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As the HIT Policy Committee and its certification workgroup grapple with the fate of CCHIT, many discuss the importance of providing buyers with a “Good Housekeeping” seal of approval. Few, however, directly admit that what they really want is already being produced in the form of KLAS reports. Leafing through one of the organization’s two main vendor performance reviews is a fascinating exercise for any industry observer, or critical for any potential buyer of a multi-, multi-million dollar system. In light of KLAS’ unique role in the industry, HCI Editor-in-Chief Anthony Guerra recently grabbed a few minutes with President Adam Gale to talk about the trends roiling healthcare IT.
GUERRA: We see deal after deal going to Epic. It seems that if you have the money, you buy Epic, if not, you pick from among the rest of the vendors. Is that overstating it?
GALE: Epic isn’t for everyone, but if you were to bet on a company that will help make you successful, Epic seems to have done it time and time again. It’s interesting for us at KLAS because a lot of these people are looking at KLAS data as they make their decisions. So we kind of have butterflies in our stomachs as we call their clients for the first time once they’ve gone live, and it is a very common theme to hear a few frustrations come out of the CIO’s mouth of, “Hey, I had real challenges with this and that,” and they’ll list two or three things, and then almost inevitably they’ll say, “But Adam, there is no one that can catch Epic out there.” We don’t make this stuff up, it keeps happening time and time again.
GUERRA: Epic seems to sign on so many customers, I wonder whether they will hit the wall in terms of being able to properly service all those organizations.
GALE: That question first came up when they signed Kaiser and Allina, and some of these big ones, all at the same time early on in their history. We’ve been asking that question for five years as we have these hospitals on the phone. There are certainly issues that come up, they have green people that customers have to deal with, they can’t possibly have the same touch at every client that they maybe had in the very early days, but their executives still have a reasonable touch with most clients. The person who sold the deal often keeps in touch with the people at the hospital where they sold it. They have amazed us at their ability to do that. In fact, we’re just about to publish here in a couple of days our sales report from last year of who sold clinical systems, and nearly 40 percent of the clinical deals out there last year went to Epic, the other 60 percent are shuffled between the other 10 vendors, which isn’t very good news if you’re one of those other 10 and you’re trying to keep pushing your product along and keep it alive.
GUERRA: Let’s talk a little broadly about the vendors in general. Although you said that the buying frenzy hasn’t started, are organizations calling their vendors to find out if the version they are on will be certified, or if the vendor will upgrade them to a certified version in time?
GALE: Yes, absolutely those calls are going on, although I think most CIOs can feel pretty confident that if you have a mainstream vendor, their product will be certified, will be CCHIT certified. It would be the kiss of death to not have that.
I think maybe what is even a more pressing question is, let’s say, you’re a McKesson Horizon client and you’re on version X today and you know that, to be certified, you’re going to have to be on Version 10.3. Well 10.3 isn’t available yet today to implement. Once it is available, there’s going to be a mad rush for resources and for McKesson’s time and all that to get this implemented. And we’re talking about a very large McKesson client based, and the same thing with Meditech with their 6.0 version. So, there’s going to be an absolute mad rush to move sites forward. With Meditech, for example, if they do 30 or 50 or 100 sites a year, that’s 10 or 20 years to get everybody moved. Doing the math, it’s very challenging to see how people will get to these current versions that aren’t even available yet.
GUERRA: Absolutely, and even after it’s turned on, if there’s a significant difference between the new version and the one you’re currently on, you need to have everyone get trained, and you also need to re-map all your interfaces to associated software, right?
GALE: It’s going to be huge just to get it turned on and live. It will be even bigger if, let’s say, you’re not yet live on CPOE because then you’ve got a lot of work to do just internally, a lot of political work and a lot of building of order sets. It takes a huge amount of internal effort to go live with CPOE, and that must happen concurrently with the implementation of these new versions, or it happens after the fact and takes a year or two.That puts you well into, I don’t know, 2012 or 2013, or I don’t know where that puts you, but it doesn’t happen in 2011.
GUERRA: What are your thoughts on the possibility that meaningful use will be defined as something that cannot be accomplished in a short amount of time at smaller, rural hospitals? Where should the bar be set?
GALE: I think, as a general rule, KLAS supports a fairly high bar, an aggressive bar, because if we’re all, as taxpayers and as individuals, paying this money to move the bar forward, for heaven’s sakes let’s move the bar forward. I think there should be a stair step approach which might require that in the first three years you get to 50 percent CPOE and then closer to 100 percent over 5 years, so you have a chance to ramp up. So, I think there are some real things that add benefit right off the bat that you should get paid extra money for. Regarding people that can’t get there, I don’t know if they should be punished, but there should be a benefit to the people who can get there.
The challenge, as I saw in the meaningful use definition, is that they weren’t trying to focus on the biggest wins. They weren’t focusing at all, they were going after everything: “We want personal health records, we want you to send alerts to people when they need to come in.” Many of those are impossible in the first year. I mean, we’d like to see a little more focus on the things that will make the biggest difference and actually advance the care of patients, and then, maybe moving towards the out years (2013/2015), towards a personal health record that’s portable. As far as I know, that would be incredibly difficult to get to in 2011 for most health systems that are just dabbling with (Microsoft) Health Vault or Google.
It’s challenging. I mean, there’s 50 different pieces they put into meaningful use. I’d rather see five and some incremental depth around what must be done to receive these funds. If they did that, we might see real progress. For example, whereas we’re at 15 percent of hospitals doing CPOE today, it’d be great to be at 70 percent at the end of this, so you can say, “Hey, we actually did move the bar and moved the needle with the $20 billion we just spent.”