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“H.I.S.-tory”by Vince Ciotti17. Next MiniPioneer- From the same amazingyear that brought us SMSand Meditech…© 2011 H.I.S. ...
But first…• Some feedback from last week’s HIS-tory installment, whichfeatured Meditech. Bill O’Toole, founder of O’Toole ...
Early “Total HIS” Mini Vendor• As we saw last week, Meditech started as an LIS nicheplayer in 1969, grew to add a full sui...
Compucare• Great name: amalgam of “Computer” and “Care!” Whatwas different about Compucare versus other vendors?• Back in ...
Plan B• So now what to do to make Compucare asuccess?• Sheldon next had a vision that reflects his roots as bothan MBA, CP...
Facilities Management! (FM)• A concept whose proverbial time has come in the ‘70s:– Professionals would take over DP, in o...
(Aside)• (Pathetic how hospitals back then gave up on runningDP/IT themselves, and paid FM firms to do it for them.• We mo...
Sales Success, Delivery Challenges…• For the first few years, sales came rolling in, as CFO afterCFO saw this FM approach ...
Irony 101• The biggest challenge Compucare faced was with clinicalapplications, like Orders, Results, Lab, RX, etc.• As we...
Exeunt stage left…• After overcoming these challenges, Shelly (ever thepioneer!) left in 1975 to form another daring ventu...
But wait, there’s more!• Baxter paid $73M for Compucare, a huge sum in thosedays, reflecting just how promising mini syste...
We’re Baaaack…• Well, if you can do it once, you can do it twice…• So Ron, with the help of other gurus like Ransom Parker...
Where are they today?• Sheldon– After selling SIDA’s “3000” data base to HIMSS,Shelly went on to become CEO of The Dorenfe...
Muchas Gracias!• For input to this week’s episode:– Ed Gavin – former McAuto sales rep and AAguru, who worked at Compucare...
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17. compucare

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17. compucare

  1. 1. “H.I.S.-tory”by Vince Ciotti17. Next MiniPioneer- From the same amazingyear that brought us SMSand Meditech…© 2011 H.I.S. Professionals, LLC, All Rights Reserved
  2. 2. But first…• Some feedback from last week’s HIS-tory installment, whichfeatured Meditech. Bill O’Toole, founder of O’Toole Law Group ofDuxbury, MA, and a regular contributor to HIStalk, sent this email:– Vince, loved the newest installment. Im sure you don’t remember this, butthe pathologist from Cape Cod Hospital is my father. I recall vividly my Dadbeing upset with Meditech one night. We went into his lab late that night totry and fix something or other. Well, long story short, my father was notpleased with their response. He communicated with Meditech by typing into aline connected to a printer in a closet at Meditech, loaded with a box of theold green-bar paper. So the good doctor types in 22 divided by 7 (VC: piece ofcake, er, pi…) and sent it to the Meditech printer. The next day he got a callfrom Meditech howling that he owed them a full box of paper!!• If you have more to add (or subtract!) from theseHIS-tory episodes, please email me at:vciotti@hispros.com
  3. 3. Early “Total HIS” Mini Vendor• As we saw last week, Meditech started as an LIS nicheplayer in 1969, grew to add a full suite of clinicals(Orders, Results, RX, RIS…) in the 70s, added financials inthe 80s.• Our second mini pioneer started out with a much biggervision: to develop a total HIS based on hospital input.• The man behind this start-up is easily one of the bestknown and most respected mavens in the HIS industry:• Sheldon I. Dorenfest, of “SIDA” fame, which was also one ofthe first HIS consulting firms and source of HIMSS Analytics.• This man’s contributions to the industry could takea full HIS-tory installment in itself, so we’ll justcover how he formed one of the earliestminicomputer vendors whose successor firm stillruns in scores of US hospitals 40 years later!
  4. 4. Compucare• Great name: amalgam of “Computer” and “Care!” Whatwas different about Compucare versus other vendors?• Back in 1969, Sheldon started Compucare originally as ashared system, just like SMS, McAuto, and scores of BlueCross and state hospital associations were doing…– To grow Compucare quickly in the highly competitive market ofshared systems, he first explored the possibility of buyinganother fledgling shared system called EDS (Executive DataSystems) based in Cedar Rapids, Iowa.• Presaging his later and most famous businesssuccess as a consultant, he gave EDS so muchadvice on how to improve their struggling sharedsystem, that they improved it enough to not sell itShelly, but continued on for many more years!
  5. 5. Plan B• So now what to do to make Compucare asuccess?• Sheldon next had a vision that reflects his roots as bothan MBA, CPA, and Assistant to the President of theHospital Division of Abbott Laboratories :– Back in the early days of HIS, many hospitals attempted to “rolltheir own” through inhouse, self-development, initially basedon IBM and “Bunch Group” mainframes, but spreading tominicomputers too as they grew in popularity in the late 60s.• Needless to say, many of these early homegrownsystems in the 60s were taking far longer than hospitalCFOs (who were responsible for “Data Processing” backthen) had either the patience or budget for. DP Managers& their stressed staffs tried their hardest, but hospitalapps just took a lot of time and money to program…• The solution? As easy as clicking for the next slide:
  6. 6. Facilities Management! (FM)• A concept whose proverbial time has come in the ‘70s:– Professionals would take over DP, in one of two ways:• Providing a DP Manger who reported to the outside firm, and wasresponsible for managing the staff, time and budget of the project.• Taking over the entire DP staff, who all became employees of theoutside firm, and had to deliver to keep receiving their paychecks…– Best of all, by forming a firm specializing in FM in hospitals,Sheldon was able to share code developed at one site withthat developed at another site, portioning out the work.• Hospital “A” worked on ADT, Hospital “B” did Billing, “C” did AR, etc.– Sort of a “shared system” for software…• For hospital execs, it was the ideal panacea:- Outside professionals managed the daunting work ofDP, so the hospital CFOs “only” had to worry aboutminor details like patient care and financial survival inthis challenging post-Medicare/Medicaid world…
  7. 7. (Aside)• (Pathetic how hospitals back then gave up on runningDP/IT themselves, and paid FM firms to do it for them.• We moderns know that FM would never work today:– Such firms merely add their profit margin to current salaries– They shuffle their people among clients to keep them happy– Their contracts have few if any penalties for poor service– Their employees are not as loyal to your hospital & mission– DP/IT today is a hospital “core competency:”• EHRs & CPOE are patient care!)• If only we could go back in a time machineand have warned those poor pioneers thatno hospital would fall for paying outsiders todo what they should manage themselves…• They should have outsourced their planning!
  8. 8. Sales Success, Delivery Challenges…• For the first few years, sales came rolling in, as CFO afterCFO saw this FM approach as the answer to prayers:– Far better than telling the Board they were giving up, sellingtheir hardware box, laying off the staff, and going shared.– And with a convenient target to blame now when things wentwrong: the outside FM firm’s DP Manager and/or staff!• However, even Compucare’s pros were stillhuman, and ran into the same problems:- Writing code for even “simple” systems likeCensus, Billing and AR was hard in thechallenging world of healthcare…• Insurance proration, late ADT input, etc.- Let alone the new world of clinical apps…- Orders, Results, LIS, RX, RIS, etc.• Plus “sharing” code among disparate hospitals…
  9. 9. Irony 101• The biggest challenge Compucare faced was with clinicalapplications, like Orders, Results, Lab, RX, etc.• As we saw with mainframe self-development, mosthospital mini shops started with financial apps like:– AR & Billing (those Medicare 1453s, 1483s1483s and 1554s1554s)• How to get the clinical apps needed?• In 1973, Shelly struck a deal with aanother fledgling firm in Boston whoclaimed to have a dynamite suite ofclinical apps they were developing forclient hospital in Cape Cod…• You guessed it: Meditech!• So now Compucare had a “Total HIS!”
  10. 10. Exeunt stage left…• After overcoming these challenges, Shelly (ever thepioneer!) left in 1975 to form another daring venture:– SIDA, one of the first and most successful HIS consulting firms.• Leaving Compucare in the hands of Ron Aprahamian- Under Ron’s tutelage, Compucare concentratedon Date General minis, with bundled turnkeysoftware & installation comprising a “Total HIS.”- Along with a host of competitors also developingturnkey mini systems, Compucare sold like hotcakes in the late 70s and early 80s.- In 1985, Ron sold Compucare to supply-firm giantBaxter, who had bought up several other minivendors: Dynamic Control (Delta) and JSData(Alpha), plus a mainframe option (Omega).- In their g{r}eek world, Compucare was “Sigma.”
  11. 11. But wait, there’s more!• Baxter paid $73M for Compucare, a huge sum in thosedays, reflecting just how promising mini systems were.• So Ron could have taken his money and retired right?• Wrong! This story gets even more incredible:- Baxter joined forces with IBM to form IBAX, andre-named all their acquired products:• JS Data (Alpha) became Series 3000• DCC (Delta) became Series 4000• Mainframes (Omega) became Series 5000- Since they were out of numbers, IBAX soldCompucare (Sigma) back to, guess who?- Ron AprahamianRon Aprahamian, in 1987 for about $30M!- Let’s see, sell the firm for $73M,buy it back for $30M, that leavesa profit of…
  12. 12. We’re Baaaack…• Well, if you can do it once, you can do it twice…• So Ron, with the help of other gurus like Ransom Parker,COO, and Christine Chapman, R&D VP, started building awhole new system to replace Sigma.• They called it “Affinity,” and it featured:– ANSI-standard MUMPS (shades of Boston?)– Open-architecture through a UNIX OS– RISC hardware (the latest in mini boxes)– Full suite of financial & clinical apps• Needless to say, Ron was open to offers…– And got one in 1998 from QuadraMed for 2.7M shares!• QuadraMed had also acquired dozens of smaller firms…
  13. 13. Where are they today?• Sheldon– After selling SIDA’s “3000” data base to HIMSS,Shelly went on to become CEO of The DorenfestChina Healthcare Group based in Shanghai,“actively investing its skill, technology and capitalin in well defined projects to help China toimprove its healthcare system.”• Ron– No moss grows on this man! He has since been:• Chairman of the Board of Superior Consultants• Independent Director of First Consulting Group• QuadraMed- Affinity went on to be implemented in about 200 hospitals at its peak,and is still running in scores of sites to this very day. It has since beencomplemented by QuadraMed’s acquisition of Misys’ “CPR” E.H.R.,--- but that’s a story for another installment of HIS-tory.
  14. 14. Muchas Gracias!• For input to this week’s episode:– Ed Gavin – former McAuto sales rep and AAguru, who worked at Compucare in the‘80s, before joining our consulting firm.– Sheldon Dorenfest – who took valuabletime off from his hectic travel scheduleto/from China, whose HIT market he findsmuch like the US back in the 50s and 60s!• For input to next week’s episode:– David Pomerance – former hospital CFO inFlorida, who built a system on an IBMSystem 3 mini for his hospital that was sogood, he sold it to 250 more hospitals!

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