patient-reported outcomes (PROs), and more.

Once the organization has a defined digital patient engagement strategy, and the role it’ll play in supporting its Digital Front Door objectives, it needs to determine how this strategy will be delivered and what technology can be used to bring it to fruition. This includes scoping out what platforms already exist, whether in-house software is the way to go, do one or more components of the patient engagement platform need to be automated, how will the return on investment (ROI) on the platform and strategy be measured, and more. 

And then, as with any digital transformation project, healthcare executives must decide whether to build or buy. While proprietary software might sound tempting, the risks are high and the fear of software getting outdated after a long development cycle is real. With a buy approach, you receive upgrades from an industry collaborative of users and most pre-built digital patient engagement solutions have extensive APIs and integration capabilities available to align with pre-existing digital front door strategies.   

Many organizations in healthcare often think that there are financial and operational advantages to building a solution in-house, leveraging pre-existing resources. But depending on the features and functionality needed, buying an off-the-shelf SaaS-based solution from a vendor who has the experience and knowledge of working with dozens of health systems offers pre-determined clinician workflows, integrations, and ongoing maintenance and support required, building may not be the best option.

Outlined in detail are pivotal components, pros and cons, key considerations, and recommendations for healthcare leaders who are evaluating building a solution in-house vs buying a pre-built digital patient engagement platform. 

Resourcing and Staffing

For organizations with large IT/informatics/dev teams, building a platform may seem feasible as it can help create a highly customized version that meets their current workflows. Additionally, since the software is built with just this one health system in mind, it is usually hyper-customized to that organization’s needs and challenges.

However, for most healthcare systems, staff and internal resources are already stretched thin and leaders need to bear in mind the significant development costs in time and labor incurred when building an in-house platform. A larger development project often requires additional resources apart from the IT/informatics team: dedicated time and commitment from frontline care teams in the discovery process, more specialists hired in software dev teams in the planning and creation phases, coordination across various teams and functions in the testing and implementation phase, and more. This potential requirement to spend on new talent or re-allocate existing human resources can take them away from other important projects.

Not only are these resources cost-intensive, it often takes attention and energy away from core activities and responsibilities for some, especially the frontline care teams. As staff shortages and strain on resources continue to spike, the efficient implementation of a commercially available solution can help avoid these challenges and maximize the success of a patient engagement platform. 

When you buy a Digital Patient Engagement solution, you can begin the deployment process immediately - at a significantly lower cost and risk. While a successful implementation of a pre-built comprehensive platform will still require the support of the internal IT team and the frontline care teams, it means significantly reducing the time, money, and resources spent on creating a platform from scratch. 

A robust enterprise platform will provide pre-built, out-of-the-box care plan content in the form of templates for different care pathways across surgical and chronic care (e.g., orthopedic, colorectal, bariatric, open heart surgery, oncology, women’s health, COPD, behavioral health, etc.) that can be either launched as is or customized to match any differences in your protocols and workflows. 

Partnering with an experienced digital health vendor reduces deployment times and minimizes the burden on IT and clinical teams. Leveraging the knowledge, lessons learned, and best practices the vendor has garnered from collaborating with multiple healthcare systems enables you to avoid common pitfalls and unforeseen obstacles to achieve your goals faster. Experienced vendors know the best approaches to rolling out patient engagement solutions to clinical teams, how to accelerate patient adoption, and how to improve patient care and clinical outcomes sooner.

Speed to Market

Healthcare is increasingly becoming a consumer-centric market as patients seek enhanced quality of care that meets their expectations - 60% of consumers expect their digital healthcare experience to mirror that of retail, and that is tall order. Most healthcare organizations therefore have to often innovate at accelerated timelines, with one survey noting that 67% of hospital executives said their organizations will implement at least one to two new digital health solutions in 2023. 

Developing an in-house digital care journey platform may appear to save some time in the initial stages since it doesn’t require health systems to explore, research, and vet available platform vendors. However, building your own platform from scratch may take a significant amount of time, likely a year or more, depending on the complexity and scale of the project. 

Also, consider that most often platform development plans exceed their expected timelines. And as with any enterprise tech development projects, it requires continuous testing and iterations for it to reach its full potential - not just in terms of the features but also physician and patient adoption and engagement rates. Healthcare providers often overlook this tedious and expensive part of in-house development. Additionally, when building digital care plan content in-house, the time required from the already-strained staff can be a big ask, which in turn can slow down the process.

One of the key components of an effective Digital Care Journey platform is the content. Often overlooked is the time and effort that it takes to build the content and architect how the content will be delivered that goes beyond merely linking to PDFs for maximum patient value. Sourcing a pre-built solution that offers customizable out-of-the-box, evidence-based care plan templates enables enterprise scalability thereby reducing the amount of time required to create content from scratch. A flexible platform can be customized to match healthcare organization or department-specific workflows, protocols and needs, incorporate the organization and physician branding, and be deployed in as little as 60-90 days. 

Additionally, the right vendor will be able to offer solutions that comply with health literacy and accessibility guidelines of the healthcare industry as well as ensure that the care plans have been developed by healthcare professionals such as nutritionists, dieticians, adult education pros, etc., and are based on medical literature. When it comes to purchasing / making an investment in the right platform, providers that have a proven track record with clinical studies, research, and customer evaluations that illustrate improvements across patient populations, service lines, and outcome metrics (e.g. improved LOS, readmissions and ER visits, lower costs, etc.), will offer a faster time to market.

Cost of Ownership

When a health system builds its own digital patient engagement platform, it owns the product, and all the rewards and the risks that come with it. Meanwhile, buying a solution might seem to have a bigger upfront price tag. However, one key consideration when deciding between buying vs. building a digital patient engagement platform is the ultimate cost of ownership - which includes not only the costs to build vs buy the underlying technology but other long-term costs, including training, content and workflow updates, maintenance, and resourcing, as well.

For instance, there are usually many ‘hidden fees’ that come with building your own solution such as constant maintenance, additional ongoing labor needed, tweaks to the platform as it is rolled out across multiple service lines, as well as all the extra time needed for clinicians, frontline staff, and relevant personnel to familiarize and train others on the platform, especially as you scale. In fact, according to a McKinsey research conducted in collaboration with the University of Oxford, large IT projects run 45% over budget and 7% over time, while delivering 56% less value than predicted - findings that are consistent across industries.

Alternatively, a proven enterprise-class, scalable digital patient engagement platform designed by healthcare professionals offers the flexibility to expand across the entire health system - essentially, one system-wide platform for multiple service lines. Standardizing on one solution reduces the total cost of technical ownership and maintenance over time by creating repeatable processes and learnings, consistency of care across patient populations, reducing the amount of staff training required (aka less strain on time and resources), streamlining training, patient enrollment and activation, on-going support from a team of trusted advisors and service professionals after program launch, as well as system-wide EHR integration if needed. 

Additionally, with buying, features and functionality can be turned on or customized as your organization’s needs evolve, allowing you to grow and scale much more quickly. With an in-house build, you may have to go back to the drawing board to assess, starting or revising the build cycle multiple times, and end up being more expensive than a pre-built solution - which has a forward-looking roadmap influenced by multiple users across various health systems - bringing together like-minded approaches and workflows, with one-eye on building in new functionality required for the future - would be.

One other aspect to consider when weighing which option is more cost-effective is the IT infrastructure required to run a platform at scale. When building, organizations could be required to purchase additional hardware, servers etc. as well as invest in ongoing operations and maintenance of both platform and infrastructure. Licensing a cloud-based SaaS platform, on the other hand, from a verified vendor eliminates costs related to installing and maintaining infrastructure, while creating more predictable monthly operating expenses - lowering the total cost of ownership.

Sustainable Implementation and Maintenance

Whether you build or buy, the ultimate goal with introducing a new platform, as with any other initiative, is to ensure that its implementation is both successful and sustainable.

However, building is not a one-time effort - it requires ongoing upkeep and maintenance for long-term success - be it fixing bugs consistently, conducting routine updates, providing ongoing support to the care teams and patients, integration with new tech as applications are introduced in the system, etc.

Meanwhile, considering the time, budget, and resources spent in building a digital patient engagement platform, any short-term failure often strikes harder. First iteration of products and projects are often riddled with challenges, but unsuccessful V1s that result in negative initial outcomes such as low patient adoption and engagement rates can subsequently impede future innovation, with the risk of a digital patient engagement strategy itself being written off as a failure early on.

Healthcare leaders have often warned against the "DIY software trap," arguing that in-house builds often lack longevity. An experienced partner vendor, on the other hand, who has a proven track record of deployment and strategies for successful implementation and user adoption, is a better fit for long sustainability and enhancing potential benefits. 

A platform that has been on the market for a significant time would have been reiterated constantly based on learnings over the years. This includes fixing any issues that may have been reported by prior or existing customers, having mechanisms in place to ensure the platform is always updated as per privacy and security regulations, ensuring all content continues to meet health standards, having a customer support team that can provide timely reviews and recommendations to enhance user adoption, and having a developer team that is keyed-in to innovations in the industry, ensuring the platform remains cutting-edge. 

A holistic partnership with a vendor that is exclusively focused on digital patient engagement and support the solution for its entire lifespan, including access to new features and care plans, comprehensive training on how to educate patients about the platform and overall initiative (including talking scripts that can be personalized), how to enroll a patient on the platform, how to manage alerts and monitor patient status on dashboards (as needed), etc. will future proof long-term maintenance, thereby reducing the total cost of ownership and burden on the organization’s clinical and IT teams.

Proven Expertise

When building, your health system owns the technology, which could mean potential licensing opportunities in the future as well as full control over how the platform grows, which can be advantageous. However, because the product is being built solely for the organization and all feedback and learnings are internal, the health system can miss out on best practice strategies from other organizations. 

Digital Patient Engagement platform vendors that collaborate with multiple hospitals, large health systems, and different service lines bring valuable experience that can be used to help avoid pitfalls that a single-organization only, first-time developers would otherwise encounter. 

First, working with a single vendor that has experience across multiple service lines/care pathways facilitates better collaboration and insights-gathering between different service lines and a more seamless implementation process within the health system itself. 

Second, using a vendor solution provides you access to the learning from their entire customer network – you can have a dialogue with, share best practices and collaborate with other clients/ healthcare providers to develop a better understanding of how to use the technology most effectively. This also includes helping you identify stakeholders and their roles both during implementation and after Go-Live, as well as having access to proven workflows for enrolling and monitoring patients that align best within the resources and clinical workflows of your team. 

This detailed ongoing collaboration and support can help ensure the highest level of success with patient satisfaction and engagement, and improve clinical and operational outcomes.

Interoperability

One other key consideration when thinking of long term success of a platform is integration with your Electronic Health Record (EHR) systems. When systems don’t speak to each other, handling the vast amount of patient data across an organization poses a big challenge for optimal digital transformation - 37% of healthcare leaders cite the lack of interoperability and data standards as the biggest barriers to adoption of digital health technology in their hospital or healthcare facility. Solutions that are proven to plug n' play with the organization’s EHR solutions save both time and money.

When building, creating an interoperable platform from scratch means considering and/or anticipating questions about EHR plans - including is the current EHR set to go through major changes, is the organization is planning to switch to a different EHR system altogether, or making significant investments to expand the use of the EHR, etc. It is critical to future-proof the platform or be ready to enter the build-cycle again if needed - both time and resource-consuming scenarios.

Alternatively, when you buy, while you may choose not to integrate the platform with your EHR at the time of purchase, consideration should be given to vendors who can easily integrate with leading EHRs such as Epic, Oracle Cerner, MEDITECH, Veradigm, and others, as well as be well-equipped to update the platform as needed in the future to meet your EHR needs.

A patient engagement platform that directly embeds into your proprietary patient portal or an existing EHR or Electronic Medical Records (EMRs) is highly recommended for not just a connected healthcare platform but also a cohesive digital front door strategy.

In Summary

For many healthcare organizations the age-old dilemma of “buy vs. build” continues to be an internal debate. While some may be inclined to build, buying a highly scalable proven enterprise solution that is backed by industry expertise and experience is the fastest way to market. 

When buying a digital patient engagement solution, here’s a checklist of 10 must-ask questions to get you started:

1. How long has the vendor platform been in use?
2. Does the vendor offer ready-to-launch, out-of-the-box solutions and care plans for multiple service lines/patient populations?
3. What evidence has been published about the operational efficiencies, patient results, patient enrollment, and clinical outcomes of the platform?
4. Does it offer enough flexibility and breadth of care plans to align with your needs today and scale across the system in the future?
5. Over time, will the total cost of ownership decrease?
6. What is the potential return on investment (ROI) with the platform?
7. Does the vendor offer a training program, workflow strategies and best practices on user (both care teams and patients) adoption?
8. What is the vendor’s EHR or information system integration capabilities?
9. Does the vendor offer continued support after Go-Live through documentation, FAQs, project management onboarding process, etc.?
10. How does the platform align with your organizational goals and broader digital front door strategy?

With the skyrocketing number of digital patient engagement solutions available and new ones entering the market everyday, there are many factors to consider when evaluating what your organization needs. Engagement solutions are  a powerful tool for keeping patient-centricity at the forefront of your digital healthcare strategy by automating care delivery, improving access to education, enhancing clinical outcomes, remote monitoring, and patient and care team satisfaction, and other several advantages. 

Long-term, when considering the build vs buy debate, investing in a technology that best fits your organization, grows as you grow, standardizes care to improves patient outcomes, and reduces high-cost services such as readmissions and ED visits not only reduces cost of surgical encounter per patient but also creates a more interconnected digital experience across a system’s digital front door, thereby meeting the digital experience expectations of consumers.

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If you are interested in exploring Digital Patient Engagement as part of your digital strategy, check out the KLAS Research Emerging Tech Spotlight on SeamlessMD, a Digital Care Journey platform that extends beyond patient communications to deliver personalized interactive patient education to improve the overall quality of patient care and drive outcomes by enabling clinicians to monitor and stay connected with patients across their healthcare journey including before, during, and after hospitalization. To see firsthand how a Digital Care Journeys platform works, request a demo or email us at info@seamless.md.

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