System Longevity

1. System
Longevity
© 2015 by H.I.S. Professionals, LLC, all rights reserved.
By Vince Ciotti

2. CLAS Follow-Up
• If you’ve been able to stay awake viewing my past presentations
on HIStalk, you may remember one I did last year on Epic being
only rated only #2 in a category that is so important in these
days of increasingly long office hours. What, you ask, Epic only
rated #2!? And not just by the DoD, IHC, and Great Plains,
• But by one of the only HIS vendor rating
firms that has never had a single critic or
complaint about its objectivity and candor:
CLAS (Ciotti’s Latest Attempted Satire)
• In case you don’t recall it, you can find them
all on our web site hispros.com: click on the
“HIS-tory” button and scroll down to the
“Misc” category – it’s listed as #123
• Better yet, just scroll through this update…

3. The Contenders
• CLAS compared two of the biggest names in the HIS industry
in a category that is on almost everyone’s lips these days:
• “Giveaway” coffee cups from
HIStalk, gifted from Lorrie at their
booth at HIMSS 2014, and one from
Epic stolen from their cafeteria in
Vernoa when Judy wasn’t looking...
• CLAS evaluated them in several ways:
- User-friendliness (handle-size)
- Source: Asia vs. Walmart (same?)
- Size - # of trips to the pot(tie)…
- Readability – have to rotate to read?
• The results: HIStalk won hands-down:

4. And Today?
• Time is an interesting question when reviewing a product or
system, especially in the ever-changing world of IT with vendors
re-branding themselves and their products continually:
– Evident is evidently as superior to CPSI, as Medhost is to HMS,
Healthland is to Dairyland, NextGen is to QSI, etc., etc., etc.
– Far better service, support, customer focus, dedication…
• Not to mention the new releases once or twice a year, with new
bugs, dropped features, and other “enhancements” in each…
• That’s why it’s so important that rating sources like Black Book
and KLAS tell you exactly which release/version of vendor
systems they are rating: is it release 6.15.a-2 or “only” 6.10.c-1?
• And how did our competing coffee cups stand up over time? Did
CLAS get it right the first time, or need we revise our results?

5. One Year Later
• Well here’s shots of the identical cups we reviewed last
December, one full year (and a few thousand refills) later:
• And these are un-retouched photos (no
photo-shopping or graphics editing)
showing exactly what the two cups
look like one year later. The two shots
show both sides of each cup...
• It looks like CLAS got it right:
- The HIStalk cup hasn’t faded in the
least – same silly headlines & logo,
- Whereas the Epic cup has faded
away to where you wouldn’t know
it was theirs if I didn’t tell you!

6. Tempus Fugit
• Is it unusual for a cup’s lettering to fade in just one year? What is
the life cycle for a coffee cup?? How long will HIStalk’s cup last???
• Well, in 1972 my wife made the dumb mistake of marrying me –
our 43rd anniversary was just last week so I remember it well!
• My Mom gave us these coffee cups for Xmas, 43 years ago:
• Not bad huh? Flawless: no fade at all!
• I hate to admit it, but I have not aged
as well as the cups, though my wife still
looks lovely as ever, and can get under
my skin with the same vim & vigor…
• Compare this longevity to the fade on
Epic’s cup on the right: you have to
squint to read the name! So just what
does time imply for HIS systems?

7. Leading Systems by Year
• I dug back into my files to see what systems were rated #1 in
various categories over time, shown in the table below. I picked
major categories only, so things didn’t get too granular, like:
– “Leading OB vendor in Critical Access Hospitals in Idaho…”
• There are some categories where time plays a major factor with
leaders changing often, while some others stay pretty constant:
2001 2003 2005 2007 2008 2010 2014
Community
Hosp. HIS
Dairylan
d
Dairyland Dairyland McKesson
Paragon
McKesson
Paragon
McKesson
Paragon
Meditech
C/S 6.0
Home
Health
Care
Lewis
Patron
Cerner
BeyondNo
w
Cerner
BeyondNow
McKesson
Home Care
McKesson
Home Care
McKesson
Home Care
EMR Eclipsys
Sunrise
Eclipsys
Sunrise
Epic
EpicCare
Epic
EpicCare
Epic
EpicCare
Epic
EpicCare
Epic
EpicCare
LIS Sunquest McKesson
Horizon
Misys Sunquest Siemens
Novius
Siemens
Novius
Epic Beaker
PACS ALI Stentor DR Systems GE
Centricity
DR Systems DR Systems
ED Wellsoft Wellsoft Wellsoft Wellsoft Wellsoft Wellsoft Wellsoft

8. When Did You Pick Your HIS?
• The implications of time are interesting when picking a system:
– Per the chart, a community hospital picking Dairyland in 2001
was smart, whereas one picking them in 2005 blew it by not
anticipating Paragon’s dominance for the next 7 years…
– And likewise, one that picked Paragon before 2014 goofed by
not anticipating the rise of Meditech’s 6.0 just last year.
• Just how does one predict the future? The answer is simple:
– You can’t! These polls are as unpredictable as the weather:
• It was near 90 degrees all month here in FL, yet last night
the temps dropped so much I have the heat on today!
• Many products change overnight: did you notice how Consumer
Reports recently retracted it’s “best buy” endorsement of Tesla?
– And I wonder how low they’ll rate all those VW diesel-engined
cars belching smoke in their reliability ratings next year??

9. Grossly Granular
• There are just too many factors for individual hospital to consider
that national polls must overlook, or they’d get too complicated:
– IT staff: CAH hospitals may have but a single FTE in IT, a 200
bed community hospital around 15 FTEs, while an AMC or IDN
has hundreds - what a difference in systems they can support!
– Location: Healthland is strong in the Midwest, while Evident
dominates in the South… Most important, does a vendor have
any installs in your state so they know local regs, EDI, & HIEs?
– Budget – a well-endowed AMC might be easily able to spend
$100M+ on an EMR, while an equally large inner-city hospital
with a large Medicaid mix has to be far more prudent.
– Apps – do you own a large physician practice, have non-acute
services like Home Health, want to include the ERP suite or
PACS? Finding a single HIS vendor that excels in all these
diverse needs is extremely challenging, if not impossible…

10. Product Evolution
• Just how long do HIS systems last? What is the typical life cycle,
after which a hospital should be searching to replace theirs??
• The best way to answer that is to look at HIS-tory: just how old
are today’s leading HIS systems – not just the companies, which
re-brand, merge and acquire often, but their products?
• E.g., here’s
the very
complex
time line
for
SMS/Siem
ens, before
the
acquisition
by Cerner
this year:

11. Systems Sold Today
• Here’s a rough timeline of the age of the HIS systems being sold
today; many company and product names have changed over
time (eg, Eclipsys bought by Allscripts), but their Sunrise product
essentially remained the same, albeit with many releases…
– (not sure of details, e.g., exactly when Judy added Resolute, Beaker, etc.,
nor when Neal branched out from just LIS to Order Entry & Results…)

12. Systems Installed Today
• Just how old are some of the systems running in hospitals today?
It’s amazing to think of how long ago some were first written:
– Siemens’ “Invision” patient accounting is based on IBM’s SHAS
(Shared Hospital Accounting System) from the late 1960s,
programmed in COBOL and using IBM’s “VSAM” file structure.
This venerable RCM is still running in 200-300 hospitals.
– Meditech’s “Magic” was programmed in “MIIS,” their version
of MUMPS, installed as an LIS in 1970 at Cape Cod Hospital.
Expanded to a full HIS over time, it still runs in 500+ clients!
– Evident’s “Thrive” is a renamed version of “The CPSI System,”
the name for CPSI’s total HIS written in COBOL in 1978, and
running strong in 600+ hospitals today, though on a new db.
– Healthland’s “Classic” financial system was written circa 1980,
and is being replaced by the more modern “Centriq” version,
although still running in several hundred CAH & small sites.

13. System Life Cycle
• The typical HIS system has a life cycle that follows the classic bell-
shaped curve in geometry, with time on the horizontal X-axis and
the number of clients on the vertical Y-axis, something like this:
# Of
Clients
Years: 5 10 15 20 25 30
• The trick is trying to figure out just where your system is in its life
cycle: is your product still selling, or has it hit its peak? The key
word is “selling” – if the number of sales are steady or increasing,
you’re cool; if sales are declining or ceased, caveat emptor!
400
350
300
250
200
150
100
50

14. Time Takeaways
• What is the impact of time on HIS systems? Some thoughts:
– Ratings – whether you’re a devotee of Black Book or KLAS,
check out the pattern of ratings over time: several years of
dominance means more than a flash in the pan one year…
– Product vs. Vendor – so many vendors have multiple products
that you have to drill down carefully into just which one is
being reviewed: think Paragon vs. Horizon, or Magic vs. 6.1.
– Life Cycle – best to buy a system that is on the way up in its
bell-shaped curve, rather than one that is on the way down…
Best indicator of that is sales, not total number of clients.
– Your Life Cycle – how long has your hospital been on its
current system? As painful as it is, re-implementing or putting
in a new system can nicely improve work flows & processes.
• And what are my qualifications on this subject? I just turned 70!
Any feedback, call 505.466.4958 or email vciotti@hispros.com