Hiring an information technology consultant almost always comes down to one of three needs for a health care organization, according to Ted Reynolds, vice president at consultancy CTG Health Solutions. An organization needs expertise it doesn't have in-house; or somebody to drive an independent decision through the organization; or short-term labor to finish a project.

Sometimes the reason to hire a consultant is a combination of all three needs. In a large electronic health records implementation, the vendor often will teach users about one-third of what they really need to know, Reynolds says. A consultant who already helped with strategy can fill in the training blanks to shorten the learning curve, and do so with a smaller force than the vendor, he asserts. "The hardest thing to make up on a project is time."

The reasons for when and why organizations choose to engage a consultant have changed significantly in recent years, contends industry veteran Steven Heck, who previously led First Consulting Group and now is president of MedSys Group in Frisco, Texas. The HITECH Act of 2009 with federally subsidies to greatly accelerate EHR adoption opened the floodgates for consultants. Firms that specialized in staffing or strategy development joined consultancies that traditionally handled systems implementations in a race to provide as many bodies as possible to EHR-adopting providers across the nation.

Health care is an industry that reacts primarily to federal reimbursement policies, so over the last few years, "it has been a full-blown 'get as many people to me as fast as you can' environment," Heck adds. Only now, he says, is the shift to implementation services starting to taper off as providers begin running low on capital.

However, no reason to shed tears for consulting firms: Work on ICD-10 is now compelling providers to use consultants to boost staffing levels, says Jackie Lucas, CIO at Baptist Health System in Louisville, Ky. "Everyone has more contracting going on. It's just been a lot tighter with staff since meaningful use and now ICD-10."

Another HITECH initiative, strengthening of the HIPAA privacy/security/breach rules, has brought a change in how consultancies themselves operate during the past two years, says consultant Beth Just, president and CEO at Just Associates in Centennial, Colo. New requirements on covered entities to better oversee HIPAA compliance of their business associates means that some providers now are conducting security risk assessments on their consultants-and may hire another consultant to do it.

Yet another burgeoning line of business for consultancies is optimization: providers and payers, having made most of their big-ticket I.T. investments, now need to optimize the use of all those new systems to handle meaningful use, accountable care, ICD-10, new HIPAA transactions and operating rules, privacy and security, data analytics, and health information management as legal medical records become digitized, among other initiatives. "A consultant brings a different set of eyes looking at your processes and how you are using the technology," says Margret Amatayakul, president of MargretA Consulting in Schaumburg, Ill.

For instance, the operating rules for electronic financial and administrative transactions are flying under the radar of many providers already saddled with so many other regulatory initiatives. But the rules will bring big changes of their own, Amatayakul says. "Operating rules used effectively can dramatically enhance the efficiency of the revenue cycle."

With a multitude of reasons for needing consultants, a feature story in the July issue of Health Data Management walks through processes to find the right consultant.

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