With T&E trimmed, just as it is in all organizations, HCI editors rarely get a chance to interview sources in person. But when our source turns out to be a fellow New Yorker, it’s time to take a cab across town for some real one-on-one time. I was lucky enough to do this recently, and have one of my best interviews of the year as a result, when I linked up with NYU Medical Center CIO Paul Conocenti. The result? An engaging look at a major medical center overhauling its IT environment to completely integrate the continuum of care. — Anthony Guerra
GUERRA: I always thought if you wanted to get everything from one vendor, GE and Siemens would be particularly attractive because they also have modalities, but you went with Epic, is it because PACS and modalities are easily plugged in, and you don’t need them really integrated?
CONOCENTI: My thoughts are that the big guys like GE and Siemens are just that, they’re really big guys and somehow they have not been able to build software that can compete with these other major vendors. They’re trying, and Siemens is trying to build software from the ground up and there’s nothing better than German engineering, except it takes a hell of a long time to get there. I think it’s wonderful, but it takes a long time.
GE just feels they can buy everybody and piece the stuff together, and that hasn’t worked, and they, in my opinion, Six Sigma-ed themselves into being paralyzed. Now, these are great institutions when it comes to medical equipment; but the reality is that there are adaptors and plug-ins for these devices, if you will. At the end of the day, they’re devices that are streaming data. And they are not as integral to the workflow for taking care of patients as these other systems.
So, I could plug in GE, I could plug in Siemens, there’s standard adaptors, and in fact, Epic and Eclipsys and many of the other vendors use the same third-party software that does the adapting, so that if you’re in the ICU, you’ve got electronic charting right off the modalities in a PACS environment. Now with 3D PACS coming onboard, it’s more important these days, so right now there is a different strategy. Siemens’ strategy is that they’re going to tether the PACS with their RIS system, but what’s happening is that the PACS technology has advanced so much that the worklists that are normally associated with a RIS are now embedded in the PACS, and so you don’t need as much power in the RIS because you’ve got it in the PACS.
So, now with an Epic, which is really a fine radiology information system but is not a PACS system, plugging into a PACS you can now have a choice — you can go with AGFA, Siemens, what have you, you can pick the best 3D PACS because those things are now embedded.
These modalities, whether it’s in cardiology, or in radiology are, at the end of the day, the device plug-ins to the clinical information system. The thing that physicians work on while taking care of patients which allows them to document a 15-minute encounter while looking the patient in the eye requires different sorts of design.
And so, I think the Siemens and the GEs, although they were positioned five years ago to take the market — I mean, they had the game, okay, they made a couple of poor purchasing decisions in my mind and, in some cases, took too long delivering product, that would be the Soarian (Siemens) thing — have left the market open. They’ve delivered some good stuff, but not enough, not fast enough. So, we can’t wait.
And now you go into the home and Microsoft, with its HealthVault, has gotten some really nice adaptors into the home appliances, whether it’s a scale or insulin measurement or what have you, they’ve got a lot of device adaptors. And they’re adaptors that can plug into things. And so it really becomes a device that you’re integrating, and there are so many different devices, which is fine, as long as you have the adaptors.
The clinical information systems that house the data are really where you’re getting the efficiency and you’re getting all the decision support rules. A rule might say, “This patient has this allergy and is of this particular heritage; and you’re trying to do this drug and that’s not going to work because of this research.” That’s embedded in the clinical information system, not the modalities, which are just capturing data at the end of the day. That’s the heart. The difficulty in interoperating that data over interfaces is that each of these systems and each of the implementations of those systems are different. I could have Eclipsys here, and I could have Eclipsys at Presby and I guarantee you, the data in our two systems are totally different.
GUERRA: The same product used differently.