Are we still having the Build vs. Buy conversation about Telemedicine?

Build vs. Buy

For hospitals and health systems looking to deploy a telemedicine program, the build vs. buy debate has been around since the dawn of telemedicine. And, it continues to this very day.

One key reason hospitals weigh the option of whether to build their own solutions internally OR align with a third-party provider is preexisting investments. Most health systems have invested heavily in one or more Electronic Medical Record (EMR) systems, which allow them to communicate and coordinate patient care among a healthcare team. With these systems fully imbedded in their workflow, coupled with the expense to implement them in the first place and the fact that EMRs contain some limited telemedicine function, many believe the right path is to build their telemedicine programs from the EMR out.

The logic seems sound; and every day hospitals take it on themselves to build vs. buy bits and pieces of telemedicine functionality, aiming to erect true remote healthcare programs around their current systems. Quite a few will fail — their missteps grounded on two fundamental and cumulative facts:

#1 – EMRs are not inherently built for Telemedicine

While EMRs present a valuable component of hospital’s overall healthcare delivery, they lack the inherent tools for the management and control of clinical, financial and operational outcomes.

Take for example the hospital that, having recently installed a premium EMR system, goes to its EMR vendor for help with its telemedicine initiative. The vendor may say, “That’s easy enough, just turn on the telemedicine module. A couple of other things will be needed, but those can be built.” But, at a price, of course.

Yet, when weighing the option to build, hospitals should consider the variables that will undoubtedly come into play in the long run:

  • Integration – the need to fully integrate a home-grown build with other third-party applications used. Do all applications in place currently speak to each other? Will vendor lock-out present a roadblock?
  • Core Competency – access to the skills needed. Is in-house talent up for the undertaking of development? Skills-rich talent can be brought in for the complexities of a build, but what happens if/when the application developers leave the organization? Will the app decline?
  • Total Costs – the costs, which are generally higher than ‘buying’, don’t stop at build-out. Let’s not forget what it will take to maintain a custom system in the ever changing world of healthcare.

Successful telemedicine programs can and do regularly leverage existing systems without the above-described pitfalls; this is where a third-party end-to-end telemedicine solution with all the needed tools can provide overall efficiencies (costs, immediate deployment, workflow, etc.).

#2 – Telemedicine is more than technology

 Innovative telemedicine requires more than technology. People and processes are just as vital.

Going back to the previous example, let’s say the hospital has completed its build and deployed its solution. Now what?

How does it field requests for a consult when several are requested at once? How does the application prioritize which ones are worked on first, second, third, and so forth? How does it know how quickly it must respond? How does it notify a clinician they’ve been paired with a patient? What pieces of hardware do clinicians use and what’s the video service that connects them? How does it document these clinical encounters? How does it measure all of those steps? What do associated analytics and reporting look like? What happens if something goes wrong clinically? If something does go wrong, from an IT perspective, is the internal team equipped to help?

Successful telemedicine is the sum of three vital parts: the people, the processes, and the technology. Technology and tools facilitate connections; people coordinate and manage; and process ties it all together. Without any one part, the program is not built to succeed.

Creating a successful telemedicine program is a labor-intensive process. And, in the age-old debate of Build vs. Buy, hospitals must be well informed and forward-thinking.


If your organization is having the Build vs. Buy debate, we may be able to help. Request a no-obligation call from one of our subject matter experts. We work with over 450 hospitals who have finished debating and are using us to expand access to care, increase throughput in busy emergency departments, and improve patient outcomes.