Lutheran Medical Center (LMC) is part of Brooklyn, N.Y.-based Lutheran HealthCare, an organization which also includes the Lutheran Family Health Centers network and Lutheran Augustana Center for Extended Care & Rehabilitation. LMC is a 476-bed Level I Trauma Center providing ambulatory surgery, cardiac care, neuroscience services, obstetrics/gynecology, spinal surgery, perinatology (maternal/fetal medicine) and oncology (cancer diagnosis and treatment). Recently, HCI Editor-in-Chief Anthony Guerra had a chance to talk with CIO Steve Art about his facility’s plans to implement the VA’s VistA open-source software supported by MedSphere.
AG: I’ve heard a few commonly cited reasons for why open source hasn’t taken off. First off, I’ve heard that CIOs too closely aligned, or dependent, on the traditional vendors – they’ve either worked for them, or may want to work for them someday and so they want to stay in bed with the usual suspects. Or because it’s easier to have a huge cadre of people to be able to call, you're not going to get fired for hiring Epic or Eclipsys.
SA: Yeah, the IBM syndrome is true. That is really true, and I think it’s wrong. I tell they story a little differently. I have McKesson here as my vendor, and every time I would need something done by McKesson that I know was just a little, little thing, they charge, no matter how big or little – they charge me to give me quote. They charge me $174 an hour just to give me a quote. Whatever it takes to them to build a quote, it cost me money. Then, if I decide to do the work, then they charge me additionally for that.
I recently put in a work order to make a change to an existing interface. I wanted to add one piece of data to the working interface. They came back to me and the programmer said it was going to be a zero charge, as it was just adding one data element to an existing interface. McKesson sent me a bill for $261 for them to tell me that there was no charge.
This is on Nov. 4, 2008, the bill came out and the due date was Dec. 5, 2008. So I said, ‘Why do I have to pay $261 for somebody to tell me that this isn’t going to cost me anything?’ And that’s the relationship that we have with our vendors. Yeah, their argument is that we have to keep it all closed so that we keep control over everything, and I appreciate that they have to keep some control over it. But every time I asked for any little thing, it costs me money. The thing I like best about open source and — anybody who has got any brains is going to figure this out over time, and I think that these guys eventually are going to change the industry — is that when I want a little change done like this, adding an element to an existing interface, my programmer can go ahead and make that change for me, and I don’t have to pay anybody, I don’t have talk to anybody, I don’t have to think about it. And that alone is worth a fortune because we make these changes all the time.
AG: So why do you think it hasn’t taken off?
SA: Because the world doesn’t believe there are enough of us that have done it yet successfully for them to see that it’s safe. I think that’s the issue. Medsphere now is in a bunch of places; they’ve got 200 Indian Health Service sites and about 11 hospitals now. Most of those places are pretty small. There’s one big guy in Midland, Texas and me in Brooklyn, and I think when we get up and there are a couple more up, I think what everybody is going to see is that this is really doable and it really works and there is no reason to be fearful of it. The guys right now are fearful because there aren’t enough of us that have done it.
AG: Once people get over the fear, isn’t it still more work for the CIO to go this route?
SA: No. The money, the affordability, is the driving thing in open source. Remember, the software is free here. There aren’t a lot of hospitals that are making enough money that can spend $10 million for a system. How many players want to spend the money on that stuff? The stimulus is making it easier because you get back some of it, depending on who you are, but I think the big guys are going to stay with those big systems because of the IBM issue. But I think the majority of people who think will buy open source. You haven't seen it yet, but this system is as good or better than any other system out there. I’ve seen them all.
AG: So companies like Medsphere — and I don’t want to just trump up Medsphere — but companies that, would you say they take the risk out of this for the CIO because you do have that support?
SA: I've said this already, it’s the same relationship I had with my vendor as I had with all other vendors. They are doing all the other stuff that normally a vendor would do and I’m doing the stuff that I can do, and if I want to take on more, I can. The relationship is I can do more if I want to, I don’t have to. And for some of their small clients, the client does nothing, literally does nothing. I’m doing more because I’m able to do more and I want to do more because I want to see this thing go. That’s why I’m building the tracking board for ED and that kind of stuff. But there is no requirement that I do that. I don’t see this is being any more difficult than putting in McKesson or Eclipsys or Epic or anybody else. This is no different.
AG: Would you call this decision a no‑brainer?
SA: This is a no‑brainer. I was at the Marcus Evans event a couple of weeks ago, and I made my presentation on EMRs and put up the slide and said, ‘This thing cost me $37.16,’ and you could see everyone’s mouth open. I’m talking to CFOs. Their mouths were hanging open. Someone asked, ‘Why does my CIO want to buy Epic or Eclipsys or the other big guys if they are free to take this chance that you’re taking about?’
I said, ‘I think that is exactly it, because it still is a chance in their mind,’ but the fact is, if they got into it and learned it, they would see what I saw. I mean, I see it.
One of the really interested things I saw at that meaning in San Antonio is that we asked the CFOs how many of them know how much stimulus money they’re in line for and they didn’t, and that just knocked me over. If you haven’t started thinking about an EMR system yet – I’m in the middle of implementing it, and I’ll get it up before 2011 – but if you haven’t bought one yet, you are going to be hard‑pressed to have it up by 2011. These things don’t go in 15 minutes. Imagine – you're potentially replacing lab, rad and pharmacy, which are all nine month installs to start with. You're going to put in CPOE and EMR. I mean, this is not something that can be shoved in.
AG: Especially if you’re talking about training and workflow change…
SA: Absolutely. You have to have doctors putting in orders too. We never finished that conversation, but I think what’s going to be measured is how many are using the system and how many orders are going through it. If that’s what meaningful use becomes and these guys haven't started thinking about it, they’re in trouble. They also need to know about the money.
My place, the Greater New York Hospital Association, came out with a guide for all the New York hospitals, and we’re in line for something like $13 million over four or five years. So we know what's at stake for us – that money will pay for this thing over and over again. This system will be paid for with the stimulus money, but only because I started when I started and because I’m going to be live by 2011.
AG: And it’s not going to pay for it if you spend $50 or $100 million …
SA: Exactly. Most places won’t be able to afford the $50 million to start with, and they’re not going to be reimbursed for it anyway. Medsphere will charge you a quarterly fee, and the fee is based on how big you, the number of beds you have, and how many modules you buy. And then they show you when the stimulus money kicks in and you get your money back, and the return for most hospitals is less than four years. That means that the stimulus money for most places, will be enough to reimburse for the system completely. And they’ll pay it out slowly to the vendor.
When you see those graphs on your hospital and you say, ‘God, I’m going to get $6 million from the government, and it’s only going to cost me $3 million to put this thing in,’ you say to yourself, ‘What am I doing, why am I looking at $50 million?’ That is just eye opening to CFO.