Bill Phillips gets at least 10 e-mails a day from companies that want to assist him in achieving meaningful use of electronic health records. Fortunately, University Health System in San Antonio, where Phillips is chief information officer, has had an EHR since 2006 and doesn't need as much meaningful-use help as some, though it does have two contract employees working on coding for the clinical decision support system.
"The difficulty with consultants is to get a good one," says Phillips. UHS has an Allscripts EHR (formerly Eclipsys), and gets its contract workers through MaxIT Healthcare, a Westfield, Ind., consulting firm. "We make sure their experience matches our product line-same version numbers and same products. Ours knew what they said they knew, and we've been very happy."
Steve Garske, CIO at Children's Hospital of Los Angeles, likes to use consultants for narrowly targeted purposes-specific pieces of infrastructure or particular applications-rather than leaning on them for broad or long-term help. He's increased his staff from 30 to 150 over the last few years, and supports most departmental applications entirely in-house, though he also buys support services from his three largest vendors: Cerner, Oracle and McKesson.
He favors single consultants or boutique shops over larger firms, whose turnover is too rapid for his taste, and he avoids having different companies working on consulting engagements at the same time. "They're likely to blame things on each other," he says. Third-party issues have been on Garske's mind for some time: He recently completed a doctoral dissertation on outsourcing.
Another Y2K?
Many health care providers are looking for extra I.T. help from third parties-consultants, value-added resellers and systems integrators-as deadlines loom for installing EHRs and achieving meaningful use in time to get full federal HITECH incentive payments.
Some observers compare the flurry of activity to Y2K, when at the end of the 1900s computer programs that had been using just the last two digits of a calendar year needed to be adjusted to accept four-digit dates for the year 2000 and beyond.
The difference is that this time, it's not just a one-shot fix. Once the EHRs go in, organizations need ongoing manpower to maintain and update them, adhere to increasingly stringent meaningful-use requirements, and incorporate advances in both computer technology and medical knowledge. Consulting engagements could last longer than many marriages.
Providers are more welcoming to third-party involvement than they were even a few years ago, says Indranil Ganguly, CIO at CentraState Healthcare System, Freehold, N.J. "They're loosening up to the idea," he says. "If I had recommended three or four years ago that we use a third party to store our data in an offsite location, [my management] would have looked at me like I had three heads."
Currently he has four consultants-two working on clinical applications and two on financial ones and all from small specialty firms.
Train in the tunnel
Further straining everyone's resources is the scheduled switch to ICD-10 coding for medical records and billing starting in 2013.
It's "the other train in the tunnel," says Mitchell Morris, M.D., who heads the health information technology practice for the national consulting firm Deloitte Services.
But consulting companies and value-added resellers are facing the same I.T. labor shortage as vendors and health care providers.
"There's lots of contention right now for talent," Morris says. "Recruiters are having a field day. We're all hiring, or hiring away. We have 80 open positions."
Deloitte is filling some gaps by differentiating between tasks that can be performed by a generic "smart person" after some training and those that demand clinical experience as well. "We're going to run out of clinicians with 15 to 20 years of experience," Morris says. "You can't get that in a year, no matter what you do."
MaxIT CEO Parker Hinshaw has ceded the sales function to others in the 540-person company and is concentrating almost full-time on recruiting people to fulfill engagements. The company has more than doubled in size in the past year, and he expects it to top 1,000 employees within two years.
"If you're a clinical person and you understand EHRs and physician adoption, you're golden right now," he says, adding that those "golden people" can command a substantially larger salary as I.T. consultants than they're probably making as clinicians. But providers shouldn't worry too much-not everyone is cut out for the itinerant life of a consultant, and the ones most likely to be tempted are often looking for a change anyway.
"We typically hire people away after a major implementation project," Hinshaw says. "They're the change agents at their hospital, and once the project is over, they're not excited about going into a maintenance role."
Vendors stretched
CentraState uses Soarian clinical computing from Siemens Healthcare, Malvern, Pa., along with an emergency department system from Wellsoft, Somerset, N.J.
The organization is shooting to achieve meaningful use sometime this year. Ganguly turns to consultants when his vendors don't have the "bench strength" to offer reliable help. He uses a mix of consultants with proven expertise in the organization's combination of software. Sometimes that expertise comes from consultants having special relationships with vendors-or just hiring the vendor's employees outright.
"You'd think it would be bad vendor relations [for a consultant to poach a vendor's staff], but there is some turnover by default," Ganguly says. "If you lose one or two people [from a large vendor], it doesn't necessarily resonate deeply, but it's a good thing for a smaller consulting firm that now has two people with solid expertise in that vendor's products, and it helps the vendor show that there's a talent pool available to help clients. Vendors make their big money on software anyway, not services."
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