Over the last year and a half, many of you have followed our journey from Magic to 6.x with all its challenges and nuances. It has been a daunting experience and not without its frustrations. If hindsight is 20-20, then hopefully our experiences have helped you. In this article, I will attempt to summarize where we are today and answer the question I keep getting again and again which is, “Would we do it again?”
So here we are 8 months post go-live. As of a month ago, we had over 32 issues with an aging of older than 60 days and some as old as 253. After a meeting with Meditech senior leadership on issues like medication reconciliation, AR still not aligned, and DR still not fully functional 6 months post go-live, they sent out a SWAT team to address many of those issues. That was a very productive engagement and many lingering issues got resolved along with additional education to our user and support community around the functionality of the 6.x product.
All parties involved stated this was a huge benefit and should be part of the normal Meditech implementation program to send a cross-functional team out 6 months post go-live to address lingering issues and assist customers in getting the most out of their product after they are familiar with it. We learned many tips and tricks, and Meditech stepped to the plate creating custom reports and making system recommendations to enhance our efficiency. As stated, it was a highly productive engagement and I recommend all 6.x sites include this in their project plans and contracts.
In terms of lessons learned, the biggest is that, “We didn’t know what we didn’t know.” 6.x was marketed as an upgrade but even Meditech leadership agrees it is a new product and needs to be handled that way. When people (users and support staff) think of an upgrade they tend to view it as a product that functions the same, with just some enhancements. That is like saying a 2012 Corvette is just an enhanced version of 1960 model — outside of them both being cars, nothing is further from the truth. Under the covers, they are light and day different in terms of performance, technology, support required, and capability. The same is true going from Magic to 6.x. Under the covers, they are very different products, and a 6.x implementation needs to be thought of and delivered in the same way you would a totally new Health Information System (HIS) implementation that was migrating you from Magic to a different vendor.
I believe Meditech has a future strategy to help make implementations more successful by handing 6.x migrations as if they were new implementations. Also, they will take a more structured and scripted approach to their implementation. In the past, it has been very much left up to the site on how to build their dictionary structures, but taking a more prescribed approach would really help consistency and successful interoperability of modules.
The level of effort is also equivalent as it would be to implement a different vendor’s HIS. In terms of cost, perhaps the biggest thing we underestimated was FTE cost. In an early adopter presentation, the hospital presenting noted that their FTE cost was 2-3 times what their total software and hardware capital costs were. That was very true for us, and the surprise came post-implementation at the additional FTE costs needed for ongoing support and operations. A couple of examples are that, moving from Magic to 6.x, we went from 9 patients per RN to 8. This was due, in part, to the addition of nursing using medication administration checking, improved data capture of home meds, and the discharge medication reconciliation process. Another one is that support needs have grown immensely from an IT perspective. The 3 RNs working on CPOE look to be a long-term need and, internal to IT, we will be adding additional 6.x financial and clinical analysts.
Another huge unanticipated cost is around reporting. You will have hundreds, if not thousands, of reports that will need to be rewritten. Eight months post go-live, we are still working on our list, and that was after an outside 3rd party vendor assisted us for a 2-month level of effort. Interface support costs and FTE costs are also likely to increase dramatically. While the interface costs are not all directly related to 6.x, indirect costs were added by such factors as choosing to go with a 3rd party ED system, MU requirements, and other initiatives.
We have also had surprise costs associated with hardware upgrades (mostly memory and disk) required by the Meditech server farm. Although we bought exactly what Meditech/Dell Perot scoped, it has proven to be underpowered in real world usage. The level of effort to get through printing during pre-go-live was also a lot more draining that we anticipated.
Yet, for the most part, the users all see an overall benefit in 6.x over Magic. The provider community also has noted some efficiencies and benefits in the 6.x product. Various levels of integrated data points between 6.x, practice management applications, and our ED product has also added to a more consolidated data approach and helped drive the 6.x acceptance. Back to the $100,000 question: “Would we do it again if we knew what we know now?”
I spoke with the good folks at KLAS and several of my peers. The consensus is that about half the CIOs would not have done it again. From my perspective, I think it comes down to 2 things. The first is how much money you have. If, like several of our competitors money is very tight, and you can’t justify the soft benefits then, no, we would not do it again. This is a broad view of a large question though. In my opinion, the cost of 6.x, when everything is said and done, is likely to be competitive with a McKesson, Cerner, or non-Soarian Siemens product. Had we known then what we know now, we might have looked more closely at the competitor products. The driver then becomes more around why you no longer want to stay with Magic? As stated, 6.x is not a Magic upgrade but rather a whole new replacement product.
That having been said, it now is more a strategic discussion than one around finances. For us, the 6.x product is felt to be a market differentiator. To start with, like others, we question whether MEDITECH can effectively support 3 product lines with all the MU enhancements, system improvements, and other challenges on the horizon. Also, even if they can, which is likely to get the bulk of their resources? Additionally, with 6.x being their flagship product, we are hoping to see marketable advantages from going with 6.x. Our leadership noted that even though the implementation went very well, it was exceedingly disruptive and left us reeling. Not sure any of us really can answer if the pain was worth the gain….
In summation, yes we still have lots of nagging little issues. We are still opening over 13 work orders a week, many of which go to development. At least we have stabilized, and the product has gained user acceptance. Meditech support is improving and (although it won’t benefit us) they have new implementation strategies gathered from lessons learned. The product is very different from the old cast iron Magic and, being Microsoft centric, will continue to provide new challenges and lessons needing to be shared across the CIO community. That is the way most new products are, and 6.x is still in its infancy. As such, we are likely to continue to see issues, product changes, and support challenges. On the benefit side of the spectrum, things are much better than they have been — CPOE is rolling out well and on the way to a full adoption, user acceptance is positive and thing are well in the world of IT as far as Meditech is concerned.
I hope you have enjoyed my series on the Magic-to-6.x migration and that I have provided a nugget or 2 of knowledge that helped you with your implementations or decision making. As always, feel free to continue to contact me either here or via my email for specific questions or comments. Thanks for your time in reading these ramblings.
Notalawyer says
Jorge, thank you for taking us through the trials, tribulations, and successes of your Meditech adventure. Your articles have been thoughtful, balanced, and informative. What’s more, you’ve been very open about the difficulties your IDN has faced during the cut-over to the 6.x platform. If nothing else, that will have reassured others that, “it’s not just me.” – Thank you again for sharing the journey.
Jorge Grillo says
Thanks. I noticed on another blog that my articles were critically commented on. It noted that my not having an understanding of the MEDITECH product and my lack of previous experience with MEDITECH as factors creating a more negative view of the product and relationship. It is great to know that there are at least some readers that felt my articles were balanced and reflective of their own experiences.
MEDITECH leadership has stated repeatedly, that the 6.x product is unique and not an upgrade of any of their current products. I would argue that unless you have a 6.x install behind you that you are not familiar with what it takes to implement it and just having MAGIC or C/S experience helps but still leaves knowledge gaps in what it takes to successfully configure and implement 6.x. As an organization we noted this from experience with consultants that had MAGIC and C/S experience but could not directly relate that experience to our 6.x needs.
I have never professed at being a MEDITECH expert. Rather my writing was a review of our experiences, trials, and lessons learned in hopes that it might help others achieve a more successful implementation at their site. It was also not thought to be intended for a broad audience but rather focused on the CIO community and meant to provide a basis for what questions might be helpful in asking early in their process along with some factors that might influence their decision making during implementation. Being exceedingly experienced in the best of breed vendor model, I have experienced about every implementation strategy and model in the market place. I don’t claim to be an expert on any of them but do think I know what has worked successfully and what has been more challenging. Also does one need to be an expert on stoves to know that if you put your hand on a burner set to high that you will likely not have a good experience? While the 6.x implementation was a unique model, I have experienced both better and worse from other vendors. Again the point was to provide a picture of what we experienced for others to learn from. I would also argue that it was not that unique experience since many CIO’s have commented that we were not alone in our challenges and they too experienced many of the same successes, frustrations, and problems that we did.
Again thanks to all that have supported my series of articles and the many that have called or written with questions or comments. Everyone is entitled to their own opinion and I support their right to one even when they don’t agree with me. That makes for interesting dialog when they are presented in a constructive manner.
Health IT Vet says
Jorge:
It doesn’t really matter whether you had experience with previous versions of MEDITECH or not. Your experience is your experience and those who read it need to understand and appreciate that. I happen to have over 20 years of experience implementing and managing MEDITECH in a variety of provider sites as a consultant and CIO. I recently took over as Interim CIO at one of the earliest adopters of MEDITECH 6.x. This site has been Live for over a year and I can attest to your challenges. We are still opening tickets for serious bugs, and I am disappointed that features I appreciated in Magic and Client/Server somehow didn’t make it into 6.x. As a former software developer and product manager, that is very puzzling. I expected MEDITECH to have a single design team and 3 development groups (Magic, C/S, 6.x) under it. This would maintain consistency and leverage all of the hard work done enhancing the previous versions. It doesn’t appear they did this.
The other thing is the support. I was also surprised when I mentioned how the Discharge routine worked in C/S to my 6.x CPOE MEDITECH implementation team. I got that ‘deer in the headlights’ look. They had no clue how C/S worked. I don’t think they even knew Magic existed. All of these people have been hired and trained specifically for 6.x, and because of the rapid adoption, most are very green in software support period, let alone the 6.x specifics. It has been a constant battle to keep the good Specialists and change-out the ones that were too new to be of any real value.
Before you get the wrong idea, I am a long-time supporter of MEDITECH and still am. I just think they made some mis-steps in 6.x development, implementation and support. I am confident they are fixing this. I remember when C/S was launched. It was very disruptive and everyone complained about the Microsoft platform as to increased cost and support needs. But look at C/S now. It is rock solid and very functional. I believe 6.x will get there as well. It’s just tough being on the front-end of the adoption curve. You take a lot of ‘arrows’ being a pioneer.
Thanks for sharing your journey. I think the greatest value to me throughout my career has been hearing from people that were going through the same thing, and having the opportunity to share stories and compare notes. I have told MEDITECH that they must drive more of these Peer-to-Peer networking opportunities for the 6.x platform. As your series of articles demonstrates, there is a lot of information to be shared.
Continued good luck!
Jorge Grillo says
Thanks again for the support and comment. If you will be at the 6.x peer to peer event or at CHIME please connect with me. Would love to discuss your experiences.
J
XMD says
Hi Jorge. How do I get in touch with you? I am trying to talk some physician colleagues out of starting up an ABM (anything-but-meditech) Facebook page.
Perhaps your experience would offer us a ray of hope?
I hope?
Jorge Grillo says
you can email me at [email protected] or call at 315-261-5200
PAPutzback says
As far as the Magic database changes. Did anyone think to create an abstraction layer or views that mapped the new tables to match the schema of the old system so all the reports did not break? Shouldn’t MediTech have provided these with the upgrade.