Pssst, Here’s an Excuse for you CPOE Vendors: The Problem Isn’t Your Product, It’s Your Choice of Customers
By Mr. HIStalk
KLAS just released its CPOE Digest 2010. It’s a pretty fun read, although not too encouraging. A full 86% of US hospitals fall short of even the paltry 10% CPOE adoption rate that the proposed Meaningful Use rules would require.
That’s probably why hospitals are whining (while looking the gift horse in the mouth) about the modest conditions that are attached to the millions in free taxpayer money they’ll get for merely using the systems they already own.
The KLAS report seems to send this message to hospitals: you’re in trouble if you’ve chosen a crappy CPOE vendor.
Everybody would agree that the whole CPOE issue is vexing. It’s healthcare IT’s Vietnam, having dragged on for years without progress while experts opine, outsiders roll their eyes, and boatloads of cash exchanges hands in a failed attempt to turn the situation around. Technical superiority is getting its butt kicked by a committed and stealthy enemy called paper.
Until Meaningful Use, hospitals had pretty much given up on CPOE. It’s like naively buying a fancy new car without doing your homework, then finding it so annoying and unsuitable that you just put it up on blocks in the back yard and cover it with a tarp so you don’t have to be visually reminded of your bad decision every time you go out.
So news from the CPOE front is not so good. But I might quibble with KLAS’s implication that it’s all because of low-quality CPOE software.
KLAS correctly observes that some CPOE products are majorly screwed up when it comes to usability and integration. The vendor names are hardly shocking: (a) smallish vendors whose customers didn’t really care about CPOE anyway, and (b) mega-corporations who dabble in HIT not because they care about patients, but because they run their business like an unfocused mutual fund and needed sector diversification.
But then you have Epic, which shames everyone by throwing off the grading curve. While the also-rans are locked in a desperate struggle for tiny percentage gains to their scores in the low 70s or worse, Epic surveys the spectacle from rarefied heights and splatters the heads of the combatants below with its droppings pretty much whenever it pleases.
Epic’s software is better than most (although a strong argument could be made that Eclipsys Sunrise has better CPOE). However, it’s naïve to think that Epic’s software is THAT much better. Or, that hospitals can move their CPOE needle by just doing a mating dance with Judy.
Epic’s secret sauce, I think, has a second ingredient: its choice of customers.
Epic knows that most hospitals don’t have the right stuff to handle big projects, especially those involving IT. They are indecisive, change-resistant, and unable to move beyond the tactical to the strategic. Epic sends those prospects away to fail under a competitor’s watch. That vendor cashes their check, but gets dinged in the KLAS report because the good customer predictably turns into a bad user.
(If you believe that software alone drives CPOE adoption, consider this: would you instantly whip out your hospital’s checkbook for a system that boasts nearly 100% CPOE utilization at every one of hundreds of hospital sites? You won’t need the checkbook – just order your free CD copy of the VA’s VistA).
One way Epic ensures that its customers are committed is by charging them exorbitant prices. Hospital C-levelers to get uncharacteristically involved in a so-called IT project when it’s costing them $50 million or more.
But more importantly, those high prices pre-qualify prospects. Badly run hospitals don’t usually have $50 million burning a hole in their pockets. Or, they may back down from their lofty ambitions, recognizing that deep in their DNA, they don’t have the right stuff to make expensive IT work. They fold their cards and slink away to a lesser-heralded and cheaper vendor rather than confidently throwing their big chips into the Epic kitty.
(I once had a sweet, competent employee who was also recruiter for a cult. She tried to get me to attend an introductory class, surprising me when she said it would cost me $100. The reason, she explained, is that free classes attracted mostly people without commitment who weren’t likely to join. Not to mention that prospects with $100 probably had more assets worth swindling once their brains had been programmed).
The KLAS report talks about vendors, but I think the real issue is one that should resonate with us IT people. It should also make hospitals think twice before dumping their current CPOE vendor to chase the Holy Grail of a higher-rated one (even Epic).
It’s PEBMAC — problem exists between monitor and chair. It’s not what you have, but how you use it. Much of the Epic ballyhoo is because they sell only to hospitals already qualified as having a high probability of success – they have enough money and motivation to want to undertake an Epic project in the first place.