To build or buy: The medical school’s software dilemma

Note to the reader: When talking with medical education professionals, we at MSAG sometimes get asked to make technology recommendations. Although every school is different, there are some common considerations to take into account when deciding whether to build a system internally or contract with a vendor. I am grateful to Derek Wilcox, director of medical education and quality improvement at the University of Tennessee Health Science Center, for sharing the comments below in an effort to help schools navigate the decision-making process. – Lois Margaret Nora, MD, JD, MBA

By Derek Wilcox, MBA

In a constantly changing world of technology solutions and needs, schools are often faced with a choice between developing systems internally or purchasing an off-the-shelf product. The process the school follows to make this decision will impact curriculum delivery, overall program effectiveness, and student and faculty satisfaction.

Establish clear objectives

You might be tempted to immediately adopt a solution or mimic something you saw another school do, but to ensure you are making the best decision for your school, start by establishing clear objectives and requirements. Clarify the problems your institution aims to solve and prioritize them realistically. Avoid attempting to tackle too many issues with a single solution.

Shift from problem-focused thinking to describing the ideal system functionality that might conceivably address the identified challenges. Consider factors like user experience, operational efficiency, regulatory compliance, and time constraints. Don’t forget to ensure clear alignment with the college’s mission.

For example, a medical school might describe a project objective and requirements in this way:

Objective: Provide a system to document student completion of the school’s required clinical experiences by <date>.

Required functionality

○     Facilitates log verification and reporting

○     Facilitates feedback delivery

○     Facilitates progress tracking and reporting

○     Facilitates compliance with LCME expectations

Preferred functionality

○     Utilization of the university’s single-sign-on authentication

○     Mobile accessibility

Additional detail can be added along the way, but it’s key to keep the objective focused and prioritized. It’s also important to clearly differentiate between required and preferred functionality. Challenges related to user experience or operational efficiency are important, for example, but regulatory compliance might take precedence.

Build a team

The decision-making process should involve key stakeholders. Start small but strategically. Engage faculty, administrators, IT professionals, and even students. Their insights will shape the direction you take.

Gather information

What are your options? Research internal and external resources, taking note of their respective costs and potential alignment with established needs and objectives.

Don’t overlook what might be already available within your institution. Inventory existing technologies. Are there tools like Microsoft applications, Qualtrics forms, or other readily available institutional resources that could be leveraged? Consider the expertise of your IT team and available infrastructure, such as project management. Can your in-house developers take on the challenge? Are there resources to maintain a system once built?

Look beyond your campus walls. What available solutions align with your objectives? Learn from other colleges. What software are they using? What challenges have they faced? These peer insights can be invaluable.

AAMC-member medical schools have the advantage of access to a database that captures the technologies utilized by peer institutions. This invaluable resource, produced by the AAMC Group on Information Resources and available to schools that participate in an annual survey, supports informed decision-making and fosters collaboration within the medical education community.

Evaluate

Keep in mind the general pros/cons of these types of decisions. While much has been said about an organization’s decision to build or buy software, consider the following general comparison:

Build

Pros

○     Customization and flexibility

○     Integration with existing systems

○     Ownership

Cons

○     Time and resource-intensive

○     Requires a skilled development team

○     Burden of ongoing maintenance and support

Buy

Pros

○     Time efficiency

○     Ongoing support from vendors

○     Scalability

Cons

○     Potential long-term subscription costs

○     Dependence on vendors for support and updates

○     Limited customization options

○     Less control over data security

With that in mind, consider your school’s specific needs and objectives. It’s helpful to take a systematic approach. One effective method is to create a decision matrix, where weighted criteria are used to evaluate options based on your institution's specific requirements and priorities. This structured approach helps differentiate between meeting minimum requirements and exceeding them, helping you to narrow your options more effectively.

Usability is another critical factor to consider when evaluating software solutions. How quickly can users adapt to the software? What is the learning curve like for faculty, staff, and students? Conducting a pilot project or proof of concept can provide valuable insights into the feasibility and usability of a particular software solution. Real-world testing allows you to gather feedback from end-users, identify potential pain points, and make a more informed decision. Additionally, involving likely end-users in the evaluation phase is crucial for ensuring buy-in and successful implementation of the chosen solution.

The decision

Recognize that technology is a means to an end, not a panacea. You're not just selecting software; you're choosing an operational process and workflow. Throughout the decision-making process, it's important to keep the project objective and your institution's mission at the forefront, ensuring that the chosen solution aligns with overarching goals and objectives. Additionally, empowering key stakeholders to take ownership of the solution fosters a sense of investment and accountability, ultimately contributing to successful implementation. The approach you take can allow you to leverage technology to enhance operations, achieve your goals, and fulfill your mission.