I’ve written many times that specialization is the key to excellence – that you can’t do anything well if you’re trying to do everything. While I still believe this as a general principle, a recent KLAS report on emergency department systems proves that every rule has its exception.
The report found that while 31 percent of those using best-of-breed systems in the ED — meaning the system is from a different vendor than their EHR/Pharmacy/CPOE provider — would consider moving to the ED product offered by their enterprise vendor in the future, only 7 percent of those using an ED system from their core vendor would consider leaving it for a best-of-breed solution. So it’s clear best-of-breed vendors — those who, in general, offer better functionality in that particular software application than their “enterprise” competitors — have little chance picking off any hospitals that have already selected their main supplier of clinical technology.
It’s interesting to note that many, many hospitals are currently living this dilemma. During the last 10 years (before HITECH), the ED was seen as a great place to start down the electronic road. At that point, not wanting to bite off more than they could chew, an enterprise EHR vision wasn’t yet in the picture. In that case, it made perfect sense to look at the ED by itself, and thus select the system best suited for it. In most cases, a best-of-breed vendor proved most pleasing to the clinicians, thus a silo was born.
I recently interviewed a CIO working through this issue. She has a best-of-breed vendor in the ED and, while the organization had leveraged interfaces to bring about some level of data liquidity, it wasn’t the same as being truly integrated. Did she plan on ditching her incumbent ED vendor for the corresponding product from her enterprise provider? Her answer indicated that while she had too much on her plate to fix this problem right now, addressing it with a switch was in her long-term plans.
The KLAS report indicates, and I believe, such is the case at many, many institutions. Meaningful Use requires integration, but organizations need more than that – they need sustainable and affordable integration — something interfaces have trouble providing. Interfaces mean extra costs, software upgrade hazards and testing, testing, testing. Interfaces are not a CIO’s best friend.
And let’s not forget about the clinicians in all of this. First off, clinicians (like everyone else) generally want to keep using whatever they’re using. The thought of change is often more frightening than the promised improvements. This means ripping out an incumbent best-of-breed ED system — and making some docs very angry in the process — isn’t an easy sell. This also means that — if the enterprise vendor’s ED offering is not as good as the best of breed (and this is often the case) the sell is even tougher. As the CIO mentioned above told me, “You can’t go to something with less functionality, only more.”
Since I don’t believe standards and interfaces will create the plug-and-play world that best-of-breed vendors need to thrive — at least not within the next five Meaningful Use years — the trend indicated in the KLAS report will likely continue. For best-of-breed vendors, that is something they can work to stem with better functionality and integration; or address through adjusted strategic plans, perhaps focusing more on standalone ED facilities. For clinicians, it means there will be some band aids being ripped off that require both learning a new system and sacrificing some domain benefits for the good of the whole.
For CIOs, it means educating the board, c-suite and clinicians about why it’s best to go down one path or another. If CIOs feel Meaningful Use requires a solid best-of-suite (almost all apps from one vendor) approach to handle, it’s time to cut loose some ancillaries, but education must come before the ax. Pulling off these band aids is going to hurt, but it will hurt a lot less if all parties involved understand why it’s being done.
flpoggio says
Ah Anthony, here we go again…’single vendor’ versus ‘best of breed’.
Since no one vendor will ever do it all for any hospital or health facility there always must be interfaces, and hopefully some level of interoperability. Only question is how much? Having one vendor is just as bad as 100 vendors in a facility. You just get a different set of problems. With BoB it’s less problems for the department, more for IT. With SV, it’s jsut the opposite.
What’s a good number? Maybe 25 or 50? It all depends on:
1) Size of facility
2) Scope and depth of medical programs
3) Strength of department(s) heads
4) Future facility plans and competition
5) Regulatory issues
6) Risk /reward personality of management
All these must be taken into account before a CIO can determine whether his/her number is 10 or 90. As far as ED is concerned, it depends on where the above answers fall. Same for lab, radiology, finance, etc.
As I mentioned in one of your earlier posts, the CIO today must become the Chief Integration Officer. He/she should not delegate that role to one or more vendors, and maybe the ‘suite approach’ reaches the best balance.
Frank Poggio
The Kelzon Group