H.I.S.-tory, by Vince Ciotti

© 2013 by H.I.S. Professionals, LLC, all rights reserved.

Episode #107:

Cerner Part 4:

1993 LIS Search

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 on end 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)– Flexible screens/reports– User-defined fields– Navigating field/screens

As this graph shows, Sunquest & Cerner were tops, ALS in the middle, and SMS last.

Automotive Analogy• 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?

User Documentation!• 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 build dictionaries?• What are the fields on the XYZ screen?• What are 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 censor…

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) is in 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 sale?

• 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

(phone references)– 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.