Recently, University of Missouri System President Gary Forsee has decided to outsource the university's medical center information technology to Cerner Corp., a large, successful medical software company. This would mean that at least 100 university employees could be traded to this corporation.
Suddenly comes the darkest shadow of micromanagement that defies all principles of hospital management. There is limited discussion and attempts for consensus. Mr. Forsee, working closely with the president of Cerner, has carried out a classical blitzkrieg maneuver — best defined by speed, coordination and surprise. Designed to hit hard and move on instantly, its aim is to create panic among the civilian population — University IT employees — and outsource our IT to Cerner with limited resistance. It worked.
Major General J.F.C. Fuller, a proponent of the military blitzkrieg, said, “Speed, and still more speed, and always speed was the secret ... and that demanded audacity, more audacity and always audacity.” This plan did not lack for either.
The plan is seductive. Taking advantage of proposed money from the Obama stimulus package and forming a unique corporation, the presidents project this institution receiving millions of dollars back into our operating budget. In spite of this tempting rhetoric, I do not know a single person in this institution at any level who has enthusiastically endorsed this plan. Many have simply accepted the fact that the blitzkrieg has worked. Even before all the ink has been signed, the outsourcing plan is being implemented. We are all now electronic prisoners, and our fiscal fate is in the hands of others. We have given away our most valuable resource: the intellectual properties and experience of dedicated employees.
When I started medical school, the chairman of pathology was Dr. Fred V. Lucas. He was a big-picture man, and his advice was that to succeed you need to control space, money, personnel and, most importantly, the data. The proof of this was when Boone Hospital was leased to Christian Hospital Corporation: The data was immediately switched to St. Louis, and it is unlikely that Boone will ever again be our county-controlled hospital. A conservative figure is that Boone Hospital over the lease period cost the county more than a half-billion dollars.
Data control and management is the heart and soul of health care delivery, and losing control exposes an institution to both a fiscal and intellectual risk. Taking away this control and placing it in the hands of others is reckless and dangerous.
I have watched the University of Missouri medical school almost fiscally collapse because of its inability to manage data and in particularly send out accurate and timely bills. It was so bad that in the 1990s there was a serious attempt to have the hospital merge with Tenet Corp.
In 2002, the university faced similar problems, and only after the state auditors were called and outside consultants were brought in — coupled with the leadership of President Elson Floyd — were we able to put the hospital back into a fiscally successful operation. The reward for President Floyd was to force him out, as he threatened the administrative structure of our good old boy network. The Board of Curators replaced him with a president with strong business experiences.
Currently, the hospital is doing well, partly due to Mr. Forsee’s new administrative structure. Finally, we have cohesive decision making in the organization. In the past, we had the equivalent of 18 Afghan tribal leaders, and no one was actually running the clinical side of the hospital.
Mr. Jim Ross, the CEO of University of Missouri Health Care, is an accomplished hospital administrator working cooperatively with the dean and the vice chancellor of health affairs, and good decisions regarding the practice of medicine are being made. Our future looks bright. Bills are more timely and accurate, and patient satisfaction is improving.
Some of this success was due to the fact that with our own department of information technology, we have been able to make Cerner's software work in most cases. The software is so cumbersome that the administrative portion of our residency program is on probation — a major component being that the Cerner software takes so much time from residency training that resident education is compromised.
I have never heard a complimentary statement about the software or their support for it from a university employee at any level. Three years ago, Cerner's software was abandoned by the Department of Radiology as they deemed it inoperable, according to the department's chairman. The natural history of Cerner is to produce relatively untried software, and their response to problems has been limited. In spite of this, Cerner is making a lot of money and is riding the wave of federal monies to support electronic medical records. It seems unlikely that a cooperative arrangement with this company is a safe bet to make on the future of this institution. Our other choice was to dump Cerner and find another computer software company, but instead we have turned our future over to this company with a questionable track record.
This should remind us of the quote by former Supreme Court Justice William O. Douglas: “As nightfall does not come at once, neither does oppression, in both instances, there’s twilight where everything remains seemingly unchanged, and it is in such twilight that we must be aware of change in the air, however slight, lest we become unwilling victims of the darkness.”
Let us pay attention to the future; there is still time to act before immeasurable damage is done to this institution. It’s never over until the last signature is placed on the final contract. Let us hope that these warnings will act to make the parties involved more dedicated and more responsible for the actions taken. Let us hope that we do not become unwilling victims of the darkness.
Eddie Adelstein is an associate professor of pathology at MU.