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Readers Write 12/28/09

December 28, 2009 Readers Write 19 Comments

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

TPD’s Review of the RIS/PACS Relationship
By The PACS Designer

As hospitals try to get more efficient, it would be a good time to review what the Radiology Information System (RIS) and Picture Archiving and Communications System (PACS) can bring to the institution when it comes to efficiency.

First, let’s review the imaging piece, which is PACS. The main purpose of the PACS is to digitize image files for easier access and increased image sharing. While a PACS is a significant change, it does start to improve processes through more rapid access to image files. The PACS also encourages the sharing of image information with other departments.

Next, the acquisition of a PACS can be a significant draw on financial resources, as it will require workstations for each radiology department member, and other need-to-know individuals who require image file access privileges.

Weighing the cost against the benefits of a PACS, the institution can reduce film and chemical costs with a PACS, and also improve process flow for patients through quicker access to image files. These improved results have to be weighed against the financial outlay that has to be made to bring digital imaging to Radiology.

Now, adding a RIS to a PACS can further improve the scheduling of patients for Radiology procedures. The RIS allows efficient scheduling to take place through its automating of the scheduling software. The software can also highlight potential bottlenecks to alert staff to a looming problem.

The RIS lets everyone know what each radiologists workload is, and how fast equipment can be used to take advantage of each equipments efficiency features.

Another benefit of adding a RIS to a PACS is the bi-directional flow of patient information after procedures are completed and sent back to the RIS for staff review and planning.

In summary, a RIS/PACS configuration can bring great value to the Radiology imaging process, and help reduce costs overall after careful redesign of existing processes.


Awards For Sale?
By Randall Swearingen

KLAS recently named its “Top 20 Best in KLAS Awards: Software & Professional Services 2009” report. Before I list my concerns, you need to understand a few basic points about KLAS.

Their main award is the “Best in KLAS” award. It is supposed to be awarded to the vendor with the highest customer satisfaction scores in a given category (i.e. the best vendor). To be “Best in KLAS”, there has to be a minimum of three non-asterisked vendors in a given category. Vendors are asterisked when they have less than 15 customer surveys because KLAS doesn’t consider the data reliable. In addition to their “Best in KLAS” award, KLAS also has “Segment Leader” awards for those vendors whose categories don’t qualify for “Best in KLAS”.

rswearingenIt is important to note where KLAS gets their revenue because it seems to indicate a conflict of interest between serving the healthcare industry and serving the healthcare vendors. One source of their revenue is from selling their reports to hospitals, clinics, consultants, vendors, etc. Since hospitals and clinics can get free reports by completing just one vendor survey, very little revenue comes from them. The bulk of KLAS revenue comes from vendors. Vendors pay KLAS to survey enough of their customers to get the asterisks removed their products. That isn’t cheap.

KLAS further encourages vendors to pay to have the asterisks removed from at least two of their inferior competitors so that they can be eligible for “Best in KLAS”.

KLAS also charges vendors an annual fee to view KLAS data (including their own). 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.

Of course most vendors elect not to pay KLAS, which is why most products are asterisked in their database. But, those who do pay and who are awarded “Best in KLAS” play the award up big time in ads, trade shows, etc.

See the conflict of interest yet? Isn’t the purpose of KLAS to identify and reward the best vendors on the basis of customer satisfaction? Not based on how much a vendor pays?

Back to this year’s report. As a radiology information system vendor, I went straight from the e-blast to review the radiology winners. The “Segment Leader” in the Radiology Ambulatory category this year went to a vendor who happens to be asterisked. Upon reviewing the report, I contacted one of my customers, who has a KLAS account, and asked them to compile some KLAS data for me. Turns out that the winning vendor had scores that were slightly better than 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 seventh out of the10 vendors in all three sections! If you have a KLAS account, you can easily verify all of this information. In the KLAS e-blast, they did not disclose how the “Segment Leaders” were selected or that it doesn’t necessarily go to the vendor with the highest scores.

I felt compelled to dig deeper, so I asked my customer to review the “Segment Leader” section of the report and look for any clues that might explain this action. My customer informed me that upon close inspection of the Top 20 KLAS report on their Web site, 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 confidence in order for a product to earn category leader status.” (That means having a minimum of two non-asterisked products somewhere in KLAS).

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. Remember, vendors have to pay to get their asterisks removed. Hmmm. What happened to the concept of the award going to the vendor with the best scores?

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.

I think the “Best in KLAS” award should be renamed to the “Deep Pockets” award. It would be more fitting.

Randall Swearingen is founder and CEO of Swearingen Software, Inc. of Houston, TX.

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Currently there are "19 comments" on this Article:

  1. As a professor of research methods, I use the KLAS system as an ideal model of marketing over anything approaching real research. KLAS is the antithesis of responsible survey research methods. In other words, anyone stupid enough to believe anything published by KLAS deserves to suffer the effects of the millions of dollars of misdirected purchases.

  2. Very well written, Mr. Swearingen. The HIT industry is becoming one of under the table bribes, kickbacks, and politician buyouts. It goes up to the President of the United States, who is surrounded by vendors who have lobbied him with massive amounts of money. Those entities that proport to “help” docs find their perfect EMR usually are way too biased to be of any help, although I’ve found EHR Scope’s website to be interesting and helpful.

    The best way for a physician to buy an EMR is to:

    1) Buy the most inexpensive EMR that best suits one’s needs.
    2) Consult fellow docs (and your admitting hospital) about the EMR that THEY use.
    3) If your hospital has a micro-HIE using a proprietary EMR and you can function well with it, buy it.

  3. “Vendors pay KLAS to survey enough of their customers to get the asterisks removed their products. That isn’t cheap. ”

    Never heard of that before. Can we get more details? How much per customer does it cost?

  4. Bravo, Randall, Bravo! I fully agree with you on KLAS (“KLAS – where you can buy your own award”) and want to add that there are rumors that some vendors incentivise their customers for good KLAS ratings. This perverts the idea of an objective customer survey about seperating the good from the best products. I think this simply does not work when its done for profit. You need an independent association for this, not a money-focused company.

  5. Dittos to Randall…
    Let’s let the free market sort this out…Where is KLAS’ competitors? Why is KLAS the “end all” for fair and objective ratings? The best way to solve this is to not give them ink!

  6. Just to be the devils advocate, I have worked directly with KLAS representing two vendors. Yes, vendors must pay to see their scores, but not to participate. As a vendor, you can supply a customer list to KLAS, but it must be a complete customer list, not just your “good” customers. The best ways to improve your KLAS scores are:
    1. Improve your solution functionality
    2. Improve your service and customer satisfaction
    Improve you implementation processes
    3. Communicate with your customers (make sure they complete the surveys)
    4. Have enough satisfied customers before you pursue a new KLAS category or request inclusion in a study.
    5. Share your KLAS scores internally and make sure all employees understand the potential impact their own performance.

    I have found the people at KLAS to be professional and that they stick to their own rules. If you work with them, they will help you understand ways that you can improve yourKLAS scores and hopefully thereby your customer satisfaction. While they certainly should not be your only source of information for system selection, they offer a good service and a good starting place.

  7. Outstanding revelation on KLAS – which I have heard rumors about on the EHR side. I am going to direct my docs who are considering EHR selection to review this blog. Several have been intrigued by the lure of “best in KLAS” products. I am vendor agnostic, but can smell a fish when I am near it. Great job! Thank you!

  8. Also of interest is that small vendors are no longer able to compete for KLAS Top 20 stature. They may only compete for ranking in their individual product line. So – many small vendors that had Top 20 ranking have been dropped from the list replaced by inferior larger vendors.

  9. Thank you Randall for eloquently exposing some of the conflicts of interest and tactics KLAS uses. I have heard that the KLAS reports were bogus but didn’t have many of the details. I see nothing wrong with KLAS selling its reports. What is wrong is that they haven’t published the details of how the data is collected and how vendors are able to “buy” better ratings and changes to the way their data is presented (without asterisks). When you encourage survey participation by offering users free reports, that in itself is a bias. Makes you wonder if vendors “encourage” users to participate in the surveys.

  10. I became aware of KLAS after several years of implementing HBOC Star applications (now McKesson) and moving to a hospital system. I completed a survey regarding a vendor application in my facility and received access to the reports. I had coworkers who didn’t put much stock in them, but I found them to be consistent with the experiences and comments I’d heard from the many customers I had worked with over the years.

    I later went to work for a vendor who was classified as a Document Imaging vendor in KLAS and our main competition at the time was McKesson, where we went back and forth as Best in KLAS in that segment. The scoring seemed VERY accurate and consistent for all the products listed in that segment and I could even point to the comments made by my specific customers; both good and not so good. I now work for another hospital system and manage the implementation of one of the document imaging products that has continually improved and has moved to 2nd place in the health care document imaging segment and have come to believe there scores are very fair and reasonable.

    I’d like to believe that there is consistency in all the segments, but maybe that’s not the case. However, in the areas I have expertise, such as patient accounting, ADT, medical records, and document imaging and some experience in the EMR arena, I think the scores have been fairly accurate over the last several years based on comments from friends and coworkers and numerous unrelated articles in other industry journals and in HISTalk.

    I for one, will continue to reference the KLAS reports, but I would never make a decision based solely on one source. Due diligence demands proper research and a complete and properly framed RFP so you know what you need and ultimately get it. The processes we deal with every day are too complex to think we can find “the silver bullet” solution and all will go well.

  11. One follow-up note: I have never been asked by a vendor to complete a KLAS report, but I enjoy reading the reviews and have completed reports just to receive free access. I acknowledge that I have some bias, good and/or bad about every product I’ve ever worked with, but isn’t that why there has to be a substantial number of reviews in order to establish a trend?

  12. I work for a software vendor and one of my primary responsibiliites is to review KLAS on a daily basis. I must point out a few misconceptions in the article above.

    1. Although the category leader box does state that the vendor must have two products that meet the KLAS minimum in order to be a category leader, it is not true. Res-Q is a category leader, and they only have one product rated.

    2. While Swearingen software does have higher scores than the other solutions, the product rated (and the only product listed when doing a vendor lookup), RISynergy, does not meet the minimum confidence level of surveys from 15 unique organizations, even when looking at the data for all bed sizes. KLAS has the unique organization rule for statistical confidence to ensure that you are reviewing apples to apples. It does not make sense to rank a vendor with one excellent survey on file higher than a vendor with fifty very good surveys on file.

    3. In the six years that I have worked with KLAS, I have never heard of paying them to have the asterisk removed. The asterisk simply indicates whether or not surveys were received from fifteen unique organizations, and would be removed whether or not the vendor paid them or not. I do suspect that vendors that pay KLAS pay more attention to their scores and work with KLAS to get more surveys in the database by giving them their customer lists, or in absence of that, contacting clients directly to complete surveys on their behalf. I also suspect (and this is pure speculation, not fact), that if there is a backlog in terms of survey processing, that they process the surveys for those that pay KLAS first and if they have time later, they come back to the others.

    Sandra’s tips above are right on target for how to improve KLAS scores and apply to any vendor, whether or not they pay KLAS or not. Obviously it is harder to monitor scores on a regular basis without access to the data. KLAS may want to think about offering a free vendor portal that gives key metrics, and a more sophiscated data drill down for those that pay to even the playing ground.

  13. Good article by Swearingen on KLAS. I’ve read the vendor/software reviews for years but always acknowledge that the revenue is heavily received from the Vendors side and that does keep me …aware/cynical/curious/interested

  14. With all respect to Mr. Swearingen, I take exception to his point that in order to achieve high ratings within the KLAS product groupings, a vendor must pay high fees to KLAS. I have the upmost respect for the Leadership Team within KLAS. Anyone who truly knows them knows that they are people of integrity and that high rankings are not ‘for sale’. I would encourage Mr. Swearingen, or any other vendor (or healthcare provider for that matter) who question the source or interpretation of the survey results to work directly with KLAS rather than through another organization or through pure speculation.

    I have used the KLAS surveys for many years and like Bkern, will continue to do so as I have found them to be accurate, insightful and typically mirror the experiences I have had with many of the vendors over a 25 year career. I also concur with Bkern, that there is no silver bullet and one size does not fit all, KLAS is intended to be used a tool, one of many that should be used when making critical decisions such as an EMR vendor.

    I have completed numerous KLAS surveys over the years and never once has a vendor offered to pay me for higher scores. I have been contacted by vendors who have indicated that they KLAS would be contacting me to conduct surveys so that they may better understand their customers. No attempt was made to sway my input. Much to Sandra’s point, I appreciated the heads up from my vendor and appreciated their attempt to better understand their customers.

  15. Couple of things that Mr. Swearingen claims in his article aren’t true from my experiences with KLAS. Vendors don’t have to pay to get their customers surveyed by KLAS nor do they have to pay to get an asterisk removed. The real issue with KLAS isn’t the really the business practices they employ but the survey methodology utilized and the ways scores are tabulated and presented.

    Some methodology improvements:

    – Greater transparency around the demographic characteristics of the provider entities surveyed and represented in the scores
    – Additional information beyond just an ‘average’ score for each measure including a median and actual S.D. for each measure. Ideally, it would be a 95% CI with S.D.
    – Indicating differences between vendors that are statistically significant.

    I understand that basic marketing folks generally don’t request this level of detail but it would go a long way to provider a greater degree of transparency and a more true “apples-to-apples” comparison between vendor products.

  16. Hey Randy….
    Great marketing, now you will NEVER get a good class rating!

    but for I few bucks I can fix it for ya…

    See ya in the alley at HIMSS.

    PS – this ain’t noting new, go check out the HIMSS analytics process and before that the Dorenfest process…more smelly fish!

  17. I’ve always had great scores (often the best) in KLAS. My issue is not about scores but rather about rankings. In 2004, I provided KLAS with contact info for over 30 of my customers. For the past five years, they’ve only contacted enough to keep me listed but never enough to remove the asterisk. If they were unbiased, and if it wasn’t about the money, they would survey a few more of my customers to remove the asterisk. They’ve had five years to do so. Yes, I could pay to have those surveys done in order to be “Best in KLAS” in the Radiology Small but I refuse. I actually flew to Utah and met with the KLAS folks back in 2004 but it was to no avail. They have their cash cows and need to protect them. As a business owner, I understand that. But that makes them no more than a paid advertisement (not an objective service provider as they claim). This last KLAS report further drives this point home when an actual 7th ranked vendor gets ranked #1.

  18. Mr. Histalk asked:
    “Why can’t every vendor voluntarily or mandatorily use the same database layout for core information?”

    The National Committee on Vital and Health Statistics (NCVHS), an advisory group to the Secretary of HHS, recently made recommendations to move in that direction (warning pdf):

    http://www.ncvhs.hhs.gov/091201lt.pdf







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