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Getting Together

August 31, 2009
by David Raths
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As changes in policy and meaningful use are made, decisions on financial systems increasingly depend on integration with clinical

Paul Pitcher

Paul Pitcher

There's no doubt it's an exciting time to be working in health information technology. In fact, the effort to create a nationwide network of interoperable electronic health records by 2014 has been compared to NASA's manned spaceflight mission to the moon in the 1960s.

As hospitals prepare to respond to proposed funding and regulatory changes, the focus is on demonstrating the meaningful use of clinical software. But that doesn't mean healthcare executives can neglect decisions regarding financial and administrative systems. The purchase of patient accounting systems has taken a back seat to upgrading clinical software for the past several years, but the push for system integration and looming regulatory changes may put additional pressure on hospitals to upgrade their financial systems. And with several large vendors rolling out new financial platforms, the degree to which they are embraced by early adopters will be key to long-term success.

With the pace of change in the industry accelerating, the “KLAS 2009 Mid-Term Performance Review: Software & Professional Services” report provides a fascinating snapshot of how providers see the vendor world. Specifically, the report lays out each vendor's product line and the performance score of each product and service in its offering. The overall score fluctuations reflect more than a particular product's feature set or a company's trajectory; they also signal the evolution in CIOs' and CFOs' mentality about how patient accounting, ERP (enterprise resource planning) and business intelligence tools interact with clinical information systems.

With customers increasingly interested in one-stop shopping, software providers are being pressed to demonstrate tighter integration between EMR and patient accounting systems. “It will be interesting to see how all the focus on clinical systems and the definition of meaningful use of health IT will impact the decisions on patient accounting systems,” says Mike Smith, general manager, financial and services research, KLAS (Orem, Utah).

What follows is a look at the Mid-Term Performance Review with an eye on trends in key financial system segments.

Patient accounting

By average overall score, patient accounting and patient management ranked 20th out of 24 software market segments in the mid-term review. Clearly, customers are dissatisfied with at least some aspects of their implementation. “The systems in place are aging,” says Bruce Hallowell, partner and director for revenue cycle solutions at Falls Church, Va. consulting firm, CSC. “Hospitals are solving problems with bolt-ons, which is turning out to be a failed strategy.”

In terms of outliers, Epic's Resolute Hospital Billing application (see page 4) had the greatest positive distance between its score (86.69) and the product segment average (74.19). The largest upside change from its year-end score came from Eclipsys' Sunrise Patient Financials (see Figure 1), which rose 6 percent, to 75.55.

Some of the lower scores in the patient accounting segment reflect legacy products using older technology, says Paul Pitcher, KLAS' director of financial systems. Providers would like greater levels of sophistication in how the systems handle transactions, but the pace of change is slow, Pitcher says. “Once they have invested millions in a system, they don't make a change lightly,” he stresses.

CSC's Hallowell agrees: “You are dealing with people who are risk-adverse anyway,” so when they do make a switch, it is sometimes because they are being dragged along by changes in clinical systems. “When you look at the KLAS report, the No. 1 (patient accounting platform) in terms of quality is Epic, but McKesson and Siemens still own the marketplace,” he says.

KLAS Chart Legend

And although many of the other vendors are offering similar solutions, Epic's high scores reflect the fact that “people say that Epic is more nimble at turning around process improvements,” Pitcher says.

Ones to watch

Some of the vendors that have struggled with new offerings, such as Siemens and Cerner, are showing signs of a turnaround. “Some customers say they like the direction those products are going, and that they are starting to deliver,” Pitcher adds.

Susan Bresee, director of business development at Ingenix Consulting's healthcare solutions delivery group in Eden Prairie, Minn., says she believes GE (see page 4) is a company to watch in this space.

KLAS Chart Legend


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