Maimonides Medical Center is among the largest independent teaching hospitals in the nation, training over 450 medical and surgical residents annually. Widely recognized for its major achievements in medical technology and patient safety, Maimonides has 705 beds and over 70 subspecialty programs. Recently, HCI Editor-in-Chief Anthony Guerra had a chance to talk with CIO Walter Fahey about his long list of projects, and what it takes to be an effective CIO in today’s HITECH-fueled world.
GUERRA: So you’ve gone from Eclipsys mainframe-based software to server-based; would the next step be true Web-based software?
FAHEY: They’re developing it as an SOA application, so they are doing a service-oriented architecture. That is probably the latest technology that you’re able to get because now you’ll have plug-ins where you didn’t have plug-ins before. In the past, you had to go in and really code a lot of things. So you have opportunities to make changes through the use of plug-ins.
GUERRA: And that’s true of the version you’re going on now, or the one they’re building for the future?
FAHEY: That’s where we’re headed, and that’s where Eclipsys is going as a corporation. NextGen is really a .NET application, so that’s all Microsoft based. A lot of the companies are going in one of those two directions at this point.
GUERRA: How do you feel about the level of technology being offered by the usual suspects?
FAHEY: It’s not as easy as they think it is to pull all these technologies together. A lot of these companies talk the talk, but don’t walk the walk. What I mean by that is they tell you they’re going to deliver certain capabilities, but they can’t. We do a lot of testing on these applications. We’ve had application folks come in and say, “This application has been running in multiple hospitals, 100 hospitals for several years, we have no bugs, we have this, that or the other thing.” But then we put it through very thorough testing and we find every bug within the application. Because, as I said, we take advantage of the technology as best we can. We push the vendors to really deliver what they say they’re delivering, and we also make sure it is compliant with all the rules, regs and everything.
We’ve had several conversations with senior management in many different companies to make sure they’re going to be there, and they’re going to ensure that this stuff is compliant. We write into every contract that they’re going to meet state and federal regulations. So where the state may supersede the feds or the feds supersede, they have to meet all of those regulations. It’s required in the contract.
GUERRA: How do you view vendor relationships? Do you think a CIO has to look at vendors somewhat adversarially or should they be viewed as partners?
FAHEY: It’s funny – the vendors want to be considered vendors in many instances, but we want them to be considered partners. There are two types of vendors out there. There are the guys that come in and deliver something and say, “This is what it is, this is how it works and goodbye, thank you very much.” Then there are the ones that are willing to work with you and develop the new technology, to help build technology. They look at it more as a visionary process in which we’re all working together for the same goal. Those are the ones we prefer to deal with.
GUERRA: I read that you have no problem bringing vendors to the hospital floor and into the patient rooms and saying, “This is how your software will be used so don’t play games.” I thought that was interesting. Can you just expand on that a little bit?
FAHEY: One of the things that we do with vendors – and we’ve done it with Cisco, Verizon, other vendors – is bring them to our ED. Or emergency department is very crowded, they can see up to 400+ patients a day, and when you have that kind of volume you need electronics. You need to be able to view what’s going on. You have the boards that are electronic to tell you when your radiology tests are done, when your lab tests as done, to see what’s being logged for the patient.
We take them into these areas and we’ll say, “How would you feel if you’re one of those people waiting to be helped and the system crashes and goes down and I can’t get at your information? Do you want to be in that scenario?” You want the information to be accurate, you want it to be timely and you want the network to be working. So we’ll take them on the floor to show them what it’s like.
We ask them, “How would you feel if you or one of your loved ones is on an operating table and, all of a sudden, the system goes down. Instead of putting in an electronic order where action will be taken immediately, you have to now leave the room, you have to go find it, you have to find somebody to get you what you need.” It’s delay in processes, and it really takes away from some of the quality control because if I’m doing this electronically for a while, people forget how to go back to paper and pencil and how to do things manually. I don’t care what anybody says, it’s true. That’s why they need refresher courses on downtime procedures and things like that. But you don’t want to be in that scenario. You want to make sure you’re providing the best quality care with the best technology money can buy.
GUERRA: Tell me about what you’re doing with Verizon, what was the genesis of it?
FAHEY: We started a relationship with Verizon many years ago with sonnet technology doing infrastructure work. We use them to buy a lot of our communications equipment and things of that nature. The reason for it is that we have a mainframe that runs in New Jersey. We built a sonnet ring to come across into Brooklyn. We have probably 25, 30 offsite facilities that we support. So we need that self-healing path to make sure clinical people have the information they need in a timely fashion.
Some of the benefits from what we’ve done with Verizon date back to Hurricane Floyd (1999), which caused some flooding in communication closets. Well, guess what – we didn’t lose communications to our mainframe. Our mainframe serves our patient accounting, our patient management, which is basically the registration system and how we transfer patients. It controls all of that, and it also housed the e7000 system from Eclipsys, which is order-entry results and documentation for different things. It was also the core record for all our laboratory and ancillary information. We build that into the core record of the e7000 so people can get on from home, physicians can get on from their offices. We use technology robustly, so we need to ensure it’s available at all times.
When the flooding happened, we actually had others come on to our sonnet ring. We were able to service people in a couple of accounts in Manhattan that were running out of the same data center because we didn’t lose any information.
When we had the blackouts a couple of years ago with the power failure, with 9/11, we didn’t lose any of our communications to any of our facilities. We stayed up and running, and we used the Internet for reporting. We have diversified our Internet. We have a popover in Newark, N.J., that runs into the mainframe data center, and we have one down on Hudson Street in Manhattan.
GUERRA: So much goes into supporting an EHR environment. Do you think smaller facilities have the ability – both financial and knowledge-base – to put everything in place?
FAHEY: At the end of the day, it has to be a cost-effective solution and you have to deliver premium care. I don’t think people realize what goes into the delivery of care. There are things that go on in healthcare that people fault, but there’s a lot of cost that goes into providing excellent care. In healthcare, you have to store records for years and years and years. There is a lot of expense. So when you say you’re going to have electronic records, I say keep in mind you need to retain an adult record for seven-10 years.
If I deliver a baby – and we deliver well over 7,000 babies a year – I’ve got to save those records for 21 years. You start to make all these records electronic, which we’ve done for the last seven, eight, or even 14 years, depending on the system and the application, and you start to see terabytes upon terabytes of data. You have to keep all of this information spinning. You talk about wanting to go green and reduce power consumption? Sure, there are things that can be done, but we’re constantly buying more capacity to store data. There should be some ways of looking at how long you really need to have this data readily available.
A lot of these companies don’t think about archiving data, but you have to archive some of this. If you need it available, it has to go off to some archivable solution. People haven’t thought enough about how to archive data. PACS images, for example, are getting much larger. If you start storing all of this stuff for years, it’s really going to create a problem down the road. Many facilities haven’t even thought about some of this stuff.
GUERRA: Running a hospital is an expensive proposition.
FAHEY: This stuff is expensive. We’ve invested more than $100 million over the years in technology. I will tell you what’s being offered as a stimulus package doesn’t come close to the cost of going electronic for a large hospital organization. That’s my take on it. It’s expensive. You have to put in all the safeguards, you have to be cognizant of all the privacy issues and security issues; all of that stuff costs a lot of money. These systems are not cheap.