System purchases support vendors' visions.
When you bought your first 8088 personal computer more than a decade ago, you essentially bought into the concept of today's fastest Pentium chip, according to David Swan, senior director of the information services division of Group Health Cooperative of Puget Sound, Seattle. Likewise, the information system that you select today supports your vendor's vision of tomorrow. Before you buy, make sure you and your vendor share the same vision of tomorrow.
"When we decided to use Sybase as our relational database two years ago, we were essentially buying the migration path to Sybase System 11 that just came out," Swan said.
"We want to stay in the center of the technology channel by following the Microsofts and Sybases of the world. We want to be along with them, but not ahead of them. We don't want a vanguard system," Swan said. "When someone like a Microsoft says they are going somewhere, that is an important path to follow."
Following the leader means maintaining a pace only few steps behind the bleeding edge of technology. Choosing the right leader to follow is the tough part. That choice, however, doesn't have to be a shot in the dark.
Group Health Cooperative of Puget Sound (GHC) is the nation's sixth largest not-for-profit health maintenance organization with more than 500,000 enrollees. Almost three years ago, GHC began the planning process to replace its data warehouse that existed on an IBM mainframe with a standard database. It was decided that relational database management system (RDBMS) technology and client/server architecture were a must for GHC's new data warehouse. Sybase, Emmeryville, Calif., was selected because of its functionality and speed, which was benchmarked against other RDBMS vendors, according to Irwin Goverman, GHC's vice president of information services and chief information officer. GHC selected Sun Microsystems, Mountain View, Calif., as the platform for the data warehouse server and the workstations.
"You just can't back into one of these things. You can't go buy it and throw it up. You have to plan it carefully by evaluating your needs and your vendor's strategy and architecture," Goverman said. "You've got to do it right. When your facing a budget, you're sometimes torn. But every time that we haven't done it right the first time, it has come back to bite us."
"Most importantly: Standardize, standardize, standardize," Goverman advised. GHC uses ethernet and Novell enterprise network standards and Microsoft Windows on all workstations. "We'll probably switch to Windows 95 this year. It's been more stable than we thought the first release would be. Besides, we need the memory management capabilities that it has and its remote accessing works better than version 3.1," Goverman Said.
Defining resources as objects Several intangibles went into the selection of Sybase, Swan said. GHC was not only buying a system, but the vendor's vision. When selecting a system, Swan advises to find a vendor that:
1. Speaks the language of client/server.
2. Discusses objects rather than applications.
3. Discusses integration as opposed to implementation.
4. Plans to operate in the new paradigm, rather than "how things used to be done."
The term objects, as used by Swan, should not be confused with object technology. Swan's usage of objects means a unit or a part of some whole. "An object is a resource or thing that is part of the I/S environment. The network, hardware and operating systems are all objects. People are not objects. Applications may be objects," Swan explained.
"The problems facing I/S are both technical and organizational. With... open systems and client/server technologies, I/D needs to rethink its organization and roles," he said. The business says: 'I just need this piece done. Don't redesign the whole system.' "That piece is an object. Objects, open systems and distributed processing are the future," (See related article about objects on page six.)
Swan takes the idea of objects a step further by using the term to replace many traditional terms. Some system support groups at GHC are now called system object groups that focus on a key aspect or piece of a system, rather than the whole system.
CIS selection looked beyond Sybase
In November, Oacis, Greenbrae, Calif., was selected as the clinical information systems (CIS) vendor for GHC and Virginia Mason Medical Center, which is involved in an alliance with GHC (see related article on this page). Goverman expects the results reporting module of the Oacis system to be operational in September. Oacis will replace the proprietary results reporting system developed by GHC.
"The market is getting better and better at developing systems," Swan said. "The market will maintain these systems. The real business of the I/S department is to run these systems--not develop them. We're not in the code writing business. We're here to run the I/S shop."
"We just can't maintain the pace of being in front of the development pack, so why race them? We need to get the most bang for our buck and writing code won't get us there," Swan said.
Goverman and Swan did not want to limit CIS selection only to those systems using the Sybase RDBMS. GHC wanted clinicians to select the system, regardless of platform or operating system. GHC already uses integration engine tools from Century Analysis, Pacheco, Calif., to integrate disparate systems.
"We already selected Sybase for our data warehouse. But we decided that if the clinicians wanted a system using Oracle or some other RDBMS, we would not say no," Swan said. "In the process of looking at Oacis, we looked at other systems using M Technology and Oracle. In the end, our users liked the Oacis system, which used Sybase."
More than 150 clinicians helped select the Oacis system, Goverman said. Several clinicians emerged as Cyberpros, Goverman's description of GHC's clinician superusers of the system. The Cyberpros will help train and support the other staff clinicians as the system becomes functional.
Group Health is pioneering the concept of an internal communications network for the health system's employees. Dubbed the "intranet," the network offers the functionality of the Internet and World Wide Web, such as e-mail, home pages and forums.
This "behind the firewall" network gives GHC employees the tools to communicate with other employees about company matters without the security concerns of Internet communications. GHC employees use standard Internet and WWW applications, such as Netscape, to access information on GHC's intranet.
"By June, Group Health employees will be able to view the real-time, online status of our information systems via an intranet home page," Swan said. "This will free up the help desk and the I/S department when a system goes down or is not functioning properly. Users will be able to tune into the home page to see if the problem is systemwide or just on their machine."
The GHC intranet is presently being used for internal e-mails, a company phone book and a CEO message of the week that is posted on the system.
"With the internal system, you don't have some of the burden on the systems. It is much less of a burden on the operating system to access the intranet vs. the Internet," Swan said.
The formation of a joint operating company increases the responsibilities, staffs and budgets of Group Health's I/S department.
The boards of Group Health and Virginia Mason Medical Center, Seattle, voted in December to form a joint operating company to govern the two entities. it will take at least 12 months to formalize the operating company agreement under regulatory filing requirements, according to GHC.
The vote strengthens an existing alliance between the two companies that has been in place since 1993.
"They will basically be merging the I/S department," said Irwin Goverman. "Together, we will have an annual budget in excess of $40 million and a staff of more than 300 people."
Virginia Mason clinicians will share the data repository built by GHC. "Patients will look at us--from an information perspective---being seamless," Goverman said.
Virginia Mason is a not-for-profit healthcare system with one hospital, 19 clinics and a research center.
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|Title Annotation:||Company Operations; includes related articles on Group Health's GHC intranet and on Group Health's and Virginia Mason Medical Center's formation of a joint operating company; Group Health Cooperative of Puget Sound's information management system|
|Publication:||Health Management Technology|
|Article Type:||Cover Story|
|Date:||Feb 1, 1996|
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