Just How Did Cerner Do it?
• The new name and capital from its 1986 IPO helped Cerner
tremendously, but how did they rise to the top of the LIS ranks
so quickly over such erstwhile competitors as Sunquest &ALS?
• To learn the answer from a hospital’s perspective, this week
we’re going to review the results of a detailed LIS search our
firm conducted for large PA client back the early 1990s.
• We bypass the traditional over-reliance on an
RFP feature checklist, with its reams of
boilerplate questions, answered with a
rubber-stamp “yes” response by vendors.
Instead, we rely heavily onend users:
- Using scored checklists to rate demos
- Reviewing actual user documentation
- Peer-to-peer telephone reference calls
- Un-chaperoned site visits to non-flagships
Wyoming Valley Health System
• Our client was a large, 2-hospital IDN in Wilkes-Barre, PA, formed
by the merger of two former competitors. Both needed a new LIS
so the search was a big step to getting the two facilities together.
• Their combined beds were pretty large (400 and 200 beds), so the
search centered on those LIS vendors who could meet the
complex needs of a large hospital, which left out LIS vendors like
Citation who concentrated on smaller hospitals of ≈100 beds.
• The 2 Lab Directors had
already narrowed the LIS
field to the 3 leaders: ALS,
Sunquest, and Cerner.
• We also included the
incumbent HIS vendor,
SMS, to check out their
mini-based LIS product.
First Step: Meaningful Demos
• Sounds like an oxymoron, but demos can be made meaningful to:
– Educate users of legacy LIS-es about the state of the art
– Place the travel burden on the vendor in the early stages
– Help the various departments appreciate each others’ needs
• We used a score sheet to rate:
– User-friendliness (GUI)
– Patient search (MPI)
– Security (pre-HIPAA)
– User-defined fields
– Navigating field/screens
As this graph shows, Sunquest
&Cerner were tops, ALS in
the middle, and SMS last.
• Car salesmen are probably the epitome
of smooth-talking sales reps, and our
next selection step is best explained by
an analogy to buying a new/used car.
• What document about a vehicle you are
considering tells you the most about it:
– The brochure with color pictures?
– The MSP price tag on the window?
– A magazine review next to an ad?
• Actually, it’s right there in the glove box,
and it all facts & figures, with no sales fluff!
- HP, 0-60 times, MPG, service intervals…
- more facts & figures than any auto RFP.
• So what’s the analogy with buying an LIS?
• It’s what you’re going to live on during the crucial implementation
and for years afterwards, so check it out well in the sales cycle.
• Today of course there are no paper manuals, but every vendor
offers e-versions instead, whether CDs, pdf files, or web access.
• As with car manuals, these documents do
not contain any sales fluff to speak of, but
delve right into the facts you need to know:
• How many steps to builddictionaries?
• What are the fields on the XYZ screen?
• Whatare the system’s standard reports?
• Is there any section or chapter on my
area of interest or sub-department?
• And what if the vendor doesn’t have user documentation – they
claim their system is so simple it doesn’t need it? Don’t buy it!!
It’s all you can count on to define the system in your contract…
How Did Cerner’s Manuals Rate?
• We used another checklist for users to evaluate their manual (or
chapter or section), just like with the demos, with questions on:
Age – how long ago was it written,
vs. when was it last updated?
Style– is it in “Geek” or English –
without jargon & acronyms?
Contents – is there as overview,
sample reports, screen shots…
Use – overall, how well would you
and your staff actually use it?
• As you can see on the graph of the scores, Cerner rocked, blowing
away both Sunquest and ALS in all categories (after the demos,
SMS was eliminated, but they usually have good documentation).
Who Should Call Whom?
• Telephone reference calls are a fairly common next step, but
there’s two issues that can make them somewhat ineffective:
1. What hospitals should you call – “flagship”
sites the vendor put all over their proposal
& marketing materials, or abject failures
that their competitors goad you to call?
• Actually most vendor references follow the classic bell-shaped
curve, with a few winners who get extra attention to stay happy,
and the inevitable unhappy clients threatening a lawsuit…
• Best to avoid both, and rather call “normal” client sites, gleaned
from a Request For Information early in the process requesting:
- Local sites in your state – to check for remote support, EDI...
- The product/release they are selling you, not older ones…
- Your size: be it large IDN, small CAH, or average sized…
- Your interfaces – both primary HIS and key niche systems…
Who Should Make The Calls?
2. Who Calls? It’s tempting to have your C-Suite make the calls:
– CEO to CEO, CFO to CFO, etc., to get high-level “buy-in”
But think of just how much (little?) your execs knows about day-
to-day operations of the current system you’re replacing…
• In over 200 system selections, we’ve learned that the best people
to make the calls are the end users who’ll be stuck with the
system daily, and whose buy-in is crucial for implementation.
• In the case of an LIS, we had our reference calls made by the
selection team members: Lab Directors, Managers over sub-
departments like Blood Bank, AP, Hematology, Chemistry, etc., as
well as IT clinical analysts. And who did they call? Their
counterparts, so they could talk shop about day-to-day
challenges in the real world. Above all, avoid any clients who
insist all such calls go to the CIO only, as they may be serving as a
Phone Reference Call Results
• We used another scored checklist for
users to ask questions covering:
– Overall satisfaction – yea or nay?
– Are any key features missing?
– Ongoing support: remote & on-site
– Hardware response times/reliability
– Training: on-site & classes at HQ
– User-friendliness: or lack of same
– Implementation: vets or rookies?
• Sorry KLAS, but no one gets a 90%!
• When you talk to end users in the real world on various shifts &
depts., the average scores we have seen in over 200 selections
(about 10,000 calls) isin the low 70th percentile. ALS, Cerner
&Sunquest all did pretty well, with average scores around 80%.
Last And Most Important Step
• Site visits are the last step and potentially the most informative –
whether you’re shopping for an LIS, EMR or a full HIS, nothing
beats having your end users walk the floors and verify system
performance in the real world with their own eyes & ears.
• So how can you screw up this step? Three things to avoid:
1. Again, bring your end users, not C-suite, and have them walk
the dept/floors and talk shop with their counterparts. No
executives from either side – they talk at too high a level…
2. Prohibit any “chaperones” in the form of vendor or IT dept.
personnel who tend to put spin on any complaints voiced.
Make the reps sit in the lobby and work their cell phones…
3. No “flagship” sites, but rather pick them yourself from what
you learned about their clients on the phone: your size and
proximate location, on your product/release, with users open
and willing to talk about both the pros & cons honestly.
Wyoming Valley’s Results
• This was the defining step for Wyoming Valley as the chart shows.
Cerner dominated Sunquest &ALS:
• Our scored checklist covered:
- “Top 10 List” of key features
each department had to have
- Ease of use – as witnessed by
our end users own eyes & ears
- Post-live support – does
anyone ever come visit again?
- Implementation – just who
taught whom in the real world?
- Sales veracity – were there
(m)any fibs told during the
• Cerner just blew the others away!
LIS Selection Recap
• As this chart shows, Cerner rose to
the top of the Lab market by
excelling in every aspect of an HIS:
– Sales & marketing (demos)
– User documentation (manuals)
– Implementation & support
– System functionality (site visits)
• Next week we’ll cover the
development of their pre-Y2K
“Millennium” HIS product suite
based on their Health Network
Architecture (HNA), acquisitions,
and hardware evolution from DEC
and HP minis to remote hosting.