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Quantum Leap

November 1, 1998
by Terry Monahan
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Brooklyn, N.Y.

120,000 patients served in 1997
33,451 inpatient

30 ambulatory centers (adding six sites per year)
704-bed hospital
Nursing home
Home health agency
Physician practices

It’s never leisurely when healthcare organizations undertake large IT implementations. Old system failures, pressures to accommodate managed competition and rapid expansion into integrated delivery systems create a climate of urgency in which millions of dollars of systems--and many more millions in staff hours--must be identified, deployed and justified. There’s no stress quite like finding your institution, let alone your career, in the middle of it.

While the experiences of other organizations can offer insight, their solutions are rarely completely transferable: If you’ve seen one healthcare organization, you’ve seen one healthcare organization. At the beginning and end of the day everybody’s on his or her own.

That’s where Brooklyn, N.Y.’s Maimonides Medical Center was in 1996 when Ann C. Sullivan came aboard as CIO. New York, famously resistant to managed care, was still migrating to a competitive, negotiated-rate healthcare environment that most of the rest of the country had already grappled with. Yet Maimonides, closely bound to its Hasidic and Orthodox Jewish community of Brooklyn’s Boro Park, was operating in the 1950s--no computers, no network, no infrastructure. And competition was headed like a wrecking ball their way.

Maimonides CEO Stanley Brezenoff and COO Pamela Brier were ready to devote more than one third of their capital budget to building an information system--buildings, staff and technologies--all at once. That entailed articulating Maimonides’ direction in the context of its competitive environment, identifing and deploying all new technology tools for which little foundation existed, and mobilizing a decidedly nontechnology-adapted staff--all while maintaining its trust and strength in the community.

Now for the most part it’s all working--which won Maimonides this year’s Computerworld Smithsonian Award for Medicine. In this interview with Sullivan and her Deputy VP/MIS Walter Fahey, CIO Sullivan credits Maimonides’ success to all those nontechnology-adapted people who were already there.

What was it like when you arrived at Maimonides?
ANN SULLIVAN: We had long-term contracts to implement clinical systems and replace legacy systems and the hospital seemed incapable of implementing what they had purchased. Physicians felt nothing was happening.

[CEO Brezenoff and COO Brier] thought there was no confidence in the MIS department to move the institution through a change process. Addressing the problem became a major priority because a lot of capital already spent was being unused. Vendors were losing interest in supporting the hospital through implementation of our systems because they felt we couldn’t organize ourselves to implement their products. We were at an impasse in being able to move the institution ahead.

Brezenoff and Brier agreed to a three-year capital plan that one-third of the capital budget over three years would be invested in systems and technology to get the hospital ready for a new competitive environment in New York.

First I tried to understand the culture of the organization--how the medical staff interacted, how the community physicians fit in to the medical staff. This hospital is highly leveraged with its community so I needed to understand that. And the only way was by walking around and trying to absorb it like a sponge.

Out of that came a sense that physicians were ready to tackle the challenge of having clinical systems and electronic records and new technologies--but the rest of the hospital wasn’t. So we had to deal one way with one group who was ready to go and another way with the 70 percent of the hospital who wasn’t ready--all while contracts were almost expiring without implementations and vendors were walking away from the place.

What did you learn from observing the culture?
To build a staff here it was important for me to hire people from within the organization and teach them technology--and particularly the clinical systems and electronic records. It would take me less time to teach them the technology than for technology people to learn this hospital.

We moved a former director of nursing (Nancy Daurio) up to be director of clinical systems, which would include PACS, radiology systems, laboratory systems, blood banking systems and the TDS order entry/results reporting system--anything clinical would be in her bailiwick. Without a doubt that was the most important move I made, because of her strong management skills and having almost her whole nursing career at Maimonides.

We increased staff rapidly in implementation of the TDS system (clinical information system bought by Alltell and then by Eclipsys). At the time, the hospital was undergoing some personnel reduction plans, and some pharmacists, lab folks and nurses had been identified for layoffs. The hospital had never had a layoff before. I proposed we become an educational center in a field that was growing--clinical systems--and I volunteered to take everyone who was being laid off and train them in clinical information systems.

We decided that education was a major part of who we were and were going to be. It worked great. Pharmacists, lab people and nurses are terrific at this. We took 16 of them on. All became IS people. Not just IS people, terrificIS people.