No one's using CPOE. Maybe your vendor should go private?

I've said it many times: despite incessant rag coverage, alluring vendor propaganda, and well-intentioned but wildly simplistic Leapfrog mandates, virtually no hospitals are doing anything close to computerized physician order entry. Still, hospitals keep opening their slim checkbooks under the starry-eyed delusion that they're ready for "clinical transformation," hoping beyond hope that those bitchy docs will line up like docile sheep to take the place of the unit secretaries who enter their orders today.

Don't fool yourself. Better places than yours have blown a lot of money, fired CIOs, and angered the medical staff over naive CPOE fumblings. Well, I've said so before here, but here's some backup.

Some interesting stats were just reported by Inside Healthcare Computing as produced by KLAS. An immeasurably small number of US hospitals (less than 2 per cent) actually do CPOE, even when you're generous with what you call CPOE.

Remember all those impressive booths and slick ads from Siemens, Epic, GE, McKesson, IDX, and Eclipsys? They must have a string of mammothly successful CPOE installs live by now, right? Wrong. None of them have even five partial installations, according to KLAS. I bet you've heard a zillion times about Horizon Expert Orders, but maybe you didn't know that only one site is even partially using CPOE (and I'm guessing that's Vanderbilt, whose main success with it seems to have been in licensing it to McKesson.)

Who are the exceptions? Cerner and Meditech have over 100 CPOE sites each (if you believe the numbers, and I frankly don't.) On the ambulatory side, only Epic has measurable CPOE.

This was one of the topics discussed at lunch with colleagues today. "Interesting," said one of them who used to sell for one of those vendors. "Why do you suppose that Meditech has the most installs in the HIS world and Epic has the highest rated product? Isn't it interesting that both are privately held companies?"

I recalled standing (figuratively) on a soapbox over this issue in the past. I'm the most ardent MBA-holding and Republican-voting capitalist pig this side of Gordon Gekko. I love it when someone builds up a company and, against all odds, sells it to Microsoft (or GE) or takes it public, pocketing obscenely large wads of cash and suddenly wearing suits to work instead of jeans and an iPod. Still, I'm not sure the HIS industry benefits from this.

I like a company where the founder or large shareholder runs the show, not some Wall Street investment banker hack who replaces him or her at the behest of the new owners. I like product guys who get their hands dirty and speak proudly of how cheap they are with the company's money, not a bunch of Ivy League pukes who want to build a resume and a bank account and move on. Mostly, I like someone who knows healthcare and not just "widgets" and beans requiring counting, companies in just one line of business: mine.

Back to the elusive point I was striving for, we need those kinds of companies in our industry. We need Meditech and Epic because we've seen the alternative: overmarketing, financial shenanigans, bizarre acquisitions, poor support, employee turnover, and quarter-by-quarter knee-jerk product decisions. You don't keep Wall Street happy by merely being fabulously profitable - only retired dentists looking for investment income love that kind of stock. High stock option value is the real carrot for all those high-paid executives, and to keep the stock price moving up, you've got to grow revenue no matter what it takes (see HBOC book-cooking articles.)

Here's the problem. We've got maybe 5,000 hospitals in the country, most of them with under 100 beds. Like real estate, they ain't making any more of it. Many of those are part of a larger system, so there really aren't that many potential customers out there. Their revenues are going down and are controlled largely by the government, who is basically already a single payor in many areas of the country. All of those hospitals have computer systems already, so the slick sales guy has to replace someone else's product to get his in the door. So, how the heck can a company grow at a rate Wall Street will slobber over if their customers are poor and don't really need what they're selling? Particularly when their product's track record of success is abysmal?

Moving on to the next lunch discussion: how big a company do you need to build and support a hospital system? If Vanderbilt University can do it better than McKesson (as would seem to be the case since McKesson bought their product instead of building one themselves) then why do we need the McKessons of the world at all? What allowed Epic and Meditech to start small, run efficiently, treat their employees and customers pretty well, make ungodly sums of money, and develop products as good or better than anyone else's without all of the suit-and-expense-account overhead and Wall Street posturing? Are we better served by the big guys than the little guys?

Meditech and Epic are almost embarrassingly naive about marketing. They don't have churn-and-burn sales guys. They build rather than acquire. They are the HIS Nazi, because if they don't like you as a potential customer, it's "no soup for you." Their technology is hardly smile-for-the-Computerworld-picture buzzware. Still, my understanding is that privately held Meditech has more hospital customers than any other vendor, and Epic is so wildly successful that Kaiser Permanente gave them somewhere near $1 billion just to get their almost-undivided attention over several years.

Maybe there's no relationship between systems sold by international conglomerates vs. those marketed by privately held companies with limited product choices and a firm conviction - driven home relentlessly by one or two owners with an iron will - that they're right and the big boys are wrong. I'd feel much better in this conclusion if it wasn't for Cerner, which has all of the above, boatloads of customers, and still keeps the stockbrokers aroused. Still, if you look down the KLAS product ratings, it's often the dark horse that's winning the race.

OK, I know many vendor folks read HIStalk.com. What do you think? Is your company different? Are you brave enough to tell me (even anonymously) what you think?