Buyers Beware
I’ve recently come to the unfortunate conclusion that the old saying of “If you build a better mousetrap, the world will beat a path to your door” no longer applies, especially in the healthcare information system world. We are seeing an alarming trend of healthcare facilities whose administration is being convinced by the large ‘single source’ vendors to abandon their ‘best of breed’ products and switch to ‘single source’. The primary motives behind such a move are; 1) claims of ‘total integration’ and 2) claims of elimination of interfaces.
I totally understand the concept of ‘single source’ but I would argue the point that most vendors who claim ‘total integration’ are, in fact, not totally integrated. Likewise, I would argue that most vendors who claim they will eliminate interfaces might eliminate interfaces to 3rd party products but they themselves contain numerous interfaces so you just trade interfaces for interfaces. If I were a facility contemplating making a switch to ‘single source’, I would have an expert attorney draw up a contract, with sharp teeth and a money back guarantee, to make the vendor guarantee their claims of ‘total integration’ and their ‘elimination of all interfaces’. Ironically and sadly, that would eliminate many vendors from consideration.
The worst parts about ‘single source’ vendors are; 1) they usually have one or two core components that are strong while the rest of the components are very limited in their capabilities, 2) once you commit to a ‘single source’ vendor, there is no turning back regardless of how bad their product and/or service proves to be and 3) having all your eggs in one basket. Thus, even though the facility might save money on the surface in the reduction of IT staff, there will likely be intangible, long term ramifications that take time to become evident such as an overall reduction in productivity, a reduction in physician goodwill, a reduction in patient goodwill, a reduction in staff moral and a lack of accurate statistical data that is necessary to effectively and efficiently run a department.
As a ‘best of breed’ RIS vendor, I am deeply concerned about the future of vendors, such as Swearingen Software, who have superior products and services than their ‘single source’ counterparts. Will the Goliaths eventually push the Davids out of competition? Anybody got a stone?
Wading Through Capital Hill Waters
In February, the Obama administration announced plans to give nearly $1 billion in grants to help health care providers implement health IT systems.
Funding for the awards comes from last year's federal economic stimulus package (Johnston, Bloomberg/BusinessWeek, 2/12).
The grants aim to extend health IT access to more than 100,000 hospitals and primary care physicians by 2014, administration officials said. The funds also will bolster training programs for careers in health care and IT (Zengerle, Reuters, 2/12).
With all of the confusion surrounding Health Information Technology for Economic and Clinical Health Act (HITECH or “The Act”) and the Meaningful Use EHR Certification Criteria, we have added a class this year to the conference that specifically addresses these issues.
Although RIS and PACs cannot, at this time, qualify as an EHR by themselves, I do feel that a comprehensive EHR package will need RIS and PACS components in order to fully establish Meaningful Use. Among other things, the facilities will need the results and the order history sent to their EHR in order to meet the criteria set by the the Office of the National Coordinator for Health IT.
Other items within our system that help to meet the criteria are:
- Computerized physician order entry.
- Drug Allergy information.
- ICD-9 reasons that can be associated with the current and active diagnoses.
- Recording of demographics.
- Provide patients with electronic copy of their health information.
- Capability to electronically exchange key clinical information among providers of care and patient authorized entities.
As Swearingen Software continuously updates our product to meet customer needs, we will be reviewing the additional criteria closesly in order to ensure that we provide as much information as possible to further meet these recommendations. If there is a way that we can help your facility to meet these criteria, please don’t hesitate to let us know.
Awards for Sale
OK, the KLAS “Top 20 Best in KLAS Awards: Software & Professional Services 2009” report was released today (December 15, 2009). Of course, as a radiology information system vendor, I went straight to review the radiology winners. Before I go further, you should understand how KLAS works. KLAS surveys customers of various healthcare information systems. A product must have at least 15 customer surveys in order to meet KLASs’ minimum requirement for the “Best of KLAS” award. Products with fewer than 15 surveys are asterisked and are not eligible for the award. KLAS will survey a few customers at no charge in order to list them on their site. But, in order to have the asterisk removed, a vendor must pay KLAS to do more surveys. KLAS also requires there be at least three non-asterisked vendors in a given category before that category is eligible for the “Best in KLAS” award. Thus, KLAS encourages vendors to pay to have the customers surveyed of, at least two of their inferior competitors, in order to remove their asterisks as well. It should also be noted that KLAS charges vendors an annual fee to view their own data. The fee is calculated as a percentage of that vendor’s annual revenue. Thus, larger companies pay more than smaller companies to view KLAS data.
KLAS first contacted Swearingen Software back in July of 2003. At that time, there was just ONE Radiology category (not three as there is today). They said that if we ‘pushed’ our customers to their website to fill out the surveys, they would not charge us since they didn’t have to pursue them. I liked the concept of KLAS, agreed to the offer and notified our customers to go to their website and complete a survey. Swearingen Software immediately achieved the highest scores in the Radiology category and was poised to be the sure-fire Best in KLAS winner for 2003. Two months before the 2003 Best in KLAS awards were to be revealed, I was contacted by KLAS who informed me that, due to Swearingen Software, they were splitting the Radiology category into a Small (<200 Beds) and a Large (>200 Bed) categories. Since most of my customers were under 200 beds, they were moving our data to the Radiology Small category where no other vendors currently existed, thus, making us ineligible for the Best in KLAS award.
Fast forward to March 2004. In order to get Swearingen Software relisted in the Radiology Large category, I informed KLAS that I had over the required minimum of 15 large customers. I further told them that 14 of those hospitals were part of one large IDN. They said they have a policy that if you have a written contract with an IDN, that their scores will only count as one. I told them we had no such contract and that each hospital in that IDN could pick whichever RIS they wanted. They were satisfied and agreed to survey my larger customers. A couple months later, I received another phone call from KLAS. This time, informing me once again, that due to Swearingen Software, they have created another new policy. The new policy was that it didn’t matter if you had a written contract or not with an IDN, they all counted as one score. Again, we were knocked out of the Radiology Large category.
Fast forward to December 2009. KLAS now has an award titled “Segment Leader” for those categories where there are not at least three non-asterisked vendors. The “Segment Leader” in the Radiology Ambulatory category this year went to a vendor who happens to be asterisked. Upon receiving the KLAS eblast, I contacted one of my customers and asked them to compile some KLAS data for me. Turns out that the winning scores slightly edged out those of Swearingen Software. I then turned my focus to the Radiology Small category. Swearingen Software had the highest scores in the Radiology Small category in all three sections (PRIMARY INDICATORS, DETAIL INDICATORS and BUSINESS INDICATORS) but the “Segment Leader” award was given to a vendor whose scores ranked 7th out of the10 vendors in all three sections! In the KLAS eblast, they did not disclose how the “Segment Leaders” were selected. I, along with most readers of the report, assume it was the vendor with the highest scores in that category. WRONG!
My customer informed me that upon closer inspection of the Top 20 KLAS report on the KLAS website, a small note is shown below the “Segment Leader” chart which states: “Other solutions must have at least two products that meet the KLAS minimum for statistical konfidence in order for a product to earn category leader status.” OK. So let me get this straight. It’s possible for a vendor to have two non-asterisked products (even if they are the absolute worst scores in their respective categories) AND they can have the absolute worst score in a different category AND they can still win the “Segment Leader” award for that category. Hmmm. Does anybody else hear the clanging of lots of coins? That means that a vendor with the absolute best scores in a given category can be beat by a vendor with far worse scores. Isn’t the purpose of KLAS to identify and reward the best vendors on the basis of customer satisfaction? KLAS certainly wants you to believe this but clear and undeniable evidence tends to paint a different picture.
Simple questions: Who monitors KLAS? Who audits them? What independent source verifies their data to make sure it is accurate and fairly represented since they seem to have influence over some buying decisions. Answer: Nobody. My conclusion is just four words… Wanna buy an award?
If you have any stories about KLAS that you would like to share with us please feel free to post them in this blog. Maybe, together, we can make a difference.
Randall Swearingen
Survival of the Fittest
RSNA has a long history serving the industry with both educational sessions and technical exhibitions. It dates back several decades and with many years of successful growth in both attendees and exhibitors. But while the official show statistics are reportedly available in January, (albeit long after our attention span has lapsed) even to the casual observer this year’s RSNA was lean. The fact the annual rad-fest drew 100 first time-exhibitors is interesting but doesn’t necessarily compute to an industry growing. I mean, after all, wasn’t one of those first-time exhibitors was a therapeutic massage company?
Don’t get me wrong, I’m not bashing the industry I’ve dedicated my company and my career to. Overall, I see some significant changes at the RSNA this year that reflects a ‘thinning out’ of the RIS and RIS/PACS marketplace. There was a lot of empty floor exhibit space that was historically fully booked. This is primarily a result of the current economic times (companies going out of business or cutting back on their unnecessary expenditures).
It is now, more than ever, a ‘survival of the fittest’ world in the radiology field. The companies, like Swearingen Software, with years of experience, solid products and services and a significant recurring stream of revenue, are surviving. The others, who depend upon new sales, are slowly but steadily disappearing or being absorbed by the more successful companies.
The fittest in the industry should weather the economic storm and continue to invest in their products and their customers, and survive. Whether you’re considering replacing a RIS, PACS or both, I encourage you to look for a survivor - a vendor with passion and one who is fit for the challenge. The last thing a buyer needs is to invest hundreds of thousands of dollars on a RIS or RIS/PACS only to find that company out of business soon afterwards.
I welcome your comments.
Randall
The Power of the Web
Last week we announced the release of our new RISynergy Web Products Suite. I don’t usually write about our products directly in my blog, but in this case, I’m very pleased to share with my blog readers as the response from our customers and the industry has been very positive. You might have seen coverage on Auntminnie.com or HealthImaging.com.
Our customers have spoken and once again, we have listened. Based on their input, we’ve selected components for the web that make the most sense from a workflow perspective as we plot our course for the future for a total web-based product.
We realize that the web can play a very important role in facilitating radiology workflow. By extending the functionality of our widely deployed RISynergy Radiology Information System, our customers can utilize the web more effectively to reach users. The Web Products Suite includes the updated release of the Web Schedule Requestor and Web Results Viewer. The Web Schedule Requestor contains additional functionality to ensure data validation and improve ease of use. The enhanced Web Results Viewer now has the ability to display PACs images.
Our newest RISynergy Web Products Suite also includes the Radiologist Signoff and Scheduling modules. The radiologist sign-off feature allows radiologists to receive the results regardless of location, allowing them to edit, approve and forward the results. The Scheduling portion of the RISynergy Web Products Suite allows approved referring physicians offices to schedule select procedures for patients online.
I hope to see many of you in a couple of weeks in Chicago at the RSNA convention and show the RISynergy Web Product Suite in person. I look forward to seeing you – our booth # is 6019.
I welcome your comments.
Randall
Integrate – Interface – Connect: What does your RIS vendor mean when they say they can do all of these?
CONNECTIVITY
Today, in order to share important information, RIS systems connect to numerous other systems such as the Hospital Information System (HIS), billing system, PACS system, Voice Recognition system, etc. Most of these interfaces are accomplished through the use of HL7. Sounds simple right? The problem lies in the fact that there are numerous flavors of HL7 that are all considered “standard HL7”. An analogy would be radio waves. Yes, you can listen to any radio station but your radio has to be able to receive different frequencies of radio waves. Imagine what would happen if a radio manufacturer produced a radio that would only pick up one frequency. The radio salesperson would say, “Yes we have a radio and it works great.” What they didn’t tell you is that their radio will only pick up one, and only one, frequency. Thus, you can listen to any station provided that you somehow convince the station to transmit at that one frequency. They didn’t lie to you. They just didn’t disclose the whole truth. Unfortunately, the same is true for HL7 interfaces. A vendor might claim they will send (or receive) standard HL7 messages but they only accept/send one variation of HL7 and they expect the other vendors to adapt.
Here are some connectivity questions that will save you a lot of headaches in the future:
1) Are your interfaces flexible enough to adapt to most variations of HL7? Often, when you try to interface two systems via HL7, you find that the two systems are incompatible in some way. The worse case scenario is when each vendor says the other vendor must be the one to change and you have a stand-off. You have to have a plan for this event before you commit to purchase a RIS.
2) What are the costs associated with interfacing to other systems? Is there a cost per connection, cost per system or cost per transaction? Interface costs can sometimes exceed the license cost of the RIS. Also, what are the annual support costs for these interfaces?
3) What mechanisms does the vendor have in place to track/debug interface issues? It is imperative that the RIS communicate effectively and efficiently with other systems. Sooner or later, the interface will experience problems. It is important to know that the vendor has tools and experience in handling such issues. In fact, when you call a vendor’s referral customers, it is a great question to ask how often the interfaces go down and what is the average length of downtime per occurrence.
Bottom line: Find out, up front, if the vendor is able and willing to interface to your other systems and also, how much the vendor will charge you to interface to each of the systems it needs to communicate with. What connectivity guarantees, if any, do they offer?
I welcome your comments and responses.
Randall
Our customers mean the world to us- to our past, our present and our future
Our customers truly do mean the world to us. They’ve shaped where we’ve been, where we are today and where we’re going. Through their participation with us at our annual user’s conference and the twelve months in between, we gain critical input into product enhancements and features to improve our customer’s value and use of the Swearingen RIS. Without their input the Swearingen RIS would not be the product it is today. Our customers are also critical to our future as without their strong support and endorsement we could not land new customers.
Today I’m writing about the importance of customer referrals and customer participation in the success of Swearingen Software. If you’re one of our long-standing customers, let me thank you again for your support. If you’re not a Swearingen RIS customer, maybe you should be – visit our website www.swearingensoftware.com and read what some of our customers have to say.
CUSTOMER REFERRALS
Checking out referrals is probably the most important due diligence activity that you will ever perform during the RIS selection process. Your facility is about to make a huge investment in dollars, time and energy. It just makes good business sense to talk to their existing customers because referrals are the absolute best way to get the skinny on vendors and their products. Unfortunately, when you ask a RIS vendor for a list of referrals, what do you get? Most vendors will give you a very short list of less than five referrals. Guess what? Those referrals will NEVER tell you something bad about the product or the company because those are the vendor’s ‘A’ list with whom they have some type of referral agreement with. On the other hand, a vendor who gives you a large list of referrals (20 or more) are much more likely to have great products and thus, happy customers.
Bottom line: Want to get the real scoop on a RIS vendor? Ask for a list of at least 20 referrals and talk to at least two people per referral site. Yes, this can be time consuming but all the time that you spend, up front, doing your due diligence will pay tremendous dividends later on.
CUSTOMER PARTICIPATION
Most vendors have a users group and an annual user’s conference. It is important to verify this because customer participation in a RIS product is crucial to that product’s long term success. Here are a couple of questions that will tell you volumes about a particular vendor:
1) What percentage of your customers attend your annual user’s conference? The average user’s conference attracts roughly 20% of a vendor’s customer base. If the level of participation is less that that, it should be viewed as a red flag because it means that the customers do not consider the conference worth while. On the other hand, if the participation level is above 20%, that means that customers believe that the conference has significant benefits.
2) Do you hold customer brainstorming sessions during the conference? The reason behind this question is simple. Who uses the RIS, you or the vendor? Then, why should the vendor decide which new features to put into their software? In an ideal world, the customers should be able to vote on future product enhancements. The next related question would be, “What percentage of ideas that received a majority of customer votes, actually get implemented into your RIS?” Maybe the vendor accepts customer ideas but does the vendor actually follow up on them? Another important related question is, “What is the average amount of time that it takes to implement a customer voted request and is there a cost associated with it?”
Bottom line: Are customers allowed to participate in product design and direction (and to what degree)? This will let you know just how customer-focused the vendor really is.
I welcome your comments and responses.
Randall
Giving back to an industry that has given much to me.
I know Thanksgiving is still a month away but the “giving” season has started early for me. I announced earlier this week that Swearingen Software would give away a RIS to a deserving hospital or clinic. You might ask why in these economic times would I give away a RIS? Well, the answer is pretty simple. You see, I’ve been fortunate to be a part of the healthcare industry for a long, long time. Because of my good fortune with Swearingen Software, I want to give back to the healthcare industry that has enabled my company to grow and thrive over the past quarter century.
And because the economic climate is as dismal as it is, I know that purchasing healthcare information technologies is difficult, if not impossible. So, we have decided to hold a contest and give away one free RIS to a "hardship" radiology department. In this case, we would like to award a hospital or clinic that has fallen on difficult economic times, our state of the art RIS. This contest includes the RISynergy software, installation and training, and one year of our superior customer support for free. This is our way of helping with the American Recovery and Reinvestment Act.
This contest will begin Monday, November 2, 2009. You can find more details on our website, www.swearingensoftware.com. You may know someone at a hospital or imaging center that needs a RIS. If you do, I’m sure they would appreciate hearing about the giveaway. The final date to enter the Hardship RIS Give-Away will be Thursday, December 31, 2009. I think you’ll agree with me that Swearingen employees and customers would be best to make the decision of who receives the RIS and we will announce the winner on Monday, February 1, 2010.
Oh, and for the cynics in the crowd who question why I’m doing this, I have just one response for you – what are you doing for your industry?
We can all recall the question posed by one of our country’s most infamous presidents as he challenged a nation to ask not what their country could do for them, but what they could do for their country. The question made sense to me then. It makes sense to me now to give back to an industry that has given much to me.
I welcome your comments and responses.
Randall
Understanding the true cost of your RIS – it may be more than you think.
COSTS
When you ask a RIS vendor for a price quote, what do you get? You generally will receive a quote that outlines the upfront cost and annual support cost for that particular system. What about the less visible costs such as software upgrade fees, hardware upgrade fees, custom programming fees, license renewal fees, etc.? Not knowing these fees can create major headaches when unbudgeted expenses begin to arise after the installation of your new RIS. To avoid these surprises, you need to ask these questions before you sign a contract:
1) How much do you charge for software upgrades and/or updates? It is not uncommon for vendors to charge 20% of license fees for upgrades in addition to the normal support fee.
2) How much do you charge per hour for custom programming for programmers vs. analysts, etc.? You might not think that you will ever need custom program changes to your RIS but approximately 80% of all facilities will need one or more such changes during the first year of use of their RIS. Imagine using your entire RIS budget to purchase your new RIS and then find out it will cost an additional $20K (or more) to make a software change that you really need.
3) Will my software license expire and if so, after how many years? Did you know that some vendor’s license agreements are for a specific number of years, such as seven? After that, you are required to purchase a brand new license agreement at the then current prices.
4) How often do you require that hardware be upgraded? Be aware that the cost to upgrade hardware is sometimes more expensive than the RIS license itself. RIS vendors that use generic hardware have an advantage over those who don’t because you can purchase generic hardware anywhere. If the hardware is more proprietary, you might be limited to only purchasing it from your RIS vendor and at higher prices.
Bottom line: Require that the vendor specify all the costs that you might incur over the first five years of use of their product.
Support for your RIS: Are you speaking the same language?
The language of radiology is unique to other departments or practices in healthcare. Those who run a radiology department for a hospital or who operate an imaging center will tell you that. Understanding the language of the RIS workflow is as important as understanding spoken language. Can you have an understanding of RIS workflow if you’ve never worked in a radiology environment? Can you truly speak effectively to someone in their native language if that is not your native language?
Most likely when you purchased your RIS, the salesperson told you they have excellent 24x7 support and not to worry if you have any problems. The system has just been installed and the install team has just left your facility and headed to their next install. A question comes up that you need answered so you call their toll-free support line only to find out that their support comes from Asia, India or some other non-English speaking country. The person you are trying to talk to can barely speak English (much less understand it). This is a major complaint among RIS users because many RIS vendors have outsourced their support outside the country in order to reduce their costs.
On the other hand, maybe the RIS support is coming directly from the United States but the support staff is comprised of folks who know their product, but don’t know the internal workings of a radiology department. Thus, it’s kind of like a male mammo tech performing a mammogram on a woman. They may have the knowledge but do they really understand the procedure the way a woman mammo tech would? The ideal support person for a RIS product is an ex-tech or an ex-radiology manager who has used that particular RIS product. Not only do they understand the product, they more importantly understand the day-to-day pressures and needs of the radiology staff.
Another important factor regarding support calls is the average time it takes to get a return call and the average time it takes a vendor to resolve an issue. Both of these are great questions to ask the referrals that you contact for a given RIS vendor. If a vendor is understaffed in support, you might experience several days before receiving a return call.
Bottom line: Make sure you know who you will be dealing with in regards to technical support for your RIS. Are they radiology knowledgeable? Can they speak understandable English? Is there ample support staff? What do existing customers think about their support?