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

PITCHER: There are a couple of elements there. One, almost irrespective of the technology you’ve put in place, physicians tend to be resistant to this because it impacts the way they have done business for years. They don’t want to see themselves as order-entry clerks or putting data in. So therefore, the customers across all of the vendors’ customer bases face that same challenge. It’s a little easier if you’re dealing with the hospitalist, a physician who is employed by you, then you can mandate use. But if they’re not, how do you get those physicians to use it? So the key is to have technology that is simple, intuitive, easy to use, and that’s where the vendors in this area struggle.

So we show some good adoption, especially CPSI with CPOE, but there isn’t necessarily a lot of physician affinity for the technology. And then, as it relates to Healthland and HMS, it’s really hard for us to measure physician affinity because they don’t have a lot of measurable sites. I think each of them had a couple of CPOE sites.

GUERRA: One of your main findings was that small hospitals are generally not happy with the vendors. I was surprised by that because I expected them to be more passive. Does that make sense?

PITCHER: It certainly does make sense and, as the study pointed out, there are not a lot of benefits to a hospital of this size tackling integration because it adds layers of difficulty. They don’t want to deal with interface engines and HL-7 messaging. So they really are seeking a single-vendor solution as much possible to reduce the amount of resources they have to put into managing this technology.

GUERRA: You talked about the architecture, which was interesting, and it seemed like the vendors in this niche did not have the more advanced Web-based architecture. Do you think that’s going to be a major issue? Is that going to limit these vendors?

PITCHER: I think it’s going to be a major issue if the vendors don’t address that. I think the market is going to force them to address that if they’re going to remain competitive, and we see that already with a couple of the vendors. First of all, McKesson’s technology is newer. We see what HMS is doing with Java, and we’re watching to see what some of the other vendors are doing.

GUERRA: It seems the jump from whatever the applications were originally built in to some native Web-based environment is very difficult because it’s such a big project. It’s painful to move your customers, and you undoubtedly lose some.

PITCHER: Well, it really becomes additionally challenging when you’re still dealing with the technology that perhaps was originally introduced 20 years ago, and you’re trying to deal with new presentation layers through the Web, etc. It’s very difficult to bridge old technologies with new technologies for that presentation layer.

McKesson, for example, took a different approach. With Paragon they started from scratch, built it all over with new technology. I think that’s probably going to pay off for them in the long run.

GUERRA: It’s better in the long run, as long as you survive the short run.

PITCHER: Yes.

GUERRA: Do you have any advice for small hospital CIOs and IT directors?

PITCHER: I have some limited advice – missteps, false starts can be a killer; they can almost take the hospital out of the game because you don’t have the ability to restart CPOE, for example, or some of these other technologies. If you lose your position on the first pass with this, you may not get them back. It’s going to be critical to select the appropriate vendor and make sure the vendor offers what you need. Again, it becomes an issue of capital resources. Hospitals don’t have the ability, the wherewithal to step back and make a new selection. Timelines are critical, so good selection and good planning are critical to this entire process.