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Pioneers of HMT

senior vice president and chief in- formation offi cer for Sutter Health, recalls work on implementing one of the industry’s fi rst comprehen- sive EMR suites, from HBOC, later acquired by McKesson. “Their pitch at the time was that their system was completely integrated,” Hum- mel laughs. “Sure, HBOC’s system had one of everything, but the indi- vidual modules weren’t integrated. It was just a collection of programs. While connections were available, each module ran on separate data- bases. Massive integration engines were needed.”

While HL7 was available, and accredited by ANSI in 1994, Hum- mel points out that vendors treated them more like guidelines than standards. “HL7 was supposed to ‘standardize’ the interfaces so that we could all share info; except that almost all vendors had their own view of HL7.”

That left Hummel with a lot of interface work. His team included more than 20 programmers who had to write the messaging for all the interfaces – over 100 million message segments each year. “We had little choice,” Hummel says. “We had to do it if we wanted to ensure connections and correction transactions.”

John Hummel JohnHummel

According to Hummel, when you go looking at healthcare IT expenses, look at the people and equip- ment that kind of monitoring and vendor

management require. It may also help explain the IT paradox – an era characterized by little or no correlation between investment in technology and the return on that investment, in terms of prof- its, improved effi ciency or other measures.

22 October 2010

Tomorrow’s troubles Ten years or so ago, the invest- ment in IT was 1 percent or less of a hospital’s operating budget, on aver- age. Big initiatives of the last decade, including EMR and CPOE projects, have brought the IT spend up rap- idly, to an average of 5 or 6 percent or above in most institutions. Just revisit some of the stagger- ing sums for major EMR initiatives: Sutter spent $600 to $700 million; Catholic Healthcare West, close to a billion. Kaiser put more than

100-core chip could soon make serv- ers we use so much more powerful than the minis on which we ran our entire enterprises.”

Sarasota’s Baker shares another concern that could affect IT opera- tions in the years ahead – a linger- ing worry about healthcare vendor mergers and acquisitions. With hundreds of IT vendors selling solu- tions in healthcare, many come into the market without knowing enough about healthcare, or without the resources or commitment to stay.

“We decided we wanted a system to keep everything, on every patient, forever – not simply the seven years that would meet regulatory requirements.”

$4 billion into system-wide EMRs. “Spending that kind of money could lead to some diffi cult times ahead for CIOs and IT departments,” Hummel projects. “Boards or CEOs could easily ask CIOs to cut their 6 percent budgets in half, to do more with less, or just shelve some key projects.”

Hummel also frames the debate another way: “It’s only right to expect the question: How much value did we get for this billion? Instead of connected computers, how much more or better care could have been given? And, that’s one reason ‘meaningful use’ is such an important concept.”

There is no doubt that EMRs and CPOE add to the cost of each pa- tient walking through the door. But as healthcare facilities get past EMR implementation, Hummel believes better patient safety and quality of care will be part of the longer term reward. “The EMR work done in the recent past and in the next couple of years will be foundational to so much more value we can’t even begin to see yet,” Hummel says. “We’re already looking at handheld devices that are more powerful, more useful than PCs were, and the


“Wall Street is a huge distraction, too much pressure on public com- panies for quick bottom line results. I wish more vendors were private corporations, working on their own missions and timelines,” says Baker. He describes how a takeover affected IT operations in Sarasota, when they licensed with PeopleSoft about nine years ago. “We were one of PeopleSoft’s

fi rst healthcare customers, and I was extra cautious in asking for contract language that locked our mainte- nance fees,” Baker says. “I wanted protection, in case of acquisition. A vice president at PeopleSoft balked, adamant that PeopleSoft would not be acquired. Of course, we know the rest of the story. Oracle bought PeopleSoft, and one of the first things Oracle did was to jack up the maintenance fees by 20 percent.”

Game-changing events

What events most changed healthcare IT operations? The pos- sibilities list is so long: the arrival of the PC, the rise of managed care, Y2K, HIPAA, emergence of the In- ternet, Sarbanes-Oxley, HITECH. The easy answer for many CIOs would be the Internet, especially

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