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SMALL HOSPITAL SPOTLIGHT: One-on-One With KLAS Director of Financial Systems Paul Pitcher

October 7, 2009
by Anthony Guerra
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Paul Pitcher says small hospitals cannot recover from selecting the wrong system.

With its carrot-like incentives, HITECH has placed severe demands on healthcare providers throughout the country to adopt electronic medical records and computerized physician order entry. And while paying for such systems is difficult, inducing clinicians, especially independent physicians, to use them can be the highest hurdle in the race to leave paper behind. KLAS recently issued a report focusing on small hospitals and the unique challenges they face in implementing core clinical technologies. HCI Editor-in-Chief Anthony Guerra recently spoke with report author Paul Pitcher about how HITECH is effecting this particular niche of healthcare.

GUERRA: We’ve heard that small hospitals are struggling to comply with meaningful use and the 10 percent CPOE requirement.

PITCHER: You’re right on the mark. For these hospitals, it’s difficult. Oftentimes, due to both dollar constraints and resource constraints, they’re challenged and they’re playing catch up to the larger hospitals, who have mostly adopted their clinical technologies. Many of these critical access hospitals are just getting started now, and even then only being forced because of ARRA.

GUERRA: KLAS recently issued a report entitled, “Closing the IT Gap: Critical Access to 50 Bed Hospitals.” What got you interested in this space? Did you see there was a demand for information among these hospitals?

PITCHER: That is exactly what happened. In fact, I want to hedge that. We, oftentimes, are focused on the larger hospitals, but with ARRA coming out, IT became a must for all hospitals. So we felt there was an opportunity to address some of their concerns, to answer some questions for smaller hospitals who are perhaps lagging, in terms of technology. We just felt it was perfect timing to put this report out and, hopefully, get this information into the right hands.

GUERRA: Did you have any expectations going in about what you would find?

PITCHER: There were not a lot of expectations. I think the initial expectation was we had an idea of which vendors would play in this space, and that really held true. We certainly had expectations that Healthland, HMS, and CPSI were going to be the major players.

Beyond that, there were no expectations. Some of the results were kind of interesting, especially as it relates to the performance scores of Healthland in comparison to their competitors. Their scores stood up, stayed the same; whereas some of the other scores fell away. So the smaller the hospital, the worse the scores became for some data elements within our study.

GUERRA: Healthland has been around for a while, formerly as Dairyland. They may not have that much name recognition unless you realize the organization does have a long track record, correct?

PITCHER: Yes, I don’t know how much name recognition they have with Healthland. Certainly, I think Dairyland had great name recognition. I don’t know whether the industry connects the two. The other two – HMS and CPSI – also have long track records.

GUERRA: So there were some interesting data points, but nothing really startling about the findings?

PITCHER: I hate to focus on a particular vendor’s performance, but I was a little bit startled to see how the Healthland scores outperformed the other competitors in 34 of the 39 measurements that we checked. And that wasn’t the case when we measured them, say, in an overall community hospital perspective. That is, if we’re looking at the vendors and including all of the customer base from HMS and CPSI, then that doesn’t hold true, but as soon as we filtered that out, then some of those better scores for the other two vendors fell away.

GUERRA: Break that down for me – does that mean they’re better or they’re not better?

PITCHER: I’m hedging here because what I don’t want to do is focus on one vendor. I would think it indicates to me that the technology has become more challenging for a critical access hospital with limited resources.

GUERRA: In the interviews I’ve done with small hospital CIOs and IT directors, I was surprised to hear that money was not the barrier I thought it would be. Does that make sense to you?

PITCHER: That makes sense to me in the context of recent events. I wouldn’t agree with that if we were to look at a longer timeline, and I would say hospitals typically have complained about the cost associated with technology, which is why many of these hospitals have lagged in clinicals. I think to put your comment into context we have to think of the dollars associated with meaningful use. In that case, these hospitals really feel it’s imperative to put these technologies in place, and so maybe the revenue constraints are less important at this juncture.

GUERRA: I did hear a lot of trepidation about CPOE, and getting the independent physicians to embrace it.