Emergency Medicine Physician Comments on the Advantages of Best-of-Breed Systems

When I began working in pathology informatics in 1982, I immediately recognized the value of best-of-breed LIS software, which is to say a system provided by a specialized lab software vendor. In those days, the alternative was expensive, lackluster products from companies such as IBM that provided HIS (hospital information system) software designed primarily to support PM/PA (patient management/patient accounting) tasks. These days, a similar choice presents itself. Choose a best-of-breed LIS vendor such as SCC or Sunquest or accept the often inadequate lab module from a vendor such as Meditech or Eclipsys whose major focus is on their most profitable EMR software.

In my opinion, a best-of-breed LIS vendor is usually preferable for lab professionals because of its focus on the needs of pathology and the clinical labs and the likelihood, but not a guarantee, of greater functionality. This latter approach frequently translates into greater work efficiency and better job performance. By way of contrast, hospital CIOs generally prefer to work with large software vendors offering a broad and "integrated" suite of modules and suffer few, if any penalties, if physicians working in the pathology or radiology departments are hampered by inadequate systems. If physician complaints get out of hand, they can easily blame the vendor (see: Another Saga of "Blame the Vendor" Leaks Out of the UK).

Fast-forward about three decades. Various types of hospital-based physician specialists have now become dependent on their own specialized information systems like the pathologists working in the 80's and 90's. Guess what? Many of them are also now endorsing best-of-breed systems. One of them, John Fontanetta, M.D., addressed this topic in a recent HIStalk guest blog (see: Why Emergency Physicians Prefer Best-of-Breed IT Systems). Below is an excerpt from his opinion piece:

According to a recent report from KLAS, some hospitals are replacing standalone, best-of-breed (BoB) emergency department information systems (EDIS) with enterprise solutions that are leaving ED clinicians — and often their patients — unsatisfied. Why unsatisfied? Because the clinical functionality in enterprise solutions is both less comprehensive and less efficient for the ED environment and they are just so hard to use. This report has re-energized the debate over the benefits of the two kinds of systems. IT professionals prefer the seamless interoperability supposedly offered by single systems, but the fact is that many large vendors have simply bought and shoehorned in a separate ED system....Overall, my specialty has been slow to adopt EHRs, not because we don’t see their importance, but because they have a reputation for being unwieldy and unresponsive to the requirements of the ED. With more and more EDs adopting BoB systems that are designed to support ED clinicians’ intricate and demanding workflows, physicians are starting to realize that an EHR can actually be an advantage in our fast-paced environment, rather than a burden. CIOs are finding that these BoB systems can offer the same, if not better, integration capabilities than a single, enterprise solution. While many of the HIS vendors are inflexible when it comes to working with other systems, BoB systems have always had to offer integration solutions and many pride themselves on their ability to integrate with almost any system.

I rest my case. I can't express these sentiments more eloquently than Dr. Fontanetta. He raises the key issue of exactly who should be served by hospital LISs, RISs, and other varieties of clinical systems -- physicians and their patients, hospital CIOs, or, shudder, the federal government? My vote on this question is obvious. However, it's best to keep one thing in mind. There was only way that the pathologists in the past, as well as the hospital-based clinicians of today, could and can obtain systems with adequate functionality. They must refuse to work with any information system that they deem inadequate.

Comments

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I think the main problem is interopability of compatible systems something that ANSI so far has not been able to deploy