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relic IBM punch card. But in the 1980s, most hospital computing work was managed on mainframes, through computer time-sharing arrangements. Hospitals would connect over phone lines to centralized ser- vices, as needed, avoiding the expense of purchasing and maintaining their own mainframe. SMS Corpora- tion, which was acquired by Siemens in 2000, made a huge success of the time-

Mike Hilts is a senior practice leader at CES Partners, a healthcare executive search fi rm headquartered in Chicago, and former editorial director and publisher of Health Management Technology.

For more information on CES Partners, visit

sharing model in healthcare, and by the mid-1980s, had hundreds of hospitals hooked up to its national computer network.

One thing SMS founder James Macaleer and his partners found while working with hospitals was that healthcare personnel were not particularly good at operating the systems, or at using the software to run the systems. SMS’ reaction, for several years, was to offer only fi nancial management systems. On one hand, that tactic fi lled the biggest need in hospitals, focusing on administrative aspects, fi nancial analytics and bill- ing. On the other hand, it left many hospitals to go it alone – to purchase their own mainframes and develop homegrown software applications. So, whether shared or purchased, mainframes served as the core platforms in hospitals well into the 1980s.

Denis Bak Denis Baker

That was the kind of environ- ment that Denis Baker stepped into at Sarasota Memorial Hos- pital, even though he arrived in 1995. That was well into the period when client-server architec- ture had supplanted mainframes, and the AS400 and RS/6000 midrange computers – more often called minis – comprised the core

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of healthcare computing. As information services di- rector, Baker worked with Jim Turnbull, CIO at the time, to lead the 800-bed hospital and health network through a signifi cant strategic plan to “get us off the mainframe” and replace the self-developed software that had served the organization since 1980. “It cost a lot of money, took a lot of marketing, edu- cation, an extremely supportive board and knowledge- able senior management, but we knew it was time to head in a direction that would serve Sarasota Memorial for another 20 years,” Baker says. “We moved forward, very committed to fulfi lling the potential of the EMR, and were fortunate to have found HealthVision, a rock- solid product, later assimilated into Eclipsys.”

The labored birth of modern IT

Similar challenges of simultaneously building a whole new infrastructure and IT teams needed to carry out the emerging strategic plans for clinical systems became common in the late 1980s and early 1990s. That’s what George (Buddy) Hick- man had to tackle when he stepped in as CIO at Allegheny Health Services in 1989, but his job was unusually complicated.

The organization was more than technology challenged. Hick-

George Hickman George Hickman

man came in to manage an information systems turnaround, starting with solving a payroll system implementation failure that occurred just before he arrived. “We had to bring the armored truck in to pay employees in cash.” It needed a new system-wide data center to support four or five hospitals. The data center Hickman’s team built ultimately supported 15 hospitals.

“Our organization was trying to do the right things – we got to work on developing a clinical data warehouse,” Hickman says. “We took slices of data to management, to demonstrate the power of data in decision making. Drug and therapeutic committees looked at utilization patterns. There had been a lot of talk about that kind of capability, but it was rare in practice.”

Still, the organization was pressing for progress faster than Hickman’s department could handle. “Basically, our biggest challenges weren’t about the technology itself, but about growing our competencies to manage the technology and the change process,” says Hickman, who is now senior vice president CIO at Albany Medical Center, a 631-bed academic medical center in New York. “We didn’t have the competency yet on staff to manage the big projects,” Hickman says. “There wasn’t a surplus of the talent we needed around the country at the time. We were building up to it, but it wasn’t in place. “We only had a couple of mainframes and very little in the way of formal management procedures in place to guide programmers on moving code changes into production,” explains Hickman. In those days, it was not uncommon for programmers to change code, test it themselves and move it into production. “Once, one of our programmers made code changes, tested them, put them into production – and left for the Jersey shore,” Hickman says. “By Monday, we found out every charge in our system had been con- verted into a mammography.”


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