Readers Write

Gary Baldwin, for HealthLeaders Media, February 26, 2008
I am down in Orlando this week, covering the massive HIMSS exhibition. Next week I will have a compilation of some of the top presentations I heard. Meanwhile, I wanted to share some of the correspondence I have received lately. The reactions to my piece, "Are IT Vendors Losing Their Marbles," are especially appropriate during HIMSS week, seeing as how the event showcases the wares of hundreds of companies trying to squeeze into this complex, crowded space.

First is a letter from Michael Davis, a member of HIMSS Analytics, which sponsored the survey I referenced.

Skeptical CIOs
I enjoyed your article--"Are IT Vendors Losing Their Marbles." In most cases the healthcare IT professionals are looking for peer-to-peer interactions without vendor influence or facilitation. This is difficult for vendors to achieve. I do believe the vendors today are performing better in delivering competitive products and providing enhanced customer service, but healthcare IT professionals have been burned too many times with incomplete or overhyped vendor solutions. Thus, they will continue to be skeptical.

I enjoy reading your take on the market. Keep them coming.

Michael W. Davis
Executive Vice President
HIMSS Analytics
Chicago, IL

'Crazy Like a Fox'
I think this article ("Are IT Vendors Losing Their Marbles?") hits the nail on the head. CIOs waste so much of their (and their staff's) time cutting through the hype and trying to get straight answers that it places an enormous unnecessary cost on the process of selecting and implementing meaningful solutions. That being said, there's another side that's even worse--the great marketer HIT vendor that can't deliver. A select few HIT vendors have learned, even mastered, the art of creating the need at the board, executive, and/or physician level, and bypassing the CIO--who knows better.

These vendors paint a wonderful picture of a future state that only they can get the organization to. The people they court have no idea of how to evaluate much less challenge their claims. They make it look so easy too! The CIO is left to stand in front of this rushing train or risk trying to implement tremendously complex systems to unreasonable expectations set by the vendor. If (or more likely when) the project fails, the vendor conveniently lays the blame at the feet of the CIO, since it "has been successfully implemented at many other sites." The light at the end of the tunnel is that over time, a realization sets in that there was insufficient scrutiny of vendor claims and lack of due diligence by organizational leadership.

The bad part is that the CIO is usually left to sort it out and move things forward regardless. That's why it is vital that CIOs educate their executives early and often on the state of our industry and the HIT solutions available so they can set realistic expectations as an organization.

I guess the answer to your article title is 'yes' but that some vendors are 'crazy like a fox!'

Vincent S. Vitali, FHIMSS
Interim CIO
Navin, Haffty & Associates
BroMenn Healthcare
Normal, IL

Providers Not Paid to Cure
You have hit on an interesting fact in healthcare that is generally underappreciated. ("Which Came First, the MRI or the Inflation?") Technology tends to raise the cost of care, not lower it (as it would in any other industry). Is healthcare fundamentally odd?

No. If providers got paid to cure something, then technology would lower the cost of care for any given outcome. But providers don't get paid to cure anything. They get paid to do something. If that something requires a piece of technology, and the technology item (a procedure, for example) has a bill code, then they do MORE of the item since they get paid for it.

In 1975 there were almost no gastroenterologists. Then we developed a number of increasingly complicated fiber optic scopes, and procedures related to them, each of which has a bill code for it. Each successive device is more expensive, and the associated bill code is higher. Now gastroenterology is one of the largest subspecialties, and the cost of GI treatment has skyrocketed, although outcomes have indeed improved.

Over the same time period, Lasik surgery has decreased in cost as outcomes rose. Lasik is not covered by insurance, hence docs get paid to deliver an outcome (to a consumer), not to perform a procedure (lasik results are often "guaranteed" to consumers).

Tim Breaux
Portland, OR

Live From HIMSS 2008

Senior Editor Gary Baldwin is reporting daily dispatches live from the annual HIMSS conference. Here are some of the stories he has published so far:

Gary Baldwin is technology editor of HealthLeaders magazine. He can be reached at
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