Luna Data Solutions: Information, Resources, and Expertise

Strategies for Ancillary Systems

The first step in the EHR Continuum is the implementation of the Electronic Health Record system. The second, the focus of this article, is another challenge – selecting and implementing ancillary systems like Radiology or Lab. Here are some tips and insights on making this second step successful.  

 I. The Ancillary System Decision

The decision of which Ancillary system to use is important because of its long term implications. After months of implementation cost and pain, you will not want to change systems and go through the process again, at least not for a long time. Decide carefully which product and vendor to go with, as you will likely live with that decision for years to come.

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 When making the decision, consider:

  • Business fit. How well does the Ancillary system match the business and care needs of the organization?
  • Technical fit. How well does the Ancillary system map to the technical infrastructure and skill set of the IT organization? Does a proven integration exist, or do you need to create it?
  • Training and Support. How will training of the healthcare team and the IT team be accomplished? If you encounter a problem downstream, will the vendor be there to help?
  • Consider both initial and long-term costs associated with the Ancillary system.
  • Speed of implementation. How long is the implementation process (and associated disruption) estimated to take? How long for integration with the EHR?
  • The Vendor. Consider factors like vendor reputation, market position, staying power. You will have a long-term relationship with this vendor, so choose someone you can work with.

The decision process can be elaborate or simplistic, but should take these factors into consideration.

II. Enterprise License Decision

This decision includes the ancillary system(s) in question and if you intend to connect them to the EHR. The choices:

a. Enterprise license

b. Best of Breed Solution – Integrated

c. Best of Breed Solution – Nonintegrated

a. An enterprise license, if available from your vendor.

This offers one vendor, one contract, consistent training, established integration with your EHR, data from these multiple sources for analysis, and the potential for bundled cost savings. This makes a strong case for the enterprise license approach, if the total price tag is within reach of your organization.

Consider Microsoft Office, a suite of products including word processing, spreadsheet, and other tools. While each may not be the strongest product in its category (some of you may remember WordPerfect), each was good enough and the suite offered cost and integration advantages. This is similar to the enterprise EHR approach.

If the enterprise license is chosen, the enterprise then rushes to migrate from the existing, nonintegrated ancillary systems to the enterprise solution, to replace those ancillary system costs with the sunk cost of the enterprise license. After all, why pay hundreds of thousands of dollars extra for an ancillary system, when the cost is already embedded in the enterprise license?

Integrated systems may be ideal, but there are factors to consider..jpeg

b. Best of Breed Solution – Integrated

If an Ancillary system is selected because it is superior to the enterprise solution due to cost, functionality, or other factors, should it be integrated with the EHR? Factors to consider include:

  • Proven Solution. Is there a proven integration method or solution? Check references to question or observe the integration effectiveness.
  • Sharing Data. Integration offers the sharing of data from both the EHR and Ancillary system with the providers, staff, and patients. Also consolidated data from the two systems may be valuable for quality and operational reporting. How well will the two systems share such data? Will it look like one system or two?
  • Upgrades. When you want to upgrade, will the integration support the upgrade of both the EHR and Ancillary system? One or both systems may be ready to upgrade, but the integration bridge may not yet support such an upgrade.
  • Coordination. The integrated Best of Breed option involves two distinct vendors. When the integration fails to work, for any reason, will the two work together in harmony or point fingers at each other?


 c. Best of Breed Solution – Nonintegrated

This standalone approach offers:

  • No Data Sharing. The physicians, staff, and patients will need to deal with two disparate systems. Reporting may not be able to produce consolidated quality or operational reports.
  • No Upgrade Issues. With no integration to worry about, when either the EHR or Ancillary system needs an upgrade, proceed.
  • No Coordination Issues between two vendors. Each system has one vendor to kick if there is a problem. The vendors do not need to work together.


III. The Contract

Negotiating the Ancillary system contract is the next important exercise, whether it be an enterprise license or a best-of-breed ancillary system license.  Focus on initial costs, future costs, flexibility, protection, viability, and extras. In the chapter on Costs in my new book,The Holistic CIO, I detail 6 focus areas for improving your technology contracts.

This will be a long-term agreement, so take your time in the negotiation process and use your leverage to generate a great deal..jpeg

Again, this will be a long-term agreement, so take your time in the negotiation process and use your leverage to generate a great deal.

 IV. Staffing

  • Staff for Implementation Success

With so much at stake, implementation is a time for bringing in experts at this, either vendor resources or consultants who have done this successfully before, including integration. It is not a time for trial and error. Leverage their experience and expertise.

Looking for the right consultants and staff..jpeg

  • Build In-House Support

Geoffrey Moore suggests separating core from context, in his book “Dealing with Darwin.” Core things are those most important to the organization, while context is everything else. For example in healthcare, core may be the Ancillary system while a Human Resources system may be context.

Hiring consultants for Ancillary implementation makes sense, using their expertise and proven skills to assure implementation success. Longer term, however, build an in-house support capability for the Ancillary work to follow. Rather than relying solely on high-cost consultants longer term for such projects as Ancillary system upgrades, look to focus your time, energy, and staff on core areas. Consider

  • Reallocating existing staff to core as a long term investment. Look for Ancillary knowledge transfer from the consultants. Invest in training of in-house staff.
  • Backfilling the reallocated staff, using lower-cost new hires to take on their prior context responsibilities. Again, while you focus on core, consider leveraging a vendor partner to locate, screen, and staff those context positions. Time spent on those staffing activities takes time away from you core focus.
  • Outsourcing some context systems like HR, using the cloud and Software as a Service solutions. Healthcare has been historically sensitive about using the cloud. I see this changing. For context systems, however, that sensitivity may have diminished.


While the workload is daunting, hopefully these insights and tips offer some assistance on Ancillary selection and implementation, the second step in the EHR Continuum.   

 Next time, the third step: EHR Optimization.   

CIO Graphic - Optimization.jpg


If you've enjoyed Galen's article above, take a look at his illustrated children's book, If You Give a Mouse an EHR - A Parody by following the link below.

If You Give a Mouse an EHR - A Parody
Galen M. Metz, FLMI, AIAA, AIM, ACS

Galen M. Metz, FLMI, AIAA, AIM, ACS

Galen is author of • Secrets of Healthcare IT Revealed ( • If You Give a Mouse an EHR – A Parody ( • The Holistic CIO ( He retired after 30 years of healthcare IT management. Previously Galen served as CIO of Group Health Cooperative in Madison, Wisconsin, with responsibilities for the electronic medical record system, health insurance system, self-service web and mobile solutions, business intelligence, and technology infrastructure. Galen is also a professional magician, specializing in close-up magic. The relationship between technology and magic was observed by Arthur C. Clarke, who wrote, “Any sufficiently advanced technology is indistinguishable from magic“.

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