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One-on-One with Atlantic Health CIO Linda Reed

May 14, 2008
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Linda Reed says that working with core clinical vendors can be like a marriage — you take the good with the bad.

Atlantic Health is a New Jersey-based care delivery system comprised of Morristown Memorial Hospital, Overlook Hospital, Goryeb Children's Hospital, Gagnon Heart Hospital, Carol G. Simon Cancer Center, and Atlantic Neuroscience Institute. With thousands of beds under her purview, system vice president and CIO Linda Reed has quite a bit on her plate. Recently, she talked with HCI Editor-in-Chief Anthony Guerra about her plans for the health system, and the evolving role of the CIO.

AG: Let’s start off with your reflections of HIMSS, any impressions you had that come to mind?

LR: I think the thing about HIMSS is it is getting so, so large that it’s so hard to get to anything that’s relevant. I don’t know if anybody else has noticed that, but it’s almost like a smattering of things, and you can only get a flavor. You have to try and take a look at where the trends are going to be. It almost reminds me of the Gartner Hype Curve, where you start getting a look, it’s like the electronic superstore, you get to take a look at what’s going to be on the hype curve, knowing that, at some point, you’re going to end up in that trough of disillusionment. I think the other thing that always hits me is exactly how many small companies are there that may not be there in the future, so you should use it as a barometer versus something that’s real.

AG: How do you evaluate those small companies to see if it’s worth taking a risk on them?

LR: I think it depends on the need and how burning the need is, and sometimes we’re willing to take a chance on a smaller company. Some of the things that we found, when we have done that, sometimes they’re not large enough to scale to an organization our size. So, we have to be always very careful. And then the other thing that happens is that they wind up getting bought, which is a lot of the reason sometimes they’re there. It’s not just courting customers. I think they court larger companies to see if they’re a viable candidate for a portfolio somewhere, but I think it really depends on the need of the moment and exactly how much of an industrial strength solution you need.

AG: Tell me about how you’ve dealt with M&A taking place regarding your vendors.

LR: I think sometimes it depends on what the application is; it depends on the company that acquires them. I think what we find — and I’m a large McKesson customer — we’ve looked at some smaller companies, and you bring them in and do a few things with them and, what we find is, once they get into a larger company, it depends on where they fall in the company. As an example, we’ve got lots of boards — patient care boards — so you’ve got a bed board, we’ve got a bed board, we’ve got a board that shows orders for CPOE, we’ve got something called Care Organizer, so there’s lots of patient boards; they bring in another product that has another board; how may boards can you put up?

Just as an example, how do they integrate the new product that they bring in? Where are the redundancies? That’s what really hits us sometimes — now they’ve bought a new product because it does function X, but it whacks us because now there’s just such a redundancy of functionality.

We work with McKesson on a couple of programs and each one of them has its own scheduling solution.

AG: So, do you decide which one you want to use?

LR: Sometimes you can’t. Sometimes it’s so siloed, so I think that's one of the things, and it’s not just McKesson, it’s everything that we work with. Large vendors bring a new product in, and they haven’t really fully thought through exactly where the product is going to sit and where the redundancies are. So, it’s not bad if you’re a customer that’s just got one product or you’re a new customer, but those that are existing long-term customers really get hit with it.

AG: When it comes to M&A among your vendors, I imagine you’ve seen different levels in their communication to you regarding what’s going on. What are the CIO’s needs in that situation?

LR: We talk to our vendors about this all the time. The sooner you tell us, the better, because then we can expectation-set with our end users and customers. We expect the truth — what you’re acquiring, why you’re acquiring it, what holes do you think it’s going to fill in your portfolio. And then you’ve got your business planners for it. I think that helps us, because I think one of the issues that we see a lot, especially down the line, like our customers, all of a sudden we have to tell them that one of our vendors has acquired something new, and they’re asking, ‘What does that mean? Are they going to stop supporting what we already have?’ From a perspective of capital planning, it’s really important because a lot of us are going through our boards, we’ve put in for projects, we’ve got capital funds; now that they’ve acquired something new, their direction is changing. So, I tell this to my vendors all the time, that the slightest little change in their business direction impacts me 10 times more. Because now we’ve made commitments, we’ve made plans; we’ve done road maps so we know where we’re going for the next couple of years. They have a little blip or change in direction, and it’s a huge wave backwards into a CIO’s world.

AG: And you’ve seen this communication flow done poorly?

LR: Yes, and it’s not just by vendor, sometimes it varies by product line. Some of the product lines do it better than others.

AG: Tell me about the relationship with McKesson. First, if you can just run down some of the main systems you’re using from McKesson, and I’m interested in learning more about the relationship. It seems like a CIO’s relationship with their core clinical vendor is really like a marriage, you have good times and bad, but it’s very difficult to get out. So, what are your thoughts there? Tell me a little bit first about what you’re doing with McKesson?

LR: Sure, we’ve been a McKesson partner, I guess, for quite a long time here, and I’ve been at Atlantic for about four years. I had a Siemens shop prior to that, so coming over to McKesson was interesting. But we have got their physician portal, we’ve got physician CPOE, their HEO (Horizon Expert Orders) product, we have got their clinical, which includes nursing documentation, care manager. I guess that also includes pharmacy; we’ve got their AdminRx product for our chronic medication administration; we’ve also got all their patient accounting Star products. We’ve got so many; sometimes you can’t even remember everything.

We have very few that are not core McKesson. We use ChartMaxx from MedPlus as our document imaging system. We have a GE RIS PACS; we now are working with McKesson with RelayHealth; we’ve been doing that for about eight to nine months; Contract Management, their financial TrendStar HPI for analytics.

I think those are the key ones. Nursing documentation we have, we’ve had that for quite a long time. We also use Horizon Practice Point Plus for our own physician practices, for practice management. So, I guess, you can see we have quite a bit in there.

AG: Because you’re so closely intertwined, I would imagine you have to make sure they don’t take you for granted.

LR: You’re absolutely right; it is a marriage because there are some areas you have to take the good stuff with the bad stuff. When you talk about CPOE and you read all the industry information, they tell you that you should really stick with your core vendor from a pharmacy perspective for closed loop medication and then CPOE, so we’ve tried to do that, but it’s difficult because the quality doesn’t always run through all their products. It’s a matter of taking the good with the bad, and the toughest part of that is with our end users. For end users, a lot of the time the functionality trumps everything else, including integration. But that’s always at first blush because some of the time, when we have gone outside of the McKesson family, integration winds up being a huge satisfier, more than the functionality. So, I think you don’t know, up front, what’s going to be the biggest issue, so it’s not getting my shop comfortable with some of the bad stuff from McKesson, or GE, or any of the others, it’s really making our end users aware of the short-term benefits versus the long-term benefits.

AG: I’ve heard, even within a company like McKesson, even one that’s grown through acquisitions, sometimes you buy two applications from McKesson and they can be merely interfaced instead of integrated. Tell me about that.

Click here for Part II

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