System Longevity

© 2015 by H.I.S. Professionals, LLC, all rights reserved.

By Vince Ciotti

CLAS Follow-Up• If you’ve been able to stay awake viewing my past presentations

on HIStalk, you may remember one I did last year on Epic being only rated only #2 in a category that is so important in these days of increasingly long office hours. What, you ask, Epic only rated #2!? And not just by the DoD, IHC, and Great Plains,

• But by one of the only HIS vendor rating firms that has never had a single critic or complaint about its objectivity and candor: CLAS (Ciotti’s Latest Attempted Satire)

• In case you don’t recall it, you can find them all on our web site hispros.com: click on the “HIS-tory” button and scroll down to the “Misc” category – it’s listed as #123

• Better yet, just scroll through this update…

The Contenders• CLAS compared two of the biggest names in the HIS industry

in a category that is on almost everyone’s lips these days:

• “Giveaway” coffee cups from HIStalk, gifted from Lorre at their booth at HIMSS 2014, and one from Epic stolen from their cafeteria in Verona when Judy wasn’t looking...

• CLAS evaluated them in several ways:- User-friendliness (handle-size)- Source: Asia vs. Walmart (same?)- Size - # of trips to the pot(tie)…- Readability – have to rotate to read?

• The results: HIStalk won hands-down:

And Today?• Time is an interesting question when reviewing a product or

system, especially in the ever-changing world of IT with vendors re-branding themselves and their products continually:– Evident is evidently as superior to CPSI, as Medhost is to HMS,

Healthland is to Dairyland, NextGen is to QSI, etc., etc., etc.– Far better service, support, customer focus, dedication…

• Not to mention the new releases once or twice a year, with new bugs, dropped features, and other “enhancements” in each…

• That’s why it’s so important that rating sources like Black Book and KLAS tell you exactly which release/version of vendor systems they are rating: is it release 6.15.a-2 or “only” 6.10.c-1?

• And how did our competing coffee cups stand up over time? Did CLAS get it right the first time, or need we revise our results?

One Year Later• Well here’s shots of the identical cups we reviewed last

December, one full year (and a few thousand refills) later:

• And these are un-retouched photos (no photo-shopping or graphics editing) showing exactly what the two cups look like one year later. The two shots show both sides of each cup...

• It looks like CLAS got it right:- The HIStalk cup hasn’t faded in the

least – same silly headlines & logo,- Whereas the Epic cup has faded

away to where you wouldn’t know it was theirs if I didn’t tell you!

Tempus Fugit• Is it unusual for a cup’s lettering to fade in just one year? What is

the life cycle for a coffee cup?? How long will HIStalk’s cup last???• Well, in 1972 my wife made the dumb mistake of marrying me –

our 43rd anniversary was just last week so I remember it well!• My Mom gave us these coffee cups for Xmas, 43 years ago:

• Not bad huh? Flawless: no fade at all!• I hate to admit it, but I have not aged

as well as the cups, though my wife still looks lovely as ever, and can get under my skin with the same vim & vigor…

• Compare this longevity to the fade on Epic’s cup on the right: you have to squint to read the name! So just what does time imply for HIS systems?

Leading Systems by Year• I dug back into my files to see what systems were rated #1 in

various categories over time, shown in the table below. I picked major categories only, so things didn’t get too granular, like:– “Leading OB vendor in Critical Access Hospitals in Idaho…”

• There are some categories where time plays a major factor with leaders changing often, while some others stay pretty constant:

2001 2003 2005 2007 2008 2010 2014Community Hosp. HIS

Dairyland Dairyland Dairyland McKesson Paragon

McKesson Paragon

McKesson Paragon

Meditech C/S 6.0

Home Health Care

Lewis Patron

Cerner BeyondNow

Cerner BeyondNow

McKesson Home Care

McKesson Home Care

McKesson Home Care

EMR Eclipsys Sunrise

Eclipsys Sunrise

Epic EpicCare

Epic EpicCare

Epic EpicCare

Epic EpicCare

Epic EpicCare

LIS Sunquest McKesson Horizon

Misys Sunquest Siemens Novius

Siemens Novius

Epic Beaker

PACS ALI Stentor DR Systems GE Centricity

DR Systems DR Systems

ED Wellsoft Wellsoft Wellsoft Wellsoft Wellsoft Wellsoft Wellsoft

When Did You Pick Your HIS?• The implications of time are interesting when picking a system:

– Per the chart, a community hospital picking Dairyland in 2001 was smart, whereas one picking them in 2005 blew it by not anticipating Paragon’s dominance for the next 7 years…

– And likewise, one that picked Paragon before 2014 goofed by not anticipating the rise of Meditech’s 6.0 just last year.

• Just how does one predict the future? The answer is simple:– You can’t! These polls are as unpredictable as the weather:

• It was near 90 degrees all month here in FL, yet last night the temps dropped so much I have the heat on today!

• Many products change overnight: did you notice how Consumer Reports recently retracted it’s “best buy” endorsement of Tesla?– And I wonder how low they’ll rate all those VW diesel-engined

cars belching smoke in their reliability ratings next year??

Grossly Granular• There are just too many factors for individual hospital to consider

that national polls must overlook, or they’d get too complicated:– IT staff: CAH hospitals may have but a single FTE in IT, a 200

bed community hospital around 15 FTEs, while an AMC or IDN has hundreds - what a difference in systems they can support!

– Location: Healthland is strong in the Midwest, while Evident dominates in the South… Most important, does a vendor have any installs in your state so they know local regs, EDI, & HIEs?

– Budget – a well-endowed AMC might be easily able to spend $100M+ on an EMR, while an equally large inner-city hospital with a large Medicaid mix has to be far more prudent.

– Apps – do you own a large physician practice, have non-acute services like Home Health, want to include the ERP suite or PACS? Finding a single HIS vendor that excels in all these diverse needs is extremely challenging, if not impossible…

Product Evolution• Just how long do HIS systems last? What is the typical life cycle,

after which a hospital should be searching to replace theirs??• The best way to answer that is to look at HIS-tory: just how old

are today’s leading HIS systems – not just the companies, which re-brand, merge and acquire often, but their products?

• E.g., here’s the very complex time line for SMS/Siemens, before the acquisition by Cerner this year:

Systems Sold Today• Here’s a rough timeline of the age of the HIS systems being sold

today; many company and product names have changed over time (eg, Eclipsys bought by Allscripts), but their Sunrise product essentially remained the same, albeit with many releases…– (not sure of details, e.g., exactly when Judy added Resolute, Beaker, etc.,

nor when Neal branched out from just LIS to Order Entry & Results…)

Systems Installed Today• Just how old are some of the systems running in hospitals today?

It’s amazing to think of how long ago some were first written:– Siemens’ “Invision” patient accounting is based on IBM’s SHAS

(Shared Hospital Accounting System) from the late 1960s, programmed in COBOL and using IBM’s “VSAM” file structure. This venerable RCM is still running in 200-300 hospitals.

– Meditech’s “Magic” was programmed in “MIIS,” their version of MUMPS, installed as an LIS in 1970 at Cape Cod Hospital. Expanded to a full HIS over time, it still runs in 500+ clients!

– Evident’s “Thrive” is a renamed version of “The CPSI System,” the name for CPSI’s total HIS written in COBOL in 1978, and running strong in 600+ hospitals today, though on a new db.

– Healthland’s “Classic” financial system was written circa 1980, and is being replaced by the more modern “Centriq” version, although still running in several hundred CAH & small sites.

System Life Cycle• The typical HIS system has a life cycle that follows the classic bell-

shaped curve in geometry, with time on the horizontal X-axis and the number of clients on the vertical Y-axis, something like this:

• The trick is trying to figure out just where your system is in its life cycle: is your product still selling, or has it hit its peak? The key word is “selling” – if the number of sales are steady or increasing, you’re cool; if sales are declining or ceased, caveat emptor!

Time Takeaways• What is the impact of time on HIS systems? Some thoughts:

– Ratings – whether you’re a devotee of Black Book or KLAS, check out the pattern of ratings over time: several years of dominance means more than a flash in the pan one year…

– Product vs. Vendor – so many vendors have multiple products that you have to drill down carefully into just which one is being reviewed: think Paragon vs. Horizon, or Magic vs. 6.1.

– Life Cycle – best to buy a system that is on the way up in its bell-shaped curve, rather than one that is on the way down… Best indicator of that is sales, not total number of clients.

– Your Life Cycle – how long has your hospital been on its current system? As painful as it is, re-implementing or putting in a new system can nicely improve work flows & processes.

• And what are my qualifications on this subject? I just turned 70! Any feedback, call 505.466.4958 or email vciotti@hispros.com