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.