How COVID-19 is impacting hospitals' IT purchasing decisions

The coronavirus pandemic is throwing a new factor into hospitals' calculations about how to proceed with current and future healthcare IT implementations.

As provider organizations face a surge of new cases, or anticipate capacity challenges in the near future, they're reconsidering the speed with which they can conduct current implementations because of limitations in IT-staff capacity and the heavy demands that high patient loads are placing on clinical staff.

Looking ahead, some providers also may see future implementation efforts delayed because organizations lack the bandwidth now to support the often long and arduous process of making future purchases.

However, some forms of technology – particularly those that support telehealth services – are in hot demand as they prove their worth during the national pandemic, say experts who assess information technology adoption by the nation's healthcare providers. 

Organizations also are looking to quickly access and use features of their current IT to enable them to better cope with the crisis.

"If an organization is implementing an on-premises system, it's been put to the side unless it's absolutely critical."

John Moore, Chilmark Research

Hard data on the impact of the COVID-19 crisis is difficult to come by, because many providers are enlisting all hands in handling the surge of cases, said Bob Cash, vice president of provider relations for KLAS. Anecdotal evidence suggests that implementations are generally continuing, but paces vary.

In areas that are facing significant impacts from COVID-19, executives "are not able to talk and share their insights," said Cash, who added that KLAS is beginning research on how the crisis will affect future IT decision-making.

On-site implementations have been slowed, said John Moore, founder and managing partner of Chilmark Research – affected to a great extent by the ability of IT personnel to have wide access to hospital facilities that are treating larger censuses of patients.

"If an organization is implementing an on-premises system, it's been put to the side unless it's absolutely critical," Moore added. "The industry has been moving to cloud-based services, and those services are being leveraged now. There's still an amount of work being done in the cloud."

Clinical informaticists "are being overwhelmed"

Health IT vendors face their own challenges in supplying personnel to support implementations, with some of them making corporate decisions to have their employees work from home, or facing state governments' stay-at-home orders. Vendors are increasing efforts to support customers virtually, with either existing products or new implementations.

For example, Cerner is emphasizing the use of virtual services to aid clients "that are on the front lines of the pandemic and being pushed to unprecedented limits," said a statement from the company supplied by Austin Cozzolino, Cerner's senior communication partner in corporate communications. "With our virtual business continuity capabilities, we are able to maintain momentum on key projects."

Some key IT staff in provider organizations are feeling the brunt of the COVID-19 surge, said Cash of KLAS. 

"The most impacted are in the area of clinical informatics, such as chief medical information officers and chief nursing information officers – they are being overwhelmed with the need to take care of the present need."

That could impact the course of future implementations, because "those folks are being diverted from longer term strategies," he added. "There is definitely distraction that will lead to (future) delays."

Healthcare organization executives may be wary about making commitments to future implementations because of financial pressures of dealing with the current crisis. 

With all the attention being paid to managing the surge of patients, there has been negligible discussion about how healthcare organizations will be reimbursed for the extraordinary cost of care, personnel and supplies that will be required.

"There's a lot of financial uncertainty," Cash admitted. There is concern that "hospitals will be set to lose money on every COVID case they treat. There's plenty of concern out there about the financial impact. We're seeing those conversations about 'Where can we delay an investment if we can safely do so?' Organizations are attempting to be wise and not harm their long-term vision."

Healthcare organizations see looming financial pressures and are attempting to make mid-course adjustments, contended Jon Winsett, CEO of NPI, an IT spend-management consultancy.

"We are working with a large hospital chain on a large ERP (enterprise resource planning) transaction; they had invested many weeks into selection and requests for proposals, and they've put the whole thing on hold. And I had an urgent call from a Louisiana system that they had to drive a lot of money from its budget. Hospitals have fixed costs that are hard to move without a lot of data and intelligence. They're really trying to push down spending now."

By contrast, healthcare organizations are increasing investments in technology to help them deal with COVID-19 pressures, Winsett noted, highlighting growing interest in telemedicine capabilities and communication and collaboration platforms, such as Microsoft Teams and Zoom.

"There's a lot of financial uncertainty. Organizations are attempting to be wise and not harm their long-term vision."

Bob Cash, KLAS

Providers are also ramping up use of existing technology that's helping them increase efficiency or expand resources to manage anticipated service demands, the experts say.

For example, they're implementing new and updated software from IT vendors to handle patient loads, said Cozzolino of Cerner. 

That's helping providers that "have temporarily shifted priorities to address the critical needs of patients afflicted with COVID-19, such as expanding current operating capacities and establishing field hospitals to prepare for the surge in patient volume. Last week, Cerner initiated 50 ICU expansions, and that work is expected to grow as demand increases."

Moore of Chilmark said organizations are likely to take more advantage of capabilities such as disease registries, which can be used to help to identify coronavirus patients or populations with comorbidities that might be highly compromised if they contract the virus.

He advises healthcare executives to take time during the pandemic to assess how IT has enabled – or failed to help – organizations deal with this crisis, and to take a strategic, forward-thinking look at existing systems. 

"A lot of healthcare organizations have tactical, IT-led departments, and they'll take a very tactical approach to this, with all hands on deck for COVID-19," he said. "Those that are strategic will look at what does this mean longer term in what we plan to adopt and use, for example, for communication tools that we'll use with our clinically integrated network."

Winsett offered several suggestions for healthcare executives, who should take time to reassess IT spending now:

• In addition to determining which projects to fast-track or to pause in the near term, HIT executives should try to anticipate how requirements will evolve in the future.
• HIT execs should perform IT-benchmark analysis on all tools to get a handle on what constitutes fair pricing for technology.
• The current crisis demonstrates the need for anticipating flexibility in new contracts, and future agreements should enable the ability to handle increases in the number of users or contracts.
• Contract terms should also contain caps on costs for maintenance and recurring expenses, and better nail down price holds for the cost of software or services.
• Executives should look for optimization opportunities in license and subscription agreements, particularly to determine if there is flexibility built in to current agreements.
• Executives also should ensure that they're able to handle shifting venues for some staff members, who may be working from home or at remote care delivery sites. Capabilities such as virtual private networks should be strengthened to ensure they're up to handling the load.

Valuable lessons on disaster response and technology capabilities will be learned in the coming months, Cash added.

"Whenever there's a crisis, there's learning that goes on. There will be positives out of this – disaster plans are being tested, executives are seeing things that they should be doing differently, systems are being evaluated, and there will be a need to improve those. There will be a lot of learning and there will be investment that comes from that. In the meantime, people are trying to get through it."