HMT Exclusive
The Information System Professionals Behind the 100 Top Hospitals
HEALTH MANAGEMENT TECHNOLOGY gets key answers from five among the best.

Behind every great hospital stands a number of people who make it happen. A board with vision. An administrator with special skills. A medical staff unparalleled. A financial officer quick on the numbers. And an information systems professional who provides the infrastructure and technology that supports all other services and operations. It is the Chief Information Officer, the IS Director, or other technology person, by whatever other title he or she is known, that this feature salutes.

Last December the Baltimore-based healthcare information company, HCIA, and the New York-based human resources management consulting firm, William M. Mercer, looked at 1997 Medicare cost and discharge data from 3,258 acute-care hospitals. Judged against nine standards, they determined the 100 best-performing hospitals and published the results in 100 Top Hospitals: Benchmarks for Success.

Health Management Technology has taken the listing one step further by identifying the designated IS person at each of those hospitals today. We salute the IS individual who carries the banner for the technological support that makes possible many functions of the hospital.

The full "honors listing" appears on pages 12 and 13. HMT chose to profile the information officer at the one hospital—Brigham and Women’s Hospital in Boston—that has appeared on the list for six consecutive years, plus the IS administrators at the four hospitals that have been on the list for five years.

MARY FINLAY
Corporate Director, Information Systems
Brigham and Women’s Hospital
Boston, Massachusetts

100 Top Hospitals: 6 years
Institution size: 663 beds
Years with institution: 11
Years in IS: 11
Diversion from Y2K issues: Roller-skating with her two daughters

How has IS helped achieve the institution’s ranking among the 100 Top Hospitals? Information technology has always been viewed as an asset and a strategic tool at BWH. Many of the efforts to sustain its ranking as a premier institution have been supported by technology, ranging from minimizing adverse drug events to streamlining patient discharges.

What systems challenges have you confronted in the past couple years for your institution? The major challenge is meeting the demands of a very large agenda. Since becoming part of an integrated delivery system, we are faced with meeting the IT demands of a large academic medical center and the demands of system integration with other entities in the delivery system.

What is the largest challenge facing IS for your institution in the next year—excluding Y2K conversion? The largest challenge is to figure out how to continue providing advanced technology in a fiscally constrained environment.

What IS changes have impacted the hospital the most in recent years? The introduction of Windows and Web technology has had the most impact on the hospital during the past few years. These technologies have broadened our computing capability and completely changed how the hospital staff interacts with computers.

What makes for a successful CIO in the business today? Successful CIOs understand the business and how technology can have an impact on the business goals and challenges. It is someone who has good communication skills, project management skills, and manages constant change. It is also someone with very thick skin.

What do you advise aspiring CIOs to assure their career? Oftentimes aspiring CIOs focus on developing an in-depth knowledge of technology. While this is important, it is equally important to develop the softer skills to be able to communicate effectively, manage projects, negotiate, and build teams. Also, find at least one mentor. Find a CIO who you admire and ask that person to help you chart your way to becoming a CIO.

THOMAS W. SMITH
Vice President, Information Systems
Evanston Northwestern Healthcare
Evanston, Illinois

100 Top Hospitals: 5 Years
Institution size: 420 beds
Years with institution: 8
Years in IS: 15
Diversion from Y2K issues: Coaching youth sports

How has IS helped achieve the institution’s ranking among the 100 Top Hospitals? We’ve had a good history of a solid set of systems for several years in financial billing and collection systems and interfacing patient accounting and accounts receivables into our general ledger and financial reporting systems. Also, we’ve tied together our financial and long range planning systems—historical data and how patients have been treated—to allow us to help hospital physicians and nurses in developing the clinical pathways we use today.

What systems challenges have you confronted in the past couple years for your institution? Merging clinical products developed by different vendors into a repository has been a challenge for us and for the vendors. Also two medical groups joined us, and integrating them quickly into our corporation was a big task because they came about on very short notice.

What is the largest challenge facing IS for your institution in the next year—excluding Y2K conversion? Balancing the need to roll out new enabling technology with the need to have consistent, reliable systems for users.

What IS changes have impacted the hospital the most in recent years? The penetration into so many areas of PCs and desktop computing, and now bedside computing—things that weren’t even on the list five or ten years ago. The percentage of our activity that’s now automated has been a big change.

What makes for a successful CIO in the business today? Developing a good overall architecture for your network and your systems; selecting vendors carefully, understanding their limitations and successes, and then selecting and keeping good people.

What do you advise aspiring CIOs to assure their career? For people who are purely technology based I’ve encouraged them to become familiar with the business side of healthcare and understand more about what goes on in the clinical setting. Also, developing skills in working well with people, even if it is just their peer group with whom they are working. If they can’t do that well, it is unlikely they are going to be successful the higher up the organization they go.

C. MARTIN HARRIS, M.D.
Chief Information Officer
Cleveland Clinic Foundation
Cleveland, Ohio

100 Top Hospitals: 5 Years
Institution size: 2,957 staffed beds (Health System)
Years with institution: 3
Years in IS: 10
Diversion from Y2K issues: Cleveland Indians

How has IS helped achieve the institution’s ranking among the 100 Top Hospitals? We have used information technology extensively in evaluating new clinical programs. Information technology is used to convert data into information that allows us to take better care of our patients.

What systems challenges have you confronted in the past couple years for your institution? Extending the use of information technology to the direct patient care process. The challenge is in improving operational efficiency at a reasonable cost.

What is the largest challenge facing IS for your institution in the next year—excluding Y2K conversion? Developing a cost-effective integration strategy for disparate provider organizations.

What IS changes have impacted the hospital the most in recent years? It’s really enhancements in data, video, and voice communications. We now have the ability to deliver clinical information to the provider at home or at the bedside.

What makes for a successful CIO in the business today? Having a true interest in the practice of medicine. The greatest advances in information technology will occur in the clinical setting over the next ten years.

What do you advise aspiring CIOs to assure their career? To spend as much time understanding the clinical operation as they do technology. A fundamental technical IT background is required, but broader management courses are equally important.

DAVID MUNTZ
Senior Vice President/CIO
Texas Health Information Services
Harris Methodist Fort Worth Hospital
Fort Worth, Texas

100 Top Hospitals: 5 Years
Institution size: 606 beds
Years with institution: 8 years
Years in IS: 27 years
Diversion from Y2K issues: Golf, biking

How has IS helped achieve the institution’s ranking among the 100 Top Hospitals? All decisions are based on information and incentives. The better the information, the better the decision. HMFW has the ability to access information along the data continuum because of our close relationship with physicians. We feed information into our Continuous Improvement Committees who then can make informed decisions to effect change.

What systems challenges have you confronted in the past couple years for your institution? No matter how much data we generate to answer our questions, the answers we get raise more questions. The need for data, converted to information, then transformed to usable knowledge is a huge challenge for all healthcare participants.

What is the largest challenge facing IS for your institution in the next year – excluding Y2K conversion? First, we need the ability to share data about patients regardless of where they are treated. More than 65 percent of data is generated outside the walls of the traditional delivery system. We need to deliver the right data to the right person at the right time in a secured and confidential manner to get the best outcomes, regardless of location. The second challenge is the need to access capital to develop the infrastructure and processes to help us achieve a community oriented information system.

What IS changes have impacted the hospital the most in recent years? Computers are everywhere. Open systems have made departments and specific areas more productive and efficient. The challenge of open systems is integrating and/or interfacing to make sure the benefits are sustained. When systems are designed thoughtfully, the hassle factor in healthcare can be reduced. Another technology that has impacted hospitals is wireless devices, from pagers to cell phones to laptop computers. Now we can think about minimizing the obstacles to communication.

What makes for a successful CIO in the business today? The CIO needs to be part visionary, politician, advocate, counselor, translator and cheerleader. Even if there was not a limit on budget, there is a limit on how much change any human-based system can absorb. It is, therefore, necessary to balance a host of factors when deploying new systems. Process has become our primary focus. Given declining access to capital, the CIO must look at the processes as a whole and determine if a non-technology solution is applicable, before turning to technology. As such, the CIO must understand business, economics, healthcare and finally, technology.

What do you advise aspiring CIOs to assure their career? Learn how to communicate effectively. To succeed you must understand the real needs of your multiple stakeholders. Often, the requirements from stakeholders force compromise to achieve the maximum result for the patient. The best advice I ever got was to lead with my ears.

LARRY G. PAULSON
Vice President, Information Systems
Catholic Health Initiatives West—St. Joseph Medical Center
Tacoma, Washington

100 Top Hospitals: 5 Years
Institution size 340 beds
Years with institution: One-half year
Years in IS: 22
Diversion from Y2K issues: Running, biking, scuba—with his family

How has IS helped achieve the institution’s ranking among the 100 Top Hospitals? We’ve leveraged greater financial efficiency and helped improve clinical outcomes by fully utilizing the data provided to us from various functions in our medical center into our decision support system.

What system challenges have you confronted in the past couple years for your institution? Integrating our disparate systems. Our challenge has been to normalize our systems from a data standpoint, getting data definitions the same across all systems.

What is the largest challenge facing IS for your institution in the next year—excluding Y2K? Our continued effort to roll out our computerized patient record system. Our development of the electronic medical record will eventually involve taking what is now a combination of paper forms and computer-based processes and switching it to a wireless, computer-at-the-bedside technology. While it is a technical challenge, the larger challenge is the re-design of the clinical process. We’re going to make the data collection and distribution process more efficient, improving our ability to have good clinical outcomes.

What IS changes have impacted the hospital the most in recent years? The greatest impact has been the Internet and Internet technology. It has made information sharing so much easier. It has become the de facto user interface standard.

What makes a successful CIO in the business today? I think the successful CIO has to understand the business they support. Strictly a technical background is no longer adequate. This person has to be able to sit at the leadership table and help design the healthcare product.

What do you advise aspiring CIOs to assure their career? I think we need to increasingly demonstrate our return on investment. We have to realize that, in fact, IS is a service department. We need to deliver service.