When do you Build it and When do you Buy it?


When it comes to platforms and technology for virtual care, when do you buy and when should you build? Building is certain to cost more up front, but it offers the option of lower costs of ongoing support. In addition, if you build it, you own it and can do what you like without interference.  Buying it leverages the experience and expertise of vendors, while alleviating programming and some internal support needs.

When it comes to creating a telemedicine offering, the struggle is real.  There are countless vendors and options.  Large companies have merged into larger major market brands.  Many companies, including startups, do one or a few things very well as targeted solutions.  Getting information on product decisions can be difficult as vendors do not always provide actual use cases. They often leave that up to the customer to define then say how their system could fulfill those needs.  Searching for something like ‘TeleICU’ returns more articles and vendors than one could reasonably read. 

Your decision options to build or buy are: selecting one vendor with a broad offering (buy), selecting separate vendor products with integration that that may require a separate integration specialty vendor or additional costs to each of the individual vendors (vendor-aided build), or ground up development (in-house build).  If you purchase from a vendor, it’s buy not build.  If you create workflows tying multiple vendor products into your offering, consider that a build.  If you are engaging programmers and app developers, then you are building. It is important to realize that with all of these options, your IT team is still going to need to be involved and will need to allocate time and personnel.

There are large complex problems to solve in an ever-expanding market, not to mention products your organization already has in place.  Raise your hand if you have more than one video product at your organization.  The telehealth vendor you are evaluating might have a separate video tool and that will be significant to an IT department considering multiple video products.

Interestingly vendors deal with this same issue.  Epic has added video directly to their EMR with a Twilio partnership, moving from a build model of deep integration or context aware linking to a buy model direct from Epic.  Companies like EngHouse offer Vidyo.  They codevelop solutions like the Ironbow Vidyo Client which is a developed buy model.  When I see a ground up build, it tends to be for a small solution and not for an entire platform like the VA did in the 1990’s.  I led development of an internal app with help from Microsoft and Quisitive.  It was a HIPAA compliant app to transfer photos and videos for teleconsults using texted secure links.  I understand most EMR vendors are building that into their platform as a feature now.

The decision to build or to buy is complex and rarely clear cut.  Be mindful of what is needed today versus what you expect and hope to do in the future.  It is a strategic decision that warrants careful deliberation.  You must also consider natural industry progression. Four years ago, my team wanted more features than what our video vendor offered at the time.  The cost of adding those video features was going to be very expensive.  We opted to not build on more features and accept what we had.  Sure enough, in today’s market, most video vendors include those same features.  Building it yourself with programming might not keep up with standard industry features and standards.

The flexibility of build vs buy gives us ever expanding options, which is a great sign for virtual care.  You grow together with your partners.  This is true for both small and large vendors.  I personally have been fortunate requesting features offered by vendors.  Those discussions have more than a few times led to product changes.  This is true with small companies and national leading companies in the healthcare industry. 

It is such an exciting time for telemedicine.  Thoughtful development along with strong partnerships is the way to lead.

NOTE: Author is providing insight as an individual with experience in the telehealth industry and not on behalf of Centura Health or any of its affiliates or partners.

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About the Author

Gerard Frunzi is the Director of Virtual Care at Centura Health.  There he is responsible for overall telehealth strategy, the adaptation of care models to assure the appropriate integration, and development of tele-enabled protocols and operational transformation across Colorado and Kansas.  He received his Bachelors of Science in Computer Information Systems from Metro State College of Denver and his Masters of Business Administration from the University of Colorado Denver.