Remember when Cabbage Patch dolls dominated Christmas and loving parents everywhere were dong stupid things to get their hands on puffy cheeked, plastic headed dolls to win the hearts and minds of their precious offspring? If things keep going the way they are going, the integration frenzy will be bigger in 2009 than Babyland General in 1982.
Based on our discussions with veterinarians in our prepurchase digital radiography service, upwards of 100% of our clients are asking about integration. Many of them are switching lab services, practice managment software, and are even willing to pay extra for digital systems that offer them integration that serves a purpose. Currently, the company that offers the most complete integration is Idexx and Idexx is on a tear.
Veterinarians are not the only ones taking note. Several digital radiography vendors and lab services contacted me recently to ask what this was all about; why they are losing clients; and what I was going to do about it*. One vendor even commented that they are losing 25% of all of their sales because of integration and automated billing.
What is this integration all about anyway?
At the trade shows you will hear loads of vendors talking about integration. The term, however, is pretty meaningless until you ask what functionality the vendor is calling integration. In most cases the term is used to describe vanilla offerings that allow you to open images in practice management software. Other times integration is a little more interesting as vendors are starting to offer DICOM modality worklist functionality. These methods of integration are a little interesting but they do not get veterinarians worked up in a hot sweat when they are shopping for a digital radiography system.
The functionality from Idexx that everyone is taking about is automated billing. Idexx integration promises that every digital radiograph their users take will automatically get billed in Cornerstone** Stated another way, with Idexx you will have no lost charges from digital radiography (and their lab services). Idexx has data to show that there are a large number of digital images that are taken and never billed. My own research supports this data. As such, buying an integrated Idexx/Cornerstone system has the potential to “pay for itself” over time.
Why does Idexx have this functionality and nobody else does?
The reason that Idexx has this functionality is that they can control the CR software AND the practice management software. This means that they can make their software (on both ends) such that you cannot order a study without charging for it. This is a proprietary bridge that is currently closed to other vendors.
Conversely, other practice management software vendors and digital radiography providers can only control only ½ of the equation. Some practice management vendors are offering DICOM modliaty worklist integration but DICOM MWL cannot gurantee automated billing. The reason is that DICOM MWL cannot account for orphan images if a technician in the radiology room takes additional views but does not go back to practice management to order those extra views. These orphan images result in lost charges.
What can be done about this situation?
This is the question the digital vendors (and more and more vets) are asking me. Personally, I think the only thing that needs to be done is compliment Idexx for creating awareness of integration and providing a product that vets find interesting. If you are a vendor and you are feeling generous you can also thank them for giving you a spanking and opening your eyes to the situation.
A better question to ask is how can we make the other vendors products more competitive so veterinarians who either do not have Cornerstone or do not want to work with Idexx (for whatever reason) can get automated billing and other integration in their practice? The way I see it, there are a few options:
1. Develop an open standard of communication between PIMS and digital radiography that will provide automated billing between disparate systems. As far as I am aware there is no off the shelf standard that can do this. This is an option that will take years of development and since it has been 5 years since we started talking about this*** I have little hope this will work.
2. PIMS and digital vendors can work together and come up with a simple solution. How about simply locking down the digital radiography devices such that they cannot be operated without first ordering images in practice management. This would eliminate orphan films immediately. Of course, there would be the need to over-ride the MWL only setting in cases of emergency but that is fairly simple to deal with. This solution would only require the digital vendors to agree on a workflow and adjust their software accordingly. The only thing PIMS vendors would have to do is offer DICOM MWL functionality. Pretty simple huh?
3. Perhaps digital vendors put away their differences and work with Idexx and convince them to provide the veterinary community with a open API so they can build interfaces to Cornerstone. Maybe this API will become an industry standard. For all you Idexx haters I know that is a scary proposition but sometimes if you are the leader you get to set the rules.
Looking at these options number 2 is probably the most viable and 3 is only possible if Idexx decides to go this route. What can be said either way is that the first step is to get everyone to start working together. Integration means communication. Right now everyone is quibbling among themselves trying to work things out in back rooms using one off integration schemes. Guys – it is kumbaya**** time. Quibbling has only served to allow a single vendor (who does not need to play along with anyone else) to back the bus up and have customers waiting at their door.
To kickstart things – I am personally pledging $10,000 in programmer time to any consortium, connect-a-thon, or group that will help promote vendors working together. Anybody want to match my pledge*****? Everyone is invited.
** Like spanking someone or play Matisyahu at level 11 until they succumb or go insane?
** This only works with Cornerstone currently. Soon it will also work with Avimark.
***Historical note: four years ago I met with just about all of the practice management software vendors and digital radiography vendors and discussed the fact that integration was coming. At the time most everyone thought I was a kook and the most vocal opponent was Idexx who said they are not hearing a call from their customers for such integration. Idexx asked for survey of veterinary practitioners to see if there is support for a move toward integration in the veterinary practice. Times have changed and it turns out that Idexx was the only one listening. It is nearly 5 years later and we are just as close as we were five years ago at working together. Cant we all just get along ?
**** Kum bay ya, my Lord, kum bay ya;Kum bay ya, the Lord, kum bay ya; Kum bay ya, my Lord, kum bay ya, O Lord, kum bay ya.
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