Advisory Panel: Budget Challenges, Favorite Vendor

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

What are your biggest capital and operational budgeting challenges and what creative solutions have you used to overcome them?

Being able to retain talent and valuable people in a very competitive environment while facing lower reimbursements.

We are receiving diminished funding for maintenance of infrastructure systems (storage, network, tools, etc.) while experiencing increasing demand for security solutions and acquisitive growth requiring unplanned support. We are shifting resources as needed to keep up with demand and we’re candidly disclosing the system availability risk levels we believe are rising as a result of delaying infrastructure maintenance. We’ve tapped philanthropic donors for “marquee” investments, leaving routine sources to the less-glamorous work. 

Our hospital has seen volumes plateau and reimbursements decreasing. Our revenues are well below target and we are trying to cut expenses everywhere. Going into our next financial year, we are focusing on optimization efforts of existing systems and infrastructure replenishment. All other projects will have to show hard dollar ROI to be approved.

[from a vendor member] We’re seeing that a number of our clients are employing advanced analytics to their administrative data to address and close gaps related to missing charges for devices, drugs or care provided. Leveraging their own historic HIS data with predictive modeling technologies, they’re bringing in millions of additional dollars in net revenue per year — an interesting and creative approach to addressing budget challenges.

Like everyone else, we are expected to do less with more. We are located in a remote area and have little access to advanced IT talent. I located a vendor who provides DBAs (and other programmers) at less than $30/hour. We currently use them for SQL and Oracle DBA as well as a Citrix administrator, all 20 hours/week. There is no way that we could afford this support any other way.

After an enormous EMR expense, the hospital is looking to cut down ongoing expenses, pointing out that IT is not a source of revenue. They seem most eager to trim optimization expenses, particularly in compensation to clinical experts and consultants. On the clinical side, we have done best with investing in fewer, but more involved subject experts ("a few good men and women"). They do well getting ad-hoc consensus and being the face of IT. On the consultant side, we have made the case that "a few good men and women" are essential to operations.

As reimbursements are continuing their decline, we are under the same scrutiny as all other departments. What was once considered nearly untouchable is now under the microscope. Our biggest challenge does not come under a program or project specific area, it is everything we do. We are in the process of figuring out what we need as essential services and what can be shut down. This is not a small task as we have some platforms that do not scale well and causes us duplicative support and infrastructure services. In addition to that, the shadow IT problem is hard to fully identify and reduce spend on. This will be an ongoing challenge for us and I believe will become more acute for all providers in the next few years.

Our board has a policy that project overruns over 5 percent have to be approved by them. We were replacing our pharmacy system and working on MU2 with the same set of resources. As MU2 came to be more complicated than anticipated, we pulled internal resources away from pharmacy and brought in more expensive outside resources. Pharmacy went live on time but $500K over budget. This is the only time in 20 years that I’ve had to go to the board for a project overrun. My point is that it demonstrates again what a huge distraction MU has and will continue to be along with potential career-limiting impact.

I work for a provider organization that manufactures many of its own products. As such prior to my arrival we had begun experimenting with outsourcing development, at least the maintenance/break-fix items from the products we develop. Largely speaking, this wasn’t successful for many reasons.  Although the entire organization was cutting back and findings ways to get more efficient, I was able to position this as a means to eliminate the outsourced relationship, hire/onboard new personnel (still in process) to create a budget neutral situation where the organization’s experience was better with our own internal resources yet achieved a positive boost from a cultural perspective (we are hiring now vs. outsourcing). From a cost savings perspective, I focused my efforts on how technology could take out costs from the organization creating re-engineering opportunities. For example, driving efficiency through the applications used by our operational teams so they could cut headcount by 20 percent. Another example is how we are re-architecting our corporate fax solution (we fax many of our results back to our customers/partners) saving 40 percent in fax costs on an annualized fashion. Re-engineering through technology doesn’t necessarily have to include headcount reductions.

Who is your favorite healthcare IT-specific vendor (product or services) right now and why?

None really. One must not underestimate the power of IT vendors to disappoint. One CMO once advised me in advance that there is really a "curve of disillusionment" but what I did not anticipate is how much disappointment I was going to experience not from the IT product itself but from the people in the company.

I continue to like Impact Advisors and their Epic consultation services. We have encountered novel integration challenges in our acquisitions and they seem to have been there/done that.

Right we are very pleased with select vendors that spend time learning about our business and figuring out how to adapt their offerings for our benefit, challenging us along the way with how to think differently. The best example for us right now is CDW, which frankly was surprising to me when joining the team. CDW offers a basic fulfillment service for most equipment we purchase but they also bundle it with creative solutions like headcount to help drive our Sharepoint implementation as well as creative packaging such that we can avoid shipping/prep of equipment at our location rather pre-loading it at Sharepoint, including asset tagging, and direct shipping it to our destination. CDW has done a nice job understanding how they can help us and brings great value outside of basic order fulfillment service

Aspen Advisors. They’ve done a few key projects for us that have come in on time and under budget.

INHS (now Engage). Hands-down favorite. My biggest beef about vendors (product or service) is that they don’t have to live with what they deliver. If you are required to support what you implement or recommend, it seems to change your build and recommendations. INHS provides the IT systems for numerous hospitals and practices, so I know that when they build something for me (a non-INHS site) or make a recommendation, it is something that they can or have lived with in the past. They also understand that the build/recommendations have to be practical and executable and as non-invasive as possible to our customer. That frame of reference makes a significant difference. 

Epic. Best support ever, and they seem committed to our success despite a rolling cast of characters. Very few issues are dropped, even when we don’t like the answers. They do prompt, customer-wide notification of clinical issues and potential near misses.

The only vendor names that come to mind are the ones that are letting us down in a significant ways by their lack of proper development focus, ability to deliver on time, or just a general lack of indifference toward our needs as a customer.

Epic. They are our EMR and provide great support

Prominence Advisors. They are a small consulting firm full of "Epic all-stars" and have been tremendous in helping us with our Epic project.

None of our vendors are standouts. They continue to deal with MU and it has distracted them.