Hospital seeks new IT system


The Health Services Authority is planning to replace or upgrade its IT system which has been plagued by operating problems since it was implemented seven years ago. 

The Authority currently uses a system for financial transactions and records, as well as patient exchange data, provided by the Cerner Corporation, which controls it remotely from Kansas City and which costs the Authority $2.7 
million a year. 

Dale Sanders, chief information officer of the Health Services Authority, said that the request for proposals, issued last month, was prompted by Cerner’s nine-year contract ending in mid 2013.  

“The Cerner system is designed around the US health care delivery model, in particular on the financial side of things. We don’t operate like the US and nor do we ever really want to,” Mr. Sanders said. 

“Getting that system configured to support the financial model we want has been very challenging. It has contributed to the financial troubles that the HSA has had in the past. Now we have focussed a lot in the last couple of years on getting the financial system fixed to be more reliable and reflective of the way we do business,” he said.  

The Health Services Authority had run at a loss since its inception in 2002, but made its first profit of $2.3 million in the 2009/2010 
financial year.  

According to the request for proposals issued by the Health Services Authority, the total cost of ownership of Cerner’s product lines is more than 85 per cent of the HSA’s entire IT budget. The Health Services Authority hopes to halve those expenses with the new contract.  

It stated, “HSA’s strategic goal is to reduce these expenses by nearly 50 per cent by working with a vendor partner that can provide a next generation HIS/EHR [Electronic Health Record] at a reasonable cost.” 

The Health Services Authority is scheduled to announce who will get the new contract on 1 June, 2012. 

Mr. Sanders said he has had concerns with the nature of the contract the Health Services Authority has with Cerner. “It has been a very expensive contract, a very long-term one and has not been easy to renegotiate,” he said.  

One of the problems encountered with the Cerner system is that payments for services in Cayman are taken in US or Cayman currencies, so the system needs to support both. “[The] HSA and the Cayman Islands are actively planning away from the dysfunctional influence of the US financial and economic model, but finding it very difficult to do so using the Cerner revenue cycle applications,” the tender bid document read. 

Doctors working with the system have also found it cumbersome to use and are “largely unhappy with the workflow and user interface” of the system, the document said. 

“Multiple logons to Windows, Cerner, and imaging systems is also inefficient, and the time required to logon to Cerner and load patient records is a distraction to efficiency,” it read. 

The system underwent a series of difficulties in its first three years and in 2006 Cerner moved the software and data processing systems to a data centre in Kansas City. 

Mr. Sanders said he would prefer to have the system hosted in Cayman, but acknowledged that at the time it was moved to the US, “it was the right thing to do” as it could not have been supported properly in Cayman then. 

The HSA launched a new economic concept for managing health care costs in Cayman last year, called CayHealth, which is a version of the Accountable Care Organisation system being introduced in the US under the country’s new health reform law. “Under CayHealth, HSA believes that patients and physicians must have the ability to explore treatment options within the context of overall cost of care, and specifically the patient’s out-of-pocket expenses, including real-time electronic claims adjudication at the point of care,” the request for proposals document read. 

Mr. Sanders said Cayman was already ahead of the field compared to many health care operations in the United States, where only 30 per cent of hospitals have similar systems. 

He said the Cerner system was the “best of a poor crop of options” available in the United States.  

The Health Services Authority has invited Cerner to rebid for the contract and Mr. Sanders said he hoped the company could come up with an option that would provide better value. 

Sixteen vendors expressed interest in submitting bids to install a new system when a request for expressions of interest was issued earlier this year, Mr. Sanders said, with companies from as far afield as Mexico, India and Portugal, as well as from the US, showing interest. 

The new system would be able to interact with other systems used by health care professionals in Cayman, including the Chrissie Tomlinson Memorial Hospital and the proposed Shetty Hospital for the purposes of exchanging patient information. 

Whomever is chosen to implement a new or improved system, Mr. Sanders said it was vital that “the system evolves at the same pace as we are trying to improve the HSA”. 


A new computer system for the Cayman Islands Hospital will be chosen next year.


  1. I just wanted to say that the EMR system is just as cumbersome and meaningfully unusable in the United States. The EMRs and CPOEs are impediments to safe and effective care in the USA.

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