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One-on-One With Maimonides Medical Center CIO Walter Fahey, Part I

October 5, 2009
by root
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Walter Fahey says the 80/20 rule helps him decide if software customization is warranted.

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: Tell me about your main projects.

FAHEY: We’re upgrading our infrastructure with Verizon as we speak, both wired and wirelessly. We’re actually upgrading our PeopleSoft financials to the current version, and it’s a full suite of products. We are currently upgrading our clinical application from the Eclipsys e7000 to Sunrise Clinical Manager. We just completed an upgrade to a single radiology platform which is a Siemens product for RIS. We are in the process of installing all new cardiac monitors throughout the entire enterprise that actually run over the hospital enterprise network. And the list goes on; how much more do you want?

GUERRA: So essentially, you’re working what … 10 to 4?

FAHEY: Yes. (laughing)

GUERRA: Explain the thinking behind the infrastructure upgrade, how much of an upgrade did you need and how did you decide on that? Is there a cost/benefit equation? Is it just a matter of envisioning how many more applications are going to be running on the network? What’s the strategy behind an infrastructure upgrade?

FAHEY: It’s a combination of all of the above. The equipment itself was reaching end of life. We were running an APM backbone which is really not supported anymore. We needed to get to a gigabit infrastructure. We have 128 closets we deliver technology from. So in doing that, we had to look at how our infrastructure was handled. We basically run some redundancy in different areas because we want fault tolerance, even though all the Cisco gear comes as a health grade network these days.

It really is the intent of the organization to have as much power as possible. So we have duplicate switches in some areas, we have duplicate core routers, things of that nature. So we have fail over in case one side goes down for some reason. We provide pretty good up time. We’re probably in the 99.999 percentile with our up time for the infrastructure. And we need to do that.

I mean if you look at us organizationally, we run everything over the enterprise infrastructure. So we have all the clinical applications, we have the OR applications on it. We are going live with an anesthesia application in October. We’re doing some parallel testing next month. We’re actually taking feeds from our monitors, and we will be putting that into electronic records. So all that runs over the enterprise. So we needed the bandwidth to be able to handle that capacity. We didn’t want to run a duplicate infrastructure for all the new cardiac monitors, and we have well over 400 monitor beds within the hospital itself. So we ran that over the enterprise infrastructure as well.

From a wireless perspective, we did some work to expand out all the technology, to handle the biomedical bands as well as 802.11. We did find some conflicts between Bluetooth and 802.11 which is a known problem – the Bluetooth actually floods the channels and can cut off some of the wireless devices. Also, in some of the areas we had microwave ovens that weren’t shielded; that actually caused interference as well, so we had to make sure all the microwaves were shielded in all the areas. Outside interferences have to be dealt with, and when you’re in a city with a population of 2.5 million people, there are a lot of areas that have interference. We have a train down the street that’s above ground, you get a lot of different devices and electronics that actually can cause interference within a wireless network. So we’ve probably put more wired capacity in rather than wireless just because of the interference issues from outside.

GUERRA: Are the application upgrades being driven by HITECH?

FAHEY: We actually started before HITECH. We’ve had electronic records for the inpatient side of the house and ambulatory well before HITECH was even thought of. We’re now actually going to the latest generation of technology. So, for instance, with NextGen we just converted the system. We bought it in 2000 and we just converted it from their standard system to their knowledge-based management system. So that was a major upgrade that took several years to convert all the data over.

With the inpatient side of the house, we’re doing all the order entry result reporting. We never did full documentation in the e7000 products. So we’re expanding that now, and that was part of the goal from the onset. We did change some of our philosophy and timelines to meet the meaningful use criteria that was announced in August of this year. So we’re really trying to work well with what’s being developed from the outside and mesh that with our vision of a good clinical record on the inside.

GUERRA: You’re using NextGen for the ambulatory practices?