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Building a New Hospital’s IT Infrastructure From Scratch

August 13, 2014
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An interview with Sajid Ahmed, chief information and innovation officer of the new Martin Luther King Jr. Community Hospital in South Los Angeles

Wouldn’t it be nice to design a hospital technology infrastructure without worrying about any legacy systems or processes still tied to paper and fax machines? That’s the opportunity Sajid Ahmed has had as chief information and innovation officer of the Martin Luther King Jr. Community Hospital in South Los Angeles, which is expected to open in early 2015.

Sajid Ahmed

I had a chance to interview Ahmed last week about the progress on the startup hospital. First, some background: There was a hospital on the site that lost its accreditation and closed down in 2007. But because the 1.2 million people in the area still need access to acute in-patient care, community stakeholders and provides formed a nonprofit corporation to build and run a new hospital.  

Ahmed, who was one of the first employees hired, was previously the director of health information technology and innovation for L.A. Care Health Plan, the nation’s largest public plan serving more than one million Los Angeles County residents. In that role he helped lead the creation of HITEC-LA (Health Information Technology Regional Extension Center for Los Angeles County) for electronic health record adoption and implementation. He still serves as vice chair of the organization’s Technical Advisory Committee.

Ahmed said he was drawn to the new position because there were really good leadership at the board level, and because he thought this hospital would be valuable for the community, which is the most medically underserved in Southern California.

“My third reason was that I get to build state-of-the-art things from the ground up for a population that hasn’t had anything state of the art for decades,” he said. “Most hospitals are converting from paper to electronic or after 15 years they are updating outdated legacy systems. I didn’t have to deal with any of those challenges. I got a brand new building and a brand new data center.”

As he decided which vendor partners to engage, Ahmed said he worked with a small core team, including the chief medical officer, chief nursing officer, chief operating officer and an interim part-time CMIO. They chose Cerner as their core HIT system, but are also working with Lawson Software, Chronos, Cisco, VMware and EMC.

 “We designed an application infrastructure that we can support,” Ahmed said. “We have chosen other application providers that we can integrate with and built a scalable model.”

CMO John Fisher, M.D., made sure the medical groups the hospital is contracting with were all participating in the design/build of the system. They sought out subject matter experts to help with the Cerner implementation.

“Early on, two things went in our favor,” Ahmed said. “We had a small group making consensus decisions quickly in startup mode. We had to balance best of breed with the constraints we have. We have to open the hospital with the dollars the county gave to us. We weren’t going to get any more money and we have to open by a particular time. We are not making any revenue. I can’t be late on the EHR implementation. We have to open the hospital so we can license it.”

MLK Jr. is going to be a relatively small 131-bed community hospital, but it has plans to potentially add another 185 beds five to eight years from now. “I wanted to make sure we have enough capacity for the future. We wanted to make sure we had systems that could grow with us. That’s one of the reasons we ended up with Cerner,” he explained. “We thought that they would be really engaged with us, and they have been. Of course, they were challenged with us, too, because we didn’t have any policies and procedures. We have no workflows. We are going to steal, beg, and borrow the best workflows that we can find and redesign them for us.”

The fact that Ahmed has the word innovation in his title is not an afterthought, he said. He didn't want to be just a CIO. In the healthcare industry, many still report to CFOs or COOs and are considered service providers, he said. He wanted to stress that he is not just a service provider to clinicians, who are in the business, but that his team is part of the organization to deliver care.

For that reason, he is creating an innovation hub called the MLK Healthcare Transformation Center to identify, pilot and adopt new technologies, processes and workforce development initiatives. “I want to innovate for the hospital, for the campus and for the community,” he said. “I want to innovate within the four walls of the hospital, to work with clinicians to deliver workflows to improve care and then find the technologies to help support them. And second, I want to innovate on campus to coordinate care. It is a perfect lab.”

Ahmed and colleagues are working on ways to support nontraditional healthcare delivery being pioneered at places such as Kaiser Permanente and Intermountain Health. One effort involves eConsult, a telehealth system he created and launched with the Los Angeles County Department of Health Services. The system allows for virtual consultations and collaboration with specialists.

Rather than just referring patients to the emergency department or specialists, eConsult provides a workflow and a tool that primary care providers can use to reach out to hospitalists and help them decide where the patient needs to go next. That should cut down on inappropriate use of the emergency department, he said.