Digitalization in healthcare – part 1: How to set up your application landscape?

The ability to look ahead is one of the crucial ingredients for successful digitalization. Important choices need to be made early on, and they’re often difficult and costly to reconsider. Choosing between buying and implementing off-the-shelf software, or developing bespoke applications is one of these strategic choices. It is an important consideration for healthcare organizations, who have to cope with regular changing rules and regulations and therefore need to be prepared for future changes. How do you set up your application landscape, and which factors do you need to consider?

Every healthcare organization has their own unique challenges and practices, so the application landscape can vary considerably from one organization to the next. Nevertheless, there are some basic principles that apply to every organization that can help in making the right strategic choices. One is Gartner’s Pace-layered model. In it, the application landscape of organizations is divided into three different layers, with the types of applications and processes and associated choices varying for each layer.

Systems of Record
The bottom layer is formed by the Systems of Record. This layer consists of systems that are part of your organization’s core. Think about administration, billing, and for healthcare organizations the electronic healthcare record (EHR). Changes to this layer are often drastic, costly and time consuming. Ideally, these types of changes should be limited. Because the wishes and demands of organizations are often clearly defined and generic, many healthcare organizations have the same demands for their EHR. Developers for these applications build great off-the-shelf software which meet the demands of a large group of organizations. This is why organizations often choose to buy their software in this layer.

Systems of Differentiation
The middle layer, which is formed by the Systems of Differentiation, consists of processes and applications unique to the type of organization, and its mode of operation. Examples include client intake, or the registration and scheduling of appointments between clients and practitioners. Typically, there are more frequent changes or new requirements for the systems in this layer, requiring them to be more agile.

In this layer, making the right choice between buying or building software often becomes more difficult. Sometimes standard software meets the set requirements without modification, but organization-specific requirements can also be the reason that standard software does not quite meet those requirements. In such cases, building bespoke applications can offer a solution. Charles Bronzwaer, partner at Bizzomate explains: “Customization on systems that are not designed to handle this, with partners who have no development capacity for these requests is asking for trouble. You get a unique system, and lose all the advantages of the standard system in the process. When the requested customization is delivered, a new version is probably already available, to which you cannot upgrade because your application has all kinds of exceptions and extras. Therefore, when customization is required, always choose a platform that is designed to do this, such as Mendix’s low-code platform.”

Systems of Innovation
The top layer consists of the Systems of Innovation. This is your organization’s space for experimentation, for launching new ideas, for example testing wearables in people’s homes. The needs and requirements for these initiatives are often still unclear, and their success and necessity have yet to be proven. Therefore, it is very important that prototypes and proof of concepts in this layer can be built and customized in a fast and flexible manner, without interfering with other systems. The systems in this layer do not yet exist, which is why you always choose to build applications in this layer, with or without a partner.

Buy or Build
In the bottom layer, you usually choose to buy standard software, while the top layer calls for building it. The middle layer, however, is a gray area, where the choice is not always easy to make.

Read “Digitalization in healthcare – part 2: Buy or Build?” in which we talk about the main considerations of healthcare organizations between “buy or build,” and download our white paper on digitalization in healthcare here for more insights and real-world examples.