My comments in blue italic:
Med Center bonus typifies UC executive pay tiffhttp://msnbc.msn.com/id/11693923/It will be interesting to see what UC Davis received for the $14+ million.
By Kathy Robertson
Sacramento Business Journal
Updated: 7:00 p.m. ET
March 5, 2006
The person in charge of setting up an electronic medical record system for the UC Davis Health System was paid a $42,100 bonus last year despite missed deadlines and other problems with the program.
The bonus came on top of Dr. Thomas Tinstman's base pay of $78,399 and negotiated salary of $205,397, for total compensation of $325,896 last year.
That is a surprising level of compensation for an "Associate Director of Clinical IT." As a Yale-trained medical informatics (clinical computing) specialist, I held a similar role (Director of Clinical IT) at a 1,100-bed regional medical center in the late 1990's, Christiana Care Health System, at a base of ~ $90,000 plus 10-15% bonus potential, which I believe is more standard for the health IT sector. Even At Merck & Co., Inc., running the scientific IT group and internal research libraries of Merck Research Labs, supporting R&D worldwide at the Director level, my base was ~ $125K just two years ago (I started at $111K in 2000) with 20-30% bonus potential in 2003, based on comps performed by Merck's HR team.
Academics often complain about inflated wages in the pharmaceutical sector...
Note that this critique is not about a person accepting a job at that salary level - one negotiates the best deal they can, of course - the issue is the UC system's offering such salaries and consultant contracts.
I should note that in 1996, when I was faculty in the Center for Medical Informatics at Yale School of Medicine, and offered a position as Director of Clinical Information Systems at Yale-New Haven Hospital (at $110K base, by the way) but also seeking industry opportunities in EMR, Cerner, and Tinstman in particular, would not even talk to me about a position. In the meantime, Cerner and Tinstman were discreetly negotiating a generous contract including relocation to the midwest with one of the postdocs I was helping to teach, an OB/GYN with significantly less IT expertise, for a position that sounded like a glorified sales role. (That person left Cerner after a few years.) While this type of behavior is not uncommon, it certainly did not instill confidence in vendors' views about the value of Medical Informatics.
This also brings to mind points about an earlier post on insights into industries that can be gleaned by who they won't hire.
The job performance and pay of one of UC Davis' top faculty members offers insight on how public money is spent on executive compensation at the University of California. The program is under attack by faculty and legislators following revelations late last year of high executive pay, job perks and severance payments.
... Internal documents show the [clinical IT] project -- with the final bill estimated to be anywhere from $75 million to $100 million -- is two years behind schedule and up to a fifth of the budget went to an outside consulting firm whose expense reports are now the subject of an internal UC audit.
Expenses include fitness club membership dues and use of a taxi by one consultant to visit her parent's home in Henderson, Nev.
75 to 100 million dollars for a clinical information system is concerning. That approaches the annual budget of the entire research IT division at a company like Merck. The fact that it is behind schedule may be due to issues I cover in my website "Sociotechnologic issues in clinical computing:Common examples of healthcare IT failure." I would like to hear more about end user reaction to the EMR implementation; while I may be wrong, it would not surpise me to hear about significant dissatisfaction. The issues in clinical IT implementations that are undergoing delays and cost overruns are somewhat predictable.
I am reminded of events at another set of California academic medical centers, the failed merger between Stanford & UCSF, "A thousand MIS personnel cannot merge two healthcare systems?"
... Tinstman, who is associate director for clinical information systems at the UC Davis Medical Center in Sacramento, collected a bonus of just under 15 percent of his total salary. His job is to replace paper patient charts with electronic ones that allow doctors to document care, enter orders, review results and send messages back and forth.
"I think my pay is in line with people who do my type of work and have my experience," Tinstman said. "In fact, it's low."
See my comments above. It might be low -- compared to, say, CIO's in major corporations.
...$14.4 million consultants: Deloitte Consulting Inc. was hired in 2002 to help get the program going. The firm billed UC at least $14.4 million over a period of three years, ending last June. "Deloitte was brought in because otherwise we would have had to hire a whole bunch of new people and then later say, 'You've been very nice but we don't need your services any more,' " Chason explained
I see. Spending millions of dollars that are just overflowing from the coffers at academic medical centers is more important than hiring people for a several-year contract and then laying them off (that too is in doubt, as the need for expansion, modernization, interative refinement, maintenance etc. never goes away, unlike the organizational knowledge gained by consultants when they leave). It's nice to be able to afford to be so polite, even if it does cost millions. I wish all industries were so polite. The norm seems to be mass layoffs without warning - except in the case of altruistic academic medical centers like UC Davis, with discretionary money for expensive consulting engagements seemingly pouring out of the woodwork.
To be blunt: for $14,000,000+ this medical center could have started an entire department of health IT implementation experts and funded them for a several years. I supported a staff of 50+ at Merck as well as purchased extremely expensive scientific and cheminformatic information assets - consuming perhaps three quarters of the budget - on an annual budget of under $13M.
In addition, if consultants were deemed necessary, Deloitte has a healthcare IT consultancy, but it is not their core focus as with other more specialized consultant groups.
... A whistleblower complained of irregularities in the expense reports last year.
This story is reminiscent of what I call the "corporate approach" to clinical IT. That is, implementation of clincial IT under the assumption that clinical IT is but a subspecies of Management Information System. Wrong. Clinical IT and business IT are two different subspecialties of IT. It is essential to have strong involvement in such projects by people who know well the hectic environment of a healthcare organization, where much of the complex labor and improvisation that keeps things running smoothly is hiding in plain sight. Consultants do not provide that level of intimacy.
Coming from a vendor environment (Tinstman was Senior Vice President and Chief Medical Officer at Cerner), it does not surprise me that the approach of using expensive consultants was adopted here. My motto on that issue is "it's absurd to believe that someone else knows your business better than you, and it's even more absurd to believe it's OK for someone else to know your business better than you."
I can only hope there were no back room deals or quid pro quo's related to previous contracts between Deloitte, Cerner, and/or Cerner clients that prompted someone to become a whistleblower. While certainly not making such an accusation, and having no such knowledge or contact with any of the principals, such an occurrence would not shock me. I am concerned since such a revelation would do further damage to the Healthcare IT industry. This technology really is beneficial - but only if done properly, and done well.