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Best of Breed or Single Vendor – Which is right for Healthcare Imaging?

August 23, 2013
by Joe Marion
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Which environment can best meet clinician needs and still achieve Meaningful Use compliance?

Recent consulting engagement discussions have brought the question of “best-of-breed” versus single vendor to the forefront. In one instance, different sections of the same academic department all have their own idea of what’s the best reporting solution for them. And it’s not just academia. I am starting an engagement with a county hospital that has three distinct vendor solutions within the same cardiology department!

The argument comes down to giving the clinicians what they want (best-of-breed) versus the impact on information systems and the ability to address Meaningful Use. Is there a way to achieve both, or does one naturally win out? That is the $64,000 question.

Let’s take the hypothetical case of an academic radiology department that wants to serve multiple satellite facilities. For various reasons each facility may have made separate decisions on a Radiology Information System (RIS) and Picture Archive and Communications System (PACS), and have different Hospital Information System (HIS) environments. The objective is to enable a singular radiology organization to “manage” all of them in a cohesive manner.

The brute force solution would be to change out all the RIS-PACS to a consistent environment with a common database, and rely on a common patient identifier. Practically speaking, this may not be possible, and it may be necessary to make disparate systems interoperate.

In another hypothetical example, a cardiovascular department has three separate reporting systems, one for interventional, one for non-interventional, and one for vascular. How does one get all these reports into an Electronic Medical Record (EMR) for reporting purposes? Or, does management put their foot down and dictate one reporting solution for all sections?

There is no simple answer, but suffice it to say, in today’s Meaningful Use environment, compliance is going to require a consistent patient identifier, and a means to insure that all data is available to the EMR. In some environments, this may be best accomplished by a single system architecture that may compromise the section benefits for the benefit of departmental compliance. In other environments, it may still be possible to have best-of-breed applications that can interoperate.

Usually reaching a position involves understanding clinician needs to determine if prior decisions were made on a realistic or a preferential basis.

Oftentimes staff turnover can be a factor. Doctor A liked this solution, but now Dr. B comes from another facility and he likes another solution because that’s what he used at another facility. The trick for Information Technology (IT) is to identify how much of clinician desires can be achieved in a singular system environment, versus the cost of supporting interfaces to multiple systems. If MU can’t be achieved with multiple systems, there will need to be compromise.

I recently read about concerns for overall healthcare under the Affordable Care Act becoming too mechanized – taking away the individual decision making of physicians. One could make the same argument for limiting IT clinical system choices. It would be ideal if we could come up with some valid test criteria to assess what is personal preference and what is hard core differentiation in functionality. Short of the ideal, we will need to rely on effective communication and collaboration between clinical users and IT staff to achieve a workable compromise. I am excited about the prospect for upcoming engagements to provide greater insight into validity testing and compromise, and possibly better tools for choosing between system options.



Single vendor architectures have the reputation of tying you to their integration/feature schedule which may or may not allow for compliance with regulations or physician preference. The ‘sale’ is that they provide the integration internally and call it their own. The net result has not always served the interests of IT and those they serve.

I agree with your post that there is not a universal solution or strategy. However healthcare IT/clinical IT has to be forward thinking and not allow them to be held hostage by the fear of integration of disparate solutions. Far from a panacea of complete transparency, we are not facing multiple user interfaces (the bane of historic best of breed) but instead able to find opportunity for integration and flow of information among applications. Databases and solutions with rules that trigger data flow are much more common among digital solutions today.

So I would submit for discussion that open system integration as an approach is not an option and should be part of any new acquisition strategy or go forward Clinical/IT plan.

With the pressure within an institution for best of breed for whatever the reason - physician preference or regulatory - we have to consider that integration beyond a department, between organizations is being pressed into the mind map of IT as Accountable Care rears its' ugly head. The new mantra for service providers in healthcare demands that information be shared and analyzed across institutions/care providers.

The result therefore is preparing for a dynamic IT/clinical tool requirement and taking control of healthcare data and not allowing it to be homogenously managed by a monolithic environment. If I were still consulting, I would present a strategy to build a flexible clinical/IT infrastructure that promotes sharing of data and allows for the dynamics of what clinical teams/IT have to support.

Open for critique. Thanks for listening.

This is a very timely topic.

Health Systems seem desperate for a single Radiology Service Line view but so many of them are 2+ years away from sharing the same HIS/RIS to enable it.

Many of them are "held up" waiting for their Monster EMR rollout to complete (including the RIS at the end of that Health System wide rollout).

They want visibility, they want the ability to measure value and compare their different radiology groups or hospitals to each other and to other similar groups.

The recurring themes that I see missing when talking to folks in the market about this topic are:

1) What is the goal of the Tech Stack (irrespective of best of breed or monolithic)? Said another way; the Tech Stack= "the How" but the Operating Plan="the Why". A lack of clear agreement (from the health system and the radiology groups) on the "why" seems to be commonplace.

2) The understanding of the need for normalized inputs (again irrespective of best of breed or monolithic).

Great topic.
Thanks for letting me share.