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An Article That Every Profit Driven Hospital Administrator Should Read!

By Randall Swearingen

In 1985, when Swearingen Software entered the RIS market, many hospitals utilized the “Best-of-Breed” approach to vendor selection. That is they picked the best product in each category (i.e. HIS, RIS, LIS, etc.) that best fit their unique needs and budgets. Department heads, along with their key staff members, were able to make those selections based upon the needs of their particular department. Best-of-breed gave the hospitals superior products BUT because there was no standardization of interfaces yet, there was the ever-present danger of the systems not communicating properly with one another and then the dreaded case of vendors pointing fingers at one another.

As the years rolled by, PACS and Voice Recognition (VR) were introduced. This was a big boost to department productivity but it even further complicated the issue of interoperability of the different systems. That’s about the time that HL7 and DICOM were introduced which standardized how systems talked to one another and virtually eliminated vendor finger pointing.

That’s also about the time that the “Single-Source” approach to vendor selection became popular.  Single-source is when the hospital purchases all of their healthcare information systems from one vendor. The concept was enticing to hospital administration because all the software was “under one umbrella” and cost structure and it was far more convenient dealing with one vendor than multiple vendors. And, as they say, there was only one neck to choke. This concept became, and still is, very popular in the healthcare industry.

But, as Newton’s Third Law of Motion points out – for every action there is an equal and opposite reaction. Yes, hospitals that purchase single-source solutions probably save money on their initial purchase (and possibly total annual support), as opposed to those of best-of-breed. And, they probably are able to somewhat simplify the interoperability of the various systems. But the equal and opposite reaction is reflected in the quality of the solutions as a whole. If you were to grade each individual system component, within a single-source solution, from 1 to 10 with 10 being the best, and then average those numbers, you would quickly see the negative side of single-source as opposed to the average grade (typically 9-10) of a best-of-breed solution because each system is hand picked.

At trade shows, I always ask visitors to our booth, “What RIS do you currently have and how do you like it?” They tell me the name of their RIS product and inevitably say, “I hate it but I didn’t have a choice in its selection because it’s part of a bigger (single-source) solution. I’m stuck with it and there’s nothing I can do about it.” I then proceed to ask about the capabilities of the RIS. I used to be shocked (but not any more) to hear that the capabilities of most the RIS products that are part of a single-source solution, are lacking significantly in features, functionality, flexibility and ease of use when compared to those of best-of-breed.

So, here we are in a world of ever improving health technology and a keen focus on the quality of patient care. Every year there are significant advances in medicine, medical equipment and computers. Since radiology is one of the main profit centers of a hospital, it seems quite contradictory that a radiology department can be “stuck” with, what they feel is an inferior RIS. Software that doesn’t meet the needs of the department. Software that’s not intuitive to use. Software that does not maximize productivity and profitability.

The work “stuck”, in this case, is a negative word that implies hopelessness. If your car gets stuck, you call a tow truck. If something gets stuck in your plumbing, you call a plumber. If you swallow something that gets stuck blocking your airflow, hopefully someone is there to perform the Heimlich maneuver. The bottom line is that if something is stuck, the goal becomes to remove the obstruction. So if you’re a radiology manager, who feels stuck with an inferior RIS, what are the obstructions to getting a better RIS?

Single source vendors use several effective tactics. Statements like the ones below can be pretty compelling if not down right intimidating:

  • All RIS systems are pretty much alike in features and functionality
  • Adding another vendor will increase your overall cost of operation
  • We can’t guarantee that our software will interface with a product from a different vendor
  • If you replace any of our products, it will void your warranty
  • If you replace any of our products, we can’t guarantee that you can achieve and maintain meaningful use

So let’s take each of these obstructions (i.e. objections) one by one and prove that they are actually no more than myths.

Myth #1 – All RIS systems are pretty much alike in features and functionality

RIS systems are like fingerprints and snowflakes. No two are alike. All one has to do is go to a website such as to see significant differences in various products but specifically RIS systems. Upon examination, you will find that some RIS systems are very easy to use while some are very difficult. Some are very flexible and configurable while others are very rigid. Some contain hundreds of management reports while others contain only a small handful. Some will guarantee to interface to any other product while others require that you interface with it. Some have great, USA based, support that return your calls in just minutes while others may take days to return your call and the support may come from overseas. So the argument that all RIS systems are pretty much alike is merely a myth. Please read the reviews on Swearingen Software’s RISynergy™ and see what our customers are saying about it. You will see that RISynergy is no ordinary RIS.

Myth #2 – Adding another vendor will increase my overall cost of operation

Let’s go back to something I discussed earlier and that’s grading individual single-source modules on a scale of 1 to 10. If a radiology manager feels “stuck” with his/her RIS, I would tend to think that they would score it a 4 or 5 (or even lower). Then, let’s say that if he/she hand picked a best-of-breed solution, they would score it as a 9 or 10. Imagine what those extra five points might represent… better patient workflow, higher productivity, better financial analysis of departmental and/or physician profitability, better referring physician satisfaction, better patient satisfaction, etc. etc. So, yes, replacing a single-source RIS with a best-of-breed RIS can have an initial cost and an on-going support fee. But what if the ROI was less than one year and after that, the hospital realized sizable financial, productivity and patient/physician satisfaction gains with the best-of-breed RIS? In that scenario, we can easily write this claim off as yet another myth.

Myth #3 – We can’t guarantee that our software will interface to a product from a different vendor

This argument might have “held water” back in the 1980’s before HL7 but it has little-to-no validity today. As long as the single-source vendor can receive and send HL7 transactions, it will easily interface to any other product that can also receive and send HL7 transactions. Yes, there are different versions of HL7 and yes, vendors can manipulate HL7 segments to be unique to themselves. But, as a best-of-breed vendor, Swearingen’s HL7 interface engine can map any HL7 field to any field in our databases so that allows us to guarantee that we can successfully interface to ANY single-source system as long as they will cooperate with us. Another myth busted!

Myth #4 – If you replace any of our products, it will void your warranty

This is one of two Gestapo tactics that some single-source vendors might use. It’s typically the last tactic they use in an effort to thwart/intimidate any customer from defecting from using one of their modules. They know that if they let just one of their modules be replaced, it would possibly open the door to more of their modules being replaced and therefore losing business but more importantly, losing dollars. The question is can a vendor legally make this threat and stand behind it. Although it is a bully tactic, if it’s written into the contract, they probably can enforce it legally. On the other hand, if it’s NOT in the contract, it would be highly illegal so it’s best to have your contact reviewed by an attorney before taking any action to replace a single-source module such as the RIS. BUT, do you think if you stood firm and replaced the RIS, the vendor would actually make a move that would jeopardize their current and future business with you? So, even though this is a possibility, I still classify it as a myth.

Myth #5 – If you replace any of our products, we can’t guarantee you meaningful use

This is the second of two Gestapo tactics used by some single-source vendors. As suggested above, I would have an attorney review your contract to see if this is really in it. Whether it is or not, I can unequivocally tell you that best-of-breed hospitals have been just as successful in achieving meaningful use as their single-source counterparts. That said, if the best-of-breed RIS vendor, such as Swearingen Software, is willing to guarantee in writing that their software will meet the meaningful use requirements of a RIS, then this threat has no teeth and is therefore just another myth.

One last note about myths 4 and 5. What does it say about a vendor who locks you in with no escape clause? What if the vendor never updates their RIS for the entire term of the contract? What if the RIS module is so poor that it actually hampers productivity and profitability of the radiology department? Just thoughts to consider before locking yourself into information system prison.

The bottom line is that I believe it’s a matter of educating hospital administrators, CEOs and CIOs. These are highly educated people with obviously very strong business skills. I firmly believe they have the best interest of the patients and the hospital organization in mind. That being so, reading this article just might open their eyes as to ways to improve productivity and profitability of their radiology profit center while increasing patient and referring physician satisfaction. If it makes good business and economical sense to replace a single-source RIS with a best-of-breed one, why not consider that as an option?

The concept of adding one or more best-of-breed products to a single-source solution has been around for some time and is referred to as a “hybrid” approach. Those hospitals have a significant competitive advantage over their pure single-source competitors because they are using better software solutions.

We actually have one customer whose hospital switched to a single-source solution. After using the single-source RIS for a short while, and realizing its many weaknesses, they switched back to RISynergy and thus implemented a hybrid approach. The fact that they would still be paying support for the now unused single-source RIS did not deter them from switching to RISynergy which goes to show the effectiveness and financial benefits of our RIS.

Swearingen Software’s RISynergy is no ordinary RIS. With over 30 years of growing and improving, based on customer input, our customers feel that there is no equal to our product and support. So, if your radiology department feels “stuck” with an inferior RIS, maybe it’s time to break the myth barriers and learn what RISynergy can do to improve the health of your radiology department. You will quickly learn why There’s No Place Like Swearingen ™.