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RIVERSIDE HEALTH CARE FACILITIES

BEST OF BUDGET

By: Terrie Tucker & Ron Hebert

Articles on the subject of systems integration in healthcare facilities have often in the past referred to the emerging concept of "Best-of-Breed" when selecting application modules from different software vendors. Given the austerity conditions in the healthcare sector today, the same emerging concept might now be referred to as "Best-of-Budget".

The Riverside Health Care Facilities Inc. (RHCFI), a three-site hospital Corporation based in Fort Frances, Ontario, was recently challenged with a significantly reduced budget in June of 1995 following the change in government in that province. Having earlier selected a preferred single-source vendor for the hospital's new information system, the Information Systems Advisory Committee was sent back to the drawing board. The committee was required to find a less expensive method of updating the hospital's eight year old single-vendor solution that offered limited functionality in the departmental software application modules that the hospital required to comply with the increased demands of the Ontario Case Costing project.

This time the hospital Information Systems Advisory Committee selected a multi-vendor approach proposed by Heron Technology Corp. (HTC) of Markham, Ontario, which included an integration engine or "Middleware" software product. The Middleware software product is from Stratsys Corporation, a Canadian software developer which has developed the Middleware product FITS (Flexible Information Transport System).

The flexibility of this approach was exemplified by the fact that the hospital Information Systems Advisory Committee selected six (6) software vendors directly who were not included in the HTC submission. This flexibility is inherent in the emerging multi-vendor implementations that are predicated on all application software modules being able to operate in the "open" systems environment, each connected to the integration engine, and all part of the overall integrated system.

One of the major objectives of the RHCFI was to be able to implement a complete Hospital Information System capable of meeting the Ontario Case Cost Guidelines, while working within the budgetary constrains affecting all hospitals today.

In fact, the hospital has now implemented a system that costs approximately 50% of what the previously-selected system would have cost, both in the initial hardware/software licensing costs, and in the ongoing support costs. In addition, the individual department Managers had total flexibility in deciding which software modules to select since they were not restricted to a single-vendor offering or a single platform, and in the end selected application software modules from twelve (12) different vendors, with whom the hospital is dealing directly.

The strongest points that can be made for the multi-vendor approach is that it offers the department managers exceptional flexibility in the selection of software to meet the unique requirements of individual departments, while at the same time permitting competitive pricing in the selection of application software from a number of potential vendors.

Another major consideration of the hospital Information Systems advisory Committee was the future! Will we have the ability to handle a change in corporate structure? How will shared services with other healthcare organizations be managed? What systems will be required? Which vendors will be offering the best systems? What will the prices be for the various application software modules? What money will the hospital have to spend? These are all future issues and very difficult to deal with accurately today.

Since information systems in healthcare facilities are becoming ever more complex to meet the increasing demands of governments, suppliers, and the population overall, flexibility must be built into the system at the outset to address these complex issues that will be arising during the next five to ten years, and beyond.

The question of integration costs often comes up in discussion, and the RHCFI allocated less than 10% of the overall system cost to this important system component. The overall fully-integrated system now consists of software modules from twelve (12) specialized suppliers with the main CUP being an IBM RAID Server running the SCO Unix O/S, which is connected via TCP/IP to a Novell network, supporting over one hundred (100) PC's throughout the hospital.

An impressive fringe benefit for the Canadian economy occurred as a result of the hospital's ability to select software from specialized vendors. About 83% of the software/training revenue remained with Canadian vendors whose head offices spanned the country from British Columbia to Nova Scotia. This is in stark contrast with the over 90% US content in most Canadian hospital single-vendor procurements today.

Compared to commercial businesses, it has been frequently noted that hospitals are many years behind in computerization. It is expected that the healthcare IT marketplace will be closing this gap during the next few years as the downsizing of budgets forces this industry to re-engineer procedures to take advantage of the increasing number of new technologies being introduced, with an increasing frequency, to the world of healthcare Information Technology.

Once the decision to proceed was made in early March of 1996, the hospital drew up an implementation plan that would leave most hospital executives breathless! All systems were to be replaced, all data converted to the new software modules, a everything, including hardware and software, was to be up and operational, on an integrated basis, within nine (9) months.

All of the above goals have been achieved, and the new system has been implemented on time and under budget, according to Terrie Tucker, Manager of Finance and Systems at RHCFI who oversaw the implementation.

Terrie Tucker is the Manager Of Finance & Systems at the Riverside Health Care Facilities In Fort Frances, Ontario

Ron Hebert is the President of Heron Technology Corp. located in Markham Ontario and can be reached at ronh@herontech.com.

More information on the RHCFI Implementation